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Morning Headlines 1/22/13

January 21, 2013 Headlines No Comments

Rex Hospital Selects Merge Hemo to Image-Enable Enterprise EHR

Rex Hospital, a member of UNC Health Care, has implemented Best in KLAS cardiology solution Merge Hemo to automate their cath lab and integrate data with their Epic EHR.

Physician EHRs emerge as hot advertising venue for drugs

Cloud-based EHRs are increasingly working with drug manufacturers to deliver point-of-care advertisements embedded within the EHR.

49 community health centers win grants to boost HIT infrastructure

Neighborhood Health Plan and Partners HealthCare award $4.25 million in grants divided among the 49 members of the Massachusetts League of Community Health Centers. The grants will help fund the implementation of practice management systems and provide meaningful use training.

Shareable Ink Achieves Substantial Growth and Expands Team

Shareable Ink, a cloud-based clinical documentation vendor, announces that during 2012 it grew 300 percent and doubled its workforce.

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January 21, 2013 Headlines No Comments

Time Capsule: Process Anarchy: Why Hospitals Buy Off the Rack, But Expect a Tailor-Made Fit

January 18, 2013 Time Capsule 6 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 May 2008.

Process Anarchy: Why Hospitals Buy Off the Rack, But Expect a Tailor-Made Fit
By Mr. HIStalk


I recently met with a group of employees from one department in a big medical center. So big, in fact, that many of that department’s couple of hundred employees didn’t know each other and had to be introduced. They’re assigned to odd locations, doing highly specialized work, and rarely poke their heads out to see what’s going on anywhere else, even within their own department.

We were talking a software rollout that affected them. That’s where the consensus thing comes into play – how they should use it, what changes they would see, and all the other painful change management stuff that wraps itself around a technology implementation.

Two of them were talking and animatedly gesticulating. It looked like an American tourist trying to get a Moscow local to understand that he’s looking for a restroom by just saying it slower and louder. Finally, one turned around and said (with some combination of wonderment and exasperation), “We work one floor apart, but it’s a completely different world.”

There’s an automation challenge for you. One information system, but two completely opposite groups trying to agree on how it should be configured. From the same department of the same hospital.

That’s a nightmare for healthcare idealists and software developers. In a perfect world, all hospitals would work the same. In a less-perfect world, hospitals might vary, but at least practices within a single hospital would be consistent. In a world that’s in disarray, everyone in a given department would at least follow a single set of rules. And in a world of madness, even small subgroups of individual departments do things their own way, a healthcare version of anarchy.

I’d say most hospitals are somewhere between disarray and madness. That doesn’t even account for IDNs with hospitals from 50 beds to 1,000 beds that face the daunting challenge of getting all of them to agree on a single software setup that reflects their intra-group disarray.

Certain hospital areas are so ruggedly individualistic that nobody else understands them 90 percent of the time (peds, oncology, surgery, ED, and ICU). Experienced nurses who transfer in feel like new grads all over again because everything is different (that’s a big problem right there). They defiantly stick with puzzling practices and dare well-intentioned outsiders (like administrators) to understand what they do, much less change it.

Those practices mimic the medical education of the doctors who work there, which rewards specialization. Each specialty proudly creates its own lingo, methods, and forms. Sometimes they’re necessary extensions, sometimes plainly bizarre and illogical practices used like gang colors – to make sure outsiders know they’re outsiders.

That’s why best-of-breed systems designed for those specialty areas won’t go away in the foreseeable future. That’s also why systems that all areas use, like CPOE and clinical documentation, can turn into an unmanageable stew of configurability options that drive vendors crazy when they’re trying to program and test changes. Instead of delivering strategic new functionality, products keep moving laterally with new options to be chosen once, even though a given client will just set it and forget it without receiving any real benefit.

Vendors have it tough. The respective agendas of current customers vs. prospects are very different. Entire new functionality may interest only a few potential users. The most vocal users are the showcase accounts, like academic medical centers, who demand changes that make no sense to the average hospital. Any resemblance to consensus is accidental.

(And here’s a vendor kudo: what little standardization exists in hospitals can be attributed to three groups: software vendors, the Joint Commission, and professional organizations for specific disciplines.)

Maybe it’s asking too much for vendors to deliver off-the-shelf software that every hospital can not only use, but love. One size doesn’t fit all.

Lip service aside, most hospitals want it their way. Anything less makes them angry. Cost and complexity forces them to buy suits off the rack when, deep down, what they really want is to have a tailor to make them one that fits perfectly.

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January 18, 2013 Time Capsule 6 Comments

News 1/18/13

January 17, 2013 News 4 Comments

Top News

1-17-2013 8-57-34 PM

HHS Secretary Kathleen Sebelius announces the final omnibus rule that substantially changes HIPAA regulations for the first time in 15 years. It (a) expands HIPAA’s reach to business associates such as contractors who will now be directly liable; (b) increases penalties to a maximum of $1.5 million per violation; and (c) clarifies the HITECH breach notification requirements. Patient provisions include (a) the right to request their own information in electronic form; (b) allowing cash-paying patients to instruct providers to not share their treatment information with their insurance company; and (c) limiting the use and sale of a patient’s information without their permission. The 563-page document has considerable detail including a discussion of feedback received, so feel free to leave a comment with nuggets you run across.

Reader Comments

From Digital Probe: “Re: headline. One of the rags ran a headline all day saying Health Information Exchange over a story about health insurance exchanges.” Indeed they did, and they’ve since quietly corrected their mistake, I see. I’m slightly mystified by their confusion, but even more so at their running a lengthy article on health insurance exchanges in an IT publication intended for a provider audience who I can’t image cares one iota about them.

From Android Powered: “Re: TPD’s list of iPhone apps. Anybody want to share their list for Android?”

1-17-2013 5-51-39 PM

From Boy Gary: “Re: Anthem CA Blue Cross. Their electronic eligibility system is down, so they e-mailed providers telling them to e-mail subscriber and patient information to check eligibility. They’re asking for the subscriber’s Social Security number to be sent by unsecured e-mail.” That’s such a bad idea that I’ll overlook their less-egregious omission of the apostrophes in the possessive occurrences of “subscriber’s.” They get credit for at least putting a manual step in place to help providers get paid.

From The PACS Designer: “MakerBot at CES. An addition to MakerBot’s product line that TPD posted about was introduced at the Consumer Electronics Show in the form of a 3D plastic design system. The MakerBot Replicator 2X 3D printer uses melted plastic to form objects based on available 3D pattern software. So, for example you want a new coffee mug, you use your pattern design software to create the desired result. Maybe one of our adventurous readers will buy the Replicator to design a new shoe for Inga!” Pretty fascinating – the $1,749 device can replicate household hardware parts, antiques, and who knows what else.

From Lumpy Rutherford: “Re: former NextGen President Pat Cline. He has resigned from the QSI board effective immediately and on his LinkedIn page lists himself as CEO of newly incorporated Delaware corporation Lightbeam Health Information Systems. I don’t know the connection, but I suppose you could draw conclusions.” Indeed you could. I was interested in the corporation’s other officers, but couldn’t turn them up on Delaware’s corporations page (at least not without paying).

HIStalk Announcements and Requests

1-17-2013 2-58-51 PM

inga_small My inbox has been filling up with inquiries about HIStalkapalooza. Here’s what I can share for now. We will post a link to the invite sometime in the next couple of weeks, so keep reading HIStalk. We will again have the Inga Loves My Shoe contest as well as a crowning of the HIStalk King and Queen for best attire. Translation: if you needed a legitimate excuse for splurging on a new outfit, you now have one. However, you might want to wait for more details on the event because it may influence your final selection. The date again is Monday, March 4 at 6:30 p.m.

inga_small The latest goodies from HIStalk Practice include: the HIStalk Practice Advisory Panel discusses the various resources they use when purchasing HIT system to compare vendors and products. Bruce Henderson of Aetna Accountable Care Solutions suggests some factors that practices should consider before committing to an ACO model. Rob Drewniak of Hayes Consulting Management overviews and defines data governance. SRS CEO Evan Steele expresses concern about the future of the EHR incentive program. Proposed legislation would provide SBA loan guarantees for the purchase of clinical IT systems. A study suggests that projected primary care physician shortages could be eliminated if practices used EHRs and shifted more care to non-physician providers. EHR adoption by family physicians is expected to exceed 80 percent by the end of 2013. Most physicians don’t find online physician ratings helpful, though the vast majority believe their own ratings are at least partially accurate. Thanks for reading.

I’m taking a short beach break, leaving Miss Inga in charge of the Monday Morning Update. You can occupy your time by (a) connecting with us via our non-Catfished social not-working profiles; (b) porting intently and clicking methodically over the ads to your right from the folks who underwrite your HIStalk habit, if such a thing exists for anyone but me; (c) signing up for spam-free e-mail updates; (d) reviewing more in-depth sponsor information and filling out a two-minute form to solicit consulting help; and (e) evangelizing to your colleagues who won’t see our slick marketing campaigns and ads since we don’t have any. Seriously, you are the best.

On the Jobs Board: Product Marketing Specialist, Expert Solution Consultant – Revenue Cycle Specialist, Healthcare Vertical Solutions Director, Sr. Applications Engineer – EMR.

Acquisitions, Funding, Business, and Stock

1-17-2013 9-07-11 PM

PE firm Primus Capital Funds invests in Emmi Solutions, a provider of patient engagement solutions.

MIT Media Lab spinout Atelion Health will commercialize one of the lab’s project, a care coordination system that’s being tested at Boston Medical Center, Joslin Diabetes center, and Mayo Clinic.

1-17-2013 8-16-40 PM

Cleveland-area data archiving vendor MediQuant, which says its revenue is growing at 45 percent per year, moves into a larger space for its 40 employees and the 10 additional it plans to hire this year.

A hedge fund shareholder of Compuware criticizes the company for “intentionally dragging your feet” by not yet responding to a $2.3 billion December 18 takeover offer from Elliott Management Corp. Just after it received that offer, Compuware announced plans to conduct an $200 million IPO of its Covisint HIE business unit by the end of March.


Centra Health (VA) selects Wolters Kluwer Health’s ProVation software for cardiology procedure documentation and coding.

HP Enterprise Services announces that it has been chosen by the VA for a $543 million, five-year, 152-hospital RTLS contract, being issued the bid again after competitor protests of last year’s award. Subcontractors are CenTrak, Intelligent InSites, and WaveMark.


1-17-2013 5-19-49 PM

The Society of Health Systems and HIMSS award Dean Athanassiades, senior director of software customer services for Philips Healthcare, the 2012 SHS/HIMSS Excellence in Healthcare Management / Process Improvement Award for leadership in implementing synergies between the process improvement and IT professions.

1-17-2013 5-22-01 PM

Symphony Health Solutions names Frank Lavelle (Siemens Medical Solutions, Medquist) CEO.

1-17-2013 5-22-53 PM

Doug Cusick (HP, IBM) joins Clinovations as a partner, tasked with leading the expansion of the company’s payer, life sciences, and technology service lines.

1-17-2013 6-23-14 PM

Dann Lemerand is promoted to EVP of strategic alliances for The HCI Group.

Announcements and Implementations

Greenway Medical Technologies unveils its interactive Developer Portal and API to facilitate creation of apps that interoperate with Greenway’s EHR and PM platform.

Siemens Healthcare offers consulting services for value-based purchasing, preventable readmissions, and healthcare-acquired conditions.

1-17-2013 9-13-14 PM

A Dell-sponsored study finds that the family medicine residency program of Tallahassee Memorial HealthCare (FL) saved $600,000 and enhanced productivity by implementing the company’s Mobile Clinical Computing solution, which includes desktop virtualization, single sign-on, and strong authentication.

Government and Politics

1-17-2013 5-28-23 PM

ONC selects four winners of its Health Design Challenge to develop patient-friendly designs for printed health records to help patients better understand and use their EHRs. The winners shared $31,000 in prize money.

ONC publishes several reports on HIEs.

1-17-2013 8-44-01 PM

In the UK, Secretary of State for Health Jeremy Hunt calls on NHS to become paperless by 2018, making it “the most modern digital health service in the world.” The physician’s union replied, “The biggest challenges to making the NHS paperless by 2018 are down to funding, resources, prioritization, and the choice of systems in secondary care. Although there may potentially be some efficiency savings, technology will not necessarily create huge cost savings. As well as ongoing hardware and software funding, sufficient resources will be required to support evolving training, IT support and admin support.” Other goals the Secretary set: (a) every patient will have online access to their own records by March 2015; (b) referrals will be paperless; (c) patient records held in different locations will be linked; and (d) records will follow patients throughout NHS and social care.


1-17-2013 8-11-40 PM

A NIH-funded University of Pittsburgh study of four skin lesion apps finds that three of them weren’t very good at diagnosing a test set containing 53 images of lesions known to be cancerous. The apps incorrectly concluded that 30 percent of the lesions weren’t cancerous. The fourth app, which sends the image to a dermatologist for review, missed only one of the samples. The conclusion is to not trust unregulated apps with important medical decisions.


The Leapfrog Group retracts the “F” grade it gave to Texas County Memorial Hospital (MO) after the hospital complains that its score was based on incorrect data. The 25-bed hospital opted not to participate in Leapfrog’s survey because it did not have the resources required to complete the 80-page questionnaire. It says Leapfrog applied “questionable methodology” and used information that was not confirmed by NQF or independently assessed for reliability and validity. The hospitals has retained legal counsel. 

Siemens Health Services CEO John Glaser, who served as an ONC senior advisor helping craft Meaningful Use in 2009 while still VP/CIO at Partners HealthCare, agrees with several member organizations in calling for a slowdown of its rollout. He says, “The pace is too damned high. People are just cramming this stuff in.” Johns Hopkins Vice Provost for IT/CIO Stephanie Reel says the “one size fits all” approach is causing headaches for specialists and the Meaningful Use program needs to be evaluated for effectiveness, saying, “To keep moving ahead with such an aggressive strategy strikes me as foolish. We don’t know what’s working and what’s not working.” Obviously pushback is escalating.

1-17-2013 7-20-08 PM

Sporting Kansas City, partly owned by Neal and Cliff of Cerner, parts ways with its charity partner, Lance Armstrong’s Livestrong. ESPN says Livestrong cancelled the stadium-naming deal because the soccer team owed it money, while Sporting KC takes advantage of the Dope Pedaler headlines by loudly announcing the breakup with perfect timing. Livestrong’s name gets yanked down from the Livestrong Sporting Park sign and it loses its percentage of the gate, worth $8-10 million over six years.

An article in a security magazine says Australian security researcher have found “dangerous, unpatched flaws” in the Philips Xper cardiovascular imaging system that allow them free access to patient information. The researchers said they weren’t able to connect with someone at Philips, so they got in touch with the Department of Homeland Security and the FDA instead. They claim Homeland Security told them the agency was taking over all aspects of software vulnerabilities related to medical devices and software. Philips says the flaw is present only in old versions of its software. The researchers also played around with an iPad-based patient monitoring and found problems.

Lurie Children’s Hospital of Chicago sues a web design firm, seeking the return of the $859,000 it paid the company to design a site to promote its new $915 million hospital.

1-17-2013 7-42-26 PM

The Dallas paper profiles Robert Abbate, DO, who started One Touch EMR, an iPad-based EMR.   

A reader once swore she would never read HIStalk again if I mentioned the term “fecal transplant” again, so here’s a sad but necessary wave goodbye to her from Weird News Andy, who subtitles the story “May I borrow some Grey Poopon?” A study finds that the unsavory procedure works better than antibiotics for treating diarrhea due to C. Diff. WNA adds, “When they figure out how to put them in a pill, maybe,” which I might argue is even more disturbing.

Sponsor Updates

1-17-2013 9-18-44 PM

  • Columbia Valley Community Health (WA) chooses Access Evolution for creating and managing paperless forms and workflow.
  • Craneware offers VP-and-above healthcare finance executives a chance to win a $250 Amazon gift card if they answer a 10-question Executive Industry Survey by February 5.
  • HMS will participate in the HFMA Region 11 conference in Las Vegas January 27-30 and the THA 2013 Annual Conference February 13-14 in Austin.
  • dbMotion shares the agenda for its February 7 seminar in Dallas on connected healthcare.
  • Emdat adds Carmichael Business Systems, Northland Business Systems, and Integrated Data Technology as resellers of its digital dictation software.
  • The Advisory Board Company offers an infographic  that addresses accountability gaps and best practices for improving teamwork among frontline staff.
  • The City of Springfield (OH) renews its contract with MED3OOO for EMS billing services through January 31, 2014.
  • The US Army Network Enterprise Technology Command issues CommVault a Certificate of Networthiness for its Simpana 9 data and information management software.
  • Santa Rosa Consulting’s Carl Jaekel discusses issues practices will need to consider to accommodate PCMHs in a blog post.
  • T-System offers its T Sheets flu documentation template free to hospitals to help EDs manage the national flu epidemic.

EPtalk by Dr. Jayne

Every day is a good day to be anonymous, especially for the HIStalk team. Sometimes I marvel that I haven’t been outed at the office. I and am grateful that apparently I have enough of a filter so that my superhero identity isn’t revealed. I do have to be especially vigilant to ensure I’m logged into the correct Facebook and Twitter accounts so I don’t inadvertently post as the “wrong” me.

I’m just one of thousands of physicians using social media and was excited to see this article in the Annals of Internal Medicine. The authors sent hypothetical social media situations to various state medical boards to evaluate whether there was consensus on which situations might lead to a disciplinary evaluation. Not surprisingly, the riskiest posts included misleading clinical or credentialing information, using patient images without permission, and inappropriate contact with patients such as contacting them on dating sites. There was low consensus for sharing clinical anecdotes (as long as confidentiality was maintained) and for “showing alcohol use without intoxication.”


I do have some latent Victorian sensibilities, so I’m not sure photos of anyone drinking belong on Facebook. I have been friended by some of my colleagues and I think that either they have forgotten that their posts are visible to the workplace or perhaps they simply don’t care. Working for a conservative non-profit, I’d be a little concerned that those posts could someday be an issue (if not for the current workplace then for a potential or future employer.)

Many organizations have social media policies or codes of conduct, but it’s not a bad idea to find out if there are “informal” policies in play as well. Is it frowned upon for subordinates to “friend” their supervisors? Is there a difference between connecting on Facebook and connecting on LinkedIn? What about posting to social medial during typical business hours? Depending on an employee’s role and career goals, some of these are less than appropriate.

Having TMI (Too Much Information) seems to have become the norm. I’m not advocating for a return to the days of inkwells and quill pens, but I do miss having a little mystery in the world. I don’t need a photo of your lunch every day, unless of course if includes an awesome martini. If you have pictures of those, feel free to e-mail me.



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

More news: HIStalk Practice, HIStalk Connect.

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January 17, 2013 News 4 Comments

Readers Write 1/16/13

January 16, 2013 Readers Write No Comments

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

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

Lessons Learned from My First HIMSS in 2007
By Bern Werner

1-16-2013 6-18-29 PM

Six years ago I set out on a journey from Pittsburgh, flying to Baltimore to be picked up by my young boss (Todd Johnson, the 25-year-old head of our six-person software company, Salar Inc) in his 140,000 mile-worn Toyota Forerunner for a trip to New Orleans. The truck was loaded with precious cargo and our booth for HIMSS07, packaged neatly in three plastic containers. 

On our first day of the journey, we mused over where the healthcare IT industry was headed and whether there was a future in it for our small company.

When I joined Salar a year earlier, we had begun implementing our physician documentation software at 20-hospital system that already had a major EMR (I’m not saying who the vendor was, but the company name has six letters and I met the owner by chance at HIMSS  before I knew that his booth was worth more than our company). I figured the big fish would just look at our success, then “ borrow” our IP and we’d be out of business in a couple of years. 

We made it safely to New Orleans, and I was excited to be on the floor. I was admittedly green, and knowing the value that we could provide, I was eager to sell it to anything that came within two feet of our booth. 

My favorite memory is of one visitor that walked up to our booth just after the convention hall had cleared for morning session. I was tending the booth on my own. He was accompanied by two booth bunnies. I was alone in front of our 10×10 booth with our slick, new, cloth marketing extravaganza. I asked him if he was interested in seeing a physician documentation tool that is better than anything on the market and drives physician adoption, etc. He was very kind and let me finish before saying, “No, thanks. I was looking for that booth that has a treadmill. Know where that is?” I did not.

As he walked away, my boss was just returning to the booth. He said to me, “Do you know who that was?” I said no. He said, “That was Neal Patterson.” Thus began my real HIMSS education.

I now find myself preparing for HIMSS 13 with the same company, but with two million completed forms and over six million captured charges behind me. Though I’m flying to New Orleans this time, there are many parallels to the 2007 road trip (which included driving through tornadoes on the way home and roaches in the non HIMSS-approved hotel) and events of the past year, with our company changing hands three times. 

One thing for sure is that I’m no longer worried about the big guys getting ahead of us when it comes to innovation. They can steal our ideas and they can try to pilfer our content, but they move like the QE2 we’re still zipping around in our speedboat, changing direction as fast as our customers demand.  

If I find HIMSS 13 to be a sales bust, no biggie. Not only will I be able to recognize some of the industry’s biggest icons, I know I’ll have a good time at the HIStalk party.

Bern Werner is VP of implementation with Salar of Baltimore, MD. 

Ambulatory EHR Adoption: Success vs. Failure
By Justin Scambray, MBA

1-16-2013 6-29-25 PM


In a New York Times article, In Second Look, Few Savings From Digital Health Records, David Blumenthal, MD expresses his thoughts on the current struggles the US health care system is facing with the successful adoption of the EHR. Technology “is only a tool,” said Blumenthal. “Like any tool, it can be used well or poorly.”

While there is strong evidence that electronic records can contribute to better care and more efficiency, the systems in place do not always work in ways that help achieve those benefits.

Technology is only a tool, and it is true that it’s all in how you use it. However, it’s not just good use of the technology that will yield results. Physicians need to understand that current processes and the way their practice has run for the last 15-20 years must change.

To put a tool like an EHR in place and expect that it will conform to existing systems and workflow is like changing all the rules in a game, but not changing how the player plays it. This is what many practices end up doing, and the very tools put in place that are supposed to help the practice begin to work against it.

After working in the ambulatory EHR market for seven years, selling and being a part of hundreds of implementations, there is one common attribute that I have seen that separates success from failure: the ability to change and adapt systems and processes to the right tools and right people.

The EHR market has been plagued with the thought that this tool — the EHR — will change the medical practice. The fact of the matter is that it is the practice that needs to change for the EHR to work properly. Careful business process mapping and systems redesign needs to take place prior to implementation of any new tool into a business, and it is no different for a medical practice.

If you have ever sat in on a physician EHR demo, they all want to see the same thing. "Show me how I would see a patient in your system from check-in to check-out." All too often, vendors will immediately start to fumble through a canned patient scenario that really has nothing to do with the current office workflow. The physician will watch, ask a few questions in between taking phone calls and signing off on charts, and never really get a good idea of how the EHR will work in their office.

Is it any wonder that a recent survey conducted by KLAS shows that the number of practices shopping for a replacement EHR jumped from 30 percent in 2011 to 50 percent in 2012? Among the top reasons for switching: decreased productivity.

The EHR is only a tool. It is a tool that requires careful integration and mapping between a current state and desired future state design. If the EHR is going to live up to expectations, it’s a focus on change in workflow, processes, and systems that’s going to get it there.

Justin Scambray is VP ofsSales and marketing for Pacific Medical Data Solutions of Paso Robles, CA

Argument for Healthcare Enterprise Project Management Office
By Joe Crandall

Every hospital project is an IT project.

How many times have you heard that in the past few years? A quick look at the evidence and there is little room for argument:

  • Hospital budgets remain stagnant while healthcare IT projects grow. Eight of ten providers expect organizational HIE budgets to significantly increase by 2014 (2012 Black Book State of the Enterprise HIE Industry report).
  • Unprecedented HIT spending. $40b investment in all IT related services, $8.2b in software services alone (RNCO study).
  • The rise of health data analytics (HDA). Almost every aspect of healthcare can be improved through the use of HDA. Terabytes of healthcare data … terabytes!

As the American healthcare industry moves into its own Information Age, the existing IT infrastructure supporting the projects of today must be realigned strategically across the entire organization to support the projects of tomorrow.

The function of a healthcare Enterprise Project Management Office (EPMO) is pretty simple. The EPMO would be the single source of information related to all strategically aligned projects for the entire organization. This creates more accountability, better communication, and data governance.

Along with implementing an EPMO, an organization must look at the portfolio management process. You can’t have one without the other. The EPMO ensures the projects are done right, but the portfolio management process ensures that the right projects are chosen.

With each IT project being considered a major strategic project, the EPMO becomes the communication hub for the organization. It provides timely and effective mitigation of issues, risks, and budgets. The EPMO makes sure communications are the right message at the right level at the right time. The EPMO also standardizes the best practices of project management across the organization so all projects run smoother.

The other byproduct of elevating the PMO to an EPMO is that the CIO and team become true partners within the organization. The IT staff is already involved in the majority of projects already. Why not leverage their skills to benefit the entire organization?

The benefits to implementing an EPMO are clear:

  1. Project alignment. All projects introduced are managed through a central resource and aligned with organizational goals
  2. Project capacity. More projects in less time. Long-term planning is simpler and efficient.
  3. Project focus. Projects are focused on the strategic goals of the institution and embrace lasting change, not the “flavor of the month.”
  4. Project execution. Projects are executed with industry-standard processes resulting in project done right, on time, and completely.
  5. Project redundancy. One central location has the knowledge to ensure projects are not duplicative or redundant.

One example. In 2008, Catholic Health Initiatives (CHI) established an IT EPMO with the goal of standardizing best practices and improving project success rates across all hospital IT departments within the health system. Since being established, the EPMO has reached its goals and then some. Due to its success, the EPMO was repositioned to support all enterprise-wide projects in 2012. 

Every hospital project is an IT project.

Joe Crandall is director of client engagement solutions of Greencastle Associates Consulting of Malvern, PA.

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January 16, 2013 Readers Write No Comments

News 1/11/13

January 10, 2013 News 2 Comments

Top News

1-10-2013 8-39-19 PM

The VA launches a Medical Appointment Scheduling System challenge to replace its VistA scheduling module. Up to three entrants will win up to $3 million each.

Reader Comments

1-10-2013 7-17-31 PM

From TV’s Frank: “Re: Intermountain Healthcare. Finally dumping GE Healthcare.” An e-mail from Intermountain CIO Marc Probst to IT employees says the still-incomplete system it’s been building with GE is deficient in clinical documentation, CPOE, and integration with coding and billing. As a result, Intermountain has evaluated GE’s future EMR strategies and decided not to renew their contract, instead considering three options: (a) keep building their homegrown EMR without GE’s involvement; (b) buy Epic, Cerner, or Siemens; or (c) buy best-of-breed and try to integrate. I’ve panned the GE-Intermountain deal since it was announced in 2005, skeptical that dumping a few hundred million dollars and GE’s questionable expertise was going to ever yield anything tangible, which apparently is exactly the case seven-plus years into the 10-year deal. Or as I described it in 2011, “GE-Intermountain screwing around that never seems to provide any real, marketable products (are those Intermountain-led Carecast enhancements just about done?)”
1-10-2013 6-46-44 PM

From Jerry Aldini: “Re: Geisinger Health System (PA). I contacted you a while back with the rumor that they were developing a commercial solution for accountable care enablement. It was announced at JPMorgan last week. Announcement attached.” I haven’t seen announcement hit the wires, but it says that Geisinger is launching xG Health Solutions, a for-profit spinoff that will commercialize its intellectual property. On the list: consulting services, population health analytics, care management, healthcare IT optimization, and third-party administration services. Geisinger EVP Earl Steinberg, MD, MPP (above) is named CEO and former Alere Chief Innovation Officer Gordon Norman, MD will be chief medical officer.

From PolishingMyResume: “Re: Allscripts. Preparing for relocations and layoffs in the software development organization for development people who work remotely or outside the seven core offices of Boston, Bangalore, Burlington, Chicago, Raleigh, Pune, and Vancouver.” Unverified. Seems like a smart strategy to me. The problem with indiscriminate acquisitions is that you have people strung out all over the place who understandably don’t want to move, limiting your opportunity for the synergy or culture management that Allscripts could use quite a bit of right about now (not to mention expense reduction, ditto). One of quite a few bad decisions by Eclipsys before Allscripts overpaid to buy the company was hiring CEOs who refused to relocate and instead occasionally jetted a few time zones over when the troops needed demoralizing, so I assume that lesson was learned and Paul Black will work out of the Chicago office. 

1-10-2013 8-07-46 PM

From Joan Hovhanesian: “Re: Howard University Hospital. Went live on Soarian clinical documentation on January 7.” Congratulations to the folks there. That’s a gutsy move going live immediately after the holidays. I still think of Joan as being with FCG and later VP/CIO of Shands Healthcare, so I’m out of touch – she’s with Program Advisors now.

HIStalk Announcements and Requests

inga_small HIStalk Practice highlights from the last week include: only 16 percent of providers met PQRS requirements in 2010. Primary care physicians are more likely to demonstrate improvement on measures of care when they have had sustained and extensive technical assistance. A billing service and four pathology groups agree to pay $140,000 to settle allegations that they improperly disposed of thousands of medical records found in a public dump. Job opportunities for physicians will continue to rise in 2013. The AMA and other professional medical organizations urge CMS to stop the implementation of the ICD-10 code set for outpatient diagnosis coding. Galen Healthcare releases a plug-in for Allscripts Enterprise EHR that sends providers EHR task updates to their PC or smartphone. It’s a new year and I hope your 2013 resolutions include not only a commitment to good health, but also a vow to expand your HIT ambulatory knowledge by faithfully perusing HIStalk Practice. Thanks for reading.

On the Job Board: Marketing Manager, Senior Applications Engineer – EMR.

1-10-2013 6-10-34 PM

Welcome to new HIStalk Gold Sponsor HTTS (Health Technology Training Solutions). For you vendors out there, this is my theory: customers often slam your product on KLAS surveys when their problem is really inadequate user training, not your software. The last thing you want customers to experience before go-live is a hastily thrown together set of PowerPoints and talking head demos put together by someone who knows the application but has no knowledge of instructional design and adult learning theory. You’ll hear an earful afterward, but not just on your training evaluation forms – users will under-use your systems, overload your help desk, and badmouth your product on reference calls. The HTTS team of healthcare IT and instructional design experts can help eliminate those problems by reviewing your training strategy, conducting a training needs analysis for new products or releases, and developing your training content using state-of-the-art learning techniques. Check out the testimonials of vendors who have engaged HTTS to optimize their training experience. If you’ve experienced professionally designed software training (both online and instructor-led), it’s easy to distinguish it from the more typical variety assembled by well-meaning amateurs. Now’s a good time to arrange a HIMSS conference connection to learn more. Thanks to HTTS for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

7 Medical Systems closes on its acquisition of HealthLink Minnesota Management Group, a provider of administrative and IT services to clinics.

1-10-2013 5-12-29 PM

ManTech International completes its acquisition of CMS contractor ALTA Systems.

1-10-2013 5-11-29 PM

EBSCO Publishing expands its evidence-based pediatric content with the acquisition of PEMSoft, a pediatric point-of-care clinical information library and multimedia decision support system.


1-10-2013 2-25-22 PM

Saint Luke’s Health System (MO/KS) expands its use of Perceptive Software solutions to include integration with Epic.

CalHIPSO contracts with ClearDATA Network to offer cloud hosting, offsite backup, and disaster recovery services to CalHIPSO provider members.

Emergency Medicine Physicians selects athenaCollector and athenaCommunicator for its 800-physician group. athenahealth also announces that Prospira PainCare with deploy athenaClinicals, athenaCollector, and athenaCommunicator.

1-10-2013 2-27-24 PM

Children’s Mercy Hospitals & Clinics (MO) selects GE Healthcare’s Centricity Business as its enterprise-wide RCM solution.

1-10-2013 5-15-44 PM

Straith Hospital for Special Surgery (MI) chooses the ONE EHR from RazorInsights.

1-10-2013 2-30-01 PM

Flagler Hospital (FL) contracts with Surgical Information Systems for Sunrise Surgery.

1-10-2013 5-17-46 PM

Doylestown Hospital (PA/NJ) subscribes to the CapSite Database to assist with the capital planning and purchasing processes.

Lincoln Orthopaedic Center (NE) selects SRS EHR for its 14 providers.

1-10-2013 8-42-32 PM

Vanderbilt University Medical Center will use event-driven software from Tibco to support its clinical decision support capabilities.

1-10-2013 3-12-54 PM

Rainbow Babies & Children’s Hospital (OH) will encourage non-emergent ED patients to instead use HealthSpot telemedicine kiosks staffed by medical assistants and equipped with monitoring instruments. Also announced: telehealth provider Teladoc will offer HealthSpot’s kiosks.


1-10-2013 5-18-39 PM 1-10-2013 5-19-37 PM

MedSys Group names Steven Heck (First Consulting Group) president and Luther Nussbaum (First Consulting Group) chairman of the board.

1-10-2013 5-21-44 PM

URAC President and CEO Alan P. Spielman announces his resignation.

Announcements and Implementations

1-10-2013 3-09-43 PM

Sentara Healthcare (VA) begins implementation of Morrisey Associate’s Concurrent Care Manager software across its 10 hospitals and 100 medical facilities.

The dbMotion-powered ClinicalConnect HIE (PA) expands its reach to 1.3 million patients.

1-10-2013 5-26-19 PM

South West Medical (KS) and Rems Murr Kliniken in Germany go live on iMDsoft’s MetaVision platform.

1-10-2013 8-30-21 PM

Hospital messaging services vendor Critical Alert Systems partners with Mobile Heartbeat, which provides hand-held messaging and alarms, to create an enhanced nurse call solution.

3M Health Information Systems opens an innovation center in Silver Spring, MD that will showcase its offerings.

Meta Healthcare IT Solutions announces customized versions of its clinical documentation, CPOE, pharmacy, and medication administration software that meet the requirements of Canada-based customers.

Government and Politics

The FCC announces it will make available up to $400 million in annual funding to healthcare providers to spur development of broadband networks for telemedicine.

HHS Secretary Kathleen Sebelius announces the formation of 106 new Medicare ACOs.

Former CMS administrator Don Berwick, MD says he is strongly considering running for Massachusetts governor in 2014. He says healthcare experience gives him sensitivity to issues, adding, “I get more and more excited about the idea of Massachusetts as a model.”


1-10-2013 6-57-49 PM

Panasonic announces an expanded line of Toughpad enterprise-grade tablets that include a 10-inch model running Windows 8 Pro ($2,899) and 7-inch ($1,199) and 10-inch ($1,299) Android versions.

HL7 releases a CCD to Blue Button Transform Tool that allows organizations using the CCD format to allow patients to download information as ASCII text.


1-10-2013 8-00-53 PM

A heavily recruited professor couple at University of Minnesota’s School of Public Health, one of them director of the ONC-funded University Partnership for Health Informatics (UP-HI), quit amidst charges they were double-dipping by simultaneously being paid by another university employer. The State of Georgia handed down felony indictments against Julie Jacko in 2011 after finding that she and Francois Sainfort were collecting full-time paychecks from both UM and Georgia Tech, but dropped charges in return for a plea agreement, restitution payments, and probation by Sainfort. Jacko ran the UP-HI project, funded by a $5.1 million ONC grant.

A California judge refuses to grant Kaiser Permanente access to the PCs and e-mail accounts of a couple whose small document storage business it hired to manage paper patient records. The state health department found last month that Kaiser put medical records at risk by turning them over to the small company without a signed contract. Kaiser claims it picked up the paper records, but the couple didn’t return everything.

Vermont’s Department of Financial Regulation scolds Porter Hospital for overrunning the $4.3 million budget of its Meditech-MedHost EMR project by 63 percent. The hospital undertook the project to earn HITECH money and to participate in Vermont Blueprint for Health. The hospital’s VP of public relations said, “The Meditech folks would hand you a box and say, ‘Good luck, do you have any questions?’” The hospital admits that during the physician practice rollout, all of its practices stopped accepting new patients for an unstated period, with the article ironically concluding, “Porter found that the productivity of doctors took a big hit each time the software was rolled out at a new practice … Officials said it has not been unusual for a doctor who normally saw 20 patients an hour to be able to see only 10 or 12 once the productivity-enhancing software was introduced.”

Weird News Andy finds this story a HIPAA stretch. Police confiscate the cell phone of a man filming an arrest on a public street, with a deputy telling him, “If I end up on YouTube, I’m gonna be upset.” The man was charged with obstruction and disorderly conduct, with the deputy claiming it was a HIPAA violation. A Stanford law expert opines the obvious: “There’s nothing in HIPAA that prevents someone who’s not subject to HIPAA from taking photographs on the public streets. HIPAA has absolutely nothing to say about that.”

1-10-2013 9-14-16 PM

It’s not an April 1 gag: the iPad-ready children’s iPotty debuts at CES. My only surprise is that the adult model wasn’t rolled out first.

Sponsor Updates

  • Jim Stilley, director of clinical workflow consulting for Versus, will discuss the use of RTLS to improve patient flow and efficiency at the 2013 Patient Flow Management Congress January 28-29 in Las Vegas.
  • The Advisory Board Company offers a February 14 Web conference on the inpatient value-based purchasing program.
  • MedHOK earns full 2013 NCQA HEDIS software certification for its 360Measures v2.56.
  • Bill Bithoney, MD of Truven Health Solutions discusses innovative and targeted approaches for reducing costs by improving care quality for better patient outcomes in a blog posting.
  • Medicity publishes a white paper discussing how to build patient centeredness into the ACO model. 
  • iMDsoft highlights some of its 2012 milestones, including successful implementations in Canada and the Czech Republic, 60 critical care and anesthesia projects, and go-lives of MetaVision in 17 countries.
  • Prognosis HIS doubles its client base for the second consecutive year and announces that all of its eligible clients exceeded baseline requirements to complete Stage 1 MU attestation using ChartAccess EHR.
  • Beacon Partners defines population health management and its relation to ACOs in a January 18 Webinar.

EPtalk with Dr. Jayne

CMS is seeking comments from hospitals, EHR vendors, and “other interested parties” on its electronic quality reporting. Starting in 2014, the Hospital Inpatient Quality Reporting (IQR) program requires use of the Quality Reporting Document Architecture (QRDA) standard. According to the e-mail, “CMS wants to increase efficiency and reduce the burden for providers…” If that’s true, I have some other suggestions for them as well. The comment period closes January 22, so sharpen those pencils and fire up those keyboards.

Speaking of CMS, don’t forget that if you completed your 2012 reporting period on time, you only have until February 28 to attest for Medicare. Those attesting with Medicaid should check for their specific state deadlines.

One more CMS deadline-related item and then I’ll quit, I promise. The comment period for ONC’s Health IT Patient Safety Action & Surveillance Plan is open until February 4. Goals of the plan include making it easier for clinicians to report patient safety events, engaging vendors to “embrace their shared responsibility for patient safety,” and incorporating health IT safety in post-market surveillance of certified EHRs. It’s only 40 pages, considerably shorter than most ONC reads.

From Follow Up Fred: “Re: sticky workplace problems. Good topics for discussion! One solution I’ve successfully employed for years is this. If I need a prompt response to a question or request communicated by voicemail or e-mail, I always end the message by asking for a response by a certain date and time. Typically, “Hey Jane, I’d appreciate it if you’d get back to me by close of business Thursday, January 10.” I then flag the e-mail or voicemail follow-up date on phone in the event the requested deadline is missed. I’ve found it very effective for myself but also the recipient, who in turn can prioritize the return response.” An excellent point, especially in a workplace where people won’t do anything until they’re absolutely up against a deadline.

The AMA continues to play Chicken Little with their ongoing pleas for CMS to halt implementation of ICD-10. Citing the cost and administrative burden, they ask that it not simply be delayed again, but to call on “appropriate stakeholders to assess an appropriate replacement for ICD-9.” There has already been significant expense to prepare for implementation and I know many people will be aggravated at the lost time, money, and effort if they’re successful. Do I sense an HIStalk poll in the making?


Inga and I are hard at work designing the beauty queen sashes for HIStalkapalooza. Thanks to some virtual BFF shoe shopping (via camera phone and text message), I’m ready for HIMSS. Do you have your shoes picked out and your accessories coordinated? E-mail me.



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

More news: HIStalk Practice, HIStalk Connect.

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January 10, 2013 News 2 Comments

Readers Write 1/9/13

January 9, 2013 Readers Write 3 Comments

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

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

Why Medical Practices Must Manage A/R Better … Now
By Tom Furr

1-9-2013 6-46-10 PM

“I didn’t go to med school to be an accountant.” How many times have we heard those words being muttered from a physician’s mouth?

Until now, that’s been an acceptable sentiment for any doctor. Today such thinking is financially dangerous if not downright disastrous. Even doctors in practice for as little as 10 years kept their focus on the insurance company, the source of 85 to 95 percent of their income. That almost predictable cash flow made reviewing accounts receivable reports — universally known as A/R — barely necessary.

Today, looking at A/R is an absolute requirement because of four letters that are having a huge impact on medical practices of all sizes and types – HDHP, which stands for High Deductible Health Plans.

These insurance plans have sent a loud and clear message to doctors across the United States: the game has changed. Simply stated, those practices that adjust quickly and wisely will be better able to survive. Those that don’t will be at risk of needing to sell out to hospitals or suffer serious issues with cash flow that could threaten the survival of their practices.

According to the annual report of America’s Health Plans, the number of U.S. residents using HDHPs rose nearly 20 percent in the past year. In 2013, 70 percent of larger employers will offer HDHPs, noted a Tower and the National Business Group of Health study. While the growth rate of this type of plan varies from region to region, no practice can think it won’t affect them soon.

The new reality is deductibles as a percent of contracted rates are about 50 percent. The days of the $25 co-pay are gone. Now practices are tasked with securing half the service bill’s balance from the patient. Unfortunately, physicians today don’t know the amount due until weeks after service, making it a priority to get the patient bill out as soon as the claim is adjudicated by the insurance company. That’s especially the case at the start of a calendar or plan year.

No one is suggesting doctors turn in their white coats and stethoscopes for green eye shades and a handful of sharpened pencils. However, they must become more attuned to the state of their practices’ financial condition. If a system is not embedded in their practice management software to manage patient bills and balances as well as produce insightful A/R reports, the doctor and his/her office manager should identify one and put it into place. Even if a new practice management system has just been deployed, that doesn’t mean you don’t need to ask the questions immediately of how to capture patient balances and post them automatically.

In the HDHP environment, everyone in the practice has a role to play, from front desk personnel to physicians. Each member of a practice should be educated on the new reality of HDHPs and how patients understand this new reality. However, it is also the responsibility of the practice to provide patients a simpler way to meet their financial obligations to the practice and continue to keep their healthcare relationships sound. If patients understand and have easy ways to remit payments, the physician keeps a sharp focus on the practice of medicine, secure in the fact that the A/R is being managed.

However, make no mistake, there is a limit on how much delegation a doctor or his/her office manager can allow. The tough calls need to be made by those individuals leading the practice. Decisions of the sort that most medical professionals could never have conceived of during their internships, like “firing” a patient.

Think about it:  with HDHPs, the shift from patient to deadbeat can occur in a matter of weeks if close attention is not paid to A/R.

Tom Furr  is CEO of PatientPay of Durham, NC.

NLP and Physician Workflow: An End to Physician Resistance?
By Chris Tackaberry, MB, ChB

“I hate all the EMRs out there, including the one our practice just bought. Notes that come from an EMR have so much extra stuffing in them that it takes me forever to figure out what you guys really had to say about the patient I referred to you. I have to wade through lines and lines of empty verbiage to finally find a meaningful sentence or two that tells me what I need to know.”

While the promise of the EHR/EMR remains as great as ever for healthcare providers, so too does the issue of physician resistance, as evidenced by this doctor’s comment, part of a conversation highlighted in a MedPageToday online article. Since EHRs came on the scene decades ago, physicians have remained slow to adopt the technology, even with the promise of improved workflow automation, enhanced care quality, rapid data exchange, and increased efficiencies. While the issue of physician resistance is certainly not new, it becomes an ever-more important concern as many hospitals continue to struggle to achieve Meaningful Use requirements.

There may be several reasons why physicians remain slow to come on board, but the most obvious is simply that doctors want to spend their time caring for patients, not struggling to use technology that introduces foreign, cumbersome tasks into their workflow. The truth is, even with today’s best systems, EHR data remains, on the whole, insufficiently descriptive or lacking in clinical context. Complete patient details often reside within historical notes embedded deep inside the EHR, and manually reviewing them for each and every patient, if a physician can access them, is incredibly time consuming and cumbersome.

Even with the technological advancements EHRs have seen over the years, physicians still have to spend tremendous amounts of time describing patient problems, medications, allergies, etc., in cumbersome forms or templates. As my colleague Tielman Van Vleck, PhD, Clinithink’s director of language processing, recently stated: “There is an intrinsic inefficiency in this process because so much of this information must be documented in the clinical notes repeatedly. As a result, there has been significant physician pushback against EHRs, despite their potential to improve both the quality and efficiency of physician-delivered care.”

NLP effectively embedded into an EHR has shown remarkable promise when it comes to minimizing the negative impact EHRs have on physician workflow. Rather than burdening physicians, NLP delivers more efficient and intuitive documentation of patient information in a manner already natural to the traditional physician workflow.

This is an important concern for providers dealing with Meaningful Use requirements, particularly Stage 2 and ICD-10, where capturing patient problem lists with unfamiliar coding terminology is another big deterrent to physicians. The good news is that NLP within an EHR can automatically tag all the problems referenced in a patient note, which in addition to facilitating analytics and clinical decision support not previously possible, can also support the capture of medications and allergies, saving physicians time associated with filling and maintaining these lists.

Physician resistance to EHRs won’t end tomorrow. But with the advent of Natural Language Processing and the manner in which this technology compliments physician workflow and will ultimately improve care quality, the light at the end of the tunnel may be considerably closer. Dr. Van Vleck recently noted, “NLP isn’t just a bigger hammer to build better widgets. If we do this right, we can improve medicine, helping people lead healthier, longer lives; we can simplify healthcare delivery and involve patients more; we can even help researchers make medical discoveries or respond to new diseases. There are a million ways that NLP can be leveraged in healthcare.”

It would seem tough to find a physician who could resist that scenario.

Chris Tackaberry, MB, ChB is CEO of Clinithink of London, England.

Vendor Resolutions for 2013
By Vince Ciotti

I tried to go to the gym today, but couldn’t get in. Too many people making New Year’s resolutions to exercise! So I went back to the office early and wrote this piece on New Year’s resolutions for our top 13 vendors, listed in order of their annual revenue.

  1. McKesson. So big (over $3B in annual revenue) that they made two: (a) find jobs for the 200+ well-paid Horizon veterans they laid off last year, all with 15+ years experience in healthcare, programming, etc., and (b) hire 200+ new employees for the expanded Paragon line, following the Epic model of young, inexperienced, and cheap.
  2. Cerner. Kick Paul Black’s butt.
  3. Siemens. Use the excellent marketing materials and RFP responses for Soarian financials to start the design and programming soon.
  4. Allscripts. Make Neal Patterson sorry he ever let Paul get away.
  5. Epic. Find a NYC bank with a high interest rate on CDs.
  6. GE. Sell something to somebody, somewhere, sometime, somehow …
  7. Meditech. Start the design work on Release 7.
  8. NextGen. Integrate the brochures, proposals, and PowerPoints for Opus, Sphere, and IntraNexus.
  9. CPSI. Sell a large hospital (over 25 beds).
  10. QuadraMed. Take a Quantim leap backwards.
  11. NTT/Keane. Optimize their disparate product lines.
  12. HMS. Get ready for Primus time.
  13. Healthland. Rearrange their various products in Concentriq circles.

Vince Ciotti is a principal with H.I.S. Professionals LLC.

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January 9, 2013 Readers Write 3 Comments

Monday Morning Update 1/7/13

January 5, 2013 News 10 Comments

From Willy Mays Hayes: “Re: Cerner. Our remote-hosted Cerner system just experienced a six-hour downtime that they are attributing to hardware failure in Kansas City. We’re wondering how many other clients were effected.” Unverified, but speak up if your system went down.

From Zorba P: “Re: non-compete agreements. A Wired essay says enlightened companies realize that non-competes hurt the economy.” The article didn’t convince me that companies shouldn’t require employees to sign non-competes, only that allowing employees to freely take their proprietary knowledge to a competitor might increase competition and thus economic output. Maybe it all works out where companies poach each other’s people like a Cold War spy exchange, but the odds of that intellectual property flow being equally balanced among all competitors seem slim and some companies are going to lose. The article tries unconvincingly to make the point that Boston’s Route 128 startup environment lost out to Silicon Valley because California law essentially voids all non-compete agreements, leaving the Massachusetts companies with no-choice lifer employees who stagnated their employers. I might agree with the conclusion that employees should be free to immediately leave and start their own companies since the economy would benefit from having more entrepreneurs and fewer unmotivated corporate clock-punchers, but I’m just not comfortable with the idea that any company with big pockets should be able to steal competitive secrets by simply hiring away insiders.

From The PACS Designer: “Re: Pebble e-paper Smart Watch. Our Travis Good posted in The Year of the Health Gadget about Pebble e-paper Smart Watch, so TPD thought it would be a good addition to the upcoming update of TPD’s List of iPhone Apps. Also found a YouTube preview explaining its use in transferring apps from mobile devices to the wrist watch.” I inadvertently burst out laughing at 0:20 when the company’s “Dream Team” (i.e., stereotypical startup nerds) make a reluctant and un-photogenic appearance, displaying palpable discomfort at being exposed to actual sunlight and fresh air. If your life won’t be complete without a rather ugly but smartphone-connected watch whose least-interesting capability is telling time, you’ll pay around $150 if it ever reaches the market (pre-orders started in May and the company isn’t providing updates), you’ll be buying from a company that failed previously before renaming itself and raising $10 million on Kickstarter, and you’ll be waiting until they find Asian companies willing to build their product cheaply. Not to mention that depending on hard-to-predict fashion acceptance, you’ll either look like the coolest kid around or a clueless idiot flashing a geeky Dick Tracy calculator watch.

1-5-2013 7-27-03 AM

As healthcare IT professionals, we’re even more skeptical than laypeople that providers can keep our medical information secure, with 84 percent of poll respondents saying they lack that confidence. New poll to your right: have you used a patient portal offered by your PCP? I have, and I like it — it’s convenient for making appointments, checking lab results, and pre-paying for a visit and printing a barcoded page that lets me check in at a kiosk instead of waiting in line.

1-5-2013 7-41-43 AM

Welcome to HealthITJobs, sponsoring both HIStalk and HIStalk Connect at the Platinum level. I like the clean look of their site, which has some pretty cool jobs listed. Employers typically need to fill positions in a hurry, and with HealthITJobs.com, positions you post go online immediately. Job hunters can manage the process from their smartphones: checking for openings, receiving real-time alerts when new jobs go up, and even applying for jobs from anywhere. As an employer, I’ve posted hospital IT jobs on some of the big job boards and it’s usually been a disaster, with 95 percent of the applicants having no healthcare experience, no US work credentials, or clearly insufficient capabilities. HealthITJobs focuses on health IT professionals, so you won’t be have Bolivian bricklayers bugging you about your CMIO position. The biggest regret I have about the crappy jobs I’ve held as an employee (thankfully not recently) was that I let inertia keep me from getting serious about moving on. It would have been so easy then and even easier now to find a new gig: register, download the iPhone app, and see what’s out there (hint: it’s a booming industry, so there’s a lot). For employers and recruiters, unfilled positions cost a lot of energy and money, so HealthITJobs is a painless way to post your listings and find that one right person who’s apparently not perusing your listings posted elsewhere. Thanks to HealthITJobs for supporting HIStalk and HIStalk Connect.

1-5-2013 7-43-31 PM

Hackers hit the servers of UNC Lineberger Comprehensive Cancer Center (NC), exposing the information of 3,500 employees and contractors. No patient information was involved. The breach occurred in May, but those affected weren’t notified until after Christmas. University IT employees say their servers are hit with attempted hacks thousands of times every hour.

CMS announces a 90-day extension for meeting Affordable Care Act transaction standards for eligibility and claim status. The reason given: nobody was going to be ready.

1-5-2013 7-44-27 PM

Wolters Kluwer Health completes its acquisition of Health Language, Inc., announced in October.

The fired former president of University of North Texas Health Science Center says he was let go for a variety of not-so-good reasons. One of them was his analysis of an all-campus shared services business center, which he says upset the university’s chancellor because it found that the health science center was paying twice as much as before with reduced quality, including a two-day EMR downtime that affected patients.

1-5-2013 7-33-02 PM

Home medical billing software vendor Brightree LLC acquires CareAnyware of Raleigh, NC, which sells home health and hospice software.

1-5-2013 8-43-06 AM

Reuters covers the recent Critical Care Medicine article in which researchers used plagiarism detection software to determine that most physician progress notes contained at least 20 percent material copied and pasted from elsewhere in the electronic record. I pulled up the original article (thanks to my academic medical center employer for providing remote access to our online journal library) and offer these observations:

  • It was a one-hospital study (MetroHealth Medical Center, Cleveland) of 135 patients admitted to a 14-bed ICU for at least three consecutive days.
  • The EMR system was Epic, which offers built-in functions for copy-paste and copy into a new note.
  • Residents copied more often, but attendings copied more actual text.
  • The threshold for identifying copying was phrases of at least four words and 20 or more total characters that contained at least a 20 percent match.
  • The authors did not interview any of the physicians found to have copied material, did not postulate why they did so, did not ask those involved in care of the identified patients whether the copied material negatively impacted patient care, and drew no conclusions about the potential or actual impact of copying progress note text on patient outcomes.

My conclusion: like many studies that raise a red flag and then run, this one seems to have been thrown together and executed quickly, resulting in a slightly interesting article that has no meaningful conclusion other than that someone with more resources should do a better study. Doctors may well copy progress note material, but that’s not necessarily a bad thing given that EMRs don’t typically offer easy ways to tag highly relevant material from the routine junk that hospital administrators, regulators, and malpractice lawyers require. It should be assumed that bringing material forward has an at least an equal likelihood of being positive for the patient since it might be missed otherwise. And intentional copying is a lot less bothersome than template-generated babble that looks good but says nothing useful.

Everybody wants to armchair quarterback how doctors document. How would you like having a roomful of stern third parties examining every e-mail you write for relevance, insightfulness, originality, and style, looking for opportunities to reduce your pay or sue you? If doctors aren’t complaining about the body of progress notes they work with in caring for their patients (including attendings reviewing the work of residents), then the armchair quarterbacks aren’t likely to find a smoking gun of vast conspiracy or widespread negligence.

If you’re a hospital, set standards on how documentation should be done. Demand that your EMR vendor develop ways to separate the useful from the worthless, and to add logic that considers the age of a documentation element and its graded value from individual providers in predicting its relevance. If you want elegant and thoughtfully composed prose, expect to pay for it in reduced physician productivity. And if you can prove that particular methods or styles of progress notes directly impact patient care, let’s see your data.

I think we can agree that electronic documentation works better in theory than in practice due to poor design and unguided use and therefore could be improved. To that end, I’ll close with a pithy quote from contributor Robert Lafsky, MD: “I’d sure like to see that visiting expert professor try to unravel a difficult case using nothing but the printed output from a typical EMR.”


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

More news: HIStalk Practice, HIStalk Connect.

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January 5, 2013 News 10 Comments

HIStalk Interviews Dan Schiller, CEO, Salar

January 4, 2013 Interviews 1 Comment

Dan Schiller is CEO of Salar of Baltimore, MD.

1-4-2013 7-58-26 PM

Salar has been through a couple of acquisitions. Explain what happened and how the company will operate going forward and the changes Constellation Software will make.

To say it’s been an interesting ride is an understatement. In the last 15 months, Salar has been purchased three times.

Initially we were bought by Transcend Services, a transcription company, in August 2011. Our hope was to create a budget-neutral documentation transition solution for existing Transcend customers by moving them off transcription and on to TeamNotes, Salar’s electronic physician documentation platform. Before we were able to formalize and launch this strategy, Nuance purchased Transcend to expand Nuance’s share of the transcription services market. This was early 2012, and we became a small blip on the larger corporate radar.

While we may not have been given the visibility we wanted, we used this time to focus on our internal processes, customers, and R&D. I think it was time well used. We’ve emerged with a new Web-based platform that we’ve deployed over the last few months to a new customer.

That brings us to our acquisition in early December by Constellation Software, Inc. We think Constellation is an ideal partner for us. They’re focused on growing vertical market software businesses that provide mission-critical solutions. They have a solid track record of purchasing and nurturing software companies in many industries. Most importantly, they believe in us – the strength of our solutions and our team.

So no immediate changes. They’re going to let us do our thing. I believe we already have the best electronic clinical documentation and billing workflow solution on the market, and with Constellation’s support, I believe we will be even stronger on the other side of 2013.


You’re a programmer moving into an executive leadership role, which rarely happens since the business world often ends up being like Dilbert and the pointy-haired boss. What are your priorities for the company and what parts of the job are you looking forward to?

I might feel out of place if this were a clothespin factory, but I know how to build software pretty well. Technical innovation has always been key to Salar’s identity, so it’s natural that a software engineer has always been at the helm. Hey, if you call in the middle of the night, you might still catch me on Tier 3 support. I hope to keep up my spot in the rotation for as long as I can.

My main priority is keeping us innovative, agile and relevant in front of all the change this industry will see in the next few years. We have always felt that, at their core, initiatives like Meaningful Use, ICD-10, and quality-driven payment reform are documentation problems, which are right in our wheelhouse.

The bottom line is that I’m eager to leave behind the mess of the last 15 months and lead this company into a very exciting future. I am fortunate to have a smart group of people who are passionate about solving real problems. With their support, this is going to be fun.


Salar’s selling point in documentation with TeamNotes has been a form-type metaphor that users could customize to look like familiar paper forms. How are users responding to that, and what kinds of devices are they using it on?

We all know that there are still large facilities using paper documentation, so that metaphor still translates to some degree. But TeamNotes has evolved far beyond just mimicking paper notes, and that’s been driven largely by the evolution we’ve witnessed in how comfortable physicians have become with technology. They want it to work for them, not against them.

For example, they want the ability to interface clinical data within their notes, jointly author notes with the entire care team, and capture structured data. Our newest version of TeamNotes enables physicians to do all these things, and do them on their preferred desktop, laptop, or mobile device. As our template content has become richer with each implementation, all of our users benefit.


Where do your documentation products fit with a hospital that’s already running a major EMR?

All of our customers already have major EMRs in place. In each case, the EMR was not able to fill their inpatient documentation needs functionally or achieve acceptable physician adoption rates. In most cases, the documentation tools are not intuitive and too rigid to fit varying clinical workflows. With Salar, each hospital has developed notes that are intuitive, reportable, and effective in their unique workflows. In our opinion this is how you achieve physician adoption of electronic clinical documentation.

There have been a lot of great strides within the industry to develop CLU and CAC tools to accommodate notes coming out of the EMR because they were never structured well in the first place. To get any sort of specificity out of a flat unstructured note, you’re required to use some expensive tools or employ smart people to deduce what happened at the point of care. This specificity needs to occur at that point of care, in the physician’s hands, and the outcome must be represented in a structured, discrete way.

These CAC tools are tremendously capable, but are employed in the wrong place in the process. By embedding CAC capabilities into the documentation workflow, Salar helps hospitals realize the full potential of their EMR investment.


How do you see your market and products changing as healthcare reform continues over the next several years?

For the short term, the customizability of our documentation platform makes us ready for everything we’re going to see in the next year or so. For ICD-10, we’re incorporating NLP tools from HLI and other vendors to accomplish meaningful front-end CDI at the point of documentation. For Meaningful Use or any other report-heavy regulations, the ability to add specific fields overnight is going to allow customers to handle these changes without any additional overhead.

Looking out a little further, we will be focusing on the front-end CDI loop in TeamNotes. By incorporating more computer-assisted tools to physicians, as well as providing for more complicated workflows with CDI staff, we believe we can truly maximize the value of these tools for both hospital and physician.

We’re very interested in how Physician/CDI/Billing workflows develop and how we can facilitate a more efficient process. We’re also very interested in the ACO model and what needs to be provided from both a reporting and a documentation perspective. We think we’re in a good position to accommodate multiple reimbursement models because of our customizable templates.

In the longer term, we’re looking at how other workflows within hospitals – and workflows between hospitals and other care organizations – are starting to blend. There are many processes that have been overlooked and underserved from a technology perspective, and for the good of the patient population, should be optimized. We can’t wait to solve these problems.

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January 4, 2013 Interviews 1 Comment

CIO Unplugged 1/1/13

December 31, 2012 Ed Marx 141 Comments

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

What Do I Stand For?

But I still wake up . . .
Oh Lord, I’m still not sure, what I stand for
What do I stand for? Oh what do I stand for?
Most nights, I don’t know any more.

I like the tune Some Nights by the indie alternative group fun. You can argue the meaning of the song, but the hook, “What do I stand for?” resonates with millions, including me.

The issue people struggle with most is discovering purpose in life. This is one topic I’m frequently invited to speak on and the one concern for which people often ask my help. In light of this, I’m revisiting a blog from a few years ago that I hope you’ll find practical.

I have no secret formula nor warrant that what worked for me and my family will work for you. Making life easy and eliminating challenge is not my goal. Living out purpose involves inherent trials. What I offer are principles and a process that will facilitate your journey into discovery and could possibly transform your life on different levels. I’ve shared these ideas for many years in different cultures and have witnessed dramatic change.

Let’s set the record straight: resolutions don’t work.

The first thing I ask those who ask for help is, “What’s your plan?” Such as, what is your mission, vision, values, objectives, etc. I’ve never received an articulate first-time response. But when I ask people about their organization’s plan, they’re quick to answer.

The dichotomy is evident. Why would you take the time to memorize and labor to achieve the plans of your organization but not do the same for yourself or your family? The good news: you already possess the tools and experience to close this gap. But it takes time, energy, and determination.

I finished grad school in 1989 with business planning concepts drilled in my brain. My company embraced these concepts, and I knew our execs jetted off to resorts to spend considerable time planning. Market performance confirmed a strong correlation.

For me, the disconnect came in hearing of their struggles on the personal side of the ledger. One particular Fortune article reinforced my thought process: “Why Grade ‘A’ Execs get an ‘F’ as Parents.” Having just started a family and career, I was searching for ways to have success in both.

Could I increase the odds of personal success by adopting business theory?

Our First Family Retreat

The Marx family’s strategic planning adventure began modestly. Short, inexpensive trips away from home reduced distraction and stimulated creativity. These trips morphed into more elaborate excursions, but the focus always remained on strategic planning.

12-31-2012 7-57-23 PM

Our first retreat in nearby Estes Park cost us about $100. We worked on a one-page plan that became known as the “Marx Family Constitution.” Originally written in 1990, it has withstood the test of time.

Since incorporating this process, we’ve all experienced dramatic increases in the quality of our careers and relationships. Our oldest, now age 25, had coached his college peers in these concepts. Not long ago, my wife heard our youngest, age 19, encourage her boyfriend to discover his life purpose and come up with a plan to live it out. Julie and I recently celebrated our 27th wedding anniversary and are still twitterpated.

I don’t have the space to share the numerous examples, but I can share the one that had the most impact. My son, age eight at the time, took a ruler and pointed to the values section of our Marx Family Constitution that hung prominently in our family room. “Dad,” he said, “was that honoring mom when you yelled?” Seven months prior, when deciding which six values needed improvement, he had contributed the word “honor.” He called me on it. Accountability!

We aim to live out what Rick Warren calls The Purpose Driven Life. Decisions on how to spend our time, energy, and resources are guided by past retreats. I could go back through 20 years of documentation and show you at least one significant event that happened each year in my career, marriage, and family. Could you?

Keeping it Fresh

Take annual retreats to focus on your plan. Get out of Dodge and spend time in a setting where beauty can inspire. A place free of distraction. As leader, your job is to facilitate.

WARNING: never force your ideas down the family’s throat. Instead, invite them to dream and evaluate. Kids especially need to think for themselves. Review your plan and encourage transparent dialogue about performance. Record the highlights of the previous year. What are the gaps and how do you close them? Include significant others and engage your kids. Teach them. Envision them — but NEVER do it FOR them. Commission them. Then watch them rock not only your world, but also the world around them.

Disney makes for great vacations. Planning retreats make for enabling identity and significance.

Take Action

Forget resolutions. They don’t work. No organization runs with resolutions. Market share would drop, and eventually you’d go bankrupt.

Schedule your first retreat and prepare to write, because earth-moving ideas existing ONLY in your head haven’t the magic to propel you forward. Write them out. Teach them. Actualize them. You only live once.

There’s nothing worse than going through planning exercises merely to have the plan collect dust. Create a living vision. When someone asks you a career or life question or you face a major decision, your purpose will keep you standing.

What do you stand for?

***If interested in creating a plan for your career, life, etc., leave a comment. I will send you a copy of my one-page strategic plans (personal, career, family). I will include a retreat guide designed to stimulate thoughts and ideas around your mission, vision, values and objectives as you put your plan together.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

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December 31, 2012 Ed Marx 141 Comments

News 12/28/12

December 27, 2012 News 1 Comment

Top News

12-27-2012 9-01-25 PM

A year-long investigation by The Washington Post finds that healthcare is among the sectors most vulnerable to hackers because it lags other industries in fixing known security holes, quoting one expert who said, “If our financial industry regarded security the way the healthcare sector does, I would stuff my cash in a mattress under my bed.” A physician user of OpenEMR, which was called out in the article for its security vulnerabilities, left this comment:

I maintain OpenEMR under Linux at my wife’s medical clinic. Behind two firewalls, not accessible over the public internet. We considered WorldVista, but that is written in MUMPS, and requires Windows clients (not on our network). WorldVista is more suited to megapractices like the VA system it was written for. OpenEMR has many problems, but being open source, the problems are being found and fixed rapidly. Software developers are encouraged to join the effort to improve it. Other alternatives include hugely expensive systems like Epic (which infests most local hospitals) and various Web-based services moving information over the public Internet (dangerous!) That is how Epic works – and anyone with two login/passwords to a megahospital system can get access to hundreds of thousands of patient records. Scary, yes – but if more barriers are added, time is lost and PATIENTS WILL DIE.

HIStalk Announcements and Requests

I don’t need an Official Red Ryder Carbine-Action, 200-Shot Range Model Air Rifle, but I could use some gifts that carry no danger of shooting my eye out: (a) sign up for spam-free e-mail updates, basking in the knowledge that doing to will make you eligible to vote in the upcoming HISsies awards; (b) support HIStalk’s sponsors by reviewing and possibly clicking their ads (now on your right), checking out their listings in the Resource Center, and using the couldn’t-be-easier Consulting RFI form to painlessly solicit consulting proposals; (c) connect our respective social ganglia on Facebook, Twitter, and LinkedIn; and (d) slip us news and rumors via the methods listed under the “Report News and Rumors” box to your right, which includes a new option: call my Rumor Line at 801.HIT.NEWS and leave a message, which thanks to Google Voice will be transcribed and e-mailed to me along with the original recording.

It’s almost New Year’s, so I’m setting my priorities for 2013. I’m looking for HIStalk-related projects or activities that would be more personally satisfying and society-benefiting than just making money, which doesn’t interest me all that much (obviously, since I work for a non-profit hospital). Thoughts?

Acquisitions, Funding, Business, and Stock

12-27-2012 7-26-24 PM

Awarepoint secures $4 million in new financing from an undisclosed investor.

12-27-2012 7-27-19 PM

McKesson says its $2.1 billion purchase of PSS World will be finalized in the first quarter.


12-27-2012 9-38-02 PM

The Oregon Community Health Information Network (OCHIN) names Scott Fields, MD (OHSU – above) CMO, Jonathan Merrell (Cherokee Nation Health Services) VP of performance improvement, Tim Burdick, MD (Fletcher Allen Health Care) CMIO, and D’Angela Merrell (US Public Health Service) clinical improvement professional.

Announcements and Implementations

HIEs Healthcare Access San Antonio and Integrated Care Collaboration begin sharing patient information.

12-27-2012 3-39-49 PM

Mercy McCune-Brooks Hospital (MO) goes live on Epic.

12-27-2012 9-23-15 PM

Texas Health Harris Methodist Hospital Alliance (TX), which opened as a new 50-bed hospital in September, earns HIMSS Analytics EMRAM Stage 7 recognition. I interviewed Winjie Tan Miao, the hospital’s president, two weeks ago.

The NJSHINE (NJ) HIE gets a $1 million grant from the New Jersey Department of Health to connect seven hospitals.


12-27-2012 12-53-37 PM

Consumer Reports rates the performance of 19 Wisconsin medical groups based on quality measurements for cancer screening, care of people age 60 and older, and treatment of patients with heart disease. ThedaCare Physicians and Marshfield Clinic earned the top spots.

The LSU hospital system notifies 416 patients that their information, including checking account numbers, has been stolen. A former billing department employee and six other people have been charged with identity theft after creating and passing counterfeit checks and ID cards from scanned check images stored in LSU’s computers.

Pittsburgh systems UPMC and West Penn Allegheny fight to acquire each other’s affiliated physician practices, leaving patients unaware of the change and sometimes forcing physicians to practice outside of Allegheny County beginning immediately without notifying their patients to satisfy non-compete clauses. The medical records stay with the practice, leaving the patient to figure out their options

University of Michigan Health System notifies 4,000 patients that their information may have been exposed in the theft of an unsecured PHI-containing electronic device from the car of an Omnicell employee.

Efforts by the Metropolitan Chicago Healthcare Council to create Chicago-area HIE may fail as just 18 of 30 targeted health providers agree to join. Money is a sticking point, with some hospitals being asked to pay six-figure annual fees to participate. Health systems are also concerned with the uncertain value of the exchange, especially at a time many are investing heavily in their own IT systems.

12-26-2012 2-44-19 PM

A third of providers say they have experienced varying levels of payment delays during the HIPAA 5010 transition, with clearinghouses causing 52 percent of those delays, according to a KLAS report.

Hospital CFOs look ahead to 2013 with concern, worried about:

  • The resources required to justify admissions
  • Possible payment and cash flow problems due to Medicare changes
  • Funding quality initiatives to support value-based payment systems
  • The high cost, questionable return, and change involved with technology implementation
  • Hiring more doctors
  • Trying to scale physician compensation to what the practice actually produces
  • Engaging physicians who practice only an outpatient setting
  • Managing growth by acquisition
  • Improving clinical documentation for patient safety and quality
  • ICD-10

12-27-2012 9-18-00 PM

A maternity hospital in a Nairobi, Kenya slum admits that it holds mothers of newborns as prisoners until they pay their hospital bills. The hospital is accused by one woman of having guards beat mothers who try to leave without paying. According to the hospital’s director, “We hold you and squeeze you until we get what we can get. We must be self-sufficient. The hospital must get money to pay electricity, to pay water. We must pay our doctors and our workers. They stay there until they pay. They must pay. If you don’t pay, the hospital will collapse.” The charge for a normal birth is $35, while a C-section runs $70 and the daily room charge is $5. A first-person report (from which the above photo came) is here.

Sponsor Updates

  • Vonlay offers tips on how to quickly recycle an IIS application pool in a blog pos.
  • PeriGen hosts a Webcast on improving financial results in obstetrics January 16 and 30.
  • Shareable Ink’s President Stephen Hau discusses mHealth applications and how they can liberate physicians and data in a guest article.
  • Dennis Weissman, founder of Washington G-2 Reports, will deliver the keynote at the Lifepoint Informatics user conference Orlando March 21.
  • Liaison Technologies offers a white paper discussing the use of cloud-based data integration to overcome interoperability challenges in health systems. 
  • API Healthcare executives participate in a giving back campaign.
  • Business NH Magazine names Digital Prospectors Corp a top small company to work for in New Hampshire.
  • Dave Caldwell of Certify Data Systems shares insights on the barriers and issues that need to be addressed in order for the healthcare industry to achieve widespread interoperability.
  • Besler Consulting will participate in next month’s HFMA MA/RI Annual Revenue Cycle Conference in Foxborough, MA and the Region 11 Annual Healthcare Symposium in Las Vegas.
  • Thomson Reuters includes 3M, AT&T, and Fujifilm on its list of the World’s Top 100 Most Innovative Organizations for 2012.
  • Saint Luke’s Health System (MO) shares how Philips Healthcare Consulting helped the organization build an eHealth strategy of regional outreach and physician-to-physician relationships to drive growth.
  • ZirMed releases its 2013 PQRS Suggested Measures and Monitoring tool.

EPtalk by Dr. Jayne

The use of Health Information Exchanges is one of my pet topics, particularly issues around governance. I’m happy to see ONC hosting one of their Town Hall meetings on the topic. It will be held on January 17, so there’s still plenty of time to sign up.

It’s always fun to get together with family over the winter holidays. This year’s hot topic among the Medicare set was the concept of Accountable Care Organizations. They wanted to know my opinion. Unfortunately, I had to give the answer of, “It depends.” Even though there are core principles for ACOs, there seem to be many different flavors out there.

Patients need to realize that a key driver of ACOs is slowing the growth of healthcare spending. Quality and meeting patient needs are also goals. For patients involved in ACOs that have a long history of managing quality and cost initiatives, there may not be much of a difference in care because referral relationships and practice patterns are already established. However, for health systems that have not been functioning in shared care models, there may be trouble ahead. There will be a significant learning curve for participating physicians and their care teams.

The subtleties of the ACO patient assignment regulations can cause situations where providers are ensnared by a single ACO. Patients also need to find out whether they will be able to continue to see all the providers from whom they receive care or whether they will have to change to specialists within the ACO. I also think it’s funny that when seniors are talking about ACOs and their benefits, they refer to the Affordable Care Act. When they’re talking about the negatives, they refer to Obamacare. They’re one and the same, folks.

With the holiday, it was a snow news week. Hopefully as people are trickling back into their offices things will pick up. In the mean time, please give your friends at HIStalk the best gift of all – send your rumors, newsy tidbits, and other reports our way.



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

More news: HIStalk Practice, HIStalk Connect.

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December 27, 2012 News 1 Comment

News 12/21/12

December 20, 2012 News 13 Comments

Top News

12-20-2012 9-11-51 PM

Allscripts shares closed Thursday at $9.14, down over 14 percent since Wednesday’s after-hours announcement that it would not pursue being acquired and instead will replace its executives and forge ahead. The company’s market cap is $1.6 billion. If you had invested $10,000 each in Allscripts and Cerner shares on January 1, 2000, you’d have $1,983 and $157,874, respectively. If you’d made the same investment five years ago, you would be holding $4,560 and $27,982. Obviously the company is hoping that Paul Black had enough influence in Cerner’s success to be able to replicate it at Allscripts. They’re bragging publicly on his background and Cerner’s success, which is odd given that Cerner is perhaps its most direct competitor.

Reader Comments

12-20-2012 6-13-48 PM

From HITEsq: “Re: another patent troll. A Puerto Rico-based company, Ingeniador, is going after GE Healthcare and McKesson for violating a 2006 patent whose claims are as ridiculous as its title – ‘Publishing System for Intranet.’”” I did some digging and found that the “company” is a former Hewlett-Packard software engineer named Marcos Polanco, who developed a database management system for his employer and then sued them for royalties. Since then, he has sued everybody and their brother, including Microsoft, HP, Oracle, Lexmark, and SAP. He apparently bought the patent he’s waving around from an oil services company. He’s big on Puerto Rican enterprise, entrepreneurship, serving as COO of glucometer vendor iCare Medical, and filing ludicrous lawsuits.

12-20-2012 6-45-15 PM

From Top Chef: “Re: Paul Black. I knew him from his Cerner days. Good guy, very smart and affable. Guess he’s ready to jump into it again!” Glen and his loyalists had to be fired, of course, when the PE tire kickers passed on Allscripts, leaving the company desperate to change something (anything) to put the stench of a disastrous year behind it — missing Wall Street expectations; firing the Eclipsys supporters on its board and barely keeping Glen; caving in to a proxy fight by reluctantly adding three HealthCor-nominated board members; watching its share price drop nearly 40 percent in a single day; having word of its private equity courtship leaked publicly; choosing the worst possible time to announce the halt in MyWay development; and having its customers name it as the worst vendor in the country with their KLAS product ratings. Not to mention the final embarrassment of having the potential acquirers walk away from the smoking wreckage. Paul Black has his work cut out for him. I would like to see his first order of business be to drop the company’s ridiculous lawsuit against NYCHHC and provide an update on the Sunrise integration status, which was supposed to have gone to beta in June per Glen. I’m not convinced Sunrise is viable given lack of sales and what must be high R&D costs and a declining user base, so they need a strategy that doesn’t involve going toe-to-toe with Epic and also to re-introduce Sunrise Financial Manager, which got lost in all the juicy company turmoil. The PE guys would have trimmed the product line and headcount (7,000 employees seems like a lot), so with Glen out of the picture, those options are surely on the table. Unfortunately, they’ll have to make those decisions under Wall Street’s microscope and that’s hard. Here’s where you get the chance to play Monday morning quarterback like me: leave a comment with the 2-3 things that Paul Black needs to do first to get Allscripts on track.

HIStalk Announcements and Requests

12-20-2012 10-38-04 AM

inga_small I got my first Christmas present in the mail yesterday from a couple of my favorite gal pals: a daily shoe calendar for 2013. Each day looks better than the next!

histalk practice new

inga_small Mr. H also gave me an early Christmas present with the refresh of the HIStalk Practice site, complete with a new logo (thank you, Dodge Communications) and a sleeker format. Take a peek and let us know what you think. This week’s HIStalk Practice highlights include a don’t miss year-in-review post by Joel Diamond, which I promise is the funniest read of the season. SRS’s EHR takes the top spot in a survey of ambulatory care specialists. The big winners and losers in KLAS’s Physician Practice Solutions categories. KLAS is criticized for favoring big vendors that subsidize KLAS operations. CareCloud names John J. Walsh CTO. Thanks for reading.

On the Jobs Board: Chief Information Officer, Cerner Experienced Providers.

If the world ends today or if I decide that nobody will be reading on Christmas Eve, there won’t be a Monday Morning Update. I’m betting I’ll be right here over the weekend, though.

Acquisitions, Funding, Business, and Stock

Allscripts held a short investor conference call Thursday morning to go over the changes. You can listen to the recording here. My notes:

  • The company still won’t say whether it received any acquisition offers, only that it decided to continue as the current entity.
  • The CFO is aggressively looking at cost controls and productivity plans.
  • Black: “We’re not going to waste any time going to work.”
  • ICD-10 functionality is complete and Meaningful Use 2 is well underway.
  • “Disruptive, open technology,” common user experience, and single patient workflow.
  • “There will be no substitute for results” and “we need to move quickly.”
  • Question: who will lead the product refresh effort? Answer: Cliff Meltzer, who will continue as EVP of solutions development.
  • Question: since the company stopped giving guidance, how’s the quarter going? Answer: we’ll benefit from the clarity around the company’s direction. The lack of clarity this year was a misstep.
  • Question: was the board’s decision to stay independent unanimous? Answer: the board doesn’t comment on their deliberations. There were no dissents on Glen stepping down.
  • Question: is customer attrition running in line historically? Answer: I don’t have the number, but retention is steady in all facets of the business.
  • Question: Glen said earlier this year that the company brought on 400 employees to work on integration. Was it money well spent and are customers happy with functionality? Answer: Not all of our clients are happy and we won’t rest until 100 percent are. I won’t be happy until we don’t need a sales force because they’re beating down our doors and our fax machines are burning up with orders. R&D spend will continue at the current level.
  • Question: what’s the order of strategic initiatives? Answer: solidify the client base; review expenses; step up revenue, engineering, and operations to keep surprises to a minimum.
  • Question: was there a precipitating event that led to the changes? Answer: just the completion of the strategic review.
  • Question: what areas other than product innovation and R&D will be emphasized? Answer: increase emphasis on application hosting, add managed services for the large ambulatory clients, review why home health and patient flow solutions don’t seem to produce as well as the market would suggest is possible.
  • Question: how will the executive suite shape up? Answer: I expect to bring folks in, but review talent and promote from within if possible. I will bring in people I’m comfortable with working with and those I’ve worked with in the past.
  • Question: what’s the lowest-hanging fruit? Answer: the large number of doctors using the systems regularly are the mother lode and the company will build around that core.

Terms of Paul Black’s deal to take over Allscripts include a three-year contract for $1 million per year in salary and a $1.5 million annual bonus target with the 2013 payout guaranteed; a $1.25 million signing bonus; $3 million in shares vesting over three years; $3 million in incentive-based shares; $2.5 million in service-based restricted shares vesting over four years; and $2.5 million in a performance-based equity award. If he quits or is fired, he gets two years’ of severance including his bonus target (total of $5 million) and an extra year of vesting. Glen Tullman and Lee Shapiro get a parting gift that includes a year’s salary, their target bonuses, and acceleration of vesting. If the company sells itself within a year, they’ll get two years’ salary plus their target bonus.


12-20-2012 5-44-05 PM

HealthEast’s (MN) board of directors approves the $135 million purchase of Epic, which will replace seven platforms.

The US Navy and Army award Dell, BRIT Systems, and Acuo Technologies a $45 million contract to create a Unified Clinical Archive for PACS to be used by 49 medical facilities.

Meadowlands Hospital Medical Center (NJ) and Urban Health Plan (NY) choose eClinicalWorks Care Coordination Medical Record and EHR solutions to advance their ACO initiatives.

12-20-2012 5-41-02 PM

Colorado Springs Health Partners will implement the Professional Charge Capture solution from MedAptus for inpatient professional services coding and billing.

Hometown Health (NV) will deploy MedHOK’s care management, quality, and compliance platform.

SAIC wins a one-year, $17 million contract to support the Coast Guard’s Integrated Health Information System, which is the name of its implementation of Epic.


12-20-2012 9-37-25 AM

Harris Corp. names Vishal Agrawal, MD (McKinsey and Co.) president of Harris Healthcare Solutions.

12-20-2012 9-40-56 AM

Bob Hajek (Humanscale) joins Divurgent as a VP of client services.

12-20-2012 10-00-11 AM  12-20-2012 3-28-26 PM  12-20-2012 5-47-28 PM

PatientSafe Solutions names Frank Pecaitis (GE Healthcare) SVP of sales and Bruce Eklund (AHM) SVP of operations, also promoting Joseph Condurso from president/COO to president/CEO.

12-20-2012 8-18-15 PM

Tom Bang (A-Life Medical, Cardinal Health) is named CEO of post-acute care systems vendor BlueStep Systems. Former CEO Roy Rasband will move to the CTO role.

Announcements and Implementations

12-20-2012 10-56-37 AM

The 500-member American College of Medical Coding Specialists votes to join AHIMA.

The Texas Organization of Rural & Community Hospitals announces the Phase 1 go-live of its TORCH HIE at Wilbarger General Hospital (TX). It uses the CollaborNet interoperability solution from Holon Solutions.

Government and Politics

HHS’s Office of Inspect General advises hospitals that they are not violating anti-kickback statutes when they provide community physician practices a free interface to support exchanging orders and results.

12-20-2012 8-28-08 PM

Charles Boustany, Jr. MD (R-LA), chair of House Subcommittee on Oversight, sends a letter to HHS Secretary Kathleen Sebelius asking her to provide the department’s policies on archiving electronic messaging. Whistleblowers have alleged that HHS’s political appointees are intentionally using instant messaging to avoid leaving a discoverable record of their communication with department employees.

The government’s Space and Naval Warfare Systems Center, charged with developing a Department of Defense database for tracking medical examinations for officer candidates, is found to be $7 million over budget and may never deliver a working system. Administration of the contract, which was issued an Alaska firm under a government requirement that Alaska native companies receive preferential treatment, has been taken over by the General Services administration.

Innovation and Research

12-20-2012 8-11-38 PM

Yet another healthcare IT accelerator fans to life, this time in Miami. Project Lift Miami will offer 10 to 15 startups seed funding, office space, and mentoring in a 100-day program.

Microsoft is working with the military to offer Kinect-powered home physical therapy treatments to injured soldiers and veterans using the ReMotion 360 software from InfoStrat. Microsoft is also working on a Kinect-based based system for conducting online group therapy sessions for patients with post-traumatic stress disorder.


The Wilmington, DE VA hospital rolls out a visitor way-finding kiosk system that features a talking avatar named Val, which stands for “Veterans Affairs locator.” The system, which also allows visitors to pre-plan their visit online, was developed by LogicJunction.

12-20-2012 7-57-11 PM

A public radio station profiles Syracuse-based startup Simple Admit, which allows patients to complete their forms online before their provider visit.

12-20-2012 8-00-31 PM

Griffin Technology offers the AirStrap Med, a $90 sling case that makes it easier to use an iPad during rounds.


A poll finds that only a third of health system leaders are confident in their organization’s readiness for Meaningful Use Stage 2.

An interesting vision of how clinical documentation could be performed by the rounding teams of academic medical centers, offered by by John Halamka on his blog:

The entire care team jointly authors a daily note for each patient using a novel application inspired by Wikipedia editing and Facebook communication. Data is captured using disease-specific templates to ensure appropriate quality indicators are recorded. At the end of each day, the primary physician responsible for the patient’s care signs the note on behalf of the care team and the note is locked. Gone are the "chart wars", redundant statements, and miscommunication among team members. As the note is signed, key concepts described in the note are codified in SNOMED-CT. The SNOMED-CT concepts are reduced to a selection of suggested ICD-10 billing codes. A rules engine reports back to the clinician where additional detail is needed to justify each ICD-10 code  i.e. a fracture must have the specifics of right/left, distal/proximal, open/closed, simple/comminuted. You can imagine that the moving parts I’ve described are modular components provided by different companies via cloud hosted web services (similar to the decision support service provider idea).

Medical device manufacturers are blaming the Affordable Care Act’s 2.3 percent tax on their products for industry layoffs, but economists say companies were already bloated in a slow market and would have had to cut jobs anyway. The manufacturers‘ trade group is trying to have repeal of the tax included in fiscal cliff negotiations, but the President says he’s not a fan of that idea.

12-20-2012 8-42-53 PM

Pediatric patients at Geisinger Medical Center (PA) receive iPad-based visits from Santa Claus in the hospital’s “Santa Cam” program.

Weird News Andy summarizes this story as “Good news, bad news.” A 27-year-old cystic fibrosis patient receives a long-awaited lung transplant, but then dies of lung cancer 16 months later. The lungs she received were from a donor who smoked heavily, which is apparently the case in 40 percent of lung transplants. The hospital trust has apologized for not disclosing that fact in their explanation of the risks involved, saying that patients almost always want whatever lungs they can get.

Sponsor Updates

12-20-2012 7-22-24 PM

  • Sunquest hosted a December 7 fundraiser to provide foster children with Christmas gifts. The cookout, Hostess Twinkie raffle, and company donation raised over $7,000 for Aviva Children’s Services.

12-20-2012 7-25-22 PM

  • CTG Health Solutions launched its Holiday Military Appreciation Campaign for military family members of its employees, sending gift packages both to those serving and to their families. The company also continued its tradition of taking the money that would have been spent on customer greeting cards and instead donating it to Operation Homefront, which provides support to military families.

12-21-2012 6-37-35 AM

  • Cornerstone Advisors establishes Cornerstone CAres, a charitable giving program funded by employee contributions and matching company donations. Its first project was to help employees of long-time client Chilton Hospital (NJ), which was severely impacted by Hurricane Sandy. Receiving the donation was Chilton VP/CIO Mark Lederman (above).
  • SIS employees raised over $12,000 to purchase gifts and supplies in support of Embracing Arms home for girls, The Empty Stocking Fund, the Secret Santa Ministry, and Toys for Tots.
  • Liaison Technologies shares its 2013 forecast for cloud adoption, business integration, and managed services.
  • Levi, Ray and Shoup offers a white paper on enhanced document printing and viewing in the healthcare industry.
  • A White Plume blog post called “Healthcare’s Wake-Up Call for 2013-2014” warns of the urgency needed to prepare for PQRS, MU2, ICD-10, and HIX.
  • Fulcrum Methods provides details of how it helped NorthBay Healthcare successfully attest for Meaningful Use.
  • Raymond Fabius, MD, chief medical officer of Truven Health Analytics, warns employers that moving to  an exchange-only health benefits model based on cost alone.
  • Business NH Magazine names Bottomline Technologies a “Best Company to Work For” for the fifth consecutive year.
  • Northwest Michigan Surgery Center shares how its implementation of Versus Advantages IR/RFIF RTLS has helped it perform as one of the nation’s top ambulatory surgery centers.
  • Medseek will incorporate the Healthwise Patient Engagement solution into its health content offerings.
  • InteliChart and RelayHealth develop a health information exchange platform that integrates with InteliChart’s suite of connectivity solutions and provides bi-directional exchange between the ambulatory and hospital settings.
  • Humedica and Pfizer announce a multi-year strategic alliance to use Humedica’s de-identified healthcare data to improve drug effectiveness.
  • EMRConsultant offers a free survey for practices interested in improving efficiency and reducing expenses.
  • Modern Healthcare names MedAssets as the largest revenue cycle company.

EPtalk by Dr. Jayne

CCHIT will develop an IT framework for Accountable Care Organizations, hoping to identify the infrastructure needed. An advisory panel is being formed to develop the framework, which will ultimately lead to additional CCHIT certification programs.

ONC seeks applications for two new consumer-focused HIT FACA Workgroups: the HIT Policy Committee’s Consumer Empowerment Workgroup and the HIT Standards Committee’s Consumer Technology Workgroup. Applications are due by January 14, 2013.

As if this week’s predicted apocalypse isn’t enough, a recent article cites ICD-10 as causing shock, awe, and fear. Seriously, people, we’ve known it’s been coming for years, and warning of “apocalyptic-type scenarios” is a little much. Remember Y2K? A staffer at UnitedHealth Group is quoted as saying that use of both ICD-9 and ICD-10 together will cause “mass hysteria.” Guess what? Using both will be reality for many of us, because not all payers are switching over. There’s no requirement for non-covered entities or those using paper claims to change.


I received a fair amount of feedback on my recent discussion of the Meaningful Use smoking status measure.

From Under the Mistletoe: “Dr. Jayne, you are not a hair splitter at all, and I think these descriptors are absurd. This is the calculation we always use: pack years. Certainly closer to quantifiable, not perfect, but I am really disappointed in what you described from SNOMED. How disappointed was I? Well, I could say ‘extremely,’ or would you prefer on a 1 to 10 scale with 10 as the worst possible – a 10?”

Mr. H hinted to one correspondent that I may have been “cranky” when I wrote that piece, which I guess is true. Like a reported 77 percent of physicians, I’m at least somewhat pessimistic about the future of medicine and exhibit a higher degree of pessimism after a day of seeing patients. When you’re dealing with parents who can’t figure out how to pay for a $4 antibiotic for their child (and who bring her to the ER because they don’t have Tylenol at home), some of the things we do in the informatics office seem pretty ludicrous.



HIMSS created a word cloud showing the educational offerings for the upcoming HIMSS13 meeting in New Orleans. In response, I offer up my own.



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

More news: HIStalk Practice, HIStalk Connect.

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December 20, 2012 News 13 Comments

Readers Write 12/19/12

December 19, 2012 Readers Write No Comments

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

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

Epic’s “Rules of the Road”
By Frank Myeroff

Are you aware of the hiring guidelines from Epic entitled “Rules of the Road?” These rules are in place to protect Epic clients by ensuring that staff members do not negatively impact their implementation projects by leaving them.

The rules state that you are not able to recruit or hire any employee from an Epic customer until four months after the go-live, unless the individual is hired for a position that is not related to Epic. You are also not able to place or hire any individual who left employment from a customer’s Epic project before critical go-lives or rollouts are complete until one year after the individual’s last day at the customer.

The “Rules of the Road” no longer permit recruiters to acquire employees from an active install or rollout. With rollouts at hospitals continuing well into 2014, the Epic contracting staff are essentially locked in and prohibited from leaving and consulting before completion. Before these rules, recruiters were able to acquire HIT talent already working at hospitals but interested in entering the job market as an Epic consultant.

As a result, the demand will continue to grow, but the consulting pool will shrink. This increased competition for Epic consultants could increase hourly rates over 2013.

From time to time, I speak with Epic candidates who have quit their jobs in order to consult prior to knowing about the “Rules of the Road.” Unfortunately, these candidates are not eligible to consult on any Epic project for one year.

Please ask the question: is the Epic contractor I’m about to hire eligible to consult? Don’t find yourself in the situation where you’ve filled an open Epic consulting position with an ineligible candidate.

Infractions to Epic’s “Rules of the Road” will result in the loss of the consultant’s access to the Epic User-Web. Eligibility of the candidate to consult should be the first question you should ask any staffing firm submitting a candidate for consideration in order to avoid this costly situation.

To be sure that you are meeting Epic’s “Rules of the Road”, only work with firms that have a relationship with Epic and its consulting relations department. Reputable firms will work closely with that department to validate that your candidate(s) is eligible to consult.

Frank Myeroff is managing partner of Direct Consulting Associates of Solon, OH.

Multi-Tasking Metrics
By Anil Kottoor

12-19-2012 1-54-56 PM

An Accountable Care Organization (ACO) is only as successful as the sum of its fundamental parts. Failure by just one participating provider to achieve a successful outcome on any of the 33 required quality measures could ultimately stand between the ACO and its eligibility for incentives under the Medicare Fee-for-Service Shared Savings Program.

So why not make those required metrics multi-task?

Every provider involved in an ACO should be leveraging the quality metrics they must already track to monitor internal performance and identify areas in need of improvement. From improved documentation to streamline care transitions to compliant coding and billing for more appropriate reimbursement levels to better utilization of resources for efficient patient throughput and reduced overhead costs, every aspect of a provider organization can be improved with internal benchmarking.

By repurposing data already collected to comply with reporting requirements, ACOs can easily perform effective internal benchmarking across the organization to identify gaps in care or areas of exposure before they affect the organization as a whole.

In particular, the metrics collected under the care coordination/patient safety and preventive care domains can reveal clinical outliers that may necessitate education, outreach, or process improvements. For example, by tracking the average HbA1c level across its diabetic population, an ACO can identify which if any patients run consistently higher than average after a one-year period. This could trigger a closer look at how individual physicians engage their diabetic patients to determine whether the outliers are a result of the treatment plan or the patient’s non-adherence to that plan.

Tracking and monitoring utilization rates and medical costs can also be useful to identify those providers who are managing care and costs more effectively compared to their peers. This information can then be leveraged to identify best practices which can be shared to align all providers within the ACO.

Further, by monitoring claims data, ACOs can identify the frequency of returned and rejected claims or missed filing deadlines. From there, the ACO can take a closer look at individual practice workflows and processes to determine how the situation can best be remedied.

The full benefits of ACO participation will only be realized when all providers are efficiently managing care and costs within the organization. One provider or practice can impact overall ACO performance. By utilizing the real-time information necessary to comply with external benchmarks for internal benchmarking purposes, providers can ensure that they are contributing to the good of the ACO and the organization is on track to meet the quality outcomes necessary to qualify for shared savings.

The successful ACO will partner with a technology company that can present data both retrospectively and in a real-time actionable manner to improve workflow and care outcomes. By focusing efforts on real-time reporting, ACOs will be more likely to demonstrate improvements in care and quality outcomes, thereby improving the likelihood of receiving financial incentives under the Shared Savings Program.

Anil Kottoor is president and CEO of MedHOK of Tampa, Fla.

Coordinated Care and the Changing Role of Payers
By Ashish Kachru

12-19-2012 1-56-12 PM

The result of the recent presidential election did more than return President Obama to the White House. His signature policy victory, the Affordable Care Act (ACA), looks like it’s here to stay as well.

Whether or not you agree with this policy politically, the ACA will introduce substantial changes to the US healthcare system. Millions more Americans will have an opportunity to purchase health insurance. The nature of that insurance is also changing. Lifetime limits on benefits and coverage of pre-existing conditions will be lifted.

One of the most significant systemic shifts introduced by the ACA is the expansion of integrated care delivery models. With millions more Americans now eligible to receive healthcare, hospitals and primary-care practitioners simply do not have the capacity to handle this new volume of patients. For RNs and other clinicians in a variety of care settings to effectively pick up the slack, patients must be assured they will receive seamless, consistent, high-quality care.

Of course, bringing millions of new patients into the healthcare system is unsustainable without to reducing the cost of care delivery. The ACA includes a host of cost containment and quality improvement initiatives that, collectively, are helping us migrate from a reactive, quantity-driven healthcare system to one that’s driven by quality, patient satisfaction and coordination among patients, physicians, providers, and payers.

It’s hard to overstate the importance of this migration. A reactive approach to care is one in which patients present symptoms to their healthcare providers. Treatment is focused on identifying the illness as presented and mitigating its effects on the overall health of the patient. Proactive care hinges on communication initiated by healthcare providers. The focus is not on treatment but prevention – identifying potentially negative health outcomes (and their associated costs) before they occur.

In a proactive care environment, physicians, hospitals, and other healthcare providers coordinate care for a population to improve the health of individual patients. With the right data, analytics tools, and workflow technology, coordinating population care can be streamlined, cost effective, and powerful.

The Center for Medicare and Medicaid Services (CMS) has taken a lead role in our migration to a proactive care environment by initiating and funding a variety of new payment and delivery models. At the federal level, more than 150 Accountable Care Organizations (ACO) have been launched since 2011. The CMS State Innovation Models Initiative provides competitive funding opportunities for states to implement and test their own payment and delivery improvement models.

Many safety-net health plans have existing population care management platforms that already enable them to coordinate care proactively with their provider community. These systems dovetail nicely with both the ACO mission and many state-specific care coordination initiatives. Many payers, in other words, are already up to speed on leveraging data – both internally-generated claims data as well as clinical data from provider EMR systems – to identify high-risk patients and actively engage them in their health.

The next few years will be crucial to ensuring our proactive, quality-driven healthcare system becomes successful. It’s a huge shift for everyone involved. But with the right technology solutions, widespread implementation of best practices and the removal of data barriers between patients, providers, and payers, the US healthcare system can successfully delivery higher-quality care to more people at a lower cost.

Ashish Kachru is CEO of Altruista Health of Reston, VA.

The Patient’s Point of View: Patient Centered Medical Homes (PCMH)
By Joe Crandall

12-19-2012 2-05-12 PM

About 10 years ago, I was hospitalized a few times for colon cancer. Because of this experience, I pursued a professional career in healthcare.

Most recently, I have seen a care provider about 10 times for myself or my kids. You could say I am an educated consumer of healthcare. I would like to offer a patient’s perspective on the PCMH being adopted as a new care delivery model for the primary care physicians (PCP) office.

First, the PCMH has a lot to offer patients and caregivers:            

  • Better access to healthcare
  • Utilizing the right healthcare provider for the right problem
  • Electronic medical records being shared to reduce tests and exams
  • Better coordination for preventative medicine and long-term disease management

However, the PCMH has two problems:

  • A marketing problem
  • A change management problem

The term Patient Centered Medical Home is confusing to patients. The confusion arises because the name implies a physical location versus what is a change in the care process. For organizations implementing this solution, they should change the name to better reflect what they want to accomplish. A title suggestive of “centralized care coordination” would be better understood and adopted by all. Patients will be pleasantly surprised by the changes if they get past the poor naming convention.

The second problem the PCMH will have to overcome is resistance to change. Most organizations are slow to change because they don’t know where to start and/or they don’t know what they need to do to get certified. Luckily, the NCQA has specific guidelines on attaining designation as a PCMH along with some great tools to help with certification. Organizations are left on their own to conduct a comprehensive, unbiased, and objective assessment of their current capabilities. A good assessment will not only tell the organization where they are, but also why they are at that state of readiness.

With the starting point clearly identified and the 2011 NCQA standards as the goal, the organization can develop detailed courses of action. Even with excellent courses of action that clearly outline the steps to certification, organizations are reluctant to change. Each and every office worker needs to be educated on the PCMH model so they can articulate a clear message to each patient that visits the office. By involving and education everyone, the chances of success increase dramatically.

My PCP adopted the PCMH last year. His office appeared to run smoother. I got an appointment immediately and I waited less. Since then I have been treated, diagnosed, prescribed medications, had x-rays, and got the results all without seeing my PCP.

I didn’t feel like I received lesser treatment. I felt I received better, more focused care because the people I saw were available when I needed them and qualified for the level of care provided – all because of a centralized care model based out of my PCP’s office (not a home).

Joe Crandall is director of client engagement solutions of Greencastle Associates Consulting of Malvern, PA.

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December 19, 2012 Readers Write No Comments

News 12/19/12

December 18, 2012 News 2 Comments

Top News

12-18-2012 9-07-23 PM

A Wells Fargo Securities analysis of EHR attestation data finds a surge in the number of hospitals and practices qualifying for Meaningful Use money, which it expects to continue through the February deadline. It also notes that Epic is starting to dominate in all measures, leading in the number of physicians that have attested in with a success rate of 35 percent and representing 21 percent of the total attestations. Athenahealth was also noted as performing at an above-average rate, with neutral numbers for Allscripts and slightly negative numbers for Quality Systems. I ran the cumulative percentages by vendor and found that 80 percent of attesting providers are represented by just 22 of the 391 vendors listed: Epic, Allscripts, eClinicalWorks, NextGen, GE Healthcare, McKesson, Greenway, Cerner, Practice Fusion, athenahealth, Vitera, e-MDs, Community Computer Service, Eyefinity, Amazing Charts, Compulink, BioMedix Vascular Solutions, MedPlus, Medflow, Aprima, Partners HealthCare, and MedInformatix.

Reader Comments

From The PACS Designer: “Re: X-rays using your phone. Two engineers from California Institute of Technology have developed a microchip that can produce images inside objects without using the normal radiation method. The circuits operate with existing mobile phone technology but use the terahertz operating region to produce the viewable image for the phone. Terahertz radiation can penetrate through the body without damaging the tissue it passes through.”

From Vendor Middle Manager: “Re: clinician compensation. Can you ping the vendor community on the levels of compensation (salary, bonuses, options, etc.) being paid to clinicians? It’s hard to find out because of inherent reluctance to disclose compensation and the variety of titles that don’t reflect true roles. It would be great to hear anonymous examples of physician and nurse compensation with the primary role specified (doing demos, designing user interfaces, developing content, etc.)” I’ll collect and anonymously report your responses if you would care to either e-mail me or use the anonymous Rumor Report.

12-18-2012 8-50-42 PM

From Mini Me: “Re: iPad Mini. I’m interested to know how doctors are using the iPad Mini.” Me, too. If you are a clinician using an iPad Mini or an IT person involved in its rollout for clinical use, let me know why you chose the Mini and how it’s being used.

Acquisitions, Funding, Business, and Stock

12-18-2012 9-10-39 PM

Investment firm Elliott Management offers to buy Compuware for about $2.4 billion, a 15 percent premium over last week’s closing price. Elliot, which owns 8 percent of the company, says Compuware’s “execution, profitability, and growth have meaningfully underperformed.” Above is CPWR’s five-year share price (blue) vs. the Nasdaq (red). Compuware filed for a possible IPO of its Covisint Corp. unit last week and could conduct the IPO in three to six months.

12-18-2012 8-52-26 PM

Revenue cycle software provider Recondo Technology acquires eHC Solutions, an Indianapolis-based developer of EDI solutions.

pMD releases a mobile version of its patient handoff product.

12-18-2012 8-23-03 PM

PatientSafe Solutions (formerly IntelliDot) raises $13.3 million in equity financing, about half of the amount it is seeking, raising its all-time financing total to $83 million. The company offers bedside scanning solutions for medications, specimens, and breast milk along with documentation and caregiver messaging.


Rideout Health (CA) selects McKesson’s Paragon HIS as its financial and clinical solution.

ARcare (KY/AR) selects SuccessEHS PM/EHR for its 45 community health center locations.

12-18-2012 5-45-14 PM

MemorialCare Health System (CA) will implement the KnowledgeEdge Enterprise Data Warehouse from Health Care DataWorks.

12-18-2012 5-46-33 PM

Trustees of St. John’s Medical Center (WY) decide to spend $240,000 to buy eClinicalWorks as a replacement for McKesson Practice Partner, which it has been running for five years. They say Practice Partner is not user friendly and makes it difficult to document office visits.


12-18-2012 6-16-28 AM

The Premier Healthcare Alliance names Gary S. Long (Surgical Information Systems) chief sales officer.

12-18-2012 12-19-39 PM  12-18-2012 1-03-17 PM  12-18-2012 5-50-41 PM

CCHIT adds Janet M. Corrigan (National Quality Forum) and Grace E. Terrell, MD (Cornerstone Health Care) to its board of trustees and promotes Executive Director Alisa Ray to CEO.

12-18-2012 1-05-52 PM

The National Quality Forum names Christine K. Cassel, MD (American Board of Internal Medicine) president and CEO effective mid-summer 2013.

12-18-2012 5-52-59 PM

James D. Morris (Western Digital) joins Harris Corporation as group president of the Integrated Network Solutions business, which includes Harris Healthcare Solutions.

12-18-2012 3-19-21 PM  12-18-2012 3-22-14 PM

The SSI Group appoints Brian Campbell SVP of sales and Tom Myers chief strategy officer. Both will maintain their roles with MedWorth, an SSI subsidiary.

12-18-2012 6-55-56 AM  12-18-2012 5-54-36 PM

Meditech promotes Carol Labadini to associate VP for development, implementation, and support of Meditech’s ambulatory solution and Hoda Sayed-Friel to EVP of strategy and marketing.

12-18-2012 3-24-10 PM  12-18-2012 3-25-37 PM

Billing company PatientFocus adds Philip Hertik (Windsor Health Group) and Lucius E. Burch, IV (Burch Investment Group) to its board of directors.

12-18-2012 7-06-41 PM

Ormed names Bill Hockstedler (Connance, Inc.) VP of sales and marketing.

12-18-2012 8-37-05 PM

Imprivata names Carina Edwards (Nuance) as SVP of its new Customer Experience Group.

Informatica names Margaret Breya (HP) chief marketing office and EVP.

Announcements and Implementations

New Horizons Health Systems (KY) goes live on Healthland Centriq EHR.

12-18-2012 9-15-59 PM

Hutchinson Clinic (KS) exchanges CCD from its Allscripts EMR to the Kansas Health Information Network using the ICA CareAlign Exchange platform.

Orion Health announces the release of Orion Health Mobile, which allows users of Orion Health HIE to view real-time patient information on their iPhones and iPads.

Ormed sells its Canadian business to a subsidiary of Constellation Software, saying it will now focus on selling it ERP, HR, and decision support products to the US healthcare market. Constellation has completed several acquisitions this month, including buying documentation and charge capture systems vendor Salar from Nuance. Constellation also owned 21 percent of Mediware, or about $40 million worth, when that company was acquired by Thoma Bravo last month.

12-18-2012 7-22-18 PM

A profile of NewYork-Presbyterian Hospital SVP/CIO Aurelia Boyer, RN, MBA describes the organization’s use of Caradigm Amalga to analyze quality measures in real time, which she says saved $1.5 million in discovering CHF treatment variations.

Medecision’s Aerial care management system earns NCQA disease management certification.  

Government and Politics

ONC recognizes Ohio for coordinating its Regional Extension Center, HIE, and Beacon Community in supporting Meaningful Use and interoperability. More than 8,200 Ohio providers have met Meaningful Use requirements, receiving $368 million in federal payments.

In England, the chair of the Public Accounts Committee says paying trusts to implement CSC’s Lorenzo system are “bribes.” An earlier report from eHealth Insider says that CSC has offered $1.6 million each to the next 10 hospitals who sign up for Lorenzo, with funds coming from the Department of Health and CSC. CSC says the report contained factual errors, while Department of Health denies the suggestion that the incentives give CSC an advantage over competitors.


An article in a North Carolina newspaper illustrates why hospitals are snapping up medical practices. Simply by buying the practice, hospitals can bill up to double or more what the same physician in the same office would have been paid for performing the same service. Non-profit hospitals argue that they deserve to bill extra because of Medicare underpayment, a higher level of regulation, treatment of the uninsured, and a higher level of staffing. The article says North Carolina Attorney General Roy Cooper is considering using of antitrust laws to keep hospitals from raising healthcare costs by buying up their practice-based competitors. It cites an example of a patient’s echocardiogram, whose cost to her jumped from a $60 co-pay to a $952 bill even though the same technician performed the same test. In the Charlotte area, more than 90 percent of cardiologists are now hospital employees, spurred by a decline in their incomes of 30 to 40 percent in the past three years.

Weird News Andy says this baby was saved by scissors, but not like you’d think. UK doctors decide to save a baby born after 23 weeks of gestation (within the limit of legal abortion in almost all US states) because she weighed the minimum one pound to be considered viable. Only later did they realize that she had been weighed without removing a pair of scissors from the scales, with her actual weight being only 13 ounces. She’s been discharged after six months (after what must have been a monumental taxpayer expense) and is doing fine.

Sponsor Updates

12-18-2012 1-42-58 PM

  • Several Marines pay a visit to eClinicalWorks’ Westboro, MA headquarters to collect donated toys for Toys for Tots.
  • CommVault will pay $5.9 million for land in Tinton Falls, NJ to build its new headquarters.
  • A Wolters Kluwer Health survey finds that 80 percent of consumers believe they would benefit from have more control of their healthcare, though only 19 percent have a PHR. Nineteen percent also say that the most important consideration when selecting a physician is the practice’s level of technology.
  • Surgical Information Systems showcased its AIMS solution at this week’s PostGraduate Assembly on Anesthesiology in New York City.
  • PSS World Medical will offer Wellcentive’s population health management and analytics platform to its customers.
  • GetWellNetwork integrates Stanley Healthcare’s RTLS with its interactive patient care solution to identify caregivers entering patient rooms.
  • Dx-Web will offer LDM Group’s PhysicianCare and ScriptGuide products to its network of EMR vendors, expanding the relationship between the companies.
  • The Center for Medicare and Medicaid Innovation awards the Mayo Clinic, Philips Research North American, and the US Critical Illness and Injury Trials Group over $16 million to improve critical care in the ICU.
  • Billian’s HealthDATA offers strategies for providers to reduce re-hospitalization rates in a blog post.
  • AirStrip Technologies will add secure messaging to its applications using Diversinet’s mobiSecure SDK.
  • RazorInsights will incorporate Health Language, Inc.’s software into its EHR system to support standard terminologies.
  • Clinithink publishes the seventh installment of its seven-part blog series entitled, "Clinical NLP in Plain English."
  • DrFirst is ranked by Black Book as the #1 vendor of standalone electronic prescribing systems.

Report from the Healthcare Privacy and Security Forum
December 2-3, Boston, MA
By MrVStream

If you are not serious about your patient information security and privacy issues, the Office of Civil Rights (OCR) is, and it will have both financial and legal consequences for the entity. Just check out the Case Examples and Resolution Agreements (more on OCR to follow.)

I had the very good two days attending the inaugural Security and Privacy Forum sponsored by Healthcare IT News and HIMSS in Boston last week. It was well attended with over 250 registrants and 15 corporate sponsors. It does remind me of the early days for HIMSS (I won’t tell you how many years ago that was). It was serious, interactive, and had relevant subjects.

Here are some of the highlights and noteworthy points.

  • The keynote was delivered by Tim Zoph, SVP of administration of Northwestern Memorial Healthcare. He shared the greatest impact of a lack of focus on patient security and privacy is the erosion of confidence from patients and consumer towards healthcare providers, with the reported 435 breaches that affected 500 or more individuals since September 22, 2009, now totaling more than 20 million impacted individuals. Tim offered hopes and guidance to healthcare leadership that through creating a culture of security, simplifying the technology environment, using a standards-based security model, being proactive, and most importantly applying the right governance structure that is multidisciplinary, we can avoid security as one of these blind spots outlined in How the Mighty Fall by Jim Collins.
  • Barbara Demster, chair of the HIMSS Patient Identity (PI) Integrity Work Group, outlined that PI Integrity has direct impacts to privacy and security in the areas of operations and finance. She offered a HIMSS white paper from the Patient Identity Integrity Toolkit. The current estimate is that records are duplicated in the eight to 12 percent range, with institutions experiencing 47 percent false negative and 51 percent false positive (more problematic). The financial impacts range from administrative, regulatory, and patient care-safety. Barbara also suggests that PI integrity processes need to include stakeholders across the organization. Barbara emphasized that commitment and explicit organizational guidelines towards data governance are imperative.
  • Lisa Gallagher (senior director of privacy and security for HIMSS) and Bob Krenek (senior director of Experian Data Breach Resolution) presented the summary results of the 2012 HIMSS Security Survey, released December 12. Summary: (a) security budgets hold steady at 3 percent of the IT budget; (b) those organizations not conducting formal risk assessments will not qualify for MU incentives; (c) organizations need to establish a robust patient information secure environment in order to be able to safely share data externally; and (d) physician practices are not as advanced as other healthcare organizations in many areas of data security.
  • Sharon Finney, corporate data security officer for Adventist Health System, shared that her approach in meeting the needs and prepare for an OCR audit is moving her department from internal audit functions to risk assessment, focus on the potential risk impact, quantifying the financial risk, and engaging other departments. She also urged understanding people and process and to focus on the connecting points between each steps. She said she expects MU audits to be performed on all the institutions received funding.
  • Edward Ricks, VP/CIO of Beaufort Memorial Hospital suggested that to prepare for an OCR audit is to simplify the process and use outside consultants for support.
  • Mobile access and BYOD in healthcare are still major issues for patient information security and privacy with no single strategy, especially in the areas of device-to-device communication of PHI and home or consumer data collection. Sample strategies: Kaiser (do not allow any BYOD), Partners (restrict to technology standards — iOS only), Children’s Hospital of Central California (provide a virtual desktop environment), and others using network security to limit information access. The general agreement is that leadership is required to create a culture of patient information security. There is plenty of work to be shared by all the functional roles, but the reality is, a low amount of resources devoted and focused on the efforts of patient information security and privacy from both the administration and the white coats.
  • Jennings Aske (CISO of  Partners HealthCare) and Darren Lacey (CISO and director of IT compliance of Johns Hopkins University and Johns Hopkins Medicine) discussed the role of cloud computing. They suggested that it is necessary for the cloud supplier to sign a BAA, disclose underlying infrastructure, obtain third-party certification, and to demonstrate disclosure transparence. They did suggest that hybrid cloud services architecture is a good compromise.

Leon Rodriguez, director of the Office for Civil Rights (OCR), made these statements in an interview:

  • HHS OCR enforces the HIPAA Privacy and Security Rules as well as the HITECH Breach Notification Rule.
  • The final HIPAA Privacy and Security Rules are expected very soon.
  • The greatest challenge is the transformation of the agency from a regulatory body to an enforcement agency, where the scope is expected to be broader in nature.
  • The director position requires a balance of business needs and the need to comply with the regulations.
  • OCR expects from providers a well-documented procedure and we expect the entity to follow the process. The focused is on encryption, encryption, and encryption.
  • The awareness of management is still lacking, which makes it difficult for healthcare organizations to meet the regulations.
  • OCR has to work to help  consumers to understand privacy violations.
  • OCR is starting to move from a reactive mode to proactive audits based on risk analysis.
  • OCR expects more monetary restitution in the future and to expand the agency using the proceeds of the fines. $4 million was collected in 2012, but that is expected to grow.
  • OCR most likely will offer technology guidance, but will focus on the process.
  • OCR is still trying to assess the level of resources necessary to complete the audit.
  • Healthcare entity leadership will separate the successful implementation of a security and privacy plan from the unsuccessful ones.

Do you hear the OCR coming down the chimney to your facility? Plan to attend the Forum next year. I think you will find it worthwhile, and it may get you on the official Good List.


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

More news: HIStalk Practice, HIStalk Connect.

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December 18, 2012 News 2 Comments

Curbside Consult with Dr. Jayne 12/17/12

December 17, 2012 Dr. Jayne 1 Comment


ONC released the 2014 Edition Test Method for EHR Certification on Friday. In case you didn’t have anything to do over the holidays, now you can curl up in front of the fire with some cute and cuddly Test Procedures.

I have to be honest. I still struggle with Meaningful Use. I completely understand the goal. I also understand that there are a number of baby steps that must be taken in order to make data more transparent and transferrable. It’s extremely frustrating as a clinician, however, to have to codify data in ways that are seemingly meaningless.

Take the certification criteria for smoking status, for example. The Test Procedure document includes the approved SNOMED CT concepts “to assist the developers and implementers of EHR technology in the implementation of this requirement.” The concepts are:

  • Current every day smoker
  • Current some day smoker
  • Former smoker
  • Never smoker
  • Smoker, current status unknown
  • Unknown if ever smoked
  • Heavy tobacco smoker
  • Light tobacco smoker

For a minute, I’m going to take of my informatics hat and put on my average primary care provider hat. Let’s assume the only thing I know about SNOMED is that it’s some kind of coding system that sits under my EHR (if I even know that much, which I might not). Although the coding allows each of these to be uniquely identifiable, I’m not sure any of these (other than “Never smoker”) have specific levels of meaning to the majority of primary care physicians without detailed explanation.

For example, what is the definition of a heavy vs. light tobacco smoker? There are significantly different clinical risks to the former smoker depending on whether they’re a former heavy smoker vs. a former “only when I drink with friends” type of smoker.

There is a clarification that “smoking status includes any form of tobacco that is smoked, but not all tobacco use.” There are different risks to pipe smokers and cigar smokers than to cigarette smokers, but we’re not required to capture that nuance. In the old world, I could write TOB: 2ppd x 20y and 99 percent of clinicians would translate that to “cigarette smoker, two packs per day for twenty years” and could appropriately assess the patient’s risk. Now, to meet Meaningful Use, I’m going to be steered towards selections that don’t have a lot of clinical meaning.

Some vendors who had detailed and granular ways of documenting this information prior to Meaningful Use have kept their ability to gather that useful data and mapped it to the required codes. I can’t help but think that this will cause the data to lose something in translation.

Other vendors who are focused more on certification have added the new fields alongside their old ones. This forces clinicians to document the data twice – once for clinical significance and once for a federal program. Although it meets the letter of the law, it makes for unhappy users and poor design. I know of at least two products out there, however, which function in this way.

ONC works through the paradox of mapping on page 3 of the smoking status document. It gives the sample of a “pack a day” smoker that the Certified EHR maps to “current heavy smoker.” It notes that when the transition of care document is created, the additional text description and any other metadata could be included along with the SNOMED. It continues”

Note that “heavy smoker” is not the only concept that is appropriate here, and we leave the decision regarding which of the eight codes is the most accurate descriptor of clinical intent to the judgment of those implementing the form, template, or other EHR data capture interface.

I’m not sure that makes me feel much better. Unless they have dedicated clinicians working through these design specifications, it leaves us with software developers deciding how to best document clinical intent.

As the document continues, they include language from the 2011 preamble of the Health Information Technology standards document. It specifies the definitions of the various selections:

… we understand that a “current every day smoker” or “current some day smoker” is an individual who has smoked at least 100 cigarettes during his/her lifetime and still regularly smokes every day or periodically, yet consistently; a “former smoker” would be an individual who has smoked at least 100 cigarettes during his/her lifetime but does not currently smoke; and a “never smoker” would be an individual who has not smoked 100 or more cigarettes during his/her lifetime. The other two statuses (smoker, current status unknown; and unknown if ever smoked) would be available if an individual’s smoking status is ambiguous. The status “smoker, current status unknown” would apply to individuals who were known to have smoked at least 100 cigarettes in the past, but their [sic] whether they currently still smoke is unknown. The last status of “unknown if ever smoked” is self-explanatory.

I wonder how many of my primary care peers have read this language and share this definition? It’s been awhile since I was in medical school and residency, but I’m pretty current on my continuing education classes and haven’t seen this emphasized in recent articles about the risks of smoking. What’s magical about 100 cigarettes? Is there solid data that shows a difference in risk once a smoker hits that number? Maybe I need to go back to school.

Continuing on, the document clarifies the cutoff of “heavy vs. light” smoking as being more than 10 or fewer than 10 cigarettes per day, “or an equivalent (but less concretely defined) quantity of cigar or pipe smoke.” What if they smoke exactly 10 cigarettes per day? They don’t meet either definition.

I realize I’m splitting hairs here and some of you may have tuned out by now, but that’s the point. We’ve taken data that had clinical meaning and was easily understandable and turned it into data that is confusing and potentially meaningless. I’m not sure if that’s really taking us forward. The data is only as good as the staff entering it and the likelihood of physicians understanding the concepts (let alone training their staff to understand the concepts) may be low.

Compared to other parts of MU, the documentation of smoking status seems fairly straightforward. That’s not very reassuring considering a program which will continue to become more complex as we move forward. We’re not even to Stage 2 yet and I need a break. As they used to say, smoke ‘em if you got ‘em.


E-mail Dr. Jayne.

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December 17, 2012 Dr. Jayne 1 Comment

Time Capsule: Community Physicians and Technology: Think Convenience Store Owner, Not Society-Minded Scientist

December 14, 2012 Time Capsule No Comments

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

I wrote this piece in February 2008.

Community Physicians and Technology: Think Convenience Store Owner, Not Society-Minded Scientist
By Mr. HIStalk


I have had the magic revelation. I know now why we healthcare IT people can’t figure out the seemingly puzzling behavior of small-practice doctors when it comes to technology adoption.

Here it is. Once they hang out a shingle, they’re no longer society-minded scientists. They’re small business owners.

The next time someone talks about physician practices, replace that term with “convenience store owner.” They’re on every corner, they compete vigorously for business, they watch expenses with an eagle eye, and they pay themselves only after everybody else gets paid. And unlike convenience store owners, they have to deal with insurance companies who tell them what they’ll get paid and hammer them with a mass of ever-changing regulations.

They’re also going to look at IT a lot differently than doctors in hospitals. Or especially, than hospitals themselves. Any money they spend on IT comes out of their own pockets. Any help they need doesn’t come from the friendly IT department — they have to find someone and pay high rates for even simple tasks, like installing a PC or figuring out connectivity problems.

Technology cheerleaders get frustrated that docs don’t just buy systems and get with the program so everybody can benefit. The problem is that everybody doesn’t benefit. Doc has just made a donation to insurance companies, patients, and hospitals who all appreciate the boost in their well-being from his or her investment. That doesn’t even include the extra time required to maintain electronic documentation, which always takes longer than scribbling. Physicians have just one thing to sell: time. They protect it strenuously, as they should.

We hospital types forget that 90 percent of a general practitioner’s time and even more of his or her income comes from their small business. Seeing patients in the hospital is a cost of doing business, not the day’s focus. While the hospital folks are going to meetings and delivering care as part of a big team, Doc’s out there on the front lines taking all comers, armed only with a few minimally trained assistants and whatever’s in his or her head, trying to improve health and provide a positive customer experience in an average of six minutes per visit.

The people they deal with in hospitals have, for the most part, never run a small business. They’ve always worked for someone else. The world looks a lot different when the only employer who’ll take care of you is you.

From an economic standpoint, doctors are paid to work. If we’ve got some kind of beef about excessive use of diagnostic procedures or esoteric treatments, we need to stop paying for them. That convenience store owner will sell you cigarettes and beer that are bad for you because (a) you want them, and (b) it adds to their bottom line. There’s a word for those civic-minded C-stores that stop selling them on principal: defunct.

Doctors are pretty much stuck in the small business model. The problem is that we’re expecting them to hold hands and join the choir even though they’re struggling to keep the doors open given rampant competition, reduced payments, and a fickle market.

I’m making a point to think twice before ripping doctors for not jumping all over e-prescribing, pay for performance, or interoperability. Unless you’ve got a rock-solid argument that would convince a convenience store owner, you’re wasting your time.

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December 14, 2012 Time Capsule No Comments

News 12/14/12

December 13, 2012 News 7 Comments

Top News

12-13-2012 6-46-09 PM

Allscripts files suit against NYC Health & Hospitals along with Epic Systems over the $303 million contract HHC awarded to Epic in late September. The complaint says the award is “arbitrary, capricious, an abuse of discretion, and lacks a rational basis” because it claims Epic’s proposed cost is $535 million more than that of the Allscripts proposal. HHC says it will defend its decision and added, “Allscripts’ claim that it underbid Epic by more than half a billion dollars is absurd and strikes us as an ill-fated attempt to reassure investors and inflate its sagging stock price. Unfortunately, as our multi-year review has revealed, Allscripts lacks a truly integrated EMR solution and has repeatedly lost business to Epic and other vendors as a result.” MDRX shares closed Thursday at $10.80, down 2.44 percent and indeed sagging at less than half their February price.

Reader Comments

From Bain Marie: “Re: Allscripts sore loser lawsuit against New York HHC. They had to deal with Hurricane Sandy and now will spend a fortune to defend themselves against Glen’s bizarre public accusation that its prospect would pay almost anything to avoid buying its product. Would you say this is the dumbest move in HIT history?” It’s certainly in the top handful, and probably the undisputed #1 in the “desperation” category (HBOC’s frenzy to mate with McKesson was even more desperate, but Allscripts wins on style points for suing a non-profit hospital.) I won’t editorialize further since Allscripts employees, shareholders, prospects, customers, and potential acquirers (if indeed any are still interested) are probably already amply embarrassed by this latest in a string of bad company decisions that always send competitors running gleefully to the scanner to make sure prospects get copies. That’s my opinion. If you work for a hospital, especially one with Allscripts connections, I’d like to hear yours. If you work for Allscripts, I’d be even more interested.

12-13-2012 7-30-50 PM

From Nasty Parts: “Re: Mike Lovett. Promoted to replace Scott Decker at NextGen.” Unverified. His LinkedIn profile shows a new job of SVP/QSI Division Leader – Ambulatory Division.

From  Kaiser Surgeon: “Re: video by KP ambulatory surgery staff at Fremont Ambulatory Surgery Department. They are well known for high-volume cataract surgery on our Kaiser patients. They do seem to have an esprit de corps.” I’m always a sucker for hospital music videos like this one.

12-13-2012 8-26-46 PM

From Former Stanley Tool: “Re: Healthcare Informatics Associates. Stanley Healthcare Solutions is shutting it down.” Unverified, but searching LinkedIn finds at least one former employee who is freshly entering the job market.

HIStalk Announcements and Requests

inga_small If you have been busy holiday shopping and missed reading HIStalk Practice this week, here are some highlights. Two-thirds of EPs will apply or have applied for MU incentives. ONC says that more office-based physicians are using EHRs that have higher-level functionality to meet MU objectives. ED use declines when patients have access to after-hours service from their primary care provider. HHS offers tools to protect PHI on mobile devices. Physicians spend more time on health content-specific websites than any other health sites, though more are also visiting EHR portals. Epocrates releases a native app for iPads and iPad minis. Dr. Gregg pronounces the consumer the heir to throne of healthcare. I made the “nice” list again this year, but the only gift I need is a few more e-mail sign-ups on HIStalk Practice. Thanks for reading. (P.S. If you are a shoe distributor, own a wine shop, or are a male admirer who likes to give expensive jewelry, please disregard the “only gift I need” statement.)

12-13-2012 7-54-55 PM

Welcome to new HIStalk Platinum sponsor RazorInsights. I’m guessing the Kennesaw, GA-based company found HIStalk because I’ve run several non-anonymous hospital reader comments about the company’s ONE Enterprise HIS for rural, critical access, and community hospitals. It offers a single-database, certified, cloud-based hospital EHR. Every one of the company’s live hospital clients have earned Meaningful Use payments. Customers enjoy one database, one simple user interface, and capabilities that include a master patient registry, patient encounter management, nursing documentation, CPOE, and physician offline orders. It’s available in multiple editions that include clinicals only, clinicals plus financials, clinicals plus ambulatory, and the Enterprise Edition including all of those. Customers can go live in as little as 90 days, enjoying cost-effective training services and around-the-clock support. People always bemoan the lack of new companies and new, scratch-built technologies in the inpatient EHR business, so here’s one for you. The company’s management has plenty of industry experience, including folks with pharmacy and nursing degrees along with vendor experience. To learn more, sign up for a live product webinar on their site or check them out at the HIMSS conference in a few weeks. Thanks to RazorInsights for supporting HIStalk.

I always head over to YouTube when introducing a new company just to see what’s out there, so here’s an introductory video from RazorInsights. You’ll get a hint about the company’s name early in the video, although you might have to Google the reference like I did.

It’s an odd time of year to be swamped at the hospital and at HIStalk, but that’s the case. I work on HIStalk until at least 10 every night and I’m back in the same chair by 5 the next morning before I head out to work. I try to respond to requests quickly, but it often doesn’t happen, and re-sending the e-mail or expressing indignation doesn’t change my time constraints one bit. I usually catch up over the weekend, though.

Acquisitions, Funding, Business, and Stock

Cerner will repurchase up to $170 million of its common stock.

Global Record Systems acquires the eCastEMR platform and service business from eCast Corporation.

Streamline Health Solutions reports Q3 results: revenue up 51 percent, EPS –$0.11 vs. $0.03.

12-13-2012 5-57-40 PM

LocalMed, a patient self-scheduling software company that won $3,500 in seed capital from the LSU Student Incubator, will establish its headquarters in Baton Rouge, LA and plans to hire 52 employees by 2016.


Sales Battle Mountain General Hospital (NV) selects ChartAccess EHR and FinancialAccess from Prognosis HIS .

HealthInfoNet, the HIE for Maine, signs a three-year agreement with Arcadia Solutions for its Analytics and Quality Data Warehouse platform for clinical data warehousing. Aracadia will also test the linkage of the HIE’s clinical data with claims data from the state’s All-Payer Claims Database.


12-13-2012 5-59-40 PM

The Brooklyn Hospital Center (NY) names Bill Moran (Dell) SVP and CIO.

12-13-2012 6-00-17 PM

Lisa Rawlins (Broward Health) joins SRG Technology as director of health care.

12-13-2012 9-13-18 PM

Norman Joseph Woodland, who co-invented the bar code as a graduate student in 1951, has died at 91.

Announcements and Implementations

Joslin Diabetes Center (MA) will use de-identified clinical data from Humedica for education and research activities.

Government and Politics

ONC launches a mobile device security initiative that provides white papers and articles to help providers understand how to protect patient information on mobile devices. The site is a product of HHS’s March 2012 Mobile Device Roundtable along with tips and information contributed during its 30-day comment period. Included is a video titled Worried About Using a Mobile Health Device for Work? Here’s What to Do!


AT&T unveils a prototype of Asthma Triggers, a wireless sensor that sends air quality data to mobile devices.


The Leapfrog Group, criticized by hospitals to which it assigned below-average patient safety grades last month, announces a partnership with Johns Hopkins Medicine to fine-tune its scoring methodology, also vowing that, “the Hospital Safety Score is here to stay.”

More than half of HIT professionals report a budget increase for information security, according to a HIMSS survey. Other key findings:

  • Most hospitals are conducting risk analyses, with 71 percent performing an analysis at least annually
  • One in five respondents say their organization experienced a security breach in the last year
  • More than half the organizations spend three percent or less of their IT budget on securing patient data
  • Two-thirds report that their organization conducted an audit of their IT security plan.

12-13-2012 9-06-44 PM

Paper medical records belonging to a recently raided and closed unlicensed pain management clinic in Florida are found in the dumpster of a nearby Dollar Store. Also found in the trash: used syringes and uncashed checks made out to a contracted pain doctor who was apparently being paid $1,500 per day to crank out oxycodone prescriptions.

Tampa General Hospital’s bond ratings agency calls out the hospital’s “compressed profitability” as being due to Epic implementation costs, lower inpatient utilization, and state Medicaid cuts.


12-13-2012 8-34-32 PM

Weird News Andy continues his armchair medical reviews with this article, in which Children’s Hospital of Philadelphia injects a disabled form of HIV into a six-year-old whose leukemia was expected to kill her within two days, hoping to stimulate her immune system enough to allow her to receive a bone marrow transplant. Six months after the infusion, the T-cells are still working and she’s in remission.

Sponsor Updates

12-13-2012 9-58-49 PM

  • Mercy Regional Health Center (KS) expands its use of the Access Intelligent Forms Suite into its human resources department.
  • Vitera Healthcare announces the general release of Live Chat, which provides customers with immediate online access to Vitera customer support.
  • Surgical Information Systems enhances its perioperative information systems to provide interoperability with Siemens Soarian Clinicals.
  • Agilum Healthcare Intelligence publishes a white paper that includes strategies to help small and mid-sized hospitals overcome common obstacles to obtaining useful business intelligence.
  • Levi, Ray & Shoup sponsors this week’s Next Generation Healthcare Summit in San Antonio.
  • Emdeon discusses the benefits of utilizing check reader devices at the point of service in a newsletter article.
  • Adirondack Radiology Associates (NY) shares how it has increased coder productivity and reduced denials since implementing the Optum Computer-Assisted Coding solution. 
  • API Healthcare’s Deborah Moore shares thoughts on the use of HIT to increase quality of care and patient satisfaction in a blog post.
  • Informatica offers predictions on where technology is heading in 2013.
  • Fourteen CareTech Solutions customers win a total of 20 eHealthcare Leadership Awards for their CareTech-designed websites.
  • RSource, a provider of receivables management recovery solutions, and Streamline Health Solutions will cross-market each other’s services within their client bases.
  • Winthrop Resources Corporation will offer equipment financing and advice to customers of MPC, an IT asset lifecycle management company.
  • The British Columbia Ministry of Health selects McKesson as the vendor of choice for its radiologist peer review initiative.
  • First Databank and JAC Pharmacy sponsor the Improving Patient Safety award at the NHS Isle of Wight Awards 2012.
  • NextGen Healthcare will offer Aviacode’s cloud-delivered medical coding services to its customers.

EPtalk by Dr. Jayne

Finally, a data breach that doesn’t involve a lost or stolen laptop.  Dr. Travis tweeted about the breach at Carolinas HealthCare where an “unauthorized electronic intruder” (is there such a thing as an authorized intruder?) obtained access to a provider’s inbound and outgoing e-mails. Although there is no evidence that the information has been misused, impacted patients are being offered free credit monitoring services.

Should a hacker gain access to my work e-mail account, have fun reading all the incessant whining and complaining from physicians who hate EHR, the implementation process, the group’s compensation model, required CME, coding/compliance audits, and a host of other things. It just might scare you straight and make you never want to hack again.


Physician social networking site Doximity issues a call for fellows who will “gain insight into the power of entrepreneurship and technology in healthcare, engage with physician thought-leaders from across the country, and leave your mark on healthcare.” Applicants must be licensed physicians (MD or DO) and the time commitment is two hours per week. I can’t imagine it would be anywhere near as fun as writing for HIStalk, but if you’re looking for something interesting to do with your free time, it might be worth a shot. Applications are due December 31.

Inga has started getting invites for the HIMSS social scene, and as a good BFF should, she is sharing them with me. I’m definitely counting down to New Orleans (in fact, tried out some new shoes today that I hope will be both sassy and comfortable in the exhibit hall) and to seeing the HIStalk crew. I’m in the process of finding the perfect date for HIStalkapalooza. With any luck, he’ll be wearing a bow tie.


I asked last week for stories about the best (or worst) office holiday party ideas. Reader Rabbit takes the prize with his submission:

My wife’s practice is having their office party at a local brewery’s tap room, also known for great food. One of the doc’s hubby runs their hop farm, which also does farm-to-table stuff. Oh, wait:

  • It is on a Saturday at 10:30 a.m.
  • There is no drinking. The legal department says it can’t support drinking during any “sanctioned” event, even if off site and even if I pay for my own and don’t work for them.
  • It is a pot luck where the docs cook main courses. Which means this guy (pointing at myself) has to wake up and start cooking Cornish game hens or smoked brisket at 5 a.m. in order to have the meal ready. Even if I went the boring turkey route, I need to rise before the sun to cook on a Saturday. The rest of the staff don’t bring anything, but sit around and judge that the doctors (and their wonderful spouses) can’t cook.
  • It is still a "Christmas Party" and we are expected to dress “festive,” which means I must don gay apparel that supports a religion I don’t follow.
  • No kids. Good luck finding a 10 a.m. babysitter in a college town on a Saturday that is reliable and sober.
  • There is also a three- hour-long White Elephant that ends the afternoon with us getting some sort of broken scented candle or a wine bottle sack/holder that looks like St. Nick.

Fa-la-la-la-la, la-la-la-la — my foot.

Oh, and I promise to take a picture of me standing in the corner seething wearing my favorite Santa sweater. Happy Holidays!

I must say I’m looking forward to the sweater pics. I definitely have some wardrobe that could hold its own in any holiday sweater contest.



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

More news: HIStalk Practice, HIStalk Connect.

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December 13, 2012 News 7 Comments

Morning Headlines 12/13/12

December 12, 2012 Headlines 2 Comments

Mediware Buys MediServe to Continue Expansion

Mediware Information Systems announces the acquisition of MediServe, a Chandler, Arizona-based provider of electronic documentation solutions for inpatient and acute care rehabilitation.

Pennsylvania Patient Safety Authority Studies Electronic Health Records’ (EHR) Safety

Pennsylvania’s Patient Safety Authority reviews 3,099 EHR-related events and determines that 89 percent resulted in no harm, 10 percent resulted in an unsafe condition but did not result in harm, and fifteen individual events resulted in actual patient harm.

Maine tops states for provider rate of EHRs, meaningful use

National Health IT coordinator Farzad Mostashari, MD, commends Maine, Kentucky and Ohio for having the most accelerated adoption of EHR rates in the nation during ONC’s annual meeting.

Cerner Announces Share Repurchase Program

Cerner approves a buyback of $170 million of its common stock, representing 1.2 percent of the company’s outstanding shares, as it closes out a year in which its stock is up more than 29 percent.

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December 12, 2012 Headlines 2 Comments

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