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HIStalk Interviews Matt Sappern, CEO, PeriGen

September 19, 2012 Interviews 1 Comment

Matthew Sappern is CEO of PeriGen of Princeton, NJ.

9-17-2012 7-26-25 PM

Tell me about yourself and the company.

I joined PeriGen in January of this year. I came over from Allscripts and Eclipsys, where I had been for about eight years in various capacities. I headed up a big chunk of our development organization at one time, ran our remote hosting business, ran our services business for awhile, and then after the merger, ran all of our client sales for a year-plus. I joined PeriGen in January and now getting my arms around labor and delivery.


What’s the size and scope of the company?

We’re about 100 folks. We’ve got offices in Tel Aviv, Princeton, and Montreal. We are the combination of two firms that merged in 2009. We’ve got more than 150 customers right now, including Banner, MedStar, Maimonides, and Albert Einstein. It’s a good cross-section of teaching hospitals as well as community hospitals. Our solution flexes pretty well across the entire gamut of hospitals.


How have fetal surveillance systems changed the way that obstetricians had practiced over the years?

The interesting part about fetal surveillance systems is that they really haven’t changed much at all for a number of years. That’s what attracted me to PeriGen. It was the first time that I saw that any vendor was applying some new technology and starting to innovate.

Surveillance systems, archiving, and annotation on the strip have been around a long time. Everybody does it, right? Philips, OBIX, GE, WatchChild, and PeriGen … we all do it pretty well, to be honest with you. PeriGen takes a different approach in applying evidence-based medicine to detect when there’s risk in labor. I’m hoping that we’re ushering in a whole new age of applying systems to healthcare. That’s really what drove me here.


That must be a different driver than at Allscripts, where you had to convince doctors to use CPOE or EMRs because someone else wanted them to even though the benefit might not necessarily accrue to them personally. I assume obstetricians want or demand PeriGen’s products.

When I was at Allscripts, Meaningful Use happened and hospitals were getting behind EMRs. It is a great feeling when we show our product. Clinicians’ eyes really light up, because it is just a bit different from everything else that’s out there.

It does everything that what I term “commodity systems” need to do, but our ability to apply technology to what has been a subjective part of labor and delivery is important. Probably 80% of medical malpractice comes back to bad interpretation of the fetal monitoring strip. We’ve figured out a way to apply technology to help interpret that strip.

Docs and nurses … their eyes tend to light up when they see this stuff. I think as with every new disruptive technology, it takes a little bit of time for people to understand why it’s so much better than what’s out there, particularly as budgets are tight.


What malpractice benefits have obstetricians seen from using the product?

There’s a bunch. Banner Health Systems has seen a precipitous drop, on the order of millions, in their malpractice expense.

Not only are we a great hedge on the downside of malpractice, but it’s my contention that we actually can help hospitals categorize when there are complications with labor, and potentially get greater reimbursement for that work. Even Medicaid provides higher reimbursement for vaginal delivery with complications as opposed to vaginal delivery without, but a lot of times that goes unchecked because there’s no simple system to categorically and systematically define or determine whether there have been complications in labor.

Most of the physician documentation begins with the moment of birth. Our ability to show that there were complications in the labor portion, we think, is going to allow hospitals to correctly charge and code their DRGs and establish some top-line revenue growth as well.


As unfortunate as it is when there’s any kind of patient harm that could have been avoided, everybody is very sensitive to anything involving newborns or peds. When you look at those malpractice-driven events, are they usually because of lack of following procedures or failure to detect complications?

Those go hand in hand sometimes. A lot of times there’s a subjective interpretation around whether the fetal monitoring strip is showing complications or not. What we’ve tried to do is firmly establish a tool that helps us determine that case. In fact, the NIH has licensed our tool to go back and take a retrospective view of thousands of strips from problematic births to determine if there’s any way to change the protocol.


Many companies are trying to develop software to analyze incoming data streams from patient monitoring systems. What have you learned as an early adopter in applying evidence to physiologic monitoring data?

You’re only as good as the evidence. We’ve put an awful lot of research into the 19 patents that we have. We have about 6,500 OB-specific protocols that we use. We’re continuously vetting that.

We’ve got some great clients. They work very closely with us in helping to shape our product as we go forward. Sometimes they say, “This protocol might be a little bit outdated,” or, “We had a case in here that your system really doesn’t contend with, and here’s how we think the workflow ought to go” and they help write new protocols. I think vigilance is part of that.


You’re applying accepted knowledge, but it sounds as though you’re also using the information you collect to develop what may become the next standard.

Yes. Standards evolve. Part of evidence-based medicine is when you get the evidence of something evolving, you got to take advantage of it. We’re constantly working with our clients to evolve our solution set. It’s really worked out well for us and for them.


Everybody’s spending a lot of their time and money working to implement electronic medical records, but the solutions market seems solid for high-acuity specialty areas like surgery, labor and delivery, and the ICU. Is it hard to earn a place at the table when those hospitals have made their big investments and you’re offering them a system they may not have thought about?

I think the rush towards Meaningful Use and deploying EMRs in as fast a manner as possible definitely eats up resources on the hospital side that they would otherwise deploy against programs like ours. But I think you’re absolutely right that there are specific areas in the hospital and labor and delivery, perinatal is probably the highest-risk service line in most hospitals. There is just so much nuance that I don’t think any of the larger EMRs can develop. I’d like to think that most of the clinicians understand the need for a specialty solution like ours.


You mentioned that your competitors do a good job. How do you differentiate PeriGen from them?

We’re the only ones who have gone well beyond that commodity solution set of surveillance, annotation, and archiving. To us, that’s great, but it’s an old application of technology. We are truly the only ones who are certainly doing that, but also applying our systems to deliver clinical decision support, to essentially say, “Hey, doc or hey, nurse — you’ve got a problem here. You need to look at this” and allowing that clinician to intervene.

None of the other systems do that.  In a way, I don’t feel like we have any competition because no other systems are doing that. Everybody is doing the commodity stuff. Nobody is doing what we do.


Where do you take it from here? Companies usually branch out into something unrelated or add functionality to what they have.

There’s a number of different directions. If you look at the number of obstetricians that are going through school, you see a downward trend in terms of available obstetrical talent. Careers are running a little bit shorter. It’s hard work being an OB, getting up in the middle of the night all the time. 

Our solution set lends itself to a service line around the remote OB hospitalist, an intriguing direction that we’re looking at. There are a number of areas that our technology is well suited for because it is so visual and it’s doing a lot of the heavy lifting for the clinician. I think we’re far more suited for that kind of a solution set than anyone else in the space.

At the heart of it, though, we also have an engine that can be abstracted away from labor and delivery content and populated with content from other departments as well. The concept of applying clinical decision support engines at the bedside in real or near-real time is one that can grow pretty significantly into other service lines.


I hadn’t heard of remote OB hospitalists. How is your product used remotely compared to products like AirStrip?

We’re published via Citrix. There’s a number of physicians using mobile applications now without using AirStrip. The last time I was at Banner, I was speaking to a doctor and he was sitting there on his iPad looking at tracings and actually entering some orders. Mobility is something that we feel pretty confident that there’s a solution set around for us and that a lot of our clients are already employing our solution in a mobile fashion.

The remote OB is a different concept. If you are in a hospital somewhere where you’re having trouble getting access to OBs, like any number of community hospitals around the country, perhaps there is a service that provides a consulting physician or that uses our system as an alerting system, like an ADP in home security.

None of these are productized now, but your question was where our application goes. Our application allows immediate visual recognition of a problem, so therefore lends itself to a number of services that don’t exist today.


In a small town, obstetricians spend a lot of time waiting on labor to progress. Is it easier for hospitals to attract and use those obstetricians efficiently when they’ve got a tool like yours?

Yes. There is no doubt that both nurses and docs have a more efficient workflow when they’re using our tools. Nurses can come in, check on patterns, and see it right away over a two-hour trend line whether there are problematic decelerations or not in the labor. It’s a lot more relevant clinical information, and a lot quicker than having to stare at the strip or unroll the strip out on the bed and see what’s going on.


How do you think obstetric services and obstetricians will fare under the Affordable Care Act?

I’m more worried about the number of obstetricians, frankly. I think they’re going to be fine. As you look at where hospitals are going with accountable care organizations, I think tools like ours are going to become more and more important.

If there’s a baby that’s born with a birth defect – heaven forbid, but we all know it happens — that child is in that system for, in many cases, the perpetuity of its life. Any tool like ours that employs systems to manage risk is going to be quite important in accountable care organizations going forward. 

Ultimately, I think that the practice of obstetrics is changing. We’re going to continue to see a higher demand, as there’s less OBs delivering babies. Systems like ours can help make those OBs and the nurses on staff a bit more productive, which is what we see a lot of excitement around.


From your time at Allscripts, what lessons did you learn that you will and won’t apply at PeriGen?

There’s a lot of things that we can do, being a much smaller organization than Allscripts and having a much tighter focus. We’ve got the freedom, agility, and speed to do things that they maybe can’t do quite as well. There are organizational tenets that I am taking a slightly different approach than we ever did at Allscripts relative to how I’m organizing our development and product teams. Stuff that the size and scope of Allscripts just wouldn’t allow.


Any concluding thoughts?

When I saw this application at work, I had been up for the job and I wasn’t sure if I was going to take it. I wanted to go see the application at work in one of our client hospitals. There was a woman having some complications and decelerations in labor, which are a bad thing. I’m not a doc, so that’s about as medical as I’m going to get. 

Our system helped detect what was going on. They were able to do an emergency C-section. Everything came out great. At that point, i saw more than ever in my career how technology can change the course of healthcare on a patient-by-patient basis.  

I feel like we’re bringing innovation where there has been little to date. We’re applying technology to one of the most problematic and subjective areas, which is interpreting the fetal monitoring strip. It’s a great proving ground for clinical decision support overall.

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September 19, 2012 Interviews 1 Comment

HIStalk Advisory Panel: Patient-Facing Technologies

September 19, 2012 Advisory Panel 4 Comments

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a provider organization (hospital, practice, etc.), you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This month’s question: What patient-facing technologies (portals, PHRs, kiosks, patient education, etc.) have you implemented that have had the most positive impact on patient satisfaction?

Patient Portal
  • We’re in the early stages of a portal deployment. Too early to tell what kind of impact it will have on patients, although our CEO sees it as a Kaiser killer. I’m not so certain.  
  • We are in transition with our Epic implementation. We have an existing patient portal and also a failed attempt to use kiosks. With Epic, we have already signed up 20,000 new users to MyChart and the reviews have been very positive. In addition, we will most likely move away from kiosks as they just don’t seem to generate much interest in spite of widespread adoption in banking (ATMs) and airlines.
  • Patient access to their health records has had the most positive impact on patient satisfaction so they can access their own information or schedule on their own time.
  • None, and "therein lies the rub!” Some doctors in my group have tried Phytel, but not with a lot of enthusiasm, and I did not hear that they had an earth-shattering experience. I chose instead to test drive on my patient population the actual need and demand for such tools before I invested time and staff effort into a technology that may as well go nowhere because my older patients are simply not ready for it. All of that while the company as a whole was looking for a more integrated solution/EMR that would offer a patient portal along with practice management and other tools all in one as opposed to having a piecemeal approach.We did find one after a long and arduous process and I hope that it will prove to be worth the wait. However the patient’s response and demand for such technology remains to be seen as many of them are not computer savvy, nor do they even have a computer.
  • Nothing yet. We are still trying to get the Stage 1 criteria met for Meaningful Use, but I’m very much looking forward to the patient portal. We’re among the last facilities in our state to allow our employees to look at their own records within our hospital information system. I want to get them moved over to the portal as soon as we can so we can close that loophole!
  • Undoubtedly it is the patient portal that has had the most impact on satisfaction. People who want to take individual control of their health appreciate and utilize the opportunities to review their test results, communicate with their caregivers, and make their own appointments, among other things. Promotion of this kind of ownership over one’s health is also a key to improving health outcomes for patients and a critical component of realizing the kinds of outcomes that will help determine our payments in the near future.
  • Many of our physicians indicate that access to a patient portal has been the most significant change in terms of patient satisfaction that they have seen in a dozen-plus years of medical practice. A physician example: for the first six months, about a third of the messages I received were just to say, "Thanks for this new system – it’s awesome." Now I have good stories to tell — the case of an elderly heart failure patient that we have interacted with regularly (via daughter and home care) using the patient portal. She was in the hospital or ED every 2-6 weeks for the year prior to the portal and (knock wood) has not been admitted in >6 months since our more frequent touch points and monitoring.
  • I have yet to work at an organization where we’ve implemented any of these with a verifiable increase in patient satisfaction. Not saying that the technologies aren’t useful, just that there was not a reliable way to verify the impact. As a side note, the implementations with the greatest impact are those where patients wait less and answer questions the fewest number of times. Implementing portals and kiosks can help support this experience, but only if the organization changes workflows to support activities such as pre-registration.
  • Most successful patient-facing tool has been Epic’s MyChart, especially on the primary care side. They have been very diligent about getting patients signed up while they are in the office using cheap netbooks. Adoption has been very strong and feedback has been very positive. The key was to go live with a fairly robust set of features enabled on day one rather than trying to ramp up over time.
  • We’re still working on implementing the patient-facing technologies. Previously as a patient, I was thrilled about patient portal. One of the cool things we’re working with our EHR vendor on is a tool that will help us proactively reach out to patients to remind them of wellness activities specific to them.
  • The area of patient portals has been a problem area for me. I struggle with how a patient should engage with a community hospital directly as opposed to a primary care physician. The fact that MU is driving both hospitals and physicians to have portals is going to create a larger issue in my opinion. This opinion is shared by patients in a recent focus group we did. Two patients in the group had recently connected to their PCPs athena portal. Their question for me and my hospital colleagues was, "What would I go to you if I have this with my PCP?" Because of MU S2, we will be implementing a patient portal and spending close to $400k to do so. This to me is another example of how MU is gone awry. A Patient Portal in an IDN make sense. In a community setting with an independent hospital and small independent providers, a portal aggregation strategy makes more sense – a single sign-on to the hospital, PCP, and specialists in a community but three separate systems. I wish such a solution existed, but we have not found one (but still looking).
  • Patient Portal. We are a large group which has over 60 percent of our patients signed up, giving patients what they want and need – actionable transactions (e.g. messaging the office or doctor, refill requests, appointment requests), not fluffy marketing material or even PHR info. We will add in more PHR info over time, but we have seen the demand for actionable items be what drives their use of the system. They LOVE it, and most of our docs now love it also, as it is an easy way to communicate in a non-synchronous manner, which allows for better explanations and web links, as well as better documentation for the chart.
  • Portals work very well. We use MyChart and have hundreds of thousands of patients using it for lab result lookup, appointment scheduling, bill review and payment, after visit summaries, etc. Public PHRs have gotten no traction. Kiosks we haven’t deployed due to ADA concerns.


  • Patient check-in kiosks associated with patient portals, allowing the patient or caregiver to fill out visit information in advance of office visit and/or in waiting area of office.
  • Kiosks. If done well, can facilitate the registration process, which starts the whole care process on a positive note.

Interactive Patient Systems

  • GREAT question.. Not sure any of them have really “delighted” our patients. If I had to pick one technology that seems to be pleasing SOME of our patients, I would suggest the kiosk, in the ambulatory environment, seems to be perceived as a good thing. We also recently developed an application that runs on our interactive television system. It allows a patient (or a family member) to view photos of all members of their care team. In a large academic medical center, this can be important. A member of the clinical team is added to the system if they order something or view something in the patient’s record. When they interact with the system, their photo, their name, and their title are added to the patient’s profile. The patient can then view the entire care team. A photo and name stay active on the profile for four days and drop off if no interaction. It’s very new, but patients seem to like it.

WiFi Access

  • The single patient satisfier most raved about by our patients was WiFi in the waiting rooms. It took many patients asking for it and some persuading of the clinical and admin folks. We had to assure them that this would not affect any of our patient care systems. We did have to add a disclaimer page that there was no support and that folks should not be going to certain sites — all of the legal jargon that admin wanted. From a technical side, we carved out some bandwidth that always uses a lessor priority and will reduce itself to almost nothing if the bandwidth is needed for patient care. We impressed on our patients that once called to an exam room, all electronics were to be powered down and turned off. We have about the same acceptance rate as the airlines or your local movie theater. Some of our more technical folks (like me) make use of any spare time to keep up on emails and issues. We got a lot of positive feedback.

Social Media

  • I think the jury is still out on our patient-facing technologies and their impact on patient satisfaction. However, it is well worth noting that our endeavors with social media (Twitter and Facebook, particularly), even though our efforts are in their infancies and perhaps relatively minor when compared to others, have yielded great increase in patient and community engagement and affinity for our health system.

Patient Messaging

  • Delivering engaging communications via text messaging (confirming appointments, medication refills, etc). They like this proactive approach versus the passive communications on the portal. My internal medicine physician practices in a fairly large group affiliated with an academic medical center. Getting anyone on the phone is a miracle. It is like they are in the Get Smart cone of silence. However, they have finally implemented a secure messaging system (they use an old flavor of Allscripts) and I recently had a positive experience using it to have a prescription refilled. Worked nicely. They do not, however, have online scheduling and I don’t think I could actually "talk" to my physician
    on line.

Printed Patient Documentation

  • In general, we are not there yet. Still getting physicians implemented on EMRs. However, we have had some very positive comments from patients who receive their clinical visit summaries at the end of their office visit. They love having their visit information printed out for them so they can share with families. This coming year, we will be implementing Patient Portal and integrating Healthwise Patient Education with eClinicalWorks.
  • So far Thomson Reuters CareNotes for patient education has had an huge impact on our patient satisfaction. The patients really appreciate have clear documentation they can take home. However, we are in the process of implementing a patient portal that I think will really increase our patient satisfaction scores.
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September 19, 2012 Advisory Panel 4 Comments

News 9/19/12

September 18, 2012 News 6 Comments

Top News

9-18-2012 10-03-17 PM

Massachusetts Eye and Ear Infirmary and its physician group will pay HHS $1.5 million to settle potential HIPAA violations following the theft of an unencrypted laptop containing electronic PHI of patients and research subjects.

Reader Comments

9-18-2012 3-47-27 PM

inga_small From Honky Cat: “Re: Waiting in line at Apple. Don’t wait in line for your iPhone upgrade. Go to this link and pre-order your phone. They will ship it to you in two to three weeks. Surely you can wait that long for it.” I considered setting my alarm to be one of the first people to go online last Friday and place an order. Instead, I slept in and waited until 6:00 am to get online. By that time Apple had stopped taking orders to reserve the iPhone 5s for pick up at the local Apple store, so I’ll wait for mine to be delivered in a couple of weeks. Apple, by the way, sold two million iPhone 5s in the first 24 hours of pre-orders, more than double the previous record set in 2011.

9-18-2012 6-11-25 PM

From The PACS Designer: “Re: mobile image viewing. TPD congratulates Aycan Medical Systems for being one of the first to gain FDA approval for its Aycan Mobile for the iPad. Now that the FDA is involved with mobile solutions, we’ll see more teleradiology mobile solution approvals for other vendors.“

From Steve: “Re: QuadraMed. To be sold in the next 7-10 days.” Unverified.

From Pointer: “Re: EHRs. A vendor-agnostic viewpoint on how they don’t change the cost curve.” It may be vendor-agnostic, but this particular article is a clearly labeled opinion piece written by authors who have been historically negative toward EMRs, EMR vendors, and government. They are entitled to their opinions, but recognize them as such despite the bait-and-switch newspaper headline trumpeting “A Major Glitch.” Their editorial conclusion is accurate, though – most studies have failed to prove that EMRs save money (I haven’t seen any studies that convinced me that paper records save money or improve outcomes either, of course.) That’s not to say they don’t, only that it’s tough to prove since nothing in healthcare stays unchanged long enough to get a baseline. It’s also true that expecting technology alone to create savings without changing incentives is unreasonable. I agree with the authors that blowing taxpayer billions to get providers to buy software they weren’t willing to spend their own money on was illogical, but no amount of Monday morning quarterbacking will bring that cash back or cause providers to toss their EMRs out the nearest window. It’s time to move on, realize that healthcare IT is here to stay, and constructively make it better instead of hand-wringing. Like everything else, the industry has 10% cheerleaders, 10% naysayers, and 80% rational people who don’t need the self-proclaimed experts on either end of the spectrum to tell them what to think or do. If you’re a provider, choose EMR or paper as you desire, do something innovative with it that improves outcomes and reduces costs, and then write your own article. That’s the one I’d rather read.

From Looking Deeper: “Re: patient portals and self-scheduling. I install patient portals for a living, including scheduling. There really aren’t technical challenges any more. Providing convenient, immediate online scheduling is a solved problem even in healthcare, especially in primary care. The problem is in people’s heads. Whenever online scheduling comes up, physicians and clinic staff will tell you that their patients can’t possibly handle it – they’ll schedule the wrong kind of visit (office visit vs. physical) or create some other vague problem. I dutifully inform them that online scheduling is working fine in clinics and practices across the nation. ‘Other clinics find that their patients can handle this,’ I always say. They usually say, ‘Not our patients.’ Interestingly, clinics serving less-affluent areas and the indigent tend to be more in favor of such patient-centric services. ‘Our patients are an especially incompetent group’ is a pretty negative view to hold of the people you’re trying to care for. If we could just get past this attitude, pretty much all primary care visits could be scheduled online. In the rare case where something needs to change, the clinic can call or e-mail the patient and reschedule, but that’s less than 5 percent of appointments scheduled online. Specialty and procedure visits are a different beast and need some careful analysis before they are opened up to online scheduling, but online scheduling for primary care is a solved problem.”

HIStalk Announcements and Requests

inga_small I have newfound respect for anyone working with insurance companies to secure payments. I had mentioned a few months ago that I had a minor medical procedure that resulted in some complications, lots of doctor office visits, and about 20 different medical claims. I was lucky enough to have both primary and secondary coverage in place since the claims were in the thousands. I also thought I was lucky because both policies were from the same very big insurance company. Unfortunately, the insurance company has spent the last four months trying to decide internally which policy should be primary, and so far no claims coordination has occurred. After several weeks of hour-long phone calls, yesterday I finally turned “not nice” and demanded to speak to a supervisor. I explained that I didn’t give a (expletive) which policy was primary or secondary, it was all one insurance company, and the (expletive) claims needed to be paid. I actually believe the claims will finally be processed correctly. The moral of this story is that if you work in a hospital or practice, take a moment to say thanks to your billing and collection staff. And bring them chocolate on a regular basis.

I don’t know about you, but I’ve been busy turning off all my Facebook and Twitter connections to folks who keep preaching politics. Has anybody ever convinced someone to change their political beliefs by proudly posting a Facebook link to the latest nut-job partisan article? Actually, they sometimes almost convince me to vote the other way out of annoyance.

9-18-2012 8-38-27 PM

Thanks to Healthcare Quality Catalyst supporting HIStalk as a Platinum Sponsor. The Salt Lake City company offers a practical clinical data warehouse solution that combine technology and clinical improvement methodologies to improve care. The information needed to answer a clinical improvement question is scattered in most hospitals (satisfaction surveys, Epic Clarity transactions, and lab and prescription information, for example) and HQC puts it together in its Adaptive Data Warehouse and subject-specific data marts (such as women and newborns) to support continuous, evidence-based care improvements. HQC offers more than just the tools, supplying clinical improvement methodologies such as role definitions and process templates to create effective improvement teams. If you’ve been around the industry for some time, you surely know some of their folks: Todd Cozzens, Larry Grandia, Dale Sanders, Bruce Turkstra, and David Burton, MD were some of those I immediately recognized. I interviewed co-founder and CIO Steve Barlow a year ago and got a good background on the company. Thanks to Healthcare Quality Catalyst for supporting HIStalk.

I naturally cruised over to YouTube and found this video that introduces Healthcare Quality Catalyst better than I did.

Acquisitions, Funding, Business, and Stock

9-18-2012 6-02-11 PM

PE firm ABRY Partners makes a “significant” investment in SourceMedical Solutions, a provider of software and services for ASCs and rehab centers.

In England, a company that commercializes university research invests in an Oxford spinoff whose software that can monitor pulse, respiration, and oxygen saturation using only a webcam.

Also in England, eHealth Insider reports that CSC will stop selling iSoft GP systems to NHS markets, in which it has 582 practice customers. CSC denies the report.

Vipaar, which sells surgery proctoring software based on technology developed at the University of Alabama at Birmingham medical school, raises half of its $1.2 million funding goal.


9-18-2012 6-03-58 PM

Community Medical Center (NE) selects BridgeHead Software’s Healthcare Data Management Solution for backup and archiving.

CommUnity Care (TX) will deploy NextGen RCM Services throughout its 22 clinics.

9-18-2012 7-47-39 PM

Pemiscot Memorial Health Systems will expand its deployment of Prognosis Health Information System by implementing its financial system and its laboratory information system powered by Orchard.

Community Hospital Grand Junction (CO) chooses the perioperative system of Surgical Information Systems.


 9-18-2012 10-51-46 AM

Zotec Partners hires Kristy Floyd (American Society of Anesthesiologists) as director of anesthesia business development.

9-18-2012 11-13-49 AM

The Medical College of Wisconsin appoints David C. Hotchkiss (University of Texas Health Science Center) VP/CIO.

9-18-2012 3-28-44 PM

Healthland names Patrick Spangler (Epocrates) CFO.

9-18-2012 8-19-54 PM

Douglas Billian, founder of Billian Publishing, died September 15 at 84.

Announcements and Implementations

9-18-2012 6-05-42 PM

HIMSS Analytics recognizes Fort HealthCare (WI) with its Stage 7 Award for EMR adoption.

Providence Medford Medical Center and Asante Rogue Regional Medical Center (OR) will complete their hospital and clinic implementations of Epic in April.

9-18-2012 6-06-34 PM

Nuance will purchase Ditech Networks, a provider of voice technologies and voice-to-text services, for $22.5 million.

AMA releases the 2013 CPT code set, which goes into effect for claims filed as of January 1, 2013.

Certify Data Systems announces the general availability of its HealthLogix HIE platform, which it says is the first to deliver an aggregated patient view from all community health encounters regardless of EHR.

9-18-2012 6-08-43 PM

Cincinnati Children’s Hospital Medical Center (OH) implements Passport Health’s PatientSimple and Smart Statement online billing solutions.

9-18-2012 6-01-14 PM

eClinicalWorks launches its $10 million open, secure collaboration platform that works with any EHR or even paper-based practices. The NHIN Direct-compatible network allows members to transmit electronic referrals and patient records with attachments.

Government and Politics

ONC posts the second wave of draft test procedures for the 2014 Edition EHR certification criteria.

I don’t think Farzad ever followed through on his promise to name the EMR vendors who took his #VDTnow pledge to allow patients to view, download, and transmit their medical information. Claudia Williams of ONC tweeted her list, which I assume is complete: Allscripts, NextGen, AlereWellogic, Intellicure, eClinicalWorks, Greenway, SOAPware, athenahealth, Azzly, and Cerner. Conspicuously but not surprisingly missing is Epic, which doesn’t even have a Twitter account as far as I know. Maybe they already offer the capability as some have suggested, but if so, all they had to do was tweet out their already-met pledge. Judy’s on ONC’s Health IT Policy Committee, after all.

Innovation and Research

The National Library of Medicine awards The Ohio State University College of Medicine’s Department of Biomedical Informatics $1.3 million to develop a system that uses EHRs to identify potential patients for clinical trials.


inga_small Wider use of EHRs over the last decade may be contributing to a growing up-coding trend that has added $11 billion to healthcare costs. Physicians argue the higher codes are justified because care of seniors has become more complex and technology allows them to code more accurately. Critics say the findings suggest billing abuse and fraud. I I were still selling EMRs, I’d be handing this study to doctors and touting it as proof that technology is helping physicians bill and be paid for the actual care provided. Meanwhile, naysayers like Mr. H will probably dig deeper and suggest objections to such hasty conclusions.

inga_small Hell hath no fury: a Washington dermatologist wins a $600,000 settlement and a rare apology from state health officials who had investigated him for drug abuse and medical fraud. An anonymous tipster had reported that the doctor was falsifying drug records, using cocaine, and running in-office orgies among his staff, patients, and prostitutes. In a separate lawsuit, the doctor was award more than $100,000 from his former wife, who turned out to be the anonymous tipster who had filed the complaint late in the couple’s bitter divorce proceedings.

The folks from Arizona Associated Surgeons sent over their video for the Western Users Group meeting at ACE (the Allscripts user meeting) last month.

9-18-2012 9-03-09 PM

Want to rub elbows with sexy celebrities on your hospital employer’s dime? CHIME’s Fall CIO Forum will feature Olympic beach volleyball gold medalists Misty May-Treanor and Kerri Walsh Jennings, mostly known for leaping around nearly naked in prime time reminiscent of the much-beloved “Girls on Trampolines” segment of The Man Show except with smaller bikinis. Misty and Kerri (or was that Misti and Kerry?) will discuss Meaningful Use Stage 2 and … no, wait, they’ll pose with star-struck CIOs, sign autographs, and collect a big non-amateur payday courtesy of patients who pay $5 for an aspirin.

A group of 30+ physicians labeling themselves as “Doccupy” complain to Contra Costa, CA county supervisors about the $45 million implementation of Epic at its hospitals. They said 10 percent of ED patients are leaving without seeing a doctor, a number that increased after the hospital’s July 1 go-live as the average time in the ED increased from three hours to four. Patient loads were cut in half to prepare for the implementation, but the doctors claim that several of their peers still quit because of stress, saying, “We were not ready for Epic and Epic was not ready for us.” An ED physician going off shift said she still had documentation to complete for 16 patients, adding, “It’s going to implode.” Some doctors spoke up about the advantages of Epic, and all agreed that it’s important to have an integrated electronic record. Detention facility nurses had complained about Epic to the supervisors last month.

9-18-2012 8-15-51 PM

The Cure JM Foundation (juvenile myositis) is in the running for a $250K research grant that will go to the charity with the highest number of Facebook votes. Information and voting links are here. Several HIT folks I’ve heard from have children with JM and I’m sure they would appreciate your vote.

Patients storm Charlton Memorial Hospital (GA) after a contracted collection company incorrectly manipulates the hospital-provided data file, sending patients collection notices for bills they don’t owe.

9-18-2012 9-52-28 PM

Of the seven highest-earning non-profit CEOs in the country, four run hospitals, according to the Chronicle of Philanthropy. I think they’ve missed a few since I’ve seen several hospital tax forms with CEO salaries above these figures.

9-18-2012 9-22-57 PM

Bloomberg Businessweek profiles Terry Ragon, founder of the Boston-based InterSystems, which sells the Cache’ database that runs Epic, Meditech, and quite a few other MUMPS-based healthcare systems. The article calls Ragon a “Hidden Software Billionaire,” estimating the value of the company he directly owns at $2 billion.

9-18-2012 8-32-54 PM

Here’s a fun coincidence. Dave Miller, vice chancellor and CIO of the University of Arkansas for Medical Sciences, sent over the above video of him doing a nice cover of “Mustang Sally” at Epic’s UGM (his wife had the camera 90 degrees off kilter for a few seconds, but his singing was fine). The day they got back home, he impulsively bought some raffle tickets from a charity fundraiser. He won the prize, which was made in 1967, the same year Wilson Pickett released “Mustang Sally” on an album – a classic Ford Mustang.

Sponsor Updates

  • SuccessEHR grows its RCM services business 92 percent over the last year.
  • First Databank hosts its 2012 FDB Customer Seminar this week in San Diego.
  • T-System offers Webinars this week on  improving ED throughput.
  • Melanie Pita JD, EVP of product management at Prognosis Health Information Systems, presented a session on EHRs and Meaningful Use at the Georgia Rural Health Association conference this week at Callaway Gardens.
  • TeraRecon is exhibiting its advanced visualization solutions for medical imaging this week at CIRSE 2012 in Lisbon, Portugal.
  • Michigan Health Connect HIE and Greenway Medical will provide data exchange between Greenway’s PrimeSUITE customers and hospitals on the Michigan Health Connect platform.   
  • MedPlus offers a three-part Webinar series hosted by Steven Waldren, MD, director of the AAFP’s Center for Health IT.
  • White Plume releases a white paper discussing practical considerations to minimize losses while migrating to ICD-10.
  • ChartWise Medical Systems unveils its ChartWise:CDI software at this month’s AHIMA convention in Chicago.
  • Orion Health opens an office in Singapore for development and technical support employees.


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

More news: HIStalk Practice, HIStalk Mobile.

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September 18, 2012 News 6 Comments

Curbside Consult with Dr. Jayne 9/17/12

September 17, 2012 Dr. Jayne 1 Comment


There’s been a lot of talk lately about the perils of cloned documentation. I had several readers forward me the recent notification from Medicare administrative contractor National Government Services that states that it will deny payments for encounters whose documentation appears cloned.

Let’s face it. Many of us have been creating what could be construed as cloned documentation since our residency days. Back when the average length of stay was a little longer (especially on a teaching service), we were encouraged to completely recap the contents of the previous day’s note, which often led to copying.

With 15 or 20 patients on our rosters, it was often impossible to remember subtleties about each patient, so you just copied what you had from the previous day, updated the lab values, any new complaints, etc. It was a lot like using copy forward / update technology in EHRs today, except a pen with a drug company logo and some truly horrific penmanship was involved.

When dictating discharge summaries, the vast majority of patients had strikingly similar exams since patients had to have largely normalized to go home: Heart regular rate and rhythm; no murmurs, rubs or gallops; lungs clear to auscultation bilaterally; and so on. When confronted with a stack of discharge summaries to dictate (which lazy attending physicians had kindly “flipped” our way) on patients we had maybe seen once, they all started to sound remarkably alike in other ways as well.

I remember being on service at a pediatric hospital, where in a single call night I personally admitted 17 patients for asthma exacerbation. The other interns on the team had at least five or 10 asthma patients each as well. Since there were three interns on a team, the senior resident was covering nearly 50 patients – and more than 30 of them had similar chief complaints and presentations. We had strict criteria for who was admitted (thanks to evidence-based medicine), so their presentations were actually very similar, and all had failed identical interventions in the emergency department before admission. You can bet those senior resident notes didn’t have any new or different information than what was presented in ours.

Ditto on Labor and Delivery during residency, where I trained at one of the highest volume birthing hospitals in the region. Since a normal uncomplicated childbirth really isn’t an illness, the documentation was routine and nearly identical. It would have been difficult to find truly unique information to write about some of the patients. I supposed we could have put in frivolous information like, “This blonde Caucasian mother of the adorable blue-eyed infant has no complaints,” but we were tasked with rounding, not writing beautiful, flowing prose.

My problem with the entire issue of cloned notes is that no one really has defined what they consider cloned, making this just another arbitrary way for payers to deny reimbursement. One contractor defines it as, “Documentation that repeats language from previous entries on that patient or from other patients with similar conditions.” I dare anyone to find a note written in the last two decades that doesn’t repeat language in some way, shape, or form.

Prior to EHR, I used a homegrown paper template documentation system that created remarkably uniform notes. On the positive side, it also created remarkably high-quality visits. Clinical decision support was baked into the documentation forms for various chief complaints. We often took materials provided by various professional organizations (AAFP, AAP, ACOG, CDC, etc.) and customized it to meet local and payer guidelines. For uncomplicated illness (strep throat, sinusitis, urinary tract infection, etc.) the notes would be strikingly similar from patient to patient.

Why is it bad thing for the physician to document exactly the appropriate information to substantiate level of care and quality? Should extraneous information be required for payment so that the note appears individualized just for the sake of being individualized?

I can easily avoid the appearance of cloned documentation across patients by including nuance information in the history of present illness. I have no problems doing so if it is relevant to the patient’s story and his or her care.

Another issue entirely is that of cloned documentation within a single patient chart. Regulators and anti-EHR voices are after those of us who like to “drag and drop” previous visits into today’s note, then update it. Note that I said “update.” I didn’t say drag, drop, and depart. Who among us who actually cares for patients does not have at least a few dozen “Groundhog Day” patients, those where every single visit is the same? I’m talking about patients like the noncompliant hypertensive diabetic who refuses to follow the instructions from the previous visit. Every single assessment and plan looks something like this:

1) Diabetes: Reviewed blood sugar log. Counseled patient to take medications as directed and continue 1,800-calorie ADA diet. Patient to exercise 30 minutes daily and check blood sugars daily, bringing meter to next visit for download.

2) Hypertension: Counseled again regarding sodium intake and packaged foods. Exercise as above, continue medications.

3) Obesity: Discussed diet and exercise as above. Refer to nutritionist. Discussed consequences of continued noncompliance including worsening of chronic health conditions, heart disease, and potentially premature death.

Really, what else do I need to say here? Maybe I should start adding incremental data like, “Counseled patient for the 15th time” to make it more individualized. Or I could document specific details of the data in the blood sugar log, but that would be redundant and also introduce a potential source of error as I manually key numbers into my note.

The bottom line is this. Why should I not be able to pull this data forward, then update or add to it? It’s clear, it’s complete, and it accurately documents what I stated in the visit. I shouldn’t have to add extraneous information just to satisfy an auditor.

A friend of mine has a collection of hilarious patient visit notes (of course, with any patient identifiers carefully redacted with a broad-tip Sharpie) from both the paper and EHR realms. One of my favorite pages in his scrapbook is the ultimate healthcare haiku, written before the days of E&M Coding:


And that, dear readers, is a thing of beauty.

Have a great example of patient documentation to share? E-mail me.


E-mail Dr. Jayne.

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September 17, 2012 Dr. Jayne 1 Comment

Monday Morning Update 9/17/12

September 15, 2012 News 7 Comments

From Another View: “Re: your Time Capsule editorial. You have missed a competitor to Epic … Sunrise/Eclipsys. Ring any bells? Long Island Jewish has it installed as well as others and it is well received. Is the price tag of Epic is going to bankrupt medicine? I really think Sunrise could very well be the Apple product that beat the giant Microsoft. Any thoughts?” Read more closely: I specifically mentioned (twice, in fact) Cerner, Eclipsys, and McKesson as Epic’s big-hospital competitors. That was true when I wrote the article in 2007, but I would expect that Allscripts/Eclipsys and McKesson have faded since then in terms of big-hospital customer count. Epic’s huge number of wins since 2007 were replacements, meaning their gain was somebody else’s loss. No, I don’t think that Allscripts (or any other vendor, at the moment) can compete with Epic in the large-hospital inpatient clinical systems market. Reasons: (a) incomplete integration; (b) narrower product line; (c) lower customer satisfaction; (d) lack of momentum; (e) hospital consolidations favoring existing Epic customers; and (f) trying to disrupt the status quo with one hand firmly planted in Wall Street’s lap. It’s not the end of the world for Allscripts – 80% hospitals aren’t candidates for Epic but need a lower-priced, pre-packaged, hosted product, meaning the biggest companies to beat are Meditech, McKesson, Cerner, and Siemens. Struggling to compete against Epic in big-hospital accounts hasn’t hurt Cerner, which doesn’t bag a lot of fresh Millennium wins over Epic but still has turned its assets into a $12 billion company. If you want to score Epic vs. Allscripts without emotion or subjectivity, it’s easy – just watch the number of new sales, the total number of beds and EPs covered, and KLAS scores.

9-15-2012 1-51-48 PM

From Music Lover: “Re: Epic UGM. You missed it, Mr. H! Some cool end users rocked the house Monday night. Anyone have pics or YouTube?” I only found the video of the opening session above, which is a clever riff on a horrible Journey song (was that redundant?) that reminds of me when Mrs. HIStalk dragged me to grit my teeth through the traveling Broadway version of “Rock of Ages” (who would have guessed that disco would be more fondly remembered than 80s hair bands?) By user group standards, though, it is darned cool. From the end of the video, it appears next year’s theme will be, predictably, Deep Space (the new 14,300-seat Deep Space auditorium pictured above will be open then.)

Listening: new from The Avett Brothers from Concord, NC, who have matured from frantic newgrass revivalists into something like an indie, rootsy Beatles with banjos. Long-term fans will have to decide whether the de-emphasis on hillbilly picking and grinning is inevitable maturity or perhaps overly slick production by hit-maker Rick Rubin. The new album is more accessible and probably less embarrassing to crank up in a vehicle that isn’t a pickup truck.

I was making an appointment for my annual PCP visit last week. After navigating through the annoying phone tree, waiting on hold, and negotiating with the scheduler for a convenient appointment time, the phone connection dropped on their end. My call-back went right to the “we’re too busy to talk to you now” message, so I figured I’d just try another day. The next day, I got an e-mail confirmation for a date/time I had declined, so it must have gone through as we were changing it. I noticed an unobtrusive link in the e-mail to “click here to cancel or reschedule” and darned if it didn’t work – I clicked, it gave me available days/times on the screen, I clicked on a convenient date/time, and I was all set. It actually felt like 2001 instead of 1980 in using Expedia to book a flight instead of wasting everybody’s time by calling a travel agent for an inefficient and entirely unnecessary telephone conversation. It’s not exactly cutting edge, but very few businesses let you schedule appointments online (restaurants being one exception, and that’s only because of OpenTable). Scheduling an appointment is a lot different than buying a product online, so the usual snarky Amazon references don’t apply.

9-15-2012 7-31-54 AM

Forbes chose the wrong company as the most innovative in healthcare, according to readers who said it’s actually Epic (had Forbes included non-publicly traded companies, of course). Cerner wasn’t too far off the mark, though. New poll to your right: have you ever requested and reviewed your electronic medical information from your PCP? The poll accepts comments if you’d care to elaborate on your experience. I didn’t even bother asking about hospital records since I know what a nightmare that can be.

9-15-2012 12-53-57 PM

Allow me to introduce new HIStalk Platinum Sponsor ChartWise Medical Systems. The Rhode Island-based company describes ChartWise:CDI as a Computer-Assisted Clinical Documentation Improvement solution that improves the accuracy and speed of documentation. it guides physicians to high-quality and complete documentation, using its built-in intelligence to analyze labs, meds, and procedures to suggest diagnoses and complications that may not have been correctly coded. Easily retrievable, auditable, and AHIMA-compliant query templates ensure compliance and consistency for internal QA and external auditors, with physician communication automatically initiated and documented by e-mail. Customers can reduce staff and physician training, ensure continuity when key team members leave, and get real-time metrics for their CDI programs. It’s offered by a subscription-based license, online training is free, and ICD-10 is built in and carries no upgrade fee. Customers can use it their way, regardless of whether documentation is on paper or EMR and with or without the participation of physicians. Half of Medicare paybacks are due to erroneous or incomplete documentation and you know the RAC auditors are out there digging since they’re paid a percentage of recovered dollars. The company was founded by Jon Elion MD, who also developed the Heartlab imaging software that was acquired by Agfa in 2005. Thanks to ChartWise for supporting HIStalk.

9-15-2012 1-42-10 PM

CapSite releases its new HIE report. It shows a big jump in hospital HIE participation in the past year (from 30% to 50%), with 71% of respondents planning to invest in new HIE technologies in the next two years. Surprisingly, two-thirds of respondents chose their primary HIE vendor because the company was an extension of their core hospital system (Epic was the most-named HIE vendor, so that gives you an idea). That probably reflects the uptick in private HIEs.

A hospital in England uses Skype for video teleconsultations with ADHD and Asperger syndrome  patients.

9-15-2012 2-40-47 PM

The flagship product of Detroit-based startup SchedFull manages an online waiting list for physician practices that allows them to fill appointments opened up when patients cancel, alerting the standby patient by e-mail or SMS if an opening matches their expressed preferences. The product is in beta.

Twenty-three employers participated in a jobs fair that was held last week in the new Sheik Zayed Tower at The Johns Hopkins Hospital, hoping to hire healthcare IT and informatics graduates from Johns Hopkins University, George Washington University, and University of Maryland University College (surely the strangest and most multiply-redundant college name ever, which they cheerfully admit and explain here). The event was held in the Chevy Chase Conference Center, which I assume is named after the nearby municipality rather than the embarrassingly unfunny comedian who did in fact have a Hollywood theater named after him for six weeks in 1993, which is all it took for his horrible late night TV show to flatline.

9-15-2012 3-58-57 PM

The Dallas-Fort Worth TV station covers the technology used in a new Texas Health Alliance hospital.

The local paper covers the use of shared medical appointments by Reliant Medical Group (MA), in which 90-minute visits are scheduled with groups of patients suffering from the same chronic health issues. Patients have the option to request one-on-one doctor time during the visit if they feel the need, but three-quarters of them like the group appointments. That’s an interesting approach to maximizing the use of resources while providing peer support for patients, which is probably far more effective than the usual online groups. All that’s missing is a financial incentive for consuming fewer resources, which is of course a healthcare problem not limited to how patients schedule their visits.

9-15-2012 3-28-27 PM

Raul Recarey is named executive director of the Illinois HIE in his third HIE leadership role in less than three years, having been named COO of the West Virginia Health Information Network in November 2009 and CEO of Missouri Health Connection in March 2011.

Indian River Medical Center (FL) will implement centralized appointment scheduling using McKesson’s Paragon Resource Scheduling, which issues printable appointment itineraries and procedure instructions. After the May go-live, the hospital will implement patient self-scheduling.

9-15-2012 3-22-21 PM

A hospital in Scotland is found by NHS to be cancelling 12% of its outpatient appointments due to problems with its new computer system. The hospital cancelled 105,000 outpatient appointments and 7,500 inpatient appoints in a 15-month period.

9-15-2012 3-35-06 PM

The author of an upcoming book says that children’s hospitals are banking huge cash surpluses and paying eye-popping executive salaries despite their non-profit status and ongoing solicitation for donations, which he says threatens their non-profit status, government subsidies, and community reputations.

California’s attorney general sends out subpoenas to several big health systems (Scripps, Sharp, Sutter, and others) in launching an antitrust investigation to determine whether consolidation among hospitals and physician groups is increasing healthcare costs through increased pricing power over payers.

A nurse working for an Atlanta-area anesthesia service is released to rehab after being charged with driving the wrong way on a highway and causing several vehicles to crash, injuring six people. She is alleged to have stolen propofol from Gwinnett Medical Center and starting an IV on herself to administer it in her car right before the accidents.

Vince tells the story of Compucare and QuadraMed this week, going right to the source in somehow connecting with Dynamic Control co-founder David Pomerance, who then introduced him to Ron Aprahamian, whose fascinating story is that he bought all of Compucare’s stock for $50,000 as a 29-year-old, struck a deal with Meditech, took Compucare public for $40 million, took leadership roles at Superior and First Consulting Group as those companies were acquired … well, just check Vince’s slides because it’s too amazing for me to summarize. I’m glad Vince shared Ron’s story because even though I knew his name, I had no idea how much influence he had on so many major industry players. We would never have heard these stories if it weren’t for Vince, who seems to be the only person willing to work hard to preserve our industry’s history. If you can help him with stories, photos, or connections to folks he should talk to, give him a shout.

E-mail Mr. H.

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September 15, 2012 News 7 Comments

News 9/7/12

September 6, 2012 News 10 Comments

Top News

9-6-2012 5-22-15 PM

Merge Healthcare’s board hires an investment bank to seek strategic alternatives for the company that could include a merger or outright sale. Merge, which has lost money for six straight quarters, has seen its share price drop 40% on the year, although shares were up 10% Thursday on the announcement. Above is the one-year share price compared to the S&P 500 (green) and Cerner (red).

Reader Comments

9-6-2012 8-54-32 PM

From Acorn: “Re: emergency power off switch. An engineer fell onto ours today.” Been there. We had just moved into a new data center at my previous employer and the entire data center was going dark a couple of times per day. We couldn’t figure it out, but suspected a construction mistake. The UPS wasn’t kicking on and the standby generator wasn’t coming up, so all systems were going down hard, creating a nightmare of system outage and recovery downtime (we’re talking every server, connection, telephone system, etc. spanning several hospitals). We eventually figured out the problem: the big, red emergency power-off switch was right beside the exit door where the old data center’s “press here to open door” button was located. Employees were smacking it by habit as they exited, and then sheepishly running for the hills without telling anybody when the data center suddenly went dark and quiet. We put a $1 plastic cover over the switch and that was the end of the problem.

9-6-2012 8-55-31 PM

From Sadie: “Re: Merge Healthcare. Three weeks after an RIF in France and one week after a 56-person RIF in the US, Merge announces plans to sell the company. I hate to say that I called this months ago.”

9-6-2012 8-57-55 PM

From MindYourOwnBusiness: “Re: UPMC. They’re in the hospital (and EMR) business, not the law enforcement business.” A patient who says she contracted hepatitis C from syringes infected by a drug-using radiology tech at UPMC sues the hospital and two of its staffing agencies. The lawsuit says UPMC caught the tech in the act of stealing fentanyl from the OR and told his contract employer to stop sending him to work there, but didn’t notify anyone else. The tech then worked at eight more hospitals, spreading hepatitis C to at least 30 cardiac cath patients and possibly hundreds or thousands. I’ve negotiated the “resignations” of a couple of hospital employees for known or strongly suspected drug theft over the years, and as irresponsible as it sounds, begrudgingly let them walk away without a resume blemish. The reason: the hospital’s legal counsel said that unless we had an airtight case against them (which is almost impossible to obtain) and ran them through a couple of cycles of optional drug rehab at our expense, they would probably sue us immediately for even insinuating to a potential employer that their records were anything but impeccable. In this case, the tech wasn’t even a UPMC employee. Nobody is bothering to sue the actual criminal, of course, given his unattractively shallow pockets.

From Curious: “Re: Dell. Heard they’ve cut a large number of experienced senior people from their outsourcing group.” Unverified.

HIStalk Announcements and Requests

inga_small HIStalk Practice highlights from the last week include: MGMA urges CMS to remove duplicate e-prescribing requirements in the MU and PQRS programs. Physicians express concerns about the impact of the ICD-10 transition on finances and practice operation. GenX physicians want a life outside of work, rely heavily on EMRs and smartphone apps, and like sharing the load with other doctors. Dr. Gregg has a geeky moment about Scanadu. The HIStalk Practice Physician Advisory Panel provides insights on patient volumes and the impact of EMRs and other technologies and the anticipated impact of the Affordable Care Act, with the possibly surprising finding that many of them won’t increase their patient volumes or workload even if it means higher incomes. Thanks for reading.

On the Jobs Board: Cerner and Epic Resources, Inside Sales Manager, Services Implementation Consultant.

Travis’s post on HIStalk Mobile, What I Learned about Health IT in Medical School, seems to be popular based on who’s linking to it or tweeting it (including some high-profile folks). Sign up for his updates and you’ll get the viewpoints of somebody who’s both a doc and an mHealth expert.

If Inga, Dr. Jayne, and I were running for office, we would kiss babies, try to appear humble by wearing carefully casual costumes to our scripted photo ops, and make a lot of promises we know we can’t keep. We aren’t, so the only vote we seek is one of approval, which you may cast by (a) connecting with us on the usual social not-working sites (and thus enlarge your own network significantly); (b) signing up for spam-free e-mail updates; (c) sending us news, anonymous rumors, and anything else that might amuse us; (d) enjoying the company as we do of our much-appreciated sponsors, whose click-worthy electronic greetings you see entirely coincidentally on this page (they look a bit like ads); (e) peering into the Resource Center, which contains more detailed sponsor information; and (f) telling others that you are shocked by the irresponsible and objectionable material you see here since nothing draws Internet page views like bad behavior. We thank you for reading, and if you were in the room with us, there’s a good chance Inga and Dr. Jayne would plant a kiss on each of your cheeks simultaneously.

Acquisitions, Funding, Business, and Stock

9-6-2012 9-10-38 PM

Registerpatient.com, which offers a Web-based patient registration and scheduling system for $50 per provider per month, raises $1.1 million towards a $4.1 million target.

Pamlico Capital acquires home health technology provider HEALTHCAREfirst from fellow PE firm The Riverside Company.

Vocera Communications announces a public offering of 4.5 million shares of common stock.

9-6-2012 9-13-41 PM

MobileHelp, a provider of mobile emergency response technology for personal use, acquires Halo Monitoring, a developer of home monitoring products.

Harris Corp. is investigating potential violations of US anti-bribery laws by its Carefx China division, whose employees were found to have provided gifts and payments to prospects and customers. Healthcare executives in government-run healthcare facilities in Europe and Asia are considered foreign government officials by the Justice Department and SEC.

9-6-2012 9-14-28 PM

Physician networking site Doximity secures $17 million in series B financing led by Morgenthaler Ventures, bringing its total funding to $27 million.


Intermountain Healthcare (UT) chooses Accelarad’s medical imaging solution for its 22 hospitals and 185 clinics.

9-6-2012 9-16-20 PM

Medical Center of the Rockies (CO) selects ProVation from Wolters Kluwer for GI documentation and coding.


9-6-2012 5-25-02 PM

Healthcare Quality Catalyst names Todd Cozzens (Optum) to its board. Todd got in touch to say that the company is building data warehouses and Subject Area Marts on top of Epic and incorporating quality and workflow principles developed at Intermountain into more of an industry quality engineering type capability. He’s been around healthcare for a long time and has a nice viewpoint from his work at Sequoia Capital, so when he says it’s the next big thing, it just may be. I interviewed Steve Barlow, CIO and co-founder, a year ago.

9-6-2012 5-27-06 PM

Intelligent InSites appoints Margaret Laub (Policy Studies, Inc.) president, CEO, and board member. Interim Doug Burgum will become executive chairman of the board.

9-6-2012 5-30-15 PM

Ivo Nelson (Encore Health Resources) is announced as a financial partner of Health Care DataWorks, where he has served as a board member.

Announcements and Implementations

9-6-2012 9-17-44 PM

HIMSS Analytics recognizes the University of Iowa Hospitals and Clinics with its Stage 7 award for EMR adoption.

Caverna Memorial Hospital (KY) and Palestine Regional Medical Center (TX) go live on their HMS information systems.

OB-GYN PM/EMR vendor digiChart will integrate Dialog Health’s text message patient reminder system into its product.

Oregon Community Health Information Network will provide Epic to 10 public health centers in King County for $500K per year.

Government and Politics

CMS reports that through the end of July, 128,000 EPs and 3,624 hospitals have collected almost $6.6 billion in MU incentives from Medicare and Medicaid.

A BMJ editorial by two professors says that, based on their fields of behavioral economics and social psychology, pay-for-performance probably won’t deliver the expected results. Their reasons: (a) risk adjustment methods are inconsistent; (b) the system can be gamed by upcoding; (c) process-based indicators are poor proxies for quality of care; (d) social characteristics of patients can make good doctors look bad; (e) overly detailed criteria may encourage just checking off the boxes instead of really taking care of the patient; and (f) doctors may stop exhibiting empathy and pride in their work since nobody’s paying them for those qualities.

9-6-2012 8-19-12 PM

A new report from the Institute of Medicine says that the US healthcare system wastes 30% of its cost, or $750 billion, on unneeded care, administrative overhead, and fraud. It says that if other industries worked like healthcare, an ATM transaction would take a full day, laborers building a house would each use different plans without talking to each other, stores wouldn’t post prices, car warranties would not be offered, and airline pilots would make up their own pre-flight check list if they felt like following one at all. Many of their potential solutions for creating a continuously learning healthcare system involve technology.


Surescripts will connect Epic’s Care Everywhere interoperability framework to its network, allowing Epic users to exchange patient-specific information with other providers regardless of their technology platform.

Forbes puts Cerner in good company as one of the 10 most innovative companies in America, citing it as #8 because “its servers handle 150 million healthcare transactions a day.”

Florida’s HIE adds Broward Health, Health First, Martin Health System, Mt. Sinai Medical Center, and Tampa Bay Regional HIE to its clinical exchange network.

Bill Clinton was such a good president (especially when graded on the 25-year curve) that the man formerly known as Slick Willie has completed his ascent to Elder Statesman/Rock Star, capped by his ad-libbing convention speech this week (how many people were like me and thought, “Why can’t we vote for him?”) and the announcement that he will deliver the Wednesday afternoon keynote at the HIMSS conference in New Orleans in March. HIMSS didn’t mention Hillarycare or his Monica Lewinski-driven impeachment, which I find myself being OK with since his relatively benign scumbaggery was eclipsed by his results in office. He could easily be elected president again, I expect, were it not for the anti-FDR 22nd Amendment that limits him to the two terms he already served. I don’t know what HIMSS is paying for his hour or so at the podium, but his rumored rate is in the $400K neighborhood. Also announced on the post-election, politics-heavy HIMSS keynote schedule: James Carville and Karl Rove, which I would find more interesting as a boxing match.

An ACO formed by Blue Shield of California and Dignity Health (the former Catholic Healthcare West) saved $37 million in projected costs over two years for the CalPERS state retirement program, with most of the improvement due to shorter hospital says and fewer readmissions.

Temple Community Hospital (CA) notifies 600 patients that their information was contained on a computer that was stolen from a locked office in the radiology department. The hospital says it will upgrade its security, presumably meaning it is belatedly considering encryption.

9-6-2012 8-36-04 PM

Lucile Packard Children’s Hospital (CA) announces a 150-bed, $1.2 billion expansion ($8 million per bed, $2,300 per square foot).

The San Franciso Jewish newspaper profiles David Jacobs, who started kidney paired donor-matching software company Silverstone Solutions within a month after his own kidney transplant in 2004. He expects to add several large hospital groups as customers in the next few weeks.

The feel-good Weird News Andy, temporarily changing his e-mail signature to Wonderful News Andy, likes stories about surgeons who help others (“a cut above,” he calls them). Two Salt Lake City surgeons win awards for their combined 100+ foreign medical trips, taken at their own expense to treat individual patients and educate physicians. WNA’s carriage turns back into a pumpkin with what he calls, “Doctors – The Flip Side,” as he reads the story of a patient undergoing surgery in a Swedish hospital whose anesthesiologist decides to knock off for lunch at the stroke of noon even though he’s the only anesthesiologist working. The patient crashes an hour later, employees can’t reach the anesthesiologist, and in the confusion someone turns off the respirator of the patient, who dies weeks later of brain damage.

9-6-2012 9-26-20 PM

Ministry Health Care (WI) tentatively agrees to join Ascension Health. Ministry’s stats: $2.2 billion annual revenue, 12,000 employees, 15 hospitals, and 46 clinics.

Self-proclaimed “EMR geek” Rob Lamberts, MD lists 10 ways EMRs could be made better. Ones I particularly liked: (a) require all visits to have a simple summary entered; (b) since the patient is often the “interface” between EMRs anyway, allow them to pull up their own records and show them to their new doctor; (c) maintain one comprehensive patient calendar that can be shared among providers; (d) let the patient manage the information they provide, such as family history, meds list, and social history; and (e) make patient records searchable.

Sponsor Updates

  • A letter to the editor of SIIM by Brad Levin of Visage Imaging offers suggestions on how the organization can decrease radiology technology commoditization by offering crowdsourced innovation theaters, product showdowns, and demonstration of extreme use cases.
  • Trustwave introduces security education services to help organizations protect against security risks and compliance missteps.
  • Jay Deady, president and CEO of Awarepoint, discusses RTLS technology in an interview.
  • MED3OOO announces that its customer PriMed (CT) will participate as an ACO in the CMS Shared Savings Program.
  • SimplifyMD will offer Capario’s EDI platform to its customers.
  • 21st Century Health selects Sandlot Solutions as a profiled business.
  • MedHOK’s 360ACO solution is NCQA certified for P4P, HEDIS, and disease-management performance measures.
  • NextGate begins operations at a new corporate office in Monrovia, CA.
  • Divurgent hosts The After Party September 12 after Epic’s UGM.
  • Wellsoft demonstrates its EDIS at next week’s 2012 ENA Scientific Assembly in San Diego.
  • T-System issues a call for presentations for its April linkED emergency care conference.

EPtalk by Dr. Jayne

I’ve spent a lot of time the last several weeks digesting everything there is to read about Stage 2 Meaningful Use. My eyes are glazed over and my brain has become addled. To help providers make sense of it all, CMS has released some tables comparing Stage 1 and Stage 2 Objectives and Measures. I’ve found them helpful, although I wish their page breaks made a bit more sense and didn’t chop a single row into multiple pages.


Mr. H wrote Monday of the Epic vs. McKesson patent appeal. For those readers who enjoy shoes as much as Inga and I do, here’s a bit of patent news. The 2nd US Circuit Court of Appeals reversed a lower court decision, with the outcome that Christian Louboutin was entitled to trademark protection of its well-recognized red soles, but only on contrasting shoes. Competitor Yves Saint Laurent is still allowed to make red soles, provided they are attached to red shoes.

A Medscape article reveals results from a survey on physician EHR preferences. Although nearly two-thirds of users were happy, that means there are a lot of unhappy users out there. Other interesting (but not surprising) tidbits: many physicians are unaware of whether their systems are hosted vs. locally installed, the magnitude of maintenance or installation costs, or what happens in the back office.

CMIO magazine has renamed itself Clinical Innovation + Technology, citing a recognition of “the ever-growing convergence of the IT and technology management teams within the provider setting.” I’m pretty sure that at most places the IT and technology management teams were already intermingled. I think it would have made more sense to say that the IT and clinical management teams were converging. For those hospitals that are still in denial about the need for a CMIO in the first place, it’s probably validating.


A recent study demonstrated that men who consumed chocolate reduced their likelihood of stroke by 17%. It’s not entirely proven how chocolate provides health benefits, but dark chocolate in particular is thought to have anti-inflammatory properties. Maybe I should try some medicinal cocoa instead of ibuprofen after my next workout.



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

More news: HIStalk Practice, HIStalk Mobile.

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September 6, 2012 News 10 Comments

HIStalk Interviews Larissa Lucas MD, Senior Deputy Editor, DynaMed

September 5, 2012 Interviews 1 Comment

Larissa Lucas MD is senior deputy editor of DynaMed of Ipswich, MA.

9-3-2012 9-47-55 AM

Tell me about yourself and the company.

I’m a general internist. I trained at Cambridge City Hospital. I practiced there in primary care after my training. 

I joined DynaMed and EBSCO Publishing about five years ago. DynaMed is a point-of-care reference tool to help clinicians answer questions in an evidence-based way while they’re with their patients. EBSCO Publishing is a larger publishing company that provides information through databases and eBooks and other technology to libraries around the world.


You called DynaMed a point-of-care reference company, which I assume is a somewhat different model than the company had when you started with them. How important is it to push the information out where it can be used?

It’s very important. Physicians are challenged today with so many changes in the healthcare system — needing to use electronic health records, communicating to patients through e-mail, and the volume of evidence that is published. It’s nearly impossible to keep up with all that information. It’s critical for physicians to have that information at their fingertips where and when they need it.


If you were to pull 1,000 patient charts and compare that to the evidence that you have on record in your product, how much compliance do you think you’d find?

What a great question. That would be an interesting study to do. For my colleagues, they’re probably pretty good. I think physicians in general do the best they can to stay current with the evidence and follow practice guidelines. Using electronic health records and  clinical decision support tools certainly has made that easier. I would say a chart review in the last five years would probably reveal a lot more compliance than a chart review 10 or 20 years ago.


Physicians presumably don’t know what they don’t know rather than ignore solid medical evidence. Do you find them to be receptive to being presented with the evidence and then changing their practice?

I think they’re receptive. It’s a matter of time balance. There’s a lot to cover in that 15 minutes. Clearly we want to spend as much time of that 15-minute visit addressing what the patient needs. A lot of the documentation and investigation of the questions that come up needs to happen usually at the end of day, before the day begins, and during lunch.  

The problem we’re trying to solve is to integrate that back into patient care, the face-to-face, point-of-care decision point. That’s where you should have the information.

The issue of information needs at the point of care has been studied by a few folks, such as our friends over at InfoPOEMs, Allen Shaughnessy’s group. Many physicians finish their clinical day with five to 10 unanswered questions. That could be disturbing from a consumer point of view, but it can also be disheartening for the physician who probably feels like they just can’t get to all of it in the same day. Creating tools that make that easier is really what we’re trying to do.


Academic medical centers have rounding teams, which you would assume probe the evidence more thoroughly than in the ambulatory setting, where it may be seen as undesirable to leave the patient to look something up. Where do you think the evidence is most heavily used and most lightly used in terms of practice setting?

The scenarios are quite different. Even in an academic setting, you have the team that’s rounding that is really also the education unit. It’s got students and residents in it and hopefully a teaching faculty that’s at the bedside engaging those residents, teaching them what questions to even ask.

There’s a lot more richer learning there, but there’s been a change in the way patients are treated in a hospital now. They’re not in the hospital for very long. A lot of those problems either get solved quickly by an intervention or they’re discharged from the hospital and those problems have to then be resolved outside the hospital.

Even that academic, rigorous learning experience has changed dramatically in the last 10 years so. You don’t necessarily have the opportunity to do the rich investigation at that time.


Studies have attempted to prove that physicians deviate further from the evidence the longer they’ve been out of medical school, which then roughly correlates a patient’s mortality risk to the age of their physician. I notice that DynaMed was recently voted by Harvard Medical School students as one of their top five favorite apps, so I was thinking that maybe having residents fresh out of school using apps like yours would influence the attending more than if that same doctor was out on their own in a non-academic setting.

Oh, absolutely. I agree with that. It’s very important to have the students and residents around. They’re asking those key questions and they challenge us to answer the “why.” Products like DynaMed also challenge the users. 

People define evidence-based medicine in different ways. I like to see it as understanding why we make our medical decisions, not just which medical decisions we should make. Many guidelines, many decision support tools, will put a patient on a protocol that doesn’t actually require a lot of thought. Sometimes that’s more efficient, sometimes not. 

From an academic standpoint, I prefer we as educators, life-long learners, and physicians think about, “Why are we doing it this way?” instead of, “What should I be doing next?” Investigating the evidence and synthesizing it around that clinical question helps answer the “why.” Certainly students and medical students and residents challenge us to do that.


Do you think having reference material available on an iPhone or an iPad has changed the willingness of physicians to use information at the point of care than when it existed only as a book they had to go find?

Definitely. Having it at the fingertips makes it a lot easier. Even as a busy clinician, you can integrate it more easily into your workflow, because now it actually seems realistic that you could achieve that steady state of having some tool that you can constantly look things up on and stay current. Before, it was such a daunting exercise that I would think it was overwhelming to physicians to think, “How could I ever look everything up that I don’t know?“ Now it’s much easier to do that.


The ideal point of inflection would be the EMR, where you have patient-specific information available on the same platform from which the treatment decision will be created. What’s the level of integration of your product within applications from vendors like Epic, Cerner, and Meditech?

DynaMed integrates very well with electronic health records. Our structure is very templated and volatized. You can see the answer to your question very quickly and you can launch different sections depending on whether you’re interested in diagnosis or treatment.

In Epic, it can integrate all the way down into the problem list. It seems to be more of a limitation on the EMR side than on our side. One of the challenges of the EMR is that each one is so different it’s hard for all of that technology to talk to each other. But we integrate very well, and with order sets, too.

We collaborate with Zynx order sets to support some of their evidence.  Users can link right to DynaMed or the Zynx evidence. That’s really where we need to be, because that’s now where physicians are interacting with their patient, and they’re interacting with their own question and intellectual curiosity.


Obviously DynaMed will continue to research the literature, but is it a different mission to work with these vendors to turn your information into more useful forms? You have more incentive than they do to accomplish that.

Yes. I think that’s on the technology side, not so much for us editorially. Editorially, our prime objective and vision stays the same. We certainly have enhanced our interface quite a bit in the last year, but more in response to our user feedback and also a need in the market for a tool that both sends out alerts and is a searching tool. We added that alerting feature as well. That doesn’t interact with the EMRs, but we are modifying the way that we’re producing the content a little bit to answer some of those demands from the market.


Do you have examples of how customers are using the information at the point of care?

We have people using it on iPads and iPhones, obviously, and we have quite a few customers using it integrated within Epic and within Meditech. I’ve seen it in Epic, either in just the InfoButton, the information drop-down menu at the top where an institution may have links to multiple resources that they subscribe to, all the way to an InfoButton right next to the problem list so that you could click on the diabetes in the patient’s problem list and launch the topic in DynaMed that would about diabetes.


Is the InfoButton the least common denominator, or is the look-up function even more standard?

All EMRs have the look-up function, usually in their top menu where institutions can put links to external web sites that have information. That’s the most basic integration that anybody can do.


The InfoButton is still somewhat unusual for a vendor to enable?

Yes. It just takes a little bit more technology.


Do you have significant usage by nurses or other clinical users who aren’t physicians?

Absolutely. DynaMed is part of a suite of point-of-care medical products that use the same evidence-based methodology and literature. We have one for nursing — that’s Nursing Reference Center. We have Rehabilitation Reference Center for physical therapists, Patient Education Reference Center for patients. 

If a hospital subscribes to all those products, they’re fully integrated within one search engine. We also provide full-text data bases to Cochrane reviews and other journals in Medline. Subscribing to the whole suite of medical products gives you information across different disciplines. We have quite a few users that go between products, so nurses will look something up in Nursing Reference Center, but then they also jump over to DynaMed and use that as well.


How is DynaMed differentiated from its competitors?

We’re all very different. DynaMed is based on the critical appraisal of the literature. Then the rest of the content is built around that, but it’s synthesized around the evidence in presenting the limitations and the strengths of the research that support our decision-making.

The other products in the market – UpToDate, ACP PIER, BMJ Point-of-Care — many are published still in a traditional textbook publishing model. The whole chapter is written by the author and then updated and kept current with the literature. It’s just a very different model. They’re all very good. I think we’re all very good at what we do.

How we’re set aside from the competition is that we are very focused on the critical appraisal piece of the evidence and providing the information to support the medical decisions so that physicians are more informed about why they’re deciding to go down a certain pathway.


You have folks on the front line that are contributing their expertise as well, right?

Yes, all over the world.


Is that hard to coordinate?

It’s very challenging.  We have sought experts from around the world. Sometimes time differences are challenging to deal with, but we try to be global.

We have a team of very experienced medical writers from varied scientific backgrounds. They’re very good at what they do, objectively evaluating the evidence. The collaboration with clinicians happens very smoothly and very naturally to make sure that relevance piece is part of what we do. With validity, anybody can follow a protocol in how to critically appraise and assess the validity of a trial, but the relevance needs to happen from the physician level. We’re always engaging with other physicians to get that input.


Do you know how your products are being used and being received by frontline physicians?

Every page has a “send comment to editor” button. That e-mail goes to myself, the editor-in-chief, and our support team. We get a lot of feedback from customers who are using it right at the point of care. That’s very helpful. It helps us drive our editorial priorities as well when we hear directly from customers.

We also work closely with many residency programs and get their ongoing feedback for how it’s used in their practices, in their education, and in their workflows. Our peer reviewers are also always giving us feedback. We definitely solicit feedback and we get it passively from our users. We love it. We’re dynamic. That’s why we have that name.


I once suggested to one of your competitors that it would be interesting to analyze the lookups of a reference product to infer information about prevalence of disease or outbreaks, like people who are always trying to use Twitter or Google searches to spot epidemics early.

That would be interesting. I’ve seen some of that research. Certainly our influenza topics had huge usage when we had the outbreak of H1N1, but typically our usage logs are consistent with what is seen in most general practices. Our top-hit topics are asthma, diabetes, pneumonia, sepsis, heart attacks, and urinary tract infections. 

It’s interesting to me, because you’d think some of the more common diseases that we see in practice, we wouldn’t have to look up answers to questions because you see it so often. You should be comfortable with it. But I like seeing that data, because it tells me my colleagues are constantly striving to see if there’s anything new. I’ve treated 50 UTIs this month, but is there anything new I can learn? In that sense, it’s very rewarding to see those usage logs are hitting some of the major topics.


Any final thoughts?

The challenges facing physicians are so complex. I really enjoy being part of this tool that’s hopefully going to make practicing medicine easier for physicians and make physicians feel more comfortable as they have to make quick decisions in their patient care. It’s definitely going to improve quality. It’s definitely going to improve patient outcomes. Those studies are yet to be determined, but I’m hopeful that all of this technology is going to to make it easier to practice medicine.

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September 5, 2012 Interviews 1 Comment

News 9/5/12

September 4, 2012 News 9 Comments

Top News

9-4-2012 8-42-16 PM

HL7 will make its standards and other intellectual property available to all healthcare stakeholders at no charge by the first quarter of 2013. The company says it hopes to increase private and governmental use by eliminating licensing fees, thereby improving care and reducing costs.

Reader Comments

9-4-2012 8-46-11 PM

From Mandrake: “Re: NuPhysicia. I’m looking for information from healthcare systems that have worked with them, but I’m not having any success and I see they haven’t been mentioned on HIStalk even though they’ve been around for several years.” I couldn’t find anything either, but I snooped around and found that the company – which has offices in Houston, Brazil, and Malaysia – shares its Houston address with medical staffing company eCareGroup and is apparently the same operation even though they never actually say so (NuPhysicia also offers telemedicine services under the name InPlace Medical Solutions). NuPhysicia is selling a commercialized version of telemedicine software developed at UTMB, best known for its use in prisons, but also used in retail clinics and on oil drilling rigs.

HIStalk Announcements and Requests

9-4-2012 5-42-54 PM

Welcome to new HIStalk Platinum Sponsor Vonlay. Given their location in the epicenter of Madison, WI, you might cleverly guess that Vonlay is an Epic consulting firm and a successful one at that, with 30 clients in more than 20 states. It deploys some of the industry’s best EHR consultants individually or on teams, working at your site when you need them there or via Vonlay’s Remote Services program, which offers big savings to its customers. If your Epic go-live is impending or completed, Vonlay’s remote experts can help work down your open tickets, pitch in on applying upgrades and SUs, and help you phase out more expensive on-site consulting services. The company also provides application mentorship and management-level strategy consulting on how to design, build, and roll out EHR projects, including technical assistance with system builds, Cache programming, interfaces, Web services, and portals. You’ll be in their neighborhood if you’re going to next week’s Epic UGM, so keep an eye out for their folks. Thanks to Vonlay for supporting HIStalk.

Here’s a fun Vonlay video I found, Attack of the Issues List.

Acquisitions, Funding, Business, and Stock

9-4-2012 8-47-18 PM

Net Health Systems, which offers an EHR for wound care, acquires competitor Wound Care Strategies.

Data analytics startup Predilytics raises $6 million in its first round of VC funding.


Geisinger Health System (PA) selects TeleTracking’s RTLS technology to track mobile medical equipment at two of its six hospitals.

Saint Vincent Health System (PA) contracts with onFocus Healthcare for its enterprise performance management software.

St. Vincent Hospital (WI) will implement Merge Healthcare’s complete cardiology solution across its enterprise.

9-4-2012 8-48-16 PM

Rex Healthcare (NC) will use Passport’s eCare NEXT solution for eligibility checking, demographic verification, precertification, and estimation of patient payment.


9-4-2012 5-11-34 PM

Virtual Radiologic names John Way (UnitedHealth Group) CFO.

9-4-2012 5-37-59 PM

John Gomez of JGo Labs is interviewed at Apple’s WWDC.

Announcements and Implementations

9-4-2012 8-49-49 PM

South Lyon Medical Center (NV) will complete transition to CPSI’s clinical applications by the end of the year. 

Government and Politics

The VA says that over one million patients have registered to download their health information via Blue Button.

The FDA issues a warning letter to Merge Healthcare, saying the company isn’t manufacturing its blood pressure monitoring kiosks within FDA’s guidelines.


9-4-2012 6-12-49 PM

Picis, Epic, and GE own the largest share of the anesthesia information system market, according to KLAS. The survey found that customer satisfaction is highest when AIMS purchasing decisions are handled cooperatively between the hospital and OR/anesthesia department rather than either entity making the decision alone.

ZirMed will undertake a $5.1 million expansion project that is expected to create 85 jobs over the next two years at its Louisville, KY headquarters. The state is offering $2 million in incentives for up to 10 years.

9-4-2012 5-27-11 PM

Apple announces a September 12 event that is likely to include its announcement of the iPhone 5 (note the shadow in the picture. )

Scotland-based Craneware says demand for its hospital revenue products has returned to high levels after a slow first half caused by US hospitals focusing on EHRs.

The government of China will invest $63 billion in its healthcare system over the next seven years, with part of the money going toward creation of an electronic health information network.

Technology investor and Sun Microsystems co-founder Vinod Khosla says computers will eventually replace 80% of doctors because computers are cheaper, more accurate, and objective, while healthcare is “witchcraft … based on tradition.” He also says that it will take outsiders to fix healthcare rather than those working within it. He has a knack for throwing out outrageous sound bites that earn him exposure, such as saying that hybrid cars offer no environmental advantage – they just make their owners feel better about themselves.

Highly regarded UCSF physician Bob Wachter, MD (chief of medicine, invented the term “hospitalist,” author) says UCSF’s new Epic system generates an impressive-looking progress note from fragments of manually entered information, but the “monkeys and typewriters” approach not only violates the legendary teachings of SOAP note inventor Larry Weed MD (in the 1971 video above that everybody who designs physician documentation systems should study regularly), it’s not as useful as the old fashioned written note. However, he also offers a solution: ditch the use of Epic’s Smart Text and offer a “Big Picture” field where physicians are encouraged to tell the patient’s story as of that moment (although he wonders whether natural language processing will make that unnecessary at some point). Wachter describes the current state as:

Why did Epic and our UCSF IT gurus structure things this way? The primary virtue is that this charting-by-problem approach allows the patient to be followed longitudinally, since one can track problems such as “hypertension” or “ovarian cancer” over years, seeing how they have been managed and observing the response to therapy. It isn’t a bad conceit, and it probably makes tons of sense when described in a fishbone diagram on an informatics seminar whiteboard. But the effect I witnessed on patient care and education was less positive. When I was on clinical service in July and read the notes written by our interns and residents, I often had no idea whether the patient was getting better or worse, whether our plan was or was not working, whether we need to rethink our whole approach or stay the course. In other words, I couldn’t figure out what was going on with the patient.

9-4-2012 8-01-15 PM

Small software vendor QueueVision says the Tampa VA hospital is refusing to pay for its medication tracking software despite using it since 2006. The company says the purchase was approved by the hospital’s pharmacy administration, but the VA won’t cough up the $214K it owes. Says a partner in the company, “We were suckers. They took us. I figured the veterans were so happy, the staff was so happy, everybody loved it. So we thought they would pay. We never fathomed that they would lie to us.”

In England, small blood-tracking systems vendor MSoft eSolutions is expanding after winning eight of eight RFPs last year. Its Bloodhound system provides positive ID of employees and patients throughout the blood transfusion process.

I liked this Facebook article by disgraced investor / interesting author Henry Blodget, in which he says publicly traded companies destroy their own value by trying to appease impatient investors and venture capitalists. He explains why nobody should be surprised at the fall in Facebook’s share price (May IPO price $38, Tuesday’s closing price $17.73) given the clear message that CEO Mark Zuckerberg has sent all along that he’s focusing on the customer experience and long-term value as Amazon has always done rather than next quarter’s share price. A snip of Blodget’s paraphrasing of a section of Zuckerberg’s pre-IPO shareholder letter:

Let me remind you that I own 57% of the voting stock of Facebook, which means I have complete control over it. I organized the company this way many years ago, with the very deliberate intention of maintaining complete control over it. I did this so I wouldn’t get overruled and canned by venture capitalists, a fate that unfortunately befalls many entrepreneurs. I also did it so in the event that we ever had to go public—which we unfortunately have to do now—I would never have to pay attention to whiny short-term public shareholders. Those whiny short-term public shareholders have destroyed many great companies by making management obsess about absurd near-term financial targets … Maximizing near-term profits" often means under-investing in future innovation, customers, and employees. And although it sometimes temporarily boosts stock prices, it often guts companies and clobbers their value over the long haul.

The Florida teenager accused of impersonating a PA and practicing medicine without a license is found guilty by a Florida jury and could go to prison for up to 10 years.

Sponsor Updates

9-4-2012 8-53-18 PM

  • Aetna will offer eviti’s oncology decision support tool on its Medicity iNexx platform.
  • The Surgical Information Systems anesthesia information management system earns the highest client satisfaction scores in KLAS’s anesthesia specialty report.
  • MED3OOO CMO Paul McLeod, MD discusses the challenges of controlling ER visits in a blog post.


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

More news: HIStalk Practice, HIStalk Mobile.

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September 4, 2012 News 9 Comments

News 8/31/12

August 30, 2012 News 20 Comments

Top News

8-30-2012 6-12-56 PM

SAIC announces Q2 results: revenue up 8%, EPS $0.32 vs. $0.32, beating expectations on revenue and meeting on earnings. The company announced plans to split itself into two independent, publicly traded companies, one offering technical services and the other delivering solutions. Healthcare will be part of the solutions business. Shares are up 10% in after hours trading. SAIC acquired Vitalize Consulting Solutions in August 2011 and maxIT Healthcare in August 2012.

Reader Comments

From Klinger: “Re: Epic support. I always heard it was second to none, but what I’m getting is lacking. Have other people noticed, or is it just the TSs that I have?”

8-30-2012 8-37-31 PM

From Palmetto Jack: “Re: Palmetto Health. Not an affiliate of USC.” Thanks for the correction. Wikipedia says Palmetto Health Richland is affiliated with University of South Carolina and Palmetto Health’s graduate medical education page says the USC School of Medicine is a “partner and close affiliate,” so it’s one kind of affiliate but not another. I don’t really claim to know the difference.

From Honey Badger: “Re: Cerner. Heard a rumor that they will switch to Greenway’s ambulatory clinic EHR product.” Unverified.

HIStalk Announcements and Requests

inga_small This week’s top picks from HIStalk Practice: Consumer Reports publishes ratings on over 500 Minnesota practices. Practice administrators at large groups see a rise in median compensation, while their small practice peers experience a decline. AMA urges CMS to delay the move to ICD-10 by at least two years. Is HealthTap’s model viable in the long term? Physicians give high scores to Amazing Charts, Epic, and the VA’s ambulatory EMR. Practice Wise CEO Julie McGovern advises practices to avoid tackling other projects in the midst of an EMR implementation. We don’t have a Like button for our posts, so the next best thing is to sign up for the e-mail updates on HIStalk Practice. Thanks for reading.

Listening: new from Dispatch, their first new material since disbanding in 2002. The indie band hoped to draw 10,000 people to its free final concert in its home town of Boston in 2004, but instead became record-holders as the largest independent music concert in history when 166,000 fans came to say goodbye. The band’s mostly Northeastern tour starts in three weeks.

8-30-2012 7-07-46 PM

Welcome to new HIStalk Platinum Sponsor Health IT Quality Solutions, a certification program offered by Quest Diagnostics to vendors of ambulatory EHR products that support Quest’s DEX lab orders and results network. The program’s goal is to maximize lab data quality and enhance interoperability for the 500,000 patients per day that use Quest’s testing services. Three certification tiers are available based on solution capabilities, implementation processes, and participation in mutually beneficial activities. The entire program is free for vendors who qualify, with benefits that include customer satisfaction, solution visibility, faster interface approval, and priority access to Quest’s IT staff. Download a brochure and take a look at the several vendors that have already earned certification. Thanks to Quest Diagnostics and Health IT Quality Solutions for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

8-30-2012 5-59-31 PM

Greenway announces Q4 results: revenue up 24%, EPS $0.07 vs. –$1.09, missing on earnings expectations. The company also projected lower than expected earnings for FY2013. Shares fell 7.1% on the announcement, making GWAY the biggest percentage loser of the day on the New York Stock Exchange. Shares priced at $10 in its February IPO are at $15.27.


The 300-provider Cornerstone Health Care (NC) selects MedAptus Pro Charge Capture solution for coding and billing.


8-30-2012 5-16-57 PM 8-30-2012 5-18-06 PM

HealthTech Holdings hires Stan Gilbreath (Allscripts) as VP of client services for its HMS and Medhost divisions and Eric Anderton (Jackson Key Practice Solutions) as VP of new account sales for HMS.

8-30-2012 5-21-29 PM

Joe Miccio (maxIT Healthcare) joins Divurgent as client services VP.

8-30-2012 7-46-11 PM

In Canada, Nancy Martin-Ronson RN, who joined Peterborough Regional Health Centre three months ago as CIO, will also take on the role of chief nursing officer.

Arkansas Governor Mike Beebe names Ancil Lea, executive director of HITArkansas, as coordinator for the Arkansas Office of Health Information Technology.

Announcements and Implementations

8-30-2012 8-34-38 PM

The Karmanos Cancer Institute (MI) implements Versus Advantages RTLS in once of its clinics to monitor patient location, track throughput, and manage workflow.

McKesson will offer NovoPath’s anatomic pathology solution to its LIS customers.

Craneware earns CMS’s Electronic Submission of Medical Documentation certification, allowing it to offer customers the ability to electronically submit medical records to review contractors.

Government and Politics

ONC names CCHIT, the Drummond Group, ICSA Labs, InfoGard Laboratories, and Orion Register as certification bodies under the Stage 2 certification program.

Farzad Mostashari says that ONC will not allow EHR vendors to drag their feet in supporting data exchange with competing EHRs.


8-30-2012 5-34-30 PM

KLAS names its top-rated Meaningful Use consulting firms in three categories: Impact Advisors (enterprise implementation leadership and advisory); Cumberland Consulting (team implementation leadership and advisory); and Navin, Haffty, & Associates (team implementation leadership and staffing). Of the 51 firms identified, more than half achieved satisfaction scores of 89 or above out of 100.

SCI Solutions announces record growth for the first six months of 2012, with 82 hospitals choosing its solutions for care coordination, referral management, and scheduling.

Queens Health Network (NY) honors Congressman Joe Crowley for supporting ARRA, which will pay the hospitals and clinics of New York City Health and Hospitals Corporation up to $200 million.

Madison Memorial Hospital (ID) unblocks access to Facebook from its wireless network after patient complaints. One employee said it was “stupid” that as a patient, she couldn’t post photos of her newborn baby on Facebook. A newspaper reader was more rational: “What an inconvenience when we have to go to a hospital and we can’t get on Facebook. I guess most of us in this day and age feel entitled to more than that what we get.”

Real estate sources say that Meditech is finalizing a deal to acquire 200,000 square feet of office space in Foxborough, MA. The company abandoned plans for a Freetown, MA campus earlier this year after running into a mountain of red tape triggered by the discovery of native American artifacts on the property.

8-29-2012 8-31-32 AM

Epic not only submitted MU Stage 2 comments to ONC, it even helpfully distributed them to their customers so they could submit the same comments under their own names. David Clunie noticed this and lists the hospitals who sent in the boilerplate, including University of Miami, which submitted the same comments five times without noticing the “Remove Before Submitting” headline that prefaced Epic’s explanation of why its customers should share its opinions with Uncle Sam.

In Kenya, the country’s hospital insurance fund won’t issue insurance to a man who claims to be 128 years old because its computer system can’t handle birth years before 1890. His family says they don’t appreciate the implication that he should be dead, and until the issue is sorted out, he’s relying on the insurance of his youthful wife of 89.

Odd: a 29-year-old man sues the maker of the sexual enhancement supplement VirilisPro, claiming that the ensuing sex with his partner in a Scottish Inn damaged his manhood to the point that blood was squirting out onto the walls. A physician expert says the man’s story is “the most absurd thing I have heard of in my life,” explaining that men often arrive embarrassed in the ED with damaged sex organs and make up elaborate stories to explain their predicament. He says, “The most common one told is they walked into an ironing board.”

Sponsor Updates

  • Billian offers its fellow HIStalk sponsors discounts on first-time purchases of its programs for vendors, including the HealthDATA database and prospecting portal and Porter Research market analysis.
  • NextGen will integrate the TRUEresult blood glucose monitoring system from Nipro Diagnostics into NextGen Ambulatory EHR.
  • Velocity Data Centers hosts an open house at its Ann Arbor, MI facility on October 25.
  • T-System offers two September 5t webinars on attesting to MU with T SystemEV.
  • HealthStream expands its suite of products with the addition of NurseCompetency’s exams and skills checklists.
  • Cumberland Consulting Group promotes Christopher Miller to principal and Jennifer Vesole to executive consultant.
  • Emdeon expands its Clinical Exchange solution to include e-prescription routing, lab orders and results exchange, care alerts, medication history, and clinical messaging.
  • Worldwide Clinical Trials selects Merge Healthcare’s eClinical OS solution for data capture, processing, and reporting on clinical trials.
  • ICSA Labs hosts two September webinars to help EHR technology developers understand the 2014 Edition certification criteria and testing requirements.
  • A CareTech Solutions white paper offers customer insights on achieving Meaningful Use Stage 1 for the 82% of hospitals that haven’t completed it yet.
  • Kareo updates its website and branding to reflect its commitment to small practices and billing services.
  • TeleTracking invites hospitals to visit its new Enteprise Solution Center in Raleigh, NC to try its capacity management solutions hands on without the time challenges of a site visit.
  • An informatica blog post covers Hadoop and big data.

EPtalk by Dr. Jayne

I often wonder how Mr. HIStalk does it all, balancing his day job with his HIStalk duties. He’s done an amazing job for just short of a decade, so when I run across a bit of writer’s block, I know I have no reason to complain.

The last few days have been bereft of ideas. Maybe it’s the weather (I hope all of you in storm-tossed areas are safe) or maybe it’s just the end-of-summer doldrums. I was particularly pleased, though, when an idea squeezed its way into my mind this morning (pun intended, keep reading).


Why All the IT in the World Will Not Fix Health Care

Like many women, I go every year for a certain radiologic screening test. This year’s adventure was a prime example of why technology is not necessarily the answer. There was a fair amount of hassle in my attempts to complete this testing, and it largely revolved around people failing to look at the monitors right in front of them.

First, I had to schedule. As in previous years, I scheduled over the phone. I have my films done at an independent imaging facility, which is funny being the CMIO of a pretty good-sized hospital. Frankly, despite all the HIPAA training, I don’t trust the hospital staff to not discuss employees who are patients. The imaging center also charges half the amount the hospital does, which makes sense with my insurance coverage limits. Plus, I don’t want to have to disrobe for people who I might have to later “counsel” about their bad EHR habits.

The first annoyance was when I was asked (after the staffer pulled up my account) whether I’d been there before. I chalked it up to someone just following a script without thinking about what they were asking. Knowing the billing and scheduling system they use, she should have been able to see the date of my last visit on the patient information screen.

Due to family history, I’m being screened at an age much younger than the standard recommendation. Because of this, I know exactly what my insurer will and will not cover. Luckily, I have a “pseudo health savings account” type of coverage which allows me a lump sum (no pun intended) for preventive services. I can use it as I see fit — exams, labs, tests, etc. — as long as they’re preventive in nature.

The staffer proceeded to argue with me about needing a physician order for the screening test, citing, “Your insurance won’t cover it without an order.” Being a doc (and a savvy patient), I know what they cover and how they cover it. I reminded the scheduler that I’ve never needed an order in the past (especially since my state allows women to have screening mammograms without an order).

She was insistent, so off I went to call a physician. I was tempted to just write my own order, but that would have been too sassy even for me. I just shook my head at the barriers to care that were being placed in front of a paying patient with a valid medical need.

Even though I regularly drink martinis and hang out with my personal physician, I didn’t want to abuse our friendship with something so clearly silly, so I called the office. They unfortunately are pretty early in their EHR transformation and do not yet have a patient portal (which would have been ideal for something like this – e-mail the request, get the order electronically, and be done with it). I survived phone tree hell and reached a nurse (they didn’t have a choice for “Press 3 if you need an order that you don’t really need, but it’s totally not urgent, requires no clinical skill, and you’re embarrassed to even have to ask for it.”) Luckily it was a nurse I know, who laughed with me and agreed to mail the order.

It was with my order in hand that I dutifully arrived 15 minutes early this morning. No one asked for it. After a few minutes of deliberation (while filling out the same information on a paper clipboard that I fill out every year), I decided to proffer the order. The receptionist handed it back to me kindly, telling me they already have my physician’s information on file and don’t need orders for screening tests.

For the actual testing, the imaging center has an excellent facility, caring staff, and “on demand” results, which is another key reason I go there. Who wants to wait to get results in the mail (or even from a patient portal) if you can get them directly from the radiologist while you wait? Especially for cancer-related screenings. If it’s not normal, I want to know right away, so I value the service they provide.

The technician didn’t bother to look at my record, instead asking me if this was my first screening, and if not, how many films have I had and where were they done. At this point, I was ready for a mint julep or perhaps some smelling salts.

Fortunately, the radiologist did take the time to look at the previous films and determine there was no change (which was good, because sometimes I have to have additional views and was spared that particular fun) and came in to chat. He knows I work for Big Hospital and usually has something funny to say about my not using their radiology department. I in turn tease him about the candy-colored kiosks from Merge Healthcare that I tried to get them to purchase a few years ago to spice up their lobby.

I decided to gently broach the details of my experience and my concerns about barriers introduced that might have been important to less-savvy patients. He’s an owner of the facility, so he has a significant interest in the amount of money spent on technology. He seemed genuinely frustrated that employees are using old paper-based processes rather than new ones supported by the technology at hand.

He pulled up my record and showed me that I am clearly flagged as high risk, an existing patient, and as a VIP (although apparently my VIP status is funny to his partners since I’m an exec at the competitor — it seems I’m not the only one.) He plans to address the workflow at the weekly staff meeting, which I appreciate.

Still, as a physician, patient, and payer (aren’t we all payers these days?) I find it striking how difficult it is to achieve ideal healthcare. In my dream world, patients are only asked information once (unless they’re asked to validate their existing information) and the staff uses the information at their fingertips to provide high-quality, expedited care. Even in a facility with a very favorable payer mix, well-paid staff who don’t appear overworked, engaged owners and managers, and a huge IT budget, they’re still part of the healthcare problem, and technology just isn’t going to fix it. Until we start addressing process, procedure, and performance, we’re just throwing money and technology at the problem.


On a lighter (but still feminine) note, an old friend of mine made my week by sending an article about the new Bic pens “for Her.” Of course, I had to go to the actual Amazon UK website and read the reviews for myself. In the words of one of yesterday’s reviewers, “If they made Bic for Her keyboards, I could write this so much easier! Darn my silly lady hands …”



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

More news: HIStalk Practice, HIStalk Mobile.

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August 30, 2012 News 20 Comments

Monday Morning Update 8/27/12

August 25, 2012 News 12 Comments

8-24-2012 7-42-36 PM

From Siemens Surfer Dude: “Re: Mark Zielazinski, CIO of Alameda County Medical Center. An e-mail was distributed to ACMC staff last week saying he’s leaving with no details. They’re in the middle of an Invision to Soarian implementation scheduled for go-live on CPOE this fall.” Verified. Mark says he’s moving on to Marin General Hospital to rejoin his old El Camino Hospital boss Lee Domanico, who is now CEO at MGH. They’re building a replacement hospital and Mark will have some related additional responsibilities beyond IT, telecomm, HIM, and biomed. As far as ACMC goes, Mark says the Siemens / NextGen rollout is going fine and ACMC is getting its ARRA money. Both organizations will make announcements about his new job sometime this week.

We would expect that an EHR technology developer could satisfy § 170.523(k)(1)(iii) by disclosing: 1) the type(s) of additional cost; and 2) to what the cost is attributed. In reference to the first example above, an EHR technology might state that “an additional ongoing fee may apply to implement XYZ online patient service.” In situations where the same types of cost apply to different services, listing each as part of one sentence would be acceptable, such as “a one-time fee is required to establish interfaces for reporting to immunization registries, cancer registries, and public health agencies.

From Frank Poggio: “Re: MU Stage 2 zinger. Buried back on Page 405 is a real ditty, Price Transparency. Looks like in spite of all the flaming comments ONC received from vendors on the draft of this idea, they are moving ahead with it. ONC backed off requiring vendors to publish a specific price list, but now mandates that they list out all component, install, training, interface, third party and other costs. At this rate, I predict in Stage 3 they will ask for the numbers. Also, in the new certification rules, ONC estimates that it will cost vendors $195 million. If you take the 816 vendors certified under Stage 1 and then reduce the $195 million by ONC’s $60 million annual budget, that means each vendor will spend $165,000 to revise and certify their software for Stage 2. Who will eventually pay, and would that money be better spent elsewhere?”

From Sagacity: “Re: MU Stage 2. For the pleasure of your readers, the bookmarked and cross-linked versions of the Stage 2 and Certification Criteria rules. Save to the same folder with the original names and the cross-linking will work.” Thanks for that.

From Luminosity: “Re: authors. You should get more people to write instead of just giving space to a few guest authors.” Everybody is welcome to submit Readers Write articles as long as they meet my requirements for length, quality, and non-promotional topics. Being invited as an ongoing contributor to HIStalk is another matter – I’m not desperate for content, so I would expect folks to be way better than average. Regulars like Ed Marx, Dr. Rick, and others have an interesting and credible perspective, state it well, are entertaining as well as informative, and are diligent enough to keep it up month after month. Writing is like teaching – everybody thinks they could do it perfectly because really talented folks make it look easy. Anyone who thinks they have the right stuff and can send me a sample article along with ideas for their ongoing series and we’ll see where it goes. That’s the limiting factor on whose articles you’ll see here, not my unwillingness to give someone else a platform.

8-24-2012 7-20-59 PM

Welcome to new HIStalk Platinum Sponsor Sandlot Solutions. The Fort Worth, TX company, which is uniquely jointly owned by Santa Rosa Consulting and North Texas Specialty Physicians (NTSP), offers a platform that turns data into information. NTSP is a pioneer ACO (one of only 32, also named one of eight ACOs to watch including its use of Sandlot Solutions by Information Week) with 2.5 million patients. They know how to connect providers with critical information. Sandlot Solutions offers a next generation HIE and analytics system that uses low-cost cloud computing to connect physicians across all care settings and practice locations to improve care and reduce costs. The underlying products include Connect (HIE and master patient index); Dimensions (data warehouse); Metrix (analytics); and Care Manager (caregiver workflow driven by near real-time clinical and claims data). If you’re in the market for HIE software, check their no-nonsense evaluation checklist. The company’s leadership team has some familiar names, including that of our own “From the Investor’s Chair” Ben Rooks as an advisor. Thanks to Sandlot Solutions for supporting my work.

Now that I’ve talked about Sandlot Solutions, let’s have a short demo (which I found by cruising YouTube).

8-24-2012 6-32-44 PM

Allscripts says its systems are open, but 70% of poll respondents say really aren’t, at least by their definition of the term (the thoughtful comments are worth reading). New poll to your right: is your reaction to the announcement of the Meaningful Use Stage 2 rules positive, negative, or indifferent? Once you’ve voted, click on the Comments link in the survey box (or click here) and explain your opinion.

From that last poll, a comment by Limber Lob was particularly thoughtful given his obvious knowledge of several vendor EMR products:

Whether Allscripts is "open" centers on the definition of the term "open." "Open" conjures up notions of "open source" or at least multiple read/write APIs for a system, but it also reminds us of the important related concept of "extensible systems." An extensible software system is one that can be "extended" by someone other than the original developer AND in the programming language in which the system was written. It isn’t widely realized that three of the four successful long-lived integrated EHRs (with single patient database) are extensible by this definition. The VA VistA’s programming Standards & Conventions (SACs) allowed the extension of VistA over the years by VA sites nationwide, with — for example — the Puget Sound VA developing VistA’s Provider Order Entry (POE) system, and the Topeka VA writing VistA’s Bar Code Medication Administration (BCMA) module. VistA’s extensibility under the VA’s Decentralized Hospital Computer Program (DHCP) of the 1980s and 1990s is a principal reason why VistA now has more than 100 major sub-systems and an estimated 125,000 function points. Cerner’s EHR can be extended using Cerner Command Language (CCL), which is a proprietary "scripting language" in which as much as a quarter of the Cerner EHR’s logic is written. Many Cerner sites employ multiple CCL programmers, and books on CCL are available from Amazon. And perhaps surprising to many, Epic’s EHR is also extensible by Epic customers, as Epic makes source code and documentation available so that customer organizations can develop name-spaced code and data structures that extend Epic’s functionality in a manner similar to Epic’s customizations of their system for their clients. Epic encourages customers to use the other mechanisms for enhancing the functionality of the Epic EHR, but they also support what they term "free range programmers" in their customers’ organizations. Meditech, the fourth of the long-lived integrated EHR systems, has a closed code base. Finally, Allscripts’ supports extension of their Sunrise environment using a package called ObjectsPlus that has a reputation for being hard to use, and requires highly skilled and expensive programmers — which makes it an impractical proposition for many Sunrise customers.

I must have received half a dozen breathless “Breaking News” e-mails at work Friday screaming that HHS had delayed ICD-10 implementation until 2014. I’m not sure why this news was earth-shattering given that HHS itself proposed the extension in early April. Were the rags expecting some other outcome, or did they just forget that this is old news?

8-24-2012 7-05-43 PM 8-24-2012 7-08-49 PM

Here’s a new book on healthcare business intelligence. The folks involved sent me a Kindle copy, but I haven’t had time for more than a quick skim so far. Amazon has the Look Inside! feature turned on, so you can peruse the table of contents and quite a few sample pages. The author is Laura B. Madsen, who works for BI vendor Lancet Software.

In England, Lewisham Healthcare NHS Trust chooses Cerner Millennium for electronic patient records, its first UK win since it jointly bid to Royal Berkshire along with UPMC in 2009. InterSystems and Cambio were the other finalists and iSoft is the incumbent.

8-25-2012 4-52-47 PM

Also in England, Buckinghamshire Healthcare NHS Trust  admits that a software problem prevented the parents of some children from receiving their follow-up vaccination notices. The trust took over the vaccination program a year ago, but some parents were sent multiple reminder letters while others received none. A trust spokesperson said other customers of the unnamed software may also have been affected.

In another item from England, the county of Herefordshire, trying to determine why only 3% of its residents received an invitation to be checked for serious disease vs. the 20% target set by the government, find that a software problem may be responsible. A doctor tells them that the screening software only works with the Google Chrome browser, while the county-side medical system is not compatible with Chrome, forcing doctors to print out their entries and then re-enter them manually on two dedicated computers.

8-24-2012 7-57-04 PM

The Meaningful Use Stage 2 Webinar offered by NeHC and ONC on Friday filled up quickly. They’ve added sessions for Tuesday and Thursday at 12 noon Eastern, or you can view Friday’s recorded session or download the slides.

Researchers working with data from hospitalized HIV patient create a predictive model to estimate the chances of readmission within 30 days and death, using only EMR information from the first two days of their admission.

8-25-2012 4-54-24 PM

Keynote speakers at New York eHealth Collaborative’s October 15-16 conference at Pier Sixty in New York City: David Brailer, chairman of Health Evolution Partners, and Stephen Dubner, author of Freakonomics. Several dozen other speakers will grace the lectern. Receiving career achievement awards in health IT at the event’s gala will be Jeff Immelt of GE and Sam Palmisano of IBM. General registration is $395, licensed healthcare professionals and government employees get a $195 rate, and students get in for $100. The gala runs an extra $750. Rooms at the Hilton New York Fashion District are $319. HIStalk sponsors who are sponsoring this event include Optum, Emdeon, NextGen, and Nuance.

8-25-2012 4-10-37 PM

Tom Carson, founder and former president CEO of MD-IT until January of this year, is named CEO of Axion Health, which sells employee and occupational health software.

ZirMed names Kenneth Willman (WellPoint) as VP of payer solutions and strategy.

8-25-2012 4-56-14 PM

The University of Toledo Medical Center announced last week that it had temporarily suspended its live donor program and suspended two nurses after unspecified human error forced surgeons to abort a planned transplant while both patients (a male donor and his sister, who was the intended recipient) were in the OR. The university provided more information Saturday: the human error was that a nurse put the donor’s kidney in the trash, ruining it.

Doctors in Ontario complain in a town hall meeting about changes in their fee codes, intended to reduce costs by $340 million but making it impossible for physicians to bill for certain services. An interventional cardiologist says doctors are now paid only $2.50 for reviewing an ECG, with the rationale being that computers are doing all the work, leading her to say, “I’d like to think I’m better than a computer. I feel disrespected and disillusioned.”

Vince takes a short HIS-tory break to memorialize industry long-timer Dick Schopp, who died earlier this month.

E-mail Mr. H.

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August 25, 2012 News 12 Comments

HIStalk Interviews Darren Dworkin, CIO, Cedars-Sinai Medical Center

August 20, 2012 Interviews 6 Comments

Darren Dworkin is senior vice president for enterprise information systems and chief information officer of Cedars-Sinai Medical Center of Los Angeles, CA.

8-20-2012 7-26-38 PM

Give me a brief overview about yourself and about the health system.

I’m the chief information officer at Cedars-Sinai Health. I’ve been here for almost seven years. Before that, I was the chief technology officer at Boston University Medical Center.

The health system itself is made up primarily of our large hospital. We’re a single-hospital facility located in Los Angeles, California. Like most large organizations, we’ve diversified through physician groups and other stuff that made us more of a health system.
We’ve been spending most of our time over the last four or five years setting and implementing our clinical IT strategy.


What’s different about working in a hospital that some people call “The Celebrity Hospital” or “The ER of the Stars,” where you got a lot of movie star patients and their supporters?

We don’t really think of it that way on a day-to-day basis. The reality is that we have a small percentage of famous clientele that use our organization, but for the most part, we try to define ourselves through the quality of care that we deliver and the programs that we offer.

That being said, I think there is no question that being here in Los Angeles, we end up having a little bit more scrutiny or an eye on us that sometimes weaves itself into our planning and even some of our communications. When it comes to implementing clinical IT, we try to make sure we do things well, but I think between our past CPOE failure and the media market it can sometimes feel a little like a fishbowl.


The one case where the Hollywood connection definitely worked against the hospital was the heparin incident with the Quaid babies. That must have triggered quite a bit of internal review. What was the IT involvement in those discussions about patient safety?

For obvious reasons, that is a hard question to fully answer, but I think that’s where Cedars has been good to not to look at errors specifically through one department, but really approach them as a system review. There’s no question that highlighted a system failure

The incident had us look at lots of different components that were part of the chain of events. But back then very few of them were directly IT related since we were busy implementing and most was not live yet.

Not to brag, but today we believe we stand in the top 5% with our use of barcoded med technology at the bedside. We scan in the high 90s on a fairly regular basis. But your readers are well informed about the complexities of the real workflows in a busy hospital, so while having bedside barcoding is great, it far from solves every problem.


The hospital has come a long way since back in 2003 when the decision was made to shut down the CPOE system after physicians protested. What do you think were the lessons learned that helped you get where you are today?

The decisions to implement and ultimately build the CPOE system are complex. They’re complex now and they were complex then. That story really starts in 1998 or 1999, as the Medical Center began looking for the right system for itself. I think back then, looking at the choices of what was available and the complexity of the organization, I think Cedars made a good decision to try to self develop.

Obviously, it didn’t end well. That story is well documented, maybe even over documented. But a lot of good lessons were taken from that failure that have since helped us, we could probably write a whole book.

It’s cliché now to talk to the idea that you have to involve clinical teams and make sure you do the right things from a training and engagement perspective, as today I think everyone understands that. Back then, these projects were seen much more as IT-centric things. 

As much as we knew we had to keep everyone engaged this time around, it was still hard to keep applying it. Especially the discipline to really focus on training — which by the way if someone insisted on me giving them only one piece of advice for a successful CPOE project, I would say besides the idea that there is not just one thing, focus on training.

The second area is the idea of a pilot and what you really want it to mean. The first time around, we used pilots as a substitute for a phase with the intention and plan to carry on to the next step regardless of the outcome. This last time around, we left real time to get input and to modify our approach.

We installed in seven phases. Epic tells us that is a record for a single site. While I would not recommend it, as we had too many, it allowed us time to tweak our approach. By the time we rolled out CPOE big bang in the hospital as the last phase, we did pretty darned well. We hit over 90% utilization — using real math — our first weekend ,and have stayed that high five months later. Remember, this is with very large private medical staff.

The last stuff is around how hard it is for organizations like hospitals to build and sustain large development teams to design and implement good clinical software. At the end of the day, a big problem of the original CPOE system was it was not great software. This drove us to select a vendor-based system as a core requirement. We chose Epic and are very happy with it.


Speaking of that, if a peer asked you what it was like to go through the selection, implementation, and now the support of Epic and to manage an IT organization throughout that process, what would you say?

For every organization, it’s different. A lot of it is where you’ve been that will shape how you decide you move forward. For us, obviously, given our history as a failed implementation, we spent a lot of focus on selection.

Selection for us was purposely run for a fairly long period, probably longer than other hospitals. It was a way of building initial engagement across the medical center in terms of helping people understand what the right type of system was for us.

The story I like to share is that shortly after selection, the good news was that it was unclear whether nurses had picked the system or the physicians had picked the system. Both constituencies thought they had played the pivotal role. I think it’s an example of having known where we started, we spent a lot of time focused on making sure that selection was done just right. We made sure we involved everybody that needed to be involved in participating in what ultimately became large-scale enterprise workflow design sessions.


People always want to know about what Epic’s secret sauce is in getting their customers live in a predictable fashion without too many surprises. How are they different from other vendors?

There are a couple of things that are unique with Epic. It’s strong software that delivers what it says it’s going to deliver. It has a strong user interface which clinicians relate to so when they’re demoing the system, they can more easily imagine how they’re going to use the system.

But most important — and I think to Epic’s credit — their secret sauce is that they rolled in an implementation methodology into the product itself. Very few people will implement Epic in a way that doesn’t use some portion of Epic’s methodology. I think that they really appreciated and understood well that it’s not just about the software. It’s how you put it in and how you ready your organization to begin to accept it.


How are you engaging with physicians now vs. before?

It’s hard for me to answer directly because I wasn’t there then, but I’m certainly part of it now. What we’ve done is more than just say we’re going to involve clinicians, which as you know sometimes involves showing it to physicians and nurses in the eleventh hour. They were part of the work teams. They were part of the teams that helped validate design. We had physicians as part of testing. We had physicians as part of the design sessions.

What we did effectively was bring together all the different members of the hospital into the same room, so that as things were worked on between the different constituents, they didn’t change so that people couldn’t recognize them as they went through a committee.

As much as possible, we brought all the people to the same place at the same time. In some ways, that resulted in 200-plus people being involved in a hotel ballroom going through something. But in the end, while at the time felt rather tedious, it paid off in terms of making sure that things were well integrated together.

Of course our challenge now, with a little bit of irony, is that as we continue to optimize the system. The number of people that want to come back into the room to really address system changes because the system is so integrated is enormous.


How did that get you on your journey to Meaningful Use and where do you see that playing out?

I’d characterize Meaningful Use more as a side trip for us rather than the journey. What I mean by that is that Meaningful Use was and still is a very important catalyst in driving IT adoption around the country, but for Cedars, our plan was well in motion and our strategy — and frankly, the tactics underneath that — were well understood prior to meaningful use being created. While we certainly knew that Meaningful Use was an important piece of the equation, we didn’t retool tactics to accommodate Meaningful Use. We knew that the end points would ultimately lead to the same destination.

When you’re looking at projects, especially when you talk about multi-year ones, you really have to make sure you demonstrate a discipline and a commitment to make sure you get to your goal as originally designed no matter how tempting the side trips may be.


You mentioned changing conditions. There’s a lot going in state and federal government. How do you see the developments that are happening changing the long-term strategy and thus the IT strategy of Cedars?

Some stuff is having a big influence. Some stuff is still yet to be defined.

Maybe speaking to the popularity of the product that we chose, it’s an integrated system that brings together ambulatory and inpatient as well as financials. As organizations ready to look at what it will take with accountable care, there’s no question that all those pieces of the puzzle need to come together. The better organizations are positioned in terms of seeing that information across the continuum merged with financials, the better equipped they will be. To that respect, not a lot has changed. I think that will continue to position ourselves to leverage our investment.

With regards to what’s ahead, there’s no question that as the demand moves higher upstream and organizations are transitioned from a fee-for-service world to accountable care, where you begin to blend in more population health management tools, we’re going to need to make sure that IT is at that center point to be able to provide it. The way we’re seeing it take shape, our agenda going forward is very much focused on the tools that will help us manage risk as we begin to take on risk in the new world and whatever form of contracting or arrangement that takes. As well as just become smarter and better at using the data that we have in a way maybe a little bit outside of that transactional lens that for a lot of years — probably going back four or five years ago — people really thought of as the objective or the goal.

Said maybe a slightly different way, I think that four or five years ago, it might have been a little bit easier to craft a goal around some of these projects — EMR projects — because you’d measure them in terms of physician orders written electronically or nurse documentation. The goals are moving well beyond that and the focus will be on the outcomes of the data that you’ve now collected.


That’s a criticism of Epic, that they were late to the database party and use a lot of gimmicks to move the data from their non-relational database to a usable form. What technology will you need to take advantage of your data?

I’m not sure I so much agree with the context of the question. We’ve not been struck by a challenge to get our information. I think our challenges have been more in terms of how we want to begin to use that information.

The reality is that perhaps for some smaller organizations, it’s true that out of the box tools or the automagical buttons might not exist in sufficient quantity to produce the data. But At the end of the day for us, the name of the game is trying to understand what we want to do with the wealth of the information we have.

To be perfectly candid, it’s relatively new to us. We went live on March 2 with CPOE , so we’re still learning which data we should begin to mine first and what we want to build.

I’ll give you a small example. For a very long time, we held back on a lot of decision support, largely because our focus was around engagement, usability, and adoption. While we knew that decision support is certainly an important tool of any EMR, we wanted to make sure we were very conservative in what we applied to maximize the usability. Now that we’ve lifted that veil since we’re successfully live, it’s been an interesting journey for us to figure out how to decide what decision support gets thrown into the system and how to ultimately prioritize that. In the end, as we better learn to manage the data that we’re collecting, I think that’s where all the work will be.

To go back to your question though, I think I would add that we do see, at least for ourselves, always a place to externally keep all of this information since it’s as critical as the EMR is for us. Our teams, have a long history of managing a clinical data repository. We will continue strategically to imagine ourselves as holding that data at a higher level than the transaction or application layer.


There’s a debate over whether implementing Epic means you’re being innovative or in fact being anti-innovation. What do you think innovation means in a hospital or health system environment and how do you practice it?

Our philosophy with Epic is that Epic does a lot of things great. Frankly, Epic provides us the innovation out of the box, which I think is maybe the theme of some of the accusations out there. But we embraced that as an opportunity in that, “Great, if somebody else has that covered, we’ll work on the next thing.”

We think of one of our roles in innovation as filling the white space between functional modules or between applications. But we try not to take too much pride of ownership in the innovation as when we see a commercial vendor — either an existing one or a newly emerging one — meeting the need, we are happy to yield the space back and look for the next opportunity.

Our challenge lately has been that healthcare IT continues to be such a hot sector that younger companies that we often look to partner with aren’t surviving long enough in their core ideas. The popularity of the sector has brought in a lot of new money with sales and growth expectations that are hard to deliver with providers. Everybody wants to expand quickly into other areas to make numbers. Nobody wants to stay and innovate in their box long enough to deliver complete end-to-end workflows. 

As we work with some of the smaller companies that start with a really good idea and fill a need, they quickly can represent to us a collection of functions intertwined with companies with intersecting business plans and colliding products. It makes you think about how private companies with strong backing can probably stay focused for longer and might be better positioned to grow an end-to-end workflow company.


How do you see the market playing out over the next 5-10 years?

I think parts of the market — as others have predicted and I will tag along — will continue to consolidate and some parts of the market will likely dwindle away. The EMR market just feels ripe for more consolidation. The niche clinical product market that’s out there — my guess is we’ll start to see that continue to dwindle away as enterprise clinical systems take over.

I still have lots of faith in the capital markets and innovation. I think that as new problems emerge, there’ll be new companies that will come up and help hospitals and health systems solve them. I have little doubt that we will continue to see data intelligence as a big focus for the next few years.

The tricky part is going to be how some of the bigger organizations like Cedars and obviously many, many others continue to learn to manage the integration challenge. Especially as health system appear to be acquiring. While we think internally that we moved away from best-of-breed, we have not moved away from deep investments in our integration technologies. Because we know that ultimately there’s always going to be a role for putting small pieces together to serve the whole. I believe this will be a big area in the next few years as well.


Does it worry you that an awful lot of hospitals have chosen Epic and that its large application set means you’re putting a lot of eggs in their basket?

I think at times there are some things we worry about, but overall I wouldn’t say that it’s a worry. I think that healthcare is still new in the consolidation business. While Epic is big, it’s not uncommon in other industries to start to see dominant players like that.

In a lot of ways, I think there are some positives with it. California is just beginning to see the potential of leveraging Epic for information exchange. Other states have been able to leapfrog some other efforts by joining together already. I also think there has been some great group think and group input that we’ve benefitted from in terms of more rapid maturity of the applications because there’s such a wide and diverse customer base.

In the end, it always gets measured in terms of what organization’s specific needs are. For us, we’re comfortable– and in fact, frankly pleased — to see a large, healthy vendor behind what is obviously a fairly large and significant investment for us. We’ve not been afraid to innovate or seek small partners if we were looking to do something that was out of their sphere.


Any concluding thoughts?

Yes, two.

The first is on people. It may sound weird, but it’s still amazing to me how much people play a big part in everything that we’re trying to accomplish. I know that there’s a lot of focus often on the software vendors and the products, but I’d tell you the same thing that we talk about internally. The largest reason for delay or the largest inhibitor to moving forward with a new project — besides funding — is most often the ability to find the right people to work on the project with the right skill sets. We spend a lot of time encouraging and growing our own teams, knowing that ultimately that’s the secret to our ability to deliver. We are recruiting and so is almost every fellow CIO I meet. We need to find a collective way to start to solve our people shortage.

And second, thank you for interviewing me. You have a great product with a rather shocking reach.

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August 20, 2012 Interviews 6 Comments

News 8/17/12

August 16, 2012 News 2 Comments

Top News

8-16-2012 5-49-13 PM

Streamline Health Solutions acquires New York-based HIM systems vendor Meta Health Technology for $15 million in a mostly cash deal. Streamline Health also announces new financing that will reduce its capital costs and a $12 million equity investment by Great Point Partners, LLC and Noro-Mosely Partners.

Reader Comments

From Grizzled Veteran: “Re: Quality Systems proxy fighter Ahmed Hussein. He sent a letter to fellow shareholders saying that NextGen VP Jerry Shultz has resigned after 15 years as sales VP, claiming that Shultz quit because the company is splitting the sales team while the market is demanding an integrated inpatient and ambulatory solution. Hussein says he’s been warning all along that critical employees could start leaving.” Unverified. Jerry Shultz still listed as SVP on the company’s site.

8-16-2012 6-09-55 PM

From exMDRX: “Re: ACE conference in Chicago. Apparently there’s some confusion this week. What is this EMR tool, and does it take 120 or 220v?” I was hoping that John Madden would take a wrong turn from his RV and join Glen on the podium with a turkey leg and Telestrator in his hands.

8-16-2012 7-05-58 PM

From Chrissy: “Re: pMD. We are big fans of HIStalk! We are a mobile charge capture company and work with doctors to streamline their practices. We released our new website today – wanted to let you know!” I would ordinarily delete a message like this without a second thought since companies are always bugging me for free PR (with said trashing being more likely if the requester isn’t one of the 2,668 members of the HIStalk Fan Club on LinkedIn, which Chrissy isn’t), but I figured I’d take a look at the new site before pressing Delete. It’s funny and brilliantly designed. The creative agency had the cool paper-cut illustrations made in Lucca, Italy, which against all odds has now been mentioned twice in one HIStalk post (see Lucca Consulting Group, coming up in a couple of inches).

HIStalk Announcements and Requests

inga_small Happy Elvis Week, everybody! If you have been too busy celebrating to stay current on HIStalk Practice, here is what you missed. PairOfAces points out that Chicago’s McCormick Center was headquarters to both the Allscripts ACE meeting and the ACE Hardware convention this week. Medical schools may not provide students adequate training on EHR usage. Several eClinicalWorks customers discuss the perks and problems of EHRs. Aaron Berdofe maps out MU attestations and looks for meaningful correlations (there are some.) When you check out these stories, please don’t be cruel; love me tender(ly) and sign up for the e-mail updates. Thanks for reading.

8-16-2012 6-17-34 PM

Welcome to new HIStalk Platinum Sponsor Lucca Consulting Group. Listen up if your organization is implementing Epic: Lucca is 100% dedicated to providing Epic implementation & training support, and can provide certified and credentialed consultants for those hard-to-find Epic skill sets, or if you’d rather, they’ll send you an entire project team. Maybe you’re worried about a big bang Epic go-live and wondering how in the world you’re going to get enough credentialed trainers or instructional designers to get over the hump. As the “go-to firm” for Epic training, Lucca can help there, too. Cedars-Sinai says “Lucca had the most qualified trainers of the competing consulting firms”, while UMass calls them "agile and accommodating." Need to backfill legacy apps so your team can move to your Epic project? Lucca can provide skilled expertise for Siemens, McKesson, Eclipsys/Allscripts, and others, working remotely to keep expenses down or on site under your direction if you prefer. They hire the best and the brightest, offering flexible employment options for those interested in a rewarding career with a company that supports them. Don’t call up asking for someone named Lucca, though — the company couldn’t get excited about yet another generic or clever healthcare IT name, so they went with Lucca, the picturesque Italian city (in Tuscany, actually) that founder Gina Craig had recently visited prior to starting Lucca in 2008 (check out this article and you’ll see why it’s memorable, but you’ll end up hungry). Thanks to Lucca Consulting Group for supporting HIStalk.

8-16-2012 8-24-19 PM

Response from e-MDs

In agreeing to publish Wednesday’s letter from Michael Stearns, MD related to his termination from e-MDs, I had said that in the interest of fairness, I would also run the company’s response if they provided one. They did, which I’ve added both to the original article and below:

e-MDs, Inc. removed all the material and information that comprised the web posting “The Truth About Michael Q. Stearns” that had been posted in March of 2010, and this removal occurred immediately following the action taken on July 2, 2012 by e-MDs that completely terminated its affiliation with Michael Q. Stearns. Both e-MDs, Inc., and Dr. David Winn, each formally retract that entire prior posting statement and want to be very clear that statement should not be relied upon as the current position of e-MDs, Inc. or of Dr. David Winn.

Acquisitions, Funding, Business, and Stock

Allscripts and Microsoft collaborate to create a healthcare open platform ecosystem through the Application Developer Program.


Long Island Radiology Associates (NY) and Horizon Imaging (AL) adopt Merge Healthcare subscription-based solutions.

8-16-2012 8-06-53 PM

Samaritan Health Services (OR) selects iSirona’s device connectivity solution to deliver patient data to Epic.

USC Care Medical Group (CA) chooses MediRevv’s Day One Self Pay Management services for self-pay cash collections.

Nonprofit health system Group Health, which offers health insurance and medical care in Washington and Idaho, chooses RTLS software from Intelligent InSites.


8-16-2012 5-34-45 PM

Origin Healthcare Solutions hires Steve Brewer (Merge Healthcare – above) as chief sales and marketing officer and Christine Campbell (Medical Present Value) as chief client offer.

8-16-2012 5-37-25 PM

Consulting firm North Highland names Richardo Martinez, MD (The Schumacher Group) its first chief medical officer.

8-16-2012 7-52-48 PM

Hill Meade (MEDecision, Siemens Healthcare) joins personalized medicine test maker Genomind as SVP of IT.

Announcements and Implementations

The local paper profiles the $70 million Epic implementation at Lee Memorial Health System (FL), which went live at four facilities earlier this month. Only one independent practice has contracted with the hospital to set up Epic in their office, and cost is a likely a barrier: affiliated practices pay $16,000 for licensing, $4,500 per year per provider for maintenance, and $25,000 to $80,000 for implementation.

McKesson announces the release of Cardiology 13.0.

Informatica introduces PowerCenter Integration Pack for dbMotion, which enables customers to draw clinical data from the dbMotion solution.

Saskatchewan eHealth (Canada) implements Orion Health’s Clinical Portal.

Allscripts announces plans to integrate American Well’s telehealth platform into its EHR. University of South Florida Health says it will use it to serve huge retirement community The Villages, which the press release describes as being “near Tampa, Florida,” which at 82 miles away and in the middle of nowhere other than being not too far off I-75 south of Ocala, could at least have been listed as near Orlando (58 miles).


8-16-2012 8-18-17 PM

inga_small Parkland Memorial Hospital (TX) reports that its staffing has reached “crisis mode” with almost 16% (more than 1,300) unfilled positions. Most are in clinical areas, including 400 in nursing. The hospital is investing $250,000 on an enhanced recruiting plan that includes wading through a backlog of 29,000 job applications. With that many applications to process, maybe the first new hires should be in HR.

inga_small Ten St. Louis-area women sue their plastic surgeon after finding their before-and-after breast augmentation surgery pictures by Googling their names. Even though the pictures were not labeled with the patients’ names, the names were attached to the image files. Not that I have any reason to believe I would have any before-and-after pics on the Web, but reading this story made me feel compelled to Google my image. Curiously, a search of Inga HIStalk brings up a picture of John Glaser. Draw your own conclusions.

A Wall Street Journal article on new medical devices shows an artificial foot being tested that allows the user to adjust the ankle microprocessor via smart phone.

8-16-2012 6-07-39 PM

Here’s the latest cartoon from Imprivata.

The number of University of California employees making over $1 million per year has quadrupled to 22 in the past five years, with most of them being either coaches or doctors.

Weird News Andy declares that there’s no beating around the bush on this issue. Family physician Emily Gibson MD urges a truce in the “war against pubic hair” (her term for bikini waxing), warning that shaving causes susceptibility to infection and abrasion.

Strange: nurses who have been on indefinite strike over a minimum wage against their hospital in India have their demands met after three of them climb on the roof and threaten to jump. The nurses made $36 per month, but the new minimum salary will jump (no pun intended) to $137 per month.

Sponsor Updates

8-16-2012 8-21-57 PM

  • Presbyterian Intercommunity Hospital (CA) connects Surgical Information System’s anesthesia information management system to its Allscripts Sunrise Surgery solution, powered by SIS.
  • The Interboro RHIO (NY) and NYC Health and Hospitals Corporation join the Statewide Information Network of New York run by NY eHealth Collaborative.
  • Imprivata records 45% year-over-year growth for the first half of 2012 and the addition of 105 healthcare clients.
  • Galway Clinic (IR) selects Access Universal Document Portal to transfer paper documents into its Meditech scanning and archiving module.
  • Centra Health (VA) participates in an Emdeon-sponsored Webinar discussing its use of Emdeon’s eligibility and enrollment services.
  • The Huntzinger Management Group joins a panel discussion on MU attestation during the IHT2 Summit in September.

Report from the Allscripts Client Experience – Day Two and Three
By Bill Rieger, CIO, Flagler Hospital

The conference has been very good. It has been a very busy couple of days. From my perspective, Allscripts has pulled off a very successful event. 

One of the only issues I have experienced relates to the sessions. I went to one today where no one showed up to present. I heard others that went that way, so there is definitely room for improvement. 

8-16-2012 5-56-05 PM

At Wednesday’s kickoff keynote, both the mayor of Chicago and Glen Tullman spoke (the mayor for 10 minutes, Glen for an hour or so.) Again, Glen focused on the open nature of Allscripts. His message was to both Allscripts clients and partners — we made it open so you can innovate.  

Thursday morning’s keynote was Dr. Daniel Kraft. He spoke about the future of healthcare in many ways — technology, cost, genomic study, data, etc. It was an overstimulating presentation. He gave you so much in the first 15 minutes that could keep you researching for days, so much to think about that it was almost distracting for the rest of his presentation. A brilliant guy with a lot of great ideas, some of which are available today (EKG on iPhone, Eye Netra, Qualcom Tricorder etc.)

I spent most of my time in the Hub, where the booths are. Similar to HIMSS, but much smaller and more focused. I spoke to some great partners like MModal, Nuance, and SIS.  

8-16-2012 6-48-27 PM

By far, the highlight of the trip for me was a discussion and demo from The Breakaway Group (a Xerox company). Many of you may have read the book Beyond Implementation written by this group. It is a great read that challenges "go-live" focus and redirects focus to adoption through proper simulation-based training.  

Before I spoke with them, I had a meeting with Steve LeLand and another great partner, iMethods, an awesome organization helping us with staffing and culture development. During the meeting, Steve talked about the new Allscripts partnership with The Breakaway Group and their focus and commitment to adoption. That fit very well with our focus on culture and its impact on successful implementation.

Another awesome part of the event was a photographer who had people write on their body with a marker, mostly on arms, and took a picture. There were some very creative ideas and people had a lot of fun with it. Tonight they have reserved Navy Pier in Chicago for a blowout party. They had a killer party at HIMSS in Orlando at the Hard Rock, so I am heading into this with high expectation! 

My take on this whole event is that Allscripts is positioned for success. They struggle with the same challenges that all of these HIS vendors do, getting the right people on board when HIT staffing right now is very fluid. If their leadership stays in place and they maintain focus on their direction, they will do well. This conference has increased my confidence in Allscripts as an organization and a partner for our community.

EPtalk by Dr. Jayne

Researched published in the September issue of Pediatrics looks at whether systematically developed clinical decision support provides usability benefit or whether it decreases cognitive workload. Seven pediatric surgeons (residents, fellows, and attending) used either an ad hoc order set or a systematically developed one for managing postoperative appendicitis patients. After a washout period, each was tested on the other order set. Authors concluded that well-designed order sets reduce cognitive workload and order variation, although they didn’t improve speed, reduce mouse clicks, or reduce free text entry.

One of the things that annoys me in practice is the IRS rule that Flexible Spending Account funds are “use it or lose it.” This means that patients are calling the office throughout December trying to find reimbursable ways to spend their money. Rules like this just promote a consumer culture and lead people to buy things they may not need rather than forfeit. The Treasury Department is seeking comments on whether this rule should be modified or eliminated. Comments can be submitted through Friday. I tend to think that promoting savings for unanticipated future needs is a good thing and allowing a rollover would be beneficial.

HIStalk contributor Ed Marx tweeted about the stress-inducing nature of open office floor plans. Having worked in an office environment that not only was open but had mere half-walls between the cubicles, I agree with the statements about high noise, lack of privacy, and distractions. What surprises me with many of the groups I work with, however, is the lack of office protocols targeted at creating a better workplace. I recently visited an IT cube farm where many of the employees were either using speakerphones or listening to music (or in one situation, both). A simple intervention like requiring workers to use telephone headsets or listen to music with earphones would have made a huge difference. I’m thinking about printing copies and leaving them anonymously on a few management desks.


This is the 35th anniversary of the death of Elvis Presley. He was 42. The annual Elvis Week celebration of his life and work is expected to draw 75,000 people.



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

More news: HIStalk Practice, HIStalk Mobile.

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August 16, 2012 News 2 Comments

HIStalk Advisory Panel: IT and Patient Outcomes 8/15/12

August 15, 2012 Advisory Panel 2 Comments

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a provider organization (hospital, practice, etc.), you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This month’s question: Why has healthcare IT not uniformly improved patient outcomes?

Vendors and Products Don’t Align with Clinical Needs

  • Doctors don’t see technology as an ally in helping them take care of patients. Please see the article recently published on Medscape. The default mode of healthcare practice in the US is to practice defensive medicine (defense against lawsuits). Examples like those given in the article above don’t raise a healthcare provider’s confidence in technology. Notice how the article specifically gives the example of vendor contracts that say if something goes wrong using our technology, it’s not our fault.
  • We have focused on a computer fixing a workflow problem while at the same time becoming more dependent on computers to tell staff what to do.
  • With few exceptions, the vendor community supports our efforts to enhance and embellish the product with each deployment. In some cases, neither the vendor nor the client has an incentive to collaborate with other vendors, or other clients, to ensure that every deployment of IT is better than the previous one. This is getting better, but we still have much to do in this regard.
  • Some outcomes take a long time to improve, longer than the HC IT has been in use. Some HC IT focuses too much on documentation without a balanced approach to deriving outcomes information let alone being integrated into the care process sufficiently to affect outcomes.
  • The answer is in part within the question: IT implementation has not really been uniform across the care spectrum. As most realize, systems are often if not usually built from a developer / programmer standpoint, reaching out to address a problem rather than starting with a problem (or "job to be done") and working back to develop the necessary system to perform that job. This has lead to numerous issues of usability, human-computer interface problems. More importantly, and more fundamentally, many systems simply aren’t designed to improve patient outcomes. They’re built from the start to support billing, financial management, documentation, etc. As a corollary to the above, rarely is the clinical environment placed at the center of the system. This is evident in the approach vendors generally take with deals: focus on administrative and IT needs (decision-makers) with lesser attention devoted towards those who both use and see the actual patient effects.
  • The Jurassic Park line, “Just because we could does not mean we should"says it all. Not every EMR or HIT app needs to be adopted or will prove to be of value. Not all of them are created equal. In many instances, it has been the technology that drove the cost with very little benefit.
  • Clinical decision support that follows the rights (right clinician, right intervention, right time, right level of alert logic, right ease of use ) is almost non-existent, except for the simplest medication alerts. Apologies to Jerry Osheroff, I don’t think he gets this quite right. Until the biggest EHR players improve their CDS functionality, and there are good guidelines for turning structured knowledge into CDS, I don’t think we will get very far. We will, but I am waiting for the ability to use a general purpose programming language on data in the EHR to create new levels of CDS that are actionable. Further, I bet not much of this happens locally until the EHR players are forced to have some "skin in the game", some liability for the CDS that is already baked into their model install. It is just silly that each of 5,000 hospital CDS committees have to decide whether an aspirin after an MI is a good thing, or whether you ought to check a cholesterol every couple of years on a statin.
  • There are many factors that contribute to uniformly improving patient outcomes. But one issue that is still a work in progress is developing and deploying a system to provide the right information to the right people in the right place at the right time. Integrating data on previous care that a patient receives from their primary care physician during regular clinic appointments, with emergency encounters, possible inpatient episodes, care provided at an ambulatory care organization, etc. pose a unique challenge to collect all of these disparate encounters and the data generated. While EHR systems bring together some of these important data elements, there are still gaps (for example — data on an emergency room visit while a patient is out-of-state on vacation). Additionally, even if data is integrated together, all of these indicators and data points need to be filtered and targeted to improve upon a specific outcome (e.g. reducing the likelihood of myocardial infarction readmission). Recommendations on improving outcome and supporting information need to be concisely delivered to the proper places when care is provided, to the physician when a patient presents at the emergency room with chest pain to the care coordinator prior to discharge.
  • While there has been considerable time spent integrating healthcare IT into related systems of care, there needs to be a more systematic approach, time and resources spent integrating into the process of care – specifically clinician workflow so the tools are optimized.

Usability/Integration Issues

  • I think Dr. Rick’s excellent articles have shed light on the usability issues of EHRs. He mentioned some data on how short-lived human working memory is. EHRs can take 5-10 seconds to respond to every mouse click.  These long delay times make it difficult to keep a coherent stream of thought going when documenting, especially when providers get interrupted (appropriately) by office staff who need something or the other. In the end, what gets produced are long canned narratives about generic patients. When the note is read a few days later by the provider or someone else, they see a generic note that tells them little about the patient. Our EHR would take 45 seconds to a minute to open a chart in the mornings. By the late afternoon, it was five minutes to open a chart. That’s typically caused by memory leaks. We (a medical clinic) had to call a technology firm that says its been in business for 20 years to tell them they had memory leaks! Now all charts take about 45 seconds to open.
  • The main problem is usability, which involves both design and implementation. Many HIT systems are simply not designed well. They are often trying to "replicate the current way of doing things" with the idea that this will improve adoption. However, it turns out that computers are lousy at being paper, and so can never match up. However, computers are really good at being computers, and so the best HIT software takes advantage of the unique properties (e.g. complex data analysis, data visualization) and enables a better experience. Additionally, good design should start with observing the real needs of the end user (not just listening to what a user thinks they need), and most importantly should involve an iterative process which acknowledges that the programmer and physician should work closely for months to fine tune a system. However, the second problem may be even more worrisome. The same EMR system can be implemented in so many ways that the results can range dramatically. A recent editorial talked about how EMRs cost a lot, and slow down doctors, and introduce new errors, and are thus not ready for prime time. But the fact is that while this is a reasonable conclusion based on many experiences, it is a short-sighted view of the potential of what can happen when a good EMR is implemented well. I think the best use of an EMR is to allow for automation and delegation of various parts of the workflow to empower a team to do more care and to do it consistently – thus resulting in both higher quality outcomes as well as less work for physicians.
  • Technology in and of itself is useless and even detrimental unless built and used correctly. In order to have a positive patient outcome, in my mind, a technology theoretically should be easy to use, be actually useful (for the user or the patient), and have minimal negative impact (on workflow or patient care). A breakdown of any single one can result in a subpar result. Patient outcomes may not have improved universally because current healthcare initiatives don’t necessarily encourage focus on all items. Also things like “usability” can be oftentimes extremely difficult to create.
  • The hodgepodge of company acquisitions that has created a market where products have never been integrated. One of the reasons Allscripts is collapsing is because of an inability to integrate Eclipsys products. I find it hard to believe that companies that size, with the resources they have, can’t integrate two products. Clinicians have to sign onto several products multiple times a day to get information they need. It is guaranteed that in such a system there will be conflicting data in different databases increasing the risk of patient harm. Maybe this makes systems like Epic better, but that also stifles innovation. EHRs aren’t going to improve with markets dominated by companies like Epic as is being demonstrated everyday right now.
  • Too many disparate systems that don’t talk to one another. Even with HL7 messages, there is still a lot of variance. All it takes is sending something in the wrong HL7 field to cause a problem.

It’s the User, Not Just the Technology

  • A dependency on the skill and performance of the user related to the IT solution in question. The use of the word "uniformly" makes me consider that every user will create a different outcome. As an example, an electronic health record relies on inputs from various sources in order to aggregate the patient history and then present a user with information to make decisions. The term "decision support" is bandied about with great import these days but as the term implies the tool is there to simply support the clinician’s capability to make a decision. Almost all technology is just that, a support system to assist the clinician or user. The same can be said of a technology such as the Da Vinci Robotic Surgical System. In the hands of a great surgeon, the outcomes can be outstanding. In the hands of a first year surgical resident, the outcomes probably will not be the same.
  • That is like asking why the carpenter’s apprentice who was recently trained on how to use a hammer, router, etc. (insert your specialized tool or technique of choice) hasn’t improved his/her ability to create beautifully crafted cabinets or furniture. It takes time to become competent, proficient, and then the master of skills with the usage of newly introduced and evolving tools. This describes skills improvement for the individual. To obtain uniformly improved skills and thereby products / outcomes, it takes even more time to build an organization or industry of skill masters. Our digital society that expects instant gratification and results has forgotten that it takes time and commitment to master skills and provide high quality products and services. This obviously is an oversimplification, but I think an appropriate analogy to the usage of a healthcare IT to improve outcomes.
  • While this question is understandable given all of the federal government’s promises and expectations of what HIT will do to improve patient outcomes, the question reveals a lack of understanding of what IT in general can and cannot do. Healthcare IT (and in fact any IT investment) on its own can do nothing; it is only when used in conjunction with improved workflow and processes that patient outcomes can be improved. That is what we should be measuring. There is a reason why IT is called an “enabler”, and a “complementary” technology (like electricity). On its own, IT (like electricity!) has no value, and therefore won’t (can’t) improve anything. It has to be used in conjunction with changes in workflows and processes in order to improve outcomes.
  • The effective deployment of technology has a number of requirements, of which the actual technology may be the smallest piece of the puzzle. At the end of the day, improved patient outcomes are a combination of provider decisions and judgment, patient compliance, adequate monitoring of efficacy of treatments and the use of technology to support all of those. The last item on that list is dependent upon the provider learning and adopting the technology to its full (not necessarily fullest) capabilities. Any one of these factors has the potential to derail the process, so if we don’t look at the process holistically, we shouldn’t expect uniform improvement.
  • Lack of leadership on the provider side and lack of appreciation and understanding of HIT on the hospital executive side (one executive in charge of 11 hospitals did not know who Todd Park is).
  • Ultimately it is not HIT by itself that will change outcomes, but what people do with it and how providers use it. Even HIT left unchecked can be harmful. I made more mistakes with electronic prescribing than I ever made on paper. I do not believe that we should stay on paper at all, but until we are all connected out there on the Medical Internet and the information flows freely, we will not reap the benefits of technology. One article in the Economist called "When the carpet calls the doctor" failed to explain how a device attached to the carpet that sends a signal to the doctor when the patient is about to fall is going to prevent that fall. Is the doctor or nurse supposed to get in the car or fly to the rescue? How about the apps that would monitor the patient’s weight or glucose — what will one do if the patient will not use it? Who is going to sit in a tower 24/7 to monitor all this and who pays for it? Not much is being said about that. As excited as I am about HIT, I do realize that our bigger-than-life expectations may not be materialized — not soon enough, anyway. Hope this helps, as it is written in between rounds at three hospitals, two of which are still on paper.
  • Because IT alone won’t accomplish anything.  If you take a bad process and simply duplicate it with IT solutions, you still have a bad process.
  • I would be mildly surprised if it had. In my view, outcomes will improve with decreased variability (with the most likely shapes of the outcome curve you can prove this mathematically) and clinical decision support. Theoretically, EHRs reduce variability with templates and order sets, but I have seen few real world examples of templates standardizing care, except in very limited areas, like DVT prophy. Clinicians still go off and do their own thing after the initial orders are in, and the templated H+P is done.

Variations in Implementation

  • Probably the top reasons would include: variability in the technology itself, variability with the implementation, and variability of the adoption/use of the technology by the end users. All of those areas of variability exist at every hospital (even those within larger health systems who attempt to "standardize" their efforts). It should surprise no one, then, that "Healthcare IT" does not have uniform results. A poor implementation of even a very good technology solution will not have the same results as a good implementation. Similarly, poor adoption will not yield results from the effort to implement the technology (or may yield negative results directly due to the hybrid environment created by poor adoption where some are using and others not using the technology). Additionally, any negative outcome will be blamed on the new technology being implemented even if something else is actually to blame. However, I would posit that a good implementation with good adoption and engaged end-users with even a mediocre technology solution has the potential of generating positive results for patients.
  • There is nothing uniform about the way we deploy healthcare IT solutions. We are often inwardly focused and insular as we define, design, and deploy the solutions that we must implement. We are often working very hard to leverage the technology we have acquired so that we can make the best use of scarce resources. We seldom take the time to measure our own local progress. We surely struggle to make time to share lessons learned with others. Our local efforts often limit the extent of our reach, while also limiting our ability to measure what impact we may have had.
  • Just because your facility has implemented an EMR system, regardless of how mature the model is, it doesn’t mean the facility is using that technology to improve outcomes. Case in point: our facility is in the last stages of an EMR implementation. We are incorporating what our clinical team believes is industry best practices and evidenced based care i.e. Elsevier and Zynx, and we are going to reduce the variation in care that not only drives cost up but produces varying outcomes. We went on a site visit to a hospital who has already implemented this system but are using terrible practices. That is not the fist place we went where we saw this. It takes real leadership to stand up and say we are going to do it a specific way that uses evidenced based/best practice care. The IT systems can readily support an organization who is trying to do this with real time clinical behavior reporting. This will start to drive outcomes.
  • Healthcare IT has not been uniformly distributed. The inequity among hospitals will be even deeper. Hospitals that are EMRAM level 6 or 7 and hospitals in rural areas that could benefit the most from health IT but cannot afford it.
  • Lack of consistent adoption. Lack of understanding on how some technology can impact outcomes. Lack of discipline in organizations to use what they have. Poor BI use that would help isolate areas of improvement.

Lack of IT Support

  • The CIO/IT Director doesn’t always get it. If we don’t understand the business of our organization, there is no way that we will provide the tools necessary to analyze / improve our business. A good example is that of business intelligence. My organization doesn’t think it is necessary or quite frankly, even understands what it is. I know that we have to have better analysis, and that in order to do that, I have to provide the appropriate tools. If I wait till the organization gets behind BI, it won’t happen for another 2-3 years and then it will be too late. I’ve searched out a solution that makes sense in our environment and began the implementation 12 months ago. The next step is to push it out to the organization and educate the management team on its value.

Meaningful Use has Distracted Clinicians and Vendors

  • The emphasis on Meaningful Use metrics over the past years has led to a significant percentage of adopters to be focused almost exclusively on meeting those criteria that would allow for bonus attainment. These tools have the possibility to bring focus to a singular patient’s health issues and treating that patient as a unique individual with unique needs. This can be done efficiently and effectively when the clinician is able to utilize the tool as they see fit. Instead the clinicians become distracted by unnecessary hurdles mandated by someone sitting on Capitol Hill. The emphasis on evidence-based medicine and population health also distracts somewhat from the unique physician / patient experience by moving the focus up a layer or two from the primary interaction. Eric Topol has written a great deal about this.

The Healthcare Business Model Stands in the Way

  • Our supply driven healthcare system and culture that needs to change. For-profit HIT, hospitals, and so on that has made us pursue the highly profitable but not always the most cost effective or valuable course of action.The only one whom I saw commenting on that was Peter Orszag, who said that it will be difficult to reconcile years of marketing in healthcare and direct-to-consumer advertising with customer satisfaction and reducing costs. We want to retire on 401(k) plans that invest heavily on healthcare companies and we want them to be profitable, but squirm when it comes to paying for it and attempting to cut cost. We cannot have it both ways.

Benefits Will Be Realized Only when Quality can be Measured

  • Most providers / clinical entities are still trying to get past the data entry hurdles. Not yet at a point where most are focused on measuring quality. No defined quality standards that most agree on. Multiple groups with multiple standards, and these are not aligned with EMR companies.
  • There is nothing stable about the environment into which we are implementing systems. The regulatory climate, the scientific environment, and the relentless pursuit of discovery creates a dynamic setting into which we are deploying systems. Collectively, this often prevents us  from thoughtfully, comprehensively, and accurately measuring the impact of our implementations. So to some degree, we don’t really know if we are making a difference. We don’t always measure the things that matter, and sometimes we aren’t certain of the aggregate benefit of our collective actions.
  • Healthcare IT has not uniformly improved patient outcomes because we have few clinicians with sufficient vision and understanding of the potential that can, in turn, influence the change. The CIO/Clinical IT employees cannot produce the level of influence needed and it will take a lot longer to move from a world of data collection to a world of data analysis. In addition, we still take too much of an individualistic approach to patient treatment. Evidence-based medicine has not been accepted in any of the organizations with which I’ve been affiliated.
  • There have not been enough in-roads in the establishment of systems where data has been uniformly stored and then shared. Taking those outcomes and running them through statistical engines is the holy grail to improve outcomes. It takes time to build the foundation to support this future endeavor.
  • Patient outcomes have not been well defined and continue to elude us. A patient who does well after open heart surgery may do so because he has a supportive family as opposed to one who lives alone. HIT cannot alter that; it can only help measure it.
  • Our litigation-crazy society has made it almost impossible to share and be transparent about mistakes and medical errors,HIT induced or not.
  • I do not believe we learned any lessons yet. Someone should interview those hospitals that spent in the $100 million range IT budgets or the ones that made mistakes so we can all be enlightened.
  • The most obvious answer is that healthcare IT has been used in different ways, and to different degrees, from one provider to another and from one department to another. Now that healthcare IT is becoming more broadly adopted, and as advanced analytics are developed to empower caregivers more, patient outcomes are expected to improve. Any discussion of outcomes should recognize its limitations. For example, some medical conditions lend themselves to objective measurements of improvement, while others don’t. Despite the extreme complexity of healthcare, there’s a natural desire to measure the end result, the output of the process, in objective and simple terms. Did the patient get better? If so, how much? Did the patient population get healthier? If so, how much? But not every patient with the same diagnosis(es) will get better in the same way. Can an objective measurement adequately convey the difference? Some patients won’t get better at all. For a terminal patient released to hospice, for example, shouldn’t we instead be asking whether the patient and loved ones feel they were treated with respect, dignity, and compassion? For them, that is an outcome. Acute care hospitals should follow the lead of the subacute sector, which focuses heavily on such measurements. For non-terminal cases – those that indeed may be expected to get better – were they and their loved ones kept informed throughout the stay, or did they feel frustrated by a disjointed, piecemeal system of specialists, which mostly kept them in the dark? Were they informed and guided through decisions? These considerations should be incorporated into any meaningful discussion of "outcomes."
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August 15, 2012 Advisory Panel 2 Comments

News 8/8/12

August 7, 2012 News 10 Comments

Top News

8-7-2012 6-49-05 PM

The board of the Kansas HIE, having found few takers for its fee-based services, meets this week to decide whether to dissolve itself and turn its operation over to the state, hoping to reduce its $400,000 in annual operating costs. Taxpayers would be on the hook to cover the remaining half of its costs. Former Kansas Governor Kathleen Sebelius, now HHS secretary, convened the commission that recommended creating KHIE by executive order in 2010, which makes it questionable as to whether the group has the legal authority to simply disband itself. KHIE funded its operations with a $9 million federal grant and has $5.5 million left.

Reader Comments

8-7-2012 7-52-59 PM

From InTheKnow: “Re: Alere. Just closed a deal to acquire DiagnosisOne.” Verified, but not announced as far as I can tell. Alere (the former Inverness Medical Innovations, which acquired interoperability vendor Wellogic last year ) offers diagnostic and health management  technologies and programs, while DiagnosisOne sells tools for order sets, decision support, analytics, and public health surveillance. DiagnosisOne is backed by Edison Ventures, which is how I verified the rumor after digging around forever – the acquisition was buried on one of the pop-up pages on their site.

8-7-2012 8-36-33 PM

From Justa CIO: “Re: Indiana University Health. Announced that Bill McConnell, Jr. started this week as CIO, replacing Chris Van Pelt, who has left the organization.” Verified. Bill has updated his LinkedIn profile showing that he started this month. He was previously CEO of FlowCo, which makes a stent-related medical device.

From Jeremy: “Re: 3D printed medicine. How would people feel about their EHRs printing the medicine ad hoc?” A research paper speculates that a 3D printer could be loaded with pre-filled, drug-containing vessels, allowing medications to be “printed” on demand.

8-7-2012 8-14-47 PM

From Rick Starkey: “Re: JAMA article. Very entertaining.” Indeed it is. John Lennon’s Elbow, by Robert H. Hirschtick MD from Northwestern University’s Feinberg School of Medicine, is funny as it criticizes EMR documentation with Beatles references (I won’t give away its conclusion, which yielded the title.) A snip:

I once asked an intern why his successively longer daily progress notes retained old or irrelevant test results. His response was revealing: “This way, my final progress note is also the discharge summary.” This Twelve Days of Christmas approach—building a final supernote by successive daily addition—yields a discharge summary that is long, thorough, and unreadable. Unreadability is a problem only if readability is a goal. But these notes are not constructed to be read. They are constructed to warehouse data. All the key information is contained within but as hard to find as a radial pulse beneath multiple color-coded wristbands.

From Consultant: “Re: Providence Health Systems. They are slowing down their Epic implementation, one of the largest in the US to learn from initial go-lives.” Unverified. The $750 million implementation was announced in 2010 and the first go-live was originally planned for 2012, with a 30-month completion timetable.

HIStalk Announcements and Requests

8-7-2012 6-23-51 PM

inga_small My top Olympics’ observation of the day: water polo players rock. Twenty-eight minutes of treading water and swimming and throwing a ball? The athleticism of it has almost inspired me to jump off the couch and go for a run. And speaking of runners, how about Felix Sanchez, the 35-year-old from the Dominican Republic who won the men’s 400m hurdles? Way to beat the youngsters. And speaking of youngsters, I am adding Uruguayan footballer Edinson Roberto Cavani Gómez to my Hot Olympian list.

Acquisitions, Funding, Business, and Stock

8-7-2012 8-38-03 PM

HCA reports Q2 results: revenue up 12% to $8.1 billion, EPS $0.85 vs. $0.43. The company reaffirms 2012 guidance, including estimated EHR incentive income of $325-$350 million and EHR expenses of $90-$115 million. The company also announced that it was notified this week that the Justice Department wants to see records from its heart procedures at certain hospitals. A New York Times report suggested that they performed unnecessary procedures to boost revenue in preparation for HCA’s 2011 IPO.

8-7-2012 8-39-16 PM

Mediware  will acquire the assets of Strategic Healthcare Group, an Indianapolis-based provider of blood management consulting.

8-7-2012 8-50-51 PM

Nuance announces Q3 numbers: revenue up 31%, EPS $0.25 vs. $0.13.

Staffing company Cross Country Healthcare swings to a Q2 loss due to a delay in an unnamed large EMR project for which it provides staffing.

It’s not healthcare related, but it’s a cautionary tale about letting computers do too much thinking (or maybe to do more testing before a rollout.) Stock trading firm Knight Capital, which single-handedly caused wild swings in stock market share prices last week when its newly installed high-speed trading software sent incorrect orders to brokerage houses over a 45-minute period, nearly goes out of business when the SEC holds it accountable for the $440 million in erroneous trades its software caused, four times the company’s profits last year.


Orlando Health (FL) selects onFocus epm software for enterprise performance management.

Muenster Memorial Hospital (TX), United Hospital District (MN), and Rothman Specialty Hospital (PA) sign with Park Place International for its OpSus|Live cloud-based hosting solution utilizing Meditech-certified servers and storage.

8-7-2012 8-42-59 PM

Poudre Valley Hospital (CO) selects ProVation Medical Software for gastroenterology procedure documentation and coding in its GI labs.

Windsor Health Plan will deploy MedHOK’s care, quality, and compliance platform that includes NCQA certified software for HEDIS, pay for performance, and disease management performance measures..

8-7-2012 8-41-41 PM

Anderson Hospital (IL) selects M*Modal Fluency Direct for use with Meditech in the hospital and NextGen in its physician offices.

Allied Services (PA) signs a contract to implement Cerner Millennium. It offers rehab, vocational, home care, and residential services.

Announcements and Implementations

South Lyon Medical Center (CA) goes live on CPSI’s EHR.

8-7-2012 8-44-24 PM

Powell Valley Healthcare (WY) goes live on NextGen’s Inpatient EHR.

Orion Health is named a reseller and services provider for Caradigm’s Amalga platform and Vergence SSO software in the Asia Pacific region.

McKesson announces McKesson Cardiology Inventory and McKesson Surgical Manager Point-of-Use Integration Module which allows a clinician’s single barcode scan to document, charge, and reorder items.

8-7-2012 7-35-20 PM

Chicago Mayor Rahm Emanuel proclaims October 30 – November 7 to be Informatics Week (plus a couple of days, apparently), a “city-wide celebration” of biomedical and health informatics that will precede the AMIA meeting there.

The VA begins its RTLS implementation at seven VA VISN 11 medical centers in Indiana, Illinois, and Michigan. HP is managing the project, which involves several brands of sensors providing real-time information to its Intelligent InSites RTLS software to track equipment and supplies, monitor temperatures, and trigger workflows. The $543 million project will eventually cover 152 medical centers.

8-7-2012 8-26-39 PM

Hospitals in Franciscan Alliance Northern Indiana Region go live on Epic, right on time from their project plan.

Zynx Health announces Version 3.0 of its AuthorSpace clinical decision support authoring tool.

Katalus announces an EHR Total Cost of Ownership model that will be offered as a cloud-based solution.

Government and Politics

The Substance Abuse and Mental Health Services Administration awards $4 million in grants to six organizations for HIT tools to expand access to substance abuse treatment in underserved areas.

Innovation and Research

Researchers from NorthShore University HealthSystem (IL) find that the increased use of EHRs by hospitals and health systems could help physicians make more exact, real-time decisions when prescribing antibiotics.


Health engagement management provider Eliza Corporation receives a notice of allowance from the patent office for its Complex Acoustic Resonance Speech Analysis System, which provides conversational, high-performance speech recognition.


8-7-2012 8-46-13 PM

Hospital officials at Olympic Medical Center (WA) tell commissioners that their ongoing transition from Meditech to Epic will cost about $6 million, with ERP software from Infor/Lawson running an additional $1 million.  

8-7-2012 9-31-46 PM

A blog post from John Glaser of Siemens Healthcare compares his selection to throw out the first pitch at a baseball game to the impending accountability of healthcare IT to improve care (in neither case would you want to pull a Baba Booey in front of a crowd.)

8-7-2012 6-57-07 PM

HHS records show that the medical records of 21 million patients have been exposed by breaches since September 2009, with six organizations reporting incidents that affected more than a million people. Leading the pack is the federal government itself, whose Department of Defense / TRICARE (specifically, federal contractor SAIC) lost backup tapes during shipping in September 2011 that contained information on 4.9 million individuals.

ONC’s Office of Consumer eHealth puts out a video pitching EHRs to consumers.  

8-7-2012 7-08-31 PM

If you’re an Epic competitor, there’s not much good news in the KLAS Mid-Term Performance Review from June that a reader just sent my way. Unless you sell anesthesia information systems, anyway.

8-7-2012 8-47-43 PM

A pharmacy technician at University of Miami who “seemed to live beyond his means” in paying $56,000 in cash for a BMW is suspected of stealing $14 million in drugs from the cancer center pharmacy over a three-year period. The university’s CFO admits that the pharmacy had no inventory controls at all in place. The technician was caught pocketing drugs on surveillance cameras, but his lawyer says that while he did steal some drugs, it could have been anyone who nabbed the $14 million worth since anybody could just grab what they wanted. He was caught when the pharmacy buyer noticed discrepancies in the quantities on hand of the drug Neulasta, which she then inventoried manually since the new inventory software “was not the most trustworthy.”

Seattle Children’s Hospital, trying to cheer up a 16-year-old cancer patient who has been hospitalized in isolation for months and missing her cat Merry, crowdsources through Facebook to collect 3,000 cat photos to project in a “virtual feline cocoon” they built for her. Her response: “You guys remind me that there is so much good in the world, and its just makes me feel so much better, and connected. I can’t tell you how it feels sometimes, feeling disconnected and cut off from the world, and then with something like cat pictures bringing me back.”

Sponsor Updates

  • GetWellNetwork launches a video on the future of patient engagement using interactive patient care solutions.
  • Billian’s HealthDATA recognizes five hospitals to watch on Twitter.
  • e-MDs hosts a webinar featuring Jen Brull MD, FAAP and her practice’s use of social media to build community and engagement with patients.
  • GE Healthcare releases details of its Centricity Perinatal National Users Group conference in October.
  • OTTR Chronic Care Solutions will participate in next week’s NATCO Conference in DC.
  • Forrester Research names Covisint a cloud identity and access management leader in its Enterprise Cloud Identity and Access Management report.
  • A Surgical Information Systems survey indicates that drivers for implementing perioperative IT include facilitating improvements in OR efficiency, the quality of patient care, and reduction of documentation errors. 
  • Howard County Medical Center (NE) selects BridgeHead Software’s healthcare data management solution as its backup and archival system.
  • Cumberland Consulting Group promotes Mark Riley to principal.
  • T-System hosts a free webinar on proper documentation of E&M services to optimize reimbursement.


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

More news: HIStalk Practice, HIStalk Mobile.

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August 7, 2012 News 10 Comments

HIStalk Interviews Simon Arkell, Two-Time Olympian and CEO of Predixion Software

August 6, 2012 Interviews 3 Comments

Simon Arkell is CEO of Predixion Software of San Juan Capistrano, CA. He represented Australia as a pole vaulter at the 1992 Summer Olympics in Barcelona, Spain and at the 1996 Summer Olympics in Atlanta, GA.

8-5-2012 12-26-27 PM

Tell me about yourself and the company.

Predixion Software is a three-year old company. We formed it back in 2009  in order to leverage what we thought was a big opportunity in the business intelligence market. That was this space of predictive analytics, which has historically been technology that is only attainable to the very most-trained data scientists and PhDs with very expensive and complex toolsets. We thought that there would be a great opportunity to take that and break down those barriers to predictive analytics and make it more available to many more people. At a very high level, that’s been our vision since Day One.

I’ve been involved in enterprise software for most of my career. I was a co-founder of a number of companies and have raised money from venture capitalists. I’ve even gone over to the dark side and done investment banking and private equity for a little while in order to really learn the business. Each time I came back to an operational role, where I just believe that this particular opportunity was the best I’d seen in my career.

The reason for that is that my co-founder and our chairman Stuart Frost had sold his company, which was in the data warehousing space, to Microsoft very successfully. It was his idea to identify predictive analytics as this hot space. The more research I did, the more I realized that we were in a position to not only create a game-changing technology, but also to leverage the success that Stuart had had a DATAllegro with the investor base.

At the same time as starting the company, we were introduced to a gentleman over at Microsoft named Jamie MacLennan, who, long story short, came across and became our founding CTO. Jamie had a vision for many years as head of data mining and predictive analytics over at Microsoft to do exactly the same thing, and that was to bring predictive analytics to the masses and to make it more available.

With that technical firepower in place up in Redmond, we now have a development office in Redmond, and have had since Day One. Our engineering team is effectively the former data mining team or predictive analytics team from Microsoft. With that story, we were able to be very successful in raising venture capital. We have a very large strategic partner — who is also an investor — that we don’t name, along with three other venture capital firms: Palomar Ventures, Miramar Ventures, and DFJ Frontier. We’re getting ready for our next round of investment.

We’ve been very successful in the healthcare space over the last year and a half. That happens to be an industry with a lot of issues and problems that are a great fit for predictive analytics technology. We’re well on our way with a great team in place and getting some really nice early success in healthcare.


What kind of healthcare problems can predictive analytics solve and what kind of data is needed to be able to start using it?

We have seen many problems in healthcare that are a perfect fit for predictive analytics. The low-hanging fruit, and the one that everyone’s talking about right now due to CMS mandates that are coming down and penalties that commence in October, is around preventable readmissions. We call them predictable readmissions.

Effectively, you can get ahead of a problem by predicting an outcome and preventing its outcome. We have nice tagline that says, “You cannot prevent what you cannot predict.” In the case of readmissions, we’re able to assign a risk of readmission to a patient when they admit into the hospital the first time. That admission or readmission probability improves in accuracy throughout the length of stay. At the point of discharge, the hospital is allowed to actually now have very stratified and targeted intervention based on the risk profile of the patient.

Being able to assign a risk profile to a specific patient when they admit the first time is something that’s a game-changing solution. We’re able to apply that concept to many different applications, like predicting hospital-acquired sepsis, predicting the length of stay, predicting which outpatients are likely to become inpatients, and the list just goes on and on. We think that being able to predict a particular outcome is what the industry needs. Customers are absolutely responding in a big way.


How customizable is the prediction algorithm based on what information a given institution has available, based its choice of electronic medical record or whether it’s doing physician documentation electronically?

Very. Everyone wants to build a Lamborghini, but we find that even if you’re not 100% data-ready and have the perfect electronic setup as a provider, you’re able to benefit from this technology. A common term in the predictive analytics industry is that, “lift is lift.” Meaning that if you can get some improvement through machine learning over and above just a human guess, then there’s a return on investment. Over time, if you bring more systems online, that can become more and more effective.

We’re seeing very, very accurate models. It’s fairly easy to determine the accuracy of a model because you just apply it to historical data and see how accurate it was in actually predicting what actually did happen. We’re seeing very accurate models, which are measured in terms of what’s called a c statistic. We have the highest in the industry, because we apply our models and our algorithms to the electronic data – whether it’s clinical data, claims data, etc. – at the hospital level.

We do not rely on a national algorithm, because no two regions and demographics are the same. You may have a hospital in Minnesota in the middle of winter, which would have an entirely different reason for readmissions than potentially one in Florida. By being local, being agile, being easy-to-use and adapt, we’re seeing a lot of uptake from our customers right now.


A few companies did a primitive version of this back into the 1990s, use technology such as neural networks to try to make patient predictions. They really didn’t get very far. Was the problem that their information wasn’t good enough, their algorithms weren’t good enough, or that hospitals weren’t ready to do anything with the information that they were getting?

I think it’s probably all of the above. Obviously there are some hospitals that are now electronically equipped and jumping on board all of the various government initiatives to bring them up to an acceptable level. The algorithms are much more accurate. We’ve got significant domain experience now in applying our algorithms or our technology to this problem set. We’re finding that the accuracy of our models is just as high amongst just about every one of the providers that we’ve used this with.

The other thing that’s much, much different is how you get the regular information worker in a provider network to actually access this information and respond to it. Having someone with a PhD in a white coat in a back room somewhere crank on these models and algorithms in order to get information is one thing, but how do you actually get that out into the hands of a nurse who can do something about it?

We’ve solved that with what we call the last mile of analytics. Two of our customers, just in the last couple of weeks, decided to move forward with our predictive readmissions portal. It’s an HTML5 thin client portal that can be accessed on any workstation or at a nurses’ station or in a hospital room, or even on a iPad or iPhone. It will give the nurse or the case manager a list of the patients that are currently under their care and are inpatients and their risk of readmission.

What we’re working on now with our customers is being able to respond according to a risk strata of the patient. Now all of a sudden your patient population of inpatients has a very low, a low, a medium, or a high risk of readmission. The intervention at discharge can be very different now for the first time. Instead of applying very limited resources to all patients that you discharge because you were using just guesswork as to who might be at the highest risk, we’re now able to create an intervention strategy for the very high-risk patients and medium-risk patients and then intervene on them.

Intervention to a high-risk patient may mean deciding whether to send them to a home healthcare facility or sending a nurse out every second day and then having someone call every day to make sure the patient’s taking their meds. You would therefore be able to put less attention to a very low-risk patient. You can become much more efficacious or accurate in how you intervene with the patients in order to reduce your readmissions rates.

The same concept applies with regard to targeted intervention for hospital-acquired sepsis, fall risk, etc. We’re seeing  a lot of new thoughts and excitement come out of our customers who now are able to do something for the first time that they previously didn’t think was possible. It’s having all sorts of ramifications with regard to brainstorming new ideas and applications and solutions.


That’s maybe the big difference from the 1990s. The idea then was to redesign a process, like using different drugs or creating different care plans, rather than intervening on individual patients, plus there was no economic incentive since hospitals got paid for readmissions anyway. Even though the technology may have been similar in a primitive way, it was a different climate.

Exactly. You know better than anyone as we move from fee-for-service to a wellness-based industry, getting ahead of the problem and actually being able to do something about it before it happens is everything.

The ramifications in the UK are even greater. One of our prospects who is about to move forward with our predictive readmission solution received a very significant fine just last month. It was over a half million dollars, just for having readmission rates at an unacceptable level. So you’re starting to see massive payback from putting in a solution that can solve this problem for you.

And you’re right, retrospective reporting is really what business intelligence has always been up until now. We’re in the business of putting prospective information into these reports so that you can get ahead of the problem and prevent it before it happens. Again, that’s not new; there are great companies out there like SAS and SPSS, which is now IBM, who have these very specialized workbenches. But again, you’re not putting the end results in the hands of a nurse or practitioner who can do something about the output; you’re relegating it to a back room with some guy with a white coat.


Kaiser Permanente is probably the most advanced user of healthcare data in the country and they’re your customer. How are they using your product?

They’re fairly private in how they announce their utilization of our technology and any other, but I will say that they’re being very aggressive with some of the stuff we’ve already talked about.


You made two trips to the Olympics as a participant. What would you say were the best and worst memories?

Good question, because everyone always talks about kind of the excitement and the best parts of it. I have learned a lesson since competing in the Olympics. Enjoying the journey is something to be embraced. I do that now in my career and in my life as much as I can.

The best part by far was living a dream and having it turn into a reality. From the age of 11, all I ever wanted to do was compete in the Olympics. The problem when I was 11 was that I wasn’t very good at anything, so I had to find my way. When I discovered pole vaulting, I absolutely fell in love with it, but realized I wasn’t very good at that, either. But my best friend was very good at it, so we kept getting invited back, and 20 years later, I got to compete.

It was a long, long journey, and one where the biggest lesson for me was that hard work and persistence absolutely pay off. I really was so excited to be walking into the opening ceremonies and marching in the Parade of Nations for the first time in Barcelona, which I then did again four years later in Atlanta. I’d say the worst part, though, was not performing to the extent that I was capable of and being too attached to a specific outcome as opposed to really just embracing and enjoying every second of it.


I would think it must be unusual for Olympians who have focused much of their lives on a single sport to suddenly do a 180 and go out and establish themselves in the world of business, especially a technology-related business. How did you get from one to the other?

The concept of risk is not one that I’m unfamiliar with. When you’re an athlete, especially an individual athlete, it’s all about risk and reward, and the risks that you take and the things that you put on hold in life.

I found that having come from Australia and being so focused on my athletics and getting to the Olympics that my friends were all getting very established in their careers, and becoming more and more senior. I continued to get educated along the way, but I started a couple of companies while I was still competing just to make sure I could get my business chops going. I knew that’s what I wanted to do.

I always felt after I retired from athletics that I had some catch-up to do, and the way to catch up was to start a company and make that highly successful, as opposed to going the common route, which is to and work for IBM or one of the big boys and work my way up. It turned into an entrepreneurial catch-up situation. I’ve been addicted to the high-risk start up environment every since.


I assume you’re watching the Olympics now. Thinking back to when you were a participant, what do you think has changed?

I think it’s much easier for the athletes to get into a whole world of trouble these days because of the advent of Twitter and Facebook. You see it time and time again. Australians were banned for posting photographs of themselves holding guns on Facebook. A triple-jumper from Greece was sent home because she made a racist comment on Twitter. You just see so much more at risk. You’re in even more of a fishbowl now as an athlete than back before social networking. 

I  see that as a big difference, but I still believe in the Olympic philosophy and competing. Competing is a great honor, and something that for me I’ll never forget.

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We’re having a lot of fun at the office right now because everyone’s keeping up with the Olympics.  Our partner account manager, Tom Hoff, I’d known from the Olympic movement. He was a member of the US volleyball team in Beijing. He was the captain and they won the gold medal, so, we use and abuse that fact and have him show up at trade shows with his gold medal. Today we’ve brought our marching uniforms in and we’re going to be taking photographs. I’ve got my opening ceremony uniform and my competition uniform and he brought his in as well, along with his gold medal, so we’re going to take some photographs and have fun with it.


Send me the pictures when you’re finished. Any concluding thoughts?

Predixion Software is in the business that is solving such massive problems for the industry. We really believe that we can save lives. Everyone here is just so focused on execution and being successful, because we truly believe that our technology can save lives and really help an industry that needs help. We’re really excited to be in the game and to be going for it.

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August 6, 2012 Interviews 3 Comments

Monday Morning Update 8/6/12

August 4, 2012 News 2 Comments

8-4-2012 2-36-36 PM

From Fact Checker: “Re: New York Times editorial. Implies that an EHR might have prevented a 2007 death at Wyckoff Heights Medical Center, but a Meditech announcement says it went live on Q1 2006.” I don’t know which Meditech applications went live in 2006, but it probably wasn’t all of them. The hospital CEO’s comment specifically referenced clinician documentation of vital signs.

8-4-2012 5-27-12 PM

From The PACS Designer: “Re: chemo preparation. No one wants to hear they have cancer, but if you have to deal with it, there’s a website called Guide2 Chemo to help anyone get prepared for their treatment plan, along with an iPhone application.” The advertising company that offers it, Health Monitor Network, has a variety of sites and tools to “create a dominant presence in targeted physician waiting and exam rooms” that results in “NRx and TRx [new and total prescriptions] script lifts.” It sells its mailing list of condition sufferers to marketing companies. The company publishes a weird magazine called New York Giants Health Monitor with a claimed readership of 3 million “male condition sufferers 40+” that not only ties Giant players and coaches to health articles, but also offers companies promotional opportunities for hair growth, erectile dysfunction, and “always adding more.” If you want to control healthcare expenses, you might logically look at anything so profitable (i.e., costly to the system) that companies spend big money to promote it directly to patients. In fact, you might conclude that a lot of this mess started when laws were changed to allow companies to market to directly to patients and to run TV commercials, drumming up demand for products that patients themselves aren’t actually paying for.

8-4-2012 1-11-59 PM

Put your money in athenahealth if you’re buying a healthcare IT stock, say 40% of poll respondents. New poll to your right, checking up on interoperability: was the information from your most recent doctor visit immediately available at your hospital of choice? Mine was.

8-4-2012 5-47-53 PM

Welcome to new HIStalk Platinum Sponsor PeriGen. As the Princeton, NJ company’s name suggests, it offers fetal surveillance systems that support real-time decision-making in caring for mothers and babies. They include PeriCALM Tracings (bedside fetal surveillance with complication recognition and evidence-based data analysis for physicians and nurses); PeriCALM Plus (ONC-ACTB certified physician and nurse documentation, labor progress analysis, and decision support); PeriBirth (ONC-ATCB certified specialty EMR for obstetrics with protocols and best practices, real-time patient integration, and enterprise EMR integration); and PeriCALM Shoulder Screen (a Web-based prenatal tool for identifying shoulder dystocia). PeriGen systems are installed at over 150 hospitals. You may know former Allscripts sales SVP Matt Sappern, who was named CEO of the company in January 2012, or former Misys VP Mike Pritts, who is president and CTO. Thanks to PeriGen for supporting HIStalk.

Here’s a new YouTube video I found that covers PeriGen’s PeriCALM Plus.

Thanks to the following sponsors, new and renewing, that supported HIStalk, HIStalk Practice, and HIStalk Mobile in July (click a logo for more information):

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Stanford Hospital announces that a laptop containing the information of 2,500 patients was stolen from a doctor’s locked office in mid-July. The article says the laptop was password protected but doesn’t specifically say it was encrypted, although the university’s IT security site says patient information cannot be stored on a computer without explicit permission, and if it is, the disk should be encrypted.

Weird News Andy finds this interesting. A 17-year-old high school student hears cries for help from a child swimming in the ocean. He pulls the child out, bystanders call for help, and both are taken to the hospital by ambulance. Weeks later, the student receives a bill for $2,600, including $1,907 for the 15-minute ambulance ride. His family, who has nine children and no insurance, is trying to arrange payments. After the story ran on TV, two anonymous volunteers offered to pay the full amount.

I mentioned the $70 Leap Motion input device awhile back. Some healthcare folks are discussing how it might be used in the clinical setting. Register for the company’s discussion board and then go to this forum to participate. The device, which won’t ship until December, is supposedly 200 times more accurate than Microsoft’s Kinect and can track the movements of all ten fingers individually. There’s a software developer kit that might be fun.

Wayne Memorial Hospital (PA) launches its Direct program using Secure Exchange Solutions.

A self-described “doctor uber-nerd” whose practice has been using an EMR for 16 years says Meaningful Use incentives have shifted focus away from the patient and instead caused a preoccupation with gathering compliance data. He says his vendor, who was “stuck in a pre-Internet, office-network design” shifted all their resources to Meaningful Use. He concludes:

This is sadly ironic. We were once using our computers in a meaningful way for the benefit of our patients, but now we are being pressured to abandon the patients in order to qualify for “meaningful use.” This should come as no shock to anyone who has watched American health care over the past 20 years. We have beaten doctors over the head with “clinical pathways,” and “evidence-based medicine,” all with a good intent: to make sure doctors gave good care. The problem was, however, that these criteria become more important than the patients they were meant to serve. The same is true with our payment system: designed with the initial intent of enabling patients to have access to care, but becoming a behemoth in the exam room, standing between the doctor and the patient.”

8-4-2012 7-14-52 PM

In Canada, an Alberta Health Services EVP/CFO resigns his $425K position after his expense reimbursements from his previous position are made public by a CBC Freedom of Information request. In three years with Capitol Health Authority (which was later absorbed into AHS) Allaudin Merali turned in $346,000 of expenses, which included costs for fixing his Mercedes, installing a car phone, buying gasoline and car washes, and purchasing a golf membership. He previously worked for scandal-ridden eHealth Ontario, where he billed an average of $76,000 per month, even turning in expenses for chocolate bars and tea. In investigating the expense claims, it was discovered that he had been paid $2.6 million in severance from his previous job, even though he ended up going to work for its successor organization. He’s eligible for almost $500K in severance this time around. His former boss at Capitol Health, who also found her way to Alberta Health Services as a board member, also resigned on the news. She had signed off on his expenses at Capitol Health, not to mention that when her CEO job there was eliminated, she received $4.1 million in retirement benefits.

A reader forwarded a client alert from law firm Post & Schell that warns companies, especially hospitals, to check their use of terminal and security software from Attachmate. They say Attachmate is aggressively auditing and suing its customers, especially those in healthcare.  The law firm warns that organizations might not even be aware that Attachmate software is installed, and since the products are licensed per PC, Attachmate could argue that running it on a Citrix server means that every PC needs a license. Attachmate bought Novell in 2011, so they advise checking those licenses as well.

8-4-2012 7-17-58 PM

The VA says the open source Web viewer it’s calling Janus will give clinicians a combined view of patient information from the DoD’s AHLTA and the VA’s VistA EMR systems, the first step in their integration project and also the first use of code from the VA’s OSEHR repository.

8-4-2012 7-17-12 PM

WellPoint takes a financial position (apparently $12 million worth) in SoloHealth, which offers a consumer health screening kiosk for vision, blood pressure, weight, and body mass index. According to the company’s site, the kiosk, which was just approved by the FDA, also allows consumers to find a doctor and schedule an appointment. An earlier investor in SoloHealth was Coinstar, the company behind Redbox.

Massachusetts announces that it will create a statewide HIE, with the $16.9 million cost paid for by the federal government in the form of ARRA and Medicaid money from CMS. Orion Health was chosen as its technology provider.

A Xerox survey finds that only 26% of Americans want their medical records stored in digital form, and 60% of them don’t think EMRs will improve care. On the other hand, the survey was conducted online and Xerox sells electronic document systems and the services of the former ACS Healthcare consulting firm (which it acquired for $6.4 billion in 2009) rather than EMRs, so the conclusion could be disputed.

SAP acknowledges that its ERP software has usability issues after companies such as Varian Medical Systems start to look for replacement products for non-core applications, citing changing user expectations brought on by the iPad and iPhone. SAP plans to offer software that allows IT departments and individual users to personalize its screens.

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An $8.1 million federal lawsuit against Kernan Hospital (MD) that claimed the hospital intentionally coded patients with a rare malnutrition disease to increase reimbursement is dismissed. A federal court said the government did not provide evidence that the hospital actually submitted the claims for payment. The hospital’s claims for kwashiorkor as a secondary diagnosis increased from three in 2005 to 358 in 2008. One of the patients was also documented as being overweight and was counseled to go on a diet. The University of Maryland Medical System, which owns the hospital, said the coding is confusing.

A GAO report covering only Florida, New York, and Texas finds that 7,000 Medicaid providers who were paid $6.6 billion in 2009 owned $791 million in back taxes. It recommended (and the IRS agreed) that more rigorous review is needed. One provider owed over $6 million in unpaid federal taxes.

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Chicago-based startup Procured Health, which helps hospitals evaluate medical devices for potential cost savings,  raises $1.1 million in seed funding from several investment groups and athenahealth’s Jonathan Bush. The company is testing its product and plans to launch in 2013.

Vince’s HIT time travels this week involve Pentamation (spoiler alert: they were acquired by Keane indirectly via an acquisition in 1992) and a sales executive who ended up as a Hollywood and Broadway producer. Vince got help this time from Gary Pollock and Doug Abel and he would he happy to receive your assistance as he continues to dig into the (sometimes) storied histories of the (sometimes) fondly remembered healthcare IT companies of yesteryear.

E-mail Mr. H.

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August 4, 2012 News 2 Comments

News 8/1/12

July 31, 2012 News 15 Comments

Top News

7-31-2012 9-55-13 PM

Accretive Health will pay $2.5 million to settle charges by Minnesota’s attorney general’s office over its aggressive patient collection tactics in hospitals (including those of Fairview Health Services) and lax security controls involving a stolen PHI-containing laptop. The company will cease all business operations in Minnesota, is banned from returning for the next two years, and can re-enter the state within the following four years only with the attorney general’s approval. Accretive is also required to return all patient information to the hospitals that provided it. The attorney general says she will turn over the patient affidavits her office collected to CMS, suggesting that Accretive’s hospital clients may have violated EMTALA laws that require them to treat emergency patients before trying to collect payment. The $2.5 million settlement will be added to a fund to compensate patients. Chicago Mayor Rahm Emanuel, who had previously inserted himself into the proceedings by trying to use his Democratic Party influence to get AG Lori Swanson to back off, declined to answer questions about his involvement.

Reader Comments

From Yesterdays: “Re: Community Health Systems. Contractor friends tell me they were part of the nearly 600 IT contractors laid off by CHS recently.” Unverified. I didn’t bother trying to confirm since I recently e-mailed someone at the for-profit hospital operator about a rumor that they were switching EMRs, but didn’t hear back.

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From Wildcat Well: “Re: Practice Fusion. They have discontinued their affiliate program, which pays websites to promote signups for their ‘free’ EHR.” Unverified. They’re still taking signups on their Web page from what I can tell.

From Carolyn: “Re: National HIT Week. Are you involved in any of the activities?” No. To be honest, I’ve hated that concept from the day HIMSS started pitching the idea that provider IT people should stand shoulder to shoulder with their vendor brethren in trying to persuade politicians to throw taxpayer money at products sold by the vendor members of HIMSS (or as HIMSS nobly rephrases it, “public and private healthcare constituents will work in partnership to educate industry and policy stakeholders on the value of health IT for the US healthcare system.”) I don’t blame vendors for trying to influence the DC crew, but I am totally mystified how hospitals can justify spending the time and money required to send their IT people traipsing around Capitol Hill for the benefit of for-profit companies.

7-31-2012 9-57-01 PM

From Safety Paradocs: “Re: Wyckoff Heights. Wired for safety ‘well before ARRA’ as reported by the newsroom of Meditech, yet the young patient was not safe. How can we prevent such striking deaths?” Wyckoff Heights Medical Center in New York, which The New York Times politely calls “one of the most troubled hospitals in the city” because of mismanagement and its hiring of political cronies, admits a 22-year-old student who had consumed a diet drug and beer while pulling an all-nighter for her college Latin course. The hospital gives her IV lorazepam, ties her arms to her bed, and makes no notations in her chart (all documentation was on paper) that anyone was checking on her. Nobody notifies her family. She dies. A few weeks ago, the hospital’s own 83-year-old former chairman, who had been forced to resign and was then admitted for fainting spells, was found in his hospital room with a broken neck. Despite its problems (check out its reviews on Yelp), the hospital earned HIMSS EMRAM Stage 6 and $4.9 million in federal taxpayer dollars for its Meditech MAGIC implementation. To be fair, the incident occurred in 2007, which I assume was long before all of its EMR accomplishments. My takeaways are as follows: (a) while it’s true that better hospitals use more technology, it’s also true that technology didn’t make them substantially better – its use is correlated, but not causative, and plenty of crappy hospitals are using cool systems; (b) all the IT systems in the world won’t help if you have unskilled or uncaring caregivers, so choose your hospital based on quality and reputation, not what they’re packing down in the data center; (c) never, ever go to a hospital for anything serious without having an intelligent and alert advocate sitting by you at close to around the clock as possible, because having worked in several hospitals for most of my adult life, I can say that every one of them screwed up regularly due to inattentive or poorly trained staff, overworked doctors, unwashed hands, failure to notice when patients start to slip, overly aggressive treatment just because it’s possible, and lack of care coordination by all the one-trick specialists running around treating their particular body part of interest. Bring along a friend or family member to check your meds, personally challenge each major decision to make sure it’s based on conviction and science rather than lack of objection, and ask nurses whether your doctor and treatment plan are any good because they know but won’t say unless you press them. I think most hospital employees would agree that you need a wingman.

7-31-2012 10-00-14 PM

From Westie: “Re: cancer patient whose costs exceeded insurance cap. Wins a victory via Twitter.” Treatment of a 31-year-old’s colon cancer exceeds the lifetime dollar limit of his Aetna student insurance plan, leaving him with no insurance. He gets into a Twitter debate with Aetna CEO Mark Bertolini, who decides to cover the $118K in bills the patient racked up before was able to sign up for a different insurance plan. The tweets are fascinating as observers jumped on Aetna, blaming the company for selling insurance with low caps, questioning what would have happened had the patient not drummed up his own social network, ridiculing the CEO’s $10.6 million salary, and questioning how the Affordable Care Act will or won’t help. I’m glad he’s getting help, but we’re back to the original issue that patients can easily run up more expenses than the insurance they voluntarily signed up for will cover, and unlike every other kind of insurance, everybody expects someone else to pay without objection even though they met their legal obligation. I’d be interested to see who charged what of the $118K University of Arizona Cancer Center bill since those folks aren’t sharing Aetna’s financial sacrifice on the patient’s behalf as far as I know.

7-31-2012 10-01-30 PM

From Frank Fontana: “Re: paid endorsement programs such as those from AHA Solutions and the HFMA Peer Review Program. What do readers think about those programs?” I said years ago that they were pay-to-play, but they do still require products to be vetted, leaving me neutral on their value (I don’t see the benefit, but if they help connect vendors with prospects, then I see no harm.) Your opinions, please.

From EMR User: “Re: downtime penalty terms in contracts. We negotiated that any issue that we deem adversely affects our access or system usability allows us to subtract 5% of our monthly fee. We can do this daily up to five times per month.” I’ve said it before, but maybe it bears repeating. List the top handful of items that would be worst-case to you once you’re live on a vendor’s system (downtime, vendor acquisition, hardware failure, lack of acceptable implementation people, poor support) and insist on a penalty if any of them occur. Or, if you’re a glass-half-full type, reduce your fixed payment amount and offer a bonus if none of the events happen (same result, but it sounds nicer.) That makes sure your vendor has a vested interest in not allowing your worst dreams to come true, and at least if they do, you get the slight satisfaction that you’re getting paid for your trouble.

From Laboratorian: “Re: Epic. Could you opine to the extent to which MUMPS is constraining the growth of Epic? Everyone suggests this is a limiting factor, but so far it hasn’t been. How and when would they hit the proverbial wall?” It’s armchair quarterbacks, not customers, that keep trying to create a non-existent Epic Achilles’ heel out of MUMPS and Cache’. Most of that hot air comes from competitors Epic is killing, self-proclaimed experts who’ve never worked a day in IT or in a hospital, and cool technology fanboys who can’t stand the idea that Epic doesn’t care what they think. Despite the use of some ancient underpinnings, Epic’s product is apparently almost infinitely scalable, it does everything customers need it to do, and it works reliably. Nobody cares what it’s written in except their programmers – customers just want solutions, and the decision-makers when Epic is purchased are usually end users and operational executives, not IT geeks who salivate over source code. The only walls Epic could hit would be if InterSystems decided to go out of business (that’s not happening – they were absolutely printing money even before all those thousands of new Epic Cache’ user licenses dropped into their lap); if InterSystems decides to get greedy and either raise their Cache’ licensing fees or stop developing it (doubtful); or if Epic can’t get programmers willing to learn MUMPS (which has never been a problem because they do all of their training in-house and new UW psychology grads aren’t exactly swimming in job offers from Microsoft or Cisco). Anyone who claims Epic is about to hit the technical wall is just trying to plant fear, uncertainty, and doubt in the market. If there’s an Epic wall to be hit, it will be high costs that hospitals can no longer afford with reduced reimbursement, lack of ability to scale as it tries to extend its dominance outside of the US, some kind of meltdown like Judy stepping down and creating a vacuum of power, or perhaps some major and heretofore unfelt shift toward open systems that would put its rather closed model at risk. You’ll know that’s happening when you see the KLAS scores move from green to yellow. The only opinions that count are those expressed by customers with their dollars.

From Infrastructure Manager: “Re: downtime. I used to work with McKesson Horizon Clinicals, which didn’t have a great downtime report system. We scripted a routine that generated a PDF on a different server than Horizon and also copied it to a few PCs. It’s not a fast system to begin with, and you can’t help but feel the system drag when running those reports every hour, even with a huge Oracle server farm run by skilled DBAs. Also, the database design is poor and the tables are not indexed properly – you’ll see 4000 IOPS on a table/storage location and wonder that the hell is going on. If you’re hosted, who cares? Chew up those servers in a data center you don’t run and hope they’ve scaled to the appropriate size. If you aren’t hosted, take these reports very seriously.”

HIStalk Announcements and Requests

7-31-2012 9-34-41 PM

inga_small Unlike the curmudgeon Mr. H, I have watched a good deal of the Olympics. Who knew team handball was even a sport, much less an Olympic one? Yep, that’s what’s on at 5:00 a.m. on Sunday (don’t ask why I was up so early.) Go Iceland, by the way. So far my biggest complaint is that the men beach volleyball players don’t wear uniforms that are nearly as hot as the women’s. Thank goodness for men’s synchronized diving, however. I have decided that someone ingenious needs to develop an app that blocks all spoilers on Twitter and Facebook so that I will be totally surprised when Michael Phelps becomes the most decorated Olympian of all time (thanks all you expats in England who just had to share the news on Facebook.) Finally, good thing Rio is only one hour ahead of Eastern time so we’ll all see more live coverage in 2016.

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Just  to prove to Inga that I’m not totally Olympics ignorant even though I haven’t watched the tape-delayed spectacle, here’s an interesting fact: the 300 hospitals beds used in the producer’s opening ceremonies tribute to NHS will be donated to hospitals in Tunisia.

Listening: reader-recommended Son Volt, music for driving or moping in smoky bars. Born of the remnants of 1990s minor stars Uncle Tupelo, somewhere between alt-country and roots rock. REM meets Neil Young.

Acquisitions, Funding, Business, and Stock

7-31-2012 10-04-53 PM

CommVault beats Wall Street expectations with its Q1 performance: net income of $10.1 million ($0.21/share) compared to $3.1 million last year on revenues of $111.3 million, up from $91.5 million.

7-31-2012 10-05-36 PM

Merge Healthcare announces Q2 numbers: revenue up 13%, adjusted EPS $.02 vs. $0.06, beating earnings estimates by a penny.


7-31-2012 10-08-02 PM

The Canadian Centre for Addiction and Mental Health selects Cerner Millennium as its clinical information system.

North Carolina HIE expands its relationship with Orion Health with the implementation of the company’s Health Direct Secure Messaging. The HIE went live in April 2012 and 70 providers have signed up, with the next phase being rollout of Orion’s EMR Lite. NC Direct is free for NC HIE participants and $100 per year per mailbox otherwise.

St. Louis-based Mercy chooses Humedica MinedShare as the Epic-integrated clinical intelligence solution it will use to manage population health for its 31 hospitals and 200 hospitals.


7-31-2012 5-41-41 PM

Lifespan (RI) names Eric Alper MD (UMass) as information systems medical director, charged with overseeing the development and implementation of clinical applications for the health system.

7-31-2012 5-44-37 PM

Amanda LeBlanc (Encore Health Resources) joins CTG Health Solutions as managing director of marketing and communications.

Announcements and Implementations

7-31-2012 10-09-46 PM

Yavapai Regional Medical Center (AZ) implements Cerner.

Christus St. Vincent Regional Medical Center (NM) goes live on the second phase of its Cerner implementation with the addition of CPOE and documentation for physicians, nurses, and ancillary care providers.

The VA system in western New York announces its participation in the HEALTHeLINK HIE as part of the VA’s Virtual Lifetime Electronic Record Health Communities Program.

Vocera announces the availability of its B3000 Communication system in France and introduces the Vocera Secure Messaging application for tracking messaging communications.

7-31-2012 10-10-57 PM

Jacksonville Medical Center (AL) goes live on CPSI.

E-prescribing system vendor NewCrop will incorporate interactive drug services from PDR Network into its platform, allowing its users to receive updated drug information, safety alerts, and regulatory and liability messages at the point of prescribing.

Caradigm (the GE-Microsoft joint venture) announces GA of Vergence 5, the latest release of its single sign-on and context management platform for healthcare.

Iowa Medicaid says its integrity program saved the state $30 million in its second year of operation, bringing the total to more than $50 million. Optum administers the program that analyzes provider claims for overcharges due to upcoding, unnoticed private insurance coverage, fraud, and simple math errors in bills.


The FDA clears Proteus Digital Health’s ingestible sensor, which works with a companion wearable patch and mobile app to monitor medication adherence.

7-31-2012 10-15-08 PM

The DoD and VA release PE (for prolonged exposure) Coach, a free smart phone app to assist service members and veterans with PTSD.


Minnesota achieves the highest rate of e-prescribing use in 2011, with 61% of prescribers routing prescriptions electronically. Massachusetts and New Hampshire had the highest physician adoption rate at 86%.

The New Orleans paper reveals that two-thirds of the full-time physicians working in Louisiana state prisons have been disciplined by the state medical board for issues that include pedophilia, substance abuse, and dealing methamphetamines.

7-31-2012 9-43-15 PM

Hartford Hospital (CT) and a home care group announce that information about 10,000 patients was contained on a laptop stolen from an employee of Greenplum, a “big data analytics” vendor and division of EMC that was doing readmission analysis for the organizations. The laptop was not encrypted.

I’m always skeptical of the Meaningful Use attestation numbers, so here’s an example that Meditech sent over in response to some of our recent posts. Inga’s analysis of numbers provided by CMS showed Meditech with around 120 hospital customers attested through May 2012. Meditech’s official number is 431, and even if mega-customer HCA is counted as only one hospital, they’re still at 271. That would place Meditech at #1, far above CMS’s #1 Epic, except that maybe CMS has their numbers wrong, too. I personally don’t think the number of attesting customers means much and this makes me even less interested in the vendor totals.

Physicians and experts testify to a House subcommittee that small practices are dropping like flies, with physicians moving to employed positions because of declining payments and increased reporting requirements. An orthopedist said his group shut down and took hospital jobs after spending $500K on an EMR hoping to reduce cost and improve quality, but the initial savings were eaten up by increased IT labor costs, upgrade fees, and the work required to document Meaningful Use.

Weird News Andy dubs New York Mayor Michael Bloomberg as “Dr. Bloomberg” after his push for hospitals to discourage new mothers from using canned baby formula instead of breast-feeding. WNA adds that he assumes the newborns won’t be allowed to have 32 ounce Big Gulps, either.

Sponsor Updates

  • Wolters Kluwers executive board member Jack Lynch discusses the emergence of “compliance clouds” during the company’s Half Year Media Roundtable meeting in Amsterdam.
  • Informatica gains partner support for its latest release of Informatica Cloud.
  • Impact Advisors earns the highest ranking in KLAS’s HIE consulting report, specifically identified as the only fully rated vendor providing HIE advisory and technical work.
  • DrFirst Chief Strategy and Privacy Officer Thomas Sullivan testifies at an ONC hearing on identity-proofing solutions for the electronic prescribing of controlled substances.
  • HIStalk sponsors earning a spot on Modern Healthcare’s Best Places to Work in Healthcare in 2012 include Aspen Advisors, DIVURGENT, Encore Health Resources, ESD, Hayes Management Group, Iatric Systems, Impact Advisors, Imprivata, Intellect Resources, Intelligent InSites, maxIT Healthcare, Santa Rosa Consulting, and The Advisory Board Company.
  • Allscripts, Beacon Partners, Cumberland Consulting Group, ESD, Merge Healthcare, and The Advisory Board Company receive the Healthcare’s Hottest companies designation by Modern Healthcare.
  • eClinicalWorks and Intelligent Medical Objects host webinars to introduce eCW IMO Problem IT Smart Search for ICD-10 coding.
  • United Hospital System of Kenosha (WI) renews its licensing agreement for Streamline Health’s Enterprise Content Management Solution.
  • MED3OOO customer Family Healthcare Network (CA) receives over $500,000 in EHR incentive payments.


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

More news: HIStalk Practice, HIStalk Mobile.

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July 31, 2012 News 15 Comments

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