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Morning Headlines 10/4/13

October 3, 2013 Headlines No Comments

Lexmark acquires PACSGEAR for $54M

PACSGEAR, an EHR/PACS integrator that transmits images, videos, and supporting documentation between PACS systems and EHRs, is acquired by Lexmark for $54 million in cash.

Providers Demand More Than Just Regulatory Reporting From Quality Management Systems

A new KLAS report evaluates quality management systems, which customers say should be doing more than just automating regulatory reports. The expectation is that quality management solutions will drive operational and financial improvements across the organization, leading to better outcomes. Xerox Healthcare comes out on top in the survey.

Google Glass in hospitals? Royal Philips, Accenture think so

Philips showcases a new Google Glass app that displays data from its surgical solution so that surgeons can review real-time patient data intraoperatively on a hands-free form factor.

HIMSS Analytics Releases 2013 Inpatient Revenue Cycle Management Study

A recent HIMSS Analytics survey about inpatient RCM solutions finds systems used for pre-certification, address validation, and bill estimation are lagging and likely to be replaced. Advisory Board, Emdeon, Experian, RelayHealth, and Recondo are among the vendors with the highest mind share.

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October 3, 2013 Headlines No Comments

Intermountain Healthcare Chooses Cerner

September 27, 2013 News 11 Comments

9-27-2013 10-20-33 AM

Intermountain Healthcare announced this morning that it has chosen Cerner as a strategic partner for its 22 hospitals and 185 clinics. Intermountain will install Cerner’s clinical and revenue cycle applications.

Intermountain announced in January 2013 that it would not renew a much-publicized relationship with GE Healthcare because the systems they were building together were deficient in CPOE, clinical documentation, and coding/billing integration.

I spoke to Don Trigg (SVP and president of Cerner Health Ventures) and Neal Patterson (chairman and CEO) from Utah following the announcement. Trigg says the partnership may go well beyond electronic medical records specifically, potentially developing into a significant “accelerator for clinical computing in pursuit of high quality, low cost care.” Toward that end, Cerner will relocate several of its executives and employees to Salt Lake City, UT, including EVP Jeff Townsend.

Trigg and Patterson report that Brent James, MD, MStat, executive director at Intermountain Institute for Health Care Delivery Research and Intermountain chief quality officer, will present a keynote address at Cerner Health Conference. CHC will be held October 6-9, 2013 in Kansas City, MO.

I will interview Neal Patterson during the conference.

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September 27, 2013 News 11 Comments

News 9/27/13

September 26, 2013 News 11 Comments

Top News

9-26-2013 11-24-53 AM

9-26-2013 8-02-35 PM

ONC Principal Deputy National Coordinator David Muntz will leave his post next month, according to an ONC email to staffers. Muntz, who joined ONC in January 2012 after six years as SVP/CIO of Baylor Health Care System, was considered by some as a potential successor to Farzad Mostashari, MD. Chief Medical Officer Jacob Reider, MD will serve as acting ONC director, while current Deputy National Coordinator for Operations Lisa Lewis will take over as acting principal deputy.

Reader Comments

9-26-2013 8-49-59 PM

From Frank: “Re: Consumer Reports list of patient medical gripes. Health IT can resolve many of these issues.” Actually, it’s the use of health IT that might solve some of these problems. I say that intentionally because doctors could fix most of these problems themselves without adding technology at all, and if they haven’t fixed them, turning themselves into technology users may not help.

From Jim: “Re: Jonathan Bush on CNBC. A classic quote on healthcare industry consolidation.” Per Bush, “The dinosaurs are mating as the ice cap is melting.”

From Horschack’s Laugh: “Re: RFI/RFP template for provided EDW/BI solution (build, buy, license options)?” I’ll allow readers to respond.

9-26-2013 9-26-52 PM

From Bo Knows: “Re: McKesson InSight in Orlando. So big it’s almost a mini-HIMSS.”

HIStalk Announcements and Requests

A few highlights from HIStalk Practice over the last week include: a chat with the CEOs of Vitera and Greenway about the impending shared ownership of their companies. A look at Practice Fusion and its plans to grow revenues and its customer base. CMS offers an online calculator to determine payment adjustments based on participation in Medicare’s e-prescribing, MU, and PQRS initiatives. A British Columbia newspaper provides insights into the province’s EMR adoption program. The American College of Physicians offers an online clinical decision support tool for internal medicine physicians. Jason Drusak, manger of consulting services at Culbert Healthcare Solutions, offers tips for preparing for Stage 2 MU. And, coming to HIStalk Practice this weekend: our annual list of must-see vendors at MGMA, all of which happen to be faithful HIStalk sponsors. Sign up for email updates so you don’t miss details on how to find these vendors and what they will be discussing at next month’s conference. Thanks for reading.

Acquisitions, Funding, Business, and Stock

9-26-2013 7-48-13 PM

Group purchasing organization Premier Inc. raises $760 million in its IPO. Shares rose 13.5 percent Thursday.

9-26-2013 7-51-27 PM

Shares of Compuware spinoff Covisint jumped 23 percent on their first day of trading Thursday.

9-26-2013 7-52-33 PM

Aventura completes a $4.3 million investment led by current investors.


9-26-2013 7-55-06 PM

F.W. Huston Medical Center (KS) will implement RazorInsights ONE-Health System Edition EHR and financials platform.

The VA extends a three-year, $8 million contract to Harris Corporation for a Correspondence Tracking Software system to improve communications between the VA and veterans.

Intermountain Healthcare (UT) selects Security Audit Manager from Iatric Systems to provide patient privacy auditing and incident risk management across its 22 hospitals and 195 clinics.

Orthopaedics & Sports Medicine Owensboro (KY/IN) selects SRS EHR for its 11 providers.

WellSpan Health chooses Perceptive Software’s vendor-neutral archive for enterprise clinical content management.


9-26-2013 8-18-07 PM

Shareable Ink appoints Dave Runck (Baxa Corporation) as CFO and announces the opening of an expanded office in Boston’s Innovation District.

9-26-2013 8-19-47 PM

Aventura appoints acting CEO John Gobron to president and CEO.

Announcements and Implementations

Cerner and Children’s National Medical Center (DC) invest several million dollars each to build an HIT center for pediatric technology innovation.

Henry County Health Center (IA) becomes the first healthcare facility to go live on the Iowa HIN.

Boston Children’s Hospital (MA)and IBM pioneer OPENPediatrics, a cloud-based learning platform for sharing best practices for the care of critically ill children.

9-26-2013 11-58-25 AM

Hillary Rodham Clinton will become the second Clinton in as many years to provide a keynote address at the HIMSS annual conference. President Bill Clinton drew such a large crowd last year that the overflow masses could only view the speech from a monitor outside the ballroom. Hillary may not attract the same numbers her husband did, but just in case, I hope HIMSS is securing a sufficiently large room to accommodate me and a few thousand of my fellow political junkies.

9-26-2013 8-30-55 PM

Fox Army Health Center (AL) goes live on Tricare Online and RelayHealth online portals.

9-26-2013 8-31-56 PM

The University of Mississippi Medical Center uses MediQuant’s DataArk active archive technology to migrate financial and patient records to a new information system.

9-26-2013 11-33-51 AM

Dossia rolls out Dossia Dashboard, a population health management system that works with the company’s personal health management platform with real-time data analytics and evidence-based health rules.

9-26-2013 9-15-47 PM

Specialty EMR vendor Modernizing Medicine will work with Miraca Life Sciences to develop an enhanced system for communicating diagnostic information between dermatologists and pathologists.

National eHealth Collaborative opens board member nominations.


9-26-2013 8-47-07 PM

Regions Hospital (MN) reduces the average amount of blood transfused by 14 percent after implementing a decision support tool with its EHR. The tool, which Regions developed with the American Red Cross, uses evidence-based clinical guidelines to determine the appropriate use of red blood cells.

Doctors in Colombia amputate a 66-year-old man’s fractured and gangrenous penis after he intentionally overdosed on Viagra to impress his new girlfriend. No word on whether she remains impressed.

Weird News Andy adds a Rodney Dangerfield quote to this story: “I was such as ugly baby that when the afterbirth came out, the doctor said, ‘Twins!’” New mothers are practicing umbilical non-severance, or lotus birth, in which the baby’s placenta is left attached until it falls off on its own days later.

Sponsor Updates

  • SCI Solutions announces details of its Client Innovation Summit next month in Braselton, GA.
  • EDCO releases a recorded Webinar, “Point of Care Medical Record Scanning.”
  • Intelligent Medical Objects releases new videos on ProblemIT and its mobile app.
  • Shaun Shakib, medical informaticist for Clinical Architecture, offers some considerations for organizations implementing and utilizing controlled clinical terminology.
  • HIStalk sponsors earning a spot on Healthcare’s Hottest recognition program for the industry’s fastest-growing companies measured by revenue growth include Allscripts, Beacon Partners, CTG Health Solutions, Cumberland Consulting Group, ESD, Impact Advisors, Imprivata, Intellect Resources, and The Advisory Board Company.
  • AirWatch announces comprehensive enterprise management support for iOS7.
  • Iatric Systems announces that its Meaningful Use Manager and all three Public Health Interfaces have been certified as modular EHRs.
  • Martin’s Point Health Care (ME) details how Forward Health Group’s PopulationManager is helping improve patient care.
  • Valence Health releases details of its November 12-13 thought leadership conference.
  • Chilmark Research selects Wellcentive as a best-of-breed vendor in its 2013 Clinical Analytics for Pop Health Market Trends Report.
  • Ping Identity CTO Patrick Harding joins the board of the Open Identity Exchange.
  • Seven disease management programs supported by TriZetto’s CareAdvantage Enterprise solution earn NCQA Disease Management Systems certification.
  • SuccessEHS hosts more than 475 attendees at its annual user conference this week in Birmingham, AL.
  • Care Team Connects offers an October 8 webinar highlighting the upcoming Medicaid expansion and what it means from a care management perspective.
  • EXTENSION will showcase its alarm safety and event response platform for nurses and other caregivers at the American Nurses Credentialing Center National Magnet Conference October 2-4.

EPtalk by Dr. Jayne

9-26-2013 7-44-23 PM

The recent announcement of the pending union of Greenway and Vitera has been hot news in the physicians’ lounge this week. One of my colleagues was even reading Inga’s interview with Tee Green and Matthew Hawkins while we were talking. Several of the providers at the table were Greenway customers and they are understandably concerned about where things are headed.

Once upon a time I was a user of Medical Manager and then of Intergy, both of which have been absorbed into the Vitera product line. Back in the day, the best part of Intergy was its use of the MEDCIN terminology as the framework for documentation. The process of building point-of-care templates was straightforward (although tedious) and it was fairly easy to document visits. Looking at Intergy now, it barely resembles its original self, which in the software life cycle is a good thing.

Since I’ve been around the EHR world a fairly long time compared to many of my primary care peers, I am sometimes asked to help a practice create an RFP document or to offer an opinion on their system selection process. Recently, I was asked to attend a demo of Greenway and to give my opinion, although my colleague wouldn’t divulge the identities of the other two competitors involved. I thought that was an interesting way to get an opinion without the pros and cons of the other products overshadowing what Greenway had to offer.

I had intended to write it up for HIStalk (after enough of a newsroom embargo to shield my identity) but didn’t want to appear as if I was just talking about a sponsor to talk about a sponsor. Now that Greenway is front page news, though, it seemed like the right time. As background, this was a web demo given by a seasoned Greenway rep and was targeted towards a solo physician in primary care.

He delivered the standard sales background, including number of specialties and clients live. Walgreens and their TakeCare business line was included, with it live in over 4,000 locations. I thought this was interesting given the prevalence of pharmacy-owned clinics in our area and thought that the potential interoperability on that might be kind of nice for the solo primary care doc I was with. He really sold the fact that PrimeSuite focused on the EHR and practice management infrastructure, positioning Greenway as a company that didn’t want to allow other business lines to distract from their core offering.

One surprise was that Greenway wasn’t keen on interfacing with an existing practice management system – it’s an all-or-nothing deal, which is generally a good idea. I’ve seen practices tank implementing a perfectly good EHR because they’ve slaved it to a dud of a practice management system using interfaces that led to dual data entry and a whole lot of headaches. In a lot of ways, refusing to interface would help a vendor choose its customers to some degree. I know several vendors who would benefit from being willing to walk away from practices who don’t understand the benefits of a unified system.

We continued on with the background including their high KLAS rankings over the last decade, which they attributed to word of mouth and happy customers. One of the reasons their customers are happy is their training approach. Their goal is to spell it out to customers as far as what it takes to be successful and how many training hours are needed – it sounded like they take a hard line with customers who don’t want to agree to the recommended amount of training. At the time, ongoing training was available with classes offered nearly every day. I’d have to check with actual clients to see if this is still the case, but it sounds better than what I’ve seen with other vendors, who let clients cheap out on training which leads to crises later.

The inclusion of upgrades in the monthly support fee is a benefit for the Meaningful Use crowd. Having been hit by one particular vendor for upgrade charges in the past, I know this can be a big deal. Greenway has been CCHIT certified a number of times and is offering a guarantee to ensure they maintain certification, otherwise they will compensate providers equal to the amount of lost stimulus funds. A pretty extensive list of happy clients was offered up without asking, including multiple sites within a 30-minute drive. That’s always a good thing to hear during a demo.

In addition to the flagship PrimeSUITE product, they have an interface engine, patient portal, mobile app, and clinical device integration, which I would expect from any vendor who plans to be a contender. Interoperability with Cerner and Epic was mentioned more than once. One offering stands out and that’s their clinical research module, PrimeRESEARCH. Not only does it have a system for managing clinical trials, it allows participating practices to network in hopes of increasing the number of eligible patients. I don’t think there are a lot of vendors offering that functionality, let alone the ability to track trial budgets, patient stipends, and sponsor funding, which it also apparently does. Monthly emails let the practice know if it has patients who would qualify for a trial. Having done outcomes research for a local medical school, this is a potential game changer for community physicians who want to participate in trials but hate the hassle.

With all that out of the way, we finally got into the product itself. Navigation was quick with the ability for users to configure it on the fly. It had everything I would expect in an ambulatory EHR as far as lab display, flowsheets, and tasking. Clinical alerts are generated based on criteria which can be customized from the base set they provide. There was an audible “ooh” from my colleague when he showed their clinical summary face sheet, which is user-customizable with drag-and-drop panes as well as the ability to hover over data elements for more information. Those of us who use products with these features every day tend to forget that a lot of systems out there don’t offer these niceties.

Visit note documentation was pretty standard, as was the ability to pull forward information from previous documents. I liked that abnormal physical exam findings displayed in red and italics. There seemed to be a lot of user-customizable features, but of course the proof is in the pudding when you actually get your hands on it rather than watching a demo. One feature that differs from some other vendors is the ability to keep multiple patients open at a time, which can be both a blessing and a curse. I have to admit I was taken by their document management (scanning) system. It has some nice features including fax integration and the ability to match incoming documents with outstanding orders, which is the holy grail for closed-loop order management.

A couple of months have passed and my colleague still hasn’t decided what she’s going to do. Thinking back on the demo as well as the company that Greenway will be keeping, it will be interesting to see what the future holds. I have several friends who work at Greenway, and for their sake, I hope it’s smooth sailing.

I’d love to hear from current customers on either the Greenway or Vitera products. What do you think the union will bring? Are there any product features you hope to jettison for something better? Email me.


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

More news: HIStalk Practice, HIStalk Connect.


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September 26, 2013 News 11 Comments

News 9/25/13

September 24, 2013 News 3 Comments

Top News

The FDA issues final guidance for mobile medical apps, saying it will exercise “enforcement discretion” (meaning it will not enforce requirements under the Federal Drug & Cosmetic Act) for the majority of health and wellness apps since they pose little risk for consumers. Examples of  low risk apps include those for self-managing a disease or condition and apps for the self-tracking of health information, exercise, or diet. Oversight focus will be on apps that present a greater risk to patients if they do not work as intended, such as those used as a medical device accessory (such as viewing a medical image on a smartphone) or as a mobile platform as a medical device (like an app that allows a smartphone to be used as an ECG to detect abnormal heart rhythms.)

Reader Comments

9-24-2013 10-50-48 PM

9-24-2013 10-51-55 PM

From The Fixer: “Combining Greenway and Vitera. I think the deal makes sense given that Greenway has more of a healthcare IT platform than Vitera does and Greenway is much more well run than Vitera. Over time, they will migrate all Vitera clients to Greenway’s platform and realize tremendous cost savings and synergies by leveraging Greenway’s infrastructure.” Perhaps they will head in that direction, but Matt Hawkins and Tee Green kept their plans pretty close to the vest when I talked with them Monday evening. Green noted that “maintaining multiple platforms probably isn’t going to be the long term strategy because that doesn’t create value for your customers and your team,” while Hawkins stressed that Vitera would continue to support, maintain, and update its various product platforms. Both declined to say who would lead the company going forward, but my money is on Hawkins taking the top spot.

From InsideOutsider: “Culture clash. Greenway has long had a reputation for its strong, family-oriented corporate culture. Kudos to Vitera for recognizing that and for trying to leverage Greenway’s better reputation and brand. Meanwhile, Greenway employees better hang on for the pending culture shock.”

From Upon Further Review: “Re: HIS Junkie’s statements about ONC systems. PopHealth is still an active project and has nothing to do with certification. Cypress had bugs, but it’s still being refined.”


HIStalk Announcements and Requests

9-24-2013 8-25-41 PM

Welcome to new HIStalk Gold Sponsor Summit Healthcare. The company offers application integration tools that include Summit Express Connect (the industry’s most powerful integration engine) and the Summit Scripting Toolkit that can automate any process (budget updates, point-of-care device integration, patient self registration.) The company has been a Meditech integration leader since 1999. Summit Provider Exchange allows patient information to be exchanged between hospitals and physician EMRs, while the Summit Downtime Reporting System gives users access to a patient data snapshot for managing  scheduled or unscheduled downtime. Thanks to Summit Healthcare for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

9-24-2013 10-11-21 PM

Practice Fusion raises $70 million in a series D round, bringing total funding to $134 million and valuing the company at an estimated $700 million.

9-24-2013 10-12-33 PM

PatientSafe Solutions closes an investment from EDBI, the investment arm of the Singapore Economic Development Board, bringing its total Series C funding to $27 million.

Mobile medication management solution provider MediSafe raises $1 million in funding, co-led by TriVentures and lool Ventures.

Online patient billing company Simplee raises $10 million in Series B funding, led by Heritage Group.

Inga interviewed the CEOs of Greenway and Vitera about their impending shared ownership on HIStalk Practice.


9-24-2013 10-15-55 PM

St. Joseph’s Hospital Health Center (NY) selects PeriGen’s PeriCALM Tracings fetal surveillance system.

University Health System (TX) licenses iSirona’s device connectivity solution for its 24 clinics, hospitals, and outpatient facilities.

South Jersey Family Medicine will replace its Alteer platform with e-MDs Solution Series EHR, PM, and patient portal solutions.

Michigan Spine Surgery Improvement Collaborative selects ArborMetrix’s registry solution to create a statewide database and reporting system for spinal surgeries.

Imaging Specialists of Charleston and Charleston Radiologists (SC) select Merge Healthcare’s Outpatient Radiology Suite and Honeycomb Archive platform.

The Houston City Council approves a $1.6 million contract with Oregon Community Health Information Network to implement an EHR for the city’s Department of Public Health and Human Services.



9-24-2013 9-02-35 AM

SyTrue hires Ketan Patel, MD (US Pain Management Corp.) as CMO.

9-24-2013 11-28-48 AM

Healthcare Data Solutions names David M. Thomas (IMS Health) to its board.

9-24-2013 11-35-20 AM

Transcription and coding solutions and services provider Amphion Medical Solutions appoints Subbu Ravi (Symphony Data Corporation) COO.

9-24-2013 10-30-10 PM

CORE Security names Eric Cowperthwaite (Providence Health & Services) as VP of advanced security and strategy.

Announcements and Implementations

9-24-2013 10-19-20 PM

The board of Greenville Hospital System (SC) approves a $97 million expense to implement Epic, replacing GE Healthcare and Siemens Soarian.

EClinicalWorks and Epic develop bidirectional interoperability between their EHRs.

Government and Politics

9-24-2013 2-46-58 PM

Seventeen GOP senators ask HHS Secretary Kathleen Sebelius for a one-year extension for Stage 2 MU to give providers extra time to meet the new requirements. The lawmakers agree that providers who are ready to attest to Stage 2 should be able to do so consistent with the current policy.


MyMedicalRecords files a complaint for patent infringement against Allscripts, alleging that its Jardogs FollowMyHealth technology violates MMR’s PHR patents.

9-24-2013 9-31-53 AM

A KLAS report finds that EHR replacement rates are up in the small practice (1-10 physician) market. Athenahealth, SRSsoft, and Practice Fusion are having the most success delivering quick and easy implementations of value-based products. Pediatrics-specific EHR PCC earned the top performance score among 27 vendors, while customers of McKesson, GE Healthcare, Allscripts, and Vitera expressed the highest levels of dissatisfaction based on unmet product expectations, poor upgrade releases, and inadequate relationships.

Senior hospital IT executives say that exchanging patient information in robust, meaningful ways and budget and staffing limitations are the biggest barriers for health information exchange between other hospitals, according to a HIMSS Analytics report.

John Lynn of EMR and HIPAA will interview Mandi Bishop of Adaptive Project Solutions Thursday from 1:00 to 1:30 on “Healthcare Big Data and Meaningful Use Challenges.” The Google+ Video Hangout will stream live, with the recording available afterward.

Zirmed earns  the highest customer satisfaction rating from large hospitals and academic medical centers in a Black Book research report on the RCM industry. Among small / rural and community hospitals, SSI Group scored highest, while Relay Health earned the highest marks from hospital systems, IDNs, CINs, chains, and ACOs.

Weird News Andy finds more weirdness: a man who had just used a university’s computer lab to Google symptoms of pain, tightness of chest, and sweating is found dead in his car in the parking lot.


Sponsor Updates

  • Elsevier launches SimChart for the Medical Office, a competency-based, simulated EHR that gives medical assisting students hands-on practice performing business and clinical skills.
  • Visage Imaging announces upgrades to Visage 7 Enterprise Imaging and Visage Ease.
  • VMware announces the GA of VMware vCloud Suite 5.5 and VMware vSphere with Operations Management 5.5. VMware also makes VMware Virtual SAN available for download and trial via a public beta program.
  • Oracle awards NTT DATA the 2013 Oracle Excellence Award for Specialized Partner of the Year – North America in Health and Life Sciences for demonstrating outstanding and innovative solutions based on Oracle products.
  • Intellect Resources President Tiffany Crenshaw talks about what’s behind the growth of her company after taking top honors in The Business Journal’s 2013 Fast 50 awards.
  • Craneware EVP of Revenue Integrity Operations Karen Bowden will lead a session on preparing for audits at next month’s 2013 CH100 Leadership and Strategy Conference in Greensboro, GA.
  • Orion Health offers scholarships and graduate recruitment programs through the University of Canterbury in New Zealand in an effort to attract talent and encourage more IT graduates.
  • Hayes Management Consulting offers two white papers to help organizations improve clinical optimization.
  • Nuance launches Clintegrity 360 | ICD-10 Education Services, an ICD-10 readiness program for physicians, coders, and clinical documentation specialists.
  • Capsule’s business development manager Elizabeth Skinner will discuss medical device integration at this week’s McKesson’s Insight365: 2013 Annual Conference in Orlando.
  • Caradigm introduces new versions of Caradigm Single Sign-On and Caradigm Context Management products, which feature tightened integration with virtual desktop technologies, simplified security compliance, and accelerated clinical workstation deployment.


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

More news: HIStalk Practice, HIStalk Connect.

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September 24, 2013 News 3 Comments

Curbside Consult with Dr. Jayne 9/23/13

September 23, 2013 Dr. Jayne No Comments


I spent most of this week conducting a site visit at a primary care practice that subscribed to our affiliated physician EHR offering last year. When they decided to take the bait on my hospital’s hook (as well as the accompanying subsidy) they were on an ambulatory system from another vendor. They had a contractor perform a partial conversion of their clinical data (“partial” due to cost) but my team was told to officially stay out of the conversion due to concerns with the subsidy agreement, data ownership, liability, and other contract-related issues. It was instead approved by the practice’s clinical champion. Since they are on their own instance of the application and their data doesn’t commingle with mine, I had no reason to push back or demand involvement.

When they migrated to our platform, our team conducted their training in the same manner with which we have trained hundreds of other physicians. Since they are affiliated and not employed (and also because they are located several hundred miles from our corporate mother ship) I hadn’t been out to visit them. Their leadership complained to our CIO that they were struggling with the system and requested that we send someone out to “fix it.” The practice is in a prime location for some fun outdoor activities, so I decided to conduct the site visit myself. After some preliminary discussion with practice leadership to obtain some background information and specifics on their concerns, I was on my way.

Performing a site visit like this is not for the faint of heart. As part of an employed medical group, we have people who are constantly after us to make sure we are compliant with OSHA, CLIA, HIPAA, and a host of other acronyms. Many small practices struggle in keeping up with these basics, not to mention with the multiple regulatory requirements that keep popping up like dandelions in spring. I always remind our process improvement team that it is important to clearly define the areas of observation and the questions to be answered before you start the site visit. Otherwise, it is possible to be overwhelmed with findings that may be outside the project parameters. Many of us have been confronted with findings that although out of scope, are so critical that they must be immediately addressed and sometimes the site visit comes to a screeching halt because of it.

I’ve had providers scream at me about unrelated issues, have had providers cry while I try to interview them, and have had them complain about their spouses making them late to the office which interferes with the schedule. There have been those that argued, others that pleaded, and some that stood up and walked away when we presented our findings. We try to stay objective and professional even when we see things that make our skin crawl.

With those experiences under our belt, sometimes we numb ourselves to the things we see because we’re there to assess people, process, and technology, not how providers are practicing or how diligent the housekeeping staff might be. In my role, I’m not there to address the fact that you just performed what you thought was a diabetic foot exam but what I thought would have earned one of my interns a trip to physical diagnosis remediation class. However, if I see you wearing a dirty lab coat with a Santa Claus pin on it in August, I’m probably going to say something whether it’s in scope or not. Luckily I didn’t run across anything like that on this visit, but what I did find was a group that is trying to perform the practice equivalent of running a marathon in high heels.

The practice has a great layout and plenty of space – it was built for six physicians but currently holds only four and all of them feel that they are equally busy. Their levels of productivity are similar except for a senior physician who no longer takes call but makes up for it with lower compensation. It’s nice to have that kind of a level playing field when you’re observing practice dynamics because when some partners are busier (or feel they are doing more of their share of the work) it’s usually a marker for dysfunctional team dynamics. They’ve had some staff turnover but not an unusual amount, and currently have two clinical support staff for each physician. Another good sign.

As part of our Meaningful Use preparation, we recently upgraded their EHR to the most current version available from our vendor and they received the same training our own physicians received. Unfortunately, the positive signs stopped there. Some of the first questions I ask when shadowing physicians involve how they feel the use of the EHR is going for them, and what their personal priorities are for use of the system. I also ask what they feel are the practice or health system’s priorities. Not only did all five of them have very different personal priorities, none of them could accurately identify the practice’s priorities. They could not identify a mission statement or a vision for how care is to be conducted in the office.

I wanted to assess how the recent upgrade impacted them and they admitted that they were not using many of the new features including some that streamlined workflow, reduced manual data entry, and others that provided clinical decision support. I felt bad that despite our educational efforts, they either failed to understand the clinical utility of the content or didn’t know how to incorporate the features into their existing work flow. In digging deeper though I found the root cause. The providers had made a deliberate choice not to use the new features. Instead, they decided that they needed to focus all their efforts on the many incentive programs available to them.

In addition to Meaningful Use, they are trying to obtain recognition as a Patient Centered Medical Home and are participating in a diabetes care collaborative. They are also participating in four different pay for performance plans that each have different metrics. Due to the disparity, they’re trying to focus on the key elements for each patient based on insurance rather than taking a population-based approach. In regards to Meaningful Use, they were not able to articulate which clinical quality measures they would be reporting or how they were performing on the MU measures overall. They haven’t run any preliminary Meaningful Use reports despite planning to attest soon. They have no idea where they stand.

Over the lunch hour, I decided to queue up some of their reports and I had some not so pleasant surprises. The first things I found were some pretty serious artifacts from their conversion. There were diagnoses such as “Verify: Gout” and “Verify: Diabetes” and “CONVERSION: DO NOT USE.” All of them had ICD-9 codes of 000.00 associated with them. I drilled down to a handful of patient charts and found that they also had multiple versions of similar diagnoses (250.00, 250.02 for example) that had not been reconciled. In addition to causing havoc with the reports, the patient diagnosis lists were messy and difficult to read with the conflicting codes present. It seems that they were supposed to clean up the diagnosis lists the first time the patient had a visit on the new EHR, but it didn’t get done. Unfortunately the providers have continued to select diagnoses of 000.00 from the patient diagnosis list which carries it forward and the coders have been fixing them on the practice management side, but no one closed the loop in the EHR.

Additionally, after a couple of months on the HER, they had stopped reconciling altogether. I had been thinking about how to create some payer-specific alerts for them for their pay for performance programs (assuming I couldn’t convince them to either care for all patients with the same standards regardless of payer or drop the incentive programs that created conflict) but without accurate codes to identify the disease states, it was going to be extremely difficult.

As much as they decided to mix it up with the pay for performance indicators, they took the opposite tack with Meaningful Use. Uncertain of the actual thresholds for some of the measures, they decided to go whole hog. Instead of reconciling medications at transitions of care, they were performing full reconciliation at each visit. Instead of summarizing tobacco use and updating any changes since the last visit, they were eliciting a complete tobacco use history even if it had already been documented. One patient actually complained about being asked the questions at every visit even though he had stopped smoking years ago. They are performing full vital signs on all patients (including infants) at every visit, regardless of the reason for visit or the time since they last presented to the office. They are trying to provide patient education for every visit, even when education may not be relevant. By the end of the first day, I was tired just watching them.

I observed each physician’s care team for several hours over a couple of days and also shadowed in the lab. Working with the billing and coding staff and the office manager, we identified additional areas for improvement. Typically at the end of a site visit I do a report-out with the providers and leadership. Most of the time I am recommending that they get moving and add MU activities to their processes. This time, though, I had to make recommendations for them to do less in some regards, which felt very strange as a recommendation. We had some good discussion and they really struggled with how to determine which things they should do for every patient and which they should do only when required.

I left them with a simple litmus test: actions should be performed at every visit only when they are clinically significant or are required by a regulatory body. We looked at the tobacco use item as an example. If the patient is not currently smoking, does it make sense to ask about their past use at every encounter? Probably not, as long as they are flagged as a never smoker or a former smoker. If the patient is currently smoking, does it make sense to ask about cessation at every visit? Yes, because all four P4P programs are looking for that element. I’ve asked them to go through their work processes and ask those kinds of questions for the various documentation elements. I’ve also asked them to start reconciling diagnoses on each visit to get those lists cleaned up before we head for ICD-10.

We’re going to set up monthly calls to check on their progress. I’ve given them some homework that is due before the first one. I’m hopeful that we can make their workflow more streamlined and less stressful while delivering quality care. They’re going to be working hard to get ready for their attestation period, but I’m cautiously optimistic. Hopefully I’ll be able to keep you posted on their progress.

For those of you who are curious about the picture, it’s Julia Plecher of Germany. She holds the Guinness World Record for the fastest 100 meters in high heels. Her time: 14.531 seconds. I wonder if Inga will be able to top that in her party hopping at MGMA? I can’t wait to find out.

E-mail Dr. Jayne.

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September 23, 2013 Dr. Jayne No Comments

News 9/20/13

September 19, 2013 News 12 Comments

Top News


The Greater Madison Convention & Visitors Bureau estimates the economic impact this week’s Epic user group meeting is $6.5 million, second only to the World Dairy Expo. Despite being behind the cow show, Judy Faulkner was apparently pleased to tell her 15,000 customers and employees that Epic now serves 51 percent of US patients and 2.4 percent of the world’s. She also reports that 86 percent of Epic implementation projects over the past two years have come in under budget.

Reader Comments

From Wild Duke: “Re: Caradigm. Did a major executive purge. Chief Medical Officer Brandon Savage and SVP of Product Management Mark Johnson both gone. COO Nigel Mason is heading back to GE. CTO Neal Singh is now running the show.” A Caradigm spokesperson responded to our inquiries by saying, “I can confirm that earlier this week Caradigm made some organizational changes within our product teams to drive greater alignment and focus on our healthcare analytics and population health solutions.” We’ll call it unverified since companies can’t comment on the status of individual employees.

9-19-2013 6-42-43 PM

FromPit Viper: “Re: VA. Under Secretary Petzel is resigning.” Unverified, but Pit Viper has been a good VA source previously. Robert Petzel, MD is Under Secretary for Health in the Department of Veterans Affairs.

9-19-2013 6-51-57 PM

From Would Like to Know:“Re: ICD-10. CMS is not requiring it for coding Liability Insurance, No-Fault, and Workers Comp until April 1, 2015. For vendors that rely on UB-04 billing data, this exception is causing some angst. We’ve heard hospitals will code in ICD-10 and then either crosswalk back to ICD-9 or code to ICD-9 for these insurers. Would you be able to survey hospitals about this? I love HIStalk and have promoted it inside my company, plus we are now a sponsor.” Thanks. I created a poll that will take hospital folks maybe 10 seconds to complete. I’ll share the results here in a few days.

9-19-2013 7-02-35 PM

From Movie Sign: “Re: open.epic. Epic’s big announcement to the world of modern startups looks like it was designed by an amateur. It doesn’t help accusations that legacy vendors are out of touch.” Nobody seems to know anything about open.epic other than what’s on the site, which indicates that it’s a connection from EpicCare to personal health devices. Folks attending UGM probably got more details.


HIStalk Announcements and Requests

9-19-2013 12-02-32 PM

inga_small Thanks to Jennifer Dennard (@SmyrnaGirl) of Billian’s HealthDATA for hosting Thursday’s #HITchicks tweetup, which happened to be the first TweetChat I’ve ever attended. The discussion covered women in the healthcare C-suite, mentoring, HIT week, and, my favorite: should women have to “harden” or “soften” themselves when in positions of leadership. I agreed with the consensus view that women (and men) must remain genuine and true to themselves. Nice job moderating, Jennifer!

9-19-2013 5-49-04 PM

inga_small I updated my iPhone 5 to iOS 7.0 last night (it took about an hour) and, so far, so good. I did have to delete about 2GB of videos to make room for the update, so beware if you are low on storage. I am excited about the new camera features, which include Instagram-like tools for enhancing photos and a faster shutter speed (which will be perfect for taking stealth photos of shoes at MGMA.) The iTunes Radio is also fun and should give Pandora a run for its money, especially since it’s ad free. I listened to a few tunes using the Bluetooth in my car, but then realized that too many tunes may be a quick way to eat up all the data included in my cell phone plan. Finally, the overall navigation is enhanced in several areas, resulting in fewer swipes to get where you are going.

9-19-2013 5-58-56 PM

Welcome to new HIStalk Platinum Sponsor Prominence Advisors. The company, founded by former Epic managers who hire Epic superstars, provides the country’s foremost healthcare organizations with Epic expertise, with over 90 percent of the company’s employees being Verona alumni. Prominence is a QlikView healthcare implementation partner, levering its knowledge of Epic’s data model to help organizations aggregate data from multiple systems to spot trends, predictively improve patient care, optimize revenue cycles, and monitor operational performance. High-profile projects require extraordinary, high-performing talent and Prominence has earned the reputation of deep domain expertise and exemplary character as it provides services in analytics, strategy, and execution. Thanks to Prominence Advisors for supporting HIStalk.

Bored? (a) sign up for email updates so you’ll be the first to know; (b) repeat for HIStalk Connect, where your signup gets you really cool HIT innovation news from Travis, Lt. Dan, and Kyle; (c) connect with us on Facebook, Twitter, and LinkedIn, including the HIStalk Fan Club that Reader Dann created a long time ago that now has 3,242 members, making my mom very proud even though she’s not sure why; (d) peruse and occasionally click the ads of the folks who keep me in keyboards and check them out in the Resource Center and Consulting RFI Blaster; (e) send me rumors, pictures, or whatever interesting stuff you have using the secure Rumor Report form that goes straight to my inbox along with any attachments you’ve included; (f) check out the Webinar Calendar and vow to learn something; and (g) accept my appreciation for your  support of HIStalk in whatever form that support takes (just reading it counts a lot.)

Upcoming conferences: Inga will be at MGMA in October, I’ll be at the mHealth Summit in December. That’s all we have on our dance cards for now.

HIStalk Webinars

9-19-2013 6-26-20 PM

Encore Health Resources will present “Full Speed Ahead: Creating Go-Live Success” on Tuesday, September 24, 2013, 1:00 – 1:45 p.m. Eastern, featuring William Sangster, MD. Dr. Bill will impart wisdom, I’ll say a few words that will be far less wise, and a lucky attendee will win a $50 Amazon gift card door prize. Register now.

Speaking of webinars, we’re doing quite a few of them and I could use a few more CIO-type reviewers. Here’s how it works: I’ll send you a link to the recorded rehearsal, you’ll spend 30 minutes or watching it and jotting down suggestions for improvement, and you’ll earn the same gift certificate as the Encore door prize winner. Let me know if you’re interested. Thanks to the folks who have been reviewing all along – your feedback is making the Webinars better and more enjoyable for everyone.

Acquisitions, Funding, Business, and Stock

9-19-2013 4-05-53 PM

Health tech business accelerator Healthbox selects its first Nashville class of seven companies, each of which will receive a $50,000 seed investment and four months of mentorship. Chosen were:

9-19-2013 8-45-00 PM

DreamIt Ventures launches DreamIT Health Baltimore, a partnership with The Johns Hopkins University and BioHealth Innovative, to accelerate the growth of early-stage HIT companies.

9-19-2013 6-21-15 PM

HIMSS acquires Health Story Project, which focuses on standards related to non-EHR clinical documentation such as transcription and electronic documents.


Skilled nursing and rehab operator Greystone Healthcare Management selects HealthMEDX as its HIT solution.

The New York Office of Mental Health awards health system integrator CGI a $48.7 contract to implement an EMR platform, including NTT DATA’s Optimum. Document Storage Systems will provide additional implementation services for the vxVistA EHR.

Vanderbilt University Medical Center (TN) will deploy MedAptus Technical Charge Capture solution to code and bill hospital-based procedures.

UC San Diego Health System (CA) selects Merge iConnect Access to image-enable its Epic EHR.

9-19-2013 9-00-19 PM

Self Regional Healthcare (SC) selects McKesson Paragon .

The New York City Health and Hospitals Corp. awards IBM an one-year, $10 million contract to build an analytics platform to improve patient care and operational efficiency.

9-19-2013 9-01-28 PM

The Torrance Memorial Medical Center (CA) selects Daylight IQ for disease-based clinical protocols.


9-19-2013 4-20-31 PM

Bronson Healthcare (MI) hires Paul Peabody (Palomar Health) as VP/CIO.

9-19-2013 4-31-22 PM

Emmi Solutions names Steve Martin (Merge Healthcare) as SVP of sales.

9-19-2013 7-31-25 PM

Ron Strachan (Community Health Network) is named CIO of McLaren Health Care.

9-19-2013 7-12-05 PM 9-19-2013 7-12-36 PM 9-19-2013 7-14-43 PM

Health Care DataWorks Co-founder Jason Buskirk is named CEO, Ivo Nelson becomes board chair, and John Gomez is engaged as a development consultant.


Announcements and Implementations

Fairfield Memorial Hospital (SC) goes live on Cerner.

9-19-2013 9-03-45 PM

Duke University Health System reports that it has installed Epic ahead of time and under budget throughout the entire system, including 223 outpatient facilities and Duke University Hospital. Epic says it was one of the company’s biggest single-day go-lives with 16,000 Duke employees trained. Competing Research Triangle health systems WakeMed and UNC are also implementing Epic.

Pacific Alliance Medical Center (CA) deploys electronic patient signature and e-forms solutions from Access.

Government and Politics

9-19-2013 7-32-34 AM

CMS publishes an online ICD-10 implementation guide to help practices, small hospitals, and payers navigate the ICD-10 transition.

9-19-2013 10-14-53 AM

ONC names GenieMD the winner of its Blue Button Co-Design Challenge for its app that helps users diagnose their symptoms, find providers, and learn more about medical conditions.

9-19-2013 10-45-36 AM

inga_small From an ONC post I missed last week: 54 percent of EPs have 2014 Edition EHR technology available to them from their primary 2011 EHR vendor; 45 percent of EHs/CAHs have 2014 Edition EHR technology available from their primary 2011 Edition vendor. An additional 13 percent of EPs and 19 percent of EHs/CAHs have a primary 2011 Edition EHR vendor that is on track toward providing a 2014 Edition solution. Translation: one out of three providers attested with EHRs that are potentially not on track with 2014 Edition technology. Another interesting nugget: 31 percent of the 861 ambulatory EHR vendors on the Certified HIT Product List and 49 percent of the 277 inpatient EHR vendors don’t have a single MU attestation. In other words, look for a sizable reduction in the number of vendors listed for 2014 Edition certification.

Here’s a new ONC video on interoperability.


The CMS Office of the Actuary projects that healthcare spending will increase at an annual rate of 5.8 percent from 2012 to 2022, or one percent faster than the GDP.

A former advisor to Australia’s billion-dollar eHealth system calls it “shambolic,” with incorrectly loaded data and doctors who don’t have the software to read it. The medical association pegs the odds of finding useful information for a given patient at 0.5 percent.

John over at EMR and EHR Videos has a Google Plus Hangout video featuring the always-fascinating Dr. Nick, aka Nick van Terheyden, MBBS, CMIO of Nuance Healthcare. You can also get on the update list and check the schedule of future events that are streamed live.

9-19-2013 6-55-36 PM

The Milwaukee newspaper runs an article about the growth in lucrative Epic consulting jobs, featuring a cool photo of Mark and Drew from Nordic, which has 350 employees and is adding 20 per month after bringing in $38 million in investor money in the past year. Frank Myeroff of Direct Consulting Associates is quoted in the article as saying the number of Epic consulting firms may approach 2,000. Also mentioned are Vonlay and BlueTree Network.

In Canada, Jewish General Hospital goes on diversion and elective imaging tests are postponed when its data center overheats, taking all of its servers down Thursday morning.

9-19-2013 7-25-27 PM

A report by Wells Fargo Securities says that CMS’s July attestation data suggests that the replacement EHR market will heat up in 2014 as practices drop productivity-sapping EHRs in favor of those products with a higher MU attestation rate. The report also says, “Replacement activity could
intensify further if CMS ever decided to audit providers who pocketed the Medicaid incentives instead of using them to fund actual EHR adoption. “

Weird News Andy, who as he says is “putting the ‘News’ in Weird News Andy for the past five minutes,” notes that Cleveland Clinic is shrinking. Employees were told this week that $330 million needs to be trimmed from the clinic’s 2014 budget and layoffs may be required.

9-19-2013 8-27-04 PM

At least it wasn’t healthcare: a BBC TV news anchor grabs a pack of copy paper instead of the intended iPad and bizarrely carries it around while reading the news. Anchors there hold the iPad to pretend they are technology-savvy journalists instead of talking heads reading off a screen, an illusion suffering mightily from this incident.

Sponsor Updates

  • The Colorado Technology Association names Ping Identity winner of its Technology Company of the Year award.
  • HCI Group posts an article titled “Credentialed Trainers – Secret Superstars of the Install.”
  • Lifepoint Informatics serves as a gold sponsor for next month’s G2 Lab Institute Conference in Arlington, VA.
  • Sunquest is attending ASCP in Chicago this week, exhibiting in Booth #219.
  • Direct Recruiters is named a Weatherhead 100 winner as one of the 100 fastest growing companies in Northeast Ohio.
  • Jeff Bell, director of IT security and risk services for CareTech Solutions, joins the HIMSS Privacy and Security Committee for a two-year term.
  • CCHIT certifies that Medseek Empower enterprise patient portal is compliant with the ONC 2014 Edition criteria and awards it certification as an EHR Module.
  • Merge Healthcare reports that radiologists use its certified EHR technology more than any other, according to HHS MU attestation data.
  • Drummond Group certifies that two SuccessEHS products, SuccessEHS 7.0 and MediaDent 9.0, are compliant with ONC 2014 Edition criteria.
  • CIC Advisory launches a Facebook page to provide an interactive forum on the operational and regulatory challenges facing HIT execs.
  • API Healthcare President and CEO JP Fingado participated in this week’s Healthcare Workforce Information Exchange demonstration.
  • Hospital Physician Partners (FL) reports on its experience using Ingenious Med’s business analytics platform.
  • Xerox researchers address the challenge of big data and what to do with social media analytics.
  • HCI Group details three areas a good credentialed trainer can impact during an EMR implementation.
  • Beacon Partners outlines six steps to minimize ICD-10’s negative impact on revenue cycle.
  • Nordic Consulting reports that its $38.3 million influx of capital from investment partners has allowed it to increase service offerings, bolster staff to over 300, and grow clients and partnerships to over 75.
  • Quantros hosts an Advisory Panel this week to discuss the commercial viability of data in an intermediary role and the value of bundled safety products.
  • Clients attending this week’s Verisk Health user conference prepared 2,000 food packs for Second Harvest Food Bank of Central Florida’s Hi-Five Kids Pack Program.
  • Vitera Intergy EHR is tested and certified as a complete EHR under the Drummond Group’s EHR ONC-ACB program and is an ONC 2014 Edition-approved solution.
  • Anita Archer, Hayes Management Consulting’s director of regulatory compliance, co-authors a HIMSS-published article entitled, “ICD-10 Documentation for State Medicaid Agencies (SMA) Health Conditions Categories.”

EPtalk by Dr. Jayne


Lt. Dan tweeted this morning about Google’s launch of Calico, a company that will focus on “the challenge of aging and associated diseases.” The venture will be led by Arthur Levinson, chairman and former CEO of Genentech. He’s also a director of drug giant Hoffman-La Roche and chairman of Apple.

My initial response to the announcement was that there are some significant conflicts of interest here. Others have had that thought as well, with Time posting a piece about it in the context of previous Google vs. Apple conflicts that received scrutiny from the Federal Trade Commission. My mind, however, was going more towards the conflict stemming from having a company like Google — which controls vast amounts of information about seemingly everything and everyone — cozying up with the pharmaceutical and genetic sphere.

For quite some time, I’ve had concerns about so-called personalized medicine. Farzad Mostashari tweeted about this earlier this week, sharing why personalized medicine might be bad for all of us. The focus of the opinion piece is that when people increase focus on themselves and their personal choices, they tend to decrease focus on population-based health, such as global vaccination efforts and other public health initiatives. It also mentions pharmacogenetics, where drugs can be targeted for patients who have certain mutations present. It mentions the example of vemurafenib as a drug for metastatic melanoma, which can help 25 percent of patients live seven months longer.

This kind of data leads me to my chief concern with personalized medicine – is it cost effective, and who is going to pay for it? Vemurafenib costs $56,400 for a six-month supply. (Surprise, when I did my Google search to find out the cost, I discovered it is made by Genentech.) If it only works 25 percent of the time for patients with a specific mutation, and their lives are only extended seven months, should we be routinely recommending it? As a primary care physician who has cared for numerous terminal patients, I understand the appeal. If it helps a father live long enough to see his daughter married, or a mother long enough to see her son graduate from college, these are the Hallmark moments we all want to think of. But in our situation where the healthcare system is collapsing under its own weight and excess, I could really make the argument that spending $56,000 to help fight diabetes, obesity, or heart disease for many patients is a better investment of our increasingly scarce healthcare dollars.

One could argue that personalized medicine is for those who can afford it, but then we will have the counter argument about healthcare being a right and about treating everyone equally. Eventually we have to come to the realization that we can’t afford to provide these expensive treatments for everyone no matter how hard our heartstrings are tugged. As a family physician, I’m all for health promotion and disease prevention. I am not, however, in favor of extending life just because we can, and I think this venture has the potential to drive efforts in the wrong direction.

I recently saw an elderly patient in her mid-90s who has been blessed with extremely good health. She has taken care of herself all her life, watched her weight, didn’t drink alcohol, and didn’t smoke. Her only “vice” was wearing high heels every day, which has caused some orthopedic problems. As for medications, all she takes are pain relievers that she takes as needed for aches and pains. She is a remarkable lady. She has been widowed for more than 30 years, outliving most of her close friends and some of her family members. She doesn’t want to live forever.

When people think of halting the aging process, I think they expect it to be something like the movie “Cocoon,” where you have a bunch of sassy septugenarians frolicking around. How are we going to fund retirement for these folks? Will they understand that if they’re going to live to be 100 they need to work until they are at least 75 or 80 because the average person cannot save enough money to fund a 35- to 40-year retirement during a 45-year working life? We already have people who can’t save enough money for retirement period, let alone an extended one. The focus on instant gratification and the “me” generation can only skew that further as people spend their current income rather than saving it.

Anyone who has worked on a medical/surgical unit at a hospital has seen the people who are not as fortunate as my ultra-healthy patient. What about the people whose lives have been prolonged through multiple invasive treatments but who are debilitated and have a very low quality of life? Wouldn’t it make more sense to talk about palliative care for the obese smoker who has had four heart attacks, multiple cardiac catheterizations and a bypass, and can’t walk to the bathroom without being exhausted than to bankrupt his family by pursuing more invasive treatments?

I’m sure the argument here is that they want to come up with technologies to help that patient have a better quality of life, but I’m not sure I buy it. Looking at the players involved (Genentech, Roche, Google, and probably multiple intermingled board members from other companies) this feels more like a profit-driven venture than a humanitarian one. Like commercial space travel, it will be only for the ultra-wealthy and will potentially divert resources and attention from important work that could benefit all patients.

What do you think about Calico? Email me.


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

More news: HIStalk Practice, HIStalk Connect.


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September 19, 2013 News 12 Comments

News 9/18/13

September 17, 2013 News 8 Comments

Top News

9-17-2013 1-52-50 PM

Here’s a news item that Judy Faulkner probably won’t mention when addressing the Epic masses in Verona this week. She earns the #243 spot on the annual “Forbes 400 Ranking of the Richest Americans” with an estimated net worth of $2.3 billion. Terry Ragon of InterSystems, which sells the Caché database that runs Epic and other healthcare IT systems, also makes the list, tying Cerner’s Neal Patterson in the #352 position with a net worth of $1.5 billion.

Reader Comments

 9-17-2013 4-25-40 PM 9-17-2013 4-26-25 PM

9-17-2013 4-18-00 PM

inga_small From Spacey: “Re: Epic UGM. Over 15,000 people in attendance including 8,500 customers and 6,600 Epic employees. They now cover over 50 percent of US patients!” We reported in 2010 that attendance was 5,500 versus 3,800 in 2009. At the rate the Epic UGM is growing, it could surpass the HIMSS conference in a few years.

From GomiesGone: “Re: Nuance. Dropped the ball by failing to release Dragon Medical Network DM360 v2.0 as promised on September 16. Word is upper management is arguing over logistics.” Unverified.

9-17-2013 6-40-20 PM

From Curious: “Re: Epic. Looks like they’re no longer hiring project managers / installers for their US locations. Does anyone know why?”

From Reluctant Epic User: “Re: HIStalk. If you’re ever in my town and willing to blow your anonymity, I’d be thrilled to buy you a beer or two for the great work you do. People in my health system routinely think I’m a genius simply because of knowledge I have gained by reading your site faithfully for the last six years.” I appreciate both the nice comment and the six years of reading. I do like beer, so that just might sway me.

Acquisitions, Funding, Business, and Stock

9-17-2013 6-47-12 PM

In England, Emis, which provides physician practice systems, will buy hospital systems vendor Ascribe for $95 million.

9-17-2013 8-03-54 PM

A UK report says that CSC will pay $98 million to settle a class action suit in which shareholders claim the company knew its Lorenzo EMR, developed by iSoft, could never be implemented in the NHS’s NPfIT program long before a Department of Health breach of contract charge sent shares down sharply. Meanwhile, a watchdog’s report says costs continue to pile up for the failed NPfIT project because of ongoing liabilities and vendor termination fees, leading it to conclude that the project is “one of the worst and most expensive contracting fiascos in the history of the public sector” as updated cost estimates are revised upward to $15.5 billion vs. an estimated benefit of $6 billion.


Hunt Regional Healthcare (TX) will implement T-System PerformNext Care Continuity.

9-17-2013 8-04-45 PM

Tift Regional Medical Center (GA) will deploy RelayHealth’s RelayClinical platform for its HIE.

NYC Health and Hospitals Corporation selects Elsevier’s ClinicalKey to provide electronic medical reference and knowledge-based information to its clinicians.

9-17-2013 8-06-46 PM

CentraCare Health (MN) selects Strata Decision Technology’s StrataJazz for costing accounting, operating budgeting, capital planning, and rolling forecasting.


9-17-2013 3-34-05 PM 9-17-2013 3-34-52 PM

The Massachusetts Technology Leadership Council names athenahealth CEO Jonathan Bush CEO of the Year and Nuance Communications CTO Vlad Sejnoha CTO of the Year.

9-17-2013 3-36-23 PM

Voalte hires Kenda West (Johns Hopkins Medicine) as COO.

9-17-2013 3-37-34 PM

Amazing Charts names John Squire (Microsoft) president and COO.

9-17-2013 4-12-29 PM

Coastal Healthcare Consulting hires Gay Fright (Pivot Point Consulting) as EVP of business development.

9-17-2013 5-57-05 PM

Virtual Radiologic names Shannon Werb (Acuo Technologies) as CIO.

9-17-2013 6-43-18 PM

Bill Keyes (Allscripts ) is named SVP of sales of CoCENTRIX.

HIMSS recognizes Farzad Mostashari, MD, Congressman Tim Murphy, CMS Administrator Marilyn Tavenner, and Rhode Island State Representative Brian Patrick Kennedy with HIT Leadership Awards in recognition of their work to improve health with IT initiatives.  

9-17-2013 6-37-34 PM

WHITEC, the Wisconsin REC, provides a bow tie tribute to outgoing National Coordinator Farzad Mostashari, MD.

Announcements and Implementations

9-17-2013 8-09-56 PM

Mid Coast Hospital (ME) implements Gemalto’s Sealys MultiApp ID smart cards and LifeMed ID’s SecureReg solution to enable secure patient authentication.

Children’s Medical Center Dallas (TX) launches its TeleNICU, which will provide regional hospitals with access its neonatologists.

9-17-2013 8-08-33 PM

HIMSS awards the University of California-Davis Medical Center its 2013 Enterprise HIMSS Davies Award of Excellence.

HealtheLink connects three other New York state RHIOs to provide sharing for 5.4 million patient health records and links to 44 hospitals.

9-17-2013 4-02-57 PM

VitalWare introduces VitalCoder, a coding and compliance resource that includes real-time, automatic updates for organization-specific coding, regulatory, and financial data.

Nuance Communications announces an Epic-optimized version of its Dragon Medical 360 | Network Edition that contains 1,000 customized commands to enhance physician productivity in a Citrix environment.

PDR Network launches PDR+ for Patients, which incorporates drug  information into EHRs so that prescribers can discuss proper use with patients during the encounter.

Government and Politics

9-17-2013 10-34-08 AM

ONC releases online tools for providers and HIEs to educate patients about the electronic sharing of health information. 

9-17-2013 3-42-16 PM

ONC also publishes models for Notices of Privacy Practices for healthcare providers, which reflect the Omnibus Rule regulatory changes that go into effect September 23.

CMS commissions the National Academy of Sciences to study how best to add social and behavioral factors to EHRs without compromising privacy.

GAO identifies 12 potentially duplicate investments at three federal agencies that over the last five years have accounted for $321 million in IT spending, including $256 million for four HHS information security systems.

9-17-2013 3-44-37 PM

The House of Representatives is considering the TELEmedicine for MEDicare (TELE-MED) Act of 2013, which would allow Medicare providers to treat patients across state lines using telehealth technology without requiring them obtain medical licenses in multiple states.

Innovation and Research

9-17-2013 3-59-22 PM

A study published in The Journal of Maternal-Fetal & Neonatal Medicine finds that neonatal depression can best be predicted not only by common excessive uterine contractions, but also the concurrent presence of fetal heart rate deceleration. The study used tracing data from PeriGen’s PeriCALM system, which allows real-time detection of the condition.


PatientPoint releases PatientPoint Tracker, a patient engagement tool for tracking patients across the care continuum.

Caradigm releases Care Management, a population health management tool developed in partnership with Geisinger Health Plan.


9-17-2013 12-49-21 PM 

inga_small Canada becomes the thirteenth country to issue a patent to MMRGlobal’s MyMedicalRecords  subsidiary for its online medical records technology. In an MMR press release, the company notes it is negotiating an agreement with an investment fund specializing in financing the enforcement and licensing of global intellectual property rights which would “maximize MMR’s ability to exploit its global health IT patent portfolio.” “Exploit” sounds like an appropriate term to describe MMR’s apparent  modus operandi.

An Accenture survey finds that 40 percent of Americans would switch doctors to gain online access to their electronic medical records. That sounds like a suspiciously high number and no doubt it is – Accenture conducted the survey online.

9-17-2013 7-10-16 PM

CHIME President and CEO Russ Branzell pens a National Health IT Week piece called “HIT Capabilities – They Are Personally Important to Me.”

9-17-2013 4-29-24 PM

MU Stage 2 is accelerating EMR-specific patient portal adoption, though the trend is negatively impacting best-of-breed vendors that are not as well equipped as EMR offerings, according to a KLAS report on patient portals. Athenahealth, Epic, and Allscripts were the top-performing vendors.

9-17-2013 6-33-49 PM

A population health management report created for institutional investors by equity research firm JAAG Research concludes that the big PHM market opportunities are at least 10 years away; that lack of data standardization, timeliness, and completeness makes a “Big Data Mess;” and on the CommonWell Alliance “Maybe it’s just us, but all of this soft, ‘.org’ alliance, love-in, ‘we’re in this together for the good of the patients’ blather sounds more like a plan for each vendor to appear collegially engaged from a public policy perspective while keeping the government from forcing a solution on the market. Meanwhile, each ‘member’ works on its own, potentially more profitable solution, outside of the auspices of the happy ‘.org’ shell.” It concludes that “PHM will require a reengineering – almost a complete rebuild – of the healthcare payment and delivery process as we know it.” It’s an excellent report and a tremendously fun read.

I found the Epic UGM tweets and photos above using the cool page that Vonlay built to curate the event. Look carefully and you’ll see Judy in her Avatar outfit.

Weird News Andy titles this story as “Doctor Gives Patient the Finger.” A Florida doctor grows back a man’s amputated finger by using a pig’s bladder as a mold.

Sponsor Updates

  • CCHIT certifies that Wellsoft’s EDIS v.11 is compliant with the ONC 2014 Edition criteria and certifies it as an EHR Module.
  • NCQA awards Case Management Accreditation to Alere and OptumHealth.
  • Quantros hosts its first annual Pharmacy Quality and Safety Summit September 25-26 in Sarasota, FL.
  • Valence Health launches its Pathfinder Accelerator Grant program, which makes $1 million available to hospitals and health systems to apply towards Valence Health’s Pathfinder services for transitioning from volume-based to value-based care.
  • Vocera Communications CMO Bridget Duffy, MD will discuss improving the patient experience at two upcoming industry events.
  • 3M Health Information Systems will offer its suite of ICD-10 and CDI consulting services and software integrated with MedPartners HIM’s credentialed and clinical documentation improvement staffing resources.
  • Consulting magazine recognizes Aspen Advisors, Cumberland Consulting, and Impact Advisors on its list of “Best Small Firms to Work For 2013” and Deloitte Consulting on its list of  “Best Firms to Work for 2013.”
  • Frost & Sullivan presents Vitera Healthcare Solutions its 2013 North American Customer Value Enhancement Award for outstanding performance and success, which recognizes the company’s focus on implementing strategies to create customer value.
  • ReadyDock partners with IT provider Red River.
  • Managed Health Care Associates will launch MHAuthorizeRx, a solution powered by CoverMyMeds and designed to streamline the drug prior authorization process for pharmacies.


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

More news: HIStalk Practice, HIStalk Connect.


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September 17, 2013 News 8 Comments

Morning Headlines 9/13/13

September 12, 2013 Headlines 1 Comment

Vanderbilt Medical Center hit with Medicare fraud suit

A lawsuit unsealed this week alleges that Vanderbilt University Medical Center has been engaging in Medicare fraud for more than a decade. The suit alleges that Vanderbilt developed a surgical billing and documentation tool that "schedule attending physicians to be in multiple places at once, while continuing to bill their services as if they were actually present and personally performing the services at each place.” The software, which also facilitated surgeon documentation, pre-populated fields in order to qualify for higher charges and required its physicians, in all instances, to document that they met Medicare’s conditions for payment.

Decision-support tool reduces deaths from pneumonia in emergency departments

Findings from a study presented at the European Respiratory Society Annual Congress claim that clinical decision support tools implemented in an emergency department EHR helped to reduce deaths from pneumonia by up to 25 percent.

Compuware’s Covisint sets terms for $64 million IPO

Covisint plans to raise $64 million in its IPO by offering 6.4 million shares at a price range of $9 to $11. At the midpoint of the proposed range, Covisint would command a fully diluted market value of $395 million.

Morgenthaler partners form new $175M fund to invest in cloud, fintech, & health IT

Three partners from Morgenthaler raise $175 million for a new investment fund, Canvas Ventures Fund, which will focus on early stage health IT startups.

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September 12, 2013 Headlines 1 Comment

News 9/13/13

September 12, 2013 News 7 Comments

Top News

9-12-2013 8-32-39 PM

A newly unsealed Medicare fraud lawsuit against Vanderbilt University Medical Center claims that its internally developed Vanderbilt Perioperative Information Management System (VPIMS) was used to bill services for physicians who were not physically present. Documents filed with the lawsuit, which claims the fraud spanned more than 10 years, include a Vanderbilt email telling surgeons to avoid documenting which rooms they were actually covering because “it only confuses and complicates the billing and documentation process.” The lawsuit concludes, “VIPIMS’ purported improvements in billing efficiency are, in fact, largely a function of Vanderbilt’s development of mandatory default software settings that require its physicians, in all instances, to document that they meet Medicare’s conditions for payment.” VUMC says its own investigation has uncovered no billing irregularities and vows to defend itself vigorously.

Reader Comments

9-12-2013 8-36-55 PM

inga_small From Bronwyn: “Re: Cerner Dynamic Documentation. Do you know of any hospitals currently using it who would be willing talk to a CIO about their experience?” Readers, send Inga a note if you can help.

9-12-2013 6-07-12 AM

9-12-2013 9-44-59 AM

inga_small From Reviewer: “HIPAA violation. If this isn’t the most egregious HIPAA violation ever, I don’t know what is!” A parent of a three-year-old patient posts a negative review on Yelp following a visit to a Phoenix plastic surgery clinic. The practice’s operations coordinator posts a reply that includes significant details about the patient and the office visit, as well as some harsh criticism of the mother and her parenting skills. Rebecca Fayed, associate general counsel and privacy officer at The Advisory Board Company, provided us her assessment:

I think that providers (or any covered entity or business associate for that matter) need to be particularly careful when posting anything online, whether it be on Yelp or other social media sites, that could be interpreted as a disclosure of protected health information. In this post,  HHS-OCR could view the response by the provider as a  disclosure of protected health information not permitted by the HIPAA Privacy Rule.

From Former Employee: “Re: Experian Healthcare, formerly Medical Present Value. Underwent its third round of layoffs this week, including its entire SME group and other client support staff. Sales are significantly down under Experian.” Unverified.

9-12-2013 6-13-00 PM

From small_data: “Re: misuse of the ‘Big Data’ buzzword. Simply storing data for archival purposes without intent of using that data for any kind of quantitative analysis is surely not ‘Big Data.’” The solution in question stores medical images. Everybody with a database now has “Big Data.” If they can export that information to Excel, they have enterprise analytics and business intelligence. If that worksheet can be emailed, they offer interoperability. If the worksheet can be stored on a Web server, it’s scalable and cloud-based. These are no longer technical terms with precise meanings; they have been hijacked by the sales and marketing people.

9-12-2013 8-07-06 PM

From Over It: “Re: Jody Albright, CIO, Overlake Hospital. Internal email says her position was eliminated and chief compliance officer will take on CIO duties. She had limited involvement with the Epic project and the go-live was a firestorm on several levels.” Unverified, but above is a purported internal email forwarded my way.

HIStalk Announcements and Requests

inga_small The latest news from HIStalk Practice includes: use of an EMR that includes automated growth monitoring helps doctors pick up on cases of possible growth disorders among kids.The AMA offers a toolkit (perhaps a little late) to help physicians prepare for upcoming HIPAA changes. HIT expenditures in physician offices jumped 28 percent from 2008 to 2012. Will cloud-based EHR/PMs really save practices from acquisition? Patients from Advocate Medical Group file a class-action lawsuit following the theft of unencrypted computers. Rhode Island primary care practices can earn up to $10,000 to connect to the state’s HIE. Culbert Healthcare Solutions VP Brad Boyd offers some advice for defining and measuring an EHR’s ROI. Thanks for reading!

9-12-2013 6-34-11 PM

Welcome to new HIStalk Platinum Sponsor EXTENSION. The Fort Wayne, IN company offers contextual alerting, secure messaging, and care team collaboration technologies, including specific solutions that address Joint Commission’s 2014 National Patient Safety Goal, “Improve the safety of clinical alarm systems.” First-generation systems just throw out a lot of alerts, but EXTENSION’s next-generation platform combines alarm safety software with a secure text messaging solution to optimize the workflow involved with clinical event response. The company’s HealthAlert solution solves the challenge of getting important clinical event notifications in the hands of clinicians, routing critical lab results, stat orders, staff assignment, patient monitoring, and patient nurse call requests. The system prioritizes the alerts, escalates based on defined rules, announces the event verbally to the recipient, and maintains an audit trail. It works with Android, Apple, Ascom, Cisco, Spectralink, and Vocera devices, including a mobile app that can run on a clinician’s own smartphone.  Thanks to EXTENSION for supporting HIStalk.

I found this short introductory YouTube video from EXTENSION called “The Power of the EHR-Extender.”

On the Jobs Board: Manager North America Professional Services West, Implementation Engineer (East Coast), Services Operations Manager.

HIStalk Webinar


Informatica will present “Best Practices for Delivering Better Quality Care and Reducing Preventable Patient Readmissions” on Thursday, September 26 from 1:00 – 1:45 p.m. Eastern.  Speakers are George Brenckle, PhD, SVP/CIO of UMass Memorial Health Care and Richard Cramer, chief healthcare strategist of Informatica (I interviewed him awhile back). Register here.

9-12-2013 8-28-25 PM

I recorded the HIPAA Omnibus webinar given by Rebecca Fayed and Eric Banks of The Advisory Board Company earlier this week and posted it to YouTube. The slides are here. Thanks to Rebecca and Eric, who stepped up when I asked for volunteers to run through the changes with HIStalk readers. We had a nice turnout, and in typical Advisory Board fashion, not a second was wasted due to inadequate preparation or lack of focus.

Acquisitions, Funding, Business, and Stock

Covisint will raise at least $64 million in its IPO by offering 6.4 million shares at an expected price of $9 to $11. The company generated $94 million in revenue for the 12 months that ended June 30.

Three partners of Morgenthaler Ventures create a new management company and the $175 million Canvas Venture Fund that will focus on early stage investments of $5 to $15 million in mobile, health IT, financial technology, and enterprise technology. The parent VC company invested in physician social network Doximity and free EMR vendor Practice Fusion.

9-12-2013 8-39-49 PM

The CSI Companies acquires Atlanta-based IT staffing firm Anteo Group.

9-12-2013 8-00-21 PM

Lincor Solutions moves its headquarters from Ireland to Nashville.


9-12-2013 8-41-38 PM

Estes Park Medical Center (CO) will implement HealthCare Anytime’s patient portal technology at its hospital and outpatient clinic.

The Valley Hospital (NJ) selects Merge Healthcare’s CTMS for Investigators to manage its clinical research operations.

UHS-Pruitt Corporation, a provider of post-acute care services, will implement healthcare analytics and population health solutions from Caradigm.

The 110-provider Prima CARE (MA/RI) selects Ingenious Med’s mobile revenue capture technology.

Washington Orthopaedics & Sports Medicine (DC/MD) selects SRS EHR for its 11 providers and three locations.


9-12-2013 3-34-37 PM

Wellcentive names Tom Zajac (Elsevier) CEO.

9-12-2013 10-14-16 AM

Health Catalyst appoints David K. Crockett, PhD (ARUP Laboratories) senior director of research and predictive analytics.

9-12-2013 5-17-06 PM

Robert Porr (Accenture)  joins Sandlot Solutions as EVP of sales and marketing.

9-12-2013 6-16-26 PM

Nancy Killefer (Department of the Treasury, IRS Oversight Board, McKinsey & Company) joins the board of The Advisory Board Company.

9-12-2013 6-31-43 PM

University of Missouri-Kansas City hires Mark Hoffman, PhD (Cerner) as director of bioinformatics core and associate professor to establish its Center for Health Insights informatics program.

9-12-2013 7-27-12 PM 9-12-2013 7-27-53 PM

Stanford Hospitals & Clinics (CA) promotes Pravene Nath, MD to CIO and Christopher Sharp, MD to CMIO.

MGMA-ACMPE names Garth Jordan (EDUCAUSE) COO.

Prime Healthcare Services (CA) will implement  Infor financials, supply chain and human capital management, clinical bridge, and analytics.

Announcements and Implementations

Quest Diagnostics joins LabCorp and almost all of Colorado’s large hospital laboratories in connecting to the Colorado RHIO.

The HIEs Michigan Health Connect and Michiana HIN will share health records between Michigan and Indiana providers.

The Patient-Centered Outcomes Research Institute board of governors issues 71 awards totaling more than $114 million to fund comparative clinical effectiveness research, including studies to improve the applicability of data collected through EHRs and social media sites and methods for engaging minority patients and caregivers in patient-centered health research.

9-12-2013 11-45-45 AM

Ivo Nelson’s Next Wave Health forms Smart Social Media, Inc., a software company that will develop a healthcare social media platform. Next Wave Health acquired the OneXPage social media platform from Digiapolis, Inc., founded by Minneapolis entrepreneur Eric Lopez, who will be CEO of Smart Social Media.

Gastroenterology EHR vendor gMed will use behavior-based prescription management messaging from LDM Group to improve medication adherence and highlight therapy options.

Government and Politics

ONC launches a patient matching initiative to seek common denominators and best practices being used by private healthcare systems and federal agencies.

Innovation and Research

The use of an electronic decision support tool linked to patients’ EMRs helped reduce deaths from pneumonia in EDs by up to 25 percent according to researchers from Intermountain Healthcare and the University of Utah.

9-12-2013 10-21-51 AM

inga_small An athenahealth analysis of EHR data from its user network reveals no signs of a national decline in childhood obesity over the last three years. Athenahealth obviously has a wealth of clinical data at its disposal and this type of analysis is interesting and arguably beneficial. However, are practices and patients aware of how athenahealth and other EMR companies may be using personal health information? More importantly, should they? To the latter question I say yes, and mechanisms should be in place to allow practices and patients to opt in or out.


AirStrip will develop and optimize its AirStrip ONE solution for Samsung tablets running Android and Windows 8.1 operating systems, as well as Samsung convertible and all-in-one desktop and laptop PCs with touch screens.

9-12-2013 8-43-40 PM

Lt. Dan covers the iPhone 5S announcement in his excellent HIStalk Connect analysis, “Apple Comes Up Big On The iPhone 5S Unveil: What it Means for Healthcare.”


The Tax Increment Financing Commission of Kansas City approves a $1.635 billion incentive for Cerner’s proposed plan to develop a 4.5 million square foot mixed-used campus.

VA psychiatrists and researchers are using natural language processing and query searches of doctors’ free-text notes to flag patients who present a clear risk of suicide.

9-12-2013 1-29-05 PM

Crittenton Hospital (MI) will provide free electronic copies of medical records to the families of patients treated by Farid Fata, MD. Fata is the Michigan Hematology Oncology physician accused of deliberately misdiagnosing patients and improperly administering chemotherapy as part of a $35 million Medicare billing fraud scheme. The hospital provides records free only to medical doctors, but reversed its policy after the doctor’s patients staged a protest.

The New England Journal of Medicine gets banned from posting pictures on Facebook after running a medical image of a patient with scrotal calcinosis, which Facebook found pornographic. Facebook changed its mind shortly after.

Sponsor Updates

  • Aventura publishes an informative and entertaining HIT Survival Handbook.
  • Allscripts will add Inovalon’s quality improvement and risk score accuracy analytics  to its EHR platform.
  • Health leaders in Leeds, UK will evaluate whether outcomes can be improved by using Alere’s healthcare platform.
  • Medseek Empower 5.0 earns CCHIT certification as an EHR Module and is compliant with the ONC 2014 Edition criteria.
  • Campbell Clinic (TN) reports that its use of Emdat’s medical documentation solutions has improved documentation completion, workflow, and transcriptionist productivity.
  • Billian’s HealthDATA interviews Collin Searle, social media manager for Intermountain Healthcare (UT), about the health system’s social media strategy. 
  • Clinovations CEO Trenor Williams discusses the need for pharma companies to  use technology and think more strategically about communications with health providers and patients. 
  • Innovative Healthcare Solutions offers a white paper series that includes tips for a successful project outcome.
  • Hot jobs on the site of Henry Elliott & Company, which specializes in Caché and M/MUMPS technology positions, include Senior M/Caché P/A, Caché M/Mumps Web Developer, VistA Analyst, and .NET/Caché Developer.
  • Cleveland Clinic’s use of BI dashboards from Harris Healthcare has driven significant ROI and performance improvement, including a $10 million increase in net income.
  • Intelligent InSites announces details of InSites Build 2013, an RTLS learning event October 28-30 in Fargo, ND.
  • Sunquest Information Systems and the Association for Pathology Informatics will host a September 26 educational webinar on pathology informatics featuring Walter Henricks, MD of Cleveland Clinic.
  • Florida Hospital Celebration Health realizes increases in key HCAHPS categories since implementing GetWellNetwork’s Interactive Patient Care and Clinical Practice Design solutions.
  • UnitedHealth reports its use of InstaMed online payment option has resulted in over $3 million in payments since its late July rollout.
  • Trinitas Regional Medical Center (NJ) enhances staff safety with Versus Visibility Staff Assist RTLS technology.
  • Hayes Management Technology adds its go-live support and legacy support services to its website.
  • Divurgent and Medix will host a Retro Arcade Event during Epic UGM. Readers may RSVP here.

EPtalk by Dr. Jayne

Mr. H mentioned that PatientSafe Solutions has joined us as a Platinum Sponsor, but I wanted to offer my own shout out for its PatientTouch system. I first saw it at HIMSS13, and as Inga can attest, was really geeked out about it. I’d love to see it installed at my institution, so maybe I’ll “accidentally” leave their information on my boss’s printer.

I spent the earlier part of this week at the AMIA Clinical Informatics Board Review Course in Chicago. There were enough sassy young female physicians in attendance, so I feel fairly safe in admitting it while being able to still remain anonymous. I even saw some sassy shoes, so I felt like I was in good company.

Why a board review, and why now? This fall marks the first opportunity for physicians to actually seek board certification in the subspecialty of Clinical Informatics through the American Board of Preventive Medicine. There’s also a pathway through the American Board of Pathology – based on the number of pathologists in the class I don’t want to neglect to mention that because I know if they’re reading they’ll correct me – but the majority of informatics physicians I know are not pathologists.

As a new specialty, they’re offering a “practice pathway” for those of us who are not fellowship-trained to seek certification, through 2017. Candidates in this pathway have to demonstrate at least 25 percent practice in clinical informatics during three of the five years preceding application. In 2018 and later, candidates will have to have completed a minimum of 24 months in an ACGME-accredited Clinical Informatics fellowship program.

Many of us are not fellowship trained. Instead we’re homegrown informaticists who have been at this quite a while. We may have done some coursework in informatics or had intensive mentoring in order to reach our level of performance. In my case, the thought of trying to go back and do a formal training program on top of working the number of hours I do currently made my skin crawl, as did the idea of spending $40,000 or more on a degree that wouldn’t raise my income or the level of respect from my peers.

After a little cajoling from a colleague, I decided to aim for certification in the first round through the practice pathway. It’s a bit daunting because it’s a brand new exam. None of us really knows what to expect, and although the Board has published an “examination content outline,”  it’s pretty daunting since the level of detail they could be expecting could be all over the map. The application process was also daunting, as I had to track down former bosses who could best attest to the time I’ve spent in the field. I’ve had five bosses at three jobs in the last five years and only one is still working at the hospital where we were colleagues.

I’ve never taken a board review course before, so this seemed like a good time to try it given the breadth of the material. The class was a nice mix including average working CMIOs and high-powered names from major academic institutions. The VA and military were well represented, as were ambulatory organizations, payers, and vendors. I’m happy to report a Bowtie Index of 3.67 bpd (bowties per day) with one attendee having particularly fetching choices.

The group was pretty social and there were some key themes heard during the cocktail hour and various breaks. One is that there are quite a few institutions out there that still don’t value the contribution that a CMIO brings to the table. Many CMIOs are forced to try to do the job without the title or the appropriate level of authority. If you’re at one of those facilities who still question whether you need a CMIO, check that exam content outline to learn more about what we do and what we can bring to the table.

Another key theme is that there is never enough money to do the work that needs to be done. That goes right along with the theme that there are always more projects to be done than can be humanly accomplished. I also learned that many physician informaticists are very driven and devoted to the field – so much so that one physician sitting near me said his colleague’s inhuman level of work product clearly means that she’s a cyborg.

I’m unfortunately having to play catch up for the days out of the office, so you’ll have to wait until Monday’s Curbside Consult to hear about the rest of the course and some fun things I learned including some informatics jokes. I’ll leave you with this one in the interim:

A programmer is asked by his spouse to get some groceries. She asks, “Can you pick up a loaf of bread, and if they have eggs, get a dozen.” He returns home with 13 loaves of bread. She asks, “What happened?” His response: “They had eggs.”


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

More news: HIStalk Practice, HIStalk Connect.


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September 12, 2013 News 7 Comments

News 9/11/13

September 10, 2013 News 5 Comments

Top News

9-10-2013 9-30-03 PM

Healthcare learning and performance improvement systems vendor HealthStream acquires Baptist Leadership Group, a consulting practice owned by Baptist Health Care in Pensacola, FL, for $8.5 million. The company also announced that the health system will use its talent management software.

Reader Comments

inga_small From Warrior: “Re: telling clients about unethical sales tactics after quitting a vendor job. The answer to the question is an easy one. Take the severance package and agree to keep the pie-hole closed. Any unethical sales techniques will eventually reveal themselves. A couple of years ago I was a victim of senior management lies and deceit, to say nothing of what was being done to clients. I quit without calling customers or the competition regarding the egregious business practices. Three months after I resigned, several of the morally bankrupt executives were shown the door with very generous golden parachutes. Blood money – what goes around, comes around. My hands are clean!” My take: unless a former employer was doing something illegal as opposed to something unethical, keep the dirty secrets to yourself. If you were one of the “good guys,” your departure will make enough of a statement.

From More Cow Bells: “Re: Sutter EHR downtime. The spokesperson cited the uptime percentage as 99.4. It bothers me that the systems handling the clinical and financial information of our hospitals are estimated to be unavailable for more than 52 hours per year. I’m not sure any other industry that deals with public safety and well-being would tolerate being down an hour a week (air traffic control?) What about striving for the old standard of five nines?”

9-10-2013 9-37-46 PM

From Dirk Diggler: “Re: Sutter EHR downtime. You mentioned news articles whose come-on headlines don’t deliver anything but an advertiser click. Here’s one.” A HIMSS-owned publication lures readers in with the cutesy and eventually misleading headline above. The article it sits astride contains nothing but shallow information extracted from old press releases about Sutter’s Epic (actually Citrix) downtime. When you finally read down through an extra click to Page 2 (banking an extra click to impress advertisers), the healthcare IT expert cited is the hospital’s nursing union rep, who offered three suggestions: (a) train people on downtime procedures; (b) communicate well; and (c) get nurses involved in system design. You can decide whether the advice is more insulting to the healthcare IT experts targeted by the publication than the article itself. At least the headline didn’t start with a number (“Eight Reasons Apple is Really Cool”) or require clicking an idiotic slideshow of unrelated photos lifted from other sites. I don’t like getting fooled and I hate wasting time, so I stop reading sites that promise more useful information than they deliver.

9-10-2013 9-41-15 PM

From Not Intuit: “Re: Intuit Health. Fifty percent staff cuts today, including me. All seniors leaders except for the product development lead gone.” Unverified, but the source is not anonymous. The former Medfusion’s name is still Intuit Health temporarily, but it’s a private company again after being bought back by founder Steve Malik a couple of weeks ago. My August 27 interview with him is here.

HIStalk Announcements and Requests

9-10-2013 7-15-53 PM 

Welcome to new HIStalk Platinum Sponsor PatientSafe Solutions. The San Diego-based company offers smart point-of-care mobile solutions for the future of accountable care, delivering measurable safety and quality improvements that fit into care team workflows. The company’s flagship PatientTouch system, with 70 implementations, offers iPhone-powered software solutions to eliminate harm, reduce waste, and improve productivity. New York-Presbyterian Hospital chose PatientTouch a few months ago and Parkview Medical Center (CO) recently extended its use and integrated it with Meditech 6.0. Thanks to PatientSafe Solutions for supporting HIStalk.

I found this YouTube video on PatientSafe’s PatientTouch.

Upcoming HIStalk Webinars:

The Transition to ICD-10: Building the Bridge as You Walk on It (Thursday, September 12, 2:00 Eastern)
Using Infrastructure and Application Monitoring to Assure an Optimal User Experience  (Thursday, September 19, 1:00 Eastern)

Acquisitions, Funding, Business, and Stock

Disclosure management services company MRO Corp. acquires the assets of MTT Enterprises, a release-of-information service provider.

9-10-2013 5-43-06 PM

Santa Rosa Consulting completes its acquisition of IT security company EGIS Systems and renames it Fortified Health Solutions.

ZappRx, a developer of a mobile e-prescribing platform, raises $1 million in seed funding lead by Atlas Venture and Life Sciences Angel Network. 

9-11-2013 6-05-10 AM

Scotland-based Craneware says its revenue and EPS were up for the year despite not hitting its target of 1-2 big-hospital sales that can be worth up to $20 million each.

A Forbes editorial urges Nuance to put Carl Icahn on its board instead of fighting him off with a poison pill provision. Reasons: (a) financial results and management guidance have been poor; (b) Nuance shareholders should want Icahn involved given his past performance; (c) it can’t hurt; (d) Nuance doesn’t seem to have a strategy other than acquiring other companies; (e) CEO Paul Ricci is overpaid, having made $78 million in the past three years; and (f) the company should break up into separate business to make its Siri-type voice offerings more attractive, or as the article says, “If I’m Apple, I don’t want a medical transcription company with a bunch of transcription workers in India, but I’d be very interested in just the mobile speech piece.”


9-10-2013 9-44-03 PM

Sentara Williamsburg Regional Medical Center (VA) selects Versus Advantages Asset Tracking and Fleet Management.

Kmart will offer LDM Group’s PharmacistCare and CarePoints messaging solutions to pharmacists and patients to improve medication adherence.


9-10-2013 5-44-58 PM

Healthcare consulting firm Decision Resources Groups hires Courtney Morris (Truven Health Analytics) as EVP of solutions.

9-10-2013 9-21-01 AM

Geeta Nayyar, MD (AT&T) is named CMIO of PatientPoint.

9-10-2013 5-47-56 PM

Clarity Health Services names Karlynn Billings (McKesson Specialty Health) VP of business development.

Announcements and Implementations

9-10-2013 9-46-14 PM

Children’s Hospital Colorado will extend its use of T-System’s ED facility coding solution to two new locations that will open in 2014.

A total of 101 Ohio hospitals are participating in the Medicity-powered CliniSync HIE.

JIT Healthcare Marketing launches to offer ad-hoc marketing, PR, and design services with a simplified payment process.

Mediware will invest $2.8 million on enhancements to its rehabilitation and respiratory care electronic documentation solutions.

Memorial Health Hermann Health System (TX) takes almost 600 providers live on eClinicalWorks EHR and adds an additional 200 user licenses.

Infor announces GA of Infor Implementation Accelerator for Healthcare for the management of financials, human capital, and supply chain processes. Infor also releases Infor EMS Integrated Healthcare suite, which provides a real-time exchange of data between EMS and hospitals.

9-10-2013 7-00-01 PM

ImageTrend releases Version 3 of its patient registry system.

Liaison Healthcare announces the launch of EMR-Link, which allows clinicians to view lab and rad results reported through its hub on any smartphone.

Corepoint Health adds Direct Project protocol support to the latest version of its integration engine, giving customers a simpler way to exchange information with external organizations.

ICA announces its SmartAlerts service, which identifies high-risk patients in real time to reduce readmissions.

Government and Politics

9-10-2013 6-10-06 PM 9-10-2013 6-10-40 PM 9-10-2013 6-11-08 PM
9-10-2013 6-11-43 PM 9-10-2013 6-12-12 PM 9-10-2013 6-12-41 PM

The Meaningful Use Workgroup of ONC’s Health IT Policy Committee plans functionality goals for MU Stage 3.

ONC releases “Certification Guidance for EHR Technology Developers Serving Health Care Providers Ineligible for Medicare and Medicaid EHR Incentive Payments,” designed to help developers of EHRs for providers who don’t usually fall under HITECH (mental and behavioral health, non-acute care settings) design systems that are interoperable with HITECH-influenced EHRs.

Innovation and Research

A study published in JAMA finds that implementation of EHRs  Kaiser Permanente Northern California in 2004-2009 was associated with a slight but statistically significant reduction in ED visits (519 vs. 490 visits per 1,000 patients) and hospitalizations (251 vs. 239 per 1,000 patients) for diabetic patients. Office visit rates exhibited no association.  Another JAMA published study finds that EHR-powered small practices produced slightly better outcomes working under a pay-for-performance program.

9-10-2013 7-38-37 PM

Mike Wasser creates the very cool BloomAPI v 0.1.0, a free self-hostable API that queries the automatically updated latest version of the National Provider Identifier database. It also supports simple and complex online queries. You’ll be interested if you want to look up doctors in real time by name, ZIP Code, address, or NPI.

9-10-2013 7-58-14 PM

Brian Norris (@Geek_Nurse) follows up his Tableau-powered MU attestation slicer and dicer with one on data breaches. He seems to enjoy tearing into large, publicly available data sets to provide new insights and the results are cool, so he might accept suggestions (that’s where the breach idea came from).

9-10-2013 8-03-10 PM

A keyword-based search of online help wanted ads finds that healthcare IT-related job postings have increased by 86 percent since HITECH passed.

Southern Polytechnic State University in Atlanta will host the CDC Health Game Jam September 20-22, challenging entrants to quickly produce games that address CDC’s health priorities, such as disease prevention and healthy lifestyles.


The European Patent Office will grant PeriGen a patent that covers specialized techniques for displaying patient data to help OBs recognize trends and deviations from normal conditions.

Streamline Health Solutions releases its dual coding enhancement for the eCAC and eAbstract applications that allows users to assign ICD-9 and ICD-10 codes simultaneously.


A HIMSS Analytics survey on clinical and business intelligence finds that only 9 percent of respondents plan to buy a dedicated solution that integrates with their EHR, but among those who do, Truven, Elsevier, and Cognos, all of which significantly trail buying whatever their EHR vendor offers.  

9-10-2013 8-16-10 PM

A debt collection agency that previously worked for the University of Chicago Physicians Group announces that an incorrect security setting on its Web server opened up information about 1,344 still-active claims to anyone who happened to find it. The problem was reported by a debtor who noticed that they could see the information of other debtors.

Hospital bond ratings may suffer from the costs and problems introduced by an Epic implementation, but the bonds of Dane County, WI (home of Epic) enjoy a AA+ rating from Fitch because of Epic’s employee growth.

Speaking of Fitch bond ratings, Mary Washington Healthcare (VA) gets a low rating and downgrade after a $28 million profitability hit in FY2012 due to a billing systems conversion and another $2 million drain due to CPOE implementation, causing the hospital to write off $25 million. I believe both systems are Siemens Soarian.

Weird News Andy wonders what the funniest or most interesting things providers have experienced from their patients as in this story, where a man coming out from surgical anesthesia notices a woman next to his bed and says, “Man, you are eye candy. Whoa. You may be the prettiest woman I’ve ever seen. Are you a model?” When reminded that the eye candy in question was in fact his wife of six years, he exclaimed, “"Oh my God, I hit the jackpot.”

Sponsor Updates

  • Capario announces it is ready to begin ICD-10 testing and offers customers an online ICD-10 submitter testing tool at no charge.
  • Aprima Medical integrates NoteSwift into its EHR system.
  • A Forbes article on the use of IT to advance the delivery of healthcare highlights QPID Health, which it calls a “promising startup software development firm.”
  • Convergent Revenue Cycle Management will offer RCM solutions to Siemens customers.
  • HIMSS Analytics reports that Imprivata OneSign is the most widely selected SSO solution among hospitals using EpicCare.
  • ZirMed will offer tools to help providers transition to ICD-10.
  • ATT offers a white paper discussing how providers can use a collaborative care approach to earn incentives and prepare for accountable care.
  • Sumit K. Nagpal, president and CEO of Alere Accountable Care Solutions, shares his thoughts on how the use of technology can improve patient outcomes.
  • Etransmedia CEO Vikram Agrawal discusses the lack of access to qualified programmers.
  • Greenway Medical adopts the EHR Developer Code of Conduct issued by the HIMSS EHR Association.
  • Divurgent posts tips for go-live personnel on how to make the most of relationships with recruiters.
  • HIStalk sponsors listed on the 2013 InformationWeek Top 500 include: ATT, CommVault, Emdeon, Informatica, InterSystems, McKesson, MModal, NTT Data,  TriZetto and Xerox.
  • The CSI Companies acquires IT staffing firm Anteo Group.
  • The GE Foundation awards The Guideline Advantage an $880,000 grant to provide 12 FQHCs with quality improvement technology from Forward Health.
  • Billian’s HealthDATA hosts an #HITchicks tweet chat September 19 to discuss four gender-related HIT topics.
  • Nuance partners with Hyland Software to enable eCopy ShareScan to scan directly into Hyland’s OnBase EMC system.
  • Benson Area Medical Center (NC) reports that it has reduced IT costs and improved security of patient data by utilizing the e-MDs EHR software within the ClearDATA HealthDATA cloud platform.


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

More news: HIStalk Practice, HIStalk Connect.


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September 10, 2013 News 5 Comments

Morning Headlines 9/10/13

September 9, 2013 Headlines No Comments

Quality Systems, Inc. Acquires Mirth Corporation

Quality Systems, Inc., parent company of NextGen, announces its acquisition of Mirth Corporation, which offers interoperability solutions that include the open source Mirth Connect integration engine. The acquisition was pursued to provide NextGen customers with improved data exchange capabilities.

Aprima and NoteSwift Announce Partnership and Distribution Agreement

Ambulatory systems vendor Aprima announces a partnership with NoteSwift that will bring voice recognition and natural language processing to the Aprima customer base. NoteSwift claims to reduce pointing and clicking by 75 percent and ensures that electronic documentation features will work while moving toward a narrative-based documentation model.

ONC’s goals for MU stage 3 in 6 charts

ONC’s primary goals for Stage 3 Meaningful Use are outlined. The theme for Stage 3 seems to be focused on squeezing improved outcomes out of the EHR and HIE infrastructures that Stage 1 and 2 established.

Medical Practices Move Health IT To Cloud

A market analysis surveying 8,000 CIOs, CFOs, and administrative support staff at US hospitals and practices finds that 87 percent plan to replace components of their core practice management solution within 12 months. Practices are turning to cloud-based options at a significantly higher rate to avoid upfront investments in licensing and hardware.

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September 9, 2013 Headlines No Comments

Readers Write: Seize the Opportunity: Making Your Meaningful Use Meaningful

September 9, 2013 Readers Write 1 Comment

Seize the Opportunity: Making Your Meaningful Use Meaningful
By Linda Lockwood, RN, MBA

9-9-2013 5-58-47 PM

In recent weeks, countless stories have appeared in healthcare-industry publications touting the complexities of Meaningful Use (MU) Stage 2 and the challenges ahead. While MU Stage 2 is no walk in the park, turning these challenges into an opportunity to establish the proper foundation at the outset goes a long way to setting up an organization for continuing success throughout the course of the EHR Incentive Program.

A strong MU program is also the basis for long-term quality and performance improvement that goes far beyond MU compliance. Viewed as strategically foundational, it can help health systems survive and thrive in today’s shift from volume- to value-based care delivery and reimbursement models.


Successfully meeting Meaningful Use requires more than just taking on another IT project, checking off boxes, and receiving incentive payments. Rather, a compelling case can be made for adopting a strategic and programmatic approach to enable ultimate success over progressive MU stages. It requires implementing a program with consideration of standardization, improved workflows, documentation at the point of care, interoperability, eCQMs as defined by multiple quality programs, and an auditable defense portfolio that provides evidence of the provider’s compliance and intent.

A full lifecycle looks beyond the initial incentive payments. It employs a comprehensive approach that closes the loop on every aspect of the program. It also establishes the culture and business plans that support improved patient care outcomes and efficiencies necessary to survive in the new, fee-for-value healthcare world.

Taking a programmatic approach to achieving meaningful use can provide foundational benefits in the long run. As we look back at the journey already traveled and ahead to MU Stage 2 and beyond, it is clear that the organizational approach to MU directly impacts future success. Organizations that chose the “easy way out” as a path to financial gain are now facing Stage 2 with increased thresholds, a focus on sharing data and engaging patients, increased emphasis on eCQMs, and realizing that they have significant work ahead.

Organizations that “seized the opportunity” at the outset and invested the time, money, and resources to set the proper foundation for value-based performance improvement are now in the lead with regard to successfully meeting the MU Stage 2 requirements.

If your MU approach was not robust enough, is all lost? Absolutely not. At the heart of every successful MU journey is an organization with a commitment from the top to view MU as a foundational strategy to improve quality and support the goals laid out by CMS. Much has been said about the transitions of care, patient engagement, and quality reporting issues, but what many don’t often talk about is how to position an organization for success. Some key points to consider include:

  • Identify and act upon lessons learned
  • Embrace a big vision; leverage the MU effort
  • Understand the scope and level of effort required; don’t underestimate Stage 2 challenges – thresholds, interoperability, and patient portal and engagement
  • Include all stakeholders; align with quality and performance improvement
  • Develop program management and governance
  • Focus on adoption and change management
  • Understand vendor approach; challenge and verify
  • Create an auditable defense portfolio and an audit plan
  • Budget for upgrades, software and services; understand how this will affect the timeline
  • Establish a comprehensive portal plan to include security, access, outreach, content, policies and procedures
  • Pay special attention to the Summary of Care – the complexities and the content to include physician documentation for care planning.

Meaningful Use is truly a journey that must be embraced beyond the IT department. To be successful, organizations must employ proactive executive sponsorship that supports the long-term, value-based, performance-improvement vision. Realization of the vision depends on developing and delivering a well-structured program. Organizations that adopt this approach will be aligned for success; they will be the frontrunners in this new world of value-based payment and performance improvement.

Linda Lockwood, RN, MBA is the partner of advisory services at Encore Health Resources of Houston, TX

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September 9, 2013 Readers Write 1 Comment

Curbside Consult with Dr. Jayne 9/9/13

September 9, 2013 Dr. Jayne 1 Comment


Before landing my current job, I had a brief sojourn in the consulting world. At my first placement, the director who hired me said this: “A consultant is someone who knows the same things you do but comes from more than 50 miles away and has a nicer briefcase, so people will listen and follow directions even though you’ve told them the exact same thing.” I giggled a little at the time because she had a Chanel tote and I had a Samsonite on wheels, but we had a successful engagement nevertheless.

In looking for other definitions of the consultant role, Urban Dictionary describes it as:

A self-proclaimed expert that extorts inflated fees from a host company in return for vague and predominantly incorrect business advice. The successful consultant detaches from its host at the exact moment its parasitic qualities are discovered by upper management …

I’ve certainly come across that type before. One of the first consultants I ever encountered could have been the reason that the “buzzword bingo” game was created. I remember sitting across the conference table thinking, “Who is this woman and who does she think she’s kidding?” as I tried to weed through the barrage of words that had very little meaning. Luckily our leadership quickly determined she was all fluff and no stuff and showed her the door. Unfortunately there are some people who are so dazzled they don’t see through the hype until long after the consultant has flown the coop.

There are many reasons why organizations hire consultants and there are many different types of consulting offerings in the healthcare IT world. Even with the best consultants, though, it’s important to manage them and understand exactly what they are supposed to be doing and the role they should play in the organization. How consultants are managed depends on the reason they are hired.

Consultants can be leveraged to backfill skill sets that are lacking in an organization. These are often well-defined, one-time projects such as constructing an interface, mapping a lab crosswalk, or installing hardware. In this situations, it’s fine to have a “once and done” philosophy and let the consultants get in and get out.

For other backfill situations such as training users prior to go-live or supporting them after, it’s important to ensure knowledge transfer. A forward-thinking organization will include time in the proposal to allow the consultant to train existing team members in the target skill set and proctor the team until it is able to function independently.

In the first situation (once and done), organizations can get away with minimal management – ensuring timelines are met and deliverables are high quality with sufficient documentation. The second situation requires more active management to ensure that training is occurring and that the team is absorbing in a manner that they can later assume the role played by the consultant. It also requires appropriate instruction to the team so that they can understand what is expected of them and that they are to adopt the methodology agreed on by the leadership and the consultant.

Another reason to use consultants is workforce augmentation – when an organization has a skill set but is involved in a project that requires more resources than they can allocate. Consultants in this role may work better remotely. I’ve seen consultants quickly lose productivity when brought on site because of constant distractions. It’s tempting to try to pull an expert resource into other initiatives and difficult for the consultant to combat scope creep. When staff augmentation occurs on site, expectations regarding time and attendance should be made clear at the beginning of the engagement. Some attention should be paid to the team dynamic so that existing staff doesn’t feel intimidated.

On the other hand, I’ve used consultants in the past simply because I needed someone to BE intimidating. I’ve leveraged our vendor to play “bad cop” to our internal “good cop.” In other situations, I’ve been asked to be the bad cop myself. The key to this strategy is making sure the consultant understands the end game. It’s never polite to knowingly make someone a punching bag, especially when you may have to work with them again down the road.

Consultants are also used for strategic planning efforts. This is where some bad consultants take advantage. The Urban Dictionary definition continues that, “the consultant preys upon upper management’s lack of job expertise and unrealistic dreams of grandeur.” This is more likely to occur when there is a lack of leadership or vision, making it easier for flimflam artists to thrive.

I’ve been in situations where management really has no idea what is going on. They don’t know exactly what they want a consultant to do or what they hope to accomplish, other than wanting someone to “just fix this.” A skilled consultant will sit down with the client and explain that there is no magic wand to be waved. He or she will then work with the client to develop realistic and actionable goals for the organization.

Too many managers assume that because a consultant is on the scene, they can be on autopilot. It’s important to understand that the consultant isn’t always part of the management structure. Unless the engagement is set up in a certain way, consultants can’t force employees to do their jobs or take action when sloppy work is done. They must work with the existing reporting structure to deal with problem people, processes, and policies.

We’ve all had our experiences with consultants run amok as well as with those that pushed us to excel. Send yours my way and I’ll share the best of the best (and the worst of the worst) with HIStalk readers.


E-mail Dr. Jayne.

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September 9, 2013 Dr. Jayne 1 Comment

Morning Headlines 9/9/13

September 8, 2013 Headlines No Comments

Aetna Once Offered To Buy NY Startup ZocDoc For More Than $300 Million And The Founders Walked Awa

A Business Insider article reveals that in 2011 insurance company Aetna offered to buy ZocDoc for more than $300 million but ZocDoc’s founders walked away. Insiders at the company, now valued at north of $700 million, say that ZocDoc is pursuing a public offering rather than a buyout.

Will An App A Day Keep The Doctor Away? The Coming Health Revolution

A Forbes article explores the market drivers that are contributing to meteoric growth in the mobile health market, citing VC and serial entrepreneur Vinod Khosla, who predicts that algorithms will one day be capable of replacing 80 percent of doctors.

Baylor Health Care System Wins 2013 Tech Titans Award for Successful Needs-Based Customizations to Allscripts EHR

Baylor Health Care System receives the 2013 Tech Titans Technology Adopter Award, an award issued annually by the largest technology trade association in Texas, for enhancements developed to improve its Allscripts CPOE and physician documentation solutions.

MyMedicalRecords Wins Appeal, Will Proceed With $30 Million Claim Against SCM

MMRGlobal is moving forward with a $30 million breach of contract suit against CA-based Surgery Center Management, LLC, a company that provides outsourced business services, including IT, to surgical centers in the region. The company signed a settlement with MMRGlobal in 2011 agreeing to pay $5 million per year in patent licensing fees but has since stopped paying.

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September 8, 2013 Headlines No Comments

Monday Morning Update 9/9/13

September 7, 2013 News 6 Comments

9-7-2013 5-53-44 PM

From The PACS Designer: “Re: Apple’s fingerprint reader. With Apple possibly launching several products next week, TPD thought it would be good to give you a glimpse of what’s coming next. The fingerprint reader, if introduced, brings an interesting security solution for healthcare in that lost devices will be unusable as long as the security lock remains active.” Above is a leaked photo of a new iPhone start button with what appears to be a built-in fingerprint reader, from Sonny Dickson.

From IT Guy Turned Patient: “Re: Apple and healthcare. Interesting perspective. I could still argue persuasively for the Windows model. but what I know about the healthcare system could be inscribed on the top of a pin and still leave room there for me to ice skate. From my perspective as a recent user of healthcare, what seems to be the driving factor is simply referrals. I go to a primary healthcare provider who by most standards would be considered way better than average. I am listened to regarding symptoms, then referred to a specialist to whom I give the same answers to regarding symptoms, I am tested, receive boilerplate textbook treatment, and ushered out the door as I hear a receptionist behind me say, ‘Next.’ Meanwhile, five months later, nothing has changed. I am in exactly the same boat as I was pre-visit to either facility except about $1.800 lighter. I’ve never been called to be asked, “How are you? How did we do?” There’s no warranty. No one really seems to care once you’re out the door, which is interesting since the industry that I work in routinely makes that call. Why do people not howl at the moon over piss-poor healthcare the way they do over even mediocre or worse car care or home remodeling? I don’t know what it would take. I don’t know whether the Apple model or the PC model would work better, but from my point of view the entire experience seems so institutionalized and insulated from capitalism and the rest of the world. Something needs to change, but getting government more involved rather than less won’t accomplish that. One thing I know for certain is that we live in the United States of Unintended Consequences.” I’ll say again as I always do — you get what you pay for. More precisely, you get what insurance companies and the government pay for, and that’s patient and procedure volume. Unfortunately for now, nobody’s paid very much to care about how you like it.

From Caveat Emptor: “Re: ethics. Is a sales employee who feels their former employer engaged in unethical sales practices obligated to inform customers instead of accepting a generous severance package that prevents disclosure of those practices” I’ll open it up to readers for comments, but my answer is no. It’s not appropriate (much less an obligation) for a company’s former employee to start calling customers making accusations about company ethics. If the sales practices were all that bad, customers will find out and make their own complaints (possibly legal ones) that would carry more weight than those of someone who didn’t speak up while drawing a paycheck from that company, but suddenly feels moved to do so after quitting. I don’t have specifics about the practices mentioned here, but I’ll ask readers to weigh in anonymously on that issue as well – what are some really abhorrent sales techniques you’ve seen used?

9-7-2013 5-06-26 PM

Half of poll respondents attend the HIMSS conference because they want to see other attendees, while only 15 percent are primarily drawn there by the educational sessions (which is probably a good thing based on my perception of the slide in quality of the education track). New poll to your right: which of John Halamka’s five CIO challenges will be most important?

George Giorgianni, who has worked for HBOC, SIS, DocusSys, and Unibased in his 35 years in healthcare IT, will retire on October 4.

9-7-2013 5-49-21 PM

Cornerstone Advisors names John McGuinness, MD (Meditech) to the newly created position of CMIO.

Baylor Health Care System wins a local technology trade association’s innovation work for its development of add-on modules for Allscripts Sunrise Clinical Manager, including a physician documentation tool.

9-7-2013 6-01-37 PM

Jimmy Weeks posted on Twitter this photo of the Bridgeport Hospital appointment conversion team beginning the move to Epic. They’re part of Yale New Haven Health.

9-7-2013 6-17-52 PM

A business site says that Aetna once offered to buy physician appointment scheduling app vendor ZocDoc for $300 million, but the founders turned the deal down, probably wisely since the company is valued at a lot more than that now.

Vince’s HIS-tory Part 4 on Cerner looks at the company in its early LIS-centric days in the form of a customer’s system search.


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

More news: HIStalk Practice, HIStalk Connect.

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September 7, 2013 News 6 Comments

News 8/28/13

August 27, 2013 News 10 Comments

Top News

8-27-2013 8-23-29 PM

8-27-2013 8-24-07 PM

Two Kansas HIEs, one covering Kansas City and the other serving the rest of the state, risk losing their federal grant money if they can’t agree on data exchange terms by the state-imposed deadline of September 30 (already extended from July 30). LACIE and KHIN could be forced to shut down by the end of the year if they haven’t worked out their differences by then. KHIN doesn’t want the network to share data with insurance companies that aren’t KHIN members, while LACIE says the agreement would prohibit organizations that are connected to an ACO from accessing the network’s data. At issue is aggregated information that could be used for non-patient care purposes. The Kansas HIE board voted to shut itself down in September 2012 and let the Kansas Department of Health and Environment take over its duties, which means the state is in charge. Kansas has no secondary data use policy.

Reader Comments

8-27-2013 8-26-55 PM

From Joyce: “Re: Mission Hospital, Asheville, NC. Laying off 70 workers, which is big news in a small town where healthcare supports the local economy.” The 730-bed hospital will cut the CEO’s salary by 26 percent, slash management salaries from 13 to 20 percent, eliminate merit increases, implement a three-month PTO freeze where time off is not accrued for worked hours, reduce its 403(b) matching, and reduce the employee wellness incentive. The hospital’s CEO made $480K in 2010, while the CIO was paid $349K. That’s the problem with hospitals – they provide growth to their local economy, but much of that is paid for by federal taxpayers in the form of unsustainably rising national healthcare costs. Building an economy based on healthcare won’t work, which politicians seem reluctant to admit since hospitals employ a lot of people and write nice political donation checks.

8-27-2013 5-37-48 PM

From HealthPlans: “Re: WellPoint. AJ Lang is no longer with the company, an internal employee tells me.” A WellPoint spokesperson confirms that Andrew J. Lang, senior VP of application development since December 2008, is no longer with the company.

8-27-2013 6-23-03 PM

From Mennonite Rockstar: “Re: BIDMC IT security after the Boston bombing. I had the impression they rearranged the setup of their homegrown application’s security from reading the Fast Company article. Perhaps Mr. HIStalk can get Halamka to clarify?” John says that his IT shop made no changes to their applications, but did tweak their audit log reports to allow the hospital’s compliance department to monitor the specific situation.

Acquisitions, Funding, Business, and Stock

8-27-2013 1-34-24 PM

Group purchasing organization Premier Inc., owned by 181 hospitals, health systems, and other healthcare organizations, files plans for an IPO of up to $100 million in common stock. Premier had $869 million in net revenue for the fiscal year that ended June 30, up 13 percent from the prior year.

8-27-2013 6-12-32 PM

Merge Healthcare Chairman Michael Ferro, Jr. resigns and is replaced by board member Dennis Bell. Ferro, Merge’s top shareholder, has indicated that he may eventually explore ways to boost shareholder value, including taking the company private. MRGE shares were unchanged on the news.

Federal HIT provider Systems Made Simple projects 2013 income of $260 million, up from $167 million in 2012.

8-27-2013 7-55-39 PM

The strategic venture arm of Canada’s TELUS makes an unspecified investment in Rockville, MD-based Get Real Health, which offers the InstantPHR personal health record. Three of the company’s seven executives came from US Web, while two were Microsoft HealthVault developers.


8-27-2013 1-38-39 PM

Southern Prairie Community Care ACO (MN) will deploy technology from Sandlot Solutions to manage patient health information and give providers access to data  at the point of care.

8-27-2013 1-41-15 PM

HealthproMed (PR) selects eClinicalWorks EHR for its two-location FQHC.

Greenway Medical will develop an HIE for more than 500 physician members of the Denver-area Rose Medical Group, Rose Medical Center, and their patients.

8-27-2013 1-43-04 PM

Grady Health System (GA) selects Strata Decision Technology’s StrataJazz for cost accounting, operating budgeting, and capital planning.

PinnacleHealth will use Care Team Connect’s integration and rules engine to integrate biometric data from Honeywell monitoring devices with other patient health data.

8-27-2013 8-29-51 PM

Palmetto Health (SC) chooses 3M 360 Encompass System for automated coding, clinical documentation improvement, and performance monitoring.

8-27-2013 7-48-52 PM

The National Football League signs a 10-year agreement for the ININITT Smart-NET PACS, which will allow the medical images of players to be viewed remotely or from mobile devices on the sidelines.


8-27-2013 1-47-01 PM

QHR Corporation, a Canada-based HIT company, names Owen Haley (Allscripts) chief commercial officer.

8-27-2013 1-48-08 PM

Tony Scott (Microsoft) joins VMware as CIO.

Cumberland Consulting Group adds Joseph Serpente (McKesson) as director of business development.

Announcements and Implementations

PeaceHealth’s Peace Island Medical Center (WA) goes live on Epic September 1.

inga_small Emdeon launches a self-service testing exchange solution for ICD-10, allowing providers and channel partners to submit ICD-10 test claims and receive claim status feedback. The Emdeon Testing Exchange for ICD-10, which Emdeon purports is the first of its kind in the industry, requires no additional software and is a free service to Emdeon providers, channel partners, and payer customers. Sounds like a great service that would be even more valuable if more payers were ready and if providers already had ICD-10-ready software updates from their vendors.

8-27-2013 12-34-57 PM

Greenway presents Innovation Awards to Boulder Community Hospital Physician Clinics (CO), Regional Obstetrical Consultants (TN), and Albuquerque Health Care for the Homeless (NM) at its PrimeLEADER user conference in Washington, DC.

8-27-2013 12-54-01 PM

Sonora Regional Medical Center (CA) goes live on Cerner September 4.

8-27-2013 8-11-45 PM

Vocera announces enhancements to its secure messaging platform that include on-call scheduling, new smartphone clients, an improved Web console, and server enhancements.

8-27-2013 12-58-10 PM

inga_small I came across this tweet today. Ah, athenahealth, I don’t think you can convince me that switching EHRs is as easy as switching from Time Warner to AT&T U-verse.

Innovation and Research

8-27-2013 8-31-56 PM

University of Florida researchers are developing a scoring model that will use hospital EHR information to identify inpatients most likely to experience an adverse drug event, allowing those patients to be more aggressively monitored. The result will be rolled out to 13 hospitals for validation in the study’s second year.


8-27-2013 7-43-43 PM

An Ohio surgeon wearing Google Glass during a surgery broadcasts the procedure over the campus network, also using it to consult with a colleague.



inga_small Apple is rumored to be planning a trade-in program for iPhones in an attempt to increase the percentage of units it sells directly. What Apple is really trying to do is get  more people like me to walk into their retail stores and spontaneously drop $50 on the latest, greatest cool Apple accessory. The speculation is that Apple will tie the trade-in value to the cost of an upgraded iPhone and offer an amount less than the open market value or what third-party companies like Gazelle would pay. I’m not due for a discounted upgrade any time soon, but my 16GB iPhone 5 is almost filled up. Maybe I’ll be one of the nerdy folks queuing up in line at the Apple store the first day the newest iPhone is released, supposedly in late September.

8-27-2013 1-27-55 PM

8-27-2013 1-31-06 PM

Cerner and Epic are winning three-fourths of all new large-hospital EMR deals, according to a new KLAS report on clinical market share. Cerner and Epic dominate in community hospitals, though McKesson Paragon and Meditech are gaining some traction. Biggest net customer losers for 2012 were McKesson and Siemens, while Epic was the only vendor that didn’t lose any customers. Allscripts, GE Healthcare, and QuadraMed had no wins at all.

8-27-2013 11-57-20 AM

inga_small HIMSS opens registration for its annual conference February 23-27 in Orlando. Aetna CEO Mark Bertolini will deliver the keynote address bright and early Monday, while Wednesday afternoon’s keynote speaker is still TBA. The Thursday afternoon keynote is “world class blind adventurer” Erik Weihenmayer, who unfortunately may not be enough of a draw to prevent weary crowds from making a mass exodus Thursday morning.

8-27-2013 7-23-01 PM

A California Nurses Association press release claims that Sutter Health’s Epic system went down Monday at its Northern California hospitals following an eight-hour upgrade-related downtime on Friday. A union spokesperson was quoted as saying, “This incident is especially worrisome. It is a reminder of the false promise of information technology in medical care. No access to medication orders, patient allergies and other information puts patients at serious risk. These systems should never be relied upon for protecting patients or assuring the delivery of the safest care.” While the union did not issue an equally passionate press release extolling the virtues of paper charts, it did throw in unrelated shots at management for urging nurses to enter patient charges correctly, apparently preferring that Sutter not bill what it’s owed even though those funds allow it to generously pay unionized nurses.

8-27-2013 8-05-52 PM

The Gainesville, FL newspaper profiles 12-employee RegisterPatient (now using the name Ingage Patient)and its CEO Jana Jones, who was formerly CEO of BCBS of Tennessee subsidiary Shared Health. According to the company’s site, the product offers appointment scheduling, alerts, registration, secure messaging, check-in, health education, a PHR, care plan integration, renewal requests, and electronic referrals.

8-27-2013 5-50-52 PM

This photo by @Nurse_Rachel_ is surely embarrassing Sinai Hospital of Baltimore as it lights up Twitter. Nobody should be surprised that hospitals and doctors do whatever pays them the most; to expect otherwise is naive.

Weird News Andy says, “Nurse, doctor, what’s the difference?” A draft VA policy would eliminate the requirement that advanced practice nurses, including nurse anesthetists, be supervised by physicians. Take a wild guess at how the American Society of Anesthesiologists feels about that.

WNA also notes an AARP report warning  that 20 years from now, aging baby boomers won’t have enough family members to take care of them because of increased longevity, fewer children, and a high divorce rate. Family care is worth an unpaid $450 billion per year

Technical problems with the site Sunday and early Monday forced me (for reasons too hard to explain) to remove Vince’s HIS-tory of Cerner in the Monday Morning Update and simply link to it instead. Here it is again. Meanwhile, the site is now running on a supercharged new server that will better handle the readership growth. I’ll probably appreciate that more after I’ve caught up for all the sleep I lost over the weekend as the web hosting people fixed the inevitable problems.


Sponsor Updates

  • Imprivata introduces OneSign ProveID Embedded for use within virtual desktop environments.
  • GetWellNetwork announces the call for presentations for its seventh annual user conference June 3-5, 2014 in Chicago.
  • Frost & Sullivan recognizes Merge Healthcare with the 2013 North America Award for Product Leadership in Interoperability Solutions for its iConnect Enterprise Clinical platform.
  • Wakely Consulting Group will process data from Truven Health MarketScan Research Databases through its Wakely Risk Assessment Model to help health plans meet HHS requirements for risk adjustment and reinsurance.
  • Jason Fortin, senior advisor at Impact Advisors, discusses MU deadlines.
  • The HCI Group is named to the Inc. 5000, coming in at #3 with 24,545 percent revenue growth in the past three years.


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

More news: HIStalk Practice, HIStalk Connect



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August 27, 2013 News 10 Comments

Readers Write: Bridging the Divide: Can Clinicians and CFOs Speak the Same Language?

August 26, 2013 Readers Write No Comments

Bridging the Divide: Can Clinicians and CFOs Speak the Same Language?
By Nick van Terheyden, MBBS

Pity poor Henry the VIII. Historians still argue over his medical records. Though his was the most scrupulously documented medical history of his age, burning questions remain. Did he suffer from syphilis as believed for centuries? More likely he had familial diabetes, which better explains his symptoms – including his well-documented inability to heal from wounds.

Imagine if Henry’s physicians were also tasked with assigning codes and complying with the clinical documentation requirements of today. The Tudor dynasty might have had some reimbursement issues. Heads would have rolled.

Sure, bloodletting is no longer an accepted therapeutic modality. But have we really come that far in bridging the divide between the clinician’s responsibility for care and the CFO’s responsibility for financial performance? Or do finance and quality continue to be involved in a forced marriage of sorts?

Clinicians are focused on their patients. While they understand the importance of billing, they need to put their energies into diagnosing and treating patients to ensure positive outcomes. And they’re overwhelmed with data – patient test results, clinical studies, guidelines, protocols – much of which they have to sift through to find relevant, critical information. Add to that, they have the burden of learning the new coding requirements under ICD-10, with the deadline approaching around the corner.

CFOs, of course, are also focused on quality but, at the same time, must juggle that priority with issues related to reimbursement, their bottom-line and ever-changing and expanding compliance requirements. They’re continually seeking out and analyzing solutions that may be able to improve both patient health and revenue performance. At the same time, they also recognize that without physician buy-in, they cannot meet any of these goals; therefore, they are looking for meaningful ways to bring them along, without disrupting their workflows.

Information that’s deemed crucial for the clinician may not be deemed useful by the CFO, and vice-versa.

Yet finding ways to break through this language barrier between the clinical and financial perspectives will be a critical success factor for healthcare organizations in the years ahead. It’s more than just a communications issue. It’s a strategic imperative aimed at translating the narrative of care into an actionable piece of information that aids in care coordination, while also ensuring appropriate reimbursement and minimizing the potential revenue leakages that keep most hospital CFOs up at night.

Clinical documentation is at the heart of plugging these revenue leakages while also meeting quality standards. Instead of finding one-stop solutions to prevent leakages across the revenue cycle, it is much easier to build accuracy from the start rather than trying to fix the problem after the train has left the station and the process is in motion.

Regardless of the tools used, clinical documentation addresses the most important concern for both physicians and CFOs: ensuring that the most useful information is captured accurately and is made readily accessible to the decision makers (and systems) who need it. At the end of the day, we all know that quality leads to a win for all.

Nick van Terheyden, MBBS is CMIO of Nuance.

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