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News 5/16/12

May 15, 2012 News 5 Comments

Top News

5-15-2012 7-53-49 PM

Accretive Health sends a detailed response to Senator Al Franken, who is investigating the company’s hospital collection practices. The company says its primary purpose is to help patients by making sure they use the benefits to which they are entitled, also adding that the company follows HFMA guidelines, including making it clear that services won’t be withheld for financial reasons. Accretive says it complies with all federal laws, including HIPAA, and that all but one of its missing laptops was encrypted and that one was because a now-fired employee messed up. The company also hires a boatload of influential guns-for-hire former politicians to polish its tarnished reputation: former HHS Secretaries Mike Leavitt and Donna Shalala, former Senate majority leaders Tom Daschle and Bill Frist, and former CMS administrator Mark McClellan. Newt Gingrich on Line 1?

Reader Comments

From MT Hammer: “Re: Transcend Services (now Nuance). Medical transcriptionists file a class action lawsuit against the company for labor law violations.” The 13 named transcriptionists claim that Transcend violated federal labor laws by paying them per line of text transcribed or edited but not for related activities such as looking up information, thereby dropping their compensation below the $7.25 federal minimum wage. I’m surprised that Transcend hired them as work-from-home employees instead of independent contractors, but maybe the company provides more direction than would be expected for a contractor.

5-15-2012 7-06-30 PM

From David Stock-Man: “Re: Quality Systems/NextGen. Anyone have thoughts on the company missing its numbers and shares getting crushed?” QSII announced preliminary Q4 results last Thursday, with expected revenue for the quarter of $107-111 million and EPS $0.24-0.27, blaming revenue recognition delays for missing expectations and issuing guidance down for the fiscal year. FY2013 guidance calls for revenue and earnings growth of up to 25%. Some folks on the stock message boards are crying foul, saying that pro traders were taking huge put positions in the shares right before the announcement, suggesting the possibility that word leaked out (without having any proof, of course.) Shares that were trading in the $45 range just a handful of weeks ago are down to $30. Above is a one-year graph of QSII (blue) and the Nasdaq (red). Shares have a long track record of steady growth, are now priced relatively cheaply, and the company’s margins are good, so if you’re feeling confident that this is just a bump in the road, you get to buy shares at a discount (and if you’re wrong, you get to lose even more money). All I know is that quite a few of the old-school EMR vendors seem to be failing to meet lofty expectations lately despite billions of taxpayer dollars being spent to help them sell product, so if not now, when?

HIStalk Announcements and Requests

Thanks very much to the 68 readers who donated to support the four young daughters of Epic analyst and long-time HIStalk reader Tim Dodson of Children’s Medical Center (TX), who passed away recently at 34. Including the three of us who matched $250 in contributions dollar for dollar, our total contribution was $5,495, which I’ve deposited to the fund set up by Tim’s wife Wendy for the girls, flagging it with a note saying it came from Tim’s fellow HIStalk readers. I covered the credit card fees, so every dollar you donated went directly to support the children. Those of us who chipped in know that it could have been us who died young and unexpectedly, leaving a family deprived of not only their loved one, but of their primary breadwinner as well. You did good.

Acquisitions, Funding, Business, and Stock

5-15-2012 8-48-22 PM

The Trizetto Group announces that its subsidiary Gateway EDI has acquired NHXS, a provider of contract compliance and point-of-service adjudication workflow automation. Gateway will incorporate NHXS’s capabilities into its EDI and RCM offerings.

Wolters Kluwer sells its prescription data business to PE firm Symphony Technology Group.

5-15-2012 8-20-04 PM

Simplee, which offers free online medical expense management tools for consumers, raises $6 million in a Series A funding round.


Unity Health System (NY) selects Phytel’s Atmosphere platform as part of its infrastructure for population health management.

Cape Cod Healthcare (MA) chooses Courion Suite for user access management for its Siemens Soarian system, scheduled for a December go-live.

5-15-2012 7-28-46 PM

Stewart Webster Hospital (GA), a 25-bed critical access hospital, selects the ONE EHR from RazorInsights.

The State of Arizona contracts with Mosaica Partners for consulting help in updating strategic and operations plans for the state’s HIE.

5-15-2012 7-29-39 PM

Orange Coast Memorial Medical Center (CA) selects PerfectServe’s clinical communication platform.

Hartford Hospital (CT) will deploy OTTR’s transplant system, including the recently announced OTTRvad module for ventricular assist device patients.

Norton Sound Health Corporation (AK) will deploy ambulatory and inpatient solutions from NextGen.

5-15-2012 7-32-13 PM

Chesapeake Regional Medical Center (VA) contracts with ICA Informatics to develop an HIE for its integrated delivery network.

Boston Medical Center (MA) signs a five-year license agreement with Streamline Health for use of its business intelligence and analytics solutions in 19 physician group practices, while Bronx-Lebanon Hospital Center (NY) extends its licensing agreement with Streamline Health for five years.

North Texas Accountable Healthcare Partnership (TX) selects Orion Health’s HIE solution to connect its 12,000 physicians.

Advocate Health Care (IL) selects Merge Healthcare’s cardiac imaging and informatics solution. Merge also announces that 12 radiology and orthopaedic practices have selected its EHR products.

Aetna selects Kony Solutions’ KonyOne Platform for its mobile health app.


5-15-2012 6-05-47 PM

The Massachusetts eHealth Institute names Laurance Stuntz (NaviNet, CSC Healthcare) as director.

5-15-2012 6-07-26 PM

e-MDs hires former CO-REC director Robyn Leone as director of public policy and government initiatives.

5-15-2012 6-08-50 PM

M*Modal brings on Kathryn Twiddy (Quintiles, Misys) as chief legal officer.

5-15-2012 6-09-38 PM

Blair Butterfield (GE Healthcare IT) joins VitalHealth Software as president of its North American division.

Announcements and Implementations

5-15-2012 8-38-16 PM

Rockford Memorial Hospital (IL) goes live next spring on the health system’s $40 million Epic system. Rockford’s physician group has been live since last year.


SoutheastHEALTH and Missouri Delta Medical Center join forces to build and manage a $3.5 million networking and data storage center for their organizations and other medical providers. Both hospitals will also install a $12 million Siemens Soarian system over the next year.

5-15-2012 8-39-34 PM

Austin Diagnostic Clinic (TX) goes lives on PatientKeeper Charge Capture for its 120 physicians.

Aetna Pharmacy Management offers its members new services based on their prescription claims data: (a) switching to once-per-day meds when appropriate; (b) recommending trying a less expensive single component of a combination drug; (c) flagging prescription that have been taken longer than recommended; (d) sending prescribers a letter for daily doses that exceed that listed in product labeling; and (e) identifying cases where a new prescription may indicate that a previous one caused side effects.

5-15-2012 8-15-40 PM

Medical billing and financial management vendor Fi-Med Management says it will expand its services and add 145 new jobs in the Milwaukee area. It says its new software can help hospitals identify over- and under-charging and avoid audits.


Allscripts will train and hire 40 City College of Chicago graduates, whose salaries will be paid by the City of Chicago for their first six months.

5-15-2012 7-35-18 PM

Cerner customer The Hospital de Denia achieves HIMSS Analytics Europe Stage 7, the first Spanish hospital and the second in Europe to do so.

A Northwestern Memorial Hospital (IL) employee is charged with identity theft after a police search of her home, triggered by her use of several credit cards to pay her water bill, uncovers the credit card numbers, birth dates, and Social Security numbers of more than 50 patients.

inga_small Last weekend I had the chance to snuggle with a relative’s new baby, which reminded me of this recent article. Laptop magazine compiled a list of 15 current technologies that newborns will never see, including wired home Internet, Windowed operating systems, hard drives, the mouse, desktop computers, and fax machines. If I had written the article, I would have put an asterisk by a few of them (desktops, fax machines) and added, “Not applicable to healthcare because providers are resistant to change.”

Sponsor Updates

5-15-2012 6-33-12 PM


  • Surgical Information Systems recognizes five hospital systems with 2012 SIS Perioperative Leadership Awards, among them Holy Spirit Hospital (PA – above.)
  • Certify Data Systems ranks as a tier one enterprise HIE vendor in the Chilmark 2012 HIE Market Report.
  • CynergisTek expands its portfolio of offerings to include the HIPAA Surveyor Solution Series and the HIPAA Audit Readiness Solution Portfolio.
  • AHA Solutions and GetWellNetwork host a Webinar featuring Texas Children’s Hospital and its interactive patient care RFP process.
  • PatientKeeper awards Ashe Memorial Hospital (NC) its customer innovation award.
  • EHRConsultant’s AIMSConsultant division provides advice on choosing the right anesthesia information management system.
  • Informatica releases its Informatica 9.5 platform, designed to maximize customers’ return on big data.
  • BridgeHead Software will sponsor The Big Event social gathering at the 2012 MUSE International Conference May 29-June 1.
  • Computerworld honors Lehigh Valley Network (PA) with its 2012 Laureate award and NASCAR Teamwork award for its innovative use of DigitalShare, T-System’s ED patient documentation system that’s based on Shareable Ink technology.
  • Barrington Orthopedic Specialists (IL) selects NextGen’s EHR, PM, portal, and other solutions for its 15-physician practice.
  • College Park Family Care Center (KS) selects eClinicalWorks EHR for its 91 providers.
  • Emerson Hospital (MA) integrates Access Intelligent Forms Suite with its Meditech Magic system.
  • Kareo upgrades its billing system clients to a new release, which includes enhanced claim scrubbing capabilities.


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

More news: HIStalk Practice, HIStalk Mobile.

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May 15, 2012 News 5 Comments

Curbside Consult with Dr. Jayne 5/14/12

May 14, 2012 Dr. Jayne 3 Comments


Over the last several months, there have been quite a few articles and studies about the growing phenomenon of mobile device distraction. Smart phones, tablets, and other devices have become ubiquitous. It’s almost unusual to see a group dining in a restaurant without devices littering the table. I don’t need to mention the danger of distraction while driving or otherwise being on the street and using a mobile device.

I wasn’t surprised then to see four Tweets in the last 24 hours that addressed the issue. There’s quite a buzz around psychologist Larry Rosen’s book iDisorder: Understanding Our Obsession with Technology and Overcoming Its Hold On Us. Some of his ideas are pretty common sense, such as the recommendation that families should have dinners where technology is not allowed at the table. I do agree with his point that technology might be making us dumber – the “Google effect” may make us less able to remember facts when we know that they are at our fingertips through search engines. His acronym for wireless mobile device (WMD) is accurate when you consider its other meaning: weapon of mass destruction.

Maybe having been required to be accessible 24×7 during my medical school and residency years jaded me, but until the last year or two, I had never been one of those people to compulsively carry my cell phone. Even now I don’t always answer it. Definitely not during a meal or a social event unless I’m on call or waiting for a specific return call.

The advent of the smart phone has made it easier to be in touch, though. I find texting or e-mailing to be less disruptive than taking a phone call as long as it’s self limited. However, when you open your e-mail to send a quick note to your staff or a colleague, it’s awfully tempting to troll through your account(s) to see what else is in there, and down the rabbit hole you go.

Like any other dependency, some have an easier time returning to real-time socialization than others. Some also have a hard time switching from texting-based communication to the traditional written word. This becomes apparent when I work with young people who can barely write grammatically correct sentences, but can text like crazy. In addition, despite having vast social networks, many are isolated when it comes to the skill of face-to-face communication.

An opinion piece in The Wall Street Journal proposes that, “We ought to group these machines with alcohol and adult movies.” I’m not sure I disagree. I’ve had to conduct interventions with parents who can’t seem to understand that their 11-year-old children shouldn’t be playing with an iPhone while I’m trying to take the child’s history and perform a physical exam.

Often, the phone belongs to the child, not the parents. That still baffles me given the cost of a data plan. I’ve had to explain more than once that when parents complain that children are spending too much time on the phone or with video games, it’s the parents’ job to put limits on those items.

What do you do, though, when the offenders are adults? It doesn’t seem like we have collectively developed the skills to police ourselves. I can’t imagine using a Bluetooth phone to make personal calls while performing surgery or surfing the Internet while administering anesthesia. We know it happens, however. I’ve had physicians complain that the EHR makes it to difficult to complete their documentation, one of them as she sat doing holiday shopping on her phone.

Do we need to put device behavior clauses in our medical staff bylaws along with rules about documentation deadlines and appropriate interpersonal behavior? Should facilities create WMD-Free Zones to allow us to decompress? Or do we just throw up our hands in defeat?

Have a suggestion on the wide-open field of WMD etiquette? E-mail me. I’ll try to read it in between surfing the net for animal-print crystal phone cases and signing charts.


E-mail Dr. Jayne.

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May 14, 2012 Dr. Jayne 3 Comments

News 5/4/12

May 3, 2012 News 7 Comments

Top News

5-3-2012 9-30-09 PM

The US Congress asks Accretive Health CEO Mary Tolan to provide the company’s hospital customer list, employee policies, and past complaints, citing its concerns about violations of HIPAA, EMTALA, and the Fair Debt Collection Practices Act. Above is a snip from the letter. AH shares dropped 3% Thursday and another 2% in extended trading, having given up 58% in the past four weeks.

Reader Comments

5-3-2012 10-40-37 PM

inga_small From Calorie Counter:  “Re: Cinnabon and nurses. Cinnabon is giving nurses free rolls (730 calories, 24 grams of fat) in honor National Nurses Week. Maybe hospitals should ban Cinnabon consumption.” Yeah, well, I wish hospitals good luck with enforcing that. Here’s another brilliant marketing idea: maybe CVS should consider honoring nurses by giving them a free pack of cigarettes.

5-3-2012 3-21-45 PM

inga_small From HIPAA Police: “Re: passwords. A nurse in IMCU was complaining to me about having to remember too many passwords. She then showed me the back of the badge to illustrate just how bad it is and let me take this photo.” In case you can’t make it out, her badge notes the passwords for several different systems, including Pyxis, pharmacy, and e-mail. I am sure that HIPAA Police does not work at the only hospital that can’t afford an SSO solution, so how do others manage multiple passwords? Bigger badges?

From Sweet Tea: “Re: size of the healthcare IT market. One commercial company’s estimate is $40 billion per year, close to your estimate of three times Vince’s $12 billion revenue number for the largest companies.”

5-3-2012 9-14-13 PM

From Stock Analyst: “Re: size of the healthcare IT market. Our company thinks it’s around $32 billion in size, of which $9 billion is hospitals.” Thanks for that information.

From J-Lo: “Re: Stage 2 comments. I seem to recall that with the Stage 1 NPRM, you could see the comments everybody else submitted. Is that not the case with Stage 2?”

From Nasty Parts: “Re: Allscripts. If things to continue to go bad for Glen Tullman, he can always focus on his other company. How many people know that Glenn is the CEO of another company?” At least 20,000+, assuming HIStalk’s readers paid attention when I mentioned it a couple of times in the past. People are always sending me stuff that I’ve already run, though, so maybe they’re trained by newspapers to assume that small stories aren’t important and are skimming HIStalk posts just a bit too fast. Here, I could describe World War III in one paragraph while using twice that space to rave about some weird band I like.

5-3-2012 10-45-36 PM

From Moe: “Re: Trinity Health. The group of hospitals in Columbus, OH (Mt. Carmel) brings 10,000 users live on Cerner big bang , including revenue cycle, clinicals, lab, and more.” Nice. If you have any pictures, send them over. Who doesn’t love command center pics?

HIStalk Announcements and Requests

inga_small This week’s highlights from HIStalk Practice: electronic medication reminders may improve adherence in the short term, but long term effectiveness remains unclear. More than 40% of all primary care providers are enrolled in RECs, including 50,000 in practices with fewer than 10 physicians. CareCloud CEO Albert Santalo wins Miami’s Technology Entrepenueur of the Year award. Dr. Gregg muses on odds and ends, inluding a shift in HIT discussions beyond Meaningful Use and the end of service for a few clinical informatics professionals. If you’re not a regular HIStalk Practice reader, what are you waiting for? And if you are one of the thousands of readers stopping by each month, many thanks!

A few folks always seem to be getting Inga and me confused, sending her information intended for me. Just to clarify: we don’t tag straight news items with who wrote them – we both do. If Inga adds her opinion, answers a question directly, or otherwise writes something in a way that might not be clear who’s talking, I put the little red icon in front of that item (as above). Otherwise, it’s me (Mr. H) you’re reading. I was tagging my items with a blue icon, but that was a bunch of unnecessary blue icons given that it’s just the two of us (other than Dr. Jayne, who has her own clearly marked section).

A pet peeve: confusing one-word adjectives with two-word nouns and adverbs. Example: Walmart may have everyday low prices, but you will see them in the story every day (not everyday.) You may have a backyard swimming pool, but it’s not in your backyard.

Acquisitions, Funding, Business, and Stock

5-3-2012 10-46-44 PM

MedAssets reports Q1 numbers: revenue up 15%, EPS $0.00 vs. -$0.28, with the company pointing to costs involved in its Broadlane acquisition in November 2010, but still beating estimates on both revenue and earnings. Non-GAAP earnings were $0.24 vs. $0.17.

5-3-2012 10-48-24 PM

The Advisory Board Company announces a 2-for-1 stock split following the release of its Q4 numbers: revenue up 33%, EPS $0.46 vs. $0.30.

5-3-2012 7-00-07 PM

Amcom Software acquires the IMCO-STAT CTRM product from IMCO Technologies that will allow traceable delivery of critical lab test results to the ordering physician by paging, PCs, tablets, and smart phones.

Facebook’s upcoming IPO will raise about $11 billion based on Thursday’s announced price range, valuing the former dorm room project at up to $100 billion.

Two law firms file class action lawsuits against Allscripts, charging the company and its officers with intentionally hiding failed integration efforts, missing its revenue and earnings guidance, and misrepresenting its post-merger prospects after it acquired Eclipsys. All routine and rarely meaningful, of course, guaranteed to happen when any company’s stock drops unexpectedly.


HHS contracts with Archimedes, Inc. to develop a modeling and simulation software platform for clinical scenarios, health interventions, and disease conditions.

5-3-2012 10-50-58 PM

Samaritan Regional Health System (OH) enters into a multi-year contract with CareTech Solutions for comprehensive IT services.

Radiology Associates of Fox Valley (WI) selects McKesson Revenue Management Solutions for its 33-physician practice.

Shands HealthCare will use the Rothman Index to monitor patient status and to conduct research at its Gainesville and Jacksonville campuses. I interviewed co-founder Michael Rothman 18 months ago for insight into how the software works.


5-3-2012 5-50-23 PM

Medecision names Katherine Schneider MD (AtlantiCare) as chief medical officer.

5-3-2012 8-32-58 PM

Former Eclipsys CFO Bob Colletti joins academic credentials exchange vendor Parchment as CFO.

5-3-2012 9-49-51 PM

MIT Sloan CIO Symposium chooses four finalists for its CIO innovation award based on four criteria: trusted advisor, business leader, strong communicator, and proven manager. Among the finalists is Catherine Bruno, VP/CIO of Eastern Maine Healthcare. Healthcare CIOs on the speaker list for the May 22 event include James Noga (Partners HealthCare), Chuck Podesta (Fletcher Allen Health Care), and Sue Schade (Brigham and Women’s Hospital.)

5-3-2012 9-56-07 PM

DuPage Medical Group (IL) names Krishna Ramachandran as chief information and transformation officer, where he will lead the 330-physician group’s Value Driven Health Care initiative. I note that he’s a member of the HIStalk Fan Club on LinkedIn, so special congratulations to him (it’s fun to read down the list of 2,408 members – since most folks have photos, it’s like an HIT yearbook.)

Announcements and Implementations

Mercy Health System (PA)  activates its Meditech EHR across its four hospitals and 44 physician offices.

Phoebe Putney Memorial Hospital (GA) goes live on McKesson CPOE on May 15.

5-3-2012 10-57-06 PM

Newark-Wayne Hospital (NY) goes live on Epic as part of Rochester General Health System’s $65 million EHR initiative.

JPS Healthcare (TX) will go live on its $110 million Epic system this Saturday, the seventh Metroplex-based health system to do so.

Practice Fusion launches an API that allows any laboratory to connect directly to its EMR and send lab results using standard HL7 data files.

Gartner names Kony Solutions a Visionary in its report on mobile application development platforms. The company also announces that it supports the BlackBerry 10 platform.

CE Broker announces the EverCheck paperless system for automatically verifying professional licenses for credentialing, including sending alerts about licensure status changes and maintaining an archive of all licensure changes for Joint Commission review. The price is $0.45 per employee per month.

Vassar Brothers Medical Center (NY) credits technology it had just installed with saving the life of a firefighter who had a heart attack during a fire. His EKG, taken immediately in the ambulance, was sent to cardiologists at the hospital, allowing them to hit a door-to-balloon time of 18 minutes, a third of the standard. The technology they use is AirStrip Cardiology (remote EKG viewing), GE Healthcare’s MUSE Cardiology (EKG storage), and Physio-Control’s LIFENET (EKG sharing between emergency medical services and hospitals).

5-3-2012 9-03-46 PM

The Johns Hopkins Hospital opens its new Sheikh Zayed Tower and The Charlotte R. Bloomberg Children’s Center using the Versus Advantages RTLS to support asset tracking, fleet management, nurse call automation, and food cart tracking. New York Mayor Mike Bloomberg donated $120 million of the $1.1 billion construction cost of the two towers.

MediServe announces a Web-based solution for private practice therapy providers. The Attigo system includes billing, documentation, scheduling, and practice management.

Government and Politics

During this week’s HIT Policy Committee meeting, members discussed whether licensed professionals and scribes should be allowed to enter data into EHRs on behalf of physicians under the Stage 2 MU program. The proposed rule would require physicians to use their own user IDs when accessing the system, also holding them responsible for approving information entered on their behalf by anyone else. Several committee members raised concerns that the doctor won’t benefit from clinical decision support otherwise since most systems provide their guidance during order entry.

Also from the HIT Policy Committee meeting: CMS reports that more than $5 billion in Medicare and Medicaid MU incentive payments have been made to 93,650 EPs and hospitals through the end of April.

5-3-2012 5-59-09 PM

Representative Renee Ellmers (R-NC), chair of a House subcommittee on health technology (also a nurse and the wife of a surgeon), asks CMS to exempt from MU requirements those physicians in small practices and those close to retirement.


The US again outspends other industrialized countries on healthcare with mixed results. At $8,000 per person, well above the next-highest Norway and Switzerland at $5,000, survival rates for breast and colorectal cancer were the highest, but death rates for asthma and diabetes-related amputations were also the highest. The report blames US costs on expensive drugs, medical services, and technology such as MRIs and CT scans, with a high obesity rate also adding to the total.

In Canada, the Hospital Employees’ Union publicly criticizes the outsourcing of 130 hospital medical transcriptionist jobs, saying the result will be less secure, of lower quality, and increasingly expensive. The hospital executive in charge of HIM says they’re already outsourcing half their transcription to the same group without problems, no information is stored on transcriptionist PCs, and per-minute rates are the same as they were in 2006 and will save $3 million of the $14 million annual transcription budget. Part of the appeal was the chance to move to a system that has better speech recognition capabilities.

Also in Canada, Nova Scotia’s Department of Health and Wellness and Canada Health Infoway announce an expansion of their peer support program for users of the Nightingale ambulatory EMR.

McKesson Automation’s building in Cranberry Township, PA was evacuated Tuesday evening after a female employee reported hearing a bomb. Police gave the OK to return when they concluded that the woman was hallucinating after experiencing an adverse reaction to an unnamed medication.

5-3-2012 9-45-04 PM

Bloomberg BusinessWeek profiles eClinical Works CEO Girish Kumar Navani and the company’s involvement with health projects in New York City. The company’s annual revenue was reported as $250 million.

5-3-2012 10-02-39 PM

Sunday night’s finale of The Amazing Race pits Epic employee Rachel Brown and her husband, Major Dave Brown, against three other couples. The winners will get $1 million.

5-3-2012 10-08-39 PM

In Ireland, three NUI Maynooth students win the Irish finals of the Microsoft’s Imagine cup for developing docTek, which allows patients with chronic illnesses to record symptoms for online review by their doctors. They will compete in the global finals this July in Sydney, Australia.

A UK doctor is investigated after sending an 18-day-old baby home with what was later determined to be myocarditis, which killed the baby the next day. The parents say that during the examination, the doctor looked up the baby’s meds on the computer and suggested giving him Tylenol, but he never left his chair to actually look at his patient.

Sponsor Updates

5-3-2012 8-25-07 PM

  • Benefis Health System (MT) signs an agreement with MedAssets to use its Spend and Clinical Resource Management Solutions and initiate use of MedAssets GPO and other cost containment services.
  • Angleton Danbury Medical Center (TX) creates a paperless registration system for its Meditech system using forms software from Access.
  • DrFirst announces that 6,000 pharmacies can now accept electronically transmitted prescriptions for controlled substances using EPCS Gold.
  • GetWellNetwork recognizes ten hospitals for Excellence in Interactive Patient Care during its GetConnected 2012 conference.
  • The Advisory Board honors Virginia Hospital Center (VA), Alegent Health (NE), and Monmouth Medical Center (NJ) with 2012 Crimson Physician Partnership Awards for improving the quality of care they provide while documenting more than $13.2 million in aggregate savings.
  • MEDecision introduces its new brand and highlights the evolving healthcare market during this week’s 2012 Client Forum.
  • A Detroit business publication profiles the growth and focus of JEMS Technology, which has seen one-year growth of 100% for its encrypted remote video solutions for healthcare.
  • Culbert Healthcare Solutions promotes Tina Sarantos to manager of consulting services for the company’s GE and Allscripts practices.

EPtalk by Dr. Jayne


CMS keeps sending me e-mails about ICD-10. For whatever reason, I thought this header was really funny given the recent delay. I’m personally worried that the 60-day comment period for the Stage 2 Meaningful Use NPRM is almost over and I haven’t gotten my personal comments finished yet. You can submit yours via the MU specific comments page. Although my organization has submitted its own official comments, I’m encouraging every physician, provider, and patient I know to comment as well.

CMS also issues a final rule on the use of the National Provider Identifier (NPI) on Medicaid and Medicare enrollment and claims documents. I can’t imagine that anyone out there practicing doesn’t have an NPI after all this time, but if you don’t, you have 60 days until the rule takes effect.

A Circulation article documents improvements in blood pressure control among US veterans. Over 10 years of data from the VA Health Data Repository was analyzed. Authors credit performance measurements in the EHR as contributing to the improvements.

Medical Economics advises providers how to respond to negative reviews on physician rating sites. Common complaints from a patient group profiled in the article include long wait times, lack of communication about delays, not being informed about test results, and failure to return phone calls promptly. Among the tips:

  • Don’t respond to negative reviews. Ask the site to remove unfair information.
  • As your patients to review you since most give positive reviews.
  • Conduct your own surveys to let patients feel heard.
  • Start a blog or practice website to help control your online presence

5-3-2012 6-34-21 PM

For women physicians tethered to their practices via smart phone, JoeyBra provides a solution that lets you avoid those pesky purses, totes, and satchels. Right now, it’s only available in leopard print. Personally I think an iPhone is a little bulky to be storing in my bra, but to each his (or her) own. Even with the leopard print, I don’t see Inga lining up to purchase one either.


Remembering an Industry Leader and Friend
By Daniel S. Herman

5-3-2012 6-39-56 PM

John Cornelius Wade, former CIO at Saint Luke’s in Kansas City, former chair of the HIMSS Board of Directors, colleague, and a close friend of mine, passed away on Saturday.

He was ill for the past several months. I spoke with his wife Cheri Thursday evening, and to John on his birthday a couple of weeks ago. He was in great spirits and was talking shop.

I first met John in Chicago in 1987 when we served on the First Illinois HFMA chapter IS Committee when I was with KPMG/Peat Marwick and he was CIO at Northwestern Memorial.  We were reacquainted by a colleague at FCG in the spring of 1993 shortly after he took the CIO position at Saint Luke’s.

John was a loyal person who was tenacious in everything he pursued. He would drive from Kansas City to Boston all night to see family. He did home repair himself, refusing to call a handyman despite his wife’s objections (until he fell off a ladder and dislocated his shoulder).

His loyalty was expressed in many ways across business and personal situations. He was an authoritarian leader when it came to running the IS shop, and was often opinionated when interacting with his customers throughout the health system.

In 1993, John took over a data processing (DP) shop from an interim management team from Andersen Consulting. He was swift to make leadership changes inside the IS organization, also changing how the department served its customers. He redefined the IT strategy; enhanced governance, project prioritization and executive ownership of technology-enabled IT initiatives; and established service level metrics by which he measured and demonstrated accountability. Saint Luke’s went on to become one of the first healthcare organizations to win the coveted Malcolm Baldrige Quality Award and the Missouri Quality Award almost 10 years ago.

When John retired from Saint Luke’s in 2008, the health system’s IT group was (and still is) considered one of the most effective and well-run healthcare provider IT functions in the country. It has been recognized for its outstanding IT governance structure.

John accomplished much in his 71 years and touched many people. I’ve learned a lot from him personally and professionally during our 25-year friendship. His memory will be in my heart for eternity.

Information about John, including photos and information about funeral and memorial services, is available here. Please take a moment to read the many memories and tributes from his friends and industry colleagues and add your own.

Daniel S. Herman is founder and managing principal of Aspen Advisors.


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

More news: HIStalk Practice, HIStalk Mobile.

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May 3, 2012 News 7 Comments

News 5/2/12

May 1, 2012 News 11 Comments

Top News

Castlight Health raises $100 million in Series D funding, raising its total to $181 million. The San Francisco company offers online tools to help consumers choose providers, evaluate cost and quality, and understand their healthcare benefits. Above is a TV news report about the company.

Reader Comments

5-1-2012 7-40-54 PM

From Reckless Speculator CIO: “Re: Allscripts. Glen will appoint someone from HealthCor to the board to placate them and save his Teflon self. I think he said after the Misys merger, ‘Given the choice to control the boardroom or executive suite, always choose the executive suite.’” I tweeted Monday that big Allscripts shareholder HealthCor Management is urging the company’s board to replace Glen Tullman as CEO or put the company up for sale, saying his 13-year record of underperformance is not acceptable, particularly with the HITECH tailwind and high returns to shareholders of the company’s competitors (Cerner and athenahealth were named). They point out the company’s strengths, such as Sunrise and EPSi.

From Customer CIO: “Re: Allscripts. Stock prices don’t mean much to us as a customer, but I would like to know what the company disagreement was about. Perhaps over resources for its clinical products vs. a new inpatient revenue cycle product.”

From EMRwatcher: “Re: Allscripts. Glen wants to engineer a buyout of the company. He’ll probably get fired first, but that will make it easier for him to spend time getting the cash together.”

From MDRX Files: “Re: Allscripts. They should be well positioned for the shift of focus to the ambulatory world with clinical integration and accountable care. Epic is benefitting from their solid vision and impeccable execution, but the door is open for Allscripts to raise the bar as the only company designed to deliver on the future. Everybody else has inpatient baggage that will slow them down. I hope Allscripts takes advantage of the stock plunge to go for it. The software side of the industry needs fresh thinking. Some companies will become commoditized as data an information prevail as strategic and they’re so entrenched in their transaction processing history that they can’t fathom any other world. Epic has the advantage of not being publicly traded and not required to deliver quarterly numbers, but maybe an Allscripts shakeup was what was needed to invigorate them to take a bolder view of the future.”  

From Global Travelin Babe: “Re: Allscripts CEO debacle. I have no idea if it has any merit, but I heard they’re going after a few brand name, reputable CEOs to get their mojo back. Two names mentioned were Ivo Nelson from Healthlink and John Glaser of Siemens.” That sounded pretty off the wall, but I asked both Ivo and John since I like to get answers when I can. They say, not surprisingly, that they have not been approached and wouldn’t be interested.

5-1-2012 9-52-23 PM

From Kermit: “Re: healthcare IT from a doctor’s point of view. This is a monthly show for the Mass Medical Society, produced at a local cable access station where I volunteer. Given my links to health IT, I suggested this topic.”

5-1-2012 9-55-16 PM

From Vince Ciotti: “Re: Susan’s inquiry about the size of the healthcare IT market. The top 13 vendors had $12 billion in revenue in 2011, so I’d guess the total market is at least twice that with all the niche players and consulting firms.” Above are Vince’s numbers.

From Dragon Man: “Re: Mike Mardini. The founder and CEO of Commissure, the radiology speech recognition company acquired by Nuance in 2007, is leaving. He was also the founder and CEO of Talk Technology, acquired by Agfa in 2001.” Unverified. No change in his LinkedIn profile so far.

5-1-2012 9-38-18 PM

From HIPPA Hound: “Re: Raleigh newspaper’s series on hospital profits and low levels of charity care. Not new since it was reported last week, but it has struck a few nerves.” Politicians (including the ever-present Sen. Chuck Grassley, who will no doubt write a scathing letter of inquiry that yields nothing) get worked up about about the ongoing series, which I’m sure is exactly what the newspaper planned. Every newspaper follows the same formula when trying to goose dying circulation: (a) write a huge and endlessly publicized series on some hot button topic, with or without solid facts and objectivity; (b) refer to their own series in some high-and-mighty editorials; (c) prod everyday people enough times about the topic du jour until they get enough outraged quotes to yield let another article; and (d) pester people in power about their articles until somebody finally at least pretends to share their outrage and makes vague promises about coming down hard on the villains. That’s about as good as it’s going to get from the dead tree folks whose readers avoid making eye contact with the politics and world news sections as they make a beeline for the sports page and comics.

From Kaiser Roll: “Re: Kaiser Permanente’s innovation award winners. Here’s the list.” Some of the technology winners:

  • Knowledge Builder, which provides a way to import clinical algorithms into a rules engine to identify appropriate treatment conditions that are likely to occur, such as kidney stones
  • OpQ, an operational dashboard that extracts information from the data warehouse and Epic Chronicles database every 10 minutes to allow outpatient managers to oversee staff assignments and patient flow.
  • Specimen Transfer and Tracking (STAT), a chain of custody tracking system for specimens that would replace paper logs.
  • Ambulance on the Information Superhighway, an inter-facility transportation clinical documentation tool.
  • Nurse Advice Chat, an online chat function for the nurse advice center.
  • Matching Clinical-Facility Data, tools to integrate various information sources to determine whether the physical environment, such as patient room characteristics, affect patient outcomes.
  • Hospital Capacity Grid, a one-screen view of activity and capacity across a 21-hospital region.
  • BirdDog, which sends lab results to the mobile devices of ED clinicians.

HIStalk Announcements and Requests

5-1-2012 6-11-43 PM

Welcome to new HIStalk Gold Sponsor nVoq. The privately held Boulder, CO company offers the SayIt speech recognition solution, exclusively endorsed by the AHA with vocabulary support for over 35 medical specialties. The SaaS-based SayIt is being rolled out in both ambulatory and inpatient healthcare settings, where users gain productivity within minutes as they dictate SOAP notes and other text directly into their EMR with no integration required, even using voice commands to navigate through their templates and operate other applications. SayIt is delivered as a low-cost Internet subscription, so users can use it at work, at home, or on the road. The company is interested in expanding its service delivery network and welcomes inquiries to VP/GM Debbi Gillotti. Thanks to nVoq for supporting HIStalk.

Here’s a video I found of Microsoft’s Bill Crounse MD talking about nVoq.

Acquisitions, Funding, Business, and Stock

Allscripts expands its stock repurchase program to $400 million from the $200 million that was approved a year ago.

5-1-2012 7-05-04 PM

Kansas City, MO startup Cognovant raises $500K in a seed round to launch its first product, the PocketHealth personal health record. The basic version will be a free App Store download, with paid upgrades available for versions that handle more complex needs and allow use by multiple family members. The founders are Joe Ketcherside MD and Stan Pestotnik RPh,  who were executives at TheraDoc before it was acquired by Hospira.

5-1-2012 9-41-47 PM

McKesson announces Q4 results: revenue up 10%, EPS $2.09 vs. $1.62, beating expectations on both. Technology Solutions revenue was down 2% and profit was down 20%. John Hammergren said in the conference call that several Horizon Clinicals customers have committed to moving to Paragon and conversions have begun. He also said that while EMRs are important, customer success will be driven more by performance management, analytics, care coordination, and payor capabilities, and that RelayHealth is well positioned for the MU Stage 2 emphasis on connectivity.


Perry County General Hospital (MS) selects RazorInsights’ ONE-Electronic Health Record for its 22-bed critical access hospital.

Southwest Medical Center (KS) contracts for Summit Healthcare’s Provider Exchange for integration with physician offices.

West Tennessee Bone & Joint Clinic selects SRS EHR for its 11 providers.

Fletcher Allen Health Care (VT) will use the CapSite hospital purchasing database, which gives subscribers access to research studies and thousands of real-life contracts, proposals, and RFP responses covering healthcare IT, imaging equipment, professional services, and medical devices from 1,400 vendors.

5-1-2012 9-42-52 PM

Somerset Medical Center (NJ) signs a renewal agreement for secure e-mail services from Zix.

Perinatal Quality Collaborative of North Carolina will implement a wireless clinical support system from San Diego-based startup Cognitive Medical Systems.


5-1-2012 5-52-48 PM

The Allscripts board of directors elects Dennis Chookaszian as its chair. He was previously chairman and CEO of retirement advice site mPower and had retired in 1999 as chairman and CEO of insurance company CNA. He’s been on the board since September 2010.

5-1-2012 5-55-03 PM

New Jersey Hospital Association’s Healthcare Business Solutions affiliate appoints Michael Guerriero (MedAssets, Eclipsys) VP of business development.

5-1-2012 5-58-14 PM

Telemedicine provider Virtual Radiologic names former US Oncology COO George Morgan as CEO. He replaces Rob Kill.

5-1-2012 5-59-49 PM

Vocera Communications subsidiary ExperiaHealth names Elizabeth Boehm (Forrester Research – above) director of patient experience collaborative and Christine Henningsgaard (Accretive Health) national practice leader.

Elsevier promotes Hajo Oltmanns to president of its CPM Resource Center.


5-1-2012 6-04-11 PM

Joanne Wood, SVP of client services of Meditech and president and COO of LSS Data Systems, died Sunday, April 29. She was 58.

5-1-2012 6-08-44 PM

John Wade, former VP/CIO of Saint Luke’s Health System and former HIMSS board chair, passed away Saturday, April 28. He was 71.

5-1-2012 7-58-02 PM

Rick Brown, founder of the UCLA Center for Health Policy Research, died April 20 at 70.

Announcements and Implementations

5-1-2012 9-44-46 PM

Bon Secours Mary Immaculate Hospital (VA) goes live on Epic as part of Bon Secours Health System’s $200 million EHR initiative.

Lifepoint Informatics introduces CPOE Connect, a plug-in solution that allows vendors and commercial labs to offer seamless lab order entry using existing EHRs.

Preceptor Consulting, which offers go-live support and clinical training for EHR implementations, is supporting the implementation of the Cerner IView charting flowsheet at all campuses of Emory Healthcare.

5-1-2012 8-46-51 PM

In Canada, The Collingwood General & Marine Hospital goes live with PatientOrderSets.com.

Government and Politics

The American Hospital Association tells CMS that most hospitals will not be able to meet proposed Stage 2 Meaningful Use requirements, warning that, “many of the proposals put regulatory requirements ahead of actual experience with these technologies – an approach that will likely have unintended consequences."

Meanwhile, CHIME urges the government to give providers more time to prepare for Stage 2. Among its specific recommendations: a 90-day EHR report period for the first payment year in Stage 2.

The General Accountability Office (GAO) recommends that CMS verify provider requirements band collect more information before paying out EHR incentives.


MedAptus selects problem search technology from Intelligent Medical Objects for its Professional Charge Capture solution, which will allow clinicians quick access to diagnoses when completing charge documentation using ICD-10.

Wyse Technology integrates Imprivata OnSign into its thin and zero clients, offering No Click Access for Citrix and VMware View that supports roaming between locations with badge validation.

5-1-2012 9-46-29 PM

Valued Relationships Inc. signs with AT&T to provide remote patient monitoring services for VRI’s nurse-staffed telemonitoring center. The service will capture information from wireless health devices in the home, such as scales and blood pressure cuffs, and issues triage alerts to the monitoring center when appropriate.

More information on the technologies used by Max Healthcare, the first two hospitals in India to earn Stage 6 EMRAM recognition from HIMSS. They include WorldVistA EHR (a free offshoot of the VA’s VistA), the open source Mirth integration engine, and a homegrown hospital information system. Dell Services manages its IT operations, including the EHR implementation, running all IT infrastructure into a private multi-protocol label switching cloud hosted at a remote data center.

5-1-2012 9-47-59 PM

In the UK, Blackpool Teaching Hospitals NHS Foundation Trust rolls out 900 Samsung Galaxy Tab tablets to clinicians in a deal with Vodafone.

5-1-2012 9-27-47 PM

A Massachusetts psychologist creates  what she says is the first evidence-based treatment app for obsessive compulsive disorder. Live OCD Free costs $79.99.


KLAS reports that half of providers anticipate buying or replacing a business intelligence solution in the next three years. In alphabetical order, the top five most considered BI vendors are IBM, McKesson, Oracle, QlikTech, and SAP.

inga_small A Weird News Andy wannabe sends this story about man with a toothache who made a poor choice of dentists: the girlfriend he had just dumped. She sedated him and removed all 32 of his teeth, saying she had tried to remain professional, but couldn’t help thinking “What a b—–d” as he was unconscious before her. Most of us gals have had that feeling once or twice.

The real Weird News Andy wonders who will update EHR med lists if the FDA allows drugs for hypertension, diabetes, infections, migraines, asthma, and allergies to be sold without a prescription, possibly justifying that practice by requiring pharmacist counseling.

Here’s a fun SNL parody video that T-System created as an opening to its user group meeting. It has a lot of details that are worth a rewind, for instance at the 1:30 mark, where development VP Bill Hall is stereotypically sucking down what appears to be a Red Bull.

In the UK, North Bristol NHS Trust admits to a huge budget overrun in its second try at a successful Cerner rollout after problems with the first. Most of the extra money was spent on additional support people.

5-1-2012 7-31-48 PM

The Dr. Oz Show partners with Temple University Health System and Practice Fusion to run a May 19 “15-Minute Physical” event in Philadelphia, where 1,000 people will be screened and the resulting analytics report presented to the city by the end of the day.

Facebook urges its users to post their organ donor status. Self-proclaimed pundits crow that Facebook is naïve in thinking that sticking a “donate” label on your profile provides legal consent, but they’re missing the point: the idea is to use social networking to encourage people to sign up with state registries. Your Facebook profile will outlive you, so your organs might as well follow its lead.

Sponsor Updates

5-1-2012 7-56-19 PM

  • Cumberland Consulting Group promotes Saman Pourkermani to executive consultant.
  • Merge Healthcare releases its Merge Honeycomb Archive archiving application.
  • Beacon Partners is named by Boston Business Journal as one of the region’s fastest-growing companies.
  • Baptist Health System (AL), INOVA Health System (VA), and Park Nicollet Health Services (MN) select  LRS software for secure document delivery from their Epic footprints.
  • T-System outlines its pending response to the proposed MU Stage 2 rule to ensure it addresses the needs of EDs.
  • Olmsted Medical Center (MN) extends its partnership with MED3OOO through 2017.
  • Teletracking hosts a free networking lunch May 11 in Baltimore featuring Kevin Capatch, director of supply chain technology and process engineering for Geisinger Health System.
  • Intelligent InSites joins the Cisco Developer Network in the wireless / mobility category.


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

More news: HIStalk Practice, HIStalk Mobile.

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May 1, 2012 News 11 Comments

Curbside Consult with Dr. Jayne 4/30/12

April 30, 2012 Dr. Jayne No Comments

I wrote a couple of weeks ago about the pending EHR upgrade at one of the emergency departments I cover on a part-time basis. The witching hour for go-live has come and gone – or at least I think it has, or might have, but who really knows because I have received no communication whatsoever from the project leadership or from my department chair.

For those of you who may have missed my previous post, here’s the scenario. I moonlight in the emergency department at a hospital that is unaffiliated with my primary employer. They have been preparing to upgrade the ED information system for the better part of a year, with several previously scheduled upgrades being canceled at the last minute. I’ve been eagerly waiting upgrade of the system, which was less than optimal from a provider perspective. Since I’m just a contractor, I have no say in the design, implementation, or support of this product, so it’s a unique opportunity to see a system from the same perspective that my own physicians see the system I manage. I know I’m hyper-critical since I do this for a living, but some of the things that occurred were pretty unbelievable.

In the Pro column, the hospital provided plenty of notice on the training sessions. We were e-mailed approximately six weeks before and asked to schedule a slot. Opportunities were offered at two locations over a three-day period, with plenty of seats available to cover the number of providers in our department. The downside of that approach would be that if a physician was on vacation that week, he or she would not have a training opportunity. Advice for the future: split your sessions over two different calendar weeks to better accommodate vacations.

The first Con was readily apparent when I couldn’t find the training room and there was no signage – another easy fix for next time. After 15 minutes of wandering, I eventually made my way to an obscure IT office on the top floor of a physician office building. They had 20 computers set up. Since I was still early, I settled in and started checking e-mail. Apparently only some of them were actually usable for training, so when the instructor arrived (late), I was forced to move and go through the whole painful log-in cycle again.

Another Con (is this only two, or are we at three with having to move workstations?) was that the copy of the production database used to create the training database was so old that none of the users’ previous three passwords would work. Unfortunately, this led to the instructor having to use his personal log-in for all five of us, resulting in many fun adventures as we documented all over each other since we were on the same log-in.

A considerable Pro was that our instructor was clearly a grizzled vet of the IT wars. He handled all of the issues with a sense of humor, which although warped, was truly appreciated and made a difficult situation tolerable. He started his preamble with an apology; as we were the second training session of the day, he already knew that the deck was stacked against him. Our training sessions were scheduled to be four hours, and apparently the IT staff had asked our department secretary to send out a notice that the scope of the upgrade had changed dramatically and training would only be an hour long. Needless to say, none of the physicians received this message (Con) and apparently he got an earful from the 8 a.m. session. The preemptive apology definitely helped mitigate the ire of my group.

Upon making it through the log-in screen (now boldly decorated with the “Meaningful Use Certified!” enthusiasm of the vendor) the first change we noted was that our beloved grey inbox was now shaded a delightful salmon color. I’m not sure exactly why a vendor would want to do that, but salmon isn’t exactly a crowd pleaser, and I found it more distracting than the relatively vanilla grey tone we had previously.

In the Pro column, the IT staff had built test patients for each provider to train with. As a Con, however, none was built for me, “because you’re just part time – but don’t worry, since we’re only giving you part of what you need, I don’t mind if I only get part of your attention.” This instructor was really on his game – deflecting the negative vibes and making us laugh. He also gave us fair warning that the morning class identified some elements of the system that were less than stable. Maybe it was good that training only took one of the projected four hours, because that gave him time to call the mother ship to request that they stop tinkering with the system while training was in progress.

One of the major upgrades to the system was the addition of templated patient visits, a big Pro in my book because of the ease of documentation. No one wants a beautiful flowing narrative in the ED – they want what we call the bullet: “This is a 43-year-old Caucasian male with a gunshot wound.” We do not want to know that this is a 43-year-old male of Germano-Irish descent who was walking along Elm Street two blocks south of Chestnut, minding his own business on a bright and sunny day, when two guys game out of nowhere and he heard a “pop.” I found the templates extremely intuitive and the system very responsive. In hindsight, however, after writing my recent piece on ICD-10, maybe I will need to know what street he was on and what the atmospheric conditions were at the time of the injury, as well as whether he heard a “pop” or a “bang” etc. For now, however, I’ll leave those questions for the police report.

The other docs in my class didn’t like the templates much, but I think that’s largely due to the fact that they’re full-time docs who don’t have any other vendor experience for reference and who have been allowed to use voice recognition in lieu of the painful “visit builder” native to the application. (As part-timers, we are not allowed to use voice recognition due to licensing costs. Go figure.)

I was pleased to see that the patient education module had been completely overhauled (big Pro) and replaced with a third-party component that allowed creation of physician-specific macros as well as those available for sharing across the department.

Unfortunately, the biggest Con is that the much-hated prescribing system received no updates at all. When I mentioned this disappointment and how I loathe not being able to prescribe exactly what I want, one of the other docs in the class was happy to demonstrate some “undocumented functionality” in the system that allowed me to do exactly what I wanted despite the constraints. Although it’s not officially sanctioned (the instructor actually covered his ears and said “la-la-la” while we were doing this) I’m ecstatic and can’t wait to try it out.

One Pro/Con was the lack of training material given to us. Good because a lot of people don’t read it anyway (can you say Sanskrit?) and it kills fewer trees, but bad for those of us that might actually want to look at it. Apparently they didn’t print anything, because even the morning of class, they were debating the scope of the upgrade. Promising to e-mail it made sense (although I have yet to receive it.)

I mentioned a few weeks ago that I was concerned that the support staff wasn’t aware of the upgrade. Apparently this is because other than the salmon-colored inbox, all of the changes were on the provider side. Assuring us that the team would e-mail us with instructions on downtime and the final preparations for the upgrade, he sent us on our way. The instructions never arrived, but I’m putting that blame on the department secretary rather than holding it against the IT team.

Totaling the score, that’s six Pro and seven Con, a mixed bag by any standard. I hope the upgrade went well (if it went at all) but I really don’t know since there’s been no communication. I’m scheduled to work later this week, so I’ll find out then.

Have any outstanding upgrade tips to share with the HIStalk community? E-mail me.


E-mail Dr. Jayne.

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April 30, 2012 Dr. Jayne No Comments

Readers Write 4/25/12

April 25, 2012 Readers Write 5 Comments

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

CDS by the Numbers: Three Useful Frameworks for Developing Clinical Decision Support Applications
By Lincoln Farnum

4-25-2012 6-11-29 PM

Clinical decision support, or CDS, is many things to many people. Ask any 10 healthcare providers what clinical decision support is and you’ll very likely get 10 (or maybe 20) different answers, all good ones. The answers are also likely to be tinged with some degree of frustration and mistrust.

CDS as a discipline stems from the original promise of computers developing artificial intelligence — actually practicing medicine, making diagnoses, and managing patient care. Obviously these early expectations have not yet been fully realized. Today, our understanding places computers in medicine into more supportive roles.

In practice today, one commonly seen CDS application is related to medication ordering — alerting for allergies; duplicate orders and therapeutic overlaps; and drug-drug and drug-food interactions. These applications have no doubt saved human lives and resources, but often do so at a high cost to prescribers in the form of confusing messages and alert fatigue from poorly designed or executed rules.

Also, ethical concerns can affect users’ experiences with CDS. Concerns that technology-driven decision making will affect the doctor-patient relationship or that it might fail to take into account the patient’s values, or produce a cumulative de-skilling effect on physician training have all been commonly cited. There are also frequent liability concerns relating to prescribers accepting erroneous advice from a computer. It’s the fallout from these common but very reasonable apprehensions that we as consultants must try to manage on a daily basis.

Designing effective CDS is as much art as science, and it’s a quite a bit of both. Detractors of clinical decision support enthusiastically point to the occasional bad examples, but are quite often not even aware of the good ones. They seldom see “good” CDS — in part because it’s so hard to do, but also because good CDS is often invisible. CDS applications are, at their best, an unseen hand gently guiding patient care and clinical decision making.

There exist today three common frameworks for designing effective CDS: the Three Pillars of Effective Clinical Decision Support, the Five Rights of CDS, and the Ten Commandments of CDS.

Let’s begin with discussing the Three Pillars.


The Three Pillars

Osherhoff, et al, in “A Roadmap for National Action on Clinical Decision Support,” uses an image of three pillars supporting effective CDS. They are represented in the image below:


4-25-2012 6-10-45 PM

Pillar 1: Best Knowledge Available When Needed

  • Represent clinical knowledge and CDS interventions in standardized formats (both human and machine-interpretable) so that a variety of knowledge developers can produce this information in a way that knowledge users can readily understand, assess, and apply it.
  • Collect, organize, and distribute clinical knowledge and CDS interventions in one or more services from which users can readily find the specific material they need and incorporate it into their own information systems and processes.

Pillar 2: High Adoption and Effective Use

  • Address policy / legal / financial barriers and create additional support and enablers for widespread CDS adoption and deployment.
  • Improve clinical adoption and usage of CDS interventions by helping clinical knowledge and information system producers and implementers design CDS systems that are easy to deploy and use, and by identifying and disseminating best practices for CDS deployment.

Pillar 3: Continuous Improvement of Knowledge and CDS Methods

  • Assess and refine the national experience with CDS by systematically capturing, organizing, and examining existing deployments. Share lessons learned and use them to continually enhance implementation best practices.
  • Advance care-guiding knowledge by fully leveraging the data available in interoperable EHRs to enhance clinical knowledge and improve health management.

The Five Rights

The Agency for Healthcare Research and Quality (AHRQ) has published a CDS Toolkit in which safe and effective medication management is supported by the use of CDS, though these concepts can easily be extrapolated to health care in general. The Five Rights of Effective CDS — not to be confused with the Five Rights of Medication Administration — proposes that we can achieve CDS-supported improvements in desired healthcare outcomes if we communicate:

  1. The right information. Evidence-based, suitable to guide action, pertinent to the circumstance.
  2. To the right person. Considering all members of the care team, including clinicians, patients, and their caretakers.
  3. In the right CDS intervention format. Such as an alert, order set, or reference information to answer a clinical question.
  4. Through the right channel. For example, a clinical information system (CIS) such as an electronic medical record (EMR), personal health record (PHR), or a more general channel such as the Internet or a mobile device.
  5. At the right time in workflow. For example, at time of decision, action, or need.

The Ten Commandments

Finally, David Bates, et al in JAMIA published “Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality,” in which he modestly proposes the following ten commandments for CDS:

  1. Speed is everything. Even if the decision support is wonderful, if it takes too long to appear, it will be useless.
  2. Anticipate information needs and deliver in real time. CDS must be presented at the moment the user needs it.
  3. Fit into the users’ workflow. Users won’t go looking for CDS — it needs to be in their workflow.
  4. Little things can make a big difference. Small changes in delivery can have an oversized effect in outcomes.
  5. Recognize that physicians will strongly resist stopping. Don’t bring clinicians to a dead end when making suggestions.
  6. Changing direction is easier than stopping. Propose alternatives when advising against something.
  7. Simple interventions work best. Complex and multi-paged guidelines will not be readily accepted.
  8. Ask for additional information only when you really need it. Try to obtain all necessary information passively. Ask for additional information only if it is absolutely required.
  9. Monitor impact, get feedback, and respond. Verify that interventions are producing the desired outcomes and communicate with your customer base.
  10. Manage and maintain your knowledge-based systems. Suggestions based on outdated information are dangerous and worse than no suggestions at all.

Obviously, this is a very high level overview of these frameworks. The below links will provide more information and context. The simple take-home lesson is that effective CDS isn’t easy and even good CDS isn’t always accepted or performs as its developers intend. The development and deployment of clinical decision support should be undertaken with an understanding of the challenges and recommendations for best practices, and with the strong cooperation of and input from the user community.

A Roadmap for National Action on Clinical Decision Support, Jerome A. Osheroff, MD, et al.

AHRQ, Approaching Clinical Decision Support in Medication Management

Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality, David W. Bates, MD, MSc, et al.

Lincoln Farnum MMI, RRT-NPS, CPHIMS is a senior consultant with Vitalize Consulting Solutions, an SAIC Company and a graduate teaching assistant in the Master of Science in Medical Informatics program at Northwestern University.

I’m a Believer in Diagnostic Decision Support
By Scott W. Tongen, MD

4-25-2012 6-41-15 PM

When I read a vendor’s brochure about diagnostic decision support software that mirrors how medical students and physicians in training are taught to diagnose patients, I had an epiphany. My peers and I today are not diagnosing patients the way we were instructed in medical school and residency. As a result, we — and our patients — pay a heavy price.

As students and residents, we were asked to provide a list of all possible diagnoses based on patient’s symptoms, medical tests, accumulated medical knowledge, and other information. Next, we would use the data at our disposal to eliminate diagnoses that did not fit until we were left with one diagnosis.

However, advances in imaging software and electronic health records, revenue pressures, and crushing time demands had led us to stop using that “differential diagnosis” methodology on a daily basis, leading to misdiagnoses or missed diagnoses.

None of us likes to admit our mistakes and fallibilities when we’ve misdiagnosed or missed a diagnosis, but it happens: 40,000 to 80,000 patients die annually due to misdiagnosis, according to a 2009 study published in the Journal of the American Medical Association.

I believe a major reason for an inaccurate or incomplete misdiagnosis is due largely in part to the increased use of powerful EHR systems. Those systems are deemed so efficient now that they lull highly skilled and trained professionals into a false sense of security. Too many physicians rely on electronic alerts and images to help them solve the mystery of a patient’s illness, forgetting that technology can be a poor or terrific tool, depending on whether it is used correctly.

Also, doctors and hospitals do not realize that EHRs are not sold “out of the box” with diagnostic decision support that generate potential diagnoses and flag high-risk “Don’t Miss” diagnoses when patient’s symptoms and vital signs are entered into the application. When clinicians do not know what they do not know or are not thinking about a possible diagnosis, they certainly will miss it.

Another reason for misdiagnoses and missed diagnoses is physicians’ busy schedules, as continual reimbursement cuts are forcing them to squeeze in more patients. This, combined with other demands competing for their time, make it impossible for doctors to remember all pertinent details that could potentially explain a patient’s problem, much less keep up with the massive explosion of peer-reviewed studies and medical discoveries published in numerous medical journals.

All those thoughts flashed across my mind as I read the brochure, which ultimately led to my convincing administrators to fund and offer the tool to our physicians. Diagnostic decision support software can help doctors address those problems while minimizing misdiagnoses that harm or kill patients.

For that reason, every physician and hospital in the country should implement diagnostic decision support software that highlights and enables them to access relevant information about potential diagnoses. They will find the tool extremely valuable, particularly when diagnosing difficult as well as rare cases. A useful objective review of these tools was published recently, “Differential Diagnosis Generators: an Evaluation of Currently Available Computer Programs” by William Bond, MD, MS et al from the Lehigh Valley Health Network.

To be clear, I am not proclaiming diagnostic software needs to emulate a physician’s thinking. What I am advocating is that doctors should use it to bring up diagnoses they otherwise would not have considered or remembered. The tool will more than pay for itself if it prevents a single fatality or serious misdiagnosis. More importantly, it will enhance quality and safety of care.

At the time this article was written, Scott W. Tongen, MD was medical director of clinical documentation, compliance, and quality at United Hospital, part of Allina Hospitals & Clinics in Minneapolis. He has since joined Vitalize Consulting Solutions, an SAIC Company as medical director.

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April 25, 2012 Readers Write 5 Comments

News 4/25/12

April 24, 2012 News 10 Comments

Top News

4-24-2012 6-30-08 PM

Cerner breaks ground on its $160 million Kansas City, KS campus, which will eventually house 4,000 employees. The first tower is projected to open mid-year 2013 and will serve 1,000 employees, including about 800 new hires.

Reader Comments

From THB: “Re: Accretive Health. Wanted to hire me with this exact thing under the guise of implementing an ACO-type process (do you want us to put the kidney stones back in?)” The State of Minnesota goes after Accretive Health for its actions on behalf of its hospital customers, including placing its employees in the ED to demand payment before services are rendered and for using information in hospital charts to try to collect overdue bills. I’m uncomfortable with the tone of the entire article, which seems to suggest that (a) hospitals should be passive in their efforts to convince patients to pay for services rendered, asking them nicely and infrequently if they wouldn’t mind setting their debts at some point if it’s not too much trouble; (b) it’s unethical to ask ED patients to make payments for previous visits before seeing them again, when in fact many of those patients show up for non-emergent conditions anyway and treat it more like a physician office visit; and (c) hospitals are being shady when they allow Accretive employees to work in its departments, even though full hospital departments like dietary and housekeeping are outsourced all the time.

Why isn’t the state upset about a national healthcare system based on ridiculously inflated charges that are favorably discounted to big insurance companies but not to patients without insurance, or with patients who incur healthcare services with no intention to pay for them even when they are financially able to do so? Hospitals and Accretive are doing exactly what you would expect given the goofy rules of the game – hospitals are often huge and hugely profitable non-profits (intentional oxymoron) with multi-million dollar executives who are wired to maximize the bottom line. The system was changed years ago to eliminate the charity and tax-supported models and instead requires hospitals to be run like a business. The shades of gray about which services are mandatory, who can and can’t afford to pay, and how aggressive the bill collectors are allowed to be just detracts from the central issue – hospitals are doing nothing illegal, just selectively distasteful to those who think healthcare isn’t a business when it clearly and intentionally is, rightly or wrongly.

4-24-2012 7-50-39 PM

From Banishing Bob: “Re: North Carolina hospitals. Subject of a scathing investigative series by the Raleigh newspaper.” The five part-series, called “Prognosis: Profits — Hospitals Prosper at Patient’s Expense” is an extension of the argument above – behavior that’s unsavory, but legal and, according to the hospitals named, necessary. North Carolina’s non-profit hospitals – which pay no income, property, or sales taxes — are banking annual profits of up to $500 million, erecting massively expensive Taj Mahospitals, paying their executives handsomely (25 in the state make over $1 million), strong-arming patients who can’t or won’t pay their bills, and sitting on multi-billion dollar reserves in a couple of cases. All in the name of sustainability and giving the locals the care they deserve, the executives say. Most of the 25 non-profit hospital executives in the million dollar club work for Novant or Carolinas HealthCare. Carolinas HealthCare paid its CEO $4.2 million, the COO $2.5 million, the CFO $1.8 million, and has EVPs making nearly $2 million. Novant’s chief clinical, medical, and administrative officers each made over $1.5 million and its general counsel was paid $1.2 million. On the IT side, Novant paid its CMIO $801K and its CIO $770K. I don’t know about Carolinas HealthCare since their federal 990 form isn’t readily available for whatever reason (I assume because they’d rather it not be). Excessive? You decide.

From Oblate Spheroid: “Re: Bill O’Connor. Gone from Zynx. What’s going on there?” Unverified. Bill’s LinkedIn profile says he’s still there. He is (or was, depending) the SVP of marketing, joining the company nine months ago.

4-24-2012 8-19-08 PM

From Beeper King: “Re: beepers. Because there is no guarantee of message delivery with cellular communications, pagers will be with us for a long time to come. How often have you received a cellular text message a day late? The cellular community will need to be pressured to make this change. However, given the small portion of their market that healthcare segment makes up, this probably isn’t likely to happen soon.” The beeper discussion is fascinating. Somehow every other industry makes do without beepers for their critical, real-time communications. The only time I felt secure in knowing whether my message was received (and opened) was in the old days of the two-way RIM pager, precursor to the BlackBerry. Even now, there’s no perfect system – secure, cheap, usable in all geographic areas, and with verifiable delivery.

From Suggestion Box: “Re: interviews. You should interview health system CEOs about IT-related topics such as Meaningful Use and ACOs.” I really like that idea. If anyone can hook me up, I’m happy to do it. I’ve tried George Halvorson of Kaiser a couple of times with no luck, but just about any big-hospital CEO would be fun.

From The PACS Designer: “Re: cloud collaboration. An application that has been adopted for collaboration by over 120,000 businesses is Box. Box offers secure, scalable content-sharing that both users and IT love. The app pioneers a new level of content management security, with role-based access controls, 99.9% uptime guarantee, and data encryption using 256-bit SSL." A one-user, 5 GB personal account is free, although so is the long-delayed, just-announced Google Drive.

From Frank Poggio: “Re: Medicare payments. CMS proposes a payment update for acute-care hospitals that it projects will increase operating payments by about 0.9% in 2013. Well, let’s see — that would mean if you did not meet Stage 1 MU, that would be a penalty of 0.3%. In a 250-bed facility, that would be maybe a $100k loss. Is it worth slamming in an EMR? I doubt it. Oh, by the way the docs got 0%, so one-third of zero equals zero penalty.”

4-24-2012 6-50-38 PM

From Daniel Barchi: “Re: Yale New Haven Health System. Greenwich Hospital went live big bang on Epic for all financial and clinical applications this past Saturday. Greenwich is the first of the three hospitals to go-live and it joins 36 physician practices from Yale Medical Group, Northeast Medical Group, and private community physicians who have been live on Epic since October. I could not be more proud of our local Epic team and the staff and leadership of Greenwich Hospital. We have also been really well supported by a talented team from Epic. I have been through many go-lives and the preparation and hard work of all of these teams made this about as smooth as a hospital go-live can go. The attached picture shows Greenwich Hospital President and CEO Frank Corvino throwing the switch at a go-live ceremony the first day.” Thanks for the report. Daniel is CIO of the Yale health system and the medical school.

HIStalk Announcements and Requests

4-24-2012 6-55-05 PM

Welcome to new HIStalk and HIStalk Practice Platinum Sponsor simplifyMD. The Atlanta-based company offers The Digital Chart Room, which includes medical-grade document management, auto-indexing of scanned documents, a template generator, the Productivity Pilot task organizer, and a personal health record. It eliminates the limitations of paper-based charts (one-person access, lost files, high labor costs), avoids the risks of EMR implementation (physician workflow interruption, expense, lack of ROI), and allows practices to increase their volume to offset higher costs and reduced payment. The company’s talking points are fast and friendly customer support, affordability, easy implementation, and elimination of customer exposure to technical obsolescence. Customers choose between a fully hosted cloud-based solution or a local cloud (a local server that allows uninterrupted operation if Internet access is lost, but with access from anywhere). It’s one monthly price ($395) for everything and the customer can just stop using it with no additional charges if they find that it doesn’t pay for itself. Check out their ROI calculator here. Thanks to simplifyMD for supporting HIStalk and HIStalk Practice.

Acquisitions, Funding, Business, and Stock

4-24-2012 6-15-50 PM

Streamline Health reports Q4 results: revenue $4.5 million vs. $4.9 million, EPS $0.00 vs. -$0.19.

4-24-2012 6-16-33 PM

Standard Register announces Q1 revenue of $157.6 million, which includes $57 million from its iMedConsent (dba Dialog Medical) division and other HIT solutions. The company notes that sales of clinical documents and administrative forms fell 12% from the previous year due to customers implementing EMRs.

4-24-2012 6-17-21 PM

Healthways acquires Ascentia Health Care Solutions, a provider of population health management technology to support physician-directed population health initiatives.

4-24-2012 6-18-03 PM

HealthStream announces Q1 numbers: revenue up 28%, EPS $0.05 vs. $0.07, beating revenue estimates but missing consensus earnings estimates of $0.06. Shares made Nasdaq’s biggest percentage losers list for the day, down 10%.

4-24-2012 6-41-41 PM

Apple beats all Q2 expectations with revenue up 59% and EPS $12.30 vs. $6.40. The company sold 35 million iPhones that accounted for 58% of its revenue. It sold 11.8 million iPads, more than double the year-ago number even though the newest model was available for only the last month of the quarter. Mac sales were up 7% to four million, while iPod sold 15% less than the year-ago figure.


DR Systems announces seven new PACS contracts totaling more than $3.7 million.

The 90-physician Allied Pediatrics (NY) selects Isabel Healthcare’s diagnosis decision support technology, which will be integrated with Allied’s GE Centricity EMR.

The VA extends its contract with Authentidate for home telehealth devices and services for at least one more year with three one-year extension options. 

4-24-2012 6-43-09 PM

Indian River Medical Center (FL) selects RelayHealth to provide HIE and PRN technologies.

The Saskatchewan Surgical Initiative announces that it will expand the implementation of Surgical Information System technologies into new hospitals.

4-24-2012 6-44-35 PM

Duke University Health System will implement iSirona’s device connectivity solution.

Cuyuna Regional Medical Center (MN) chooses PatientKeeper’s clinical applications to create a virtual EMR from the hospital’s Meditech inpatient and Allscripts outpatient systems.


4-24-2012 6-27-11 PM

Poudre Valley Medical Group CEO Russell Branzell joins GetWellNetwork’s board of directors. He was formerly CIO of Poudre Valley Health Systems and the president and CEO of that organization’s for-profit IT company.

4-24-2012 6-27-54 PM

Communications consulting firm WCG hires Rob Cronin, the former head of corporate communications for SureScripts, as practice leader of healthcare technology and transformation.

4-24-2012 8-30-48 PM

AMIA President and CEO Kevin Fickenscher MD is named chairman of the newly created healthcare advisory board of Intelligent InSites.

4-24-2012 8-25-50 PM

Lt. Col. Danny J. Morton (on the right above) is named as the Army’s MC4 battlefield EMR product manager, replacing Lt. Col. William E. Geesey in a ceremony at Fort Detrick, MD.

Announcements and Implementations

Open source provider Medsphere Systems joins the Open Source Electronic Health Record Agent community, which focuses on establishing a code repository for the VA’s VistA EHR.

4-24-2012 9-37-52 PM

Mount Sinai Medical Center (NY) implements Perminova EP to manage the scheduling, workflow, documentation, and billing processes for cardiac electrophysiology procedures.

Phreesia adds an electronic version of the M-CHAT autism screening tool for toddlers to its patient check-in system.

The Health Information Trust Alliance (HITRUST) establishes the Cybersecurity Incident Response and Coordination Center to provide alerts and information-sharing related to healthcare cybersecurity threats.

EHR Doctors announces that its CCD Generator is being used by Ministry Health Care to create an ONC-ATCB certified Continuity of Care Document from its multiple EHR systems.

TigerText announces a new version of its secure text messaging application, with University of Louisville as its first higher education customer.

In Canada, doctors at Ottawa’s Queensway Carleton Hospital say they like what they’re seeing in the pilot project for a discharge information system developed by TELUS Health. PCPs automatically get electronic copies of the records of their patients who are seen in the hospital’s ED, replacing the paper records that took two weeks to deliver.


inga_small I don’t watch much TV (American Idol excluded) but I was glad to see that Epic employee Rachel Brown is still a contender in The Amazing Race. Rachel and her Army helicopter husband Dave are one of four remaining couples in the running to win a $1 million grand prize. If the Browns win, I am sure that Judy will be happy to offer investment advice.

A KLAS report says almost half of inpatient providers plan to purchase a computer-assisted coding solution within the next two years, according to KLAS, mostly because of ICD-10. The most recognized vendors are 3M, OptumInsight, and Dolbey.

4-24-2012 8-05-20 PM

Epic beats IBM in the StarCraft II Championship, earning $5,000 for its charity of choice, Doctors Without Borders. The motto of the 12-0 team, captained by JDUB, is “Need Medical Attention?”

A New Zealand doctor is reprimanded for failing to tell a patient about an abnormal blood test result. The doctor said he hit the wrong key on the keyboard, but a public health commission said he should have used other software to remind him about the result.

Sponsor Updates

4-24-2012 7-57-37 PM

  • GetWellNetwork customer Celebration Health and its CEO, Monica Reed MD, will host all 350+ attendees on its campus to kick off GetWellNetwork’s user group meeting in Orlando next week.
  • CynergisTek partners with the law firm of Davis Wright Tremaine to create the HIPAA Audit Readiness and Response Solution Portfolio for OCR audit compliance.
  • NextGate announces the release of MatchMetrix v8 and NextGate Registries for Healthcare for accurate identity matching and health information exchange.
  • Cuyuna Regional Medical Center (MN) selects PatientKeeper technology to aggregate data from the MEDITECH system used by the hospital and the  ambulatory care offices’ Allscripts system.
  • Meritas Health Corporation (MO) selects eClinicalWorks EMR for its 72 employed physicians.
  • Lakeside Orthopedics (NE) chooses the SRS EHR for its five physicians.
  • eClinicalWorks opens a Chicago office to provide a central US presence. The city will host eCW’s user group meeting April 28-29.


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

More news: HIStalk Practice, HIStalk Mobile.

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April 24, 2012 News 10 Comments

HIStalk Interviews Steve Liu, Founder, Ingenious Med

April 18, 2012 Interviews No Comments

Steven T. Liu MD, SFHM is founder, executive chairman, and chief medical officer of Ingenious Med of Atlanta, GA.

4-18-2012 5-11-53 PM

Give me some background about yourself and about the company.

I was an engineer first and earlier in life – electrical — and it’s just it wasn’t for me. I couldn’t see myself doing this for a long period of time. I decided at the last minute to do what I really wanted, which was become a physician.

When I got out, it was a really interesting time. In 1999, there was this new movement called hospitalist, which is what I became. I took a chance and jumped in to that. 

At the same time, I started building tools that I needed for myself to manage the hospitalist group — capture data, improve quality, and improve the practice’s performance. It was nice because that ultimately resulted in me building the company. There was an opportunity. I built some tools that were really helpful for myself and it turns out there was a market — a lot of other folks were having the same problems. That’s the inception of Ingenious Med.

At this point, we’re probably the largest inpatient revenue capture physician management solution out there, with about 14,000 users. We did the tally a couple of months ago. We did about 10 million individual encounters that we captured for the physicians and hospitals across the nation in 2011.

We’re a point-of-care solution. We’re in the physician’s hands every day on every patient. We’re able to engender correct actions in data capture and give feedback and align those physicians with the goals of their organizations, whatever those might be — cost, quality, revenue.


Describe the workflow of your users and how your application captures charges and documentation within that workflow.

Our bread and butter used to be hospitalists. They’re the minority of our users – it’s really inpatient physicians. The workflow is pretty similar across the board, whether you’re a cardiologist or a hospitalist or whatnot. 

Physicians round in the hospital. I measured it one day — I walk something like five to eight miles a day in a hospital when I’m rounding. They’re extremely mobile. As a result, it’s hard to always have access to a workstation. They see patients, but actual patient care time is only about 15 minutes. The rest of the time is spent thinking about patient, documenting information, and then capturing your revenue by making sure you document for compliance and quality and all those other things that your organization needs you to do.

We’re at the very front part of that revenue cycle process. There are only a few technology touch points with a physician where you can give them feedback and have them change behavior. Most of the time it’s through the EMR, but another opportunity is what we do, which is the mobile cloud space of revenue. When they finish doing everything they do with the patient, they need to capture the work that they performed. That’s what we do.

We do a whole bunch of stuff once they enter information for us. We give them a lot of feedback and education to hopefully enhance their behavior and performance. Then we take all that information and process it, give reports back to administration, to the physicians, score cards, etc. Then get it to the billing services or the back offices to be handled from their standpoint.

We’re highly adopted – we’re literally there at the point of care on every single patient of our users every day. It’s sort of an opportunity to do all this cool stuff.

Who are your competitors and what’s the alternative for physicians to improve if they aren’t using any system?

Back in ‘99, everyone was on paper. That was the best solution. Paper is probably one of the most ergonomic things out there. You can’t supplant it in many different areas, obviously, because we’re still 10 years out and we see practices still walking around with 3×5 cards and superbills. 

That’s the de novo basic situation. It has a lot benefits, but a lot of inefficiency. There’s been many studies and a lot of data on just how moving to electronic systems gets rid of all the inefficiencies of lost paper, illegible handwriting, and all that sort of stuff. 

There’s probably about two major competitors that focus on our space. They have wonderful products and we highly respect them, but it’s what you do with the charge capture. Everyone has charge capture, even 10 years ago. EMRs, HIS systems … people have it. But it’s such a critical part of a practice. If it’s not done correctly, your livelihood is very much at risk.

As a result, people started to migrate towards best-of-breed solutions rather than the de novo systems that were available, maybe even for free. That’s why people come to us.


It’s almost as though you’re the CPOE of physician financials. It’s easier for them to use paper, but you have to give them an incentive to go electronic.

I’ve never heard that spoken that way, but that actually is a really great way to describe what we do. That’s perfect. We’re the CPOE of financials and revenue for the physician — exactly. It’s not just capturing an E&M code and some diagnoses. It’s way more than that. That’s our core business, but there’s so much that goes on, so much that can be lost revenue-wise, and so much opportunity to do other things outside of just charge capture.

The whole industry is living towards managed care. Instead of charge capture, it’s work capture. With that information that you get right there at the point of care, you can do some really, really great stuff that impacts things that are non-financial or indirectly financial, like quality and core measures and all the things that are now becoming the new way to have a healthy revenue in your practice.


So your goal is not to be a documentation system, but to capture information that isn’t available in other systems as a by-product of capturing charges?

We think of ourselves as a complementary. One of our major missions in whatever we design in a roadmap is to always complement the EMR, not to go head to head with the big functionality that they do. 

One of the things we do is complement the documentation. We don’t really want to become the medical record. It’s really not our role. But existing systems may not do things as well as they could. You find that with all the requirements coming in healthcare in both financial as well as quality reform, the physician’s pen is the most powerful thing in the hospital. Everything comes out of that. As a result, you can shore up documentation. That’s how we think of our role in documentation — shoring it up.


Do you find it tough to fight for space on the portable devices or desktops, like what happened with the proliferation of devices and applications that demanded the attention of nurses a few years ago?

Not really. The reason why, I think, if something is pretty usable …  ergonomics and ease of use are absolutely paramount to have any sort of adaption. It’s like Hair Club for Men – I’m not only telling you to use the product, I’m a member. I use the product. That’s why I still practice. You have to be a clinician and use it in order to actually design really good stuff.

We have something that’s very embedded and keeps pace with the physicians from an electronic device – Web , PDA, or smart phones. It has to be usable, and then also useful. I think because we’ve got that combination, they do generate more revenue, capture more value, showcase more quality, or improve their care with our functionality. It doesn’t feel like a hindrance. It’s looked at more as a useful tool that you use every single time you see your patient.


How do lay out your turf beyond just charge capture?

Only 10-15% of our solution is charge capture these days. Over the past 10 years we’ve built that and we continue to build that up, but that’s a small part of what we do.

Our most powerful points — why people often choose our platform — is not necessarily for the revenue and the charge piece, but the other tools — the physician management functionality, the reporting and ability to scorecard your physician and let you know exactly what they’re doing to manage their performance and give them feedback and really engender change. That’s one of the most powerful things that has been very successful for us. I think it’s what we do very well, if not the best way in our particular market.
That’s an area for sure that we will continue to move down.

I think some of the other areas in terms of point of care, education and feedback … even a limited focus of decision support is probably another area that we would like to establish as huge experts in.


Most companies have figured out an angle to ride the wave of Meaningful use, accountable care organizations, analytics, or more than one of those. Are you finding that those are good springboards for your business or are they taking people’s attention away from what you’re offering?

Meaningful Use doesn’t impact us too much. It’s not a huge focus, simply because that’s what everyone else is focusing on. That doesn’t impact us as much. 

ACOs, however, do. If in a world of managed care and ACOs, you just change the word “charge capture” to “work capture.” You still have to measure the amount of productivity that physician actually does in order to see how contracts gets renegotiated, etc. ACO is an area that has been beneficial for us. We see that as an area of opportunity as we transform our offerings to fit the coming landscape.

The other areas that we see as being directly related through the functionality that we have are value-based purchasing and quality improvement and capturing all that data. PQRS is the physician component of VBP. That’s what we do. We were one of the nation’s first PQRS registries and we have 100% success with that. We would like to take our knowledge there and move it towards VBP.


You won a physician entrepreneur award in the fall and almost immediately brought some new folks into the company at the executive level. What’s the long-term strategy for the company?

You’ve probably heard this a million times .. an entrepreneur five years ago, eight years ago who said, “We’re at the hockey stick inflection point where we’re really about to grow.” You check in four years later they just haven’t done it for whatever reasons. I’ve been saying that for a long time. 

What happens is — especially with a growing company — if you’re smart, you reinvest and reinvest and reinvest in the company. That’s what we have been doing. We really have hit that inflection point. We’re on the other side. As a result, you have to go through big organizational change.

A couple of years ago, I put in a CEO to replace my role as CEO at the company, more for personal reasons, so I could start a family. That was one of the best decisions I ever made. We were able to really, really focus on strategy for the coming change. As a result, that was the first step in maturing the company — putting in the CFO and our CTO and really capable management. The new stage is large enterprise healthcare organizations — being able to support their needs. And not even just with those clients, but also to build the company out for what needs to be done 2-3 years out for the coming change.

Any final thoughts?

I’m humbled and thankful to be where we are right now in healthcare. It’s a pretty exciting time. It’s a time that forces folks to think about the future and innovate and grow. There’s a lot of opportunity. I think it’s a neat place to be. I’m pretty thankful about that. 

With everything that’s going on, it’s nice have sites like your own to have a touch point for what’s going on in the industry. Believe it or not, you really do educate myself and a lot of the healthcare folks out there about what’s going on in the industry and trends and all of that. 

I’m thankful just for having a role and being able to be successful in providing really, really neat, great functionality to the hospitals and providers out there that hopefully improves our lives. It’s part of our mission statement. It’s nice to be able to live on that.

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April 18, 2012 Interviews No Comments

Monday Morning Update 4/16/12

April 15, 2012 News 20 Comments

From ZZtop: “Re: Meditech ambulatory. Meditech is developing an ambulatory product written in part with M-AT (focus) and M-AT WebServer (unreleased and a SAAS application). It will be available in 2013 starting at the 6.1X product line as they are merging P/BR and B/AR into one application. The design is very un-Meditech with horizontal tabs. Looks a bit Epic-ish.” Unverified.

From Epic Dude: “Re: Nuance. Apparently sunsetting their RadPort imaging decision support service.” Unverified.

From Senor Ortega: “Re: [company name omitted]. Ceased operations on Monday, April 9 and will declare bankruptcy next week, according to an e-mail sent by a member of their board of directors.” Unverified, so I’ve left the company name out for now. I e-mailed and asked them to confirm or deny and will re-run with their name if they don’t respond.

4-15-2012 4-37-45 PM

From Dr. Beeper: “Re: Henry Ford Health System. They spent $150 million to replace the 25-year-old McKesson MIMS product starting in 2006, bringing in CSC, RelWare, and Siemens to develop Care Plus Next Generation (the intellectual property is still owned by HFHS and RelWare.) That product did not have revenue cycle capabilities and it captured, normalized, and stored data from over 150 interfaces. HFHS needed to replace 150 individual solutions with a single, unified record with full RCM, inpatient, and ambulatory. That’s why they are spending $300 million on Epic.” Above is a March 2011 quote from the HFHS’s president and COO, talking to the local TV station upon Care Plus Next Generation’s go-live. Eight months later, HFHS was finalizing its contract with Epic to replace the whole thing.

From Epic Envy: “Re: Epic. I get it, Epic is the best of a bad lot. They’ve copied the Meditech business model and have executed it well. But does anyone really believe their KLAS scores aren’t ‘engineered?’ Ask who is KLAS’s biggest paying customer while reading KLAS’ users comments. Ask yourself what effect their ‘good maintenance’ contract incentive has on muting malcontents. Finally, allow your mind to wonder why they don’t foster the use of social media customer dialogue. I am envious, indeed but not naive.” Point A, not effective – just because they’re a KLAS customer doesn’t automatically mean they get to fudge the numbers and I don’t think they control the results any more than other vendors who encourage certain customers to participate. Point B, effective, but I think there’s another factor that automatically quiets down any complainers – who wants go to public with gripes after you’ve just spend hundreds of millions of dollars on Epic? (the hospital’s board would not appreciate public second guessing after approving a decision of that magnitude and the messenger would undoubtedly be shot). Point C, not effective – customers can talk among themselves all they want and I haven’t heard any say that Epic’s giant user group meeting is full of bitter complaining like I’ve seen at similar events held by Epic’s competitors. Point B wins – nobody buys a Rolls Royce and then whines about crappy gas mileage or expensive oil changes because it would just make them look stupid for buying it in the first place. Compounded by the fact that Epic seems to be pretty open with its customers, so there’s not a lot to be gained by airing dirty laundry to a bunch of sideline-watchers, especially when the company is privately held and thus not too worried about negative publicity that might otherwise get shareholder attention.

From Deep Throat: “Re: Thomson Reuters Healthcare Division. Any news about who has purchased it?” I haven’t heard anything, but maybe someone has and will share.

From The PACS Designer: “Re: Windows 8.  Microsoft has released a consumer preview for Windows 8. The new version has vast changes from previous versions and will take some time to get used to if you are in the market for a new system.  In many respects, it appears that Microsoft is trying to challenge Apple’s iPhone/iPad user interface to create some marketing buzz amongst consumers.” Microsoft couldn’t possibly do like everyone else and post the intro video on YouTube or something that might involve a competitor – they had to run it in the non-shareable, proprietary Silverlight format. Luckily someone smarter than the Microsoft marketing folks (why wouldn’t you use a competitor’s free service to pitch your product?) posted an intro video to YouTube where someone might actually see it, which I’m including above. We’ll see on Win 8. Given the radical changes, I’m not convinced it won’t follow the “every other release sucks” pattern like Vista before it and Windows ME before that.

4-15-2012 3-40-53 PM

HIStalk readers apparently aren’t all that interested in the JOBS act and aren’t that optimistic that it will spur startup growth and create jobs. New poll to your right, from recent headlines: should hospitals decline to hire overweight people or smokers? The poll accepts comments, so feel free to argue your position.

My Time Capsule editorial this time around: Rogue IT Shops: Provide Rules, but Leave Them There. A flash of the goods: “As soon as IT gets in trouble or tries to hide staff shortages like a balding man’s comb-over, it’s all hands on deck to save the tanking projects, meaning those previously dedicated departmental resources will be yanked to put out some new fire, often self inflicted by poor planning.”

I periodically need to vent about a pet peeve, so here’s one: a character-based GUI is not the same as a DOS application. If you hear someone refer to Meditech Magic or a mainframe app as “DOS-based,” stop listening because they just revealed a startling lack of even basic IT knowledge. I’m also lately irked when I read, “I had a couple drinks …” or something like that where somehow the author feels the “of” separator is superfluous, which to me sounds like someone who’s talking after more than just two drinks.

4-15-2012 2-10-50 PM

FirstHealth of the Carolinas CIO Dave Dillehunt left an excellent comment he left on Travis’s HIStalk Mobile post on pagers that hits a point I’ve been trying to tell people about: one-way pager coverage sucks and is getting worse once you get even a few miles away from a reasonably sized city, just like cell phones of the 1990s. They work fine on a hospital campus, but not well for folks covering call from home or traveling even locally. Not to mention that if you aren’t in range when the page goes through – unlike a cell phone – there’s no notice to the sender or voice mail for the recipient since alpha paging is incredibly unintelligent technology. For example, above is a USA Mobility coverage map for Tennessee. They may well have statewide coverage, but only if you’re in the blue areas (which look to be maybe 10% of the geographic area), so if you’re on weekend call, the electronic leash is pretty short. There may be a way for the commonly used Amcom paging system to detect failed delivery or to allow users to forward to a cell number to have the page converted to an SMS text message, but I haven’t figured it out if so. Anyway, here’s what Dave had to say:

Because traditional paging technology is dying, and customers are leaving in favor of their smart phone texting apps, the industry is now milking what revenues they have left and are no longer repairing or replacing damaged and failing paging towers and equipment. As a result, paging coverage is rapidly deteriorating. This is now causing more people to abandon that technology, further worsening the problem. While cellular coverage is sketchy as well, technologies that send out through both cellular and wi-fi are a good start and probably provide better coverage than the current (worsening) paging coverage. Our physicians (and others) are now demanding something other than paging (beeper) systems. Personally, I predict that paging will be gone within 36 months.

Cell phones probably can’t replace pagers for a variety of reasons, though: (a) cell plans cost too much to give every pager-equipped employee a cell phone instead; (b) wireless carriers price text messaging ridiculously high given the few hundred bytes of bandwidth a text message consumes; (c) cell coverage is often bad in specific areas of a hospital; and (d) it’s harder to set up a virtual cell phone that would allow one-number coverage by multiple people without requiring them to pass a physical phone among themselves. In other words, pagers are still used despite ample faults because they are cheap and generally work will given known limitations.  I was trying to decide if a “one number” service like Google Voice could be used to overcome these issues, allowing someone to auto-forward to an SMS message, pager, or e-mail of their choice. You might want to give that some thought given Dave’s prediction of the demise of alpha paging in the near future, which seems entirely reasonable to me.
New from Practice Fusion: a chat-like function that allows physicians to securely communicate with each other. Future enhancements will cover chart notes, attachments, and referrals. Another recent enhancement includes a site where consumers can review their physicians. Other upcoming features mentioned in this article: appointment scheduling, the ability for patients with similar conditions to be able to communicate with each other and seek second opinions, and real-time online patient visit capability.

Mercy Memorial Hospital System (MI) goes live with Indigo Identityware user authentication and single sign-on.

4-15-2012 1-34-16 PM

Chris Rangel MD, an internist at El Paso Hospitalist Group (TX), posts on his blog an editorial that likens today’s EMRs to electronic bulletin board services of the 1980s rather than the Facebook of today. He’s mostly griping because EMRs don’t talk to each other, which bulletin boards didn’t either. The point he didn’t make: the financial model didn’t encourage either BBSs or EMRs to interoperate (not to mention that the big story with the Internet isn’t that it killed BBSs, but that it killed the distribution model of expensive, shrink-wrapped applications sold by physical stores.) The Internet came along, which was sold as a free service with local connectivity charges that allowed users to run whatever they wanted without worrying about the connectivity aspect. Even Internet-based EMRs aren’t really designed for open data sharing, for a variety of reasons that have no parallels in BBSs: HIPAA, patient consent, the belief of the physician customer that it’s their data and not that of the patient, and lack of demand (both patient and physician) for consistent exchange of patient information. All reasons aside; his Facebook model would fan to life if customers demanded it with their dollars, but they aren’t (and if a Facebook-like app would really provide any value as an EMR for doctors expecting to be paid and to retain legal records, which it would not.) They are just occasionally complaining while continuing to reward the status quo by paying their current vendor, helped along by ONC taxpayer-funded bribes to stick with what was already being sold.

4-15-2012 2-31-19 PM

Medicomp Systems promotes Dave Lareau to CEO. He had been COO since 1995. Founder Peter Goltra will remain as chairman and president.

4-15-2012 3-23-37 PM

Beaumont Health System (MI) promotes Subra Sripada to EVP/chief administrative & information officer. He was previously SVP/CIO.

A letter to the editor of an Ohio newspaper complains that the author’s primary care provider, who is implementing an EMR, asks patients too many personal questions in his four-page intake form, such as marital status, who the patient lives with, diet, and whether firearms are kept in the house. He concludes, “You are probably thinking, so what do all of the above-mentioned things have to do with medical records? That’s my question, too. Could it be that Obamacare has reached our city already? Do you want all this information out in cyberspace? I think not!” 

Vince covers Commodore founder Jack Tramiel this week.

This week’s employee e-mail from Kaiser Permanente Chairman and CEO, like many of those he writes, focuses on its HealthConnect system:

In Europe, we won’t win any awards but the HIMSS conference in Copenhagen will basically have a Kaiser Permanente morning featuring a keynote speech about KP followed by several sessions involving Ministers of Health from European countries who will — in part — be discussing what KP is now doing. That is next month. In two months, more than 30 chief information officers from around the world will come to a special meeting in Oakland to spend a couple of days learning from our IT leaders and our health care leadership, our agenda, and our successes. 

The Riverside, CA paper profiles iMedRIS, which offers Web-based research management tools (such as IRB.) The company has 30 employees and plans to hire 20 more by the end of the year.

At TEDx San Jose, GE Healthcare Innovation Architect Doug Dietz moves the audience to tears in describing his efforts to make MRI machines less frightening to children. He describes his work in the video above, which is not from the actual presentation.

A British newspaper seems way too incensed about what sounds like a minor data faux pas: a “fiasco” occurred with NHS patient data was “dumped” by GE Healthcare on servers physically located in the US, which the newspaper says (with nothing to back it up) made politicians and civil libertarians “furious” even though absolutely nothing happened with the data as a result. The only interesting part of the article was the name of the privacy advocate quoted: Nick Pickles.

E-mail Mr. H.

The Healthcare IT Week in Review

1. Utah: Do These Breaches Make My Butt Look Big?

Facts and Background

European hackers penetrate a Utah Medicaid claims server, downloading files covering nearly a million individuals and stealing the Social Security numbers of more than 250,000 of them.


Hackers can get into anything stored online given the proper motivation and resources. Breaches happen all the time. This just happened to be a very large one and the state  government just happened to be very wrong in its initial assessment of the extent of the breach.


  • Of all the things you could profitably hack, why would you want to steal the identities of welfare recipients? Possible answer: health records are often complete and therefore a convenient package for stealing someone’s identify.
  • An IT technician’s weak password was identified as being cracked to gain access. That illustrates two points: (a) trying to compose and remember a bunch of complex passwords means most people won’t do it, and (b) at least this was a refreshing way to hack since most PHI exposures are due to inappropriate server security settings rather than old-school password cracks.
  • The more other industries beef up their information security because they can and must, the more healthcare becomes the target of choice because security is primitive compared to that used by banks and retailers. Not to mention that healthcare records may include valuable data elements these days, such as bank account and credit card information.
  • Utah had better be glad it’s not two states west since California’s breach penalty would have triggered an automatic penalty of $800 million.
  • The state is now warning consumers that scammers may take advantage of the situation by calling people up randomly, telling them their information may have been compromised, and asking them to provide personal information (like their SSN) to find out.
  • Adequate security is probably an unreasonable target when possession of just a couple of numbers (SSN, insurance ID, date of birth, etc.) is presumed to be positive identification to receive expensive benefits.

2. DoD’s EMR, Out-Of-Control Psychiatrists Prescribing Blamed for Addicted Marines 

Facts and Background

Poor EMR medication functionality is partly to blame for high rates of abuse of both prescribed and illicit drugs in a program for wounded Marines, according to the Defense Department’s inspector general. Also blamed is overprescribing of addictive drugs, particularly by psychiatrists.


It may well be that the multi-billion dollar AHTLA EMR can’t bring in data from community pharmacies or the VA to help prescribers identify overmedicated patients. However, that would put it right on par with the systems used by non-military doctors.


  • For identifying patients who may have an addiction problem, why can’t the government ignore prescribing records and instead look at pharmacy dispensing records? The only ways the problem can be identified in the private sector are by doctor shopper databases and examination of claims records (which won’t work if drug-seeking patients get smart and pay cash).
  • While illegally obtained drugs are mentioned in the report, the emphasis seems to be on those prescribed from a sound doctor-patient relationship. In other words, the real problem is the doctors doing the prescribing, who in the absence of other motivation must think they’re doing the right thing clinically (i.e, it’s an education problem).
  • The problem here is the same as it is in private medicine: doctors are pressured by patients to overprescribe, use of addictive drugs is often anything but evidence based, and any crackdown means chronic pain patients with a legitimate need for aggressive pain therapy will suffer from under-medication.

3. 3M Acquires CodeRyte

Facts and Background

3M announced last week that it acquired CodeRyte, which offers medical coding tools based on extracting information from free text using natural language processing. 3M was already using CodeRyte’s technology in some of its offerings.


CodeRyte had put together some attention-grabbing bullet points: 250 customers, heavy penetration into deep pockets academic medical centers, 3M’s reliance on its products, and a potential ICD-10 play. If you’re going to make yourself attractive to a potential acquisition partner, it’s nice when your attributes make a deep pockets partner the logical choice.


  • CodeRyte’s #1 philosophy, according to its corporate overview, was to “stay private as long as possible to allow the technology to become ubiquitous rather than a benefit to a small subset of health care through one vendor’s client base.” I translate that to mean, “3M, you’d better bring a wheelbarrow full of money if you want to get our attention.” Which I assume was the case.
  • The company had brought over some former Cerner execs: Glenn Tobin as COO and Don Trigg as chief revenue officer.
  • CodeRyte’s board of directors had five members other than CEO Andy Kapit. Every one of them was from a different venture capital firm with investment in the company. Surely the company’s financial ambitions were obvious.
  • 3M has a steady cash cow in coding solutions and it has made few obvious acquisitions or investments in that market. This move seems preordained.
  • The integration of CodeRyte’s product into 3M’s was not all that great, at least according to folks I talked to. Now 3M loses both its barrier and its excuse.
  • 3M and Nuance announced just over a year ago a deal to deliver computer-assisted physician documentation and coding solutions from speech recognition. I don’t know if 3M’s contribution of the coding technology relied on CodeRyte to take the Nuance-converted dictation text and apply NLP to it, but that seems reasonable.
  • CodeRyte’s technology was developed by linguistics professor Philip Resnick PhD, who still advises the company.
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April 15, 2012 News 20 Comments

Time Capsule: Rogue IT Shops: Provide Rules, but Leave Them There

April 15, 2012 Time Capsule 3 Comments

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in April 2007.

Rogue IT Shops: Provide Rules, but Leave Them There
By Mr. HIStalk


An ongoing hospital IT dispute involves the common existence of so-called “hidden IT shops.” Those are pockets of specialized IT that, instead of reporting to IT, are managed within their individual departments, such as patient financial services, human resources, and laboratory.

I’ve been on both sides of that particular fence, so I feel qualified to opine.

More than once, I’ve been in an IT leadership role as we reined in rogue IT operations. We cracked down on non-rules following departments that were spending IT funds unwisely, exposing the organization to risk, and insulting our IT leadership by flaunting their minimally supervised existence.

Also more than once, I’ve worked for a clinical department’s rogue IT operation, born of necessity after a Dilbert-esque IT shop couldn’t meet our department’s needs. The IT suits talked endlessly about professional IT management, but they were mostly known for starting projects they could never finish, using help desk analysts as human shields to prevent users from talking to the few experts they had, and conducting endless meetings to grind down the rational opposition to whatever they had already decided to do behind closed doors. They were much like a questionably motivated vendor, in other words.

If I have to take a position, I’ll side with allowing user departments to keep their existing IT employees.

“Common plumbing” is an IT responsibility. Departments shouldn’t have their own network technicians, e-mail administrators, server experts, or database administrators. They should not negotiate IT contracts or make capital purchases. I’m sure we agree on this.

Beyond that, my experience is that departmental IT people do a better job than their IT counterparts. They have the luxury of working hands-on with their users, free of the distrust that IT departments often generate. Since they understand the workflow and the specific technologies in place, they excel at setting priorities, can develop creative system workarounds and extensions, and are unsurpassed at retrieving and analyzing system data.

They also are keenly motivated because they are judged exclusively by their departmental co-workers, who ensure their high performance by lauding them for even the most mundane and sometimes comically easy accomplishments that seem hard to a layperson (I think that last issue is what steams the IT guys.)

I know the IT arguments because I’ve used them myself, although only half-heartedly:

  • IT systems involve risk that only an IT department can assess and manage
  • Centralizing IT creates efficiencies and prevents critical reliance on an individual
  • Project funding should be centrally administered based on overall organizational priorities, not the needs of a single department
  • Standardized practices should be used for the help desk, change management, knowledge management, and project management

What I’ve seen in reality from both sides of the fence:

  • All the logical arguments aside, the primary motivator for IT centralization is the ego of the IT department’s management
  • The IT department’s insistence on rules is often at the expense of creativity and flexibility
  • Despite all the available tools, the IT department can’t match the service levels of locally assigned and managed IT employees
  • As soon as IT gets in trouble or tries to hide staff shortages like a balding man’s comb-over, it’s all hands on deck to save the tanking projects, meaning those previously dedicated departmental resources will be yanked to put out some new fire, often self inflicted by poor planning
  • Department employees often despise working in the detached, command-and-control bureaucracy of the IT department, so they leave, taking years of specialized experience with them and disproving the theory that IT can provide more resource depth than was already in place

I have loyalties both ways. These conclusions come from multiple personal observations.

Certainly other less dramatic options exist. You can have local IT resources report via dotted line to the IT department, providing guidelines on what they can and can’t do. You can insist that those teams follow documentation and change management standards. You can steer them toward standard technical tools, provide them with training, invite them to meetings, roll up their budgets under IT, and even move their chairs to the soulless cubes that IT departments love.

If you do decide to absorb the hidden IT shops, beware. Unless your IT shop is superbly managed, you’ll probably set unattainable expectations that you can’t deliver.

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April 15, 2012 Time Capsule 3 Comments

News 4/13/12

April 12, 2012 News 6 Comments

Top News

4-12-2012 10-37-03 PM

The Defense Department’s inspector general finds that drug abuse among Marines in the Wounded Warrior Battalion at Camp Lejeune, NC is hard to detect because of shortcomings in its CHCS and AHLTA EMRs. Prescription information from the VA and civilian doctors are not visible in AHLTA. An Army doctor said AHLTA’s medication module is “a mess,” saying that it’s so bad that doctors just free-text in the patient’s medication list, especially after the most recent update that added interfaces to civilian pharmacies and the VA. The battalion also wanted to implement the EMMA medication dispensing system used by the Army at Fort Bragg, but the Navy nixed that idea over concerns that it might not be HIPAA compliant.

Reader Comments

4-12-2012 9-00-50 PM

From X-Ray Gun: “Re: Philips. In December, decided to discontinue their RIS product, XIRIS in NA. They have also decided to discontinue their Digital Dictation and VR solution.” Unverified. They live on at least as artifacts on the company’s webpage.

4-12-2012 8-59-11 PM

From WildcatWell: “Re: requirement to have health insurance like car insurance. Will it flood my TV with endless commercials such as we see now from Allstate, GEICO, et al? It’ll be worse than political season! But, imagine: ‘15 minutes on HIStalk could save you $15K or more on life insurance.’ Send me a royalty! Keep up the good work.” I would need to dress Inga up in all white with red lipstick like that loopy Flo chick from the Progressive commercials, which are indeed ubiquitous. I’m more of a fan of the Allstate ones since they feature Dennis Haysbert, best known for playing Pedro Cerrano, the Jobu-worshipping outfielder in Major League, one of the best movies ever.

From Recent Interviewee: “Re: interview. I’ve been answering very nice e-mails since the HIStalk interview ran. Congratulations on such a great service you provide to the industry. Everyone reads it.” Thanks. I do quite a few interviews and always let the interviewee know upfront that the result is usually quite a few reach-outs from folks who’ve lost touch over the years. I don’t think they generally believe it until it happens. Healthcare IT really is a small world and most of the players just move around in it without ever straying far.

4-12-2012 9-12-15 PM

From Gesundheit: “Re: Henry Ford Health System. The $100 million MIMS system was built in the 1980s, when there were no good vendor offerings. It lasted over 20 years – not bad in today’s environment. However, adding $300 million for Epic is insanity or some lack of governance process or client acceptance. I’d like to see the fact finding on this one.”

From Ixnay: “Re: Meditech. Heard they’re ditching LSS to create their own ambulatory product.” Unverified. That rumor has been going around for at least a year and they’ve bought the remainder of LSS in the mean time. I don’t know if it’s a competitive offering, but the rumors would suggest that at least some folks think it isn’t. Most inpatient vendors still have a weak ambulatory albatross hanging around their necks, not surprising for systems whose underpinnings go back decades when nobody in hospitals cared what physician practices did.

4-12-2012 9-02-38 PM

From Jonathan Grau: “Re: International Congress on Nursing Informatics. The meeting is one of the most important activities of the International Medical Informatics Association -Nursing Informatics Special Interest Group (IMIA/NI-SIG) and is held every third year to promote all aspects of nursing and health informatics globally. We expect over 800 in Montreal, June 23-27.” I don’t usually give free plugs since I don’t want to open the floodgates, but I’m feeling uncharacteristically generous. Jonathan is with AMIA. Attendees can hang around afterward and catch the Montreal jazz festival, with performers that include Norah Jones, BB King, Ben Harper, George Thorogood and the Destroyers, James Taylor, Liza Minelli, Seal, Stanley Clarke, old favorite Van der Graaf Generator, and an interesting group whose 1970s LPs populate part of my collection, Tangerine Dream. They put me to sleep every time with their all-instrumental space music that sounds like Pink Floyd taking an on-stage break, but I like the name and covers.

HIStalk Announcements and Requests

inga_small Catch up on your HIStalk Practice reading so you have the full scoop on these posts: PCMHs improve quality and reduce costs in New Jersey. CareCloud CEO Albert Santalo joins President Obama during the signing of the JOBS bill. AMA names HP its preferred provider for technology products. Dr. Gregg sends out an RFP for an EHR – and stirs some good discussion from readers. I am a firm believer that you can never be too rich, too thin, or have too many HIStalk Practice e-mail subscribers, so please either send money or diet tips or sign up for the e-mail notifications. Thanks for reading.

Listening: the brand new first album from Alabama Shakes, Joplin-esque (or is it Otis Redding?) Southern soul from Athens, AL, just in time for summer. Singer Brittany Howard, 23 years old, belts it out and leaves it all on the stage. Killer Led Zep cover here.

4-12-2012 10-43-28 PM

Travis is on fire over on HIStalk Mobile, with one excellent, meaty post after another. His latest: Pagers – There’s an App For That, which arrives at thought-provoking conclusions about the situations when hospitals can and can’t do like drug dealers did in the 1990s in dumping the typewriter of the communications world, alpha pagers, which surely have no market left other than in healthcare.

On the Jobs Board: HL7 Business Analyst, Director of Marketing, Director of Business Development. On Healthcare IT Jobs: PACS Application Coordinator II, McKesson Paragon Consultants, Cerner Go-Live Project Manager.

It’s a strange, strange world we live in, Master Jack. Reality TV that’s anything but real, rampant Facebook narcissism, crumbling economies, and celebrities whose IQs and morality levels compete like golfers shooting for the lowest score. One thing you can count on, though – like Big Ben or Old Faithful, I will be predictably spooning with my PC to bring you news, rumors, and Cerrano photos almost every day of the week just like I’ve been doing for nine (!!) years. How might one harvest this rich outpouring of prosaic potpourri, you might ask? Simple – just click the Subscribe to Updates link at the upper right of the page to get into the exclusive club of industry movers and shakers who read HIStalk but probably won’t admit it publicly, putting it right up there with pr0n in the guilty pleasure category. Should  you wish to take our relationship to a deeper level, may I suggest: (a) electronically bond with Inga, Dr. Jayne, and me on social not-working sites like Facebook and LinkedIn, where rejection is impossible because we accept connections from everyone; (b) send me rumors and secrets; (c) pay homage to the companies that pay the bills by perusing the Resource Center and the plethora of newly animation-free ads to your left, replacing heartfelt applause with mouse clicks to see what they all actually do; (d) if you are a provider seeking consulting help, broadcast your RFI to several companies in seconds via the RFI Blaster; (e) tell someone you know about HIStalk since they won’t hear about it otherwise; and (f) bow your head humbly as I strap on the Honorary Reflector Thingy in knighting you with gratitude as my tireless confidante and defender. Thanks for reading.

Acquisitions, Funding, Business, and Stock

4-12-2012 10-40-55 PM

Emdeon reports Q4 revenue of $284 million, up 3% from a year ago. Net loss for the quarter was $71 million compared to the previous year’s net income of $15 million. Emdeon, which went private last year, says the loss was “primarily due to costs and expenses, including increased interest expense.” The company also announces its intention to re-price its existing senior secured credit facilities to take advantage of current market rates and borrow $60 million of additional term loans for general corporate purposes, including potential acquisitions.

4-12-2012 10-41-33 PM

McKesson shares rose 4% to a 52-week high Thursday on news that its $4 billion per year drug supply contract with the VA will be extended for up to eight more years.

I recently interviewed Brian Phelps, the ED doc who co-founded iPad-based system vendor Montrue Technologies, whose Sparrow ED product won the Nuance’s Mobile Clinical Voice Challenge that I judged a couple of months ago. The company learned Wednesday that it had won the $160,000 Southern Oregon Angel Investment prize. It had already received $200,000 in angel investor money at a similar conference and some pretty nice prizes from Nuance.

4-12-2012 10-44-35 PM

CPSI will move some of its Mobile, AL operations to Fairhope, saying it has run out of room.


The State of Minnesota selects Hielix, Inc. to develop a statewide HIE.

4-12-2012 10-46-21 PM

Bayfront Health System (FL) signs an agreement with Unibased Systems Architecture to deploy its surgery management and physician order management solutions across more than 20 operating rooms.

Blue Mountain Hospital (UT) chooses clinical and financial solutions from Prognosis. 

Orion Health wins the HIE contract for North Texas Accountable Healthcare Partnership. Also announced: former T-System VP Joe Lastinger was named CEO of the HIE.

Franciscan Alliance selects iSirona’s enterprise device connectivity solution to integrate medical devices with Epic in its 14 hospitals.

Care Logistics sells something that sounds kind of software related to Catholic Healthcare East, but I can’t figure out what it is from this sly hint: “This comprehensive approach combines an organizational commitment to efficiency, systemwide process reengineering and enterprise logistics software to help hospitals achieve reliable and predictive operational performance in the areas of throughput, quality and patient experience.” Their site is similarly vague, but is clogged up with enormous blocks of dense text sure to send all but the most determined visitors fleeing.


4-12-2012 6-27-48 PM

Post acute care IT provider American HealthTech names David Houghton (Advocat) as COO.

4-12-2012 6-29-29 PM

Hospice and homecare IT provider CareAnyware names Ray DeArmitt (CellTrak Technologies, Allscripts Homecare) as sales VP.

4-12-2012 6-31-46 PM

Quest Diagnostics appoints former Philips Healthcare CEO Stephen H. Rusckowski president and CEO immediately after his resignation from Philips. He replaces Surya N. Mohapatra, who will join the company’s board.

4-12-2012 7-19-56 PM

Philips Healthcare promotes Deborah DiSanzo to CEO. She was previously CEO of Patient Care and Clinical Informatics for the company.

4-12-2012 6-45-32 PM

MediClick names Scott Pettingell (GHX) VP of the company’s new consulting services business.

The Healthcare Financial Management Association appoints Joseph J. Fifer its president and CEO, succeeding the retiring Richard L. Clarke. He most recently was VP of hospital finance at Spectrum Health.

Announcements and Implementations

The Hawaii REC names Curas its preferred eClinicalWorks vendor.

The Carolina eHealth Alliance (SC) announces that 11 Charleston area emergency departments are now connected to its HIE.

NexJ partners with Beth Israel Deaconess Medical Center (MA) to digitize the health system’s Passport to TRUST program and make it available through NexJ’s Connected Wellness Platform.

The New York Times profiles remote monitoring system vendor AirStrip Technologies in its list of companies it says are pushing healthcare transformation. Also on the list: Avado (Web-based forms and health status tracking); ClickCare (secure physician communication for consultations); ZocDoc (making physician appointments); and Telcare (cloud-based glucose meter data sharing).

Yuma Regional Medical Center (AZ) will go live May 1 on its $73 million Epic system.

Government and Politics

CMS Innovation Center picks seven states to pilot the Comprehensive Primary Care Initiative, which aims to strengthen coordination and collaboration between private and public healthcare payers to improve primary care.


The athenahealth folks sent over this video entitled It Sucks to Be Me, which highlights why it’s not easy being a physician, nurse, administrator, and patient. OK, so it’s mildly cheesy like an overwrought, applause-milking truck show Broadway musical on opening night in Omaha  (check out the drummer’s cowbell and wood block work – think Waiting for Guffman), but you’ve got to love athenahealth for its out-of-the-box marketing.

Several members of the Medicare Payment Advisory Commission (MedPAC) express concern that federal incentives may not cover the true cost of implementing an EHR. Some specific worries are that Stage 1 requirements are set too high and some required elements are too expensive to implement and offer questionable value.

Allscripts CEO Glen Tullman writes a Forbes piece on how consumer technology can be used in healthcare. He mentions FaceTime, Kinect, and FitBit. He included a video from Madonna Hospital showing some futuristic ideas that I was going to run here, but I noticed it’s a couple of years old and I would hope they’ve come up with new stuff since then.

This seems like a bad idea: an Indiana hospital implements a Web-based incident management system, intended for use during tornadoes and other natural disasters during which Internet connectivity is often lost.

4-12-2012 10-50-23 PM

A laid-off IT security administrator at Waterbury Hospital (CT) is arrested for hacking into the hospital’s computer system hours after he was marched out, using his boss’s own e-mail account to send him threatening messages.

A newspaper’s investigation finds that five electrophysiologists – cardiologists with the Ohio State University Wexner Medical Center were each paid a $1.3 million bonus in 2011, raising their one-year pay to $2 million each. The only employee at the state university to earn more was the basketball coach.

Sponsor Updates

  • EHRtv posts its HIMSS 2012 interview with T-System CEO Sunny Sanyal.
  • Macadamian assists in the design of Elsevier’s Mosby’s Certified Nurse Exam Prep smart phone app and its development for the iPhone, iPod Touch, and iPad. 
  • HealthMEDX provides an update on its HIPAA 5010 readiness preparations.
  • Allscripts President Lee Shapiro participated this week in a TechNexus panel discussion on the changing face of technology in healthcare.
  • A white paper from Care360 discusses the positive impact of technology on the quality of patient care.
  • NextGen will integrate Entrada’s clinical documentation technology with its PM/EHR.
  • GE Healthcare launches Centricity EDI Services 5.4,which includes support for HIPAA 5010 and stronger analytics.
  • Beacon Partners expands its ICD-10 Assessment Service with the addition of an ICD-10 translator and business intelligence application from McGladrey.

EPtalk by Dr. Jayne


The Colorado Regional Health Information Organization (CORHIO) releases a report on integrating behavioral health information through health information exchanges. Although agreeing that information on mental illness is a vital part of the overall data influencing the health of a patient, a role-based tiered consent structure was recommended. Surprisingly, the roles weren’t based on physician vs. nurse vs. checkout clerk but rather the specialty of physicians involved. For example, participants in community focus groups felt that specialists such as OB/GYN or dermatology had less need to know information than did hospital-based physicians. Being a primary care doc at heart, I think any time you start excluding classes of providers (especially when drugs to treat mental health have a number of potential interactions and contraindications) it’s a detriment to patient safety. Who will be liable when harm occurs because a physician was denied information that would have made a difference? Needless to say, I’m not a fan of pick-and-choose consent policies.

CMS has compiled individual quality and resource reports for physicians in Iowa, Kansas, Missouri, and Nebraska. Practices have been e-mailed a link to the reports, but only 3,300 of 23,730 reports have been accessed. I reached out to at least 10 physicians in these states and none of them knew anything about it. My guess is the e-mails either went to spam folders or are sitting in some administrator’s inbox.


I’m a reasonably diligent reader of the Federal Register but somehow I missed this item. The Drug Enforcement Administration is increasing physician fees for the privilege of prescribing controlled substances by nearly 33% – from $551 to $731. This allows us the privilege of having drug-seekers hassle us for meds and increases scrutiny of our practice patterns (not to mention an increase in medical liability insurance premiums.) It seems like what the feds provide in MU funding just slowly erodes to other areas.

I’m a little behind on my reading, so I laughed when I came across this article about the recent Utah Medicaid data breach reported to affect 24,000 patients. As of today, the number is closer to 900,000.

One of the folks I’ve found on Twitter has turned out to be one of my new favorite bloggers. Skeptical Scalpel is written by a surgeon with considerable (40+ years) experience in the field. Worth a view, especially if you have a clinical background. And if you aren’t clinical, it may provide some good conversation-starters to help you bond with physicians who are generally ticked off at the world when all you’re trying to do is fix their laptops.


I enjoy reader correspondence and always like to try to share information when I can. Recently a reader asked, “I am looking for a good hospital BYOD policy for physicians. We’re enabling physician use of iPads and similar devices to connect to our clinical systems and I am in need of a policy that covers their use. Have you come across a good one yet? If so, can you share it?” Being from a strictly “don’t touch my network” hospital, I don’t have personal experience with the thrill of being able to actually use my own device on the network. I do however have much experience hooking to the patient access network so I can use the forbidden Twitter and Facebook. I also have experience carrying both my own smart phone and a hospital-issue BlackBerry, which really makes me look goofy at times. Can anyone help a fellow reader? E-mail me.



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

More news: HIStalk Practice, HIStalk Mobile.

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April 12, 2012 News 6 Comments

3M Acquires CodeRyte

April 10, 2012 News 1 Comment

3M announced this morning that it has acquired CodeRyte, which offers natural language processing and computer-assisted coding tools. 3M has offered CodeRyte’s computer assisted coding products to its own customers since 2009.

CodeRyte offerings include Health System Coding (natural language processing and coding workflows); CodeAssist (automated coding using extracted text from physician documentation); CodeComplete (outsourced coding services); and DataScout (analytics using information extracted from both structured and unstructured records.)

3M Health Information Systems VP/GM Jon Lindekugel was quote as saying in the announcement, “This acquisition allows us to apply CodeRyte’s leading edge NLP technology to our new 3M 360 Encompass System. We believe CodeRyte’s powerful NLP engine combined with 3M’s deep expertise in coding, reimbursement and patient classification will foster further innovation in the application of NLP.”

CodeRyte’s 130 Bethesda, MD-based employees serve 250 customers, which the company says represents 85% of academic medical centers that use computer-assisted coding.

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April 10, 2012 News 1 Comment

News 4/4/12

April 3, 2012 News 1 Comment

Top News

4-3-2012 9-28-00 PM

A National eHealth Collaborative paper says that HIEs have great potential to improve care and reduce cost, but despite ONC emphasis and incentives, not a lot of value has been realized so far. Big issues remain funding, provider adoption, and difficulties connecting to the wide variety of available EMRs. They recommend focusing on patients above all else, build trust and a common vision among participants that often don’t particularly like or trust each other, ignore “one size fits all” proposals and listen to what the local community wants, and figure out how to make money once the grants run out.

Reader Comments

4-3-2012 6-37-27 PM

From Hardware Sue: “Re: Navin, Haffty & Associates. Heard that Park Place International is looking to buy them out.” Not true, NHA President John Haffty tells me. Park Place has expanded its technical offerings related to Meditech and NHA has collaborated with them on projects and will continue to do so since their work is complementary, but no acquisition-related discussions have been held or encouraged. Per John, “We have great respect for the old and new team over at Park Place, but we are committed to maintaining our independent status.” Norwell, MA-based NHA offers consulting services exclusively for Meditech customers.

From JayGlo: “Re: security testing firms. Know any that specialize in EHRs in general and Epic in particular? Who are the best white hat hackers?” I’ll defer to readers – leave a comment if you have suggestions.

From ForthePatients: “Re: Tampa Bay RHIO. Work has been dragging in the swamp for almost five years with a long list of special interests – academic medicine, lawyer, homegrown exchange vendor, and hospitals interested in connecting to their own practices. Who controls what is clearly a the crux of this one and not a focus on the patients or the community.”

Acquisitions, Funding, Business, and Stock

4-3-2012 9-30-56 PM

Santa Rosa Consulting announces that it has completed its acquisition of Nashville-based healthcare IT consulting firm InfoPartners.

4-3-2012 9-31-35 PM

Charge master vendor Craneware opens an office in Scottsdale, AZ.

4-3-2012 9-30-15 PM

Merge Healthcare shares dropped 16% on Tuesday after the company filed an SEC 8-K form indicating that a $2.75 million sale of kiosks was to higi LLC, a company founded and controlled by Merge Chairman Michael Ferro. Merge’s audit committee had cleared the sale. Merge topped the biggest percentage price decliner on Nasdaq list, shedding nearly $90 million of value for the day.


4-3-2012 9-32-50 PM

Cooper University Hospital (NJ) signs a three-year agreement with Newport Credentialing Solutions for its reporting and analytics software and back office credentialing solutions.

Southeast Michigan Beacon Community selects Covisint’s accountable care technology to aggregate regional health information.

DuPage Medical Group (IL) selects Humedica MinedShare to provide clinical benchmarking and analytics from its Epic EMR.

4-3-2012 9-36-07 PM

Einstein Healthcare Network (PA) licenses business analytics and patient financial services solutions from Streamline Health to monitor and drive revenue cycle performance in its 1,000- physician ambulatory care network.

Mount Sinai Medical Center signs with Siemens MobileMD for an HIE service agreement.


4-3-2012 6-21-38 PM

Cognosante names Eileen Cassidy Rivera (Vangent) as VP of marketing and communications.

4-3-2012 6-22-19 PM

Former Cigna VP of IT Marcus B. Shipley joins Trinity Health (MI) as SVP and CIO. He  replaces Paul Browne, who has been named Trinity’s SVP of integration services.

4-3-2012 8-15-25 PM

Nashville-based The Rehab Documentation Company, which sells therapy documentation systems, names Antoine Agassi as president and COO. He comes from Cogent Healthcare and was previously chair of Tennessee’s Governor’s eHealth Advisory Council and held executive roles at Spheris and WebMD Transaction Services.

Announcements and Implementations

Southeastern Med (OH) hosts a midnight ribbon cutting ceremony to officially launch its Meditech go-live.

West Calcasieu Cameron Hospital (LA) launches bedside bar code verification with McKesson’s Horizon Admin-RX.

4-3-2012 9-38-29 PM

Biggs-Gridley Memorial Hospital (CA) goes live on the Prognosis ChartAccess EHR.

Humana Cares completes installation of a 1,600 monitoring devices for a telehealth pilot project, where nurses will remotely check the vital signs daily of CHF patients in hopes of decreasing hospitalization. The project uses the Intel-GE Care Innovations Health Guide, a blood pressure monitor, and scales.

Government and Politics

A bipartisan group of House and Senate lawmakers introduces a bill proposing to link the prescription drug monitoring programs of individual states, allowing prescribers to look for patterns of prescription drug abuse across state lines.

VA CIO Roger Baker says the $4 billion joint VA/DoD EHR system could be available by 2014 and will be piloted at military installations in Hampton Roads, VA and San Antonio, TX.

4-3-2012 6-57-50 PM

The VA cancels its Software Assurance agreement with Microsoft covering its 300,000 users, giving the agency flexibility in seeking non-Microsoft alternative technologies, such as tablets and cloud-based systems.

The Coast Guard prepares to go live on its Epic-based EHR. It plans to provide mobile access via cellular network and to run cached copies of information from its vessels, which often do not have connectivity. The Coast Guard is looking for companies to provide service desk support.

Innovation and Research

A study performed in large UK teaching hospital finds that off-hours clinician response and satisfaction improved when pagers were replaced with wireless call handling and task management. Tasks were logged on a PC that sent messages to a coordinator’s tablet, who then routed the tasks via text message to on-call phones. Users liked the improvement in handoffs: task prioritization, the ability to monitor task assignment and completion, and elimination of handwritten notes.


4-3-2012 9-40-42 PM

Rochester, MN-based mobile healthcare apps vendor Preventice, partly owned by Mayo Clinic, expands into the medical device business with BodyGuardian, a diagnostic heart and respiratory monitor that patients can wear during normal activity. The company says the final product, when approved by the FDA, will be just 8×8 mm in size (about a third of an inch high and wide) and will attach like a Band-Aid for up to seven days, sending the physician a text message and EKG by Bluetooth when it detects cardiac events. The company plans to hire 15 employees and will move to new headquarters in Minneapolis.

4-3-2012 9-00-09 PM

Microsoft announces the 11 startups chosen from 500 applicants that will participate in its 2012 Kinect Accelerator. Among them are GestSure, which creates touchless interfaces for surgeons and interventional radiologists; and Jintronix, a virtual reality rehabilitation system for patients with motor control problems.


4-3-2012 7-06-22 PM

The University of Arizona Medical Center will replace Allscripts and iMed with Epic at its two hospitals and outpatient centers. The project will cost $100-135 million, will require 87 full-time employees over the next three years, and will involve providing 12 hours of training to each of 6,000 employees. Four miles away, Tucson Medical Center is already running Epic, having completed its rollout in June 2010.

Partners HealthCare researchers find that the number of lab tests ordered for outpatients who were seen at both at Brigham and Women’s Hospital and Massachusetts General Hospital dropped from seven to four after implementation of an HIE that allowed previous results to be viewed by either facility. The full text article isn’t available online to non-subscribers and the usual disclaimers apply: the study sample appears to be quite small, the study data was old (1999 to 2004), and whatever correlation was implied does not prove causation. 

Despite a fall in net income from $158 million in 2010 to just $1 million in 2011, Novant Health (NC) will spend $600 to $700 million over the next four years on its Epic project. Novant expects the first of its 13 hospitals to go live by the end of 2013.

4-3-2012 7-43-28 PM 4-3-2012 7-44-24 PM

Several readers found this non-HIT story interesting enough to send over. The $4 million-per-year CEO of Pittsburgh-based insurance company Highmark is fired after an ugly love triangle fight over his 28-year-old girlfriend, who worked for him at Highmark. Kenneth Melani, 58 and married, showed up at the girlfriend’s home and refused to leave when ordered by her 48-year-old husband, resulting in criminal charges. Melani has engaged an attorney to determine whether his dismissal was legal, while the DA agreed to postpone his preliminary hearing provided he undergoes anger management counseling.

Leila Denmark MD died this past weekend in Georgia at 114 years old. She she was the world’s oldest practicing physician when she retired at 103, having begun her pediatrics practice in Atlanta in 1931.

Sponsor Updates

  • Practice Fusion customers have received $22 million in EMR incentives through January, the company reports.
  • Emdeon offers a free weekly webinar on Emdeon Vision for Claim Management.
  • The HITR nursing technology blog is running a Bodacious Scrubs contest through April 25.
  • Iowa Health System contracts with Hayes Management Consulting and Coastal Healthcare Consulting to provide legacy support services.
  • MED3OOO’s IT and services divisions hosts a virtual job fair May 2. 
  • Encore Health Resources names attorney Tom Luce to its board.
  • ICA launches HIT Me Blog with commentary on current healthcare and HIT issues.
  • Lifepoint Informatics will participate in the 2012 Executive War College on Laboratory and Pathology as a corporate benefactor. The event will take place in New Orleans May 1-2.
  • Cognosante and 3M partner to provide 3M’s ICD-10 Code Translation Tool to state-sponsored health plans.
  • MedHOK announces that its 360Measures V 2.55 has achieved 2012 P4P certification.


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

More news: HIStalk Practice, HIStalk Mobile.

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April 3, 2012 News 1 Comment

Monday Morning Update 4/2/12

March 31, 2012 News 3 Comments

3-31-2012 8-15-36 PM

From HMSUser: “Re: HMS CEO departure. The company confirms.” HIS vendor Healthcare Management Systems (HMS) confirms the rumor I ran here Friday from HMSUser: President and CEO Tom Stephenson, a 25-year company veteran, has left “to pursue some long-time interests.” According to his LinkedIn profile, he is now assistant grass cutter at Stephenson Landscaping Services LLC. Pretty darned witty if you ask me.


3-31-2012 7-12-30 PM

Survey respondents say that companies in the hospital and physician practice market will lag those that are working in interoperability and post-acute care. New poll to your right: how will the Supreme Court rule on PPACA? (no fair answering after the decision is announced.)

My Time Capsule editorial this week from the 2007 vault: Brailer’s Santa Barbara RHIO Baby Goes Down the Tubes. The expensive flop that was the Santa Barbara RHIO launched David Brailer into the first ONC job and got everybody stoked about interoperability despite not having one iota of impact on patients or providers. Some of my parchment-scribed words from way back then: “SBCCDE was a ‘big hat, no cattle’ kind of project that left two sad legacies: (a) it blew millions in grant money,  and (b) it seduced politicians and reporters into thinking they’d seen the Second Coming of CHINs, only destined for success this time. They were half right.”

Readers keep asking me to do some kind of “top stories” summary each week. I used to do that with the Brev+IT newsletter I started, in which I rattled off stream-of-consciousness cynical musings about the week’s top news, usually after I was tired from writing HIStalk for the weekend and therefore likely to blurt out just about anything to get finished. I’ll revive that practice at the bottom of this post and give it a try for a few weeks. I’ll kill it if I get bored with it, if I don’t have the time, or if nobody seems to care much one way or another. I’m not looking to create more work for myself, but I’m pathologically eager to please.

3-31-2012 7-53-41 PM

Welcome to new HIStalk Platinum Sponsor TrustHCS. The Springfield, MO company’s consulting expertise covers coding, compliance, ICD-10, and cancer registry. Vacant coder positions threaten financial performance and TrustHCS can help out with staff augmentation or full outsourcing of coding services, with every one of the company’s employees holding AHIMA and/or AAPC credentials. They can work on-site or remote, with flexible pricing to meet budget requirements. The company can help provider organizations take advantage of the ICD-10 breather by performing the assessment, analysis, and education that they might have skipped back when the implementation deadline was looming. TrustHCS works with hospitals, practices, ambulatory surgery centers, and any other provider organization that does coding, offering whatever level of support is needed to optimize the revenue cycle. The company can provide the oversight and coding compliance training needed to avoid headlines that throw the whole “bad press is better than none” concept into serious doubt. Relationship matters and experience leads at TrustHCS, whose support I gratefully acknowledge.

3-31-2012 7-33-31 PM

3-31-2012 7-36-31 PM

Weill Cornell Medical College establishes the Center for Healthcare Informatics and Policy, which will conduct HIT-related research and offer a two-year fellowship in quality and informatics. Rainu Kaushal MD, MPH, a medical informatics professor and director of pediatric quality and patient safety at New York-Presbyterian Hospital, will serve as executive director.  

A nice HIStalk Practice post by Dr. Gregg poses the question: are EMRs to blame for terse physician documentation, or are lengthy patient “stories” less common due to (a) lack of physician time, (b) wordy residents who grew up to be more concise, or (c) lack of value when documenting the same old acute conditions over and over?

Vince continues his HIS-tory this week with Part 2 on MedTake. These pieces aren’t just overly fond looks back at long-dead companies – they always contain lessons that might prevent someone from repeating the same mistakes.

3-31-2012 8-39-21 PM

HIT Application Solutions raises $2.75 million in a Series A funding round. The Exton, PA company offers the Notifi communications platform for alerts, broadcast communications, and critical test results.

3-31-2012 8-41-37 PM

San Francisco-based healthcare IT incubator Rock Health will expand to Boston in June, adding a program on the campus of Harvard Medical School.

4-1-2012 7-31-47 AM

Epic did its always entertaining April Fool’s Day page, even dropping in an Inga mention with ”The Shoe’s on the Other Foot: HIStalk’s Inga Disputes Rumor She Wore Birks to Symphony.” I like it because I did a similar HIStalk spoof years ago and referred to Epic as the Birkenstock-wearing crowd.

E-mail Mr. H.

The Healthcare IT Week in Review

1. Vocera IPO Shares Jump 50%, Meaning the Company Paid Good Money for Bad Pricing Advice

Facts and Background

Shares in mobile healthcare communications Vocera jumped almost 50% in their first three days of trading after Wednesday’s initial public offering, opening at $16 and closing Friday at $23.40.


The company either priced its shares incorrectly or intentionally undervalued them to create positive press from the price run-up. Either way, investors and not the company pocketed the $41 million price difference in the 5.9 million shares offered. Still, the company was smart enough to up the originally planned $12-14 price. A $100 million IPO yield is impressive for a company that isn’t all that widely known and that lost money in FY2011.


  • Timing is everything when it comes to IPOs. Riding Facebook’s IPO coattails isn’t such a bad thing, at least unless Facebook stumbles.
  • The company, like most hardware vendors that are anxious to avoid commoditization and increase margins and professional services income by turning themselves into software vendors (think RTLS and bed management systems), markets benefits around its “Star Trek” badge communicators that include care transition, patient transfer optimization, and patient discharge communication.
  • Vocera made some key acquisitions in the past couple of years: Wallace Wireless in January 2011 (delivery of alerts to smart phones) and two White Stone Group spinoffs in November 2010 (handoff communications.)
  • More acquisitions are sure to come now that the company has $94 million of IPO money in the bank and needs to feed the earnings engine. A priority will almost certainly be value-added software for nurses that can run on the company’s existing communication platform since nurses are its primary users and therefore are most likely to advocate new purchases to otherwise indifferent hospital executives.
  • Chairman and CEO Bob Zollars, who joined the company in 2007, was best known as having run high-flying healthcare supply chain vendor Neoforma, and before that having executive roles at Cardinal Health and Baxter. He rode the irrational exuberance bubble hard in January of 2000, when Neoforma.com’s IPO, priced at $13 for 7 million shares, soared to $52.38 on their first day of trading. Not bad for a company with revenue of $464,000 in the previous nine months, in which the company lost $25 million but formed a complex ownership and incentive agreement with hospital buying groups VHA and UHC. Neoforma announced plans to buy Eclipsys for $2.1 billion of its stock in March 2000, but backed off two months later when its own shares dropped by 70%. He knows how Wall Street works and has a real company with strong revenue this time around.
  • It’s interesting that the Vocera IPO did so well while investor interest in the HITECH-goosed side of HIT seems to be waning. But everybody likes IPOs, at least for the first few weeks before the quarterly earnings grind sets in.
  • I don’t see Vocera getting into the mHealth market, but the successful IPO gives it a strong position in mobile apps for clinicians. It needs a doctor product, though, preferably one with direct impact on patient outcomes since that’s what hospitals will pay big bucks for.

2. Tampa Doctors, Hospitals Fight Over Which Group Will Lead Their Selfless Data Sharing Efforts

Facts and Background

A group of Tampa-area hospitals and the county medical association are pursuing independent efforts to share electronic patient information.


Florida has quite a few active HIE/RHIO projects that haven’t made much progress, probably because competition there, particularly among large health systems, is intense. This is one of few times where the previously unstated suspicion and distrust came right out on the table, as observed by a perceptive local reporter.


  • Neither group seems to be making much progress, which isn’t surprising when asking competitors to collaborate selectively with unknown benefits to each.
  • Florida’s AHCA issued a four-year, $19 million contract to Harris Corp. in late 2010 to develop a statewide HIE. Two months later, Harris announced that it had acquired Carefx, which offers the Fusionfx data sharing technology for competitors that need to exchange information. The only progress I’ve heard of is the availability of a secure e-mail program for providers and limited patient look-up services among the Big Bend RHIO and a couple of health systems, but it’s only been a year. I don’t know who’s getting ONC’s HIE grant money in Florida.
  • Hospitals bring most of the money and technical expertise to the table, while practices create much of the information that needs to be shared. Doctors also believe their motivations are purer than those of hospitals, which have a reputation for wanting to control anything they’re involved with for their own financial or strategic benefit. That plus the technical challenges may kill this initiative off early.
  • The main benefit of interoperability comes from hospitals exchanging information with their affiliated practices, which they often undertake without going to a third-party interoperability project. Unlike in some areas, Epic does not dominate the Tampa market. That would be an interesting follow-up article for the reporter – how well do the hospitals that want to control this project interoperate with their owned or affiliated practices?


3. Post-Op Patients Love iPads So Much They Don’t Mind that their Surgeons Don’t Visit Them

Facts and Background

Henry Ford Health System implements telerounding, where post-operative patients are given iPads to communicate by video with their surgeons, who may be miles away.


This is a really good idea since it seems cool and high tech, but basically frees surgeons of the requirement to actually make post-op rounds and makes them immediately available so that delayed actions don’t hinder the discharge pathway. But most of all because this is the first high-profile use of the iPad by patients since video projects usually involve Skype on PCs.


  • Post-op patients are usually coherent and can report their own medical situation, so this is more like ambulatory telemedicine than remote ICU monitoring.
  • Using iPads is a smart idea since they are portable and cheap. Installing telepresence hardware in individual patient rooms would be ridiculously expensive, and the enhanced video quality would offer no advantage when the intention is simply to chat with the patient. Observers often overlook the iPad’s price and maintenance advantage – it does a lot for $500.
  • Cynics might say that a phone call would work just as well as a video call, but physicians like seeing and not just hearing.
  • Once the iPads are in the hands of patients, their use could be extended to video-based patient education and self-documentation.
  • Once again Apple products prove their medical value not because of more in-depth technical capabilities over PCs, but because they are easy and fast to use, especially since a lot more people know how to use iOS products like the iPhone than have Windows expertise.
  • It’s easy to see how this project could be translated into home health or skilled nursing care, where it’s just not practical to have an ongoing physician presence. For that matter, a nurse could round with a single iPad as the physician participates by video.
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March 31, 2012 News 3 Comments

News 3/30/12

March 29, 2012 News 2 Comments

Top News

3-29-2012 9-40-00 PM

Vocera shares gain 40% over the $16 offering price in the company’s Wednesday IPO. Shares were up another 19% Thursday to $24.91, giving VCRA a 56% jump in the company’s first two days of being publicly traded.

Reader Comments

3-29-2012 9-45-10 PM

From Max: “Re: Microsoft/Sentillion. The bloodbath is in full effect. Employees received either a 60-day notice this week or an offer to move to Caradigm. I’ve heard losses on the Amalga side were significant.” Unverified. I asked my Microsoft contact, who says that like most companies, Microsoft doesn’t comment publicly on HR-related questions.

From HMSUser: “Re: HMS CEO. ‘Resigned’ last Friday, rumor that more high-level people will be shown the door.” Unverified, but Tom Stephenson’s bio has vanished from the executive team page. HMS’s parent company, HealthTech Holdings, has been owned since 2007 by private equity firm Primus, whose other healthcare IT-related investments include InSite One, Medhost, and Passport Health Communications.

From Epic-urious: “Re: Epic leading the market and gunning for the big guys. I’ve only read a few new customer updates. Where are all of these new customers?” Just to be clear, Epic is the big guy now, so there’s nobody left to gun for in terms of penetration of patients and providers (not necessarily in  number of hospitals since it’s a lot easier to dominate the market selling to one 1,000 bed hospital than ten 100-bed ones.) The company doesn’t announce sales, so new customers come to light only casually, like at conferences with mostly large-hospital attendees, where just about everybody finds out simultaneously that they’re all implementing Epic. Another way to look at it: the lack of significant sales announcements from Epic’s competitors, who do indeed happily announce new sales when they can get them.

HIStalk Announcements and Requests

3-29-2012 9-30-41 PM

inga_small This week on HIStalk Practice: a physician being sued by his former practice resigns over “technology troubles” and “billing errors” that he claims were the caused by computer problems. CMS offers help to providers not deemed “successful electronic prescribers” in 2011. Nancy Pelosi’s connection (or lack of one) between Practice Fusion’s rapid growth and the Affordable Care Act as she cuts the ribbon at the company’s new building (above.) Brad Boyd urges providers to continue moving forward on their ICD-10 transition. In our reader survey, 85% said reading HIStalk Practice helped them perform their job better last year, so if you’re in ambulatory HIT and need performance enhancement, you should be reading.

Listening: new from The Mars Volta, complex, perfectionist progressive rockers from El Paso, TX. An Amazon reviewer said it well: they’re what Led Zeppelin would have sounded like time warped into 2050. Dead ringers for Manfred Mann’s Earth Band at the 4:10 mark of the video, but very Zeppelin-like at 5:00. And I’m reflecting on the amazing musical contributions of Earl Scruggs, who almost single-handedly gave non-hayseed credibility to both the banjo as a musical instrument and to bluegrass as a uniquely American musical genre and who died Wednesday at 88. Foggy Mountain Breakdown was the speed metal of its day and it still sounds amazing as I listen to it right now.

Acquisitions, Funding, Business, and Stock

3-29-2012 9-47-54 PM

ClearDATA Networks, which provides healthcare cloud computing services, secures funding from Norwest Venture Partners and several angel investors.

3-29-2012 9-48-34 PM

Seven-month-old hospice management software vendor Hospicelink of Birmingham, AL says it expects $50 million in sales by the end of 2012. Color me skeptical.

3-29-2012 9-49-13 PM

Ann Arbor, MI-based HIE vendor CareEvolution is expanding its 22-employee workforce to 38, expecting to hire three software developers per quarter. I notice from the company’s site that they claim a trademark on the term One Patient, One Record, which I would associate more with Epic than CareEvolution, which I’ve heard of only once when a reader said they did an impressive demo but still lost the West Virginia Health Information Network bid. UPDATE: the company clarified the newspaper article – it has 38 employees now (22 of them in Ann Arbor) and will add another 15. WVHIN did choose Thomson Reuters’ HIE Advantage, but that product actually runs CareEvolution’s HIEBus under an expanded agreement between the companies signed in February 2011, so CareEvolution is in place (and scheduled for go-live next month) even though the announced winner was Thomson Reuters.

3-29-2012 9-52-02 PM

BlackBerry maker Research in Motion reports sagging sales, a quarterly loss, and an executive housecleaning. The CEO says he won’t rule out selling the company now that he’s seen from the inside just how dire the situation is, although he’s hoping for a turnaround. The steep downward slope above is the one-year share price, down 75%.


3-29-2012 9-56-45 PM

Asante Health System (OR) selects iSirona’s medical device connectivity solution to populate patient data in its Epic system.

Memorial Hospital of Union County (OH) selects Wolters Kluwer Health’s Provation MD for its gastroenterology and pulmonology departments. In addition, Duke University Health System (NC) licenses ProVation Order Sets.

3-29-2012 9-57-48 PM

Duke University Health System (NC) selects M*Modal Speech Understanding technology to support the Epic system it’s implementing.

Two practices within the University at Buffalo School of Medicine select PatientKeeper Charge Capture, which will be integrated with UBMD’s GE Centricity Group Management PM product.


3-29-2012 5-38-12 PM

EMR vendor CareCloud appoints PowerReviews CEO Ken Comée to its board.

3-29-2012 5-39-26 PM

Online physician networking site Sermo names former Revolution Health president Tim Davenport CEO. He replaces founder Daniel Palestrant, who left the company in January to run Par80, a startup focused on patient referrals.

3-29-2012 5-41-45 PM

Aventura hires Brian Stern (NewsGator Technologies) as SVP of sales and marketing and Brandi Narvaez (Sentillion, Vitalize – above) as chief customer officer.

3-29-2012 5-42-52 PM

eMerge Health Solutions, a provider of voice-powered documentation systems, hires Trent McCracken as president and CEO. He was previously owner of a telecommunications software company.

Announcements and Implementations

St. Francis Hospital & Health Services (MO) will go live on Epic Saturday morning.

3-29-2012 9-59-45 PM

The Verizon Foundation donates $100,000 to launch a telemedicine pilot project at Children’s Hospital of Philadelphia. CHOP will offer community hospitals consults with its pediatric specialists.

Government and Politics

The New York eHealth Collaborative and the New York State Department of Health form the Statewide Health Information Network of New York Policy Committee, tasked with updating and creating policy measures to protect PHI while expanding the state’s ability to electronically share clinical data.

The White House announced Thursday that various government agencies will invest $200 million of taxpayer money in so-called “Big Data” R&D. A NSF/NIH project will look at large-scale health and disease databases.

It’s not healthcare related, but it’s another hugely expensive government computing foul-up: the State of California pulls the plug on a $2 billion court system that still isn’t fully rolled out 11 years after the project started. The project was originally supposed to cost $260 million, with a state audit last year finding that the massive overruns were due to poor management of contractors. An IT project failure expert said, “I am dumbstruck over the incredible waste and obvious poor planning associated with this system. This failure only adds to California’s reputation as the land of IT boondoggles”


Henry Ford Hospital (MI) implements telerounding, in which minimally invasive surgery inpatients are given an iPad to post-operatively communicate with their remotely located surgeons using the FaceTime video chat app.


Weird News Andy likes this video story of a BYU nurse practitioner student whose professor, while observing her practice thyroid exams in her third week of class, happens to notice that she has a hard-to-spot tumor. The mass turned out to be highly aggressive, but she’s OK after fast-track surgery and radiation therapy. She will take a nurse practitioner job at the Thyroid Institute of Utah when she graduates this summer.

Hill-Rom joins Stryker and Zimmer in laying off hundreds of its employees to offset the cost of complying with a new medical device tax that takes effect next year. The 2.3% tax, enacted in the Affordable Care Act, is based on company revenue regardless of profitability. The industry estimates the tax will cost its members $30.5 billion and could result in the loss of up to 38,000 jobs.

3-29-2012 9-07-00 PM

Howard University Hospital (DC) notifies 34,000 patients that their health information was potentially exposed in January when a laptop was stolen from the car of a contractor who had downloaded the information in violation of hospital policy. The contractor had quit working for the hospital in December 2011, but reported the theft on January 25 of this year.

The government’s bet-the-farm idea of paying hospitals for quality didn’t move the needle on deaths or readmissions in its own demonstration project, a study published Wednesday in the New England Journal of Medicine found. The Harvard public health author says incentives are the right idea, but the metrics aren’t yet right. He also says it’s nice when processes are executed consistently, but the only thing that counts is that patients get healthier, and that didn’t seem to happen here.

It’s definitely not up to the high snark standards of The Onion, but this satirical article called Myanmar Embraces Facebook as Electronic Medical Record is kind of funny. “Whilst Facebook users can currently Add and Delete Friends, the updated site is going to allow users to Add Doctors, Nurses and other allied health professionals, who can be granted varying degrees of access to confidential medical data. ” You just know someone out there is working on this already.

3-29-2012 8-17-57 PM

I probably would find a new press release headline writer.

Here’s what HITECH has driven providers to. Physicians at Samaritan Healthcare (WA) gripe at a hospital board meeting about the hospital’s new Meditech system, which the hospital freely admits it implemented for only one reason: to get a $2.2 million HITECH check. According to one doctor, Meditech is “… time-consuming, it is frustrating, it is archaic, it’s hard to work with … It didn’t matter what we said, you were going to go ahead and implement this because there were the economic benefits being reaped by the hospital at our expense.” In response, the hospital CEO admitted that the system isn’t ideal, but says now that the money’s in the bank, Meditech is history, its replacement to be paid for by the HITECH money Meditech earned for the hospital.

3-29-2012 9-00-20 PM

Strange: two-thirds of respondents to an online poll run by the Chinese Communist Party’s newspaper choose a “smiley face” as their reaction to a story about a medical intern who was murdered by an enraged patient in a hospital, apparently because doctors are right up there with government workers in being hated for insisting on being paid bribes to do their jobs. The poll was quickly taken down. The government reported that over 5,000 medical personnel were injured by patients in 2006, the last year such statistics were published. Experts blame the anti-doctor mood to the lack of a medical malpractice system to provide compensation for errors, physician salaries that start at only $500 per month, and the fact that doctors are legally paid commissions for orders written. It was also reported that some doctors are taking kickbacks from funeral homes for promptly alerting them of the newly deceased.

Sponsor Updates

  • EHRtv runs an interview with David Caldwell, EVP of HIE vendor Certify Data Systems, filmed at the HIMSS conference. We interviewed CEO Mark Willard last month.
  • Salar and Transcend will participate in the Society Hospital Medicine 2012 Conference April 1-4, 2012, in San Diego, CA
  • MedAssets launches its Population Health solution suite to support the industry’s transition to fee for service and accountable care.
  • Greenway Medical Technologies announces the availability of PrimeMOBILE for Android and tablet devices.
  • TELUS Health Solutions will license Get Real Consulting’s InstantPHRO to resell into Canada under the TELUS Personal Health Record brand.
  • MEDSEEK announces that its eHealth ecoSystem V4.0 is 2011/2012 compliant and certified as an EHR Module.
  • Queensway Carleton Hospital (Canada) is delivering ED records to more than 120 family doctors using TELUS Health Solutions’ CareShare technology. 
  • GetWellNetwork announces its fifth annual users conference, to be held April 30 – May 2 in Orlando.

EPtalk by Dr. Jayne


All eyes are on the Supreme Court this week. Oral arguments for the cases challenging the Affordable Care Act concluded Wednesday. This has been a busy week at work so I haven’t been able to process the transcripts as quickly as I’d like. Stay tuned for my detailed reaction in Monday’s Curbside Consult. I find the whole process fascinating. It wakes up the non-medical part of my brain with the interplay of the Justices’ personalities and the complexities of legal theories of intent, severability, and judicial restraint.

The focus on PPACA overshadowed dialogue on last week’s ruling that state workers cannot sue their employer for violating a part of the Family and Medical Leave Act. A 2003 decision allows suits against state agencies for violations related to leave taken to care for family members, this decision involves leave take by employees to take care of their own health. There are already many loopholes in FMLA due to multiple court challenges over the past two decades. Additionally, states have made their own requirements and definitions, turning it into a patchwork. It’s a great example of what might happen to PPACA over the next few decades should it be allowed to stand.

My other exciting reading this week has been the recently-issued NIST protocol on EHR usability. The three-step process includes EHR application analysis, user interface expert review, and user interface validation testing. There are some interesting points in the document. Check out Appendix A, which discusses the use of human factors engineering by the Department of Defense, the Nuclear Regulatory Commission, and the Federal Aviation Administration.

It also provides questions used to evaluate an EHR’s “aesthetic and minimalist design” and “pleasurable and respectful interaction with the user,” including whether the EHR has artistic value. I never found that documenting as required by CMS (and now other payers) is particularly pleasurable, nor do I find artistic value relevant to patient care. I don’t care how ugly it is — I just want it to be easy to use and comprehensive.


AHIMA announces the Grace Award, which recognizes excellence in health information management. Nominations are open through June 30 and the award will be presented at the annual meeting in September. I give this new award a thumbs up for aesthetic and minimalist design (NIST would be proud.) It would look great on my credenza.


Wireless medical monitoring devices are highlighted in an article published yesterday. I like the idea of an edible sensor integrated into a medication that can document when it was taken, although I don’t want to receive patient information on my phone so that I can try to interpret it “all without a visit to the doctor.” Let’s take it one step further and integrate a monitoring sensor into every Girl Scout cookie produced, and if too many are consumed at a single sitting, it can send warning texts to purchasers. Having just found a stash of Thin Mints at the back of my freezer, I could definitely use the moral support.


More news: HIStalk Practice, HIStalk Mobile.

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March 29, 2012 News 2 Comments

Readers Write 3/26/12

March 26, 2012 Readers Write 2 Comments

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

If You Did It, Enter It in the EHR
By Mitch McClellan

3-26-2012 4-25-12 PM

I was recently asked the following by a colleague:

We know that every organization has some physicians who just will not fully use the EHR. They will have nurses, MAs, and other clinical staff do all of the data entry. They may just hand the staff a piece of paper and have them enter the problem list. A specific example would be the MU requirement for weight counseling – do you think it is acceptable for an MA to indicate in the record that the physician did the weight counseling? Clearly it makes sense to have nurses and other clinical staff enter medications and even other orders and even start notes, but where do you draw the line?

This question certainly walks the line between facilitating accurate data entry vs.what is appropriate.

If an organization is truly going to embrace this much-needed change in healthcare, they need to enforce that their clinicians do the right thing. In this case, it would be physicians taking 100% ownership of entering the documentation specific to weight counseling. They are the ones actually provided the counseling.

I understand that is a black-and-white response, but I strongly believe that if an organization’s culture accommodates physicians who choose not to do their complete EHR responsibilities (e.g. not documenting the counseling that YOU provided), then it defeats the entire purpose of what we’re doing.

The EHR revolution is strongly driven by the fact that paper is not efficient and creates too many points of failure. Not only is the medium (paper) antiquated, so are many of the policies and processes that support those paper workflows (e.g. documenting a note that you then pass on to someone else to then "document a note" on your behalf).

Unfortunately, I believe most physicians are put into a "get it done now vs. a get it done right" scenario due to the payers’ stringent reimbursement policies. I completely understand the time demands on these physicians. But the rule I try to instill with all of my groups is that, "if you did it, then you must enter it in the HER." Otherwise, the effectiveness and efficiencies of an EHR are lost if the old way of doing things is still embraced.

The groups that I’ve worked with would require the physician enter that piece of documentation themselves instead of the MA. The only groups that I’ve worked with that would allow this scenario to happen would be if it was the physician’s nurse — not an MA –entering the documentation. To me, the issue is twofold. The first is workflow (reasons already stated), the second is the lack of credentials of an MA. I know I’d want a higher-credentialed healthcare provider entering that information if it’s not the physician themselves.

Mitch McClellan is manager of implementations at MBA HealthGroup of South Burlington, VT.

By Dave Vreeland

3-26-2012 7-26-43 PM

Cumberland brought together a select group of HIT executives from some of the nation’s leading health systems for a recent breakfast discussion The topic: optimization.

Now that many are on track for Stage 1 Meaningful Use and other compliance deadlines, the focus is beginning to shift beyond go-live toward getting the most out of HIT systems. The panel, made up of Cumberland’s Brian Junghans, HCA’s Dr. Divya Shroff, and Memorial Healthcare System’s Jeff Sturman, shared how non-profit Memorial and industry giant HCA are tackling optimization.

The takeaway: success largely hinges on solid communication and the collaboration of two very different worlds – IT and clinical. Clinicians are arguably the keystone in achieving effective system adoption and long-term optimization.

Junghans points out that IT folks tend to think in terms of projects, which have a defined beginning and end. When it comes to IT implementation projects, the end is go-live. In contrast, optimization is an ongoing effort.

Dr. Shroff points out that clinicians have more of an optimization mindset, with a continuous focus on improved quality of care, optimal patient outcomes, and best practices.

With techies and clinicians in different mindsets, speaking two different languages, communication issues are common. HCA has success placing physicians and other clinical professionals like Dr. Shroff in clinical transformation roles. Valuable insight and hands-on experience makes these clinicians effective ambassadors for both the IT and clinical teams. 

Sturman and the Memorial team have incorporated clinical aspects into their approach to optimization. The team makes regularly scheduled rounds to observe workflow, system usage patterns and identify opportunities for improvement throughout each of their six hospitals, clinics, and ambulatory practices.

The importance of a clear distinction between IT support and optimization teams was also stressed. HCA trains the IT support team to triage incoming calls, address specific break/fix issues, and refer optimization matters to the optimization team.

Both organizations have seen success with various efforts to improve clinical/IT relations and are on track with current and long-term efforts toward optimization.

In addition to a number of lessons learned and critical success factors to consider during and after the implementation process (summarized in our presentation Beyond Go-Live: Achieving HIT System Optimization), it was interesting to hear this room of executives from diverse organizations, representing both the clinical and IT fields, reinforce the significant impact collaboration between the two worlds has on the success of end-user adoption and achieving true optimization.  

Dave Vreeland is partner with Cumberland Consulting Group of Franklin, TN.

Stage 2: The Vendor View
By Frank Poggio

3-26-2012 7-47-00 PM

On March 7, 2012, a draft for comment on the new Stage 2 rules was published in the Federal Register. Actually there were two separate parts to the rules. They are:

  1. The CMS part that is aimed at provider requirements necessary to meet Meaningful Use, and
  2. The ONC piece that addressed proposed changes to the certification process for EHR vendors.

On the provider side, there are innumerable blogs and Web sites that are covering the provider issues, which deal mostly with a few added MU criteria such as electronic medication administration records, menu options in Stage 1 that are now mandatory in Stage 2, greater emphasis on exchanging patent care information across care levels, and greater patient access to care information.

This article will focus on the “second side” of the regulations — the elements that most impact the system suppliers, with emphasis on the impact to niche or best-of-breed (BoB) vendors.

The full text of the new ONC Certification proposed rules can be found at here.

Before we hit the high (and low) points of the rules keep in mind these are proposed rules. If there is anything you don’t like about them, have suggestions for improvements, etc. you have from now until June 7 to post comments on the federal Web site. Speak now or forever hold your price! (No that is not a typo … see the Ugly).

Here’s the Good, the Bad, and the Ugly of proposed certification changes for vendors.

The good news:

Privacy and Security — will it go away?

EHR Module certification gets a little easier for niche and best-of-breed vendors (BoB). The big change here is that Module certification no longer requires you to address any of the privacy and security criteria. In the past, there were eight P&S criteria (number nine was always optional), and in our working through many ATCB tests, if you said the right phrase, you could get a waiver on three others (Integrity, General Encryption, and HIE.) Proposed under the Stage 2 as a niche/BoB vendor, you can ignore all the P&S criteria. To get certified under Stage 2, it would seem all you will need to do is pass any one Inpatient, Ambulatory, or General criteria, just ignore the P&S criteria, and you’re home free.

ONC said they made this change because many of the smaller firms complained that the P&S criteria did not apply or were too burdensome. This may sound too good to be true. Maybe it is. Read what ONC says in other parts of the document:

Finally, we propose to require that test results used for the certification of EHR technology be available to the public in an effort to increase transparency around the certification process. We believe that there will be market pressures to have certified Complete EHRs and certified EHR Modules ready and available prior to when EPs, EHs, and CAHs must meet the proposed revised definition of CEHRT for FY/CY 2014. We assume this factor will cause a greater number of developers to prepare EHR technology for testing and certification towards the end of 2012 and throughout 2013, rather than in 2014.

This is classic ONC. They say you don’t have to get certified. There is no law that says any vendor MUST – even a full EMR vendor. They believe the market will tell you. And by the way, ONC will be publishing the details of your certification so the world can compare you against your peers.

As we tell our clients, the MU criteria you choose to test on is dictated more by your competition and clients, not by the ONC.

Gap certification for Stage 2

A question that we have heard frequently was if I was certified on 20 criteria for Stage 1, under Stage 2, would I have to be tested again for those same criteria? Under the proposed Stage 2 rules, you would not need to get re-certified on Stage 1 criteria. You will only have to be tested on new criteria you select, and tested on Stage1 criteria that has changed or been revised by ONC.

A good example is the encryption P&S test. The focus now will be on encryption for data at rest. They state:

EHR technology presented for certification must be able to encrypt the electronic health information that remains on end user devices. And, to comply with paragraph (d)(7)(i), this capability must be enabled (i.e., turned on) by default and only be permitted to be disabled (and re-enabled) by a limited set of identified users.

So if you tested out on encryption under Stage 1 and want to carry it forward into Stage 2, you’ll probably have to show how you default encryption for user devices.

Component EHR vs. Complete EHR

A typical misunderstanding we came across many times during past year taking our clients through the certification process was a CIO at a hospital would say to the vendor that he/she believed they had to install a full EMR from a single vendor to meet all the MU criteria. In the proposed regulations, ONC has clearly addressed this question. On page 104, they say:

Certified EHR technology means: 1. For any Federal fiscal year (FY) or calendar year (CY) up to and including 2013: i. A Complete EHR that meets the requirements included in the definition of a Qualified EHR and has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the Secretary for the 2011 Edition EHR certification criteria or the equivalent 2014 Edition EHR certification criteria; or ii. A combination of EHR Modules in which each constituent EHR Module of the combination has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the Secretary for the 2011 Edition HER certification criteria or the equivalent 2014 Edition EHR certification criteria, and the resultant combination also meets the requirements included in the definition of a Qualified EHR.

In effect, a provider could meet the MU criteria using as many suites of BoB systems as they believe necessary. They do not have to be from one or the same vendor.


Now some bad news:

Criteria components

Many BoBs struggled with the make up of the criteria for Vitals and Demographics and several other clinical criteria. On the surface, they seemed easy to pass. The problem was they contained some data elements that were not typically found in BoB systems. For vitals, the hurdle was growth charts. For demographics, the hurdle is date and time of death. To pass these criteria, some vendors would use user-defined fields or create new inputs that they knew their clients would never use. Repeatedly I was asked by niche and BoB clients, “Why would you ask a patient during a registration process, ‘When did you die?’” Now there’s a comforting dialog!

Keep in mind several or the participants in building the HITECH/MU program were academics and researchers who would find that piece of information critical to their retrospective medical data analyses. Also, vendors of full EMR systems would easily have that piece of data readily available in their medical record abstract system. But for an ancillary or niche vendor, not likely. As far as I know, there were no niche or BoB vendors represented on any of the HITECH Policy or Standard Committees.

You may wonder why any firm would go through the trouble of adding a useless data element. Again, keep in mind what ONC said above: market will require certification. It can be virtually impossible to sell an ancillary system such as surgery, ICU monitoring, therapy, anesthesia, etc. if you had to tell your prospect your product was not certified for vitals.

Unfortunately this issue is still there for BoBs. The big change is on the provider side. ONC has greatly liberalized the granting of exceptions to providers for MU attestation if the MU criteria (or element of the criteria) do not apply to their practice of facility. As an example, a psychiatrist does not have to do growth charts for his patients — an exemption will be readily available. But the vendor who sold him the system still must!

Continuing this topic, in a recent interview Dr. Mostashari chided EHR vendors who "aren’t making meaningful use of Meaningful Use." Instead of attempting to seamlessly incorporate MU standards into their interfaces, Mostashari said "vendors did what vendors do—they slammed in the criteria and got certified.”

I submit that ONC slammed these regulations into being as fast as they could due to Congressional and Executive pressure, so one good slam deserves another. Maybe if ONC took a moment to look at the impact of certification on niche and BoBs — which are mostly the smaller, more innovative developers — and adjusted the criteria, we all could stop slamming.


And now the ugly:

As I mentioned in an earlier HIStalk post, ONC wants comments on vendor product price transparency. Here’s the ONC statement:

During implementation of the temporary certification program, we have received feedback from stakeholders that some EHR technology developers do not provide clear price transparency related to the full cost of a certified Complete EHR or certified EHR Module. Instead, some EHR technology developers identify prices for multiple groupings of capabilities even though the groupings do not correlate to the capabilities of the entire certified Complete EHR or certified EHR Module. Thus, with the transparency already required by §170.523(k)(3) in mind, we believe that the EHR technology market could benefit from transparency related to the price associated with a certified Complete EHR or certified EHR Module. We believe price transparency could be achieved through a requirement that ONC ACBs ensure that EHR technology developers include clear pricing of the full cost of their certified Complete EHR and/or certified EHR Module on their websites and in all marketing materials, communications, statements, and other assertions related to a Complete EHR’s or EHR Module’s certification. Put simply, this provision would require EHR technology developers to disclose only the full cost of a certified Complete EHR or certified EHR Module.

As a former CFO, I know that the through definition of ‘full cost’ would take at least another 500 pages in the Federal Register. After the vendors in the audience come down off the ceiling, you’d probably like to share your reaction with ONC. Just click here.

Frank L. Poggio is president of The Kelzon Group.

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March 26, 2012 Readers Write 2 Comments

News 3/23/12

March 22, 2012 News 4 Comments

Top News

3-22-2012 9-10-24 PM

Thomson Reuters reportedly puts its healthcare data and analytics unit back on the market after shelving the process last year due to tough market conditions. Multiple bidders may be vying for the business, which is expected to fetch up to $1 billion.

Reader Comments

mrh_small From Willy Loman: “Re: Imprivata. Being sued for patent infringement for its OneSign SSO.” I Googled and came up with a new suit brought by CeeColor Industries LLC claiming that Imprivata is infringing on its 1999 patent for proximity-based security using electronic sensors. Imprivata’s OneSign uses a webcam with optional facial recognition software to validate a user and lock their session when they walk away. I can find nothing about CeeColor Industries, which suggests that their primary business, if they have one beyond just owning a patent, at least isn’t extortion by litigation. Companies get sued all the time for reasons both valid and not, so I wouldn’t get too excited about this lawsuit just yet. I interviewed Imprivata CEO Omar Hussain a year ago and asked him about Secure Walk-Away and how the webcam aspect works. Above is a video that explains it.


3-22-2012 6-52-20 PM

mrh_small From James: “Re: Roy the HIStalk King. We (Medicomp) had Roy’s HIStalkapalooza sash framed. He seems very happy about it ;)” Roy Soltoff from Medicomp was not only named HIStalk King, he also served as part of Inga’s security detail for her Quipstar competition. You can see Roy in action in the excellent HIStalkapalooza video that ESD put together (he wins at the 2:30 mark.) His beauty queen sash looks good up there on his wall and the color / black and white photo effect is cool (either that or Medicomp and its people are very drab.)  

mrh_small From Roller Boy: “Re: Allscripts. Downgrades from Jim Cramer and JP Morgan have created the perfect storm. Night and weekend meetings with board and execs with talk of impending changes.” Unverified and unwarranted, I’d say, given that shares are down only 6% in the past month, although the Nasdaq was up 4% in that same period. Other brokers have stood by their recommendations and neither Cramer or Morgan said anything new – they just recited the obvious challenges the company faces in integrating and selling Sunrise after its $1.3 billion acquisition of Eclipsys, if indeed that’s such an important driver of their business. My interview with Phil Pead and Glen Tullman about the acquisition is here and worth a revisit since I asked some tough questions, like how their performance should be graded two years down the road (that date is coming up soon.) I also said this about Eclipsys when the deal was announced in June 2010:

Despite the arguably superior CPOE and clinical documentation capabilities of Sunrise, it has competed poorly against Epic and Cerner … Nearly 40% of ECLP revenue supposedly comes from about 20 big customers … Eclipsys most likely paid big money for its recent acquisitions, buying the former Medinotes/Bond practice EMR products, EPSi financial management, and Premise throughput management as it desperately sought to diversify away from its at-risk Sunrise user base. Those acquisitions didn’t seem to do much for the company’s performance … It’s late in the HITECH land grab to try to integrate companies and products in the hopes that enough hospitals are left that haven’t locked into their vendor partners to prepare for Meaningful Use. This would have been a much better deal a year ago.

mrh_small From HITwatcher: “Re: system sales. A quiet year as everyone is hunkered down protecting their base while Epic continues to go after the huge brass rings. Will Partners really announce a choice of Epic by April 1? Dunno, but they will go that route, then on to HCA for the no pie-in-face lady.”

HIStalk Announcements and Requests

inga_small What you missed if you didn’t check out HIStalk Practice this week: Dr. Gregg’s recent cloud/hosted server debate. Joslin Diabetes Center (MA) offers national telehealth services. Practices adopting the PCMH model of care have higher staff morale but also higher physician burnout. EZ DERM incorporates Nuance’s medical speech capabilities into its iPad EHR. Practice Fusion offers free interfaces to 16 reference labs. While you are stopping by HIStalk Practice, take a moment to sign up for the e-mail updates because it will keep you smart and make make me feel loved.

inga_small My Internet (and cable TV) went out earlier this week, so I have resorted to tethering my laptop to my iPhone for Internet access. It’s not an ideal solution (the connection seems to drop at least once an hour) but it’s actually pretty handy. I’ve used the tethering option a bit in the past when I’ve bee in an area without free Wifi, but never before full time. I wouldn’t trade trade tethering for my high-speed cable, but it’s a surprisingly workable solution. Meanwhile, I keep wondering if no cable TV means no recordings of American Idol on the DVR.

mrh_small On the Jobs Board: Release Manager, Consultant, Application Developer. On Healthcare IT Jobs: Director of Federal Health Business Development, Technical Project Manager, Health Information Systems Programmer/Analysts.

mrh_small Inga, Dr. Jayne, and I are emotionally needy. We yearn for intimacy and fulfillment with our much-loved readers, but alas, our anonymity and geographic separation preclude such contact. Therefore, like a prisoner who proposes surreptitious visual stimulation from the other side of the telephone room glass or requests passionate mail in lieu of physical contact, may I suggest that you: (a) sign up for the e-mail updates; (b) engage in the mutually satisfying activity of liking, friending, and connecting via the appropriate online services in which we dwell; (c) send us news, rumors, or anything else that might serve as a fancy-tickler; (d) review and click some sponsor ads, marveling that otherwise button-down companies publicly support our unpolished journalistic style and sophomoric humor because their executives at times find as amusing and informative as a hyperactive, crude teen armed with neighborhood gossip; (e) check out the Resource Center for more sponsor information and the Consulting Engagement RFI Blaster to painlessly request consulting proposals; and (f) enjoy our fleeting moments together since one of these days when I’m no longer clacking the keyboard, you’ll be bereft of musical recommendations and HIMSS booth critiques. Thanks for reading, since without you all this typing would be pointless.

Acquisitions, Funding, Business, and Stock

3-22-2012 9-34-04 PM

On Assignment, a provider of temporary workers to IT and healthcare companies, will purchase IT staffing firm Apex Systems for $383 million in cash and $217 million in new stock.


Xerox’s IT division wins a 10-year, $1.6 billion contract to oversee claims processing for California’s Medicaid program.

WESTMED Medical Group (NY) chooses UnitedHealthcare and Optum to help it launch an ACO for its 220 physicians in Westchester County, NY.


3-22-2012 5-57-34 PM

The Huntzinger Management Group hires Nancy Chapman (ACS) as practice director of ICD-10 transition and RCM services. We also note that she is part of an exclusive group of 2,324 industry leaders who have joined the HIStalk Fan Club that long-time reader Dann started and maintains on LinkedIn.

3-22-2012 6-01-19 PM 3-22-2012 6-02-39 PM

LifePoint Hospitals (TN) appoints Karla Schnell (North Highland) as senior director of informatics and Paige Porter as senior director of pharmacy informatics.

3-22-2012 7-49-11 PM

National coordinator Farzad Mostashari will present the opening keynote address at the Summit on the Future of Health Privacy in Washington, DC on June 6-7, hosted by Patient Privacy Rights and Georgetown University. Security expert Ross Anderson PhD, FRS will also address the conference and Rep. Joe Barton (R-TX) will receive an award for his support of privacy and security protections in the HITECH act. Registration is free.

Announcements and Implementations

US Preventative Medicine announces an agreement to offer its wellness platform through Dossia’s Health Management System.

3-22-2012 6-04-50 PM

HIMSS names The Health Information Exchange Formation Guide, written by Laura Kolkman and Bob Brown, as its 2011 Book of the Year.

PerfectServe announces that its clinical communication applications are available for BlackBerry and Android smart phones.

iMDSoft’s MetaVision Suite for ICUs and ORs earns ONC-ATCB 2011/2012 certification.

Elsevier signs an agreement with ExitCare LLC to offer its patient education information via Elsevier’s Clinical Pharmacology electronic reference. Elsevier will also offer ExitCare licenses to its customers.

Air ambulance operator Mercy Jets implements iPad-based medical records, allowing its medical teams to monitor vital signs and to document care delivered during patient transport.

In England, Northumbria Healthcare NHS Foundation Trust goes live on NextGate’s Multi-Language EMPI for its clinical portal that links multiple systems.

Government and Politics

3-22-2012 10-01-06 PM

HHS launches a developers’ challenge to design Web-based applications that use Twitter to track health trends in real time, allowing officials to identify emerging health issues.

3-22-2012 10-02-16 PM

The FDA’s Janet Woodcock MD says the agency could do a better job of predicting the effectiveness and safety of new drugs if it were able to collect information from the field electronically rather than relying on voluntary drug company reporting.

3-22-2012 8-02-06 PM

mrh_small The State of Maryland, along with the CRISP RHIO and the Abell Foundation, launches a competition to identify innovative ways to improve public health using clinical information available from Maryland’s HIE, either alone or tied into publicly available data sets (motor vehicle records, birth and death, boards of education, etc. or Maryland subsets of federal databases) Submissions can address either general public health issues or ideas related to the Million Hearts initiative to prevent heart attacks and strokes. Prizes are offered and submissions are due by April 16. If you don’t want to submit, you can vote – the first round of vetting and discussion will involve the public, who can participate right on the site.


Memorial Sloan-Kettering Cancer Center and IBM collaborate to combine the computational power of IBM Watson with MSKCC’s clinical knowledge and data to create an outcome and evidence-based decision support system.


The Saginaw newspaper describes Covent HealthCare’s used of 14 locally trained scribes in the ED to interact with its Epic system while the physician focuses on the patient. Doctors say they save at least an hour for every 25 patients they see.

3-22-2012 7-11-42 PM

mrh_small HIMSS clarifies that hotel rooms for exhibitors at HIMSS13 haven’t been released yet, so they aren’t showing up on the housing site. They says a “blog site” (obviously this one) said they’re full, which isn’t exactly true – a reader (two, actually) told me that rooms weren’t showing up and I said I don’t know anything about exhibitor housing since I’m a provider grunt, but I did see at least 10 hotels showing non-exhibitor availability. Like most everything else at the conference, high rollers (Diamond members) get first crack. It’s like college football programs that require a big upfront donation to earn the privilege of buying expensive football season tickets.

Epic is awarded a patent for a search method that provides a list of possible appointments that match require provider and resource criteria.

Federal agents seize documents and computers from the town hall of West New York, NJ, reportedly investigating possible insurance fraud by Mayor Felix Roque, a physician who runs a pain clinic. Campaign staffers of the mayor’s defeated political opponent admit that they provided information to federal authorities hoping to discredit him.

mrh_small A highly regarded and long-established family clinic in Wisconsin becomes one of the first in the state to stop accepting Medicare, citing inadequate payments and increasing expenses that include $700K for a new EMR. Says the founder: “I love taking care of Medicare patients, but every time we treat them we have to dig into our wallets. What kind of business model is that?” The doctor’s wife says he says up until midnight at home some nights to finish up his EMR charts.

3-22-2012 8-55-15 PM

mrh_small A former patient sues a just-closed eight-bed Ohio hospital, claiming the struggling facility refused to transfer him to a more capable hospital because it didn’t want to lose the revenue. The lawsuit claims that lack of prompt treatment of the man’s infection by Physician’s Choice Hospital resulted in gangrene that required surgeons to perform emergency surgery, which included removing skin from his penis. He said it hurt, of which I have little doubt.

Sponsor Updates

3-22-2012 6-50-24 PM

  • T-System posts a new video showing its T SystemEV EDIS.
  • Lifepoint Informatics announces that its March user conference was attended by over 40 clients, with a keynote address by Bruce Friedman MD on “The Continuous Search for Greater Lab Functionality: Best of Breed LIS versus Enterprise-Wide Solutions.”
  • GE Healthcare will introduce Centricity Cardio Enterprise at next week’s 61st Meeting of the American College of Cardiology.
  • TELUS Health Solutions announces the integration of HIPAAT’s privacy consent management services into its Assure EHR Integration Platform.
  • API Healthcare sponsors the DAISY Foundation, which honors nurses through its DAISY Award for Extraordinary Nurses.
  • MedAssets offers a case study of the $65.4 million it helped Texas Purchasing Coalition save from its supply chain.
  • White Plume releases AccelaMOBILE, a free physician charge capture app for mobile devices.
  • The Advisory Board Company launches its Innovations in Impact grant program designed to reward best practice-driven initiatives that articulate measurable, quantitative outcomes goals. The application deadline for the $20,000 per year grants is April 13.
  • Houston Orthopedic & Spine Hospital achieves Stage 1 MU using the Healthcare Management Systems (HMS) EHR. 
  • Gateway EDI earns full EHNAC Healthcare Network accreditation. Gateway also shares results of ICD-10 preparedness survey, which includes the finding that 56% of practices report are moving forward with ICD-10 preparation despite the enforcement delay.
  • DrFirst congratulates 44 of its EHR partners who were awarded the Surescripts White Coat of Quality for 2011.
  • Nuesoft posts a full transcript of its billing webinar series on third-party insurance billing.
  • An article by Santa Rosa Consulting’s Matt Wimberley discusses the opportunity to improve a hospital’s financial outlook through participation in the MU program.
  • Informatica highlights BCBS Michigan’s ICD-10 transition and Ochsner’s standardization on Informatica technologies for its HIE.    
  • Recondo Technology partners with ZirMed to offer the ZPay credit card and check processing solution.

EPtalk by Dr. Jayne


Several readers were taken with my article on the caduceus vs. rod of Aesculapius debate. Several mentioned Nehushtan, the fiery serpent used by Moses to heal those who looked upon it.

CMS asks  providers who feel they have received an ePrescribing penalty in error to contact them. Impacted providers may have had their G codes stripped by billing clearinghouses or may have reported the wrong annual code. Problems with hardship exemptions may also be the culprit.

HHS’s Office of the Inspector General approves Ascension Health Alliance to form a group purchasing organization, allowing it to offer its contracting services to hospitals and health systems outside of Ascension. The 21-state Ascension, the largest Catholic healthcare organization in the US, says formation of the GPO “demonstrates our commitment to transform healthcare by 2020.”

A research letter in this week’s issue of JAMA discusses the prevalence of physicians using social media to post unprofessional content online. Surveying state medical boards, the authors found violations that included inappropriate patient communication, sexual misconduct, prescribing without a clinical relationship, and online misrepresentation of credentials.

IBM Research teams with an Italian cancer center on a new analytics platform that will personalize treatment based on pathology guidelines and past clinical outcomes as documented in hospital systems. The Clinical Genomics tool can also provide an aggregated view of patient care.

AMA Board of Trustees chair Robert M. Wah MD reflects on his recent trip to the HIMSS conference, calling it “a gathering of more than 40,000 of my closest friends and colleagues.” Dr. Wah has an interesting pedigree: Navy active duty, deputy national coordinator for health IT and founding staffer at ONC, chief medical officer at Computer Sciences Corp., and head of the Navy’s largest OB/GYN training program. He’s an interesting guy and I am glad someone with his experience is chairing the board. I hope the AMA will show real healthcare IT leadership to reverse the black eye it obtained by blocking ICD-10.

3-22-2012 6-28-25 PM

Speaking of ICD-10 codes, one of my Twitter followers keyed me in to this app available on iTunes. For $24.99 and it only one review, I think at this point I’ll take a pass.

Several readers responded to my mention of the allergist who closed his practice to join the Army as a lieutenant colonel. Rank is apparently based on experience and specialty. One reader told a great story about his own Army service, where he had to take away several service weapons from physicians who mishandled or misplaced them, including one major who left his Beretta in the PX while shopping. That’s a little different than losing your sunglasses or your keys.

A shout out to Children’s Hospital Los Angeles Medical Group, which is hosting its annual “Pediatrics in the Islands: Clinical Pearls” conference in Maui. It’s a great conference. but I think it’s time to include some health IT topics, hint hint. Perhaps a celebrity guest speaker?



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

More news: HIStalk Practice, HIStalk Mobile.

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March 22, 2012 News 4 Comments

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Reader Comments

  • Jolynn: Ed, first of all I am glad you're back home and safe. I lost a friend many years ago. He succumbed to HAPE before they ...
  • Money Man: Someone should investigate AthenaHealth for Information Blocking. They are slow playing standards based connections whi...
  • Ted Reynolds: Thanks Kevin. I agree - a national patient identifier would help reduce the duplicate and mis-identified patient record...
  • Confused Consultant: re: KLAS rankings. Is anyone else curious about Epic's KLAS wins for HIE and Lab? Every evaluation we see about Beaker r...
  • meltoots: It could be a 90 minute reporting period, no one is doing MU2. MU is dead to the EP. Its way too much work, the cost ben...

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