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News 2/6/13

February 5, 2013 News 7 Comments

Top News

2-5-2013 6-26-04 PM

Cerner announces Q4 results: revenue up 15 percent, EPS $0.67 vs. $0.55, beating estimates of $0.64. Shares rose five percent in after-hours trading Tuesday. The company’s market cap is $14.3 billion. From the earnings call:

  • Q4 bookings were just over $1 billion, a record
  • System sales were $252 million of the $710 million in revenue
  • Thirty percent of the bookings came from non-Millennium clients
  • The company says it had nearly double the number of new HIMSS EMRAM Stage 6/7 users as its closest competitor, presumably Epic
  • It claims that Epic is pushing back on Meaningful Use Stages 2 and beyond because it will be challenged to meet them
  • EVP Jeff Townsend said the industry needs to step up to the challenges of interoperability, including use of a patient identifier
  • The company says it thinks even Epic clients that have paid a lot of money can be convinced to change systems if their reimbursement is threatened due to quality problems
  • The company signed four deals worth $40 million or more, with the showcase being LA County
  • Neal Patterson said the market is really a choice between two companies, presumably Cerner and Epic
  • The company says 85 percent of its customer base has completed Stage 1 attestation

Reader Comments

2-5-2013 6-14-35 PM

From Mike Tomlin: “Re: Rich Goldberg. He is leaving McKesson/MED3OOO to run marketing for GE reseller Virtual OfficeWare.” Unconfirmed, but the source is good and his departure would not be surprising given McKesson’s recent acquisition of MED3OOO.

From Bean Enumerator: “Re: Brigham and Women’s CIO position. Not filled yet.” A reader reported on January 30 that Joe Schmitt was taking the job, but that was not verified. The opening remains posted.

2-5-2013 7-46-15 PM

From MedWreck: “Re: Innovation Institute. Color me skeptical.” St. Joseph Health (CA) launches for-profit The Innovation Institute that will include includes an incubator, shared services, and an investment portfolio. The primary motivator seems to be to commercialize the intellectual property of large academic medical centers. The only hospital member named is St. Joseph Health, which provided almost all the institute’s executives, including former St. Joseph Health SVP/CIO Larry Stofko, who will run the Innovation Lab. Larry let me know about the Institute’s formation last summer, at which time I mentioned it and his new job there.

2-5-2013 7-18-05 PM

From Incredulator: “Re: HIMSS e-mail blast. A customer forwarded this e-mail they received from a company pitching their HIMSS booth. Check out the last line.” It’s easy to doctor a forwarded e-mail, so I’ll assume that’s the case since surely the company whose identifiers I’ve blurred wouldn’t be stupid enough to end an otherwise button-down e-mail blast with a puzzling grand finale. Although if they did, I’ll be interested to see if they own up to it as either a horrific faux pas or an overly bold attention-getter.


HIStalk Announcements and Requests

We did a good interview with Vocera Chairman and CEO Bob Zollars on HIStalk Connect.

2-5-2013 10-02-06 PM

Welcome to new HIStalk Platinum Sponsor Cornerstone Advisors Group. The five-year-old Georgetown, CT-based professional services firm, in its own words, “provides high-value consulting, advisory, implementation, and staffing services to the healthcare delivery middle and lower market segments at a fair and reasonable price” around its core principles of partnership, integrity, commitment, and value (remember “value” because it’s coming up again). The company took the #1 spot in “Planning and Assessment” and #2 in “Vendor Selection” in the 2012 Best in KLAS awards, with its customers scoring it with a sweet 98.4 and 96.1, respectively, also giving Cornerstone stellar marks for value with a 9.0 in the all-important “Money’s Worth” score in both categories. Cornerstone’s leaders and associates are former Big Six consultants, CIOs, and physicians, and I notice that President and Founder Keith Ryan has a distinguished industry history on the front lines as VP/CIO of Stamford Health (CT) and Elmhurst Memorial Healthcare (IL) as well as having held executive positions with top consulting firms, not to mention that I notice he is an HIStalk Fan Club member, which carries a lot of weight (with me, anyway). I’ve seen the company’s revenue and FTE numbers by year and it’s a steep curve up, earning it a spot on the Inc. 5000 with 431 percent three-year growth. Some of its clients include HCA, William Backus, Chilton Memorial, and Finger Lakes. If you need help with advisory, implementation, or staffing services, consider giving Cornerstone Advisors Group a chance to earn your business. I appreciate their support.


Acquisitions, Funding, Business, and Stock

Oak Investment Partners invests $40 million in xG Health Solutions, an independently operated venture that will market intellectual property and expertise developed by Geisinger Health System, including healthcare IT optimization, consulting services, population health data analytics, and care management. We announced the news on January 11 when phony-named reader Jerry Aldini forwarded a copy of the internal announcement.

2-5-2013 6-25-23 PM

CTG acquires etrinity, a provider of IT services to the healthcare market in Belgium and the Netherlands.

2-5-2013 6-29-43 PM

Michael Dell will regain control of the fading company he founded as Dell announces plans to be taken private in a $24 billion leveraged buyout that also includes taking a loan from Microsoft. The company plans to move its focus from low-margin and low-demand PCs to enterprise services, which worked for IBM years ago as it moved away from hardware. That same strategy hasn’t done much for HP, which is now discussing breaking the company up in hopes of finding shareholder value hidden somewhere in its diverse offerings. The Dell change could be good for its healthcare consulting folks, most of whom were brought on board with its 2009 Perot acquisition that included the former JJ Wild.

Startup eLuminate Health announces plans to open its headquarters in Leawood, KS and create 200 jobs over the next five years. The company offers a network for imaging and surgical providers to provide transparent pricing, clinical quality, and customer satisfaction ratings for consumers (sounds pretty much like an Angie’s List for elective surgery). CEO Tami Hutchison came from Cerner, which you probably guessed given the company’s location and line of business.

Speech technology vendor Vestec raises $1.5 million in capital from V. Raman Kumar, founder and former CEO of MModal. The company offers a speech recognition engine and a Natural Language Understanding system, with a text-to-speech engine planned. The products seem to be small-vocabulary systems for specific voice commands for use in devices such as TVs, GPSs, and PBX-type setups, although Kumar says he’ll help the company move into healthcare.


Sales

CHRISTUS Continuing Care (TX) selects HEALTHCAREfirst’s homecare, hospice, and CPO solutions.

MDH Radiology chooses Sectra’s Breast Imaging PACS, Merge Healthcare’s CADstream, and other tools to create a national telemammography solution.

2-5-2013 3-17-22 PM

MD Anderson (TX) chooses Oracle Health Sciences applications  and Oracle technology for an organization-wide analytics initiative to develop personalized cancer treatments.

CMS awards Emdeon a contract to define the process for testing new HIPAA and ACA transaction standards.

Kentucky Medical Services Foundation and UK Healthcare sign a five-year agreement for Opportunity AnyWare, the business analytics platform from Streamline Health Solutions.

2-5-2013 3-19-19 PM

Kalispell Regional Medical Center (MT) selects EDCO Health Information Solutions for its day-forward scanning technology and services.

Middletown Community Health Center (NY) chooses EHR, PM, and EDR (dental) solutions from SuccessEHS for nine service locations and two mobile health units, announcing plans to go live within 90 days. 

2-5-2013 10-25-25 PM

Parkview Health (IN) selects ProVation Medical from Wolters Kluwer Health for gastroenterology procedure documentation and coding.



People

2-5-2013 7-04-20 PM

Kasey Fahey joins Direct Recruiters as project coordinator in its healthcare IT practice.


Announcements and Implementations

Covisint launches Covisint Healthcare, an integrated solution for analytics across multiple systems and stakeholders that includes enhanced data capture and reporting, real-time admission and discharge notifications, and patient outreach and scheduling.

2-5-2013 6-41-23 PM

Reading Hospital (PA) goes live on its $150 million Epic implementation.

Four hospitals of Bassett Healthcare Network (NY) go live with Epic.

LHP Hospital Group (TX) implements McKesson Paragon at five hospitals.

Cox Medical Center Branson (MO) completes activation of T-System’s PerformNext Care Continuity solution to facilitate patient transitions and improve communication and access to clinical data.

2-5-2013 6-50-48 PM

ZirMed launches Clinical Link, a nationwide provider-to-provider information exchange platform.

2-5-2013 6-53-53 PM

Awarepoint Corporation launches Bed and Bay Sensor for precise tracking of mobile equipment and patient and caregiver interactions in locations with tight bed spacing such as the ED and PACU.


Government and Politics

2-5-2013 6-46-11 PM

The VA solicits bids for a pilot program to test how advanced clinical reasoning and prediction systems can use its VistA patient data to improve care, efficiency, and outcomes.

Brian Ahier reports that a new federal law will be published this Friday that will require drug, device, and medical supply managers to publicly disclose gifts given to physicians or teaching hospitals. The Physician Payment Sunshine Act, part of the Affordable Care Act, charges HHS with collecting information about consulting fees, gifts, honoraria, food, entertainment, and travel from companies that are covered by any federal health program.


Innovation and Research

2-5-2013 2-53-03 PM

The Washington Post looks at the burgeoning field of geomedicine, which uses geographic information system technology to correlate environmental conditions with health risks. One example is an inhaler device from Asthmapolis that is equipped with Bluetooth to track when and where patients use their inhalers.

2-5-2013 7-28-35 PM

A Germany-based company develops an intelligent armchair that contains health-monitoring technology that constantly measures the health of its occupant, also displaying the user’s historical health measurements via a tablet PC to the TV using Bluetooth. A virtual health assistant uses the information to develop and monitor a personalizes health plan, for which the chair transforms into a rowing machine. The company plans to add mental games to encourage participation and increase alertness.

2-5-2013 8-39-58 PM

Fast Company covers the just-concluded MIT Health and Wellness Hackathon, which focuses on commercially viable products. Some of the entrants: an app that encourages HIV/AIDS patients to take their meds, a sensor-based home monitor for congestive heart failure, an endometriosis surgery app for patients, home Parkinson’s monitoring tools built into gloves and a coffee cup, a blood pressure pill bottle reminder, and a diet tracker for epileptics.


Other

I don’t see the point of “pass a test, earn some paper” certifications like the ones offered by HIMSS and some for-profit companies, but this one really puzzles me. HIMSS introduces CAHIMS, designed for “emerging professionals” with less than five years’ experience in healthcare IT. I would be doing all I could to try to hide my newbie status on my resume rather than proudly waving around a paid-for certificate that boasts of my relative inexperience.

2-5-2013 8-26-50 PM

Baltimore-based startup Parallax Enterprises, founded by a physician who is also a military pilot and an Air Force major, raises $1 million to develop a heads-up display of surgical checklists. I’m intrigued that Jeff Woolford, MD has booked 1,000 hours in the single-seat, low-level combat A-10 Thunderbolt II tank killer, which is ugly, slow, low-tech, cheap, and scary as heck for the pilot but the most reassuring sight imaginable for ground troops, at least those on the same side. I’ve seen live exhibition flights of just about every modern-era US warplane and the A-10 was the most memorable. Hats off to Dr. Woolford for his service as a Wart Hog driver over Afghanistan.

Former HealthStream executive Luther Cale offers 33 Ways to Reboot Your Life, free on Amazon through midnight Wednesday. Judging from the “Look Inside” feature, you won’t get much out of it if you don’t believe in non-traditional medical techniques like spiritual psychotherapy and healing tonics.

Unverified rumors claim that Cerner and McKesson will open up interoperability between their systems to try to compete with the Epic juggernaut, with a potential announcement planned for the HIMSS conference. I’m skeptical that two large, publicly traded competing companies would agree to such cooperation, so if you have details, please share.

2-5-2013 9-12-13 PM

Seattle-based Carena launches its CareSimple program, offering Webcam-based virtual visits with one of its 15 physicians and nurse practitioners for limited conditions for a cost of $85 or for $5 with a family membership of $35 per month.

Texas Medicaid tries to revise its “pay and chase” policies after a TV station’s investigation finds that taxpayers were charged for $705 million over three years for orthodontics. The state is holding the payments of 91 dentists suspected of fraud.


Sponsor Updates

  • MedAssets pledges support to employees who serve in the National Guard and Army Reserve.
  • Chris Tackaberry, co-founder and CEO of Clinithink, shares details of how Clinithink came about and the challenges along the way in an interview. 
  • SimplifyMD reports that 100 percent of its customers choosing to file for MU attestation have completed the process.
  • The Advisory Board Company hosts senior policy makers on Capitol Hill to discuss efforts to improve care under new Medicare value payment programs.
  • Cerner will integrate Gateway EDI’s claims and remit systems with its PM solutions.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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February 5, 2013 News 7 Comments

Curbside Consult with Dr. Jayne 2/4/13

February 4, 2013 Dr. Jayne No Comments

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I wrote a few weeks ago about the ICD-10 planning debacle at our hospital. Our ICD-10 task force had come to a physician staff meeting to discuss the transition plan, which had been created in a silo. I asked betting folks how long they thought it would take until the application team managers were asked to redo the planning. Any of you who guessed four days wins a prize.

The announcement that the IT teams would now own the initiative occurred just before our annual IT planning conference. During most years, we lock ourselves in a room for several days of bad takeout food, worse coffee, and questionable prioritization exercises.

I usually find myself at the end feeling bewildered at some of the initiatives that are given the green light. For example, last year we approved a hideous EHR conversion project for a single practice, but placed a project for hospital charge capture on the back burner even though the charge capture project was cheaper and easier.

If anyone asks, we use a well-known proprietary decision making process to decide which projects are most valuable to the organization. We all had to go through a multi-day course to use this methodology, although at the time it felt like multiple weeks. For those of you whose organizations are into that sort of thing, I salute you as survivors. (I don’t want to get sued using their name, but if you’ve ever dealt with The Red Sweat, you know what I’m talking about.)

For the physicians on the team who are used to assimilating numerous disparate data points and coming up with a diagnosis rapidly, it was pure torture to sit creating grids, weights, and ranks for various decision points. The hospital spent a huge amount of money licensing the program and training all of us, however, so we’re stuck with it.

For each project proposal, we have to create a matrix where we then rank things to hopefully achieve an objective outcome. It’s a completely biased process, however, because most of us know how to game the different measures to up- or down-rank a project. The outcomes remind me of the worst kind of back-room dealing. At least if we agreed up front that the decisions would all be political, we could save a couple of days and a few thousand calories of bad catering.

This year, we really should have skipped it. The results were so skewed it can hardly be called a prioritization process. Every project proposal seemed to earn the highest marks except for ICD-10 and MU-2, which of course shouldn’t have been part of the process since they’d already been labeled as mandatory.

One team member was hell-bent on twisting each of her pet items to associate to a regulatory requirement. It reminded me of Animal Farm, where all animals are equal, but some are more equal than others. By the end of the planning retreat, my fingers were raw from speed-surfing the Web trying to research and contradict her continued demands that we do every single item “because it’s regulatory.”

My current boss is extremely non-confrontational, so this behavior was allowed to continue. We are now left with a list of things to do that would require a team three times our current size. So much for prioritization.

Now it’s up to the managers to get together and cut deals to see they can help each other out and what projects overlap or can share resources so we actually have a shred of hope that we will get them done. There’s certainly no extra money floating around, so we’re going to have to shuffle the pieces on the board and figure out how to deliver the impossible. It’s lining up to be a very interesting year.

Have a great story about your organizational planning strategy? Do you feel like you spend every day in a war room? E-mail me.

Jayne125

E-mail Dr. Jayne.

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February 4, 2013 Dr. Jayne No Comments

Monday Morning Update 2/4/13

February 3, 2013 News 10 Comments

2-3-2013 8-45-21 AM

From HIStalk Fan: “Re: HITPC/HITSC testimony of Karen Van Wagner, executive director of North Texas Specialty Physicians. The Pioneer ACO shares results of its community HIE.” She talks about successful efforts to increase EMR usage (eCW, Allscripts, NextGen) and the results of the exchange (Sandlot Solutions), which was launched in 2006. She says traditional healthcare IT isn’t providing cost and quality improvements because it focuses on retrospective data, often from claims databases, and the optimal solution involves both retrospective and current clinical information. They did a discharge transitions project study that exceeded targets for PCP follow-up, having discharge summaries available for the follow-up PCP visit, and readmissions. Her specific recommendations to the government: (a) simplify consent and disclosure rules; (b) expedite adoption of IHE standards; (c) require laboratory diagnoses to delivered by LOINC standards; (d) require hospital EMRs to send a “just admitted” notice to community providers via their own EMRs; and (e) require pharmacy systems to communicate with HIEs and provide their information at no charge.

Hospitalist DZA MD left an insightful comment on my Time Capsule article about doctors getting lost in the barrage of generally useless information cluttering up EMRs. Excerpting:

Anything that is templated has exactly zero clinical information value to me. I don’t care if Osler himself dropped in “dyspnea improved,” “no diarrhea” … If I want to know the validity of that kind of thing, I will look at the narrative part of the nursing note … The only data I look at that actually represents signal is the vital signs and lab data. The rest of the discrete data is noise … The narrative and visual graphics (including graphic displays of lab and vital signs data) are for us (clinicians). The templated stuff is for the suits and insurance grifters. QED.

2-3-2013 9-27-06 AM

From The PACS Designer: “Re: Microsoft Office 365. Microsoft is making a dramatic switch by selling its enhanced Office products in the cloud. They are calling it Office + Office 365, and will be offering a monthly subscription service with pricing based on business size and features selected by the customer. It’s a big gamble on users satisfaction with cloud services which as we know can experience interruptions in service at inappropriate times of the business cycle.” The good thing about Office is that the once-touted Office killers, especially Google Apps, are vastly inferior flops. The bad thing is that home Office users aren’t likely to lock themselves into a $100 ongoing subscription for something they formerly bought or stole once, although it’s a pretty good deal if you have a bunch of PCs since the home license covers up to five (less likely now that everybody’s using iPads and phones instead of extra PCs). And, you can temporarily load and run it to a non-licensed PC. I think it can work – antivirus software moved subscription software for home users to the mainstream, not to mention that Microsoft can just jack up the price of the box version to move people toward the cloud-based offering,  which would also kill the bootleg business (possibly their primary motivation). It won’t help that Office 365 had an outage almost immediately after its launch, allowing the boxed software users to work merrily along while the leasers couldn’t even get to Outlook.

From Godzilla: “Re: [hospital name removed]. Filing suit against [vendor name removed]. Unhappy with the products, implementation, and project management.” A hospital media spokesperson replied on the record to my inquiry, “Nothing could be further from the truth. Inaccurate on all counts.”

From Unbeatable: “Re: [vendor name removed]. Laid off 31 developers and outsourced all work to India and the Ukraine. The Chicago office lost the largest number of staff.” I’ll see what I can find out.

From IndustryBnkr: “Re: OptumHealth. Rick Jelinek is leaving as CEO to pursue another opportunity outside the company, with Larry Renfro taking over.” Unverified, but his former “About Us” page has been deleted. He took the CEO job a year ago.

2-3-2013 9-52-42 AM

From HITEsq: “Re: MMR. Made good on its threats to sue someone for patent infringement in January, going after Walgreens. MMR’s theory is that displaying a list of your prescriptions infringes on its patents. I seem to remember having access on Walgreens before 2005 when the MMR patent was filed.” Patent trolls love the US system because (a) the Patent Office is overwhelmed, they don’t have the knowledge required to understand highly technical patent requests, and will approve just about anything and let the courts sort it out later; and (b) lawyers are so expensive that mounting a legal defense can bankrupt a defendant even when they are clearly right since our legal system requires the winner to pay their own legal costs. Unfortunately lawyers often morph into politicians and are predictably loathe to bite the hands (as inserted into the pockets of others) that once fed them and may again, so we are required to be collectively complacent about the status quo.

Speaking of despicable patent trolls, let us hear from our new hero, Lee Cheng, Newegg chief legal officer and extortionist squasher. 

2-3-2013 12-07-09 PM

In related patent troll news, billionaire bad boy Mark Cuban endows “The Mark Cuban Chair to Eliminate Stupid Patents” at the Electronic Frontier Foundation, which he funded because, “Dumbass patents are crushing small businesses. I have had multiple small companies I am an investor in have to fight or pay trolls for patents that were patently ridiculous.” Mentioned in the article is Acacia Research, which I’ve railed about here many times, which claims to own the process of sending medical images over the Internet.

2-3-2013 8-54-45 AM

Yale-New Haven Hospital (CT) went live with Epic on January 31. Above: Sue Fitzsimons, RN, PhD (SVP, patient services); James Staten (EVP, finance); Marna Borgstrom (CEO); Daniel Barchi (CIO, health system and medical school); Lisa Stump (VP, Epic project); Peter Herbert, MD (chief medical officer); and Richard D’Aquila (president and COO).

2-3-2013 8-59-17 AM

The stock-pickers among us like Cerner and athenahealth just about equally. New poll to your right: did you go to the HIMSS conference last year, and are you going this year?

Speaking of those stocks I listed, I decided to see how they’ve done in the past year: athenahealth (up 40 percent), Allscripts (down 45 percent), Quality Systems (down 57 percent), Cerner (up 34 percent), and Merge (down 49 percent).

Thanks to the following sponsors, new and renewing, that have recently supported HIStalk, HIStalk Connect, and HIStalk Practice. Click a logo for more information.

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2-3-2013 10-18-18 AM

Psychology scientists from Brigham and Women’s Hospital perform an interesting study in their research into “inattentional blindness.” Radiologists were asked to examine the CT scans of five patients and click on whichever of the 10 known nodules they could find. The final case included a gorilla image that was 50 times the size of the nodule, which 20 of the 24 radiologists did not notice even though eye-tracking instruments showed they had looked right at it. I don’t see this as necessarily bad – a lot of the work in medicine is tuning out the noise to focus on what you’re looking for. However, it does reinforce the idea that in general it’s good to get a second opinion from someone less focused on the problem at hand, and if you’re a patient or lesser expert, you still might detect the forest that the tree-obsessed people have missed. It may also touch on confirmational bias, where people tend to place higher value on information that matches what they already believe (like brains not containing gorillas).

A New York Times op-ed piece observes a “casual lack of transparency” in that drug and device companies make sure that only positive studies are published, with the trigger being Johnson & Johnson’s recalled artificial hip that was marketed despite known problems that the public wasn’t told about. It observes two attempted fixes that have failed: (a) the FDA requires new clinical trials to have summaries posted on a federal site, but an audit found that 80 percent of the trials ignored the requirement and no fines have been levied; and (b) the medical journal industry promised to publish only pre-registered studies, but an audit found that more than half of published articles involved trials that weren’t registered correctly and one-fourth covered studies that weren’t registered at all.

2-3-2013 12-10-37 PM

Good luck explaining healthcare pricing to the public. A graduate student’s gallbladder removal was billed at $60,000 by an out-of-network provider. His insurance paid what it defined as a reasonable rate: $2,000. The average commercial price is $12,292, while Medicare would have paid $958. An advocacy group stepped in and the surgeon accepted $340. The article says the Affordable Care Act does nothing to limit out-of-network fees, which are almost always a surprise to patients since buildings and white coats don’t come with “I’m in your network” labels. I’ve known people burned by in-network EDs that used out-of-network doctors or lab companies, and of course nobody volunteered that information, not that you really have a choice in the ED anyway. The comments left on the New York Times article are fascinating and often insightful. The graphic above is from a new AHIP report.

A foundation employee of Fairbanks Memorial Hospital (AK) is charged with diverting $12,000 in donations that had been collected online via PayPal.

GE Healthcare is working with the VA to develop surgical robots that can locate, sterilize, and deliver instruments.  

2-3-2013 12-03-36 PM

Meditech files its annual report. For the year, revenue was up 9.7 percent, EPS $3.55 vs. $3.41. Neil Pappalardo owns nearly 39 percent of the company, holding shares worth around $650 million. CEO Howard Messing’s shares are valued at around $18 million. Share values are probably low given that the company is not publicly traded – I just used the most recent per-share acquisition price, but if the company were to be sold or IPO’d, the value would probably be a lot higher.

Nuggets from the McKesson earnings conference call late last week:

  • Technology Solutions revenue was flat
  • Margins of the Technology Solutions numbers was hurt by a required revenue recognition change for the System C UK business McKesson acquired in 2012
  • RelayHealth and the payor software business contributed more than half of the profits of Technology Solutions
  • More legacy customers than expected have either already moved to Paragon or have committed to do so instead of moving to competitor systems
  • The Paragon ED solution is close to being generally available
  • Both Horizon and Paragon will support Meaningful Use Stages 2 and 3

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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February 3, 2013 News 10 Comments

Readers Write: Students in the HIT Spotlight

February 1, 2013 Readers Write No Comments

Students in the HIT Spotlight
By Lisa Reichard RN, BSN

2-1-2013 5-28-37 PM

Inspiring! That was the word that ran through my mind when I heard that the HOSA team of Harris County High School, Hamilton, GA had won the second annual Student HIT Innovation Award at the Health IT Leadership Summit for its Type 1 diabetes mobile health app.

As a former pediatric nurse who has worked with children newly diagnosed with diabetes, I was thrilled to see an app that can aid in the education and training of newly diagnosed patients developed by 11th grade high school students. Best of all, right here in my own back yard.

In my experience, this can be an isolating disease with challenging daily management. According to the Center’s for Disease Control (CDC), Type I diabetes has spiked 23 percent among children, with a 21 percent increase in Type II diabetes also reported.

The student team from HCHS rose to the challenge and was chosen from 12 semifinalists followed by a final four selection. HIStalk Connect’s own Travis Good, MD was on the judging panel.

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Left to right: Todd Bell, senior VP at Verizon; Brooke Grantham; Aleah Harris; Hank Huckaby, chancellor of the University System of Georgia; Christopher Keough; Brittney Wilkins; and Cheryl Batts, Harris County High School HOSA Advisor

I had a chance to chat with team member Christopher Keough to hear more about the experience.

How does your Type 1 Project app work and how does one download it?

Our Type 1 Project app has several links to choose from that provide general information about Type 1 diabetes, informational videos, a link to our website and Facebook page, and even a link to a carb counter. To download our app, search for “Type 1 Project” in the Google Play store, or to access it on your iPhone, visit type1project.conduitapps.com and just add to your home screen.

How will the app help kids recently diagnosed with diabetes?

We feel that kids would rather use a mobile application than receive information from a doctor or a book because most of them own some form of technology. Children and young adults can relate to how to best calculate the amount of carbs in food on the go with the link that we’ve provided through the app. They can also learn more about their condition through our website and the informational videos that we’ve provided.”

What are the plans for the product?

This mobile application started as a project for the Health IT Leadership Summit award, but we plan to keep it live for a limited time and try to make more users aware of the app through Facebook and other methods. We also plan to make ongoing improvements to the mobile application.

I also had the chance to ask Cheryl Batts, Keough’s advisor, how those of us in the health IT community can encourage students to foster future creativity in application development, and succeed in pursuing future IT careers.

“We can start in our classrooms,” she explained. “Last year, the health IT project was directed toward middle school students. Although an estimated 95 percent of students in my classes have cell phones, and this is where our mobile app can come into play, I believe many students have no idea what healthcare IT is. I know when I mention the number of job openings in Atlanta in my classroom, they all start thinking hard about it.”

“The mobile app we developed had a monetary award for our HOSA organization. HOSA, a national student organization, used to be an acronym for Health Occupations Students of America. However, it now stands for just Future Health Professionals. The chapter is for any student interested in a career in healthcare. The mission of HOSA is to enhance delivery of compassionate, quality healthcare by providing opportunities for knowledge, skill and leadership development of students. HOSA provides competitive events and leadership training at conferences that include knowledge and skill competencies through a program of motivation, awareness and recognition as part of the Health Science Education instructional program. Of course, these conferences cost money, so earning money for the organization helps reduce student expenses. The offering of scholarships is a big help to our students as well.”

Congratulations to Harris County High School on the receipt of this milestone award. Let’s all do what we can to support our local students. Who knows? We may start seeing more students demoing apps at trade shows. The future is looking bright!

Lisa Reichard, RN, BSN is director of business development of Billian’s HealthDATA of Atlanta, GA.

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February 1, 2013 Readers Write No Comments

Readers Write: It’s a Matter of “Over Promise and Under Deliver”

February 1, 2013 Readers Write 2 Comments

It’s a Matter of “Over Promise and Under Deliver”
By Mike Silverstein

2-1-2013 3-28-14 PM

As a recruiter in the healthcare IT industry, I attend HIMSS every year and make it a point to know what vendors are hot and what products and solutions are being purchased by the healthcare community. I am always shocked when I walk into the HIMSS exhibit hall and see massive booths of vendors I have never heard of. Even more shocking is the number of these massive booths that were at HIMSS the previous year but are not at this year’s show. I ask myself, “How does this happen?”

The answer took me to the biggest complaint I hear again and again when talking with hospital executives about their feelings toward vendors. It’s a matter of “over promise and under deliver.”

I am not using the over promise and under deliver adage when it comes to the performance of these seemingly fleeting companies’ products. Frankly, as a recruiter in this business, I have no idea what differentiates a good product from a bad one. The lens I look through is that of a search consultant who on occasion gets a call from one of these startup companies which has just received a considerable round of funding and is looking to recruit the top sales talent in the industry.

Their game plan is often the same: spend a bunch of money to hire salespeople who can go out and sell something, then hope something sticks and figure out the rest later. According to these same salespeople, the problem quickly becomes: (a) the product isn’t ready for prime time; (2) the company can’t implement what they sold; ( 3) they don’t get paid until go-live and it doesn’t look that’s going to happen in the next decade, so Mike, can you help me get out of here?

I recognize that the industry is primed for PE and VC investment. As a guy who makes a living by helping companies hire, I’m not going to complain. That being said, I think that the healthcare community could cut down on wasted IT spending, vendors could maintain better relationships with their customers, and I could cut down on the number of candidate resumes I have on my desk who took a chance on a startup. In fact, in the time it took me to write this piece, I received four more of these resumes in my inbox.

If everyone would more appropriately manage expectations and think about building an infrastructure and not just a sales team, the result would stop the over promising and under delivering circumstances.

Mike Silverstein is director of healthcare IT of Direct Recruiters, Inc.

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February 1, 2013 Readers Write 2 Comments

News 2/1/13

January 31, 2013 News 9 Comments

Top News

1-31-2013 5-38-58 PM

McKesson announces Q3 results: revenue up one percent, non-GAAP EPS $1.41 vs. $1.40, missing earnings expectations of $1.63 and guiding earnings slightly down for FY2013. Operating costs rose 10 percent, while technology solutions revenues were flat.


Reader Comments

1-31-2013 7-52-02 PM

From AphexTwin: “Re: Allscripts. Laid off five percent of its workforce (350 people) in testing and development roles. All remote development staff are being forced to relocate or be terminated.” An Allscripts spokesperson provided this response:

We internally announced the creation of R&D Centers of Excellence to enable us to better serve our clients, reduce complexity, and save costs. By making this move, we’re aligning with industry best practice and will be more agile in delivering results for our clients. Many team members will have the opportunity to relocate and some to work remotely. Unfortunately, there will be some team members whose positions will be adversely impacted, and they will be offered a severance package. In addition, we anticipate there will be Development jobs created in the North American locations with the majority of those in our Raleigh and Boston locations.

1-31-2013 7-59-22 PM

From The PACS Designer: “Re: iPad with Retina display. Apple keeps making the iPad more brilliant and powerful with the announcement of the iPad with Retina display. This new version also has 128GB of storage and a selling price of $799. The communications options now include both Wi-Fi and iPad with Wi-Fi+ Cellular as added features.”


HIStalk Announcements and Requests

1-31-2013 1-31-00 PM

Highlights from HIStalk Practice this week include: Epic, Allscripts, and eClinicalWorks accounted for 42 percent of all EP MU attestations through October, 2012. iPractice Group confirms that it has ceased operations. AMGA says it now represents 430 group practices and 130,000 FTE physicians. The HIStalk Practice Advisory Panel shares details of their practices’ social media policies and privacy and security measures. As always, thanks for reading.

On the Jobs Board: Director of Marketing, Epic Experienced Providers, Product Marketing Manager.

January, which isn’t quite over yet as I write this, will set an HIStalk record for the most monthly visits ever at 140,000, up 25 percent over January 2012.

1-31-2013 5-58-58 PM

Welcome to new HIStalk Platinum Sponsor VitalWare, a market leader in healthcare intelligence and regulatory compliance. The Yakima, WA company’s offerings include VitalView (ICD-10 planning and status between hospitals and vendors), VitalSigns (supports real-time retrospective coding to ICD-10 for starting efforts now to estimate impact on reimbursement and cash flow), VitalCoder (next-generation coding and revenue cycle resource), the just-announced CDM Navigator (charge master maintenance), and ICD-10 consulting and implementation. The company also offers VitalVendors, a vendor ICD-10 readiness rating system that’s part of the HIMSS ICD-10 Playbook. A guest post by Founder and CEO Kerry Martin provides a sobering update on the stage of vendor readiness for the October 1, 2014 ICD-10 compliance date. Thanks to VitalWare for supporting HIStalk, which thanks to its support will be fully ICD-10 ready.


Acquisitions, Funding, Business, and Stock

CommVault announces Q3 numbers: revenue up 24 percent, non-GAAP EPS $0.39 vs. 0.27.

Aetna announces Q4 numbers: revenue up 16 percent, EPS $0.56 vs. $1.02.

1-31-2013 7-53-01 PM

CPSI announces Q4 results: revenue up 14 percent, EPS $0.83 vs. $0.59, falling short of consensus estimates of $0.88. Shares are down nearly nine percent in after-hours trading.


Sales

1-31-2013 5-09-37 PM

Wenatchee Valley Medical Center (WA) and Central Washington Hospital select NextGate’s EMPI and provider registry systems.

Huron Valley Physicians Association (MI) chooses eClinicalWorks EHR for its 600 providers.


People

1-31-2013 5-11-06 PM

AHRQ Director Carolyn Clancy, MD announces plans to step down.

1-31-2013 5-20-26 PM

API Healthcare expands General Counsel Hayden Creque’s role to include vice president of human resources.


Announcements and Implementations

The VA completes integration and testing between VistA and Authentidate’s Electronic House Call and Interactive Voice Response telehealth systems.

1-31-2013 5-12-14 PM

The 24-bed Melissa Memorial Hospital (CO) completes implementation of its EMR.

1-31-2013 5-14-12 PM

Piedmont Newnan Hospital (GA) goes live this week on Epic.

Welch Allyn will distribute the EarlySense proactive patient care solutions to US hospitals.

1-31-2013 3-28-53 PM

Good Samaritan Hospital (NY) goes live on Epic March 9.

1-31-2013 3-30-19 PM

The University of California at Irvine uses the dbMotion interoperability platform to connect with  the Orange County Partnership RHIO.

Quantum Health integrates the Healthwise Care Management Solution into its Patient Information Virtual Integration Tool to provide real-time healthcare education to its members.

Stellaris Health Network (NY) goes live on PatientKeeper Charge Capture at five of its clinical practices group.

 


Government and Politics

The VA enhances Blue Button to give patients access to their Continuity of Care Document and the VA’s OpenNotes provider documentation.


Innovation and Research

1-31-2013 7-31-36 PM

A University of Washington graduate student develops FoneAstra, an Android phone app that monitors the pasteurization of donated breast milk. It’s being tested in South Africa. Other versions are used to ensure that vaccines remain refrigerated in developing countries.


Technology

1-31-2013 7-54-51 PM

Lt. Dan summarizes what the BlackBerry10 announcement means for mHealth and healthcare on HIStalk Connect.

University of Missouri-Kansas City’s Innovation Center will launch the partially federally funded Digital Sandbox KC IT accelerator on Friday, with officials from Cerner and other businesses on hand.


Other

Fifty-seven percent of Canada’s primary care physicians are using EMRs, which is almost double 2006’s adoption rate. Almost half routinely e-prescribe compared to 11 percent six years ago.

KLAS and EHI, a UK-based HIT research firm, partner to improve transparency and performance measures for the UK health technology market and to cross-market their research products.

Michael Dell’s family foundation donates $50 million to build Dell Medical School in Austin, TX.

The Minnesota Supreme Court rules that calling a doctor “a real tool” on a doctor rating site is protected speech.

1-31-2013 6-54-01 PM

Here’s an example of how technologically backward healthcare is. A body shop in Canada has been receiving faxed medical information for three years because its fax number is one digit different from that of the local health center. Says the body show owner, “In this day and age, why are they still using fax machines? It seems odd to me.”

I’m fascinated that this happens regularly in India. Twelve angry relatives of a teen who died after a bicycle accident trash the ICU and beat doctors and security guards. Medical residents then go on strike to demand better security and the arrest of the family members, which requires patients to be diverted and surgeries to be cancelled when only 20 doctors remain to care for 300 inpatients.

WNA thinks a hospital parody video makes him wonder whether ACO stands for Abridged Care Organization. Fox Business News says the video “mocks how health reform can make more money for doctors and hospitals” by showing staff blocking the admissions department door, handing out stacks of cash, and giving free laptops to employees. I didn’t see it that way – it looked like fun way to get the ACO idea across to otherwise learning-indifferent employees. The hospital says the video was a contest winner. Fox claims the video was “leaked,” which apparently means “posted to YouTube under the hospital’s name and still there but copied to Fox’s servers and covered with self-promoting graphics to make it look like the result of crack investigative reporting.”


Sponsor Updates

  • ESD joins ANIA as a Gold Level member.
  • dbMotion hosts a February 7 seminar in Dallas on connecting communities through clinical integration.
  • Laura DeBusk from White Plume Technologies will co-present an ICD-10 session at the Becker’s Hospital Review Fourth Annual Meeting in Chicago in May.
  • 2012 highlights for Aspen Advisors include the addition of 26 clients and the development and deployment of a population HIT planning methodology, a data governance maturity model, and an EHR value realization maturity model.
  • DynaMed showcases how Memorial Hermann Healthcare System (TX) utilizes technology to allow physicians to practice evidence-based medicine in a journal article.
  • Emdat Mobile usage has quadrupled from January 2012 with the rapid adoption of smartphones.
  • Lucca Consulting Group posts new client, consultant, and trainer testimonials on it website.
  • Macadamian CEO Frederic Boulanger says he is impressed with the new BlackBerry 10 and the company has developed 10 apps for it.
  • Truven Health Analytics announces that staff members Eboney White and Jillian Thomas have been presented with the unique credential of Accredited Health Care Fraud Investigator.
  • CareTech Solutions added five Service Desk clients in 2012 and experienced a 75 percent uptick in the use of its help desk services overall.

EPtalk by Dr. Jayne

Earlier this month, Virginia Senator Stephen J. Martin introduced SB 1275, “Medical data in an electronic or digital format; limitations on use, storage, sharing, & processing.” As a medical informaticist, all I can ask is what was he thinking? It would prohibit anyone who stores medical data in an electronic or digital format from participating in the Nationwide Health Information Network; performing analysis or statistical processing on medical records for purposes of diagnosis or treatment, including population health management; processing medical data within Virginia where a majority of the patients do not live in Virginia; and storing data on more than 10,000 patients in a single database, It also prevents providers who refuse to implement EHRs from being penalized and prohibits Virginia from authorizing or operating a health information exchange. I’d be interested to hear from anyone in Virginia who can tell us more about what’s really behind this besides anti-ARRA posturing. It’s been sent to committee where it will likely die, but still makes for good cocktail party conversation (at least among HIT folks).

It’s about time: Medicare will look at the facility fees charged by ambulatory medical practices. Many feel that these hospital-owned practices are driving up the cost of health are with this billing practice. Many of the groups in my area are now doing this. It’s not only annoying, but also feels dishonest.

Lots of buzz this week about the HIPAA update and the impending September compliance date. Looking forward to reading hundreds of pages of fun during my free time, whenever that is.

Although I thankfully don’t have any direct reports, before our recent hiring freeze I was often asked to interview potential employees for other managers. I’m going to keep this list of bizarre interview questions tucked away for when administration figures out we’re dangerously short-handed on some of our teams.

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Bad news for Inga: an increasing number of young women are having issues with their feet that require surgery. Some blame is being placed on genetics, but the phenomenon is at least partially attributed to high heels and pointy-toed shoes. She’s always telling me I’m too conservative in the shoe department, so maybe for HIStalkapalooza I’ll be more inspired this year.

Print


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 31, 2013 News 9 Comments

Morning Headlines 1/31/13

January 31, 2013 Headlines 1 Comment

Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA

JAMIA publishes the recommendations of a year-long EHR usability task force that included representatives from academic settings and EHR design analysts.

Huron Valley Physicians Association IPA Selects eClinicalWorks

Huron Valley Physicians Association of Ann Arbor, Michigan, has selected eClinicalWorks as an ambulatory EHR solution for its 600 providers.

HIT 2012 Annual and Q4 Funding and M&A Report

A 2012 HIT market analysis shows significantly increased venture capital funding, with $1.2B in funding spread over 163 individual deals.

EHI and KLAS Partner to Improve NHS IT Measures

KLAS has partnered with EHealth Insider, a UK-based health IT news and research firm, to bring performance measures to the UK health technology market.

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January 31, 2013 Headlines 1 Comment

HIStalk Advisory Panel: HIPAA Concerns and Priorities

January 30, 2013 Advisory Panel 4 Comments

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

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

This question this time: When you think of potential HIPAA isses, what parts of your health system’s operation give you the most concern? What are your top HIPAA-related priorities?


Our top HIPAA concerns relate to the use of personal devices such as smartphones to transmit pictures and unsecured text. While we can and do provide secure alternatives, there is really nothing we can do to prevent a medical student from snapping a picture of a patient or patient data and sending it to several hundred of his closest friends.


HIPAA is an interesting concept. How do you balance providing sufficient access to critical information that can impact a patient’s health and still protect their privacy? It’s not easy. For many of the children we care for, privacy is not just a regulation to follow, it’s life and death – for children in custody disputes and victims of violence. The most significant challenges we face involve the fact that both the rules and technology are changing at an ever-increasing pace. The people writing the rules aren’t always the ones with the most knowledge about how (and even if it’s possible) to implement.

It’s ironic that we are both demanding healthcare costs go down and simultaneously creating new and unfunded mandates that require enormous amounts of time and money to implement. The two things I worry about most: mobility of devices and data  and staying current on vastly complex laws. Small hospitals outside of a larger system are still required to adhere to the same rules and regulations even if they have a fraction of the resources with which to do so.


Top HIPAA-related priorities and concern for us center around secure communication between our staff with clients and providers. Ensuring that the proper processes and technologies are used to secure communications via e-mail, instant message, or any channel is paramount.


When it comes to protecting PHI, my biggest concern is the data that goes to our physicians’ offices for billing. There are many concerns, but how the practice and the billing services treat this data is my greatest. We have no way to audit how this data is used and disposed of. Practice adherence to HIPAA security and privacy is very minimal, as an independent practice has little knowledge or resources to dedicate to this requirement. 


HIPAA security requires complete control of PHI storage. There is so much distributed data acquisition going on that it’s difficult to ensure complete control. Example: digital photos taken in the clinic stored on memory cards. Clinical staff don’t see these cards as containing PHI, but they do. Thieves see the cameras as easy to pawn theft targets. When stolen, we have a privacy breach on our hands. In retrospect, we learned we lack procedures to wipe the cards of data once the images are stored in the EHR. These novel data stores continue to pop up and represent control risks.


I lay awake at night thinking about unencrypted laptops. With all the other projects, this one keeps sliding down the priority list. The CFO all but refuses to fund this. We have a policy against keeping PHI on the PC, but I know no one follows this policy.


I’m glad you’re running my comments anonymously because I don’t want to advertise how many potential HIPAA vulnerabilities we have in our organization, ranging from PHI routinely sent via insecure text messages (and the Web-based paging system), workstations that are visible to the outside world that don’t secure properly, shared common windows passwords, shared common remote login passwords, EHR printouts that aren’t shredded in a timely manner, etc. I’ll stop now before I trigger a subpoena coming your way.


Mobile device security and BYOD are probably our biggest concerns. We have a number of clinicians using their own devices, communicating and coordinating patient care. We are putting in place comprehensive mobile device management system that will provide secure communications options. We are in the process of encrypting laptops and securing USB ports.


General staff knowledge and awareness would be the first thing that comes to mind. We can write policy and implement all the controls we want, but people will find ways to circumvent if they don’t understand the whys. Our top priorities in the coming year include establish ongoing staff education, conduct annual policy review, create mobile device management strategies, and evaluate data loss prevention solutions.


We do a good job of educating our employees on HIPAA. We don’t see too many concerns with patients. We do get the occasional employee who looks at a relative’s records. Our greater concern is office staff of independent providers who have access to our patient database by necessity. We rely on the physicians in their office to provide initial and ongoing HIPAA training and this breaks down. We also have the issue of those employees leaving employment in the physician office and the office not informing us to cancel their access. We do a manual audit every 90 days.


There are really four classes of data we are charged with protecting. First, our current data, which may be stored locally or remotely. Second, the data we push out to others (patients, providers and organizations). Third, the data we receive from others and is received in various formats. Fourth, our archived data which might be scanned, paper, or legacy digital formats. The diversity of data itself poses its own challenges.

We often think of securing data through protection from security breaches such as device theft or hackers. Encryption has become the standard in this regard. However, the more common occurrence would be in the form of end user error — leaving devices without logging out or the dreaded exposed password. While much of our effort has to be on prevention of the "big event," we must still focus on end user HIPAA training and routine auditing as the first line deterrent to loss of PHI.


My biggest technical concerns are with mobile devices. We are pushing quite a bit of data to them in e-mail alone, and even with security policy in place, it is still a huge exposure. While internal threats like staff inappropriately accessing someone’s records may be larger, technical solutions to a threat like that are harder to address. Our privacy officer gets to lose sleep over those.


The inability to control what disgruntled employees can do with sensitive health information. Overly curious individuals are also a problem in terms of celebrities or people they know, but they typically would not compromise the sizable amounts of information that could be breached by someone with a grudge and/or desire to sell information for money. Carelessness is also a major problem when people are working with large data sets or spreadsheets as part of their job and leaving it on laptops or sending it in unencrypted files via e-mail. 

The use of workarounds to data security initiatives. The tighter the security lockdown, the greater the impingement on ordinary work and productivity, especially in comparison what people are used to doing in other realms of life. Rather than helping with data security, the workarounds just seem to make matters a whole lot worse because then people exchange info surreptitiously by cell phone images, Gmail, and the like. 

Since I’m not in management, my top priority is making sure that I keep the data of my own patients secure. Another goal is to educate residents and medical students about the importance of patient privacy. I also advocate for more enlightened approaches at a local and national level for protecting confidential information and for giving patients more say in the way their sensitive information is stored and shared with others.


Where to start? My biggest concern is not knowing what I don’t know. Our customers are doing all kinds of things that I can’t control. I’m sure that data is leaking like crazy and we’re doing all we can to contain it. I am hopeful that in the next 60 days we will have a much better understanding of what is occurring and that we will have better control. Our biggest HIPAA priorities are data loss protection and then preparing for the inevitable audits.


With the increasing use of clinical and other data (read PHI), our concerns are growing around mobility and continued violations of our use policies. We are moving to our second mobile security platform/tool, but are not convinced that even after best efforts that we are "safe." There will always be threats and we have to continuously evaluate what those threats are and how to prioritize the work to protect our data.

Our organization has finally realized we are not impervious to breaches or attacks and is supporting new efforts to ensure we are doing what is appropriate to secure the environment. In addition, we are trying to play more "hard ball" with violators of policy on data use and access. I am afraid a few examples will have to occur before the majority of our users realize we are serious about this as an organization.


The biggest HIPAA issue would be a breach > 500 which triggers a multitude of bad events  We do take the approach of "when" not "if" so we are prepared, but we are implementing technology and procedures to reduce the risk of occurrence. The biggest risk is related to PHI leaving the organization. That can happen in many ways (e.g. mobile devices, mobile media, viruses and e-mail). We have implemented encryption in these areas to reduce this risk. We also have virus protection and a SEIM tool to monitor network attacks.

Our next effort is implementation of a data loss protection (DLP) tool. This tool maps the location of all PHI in your domain. Strict rules can then be applied to govern the movement of that PHI. Besides encryption, my feeling is that DLP will have the biggest impact in protecting an organization from a breach.


We had two significant reportable breaks last year, but neither were related to the electronic medical record or other electronic systems here. The first was a physician who e-mailed an Excel spreadsheet which contained PHI to an external unsecured e-mail server. The other was a resident who took home paper copies of patient records for the purposes of a lawsuit they were gathering potential evidence for. In neither case was the patient information actually exposed, but they were reportable breaches nonetheless.

We are in the process of implementing a new clinical platform, so my focus is creating one balancing the new robust functionality with the safeguards that are needed to protect the information. Not an easy task.


Laptops. No matter what we do or what we say, folks will still copy and past information and manage to store PHI on their laptops. We lock down the laptop as much as possible, train, and continuously educate and inform, but the laptop is still our weakest link in the chain.

New phones. With new phones and applications for them, I believe there is more opportunity to access PHI. If you can clone someone’s phone by walking by them and picking up their information, what happens if someone is sending them e-mails, updates, or questions via e-mail, etc.?  I am not very informed in this area, but very concerned.


Top concerns: access controls within older non-core EHR systems, such as radiology, lab, and custom systems that we have developed. Providing appropriate levels of adolescent confidentiality. Opening access to psychiatric care visit information as much as legally possible. 

Top priorities: dealing with the above. Getting lawyers and others to understand that data-sharing across legal entities for ongoing and potential future care is the same as "treatment" and therefore allowed by HIPAA. Physicians who are members of different legal entities who practice together (e.g., in an ACO) often need to use the same EMR database and that having two or more separate records in a system for a single patient (which is their idea how to do this) is just dangerous.


Vulnerabilities that are rooted in human behavior or misbehavior concern me the most: apathy, naiveté, curiosity, theft, and vengeance. Continual education and empowering employees and physicians with scenario techniques on how to appropriately deal with common situations is helpful. Not intending to scare or intimidate people into compliance, we share media stories of fines and prosecutions of healthcare systems who have had incidents of security or privacy breaches.


The proliferation of personal devices where clinical information can be accessed (smartphones, tablets). We’re working on how to best encourage provider access / patient engagement while still ensuring appropriate security and privacy. 

Many vendors, including our eClinicalWorks vendor, are increasingly utilizing cloud technology. We’re working to be able to make best use of the new products while managing security.


The people. Information technology systems are relatively easy to secure, but people have this aggravating habit of not doing what you tell them or expect them to do. I’m functionally the assistant security officer, although my title doesn’t reflect it.  I did about half of the facility education in 2003 for the Privacy Rule implementation and it still amazes me how many people don’t make basic information security and patient privacy a part of their day-to-day existence in healthcare.

In 2003, there were three groups of people: those who lived privacy, those who had heard of privacy but for whom it was an add-on to their daily life, and those who had never heard of privacy or the Privacy Rule. In 10 years, we’ve pretty much stamped out the "never heard of it" problem, but there are a lot of people who still treat patient privacy as something to think about when everything else is done. A text message to a friend here, a social media message to a friend there (even a private one) and you have opened yourself up to serious problems. Somehow we still have to convert those folks over to people whose lives include patient privacy. I’m still working on how.


Not misspelling HIPAA :) 

The use of HIPAA as a way to make life harder for physicians, such as CIOs and lawyers creating inane password policies or medical record clerks denying access to results of study I ordered without a written consent "because of HIPAA.”

Stupid mistakes (e.g. having patient info on an unprotected medium which gets stolen). Interestingly, while this may result in embarrassment and financial penalties, it rarely actually compromises a patient’s medical information.

The reality is that HIPAA is simply a mandate of common sense (i.e. only share patient info with someone who should be able to see it for obvious clinical, operations, or payment reasons), and yet ironically it actually winds up making people lose their common sense in how to deal with data and potentially hurts the quality of care by denying access to data needed by caregivers.


Downloading PHI to personal laptops or other mobile storage devices that are not encrypted and not secured with a strong password. All of our corporate laptops and portable storage devices (e.g., thumb drives) are encrypted and password protected, but that’s not the case with personal laptops which inevitably are used by employees for work-related tasks. I’m also constantly concerned about insiders and trusted agents who engage in for-profit identity theft.


In our organization, a chief privacy officer has virtually shut down all research in the name of HIPAA and patient privacy. She has even begun to question the utility of quality improvement efforts and their need to review patient records.

Our health system is most vulnerable with the new culture of real-time information, which means that caregivers are texting, e-mailing, taking photos, etc. as part of the normal practice of patient care. Our EMS and cardiology service line had a great process in place to get information to cardiologist on the patient prior to arrival by using a smartphone to take a picture of the EKG and text it to the physician. Great idea, but not vetted for patient privacy and security.

It is up to us to stay in front of this new culture and put the appropriate privacy and security measures into place. Our health system is developing its updated security program now and I’m concerned that some of these things are going on without our knowledge or preparation.


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January 30, 2013 Advisory Panel 4 Comments

News 1/30/13

January 29, 2013 News 10 Comments

Top News

1-29-2013 6-31-49 PM

Medecision, which just announced plans to lay off 83 employees, acquires Cerecons, a provider of care coordination, population management, and quality outcomes and reporting applications for ACOs.


Reader Comments

1-29-2013 7-10-48 PM

From Greenway Rep: “Re: iPractice Group. During the last few days, we did learn that iPractice Group, one of Greenway’s resellers, ceased operations effective last Friday, January 25. This reseller represents a very small percentage of our provider base. We look forward to continue working with these sites, which will have the option to either transition to another Greenway partner or choose to work directly with us for implementation and/or support services.” Greenway confirmed that iPractice Group has ceased operations, as reported by reader Nasty Parts this past weekend. The company claimed to have almost 1,000 provider clients, so the impact to Greenway remains to be seen. The CEO of the three-year-old iPractice blamed its closure on poor Q4 sales. The company moved into a new headquarters building in October 2012 that was more than triple the size of its former location, increased headcount by 800 percent to 70 employees since 2011, and acquired a competitor in 2011. Greg Bolan, who runs the healthcare equity research arm of brokerage firm Stern Agee, credited HIStalk with the initial rumor in an investor flash note, also expressing concern about the impact on Greenway’s sales. Greenway was among the ten biggest percentage decliners on the NYSE Tuesday, with shares dropping 7.7 percent.

From Tom: “Re: [inpatient vendor name omitted]. Is laying off 75 percent of its staff. All IT staff gone, most implementation and some development staff gone.” Unverified, so I’ve left the vendor’s name off for now. Usually someone leaves a comment saying, “Yep, that’s my company and it’s true,” so we’ll see.

1-29-2013 9-52-49 PM

From Mrs. Te’o: “Re:  Joe Schmitt, previous CIO of Steward Health Care. Will be named new CIO of Brigham and Women’s.” Unverified, but the forwarded second-hand e-mail insists that’s the case.

1-29-2013 8-11-15 PM

From CIO Tracker: “Re: Barry Blumenfeld, MD, MS. Leaving as SVP/CIO of MaineHealth less than 60 days after bringing Epic live at the main hospital. The planned rollout to seven member hospitals is being pushed back while the main hospital consumes all resources. The CIO is a casualty of exceptionally wide scope without commensurate resources.” CIO Tracker provided a genuine-looking memo purporting to be Barry’s notice to staff that he’s leaving as of January 30, but I’ve heard that he actually left early. They’re looking for an interim CIO, rumors say.

From The Amish Avenger: “Re: GE/IDX. I want to pare back its use for scheduling and registration and use the EMR instead. I keep hearing that GE/IDX isn’t selling well and has had job cutbacks. What can I expect to see? Fewer code updates? Less support?” I’ll step aside and let readers chime in.

1-29-2013 7-29-58 PM

From Danbury Whaler: “Re: Norwalk Hospital. Getting swallowed up by Western Connecticut Health System. Rumored layoffs of 200+.” Norwalk signed the affiliation agreement last week. Layoffs weren’t mentioned, but are certainly likely.


HIStalk Announcements and Requests

1-29-2013 7-02-37 PM

The window for expressing interest in attending HIStalkapalooza is closing. Sign up now if you’re interested in a March 4 evening of food, drink, HISsies, bowling, and Zydeco music.

1-29-2013 7-53-01 PM

Welcome to new HIStalk Platinum Sponsor Dearborn Advisors, LLC. The Chicago-area professional services firm, founded in 2001, is a trusted advisor to clients who need help with clinical systems strategy, adoption, and deployment. Its services fall into three groups: strategy and value, clinical, and engagement and project management. All of those help clients maximize the return on investment of their clinical systems. The company’s consultants are experts in Allscripts, Cerner, Epic, GE, McKesson, Meditech, and NextGen, while the company maintains a close working relationship with Epic and Meditech. I’m impressed by the quality of their blog posts, such as this one on medication management. You surely know some of their executive team members if you’ve been around the industry for a while: Rick Mager, Jay Toole, Sally Akers, Bruce Bowers, John Brill, and quite a few more highly experienced people, with a significant number of them clinicians. Thanks to Dearborn Advisors for supporting HIStalk.


Acquisitions, Funding, Business, and Stock

1-29-2013 6-32-50 PM

Intuitive Health, which offers a platform that connects providers with at-home patients and their personal health devices, raises $3.8 million.

Informatica’s Q4 results: revenues up three percent; non-GAAP EPS of $0.41, down from $0.47 last year. The consensus EPS estimate was $0.37.

Roper Industries announces Q4 results: revenue up 10 percent, EPS $1.44 vs. $1.23, beating expectations on earnings while falling short on revenue. Chairman, President, and CEO Brian Jellison said the integration of Sunquest, which the company acquired this past summer, is on track, with Sunquest being a strong performer with high single-digit growth. The company’s CFO did note in explaining a tax rate adjustment, “Sunquest as a US-based company generates most of their earnings in the United States, which is the highest tax rate in the world.”

1-29-2013 10-06-41 PM

Lexmark announces Q4 results: revenue down nine percent, EPS $0.10 vs. $0.94. Its Perceptive Software unit was the bright spot, reporting revenue that increased by 40 percent over 2011.

1-29-2013 9-40-18 PM

Startup Ringadoc, which offers after-hours triaging of physician calls for $50 per month with no contract, raises $1.2 million in seed funding. I believe that’s a reflector thingy in its logo.

Philips announces that it will exit the consumer audio and video business to focus on home appliances and healthcare.

1-29-2013 10-08-03 PM

Margo Hendrickson, athenahealth VP of human resources, responded to our query about the company’s announced plans to lay off 36 employees of its Birmingham, AL office on March 6. That office is the site of the former care coordination platform vendor Proxsys that athenahealth acquired in July 2011:

“As a high growth company, we are always looking to apply efficiencies to the way we work. While it is incredibly difficult to let people go from what otherwise is a growing employee base, our intent and commitment to shareholders is to align investment with business growth opportunities. This focused set of employee restructuring will allow us to achieve several critical business scaling and financial objectives that otherwise we would struggle to meet. At athenahealth, we are committed to ongoing team growth; in the past year alone the Company has grown its US employee base 28 percent, adding a total of 473 new employees to its US total of 2,140.”



Sales

1-29-2013 2-55-23 PM

Sidra Medical and Research Center in Qatar selects Amcom’s emergency notification and call center solution and Omnicell’s G4 automated medication management system.

1-29-2013 6-34-33 PM

Scripps Health (CA) will implement Wolters Kluwer Health’s ProVation Order Sets software as its electronic order set solution.

Pioneer Medical Group (CA) signs an agreement with McKesson’s MED3OOO division to jointly own and operate an advanced management services joint venture.

1-29-2013 3-03-12 PM

Holyoke Medical Center (MA) expands its relationship with eClinicalWorks to include the eCW Care Coordination Medical Record for advancing ACO and PCMH objectives.

1-29-2013 3-04-18 PM

University of Virginia Health System will deploy MModal Fluency Direct and MModal Catalyst for Quality to speech enable its EHR systems.


People

1-29-2013 3-06-17 PM

HealthTech Holdings hires Tom Mitchell (MModal) as VP of marketing for its HMS, MEDHOST, and PatientLogic companies.

1-29-2013 3-15-34 PM  1-29-2013 10-26-32 AM

HIMSS recognizes James L. Holly, MD (UT Health Science Center) with its 2012 Physician IT Leadership Award and Robin S. Raiford (The Advisory Board Company) with its 2012 Nursing Informatics Leadership Award.

1-29-2013 6-39-08 PM

MedAssets appoints Keith L. Thurgood (US Army Reserve) president of its Spend and Clinical Resource management segment.

1-29-2013 3-22-52 PM  1-29-2013 3-24-36 PM

Streamline Health adds  Richard D. Nelli (OptumInsight) as SVP/CTO and Herb Larsen (Edifecs) as SVP of client services. Streamline also announces the resignation of SVP/COO Gary Winzenread.

1-29-2013 3-26-59 PM    1-29-2013 3-31-53 PM

HL7 appoints Joyce Sensmeier (HIMSS) and Walter Suarez, MD (Kaiser Permanente) to its advisory council.

1-29-2013 8-35-45 PM

Randy Gaboriault, VP/CIO of Christiana Care Health System (DE), is named by Computerworld as a 2013 Premier 100 IT Leader.

Former Barnabas Health (NJ) SVP/CIO Joseph Sullivan is named “client in residence” by management print services vendor Auxilio.



Announcements and Implementations

1-29-2013 3-33-16 PM

CPSI announces the formation of TruBridge, LLC, a wholly-owned subsidiary that will provide business services, consulting services, and managed IT services to rural and community healthcare organizations.

Intelligence InSites announces integration of its real-time intelligence platform with ScheduleAnywhere, an online employee scheduling software from Atlas Business Solutions.

1-29-2013 10-00-13 PM

Gottlieb Memorial Hospital (IL), part of Loyola University Health System, goes live with Epic.

TriZetto announces that BCBS of Tennessee is using its benefits solution to offer value-based insurance benefits to members.



Government and Politics

ONC publishes research to help providers putting HIEs in place, including findings on query-based exchange, HIE-driven notifications and subscription services, provider directory solutions, master data management, and consumer engagement and consumer-mediated exchange.

The operator of the leading cord blood bank settles FTC charges that it lacked policies and procedures to protect patient information in a 2010 breach involving unencrypted computer equipment stolen from an employee’s car containing the information of 298,000 patients. The company avoided a financial penalties by agreeing to improve IT security and to conduct a security audit every other year.


Technology

1-29-2013 10-09-18 PM

State auditors cite University of Iowa Hospitals and Clinics for not encrypting laptops. The hospital responded by saying it encrypts “where technically possible,” but the state official refused to back down, saying, “If it’s not technically possible, then they need to tweak the system a bit so that it is technically possible.”


Other

1-29-2013 7-41-27 PM

This patent troll story doesn’t involve healthcare, but it provides a good lesson. A fake company set up by a lawyer who bought some old patents and created a business based entirely on suing big companies for infringing on its claimed patent on online shopping carts finally gets its butt kicked, courtesy of online retailer Newegg. The company had shaken down big online retailers, demanding a percentage of annual revenues. Victoria’s Secret and Avon had already been ordered to pay $18 million and one percent of their annual online revenue, while Amazon had paid the patent troll an amazing $40 million. Newegg, which has vowed that it will never settle with a patent troll, successfully had the company’s patents invalidated on appeal. You have to admire Lee Cheng, Newegg’s chief legal officer (above):

”We basically took a look at this situation and said, ‘This is bullshit.’ We saw that if we paid off this patent holder, we’d have to pay off every patent holder this same amount. This is the first case we took all the way to trial. And now, nobody has to pay Soverain jack squat for these patents … Just think about the dynamic if you’re a juror … Everyone wants to go home. It’s not their money. Defense oriented jurors are more likely to compromise and say, ‘Maybe we’ll just split the baby. Maybe we’ll just give them $2.5 million and call it a day.’ … We’re competing with other economies that are not burdened with this type of litigation. China doesn’t have this, South Korea doesn’t have this, Europe doesn’t have this. Just in our experience, we’ve been hit by companies that claim to own the drop-down menu, or a search box, or Web navigation. In fact, I think there’s at least four that claim to ‘own’ some part of a search box … Then they pop up and say, ‘Hello, surprise! Give us your money or we will shut you down!’ Screw them. Seriously, screw them. You can quote me on that.”

1-29-2013 10-02-19 PM

Guam Memorial Hospital says a software bug introduced by its vendor NTT Data caused it to underbill drugs by $1.9 million since May 2012. It found the problem as part of a financial improvement initiative and says NTT Data has confirmed and fixed the bug.

Zoll Medical says it’s the first defibrillator vendor to promise that it will share patient data from its devices, providing tools that allow other vendors to share the information it collects for patient care, such as in emergency medicine.

A small town in Australia loses its Internet connectivity for the third or fourth time in a month, with some of the previous outages having lasted days. Merchants can’t charge credit cards, but the medical clinic brings up more pressing problems: “We receive all our pathology results, specialist letters and discharge summaries through the Internet. If a patient comes to us needing treatment after they have just been discharged from hospital and we don’t know what they need or what they’ve had done, that’s a real problem.”

HIT incubator Rock Health rolls out a single online employment and internship form for applying to work at any of its 49 portfolio companies.

Weird News Andy finds this story amazing: researchers at Texas Heart Institute are building replacement human hearts from pig hearts, saying animal organs “reanimated” with human stem cells can be used in emergencies. The lead scientist also predicts being able to reverse aging at some point, storing stem cells from patients while they’re healthy as replacements for when they aren’t. She says she’s regularly called Dr. Frankenstein.


Sponsor Updates

  • Intellect Resources offers tips for job seekers hoping to get the attention of online recruiters.
  • Infor Healthcare and NTT DATA host a February 13 webinar to discuss Lawson Financials and the effective interaction between legacy and new technology systems.
  • CommVault announces details of its fifth annual WTG Customer Seminar March 13 in Boston.
  • Truven Health Analytics hosts a January 31 Webinar highlighting coverage challenges under the ACA.
  • First Databank releases the FDB State and Federal Controlled Substances Module, which facilitates the e-prescribing, dispensing, tracking, reporting, and claims processing of controlled substances.
  • Vitera Healthcare Solutions will give practices using its Vitera Stat PM/EHR product access to DiagnosisOne’s CDS content and patient education materials at the point of care.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 29, 2013 News 10 Comments

Morning Headlines 1/29/13

January 28, 2013 Headlines No Comments

Computer Programs and Systems, Inc. Announces Formation of TruBridge, LLC

CPSI announces the formation of TruBridge, LLC, a wholly owned subsidiary which will provide business services, consulting services, and contracted IT services.

Siemens Healthcare’s Q1 profits jump 38%

Siemens posted quarterly profits of $1.62 billion, or $1.89 per share, on sales of $24.15 billion.

Request for Information on Hospital and Vendor Readiness for Electronic Health Records Hospital Inpatient Quality Data Reporting

CHIME comments on CMS’s request for information on EHR-based quality reporting readiness, raising concerns over how discrete data should be extracted from narrative physician notes for reporting.

5 findings in ONC HIE research

ONC publishes new research highlighting the types of high-impact services that can sustain HIE organizations.

Health chief wants big telemedicine network across Georgia

Brenda Fitzgerald, MD, public health commissioner for Georgia, reports that every public health center across the state will be able to put patients in front of top specialists via telemedicine within three years, citing grant applications as the primary means of paying for the program.

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January 28, 2013 Headlines No Comments

Readers Write: In Defense of Copy-Forward

January 28, 2013 Readers Write 5 Comments

In Defense of Copy-Forward
By Lyle Berkowitz, MD

1-28-2013 6-34-06 PM

I’m part of the Association of Medical Directors of Clinical Information Systems (AMDIS), a group of 2,000+ physicians who are the experts in implementing and using EMRs. We have a pretty lively listserv discussion board, and I enjoy seeing what my colleagues are thinking, as well as posting my own thoughts. I especially enjoy posting when I feel like certain studies or comments by non-clinical researchers, administrators, or politicians make us start to question common sense.

One of my favorite topics recently came up — the fear and horror associated with actually reusing some of a previous note. This usually falls into the concept of "Copy-Forward" (when you copy forward the whole note and then edit for today’s visit), or "Copy-Paste" (when you select certain parts of a past note and just copy that part of it. I posted my reply and thought I’d share and expand a bit.

So as not to bury the lead, I think Copy-Forward of a note is a great tool and supports both efficiency and quality, when used appropriately. Turning it off is a classic throwing the baby out with the bathwater analogy. To clarify my biases, my thoughts and ideas are mainly from the perspective of an outpatient physician using Copy-Forward over the past decade, but much of this certainly can be applied to the inpatient world in various ways.

Also, the use of Copy-Paste has some similarities to Copy-Forward, but I agree Copy-Paste is not nearly as efficient and poses more quality issues since it does not have the automatic updating features you might see with Copy-Forward. Here are the points I would suggest we consider.

First, I am sick of these reports which say that things like, "We used plagiarism software to show that 60-80 percent of a doctor’s note is the same as their last one." Um, of course! Since when did progress notes become creative writing endeavors about coming up with different ways to document diabetes, hypertension, and obesity in the same patient visit after visit?

The creative parts of doctoring should involve being "House": figuring out the diagnosis, figuring out the best treatment plan, and artfully explaining it all to the patient. It should not be writing Edgar Allen Poe-like short stories to amuse our auditors or confuse our colleagues. Although, it could be fun, hmmm… what if I described a diabetic’s problems with hypoglycemia in Poe’s style: "Arousing from the most profound of slumbers (due to a glucose of 45), the patient states he feels as if he was in a gossamer web of some dream. Yet in a second afterward, so frail may that web have been, he claims to not remember that which he was dreaming."

Second, there are obvious efficiency benefits to Copy-Forward, but there are very real quality benefits as well. The most obvious is that this type of workflow makes it less likely that important diagnoses will be missed or forgotten over time. Additionally, many systems update certain pieces of data during the Copy-Forward process, so that you can see the most recent results (discussed more below). Obviously incorrect information can be duplicated, especially when a note is being authored by multiple providers over time, but this is where good training and leadership are needed to ensure every provider feels fully responsible for everything in their notes.

Third, getting rid of Copy-Forward or even Copy-Paste is certainly overkill, but we do need to use some common sense in designing technology, workflows, and processes that make it easy to do the right thing when documenting. In the ideal system, much of the critical data would either be updated automatically (e.g. the most recent lab would appear when a note is copied forward), or the system would date entries so it is clear what was done in the past versus today. To clarify, let me break down how an ideal progress note might look like when Copy-Forward is used:

Allergies, Meds, Problems

These update automatically, which is great, and means the note has the most recent data. I would hope all EMRs have this functionality already.

Past Histories (Social, Surgical, Family)

These copy forward and allow for easy editing in the note. Ideally, they could be managed in a widget external to the note and have them update from those profiles as well.

Physical Exam

Want to ideally be able to view old physical exams, and even reuse them when desired (except for vitals). In my current system, the full exam (sans vitals) does copy forward. So I usually just delete it and drop in a new macro and edit that. However, some patients have findings I want to compare from last time (e.g. size of a rash), or consistent findings (e.g. murmur) which I want to be reminded about

Labs/Studies

For labs (e.g. CBC, chem, chol profile) and certain studies (e.g. mammogram results, last ECG), we use macros which "auto-updatem" so when a note is copied forward, they update automatically to the most recent dates and values.

HPI/Impression/Plan

As some have heard me detail before, I use a form of "problem-oriented charting" in which I type out the history, impression, and plan for a diagnosis (e.g. diabetes) or system/problem area (e.g. "GI issues") all on one line. I also use a macro which includes the date of the entry and my initials.

  • Example for a diabetic patient. "01/19/13(LLB): Stable on Metformin 500bid, CS 100-120s before meals, no med side effects or other complaints. Impr: Stable DM, PLAN: CPM, labs, rtc 4 mos". No flourish is needed. The result is that when copied forward I can see the last time I addressed the DM and if I made any changes. In the same "area" for the problem, I would also have a list of relevant meds, labs, and testing results (e.g. ECGs and ECHOs for hypertension). This way I can see everything I need about a problem all in once place – which means I can make quicker and more accurate decisions.
  • Summarizing old entries over time. I will either retain the old entry, or can summarize over time (e.g. I might take four entries from 2012 and summarize into one line such as, "2012: Dx with DM 4/12, added Metformin 500qd, 6/12 incr to 500 bid and did well").
  • Multiple issues. Since I often address multiple issues in a given visit, I created a line which reads, "Problems below not addressed this visit" so that I can clearly demarcate what I did and did not address on a certain day. I think this method is extremely efficient and higher quality than the method of trying to document all the HPI about multiple issues at the top of a note, and then separating out the Impr/Plan at the bottom.
  • What is a SOAP note? Larry Weed, MD devised the concept of problem-oriented charting 50 years ago, but I think it’s fair to say we have over-complicated it over time. The SOAP note is supposed to be based around a problem. In other words, each problem should have a documentation area for Subjective, Objective, Assessment and Plan. Instead, we create one large SOAP note where we break away all the Subjectives into their own paragraph ("HPI"), thereby distancing your thinking about the complaint and what we are going to do about it. I hope we will soon see more EMRs going "back to the future" by embracing the true problem oriented charting philosophy.

Fourth, the outpatient world is different from inpatient, but there are similarities. I understand that inpatient notes can be more difficult to manage due to quickly changing problems, and especially multiple authors. Personally, I hope we put some more thought into the concept of an "Inpatient Wiki," a single type of inpatient note that can automatically pull in the relevant information for each specialty (e.g. different for medicine, OB, and various types of surgery). Then each author could see what they need to see – it would pull in the labs, tests, consult suggestions, or a nursing note – why make the doctor repeat this themselves every time?

The care provider would then be prompted to write what they are supposed to add, and the note would be a living document which flexes to the individual, but can be time-stamped for medico-legal purposes as well. It could have clear sections (similar to above), as well as an organ or system based areas (e.g. Cardiology issues, GI Issues, Neuro Issues, F/E/N issues) for documenting the SOAP note .

In summary, I would go as far as to say that we need to change our paradigm to "The Note is the Chart." The chart should no longer be a collection of distinct and incomplete notes, but rather the last note can really be the complete chart which contains everything a provider needs. If we do this, then we can reframe our expected workflow from, "You need to read every note ever written to understand the full patient" to, "You just need to read the last note".

The result: when a patient goes to the ER or sees another doc, those providers will find that the most recent note in the system will have all the info they need, so they won’t need to try and dig through 48 notes over 10 years (and let’s face it, they never do that anyway). Granted, the paper record allowed for a much easier way to flip thru past notes, but sooner or later we have to acknowledge that computerized systems have different attributes than paper. We can either keep trying to force the computer to act like paper, which never works out well, or we can start embracing the differences and truly take advantage of them.

Lyle Berkowitz, MD, FACP, FHIMSS is associate chief medical officer of innovation for Northwestern Memorial Hospital; medical director of IT and innovation for Northwestern Memorial Physicians Group; and co-founder and chairman of healthfinch.

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January 28, 2013 Readers Write 5 Comments

Monday Morning Update 1/28/13

January 26, 2013 News 12 Comments

1-25-2013 2-09-37 PM

From Optumized: “Re: Optum’s acquisition of Humedica. Confirmed by Lazard Capital Markets.” I appreciate that the update from Steven Halper, managing director of equity research, credited HIStalk as the original source (as I, in turn, should thank Embers and another couple of readers who tipped me off). A Boston Business Journal article says the acquisition is valued by an insider in the hundreds of million dollars. I interviewed Humedica President and CEO Michael Weintraub a year ago. I notice that the Boston paper is getting credit for breaking the news with its Friday afternoon article even though I ran and confirmed it Tuesday evening with the help of readers.

From False Positive: “Re: Farzad’s rebuttal that talks about ‘cynical critics.’ Who are they? How does he know that they don’t like paper?” The cynical critics, at least those constantly seeking attention, are easy to spot because they sing only one loud and sustained note. When I read an emotional, overwrought restaurant review on Yelp, I always click that person’s profile to see if they have a mix of positive and negative reviews and ignore them if not. Likewise, I twit filter the monotonic EMR whiners and cheerleaders alike, placing a lot more value on the 80 percent who don’t flaunt their blinders publicly. Farzad was right about the RAND study – they said their original projections about EMR savings were wrong because EMR adoption was less than expected and payment incentives are still screwed up. The job of EMRs is to support reform, not to create it. He’s also right that those cynical critics haven’t written smug and pedantic articles extolling the virtues of paper medical records, so they’re leaving us to breathlessly anticipate their suggested alternative. And if they’re intentionally avoiding EMR-using doctors and hospitals for their own care, they aren’t blowing that horn either. What they should be criticizing is the healthcare system that created the current batch of EMRs that conform precisely to its ridiculousness.

1-25-2013 3-41-10 PM

From The PACS Designer: “Re: TPD’s List. The recent update of TPD’s List of iPhone Apps that added a HIStalk Sponsors section has created new interest amongst them to recognize their iPhone apps. Vitera informed us about an app (above) that provides healthcare providers access to their Intergy EHR solution enabling anytime, anywhere access to schedules, tasks, patient records, and e-prescribing. Humetrix alerted us to several iBlueButton apps they developed with HHS. These new apps will be added to the next TPD’s List update.”

From Ear-Ground Continuum: “Re: MEDecision. Huge downsizing – they let 83 people go last month with another round this week and next.” Unverified. Recent comments on Glassdoor are certainly interesting. UPDATE: Verified by a reader’s link.

From Nasty Parts: “Re: Greenway reseller iPractice Group. Closed its doors today. Sources say cash flow problems despite strong sales, so the board pulled the plug.” Unverified. I e-mailed the company but haven’t heard back.

1-26-2013 11-44-38 AM

Speaking of the RAND study, more readers think it was naïve rather than biased (and yes, RAND should be capitalized, at least if you buy the idea that it’s OK to make up acronyms solely to create a conveniently pronounceable word, in this case Research ANd Development.) Anyway, new poll to your right: if you had to buy a vendor’s stock, which of the five listed would you choose?

Several readers (me included) expressed an interest in hearing more from Robert D. Lafsky, MD, whose guest articles always contain an impressive mix of medical knowledge, wry cynicism, and grammatical excellence (he always e-mails me when he finds my mistakes, and the threat of incurring his gentle wrath caused me to double-check the spelling of RAND). He has agreed to elevation to regular contributor under the nameplate The Skeptical Convert, with his first installment running this weekend.

Here’s a new Spotify playlist of what I’m listening to: new Aaron Neville, The Cardigans, 4 Non Blondes, Alabama Shakes, Imperial Teen, and a few more.

1-25-2013 5-25-24 PM

Welcome to new HIStalk Platinum sponsor The McHenry Group, an executive search firm focused entirely on the healthcare software and services vendor market. TMG’s team of search consultants averages more than 11 years with the company, having placed over 2,000 candidates since 1991. TMG has developed the industry’s largest candidate database of hard-to-find talent, including the hidden candidate market. The company conducts videoconference interviews with every candidate and forwards the videos of the strongest to the client for their review which moves things along faster and gives a better fit, enabling TMG to offer an extra-long 12-month replacement guarantee. TMG has filled positions for CEO, COO, CMO, CMIO, SVP, business development, sales VP, and informatics roles for companies such as RelayHealth, McKesson, Orion Health, and Health Language. They have conducted searches across the entire US as well as for non-US companies building their US operations. Featured business development stars are experts in clinical software, Meaningful Use, and payor technology, while project manager and implementation candidates are available in EMR, multi-hospital implementations, and client services. TMG provides well-screened candidates, ethical search consultants, and a promise to understand the client’s business needs. Thanks to The McHenry Group for supporting HIStalk.

Athenahealth files notice with the State of Alabama that it will lay off 36 employees at its Birmingham office on March 6. The company has not announced what types of workers are affected, although Birmingham was the location of Proxsys, the care coordination systems vendor athenahealth acquired in 2011 to boost its athenaCoordinator product.

Compuware turns down the $2.3 billion buyout offer of Elliott Management Corp and says it will instead spin off Covisint as originally planned.

1-25-2013 2-34-11 PM

Weird News Andy says this is better than die-alysis. A kidney patient in China who can’t afford dialysis treatments has lived for 13 years so far by dialyzing himself three times each week using a machine he built from kitchen tools and old medical equipment. He recently declined the Chinese government’s offer of free dialysis that was extended after his story was picked up worldwide, saying the hospitals are too far away and too crowded. He’s not worried that two of his friends died after trying a similar setup.

WNA also likes the RP-VITA iPad-controlled medical robot that just received FDA approval.

Farzad Mostashari can bask in the knowledge that he’s a big enough name to be featured in a CAP News parody (it’s like The Onion, but not as well done). I think they probably chose him randomly for the article Toilet Sizes Expand to Meet Needs of Obese Nation, quoting him in describing a new HHS standard called “Ass Cheek/Toilet Seat Ratio.”

1-26-2013 8-51-03 AM

Gartner says Big Data has reached the Trough of Disillusionment stage of its ingenious Hype Cycle, of which I’ve been a long-time fan. If the author is correct – and I would say she is – the previously Big Data-fawning press will start running negative articles, which is OK since once that negativity has been purged, it’s on to the Trough of Enlightenment, where organizations whose interest is more than fad-chasing start delivering results. A Wall Street Journal blog post on the Gartner item quotes Aurelia Boyer, CIO of New York Presbyterian Hospital, who says they’re using Hadoop with natural language processing to analyze millions of patient records to find, for example, how many of them have mentioned a gunshot wound.

A study looks at why patients may think doctors who use clinical decision support are less capable. Apparently patients worry more about doctors using non-human tools rather than having a doctor who seeks external advice.

New Hanover Regional Medical Center (NC) goes to paper downtime procedures for seven hours Thursday when its Epic system goes offline due to an AT&T regional outage.


An online publication HITECH article elicited interesting comments. Granted some of them veer into death panel nut job territory, but they’re still fun to read and some are insightful.
  • “EMRs encourage doctors and nurses to cheat and lie. EMRs have made medical records inaccurate and unreliable. When I read medical records nowadays, I often can’t tell what the hell happened.”
  • “In an EMR, every URI is an average URI.”
  • On the use of surgical case templates: “… worked out with the hospital risk management department to describe what should happen, and entered in the EMR with one click of a mouse. What actually happened? No one can tell.”
  • “The response calling this idiocy a step in the right direction apparently fails to get the point, which is that EMRs make crappy doctors look like decent ones by giving them the same well-written notes as the good ones.”
  • “It seems to me that this isn’t exactly the unintended consequences of EMR; it’s the unintended consequences of the government incentivizing bad EMR by incentivizing the wrong things:  the ACA encourages rapid adoption of immature or awkward technologies without clear benefits; medicare, medicaid, ACA, and the employer-provided health insurance tax exemption incentivize egregious billing practices. EMR and provider companies respond to the incentives; the problem isn’t the software per se, but the incentives. There’s no inherent reason why an EMR system should require more data entry on the part of doctors, or why the data entry should take longer than updating a paper chart. Systems could be designed that work better and provide consumer benefits, but they aren’t appearing because the system incentives really aren’t designed to serve the customer.
  • A physician on not customizing template-created notes: “I like to think most of us are pretty honest, and this doesn’t feel like a lie, more like the best that can be done with the time available and the limits of the EMR. I don’t know if I am only humoring myself about the honesty. I do know the job can’t be done except by the copy and paste method.”
  • “This article misses a key point. If they’re fine falsifying electronic records, why wouldn’t they be comfortable falsifying written records? Moreover, electronic records are easier to falsify, but they’re also easier to catch.”
  • “I think physician associations need to reemphasize that documentation by exception is not appropriate for physicians, perhaps even take it a step farther and officially declare it outside the standard of practice. The great potential benefit of EMR’s (along with the requirement that they be able to produce data in a standard format) is that medical charting will stop being primarily about stories and start being primarily about data. This will not only make treatment of patients more scientific, it will energize evidence-based medicine. Right now, about half of medical treatment is done despite no evidence of efficacy. Of course, if the data is unreliable, we have GIGO. So the use of charting by exception leading to bad data is a huge problem.”
  • “EMR’s are the vehicle for corporate and government direction of medical care. I predict that within 5 years, it will be illegal to provide medical care to a patient unless it is through an Electronic Medical Record … this idea will be advanced as important to preventing waste, fraud and abuse.”
  • “Simply put, doing a thing, and documenting the doing of a thing, are two separate, and not particularity related skills (I would figure that journalists would understand this better than anyone), and it is unlikely that a person who is good at the former is also good at the latter, and when we ask him to do both, this is what we get. Cheer up, we could get the people who do amazingly good documentation to do the surgery. I suspect that would be much worse.”

I’m scooping Weird News Andy on this story: a drunken Englishman is hospitalized after the paramedics he called found his frigid sexual partner dismembered in a snowy field. The partner was a snowman; the man’s injury involved frostbite of his manhood, which nearly required amputation.

It’s NextGen Part 3 from Vince this week as he covers Opus Healthcare Solutions.


Sponsor Updates

  • SimplifyMD is running cartoons and videos looking at the humorous side of medical practice at “Easy Street Family Practice.”
  • Nuance announces that the electronic medical records systems used by hospitals and clinics in the United Arab Emirates will be voice-enabled using Dragon Medical.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 26, 2013 News 12 Comments

Collective Action 1/25/13

January 25, 2013 Bill Rieger 1 Comment

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

Leader the Follow (Part 2) — Identity

Let’s see … where were we? Oh yes, talking about being a follower and the significance of that role. This is a follow up to the last Collective Action post on HIStalk.

Last time I asked for input from readers about what kind of leader you would follow. I received several responses and I will include some of them at the end of this article. Thank you to all who provided feedback — it was insightful and entertaining. 

The key to studying followers is similar to the key to studying leaders. It is not about characteristics of a leader or follower. To me, the key is identity. How you see yourself determines your effectiveness. 

I agree we need to talk about Meaningful Use, business intelligence, ACOs, and what the next great innovation in healthcare will be. But none of those things can happen without  a focus on both leaders and followers and teams they lead.

As I was researching this topic of identity, I came across an interesting term: “metaperceptions.”  This is not how you are perceived, but rather how you perceive others perceive you. The difference is slight, but profound. 

I have a great example of this from a recent presentation I gave. I was speaking to a crowd of about 100 people here at our hospital at a recent event. It was an EMR project-related event that we themed “Finish Strong,” where I and others presented concepts from Dan Green’s book Finish Strong

I consider myself a good communicator. I believe I have a gift that allows me to write and present well. As I was presenting, someone in the audience dozed off. I thought right then that her perception of me was that I was a lousy presenter. Instead of continuing as I should have, I got thrown off. I thought they had lost interest and I started rushing through the rest of the presentation, not giving some of the more impactful parts ample time. 

Afterwards, I spoke to her and asked her how she liked the event and presentation. She said that she loved it, but had a new baby and was very tired. She made some comments about what was said and how it impacted her. I was blown away. My metaperception was wrong, but that didn’t matter, it impacted my effectiveness.

The root of our identity is only partially based on what others think. It is mostly based on how we view and think about ourselves. Here are some interesting statistics regarding how we think about ourselves. 

According to Daniel Amen, MD, a renowned psychiatrist and brain imaging specialist, we have about 60,000 thoughts per day — one every second while we are awake. Ninety-five percent of those thoughts are the same ones we had yesterday (a broken record!) For the average person, 80 percent of those thoughts are negative. 

That is incredible. Every day, the average person working in your department or your hospital or living in your home has 45,000 negative thoughts. Whether you are a leader or a follower, whether or not you care about what others say about you, you can do enough damage to yourself to keep yourself from fulfilling your destiny.

How do we combat this? How do we help those around us combat this? If you don’t think this is true about yourself, then you are probably not average, but you know someone who is. While it may not directly impact you, it impacts you in some way.

Let me offer something to you that is a bit unorthodox, but that has literally changed my life. I got this from the late Zig Ziglar, who says that how you see yourself is everything. A part of his program, called Self Talk, includes a laundry list of positive attributes: honest, intelligent, organized, responsible, committed, teachable etc. He offers several paragraphs with affirmations and instructs everyone he works with to say this list of affirmations in the mirror, morning and night, for at least 30 days. 

When I first heard this, I thought it was ridiculous, much like what you are likely thinking now. When I tried it, I thought it was stupid and embarrassing. I would not tell my wife. I locked the bathroom door and went through it as fast as possible. 

A peculiar thing happened after a couple of weeks. First of all, I finally told my wife, but I also started to become less embarrassed. I started to see that I really was some of these things, and some of them all the time. Other characteristics were just seeds and needed watering. 

At the end of 30 days, although I did not count, I literally sensed the number of daily negative thoughts decreasing, being replaced with thoughts that were empowering. Dare I say, I started to believe that I was just scratching the surface of what I thought I could accomplish in life. There is a lot more to that story, but it is for another post.

Besides how we talk to ourselves, there are additional factors in our life that impact those 60,000 thoughts. In Darren Hardy’s book The Compound Effect, he dedicates a chapter to influences. He says that everyone is affected by three kinds of influences: input (what you feed your mind), associations (the people with whom you spend time), and environment (your surroundings). These external forces are very powerful and dramatically affect how we think and feel about ourselves, our choices, behaviors, and our habits. In this book, he offers suggestions on how you can govern these forces so they can support and not derail your journey towards success.

To help deal with this on a corporate level, we have been walking our team through a couple of things to help positively reinforce who they are and where they are going.

The first was we helped everyone on our team develop a brand statement for themselves and complete a professional bio. This exercise forced them to take a look inside and actually write down what they have accomplished and really who they are as a person and a professional. 

The second thing we did was have everyone complete Clifton’s Strengthsfinder assessment. The result of the assessment was a list of your top five strengths, which most everyone, including myself, has posted on their door or cubicle wall. 

We review these things in team meetings. We try to use them to better align teams. Although we have a long way to go to really perfect this, the attempt alone at trying to deal with this has had a positive effect in the department.

Follower or leader, both are important roles, and while healthcare goes through rapid transformation, we need the best and brightest operating in their gifts with full confidence. If you struggle with this or know someone who does, you can be a resource in their life, and in turn, in this industry. The answer to how to improve healthcare will come from the people within healthcare, and we need these people thinking they can affect change. 

While this topic may not seem relevant, I believe it is at the root of advancement. Whether leader or follower, even this little bit of knowledge about your identity and how you see yourself can help you and help you help others. This is your destiny!   


Responses

The first response came from a popular HIT blogger who reached out via Twitter (@SmyrnaGirl) and said, “I would follow a leader who wouldn’t be afraid to impart wisdom and one day let me lead in their place.” 

Not all followers share this sentiment. An anonymous person shared the following. “When my personal convictions are strong and clear, others may agree and choose to follow, but they do so on their own. On the other hand, if my convictions happen to align with those of others before me, then I may seem to be a follower, but in reality I am going my own way. Either way is fine with me. I will never follow or lead just because someone thinks I should, and I have no inherent desire to fill either role.” After a few more comments, he went on to answer the question directly. “For me, I would have to first decide if it was my battle. If so, then I’d follow the plans and directions of the one who seemed most aligned to my own thinking.”  

A practice administrator in Jacksonville, FL had this to say. “This organization thus  far has given me almost free reign on how and where I am taking our primary care network, with the expectation that I do it within cultural norms and corporate guidelines. After 10 months, I am happy to report that this is a comfortable position for me.” 

A quality management informatics analyst sent an e-mail saying, “One of the best leaders I had was a supervisor who openly said that he ‘had my back.’ When business events happened that threatened to undermine my authority or the scope of my work, he would respond by protecting me and promoting my interest in the situation. As a result, I felt a lot of loyalty and trust toward him and tried even more to meet his expectations.”  

The final comment came from a chief operating officer of an HIT vendor. He provided some great comments about leadership and following in general. We had an e-mail dialogue that really gave me some great insight into leadership. He said, “Inspirational leadership is great, but good execution combined with it is rare. Find a CEO or president who is a visionary and the matching CEO or COO who has the power of execution to make it happen. Typically, the inspirational people are not good at actual execution, but they need to let go to have others execute.” It sounds like he would be willing to follow someone who in addition to being able to recognize their strengths,they can recognize their weakness and bring someone in who can help bridge the gap.

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.

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January 25, 2013 Bill Rieger 1 Comment

News 1/25/13

January 24, 2013 News 9 Comments

Top News

1-24-2013 9-15-30 PM

Quality Systems (NextGen) reports Q3 results: revenue up two percent, EPS $0.26 vs. $0.36, missing analyst estimates on both. The company reported a 29 percent drop in system sales revenue as operating expenses rose six percent. The earnings call transcript is here. The results were announced before Thursday’s market open, with shares closing down only 0.16 percent by the market’s close.


Reader Comments

1-24-2013 5-53-24 PM

From Kojak: “Re: Intuit Health changes. Medfusion founder Steve Malik is retiring in June and Sanjiv Waghmare is taking over as Intuit Health’s new GM.” The e-mail announcement was attached. Malik (above) was named president of the Intuit Health Group when Intuit purchased Cary, NC-based portal vendor Medfusion for $91 million in 2010. Waghmare is a VP of product marketing.

From WHIMSSical: “Re: booth demo stations. PowerPoint or video? Should vendors use PPT since nobody can hear the video?” I say video and/or a live demo backed by a credible and engaging demonstrator, but perhaps also a fast-paced and highly graphical looping PowerPoint on a big projection screen as a billboard to grab attention as attendees streak by. Readers, what would get your attention?

From Doc Tari: “Re: Allina. Did know if you heard Allina having a bit of restructure. CMIO Shrift left to Cleveland and now CIO over all the IS areas.” 

1-24-2013 6-34-08 PM 1-24-2013 7-18-27 PM

inga_small From Carrie Prejean: “Re: HIStalkapalooza. What exactly does one wear to HIStalkapalooza this year? Bowling shoes? I want to come prepared because I am determined to win the ‘Inga Loves My Shoes’ contest!” When I first heard that this year’s bash was going to be in a (very cool) bowling alley, I was also perplexed on the proper attire. We are fine-tuning things, but suffice it to say that just about anything will go. We will once again have a red carpet, so arriving in stiletto heels and sequins will be totally acceptable. Alternatively, if you own a vintage bowling shirt, this could be the time to pull it out of the back of the closet. The shoe contest will include categories for those partial to high fashion as well as those who choose to adorn more functional bowling shoes. We will also be crowning a HIStalk King and Queen based on their total fashion package. Winners will be awarded amazing prizes, so don’t show up in your “straight off the exhibit floor” attire, especially if the look includes a company logo’d tee shirt.

1-24-2013 6-43-11 PM

From RFP: “Re: MD Anderson. Posts an EHR RFP.” The RFP strongly suggests that prospective bidders attend the pre-proposal conference on Wednesday, January 30 just in case you want to thrown your electronic hat into the ring.

From Slim: “Re: Optum. I read your update confirming that Humedica was bought by Optum. Wouldn’t it have to be announced since Optum is part of UnitedHealth Group, which is publicly traded?” I’m not an expert, but I believe SEC disclosure requirements cover only “material events,” meaning companies must file an 8-K form only if a merger, loss of a key customer, or policy change could reasonably be expected to impact share price in the company’s subjective judgment. UnitedHealth Group’s market cap of $58 billion and annual revenue of $111 billion would make all but a huge acquisition non-material.

1-24-2013 7-41-12 PM

From Bill O’Plenty: “Re: SB 1275. Crazy law introduced in Virginia.” Virginia State Senate Bill 1275, introduced January 14, would prohibit any organization that stores electronic medical information from (a) participating in the Nationwide Health Information Network; (b) performing analytics on multiple patient records for diagnosis, treatment, or population health management; and (c) processing medical data within Virginia if most of the patients represented live out of state. It also mandates that providers cannot be penalized for refusing to implement EHRs, that patient consent for electronically storing their information is valid only for healthcare coverage purposes, and that the state is prohibited from starting or operating an HIE. I e-mailed the office of the bill’s sponsor, Republican Senator Stephen H. Martin, to ask what he’s trying to accomplish with the bill, but I haven’t heard back. Senator Martin is running for lieutenant governor, which could ironically pit him against Democrat Aneesh Chopra, former White House CTO and advocate for all the items that the bill would prohibit, so perhaps he’s just trying to pick a fight.

From Wearing Dad’s Suit: “Re: Epic’s non-compete. Does it cover this?” Applicants for the head football coaching job posted on the University of Wisconsin’s HR website include a Walgreens pharmacist whose only relevant experience was as a season ticket holder, a Fedex driver who said he’d take $60K to lead the Badgers, and a financial analyst with Epic whose college athletics experience consists of having been a practice player for Tulane’s basketball team. I give our young Epic friend credit for trying even though he lost the $2 million job to a more experienced candidate who responded to the online posting, Utah State Coach Gary Andersen.


HIStalk Announcements and Requests

The latest highlights from HIStalk Practice include: Epocrates says its app has helped clinicians avoid more than 27 million adverse drug events. Farzad Mostashari, MD highlights some of the ONC’s 2012 achievements. Pharmaceutical companies and other businesses embrace advertising opportunities within cloud-based EMRs. E-visits may be as effective as in-person office visits for uncomplicated ailments. Dr. Gregg describes a day in the office in the Year 2063 (quite fun.) You know the drill: catch up on all the latest ambulatory HIT news, click on a few sponsor ads to find a goodie or two that might improve your life, and sign up for the e-mail updates. Thanks for reading.

On the Jobs Board: Cerner Experienced Providers, Product Marketing Manager, Healthcare Strategy Communications Specialist, Project Specialist.


Acquisitions, Funding, Business, and Stock

1-24-2013 5-56-29 PM

Healthcare social networking site iMedicor acquires iPenMD, which offers a digital pen solution to capture clinical data. iPenMD apparently bought the intellectual property of nextEMR this past July per a reader’s rumor report.

1-24-2013 6-03-35 PM

Merck Global Health provides $6 million in growth capital to eHealth Technologies, a provider of continuity of care solutions.

1-24-2013 6-04-22 PM

Praesidian Capital invests second lien debt capital in eTransmedia Technology to replace debt and fund growth.

1-24-2013 8-34-24 PM

Revenue cycle systems vendor Recondo Technology receives a $20 million growth investment from private equity firm Bregal Sagemount.

1-24-2013 6-25-07 PM

Healthcare Growth Partners releases its 2012 HIT Market and M&A review that summarizes capital markets, M&A, and capital raising activity for the healthcare IT and services sector.


Sales

1-24-2013 4-02-46 PM

Tampa General Hospital (FL) selects Merge’s CTMS for Investigators solution for enterprise management of clinical trials.


People

1-24-2013 3-50-34 PM  1-24-2013 3-51-42 PM

Huron Consulting Group adds Jim Agnew (Navigant Consulting) and Jeffrey McLaren (VHA, Inc.) as managing directors in its Huron Healthcare practice.

1-24-2013 3-53-51 PM

HIMSS promotes Thomas M. Leary to VP of government relations, taking the place of Dave Roberts, who was elected to the San Diego Board of Supervisors.

1-24-2013 1-39-04 PM

Iatric Systems promotes Frank Fortner from SVP of software solutions to  president.

1-24-2013 6-09-34 PM

The Northeast Business Group on Health honors Truven Health Analytics president and CEO Mike Boswood at its 18th Annual Tribute to Leadership.

1-24-2013 3-56-46 PM

Clinical data integration provider Apixio hires Jonathan Murray (Aetna) as chief business development officer.

1-24-2013 6-12-51 PM   1-24-2013 6-14-16 PM

Intellect Resources announces triple-digit growth in 2012 and announces several promotions and hires, including the promotion of Eileen Dick to VP of technology and Cindy Orr to VP of go-live services.

1-24-2013 9-11-26 PM

Robert Rowley, MD (Practice Fusion) is named medical advisor for personal health care vendor LifeNexus.


Announcements and Implementations

CareCloud and HealthTronics partner to combine CareCloud’s PM product with HealthTronics’ UroChart EHR and meridianEMR urology-specific EHR platforms.

1-24-2013 9-22-42 PM

Fletcher Allen and Dartmouth Hitchcock Medical Center (above) announce the creation of OneCareVermont, the nation’s first statewide ACO that includes 13 hospitals and hundreds of primary care physicians. We announced their plans in September.

Three Ontario hospitals go live on PatientKeeper Physician Portal, Mobile Clinical Results, and NoteWriter, including Alexandra Marine & General Hospital and two hospitals in the Huron Perth Alliance.

The RFID in Healthcare Consortium and Intelligent Hospital.org recognize six organizations for their advanced use of healthcare technology solutions.

GE Healthcare introduces Centricity Practice Solution 11.


Other

Winthrop Resources is conducting a survey on cloud solutions and bring-your-own-device practices. If you’d like to take about 10 minutes to help them out, the survey is here.

HIMSS finds yet another way to offer preferential treatment for its higher-ranking provider members whose purchasing influence makes its vendor members salivate. Healthcare Transformation Project offers “exclusive access” to services, meaning of course that someone has to be excluded (like the rest of us dues-paying members). For example, invitation-only HTPers get “up-front VIP seating at the HIMSS13 Keynote Address by President Bill Clinton” (I was going to insert a cigar joke, but decorum prevailed). The Transformers who are willing to spend $295 of their employer’s money to attend its annual forum at the HIMSS conference get to hear a bizarrely HIT-unrelated group of political speakers – former Florida Governor Jeb Bush, Democratic political strategist Donna Brazile, and former Nixon speechwriter Pat Buchanan. HIMSS says that “participants will make commitments that will translate goals into meaningful and measurable results in their own organization or community,” so we can all look forward to seeing how those work out for patients. Meanwhile, HIMSS offers vendors a bunch of expensive ways to get in or near those decision-making faces, with $50K buying you a podium speaking slot and free tickets for prospects who would be impressed by Pat Buchanan.

Cerner and Sporting KC take heat for failing to keep their promise to build a $35 million youth soccer complex in return for the $200 million in taxpayer-funded incentives they received to build their professional soccer stadium and Cerner office buildings. The youth fields were supposed to in use by now, but work hasn’t started.

1-24-2013 8-41-55 PM

Spain’s leading newspaper says it was duped when it ran a fake photo of Venezuelan President Hugo Chavez in his hospital bed, which the paper was told had been taken illicitly by a hospital nurse. The image, widely panned as unconvincing, turned out to be a screen shot of a YouTube surgery video from 2008 featuring an acromegaly patient being intubated.  

The local TV station covers the use by Georgetown University Hospital (DC) of the iPad-based patient data collection system from Tonic Health that replaces paper forms in the doctor’s office. The story says other Tonic users include Mayo, UCLA, the VA, and Kaiser. The company says the product integrates with EHRs via HL7 or can send a CCD record. It offers a free version with limited functionality. Founder and investment information is here.

1-24-2013 9-28-26 PM

As tweeted by @Cascadia: a Virginia medical practice charges patients for using its patient portal, billing $125 per year for Gold access to make appointments and refill requests, while the $250 per year Platinum plan adds three electronic visits. That’s the opposite of every other industry, where free online services encourage customers to do it themselves without tying up an expensive employee. This is like banks offering free teller service but charging for ATM access, or maybe McDonalds adding a drive-through surcharge.

A Texas judge orders the deposition of two partners of a CPA firm accused by a medical practice of failing to secure the accounting system it installed in the practice, which the practice says allowed an employee of the practice to embezzle $1 million over five years.

Weird News Andy says this man wears his nose on his sleeve, also wondering if he will pick his nose in public. British scientists are using a man’s own cells to grow a new nose to replace the one he lost to cancer. They have two noses underway (“just in case someone drops one,” the researcher said) and the patient will chose one of them to be implanted under the skin of his arm until it’s ready to transplant.

I had a feeling where WNA’s story was going when I saw his best-ever headline, “Nothing like having a cold one after work,” but I still nearly choked on my soda when I saw the story, in which a male hospital nurse is arrested on suspicion of having sex with the body of a deceased patient.


Sponsor Updates

  • Nuesoft Technologies CEO Massoud Alibakhsh discusses data security and Nuesoft’s technology platform in the video above.
  • Awarepoint celebrates its tenth anniversary and recaps key successes.
  • GetWellNetwork Founder and CEO Michael O’Neil delivered Thursday’s keynote address on interactive patient care technologies at the IPC Symposium at Hasbro Children’s Hospital (RI).

EPtalk by Dr. Jayne

Your tax dollars at work. On Tuesday, the US Supreme Court rejected an attempt to reopen Medicare claims that are more than two decades old. The hospitals assert that CMS miscalculated payments between 1987 and 1994 that were intended to compensate their treating large numbers of low-income patients. Based on the fact that it took my local academic medical center over a year to settle the bill for a routine eye care visit, it doesn’t surprise me that it takes years for hospitals to figure out they’re missing money.

Attention vendors: Mayo Clinic releases a new list of the top reasons for visiting US health care providers. Maybe you should use this as a starting point for your primary care office visit templates rather than some of the bizarre things I sometimes see on your screens. Granted the data is from Olmsted County, MN, but it looks surprisingly similar to my clinic roster this week except for the absence of “flu” and “freaking out that spouse has the flu.”

I received my first HIMSS-related mailing today. It was so underwhelming I can’t even remember who it was from. When I went to dig it out of my recycling bin, I couldn’t find it – which means it was nondescript as well. Great job, marketing team!

A wise man once told me to always spend a small amount of time “looking for your next gig” because things are constantly shifting in the world of medicine. For those of you who think the same way, ONC is looking for a policy advisor “who knows meaningful use policy backwards and forwards.” I was curious, so I checked out the link and got the best laugh of the day. The low end of the salary range is $123,758. Leave it to the federal government to specify it down to a bizarre dollar amount.

I had lunch with four of the smartest women in the world today. Three have been my boss in the past while the fourth who taught me everything I know about billing. Here’s a shout out for leaders who not only know their fields but “get it” as far as motivating employees to excellence. Thanks for keeping me grounded and reminding me that although I currently work in chaos, I can always count on your listening ears. And your unbiased opinions when I text you pictures of shoes I’m thinking of buying. And your assistance with crafting the “Typhoon Jayne” cocktail for HIStalkapalooza. Salud!

Print



Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 24, 2013 News 9 Comments

Morning Headlines 1/23/13

January 22, 2013 Headlines No Comments

Missouri, Kansas and Nebraska Connect via Direct Secured Messaging

The Nebraska Health Information Initiative, Kansas Health Information Network, and Missouri Health Connection announce that they are now connected and able to exchange Direct secure messages across state lines.

Naperville’s Edward Hospital to merge with Elmhurst Memorial

Edward Hospital & Health Services of Naperville, IL and Elmhurst Memorial Healthcare announce plans to merge, forming a three-hospital health system with revenues of more than $1 billion.

Providers Get Help From Clinical Decision Support Evidence Vendors but Still Face Obstacles

KLAS evaluates clinical decision support strategies and roadblocks for providers and concludes that third-party order sets, care plans, and drug dictionaries lead the pack in CDS plans but notes that a lack of integration with EHRs is hindering the utilization of these tools.

King Saud University Signs a Strategic Agreement With Cerner for Two Major Hospitals in Saudi Arabia

King Saud University signs with Cerner to implement EHRs for two academic facilities in Saudi Arabia.

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January 22, 2013 Headlines No Comments

News 1/23/13

January 22, 2013 News 5 Comments

Top News

The Nebraska Health Information Initiative, Kansas HIN, and Missouri Health Connection connect their exchanges to share Direct secure messages across state lines.


Reader Comments

1-22-2013 10-01-20 PM

From Embers: “Re: Humedica. Being bought by Optum, I’ve heard. I wonder what will become of the Allscripts deal that frankly brought Humedica some business, but also had them running in circles (true for anyone dealing with Allscripts in the past few years)? Also, the new Optum research center in Cambridge is gathering steam and they are putting together a nice team to be a healthcare think tank. Hope you had a nice few days off – my imagination puts you on the podium with Obama and not sipping drinks by the pool.” A couple of readers told me they’ve heard that clinical data vendor Humedica has been acquired, one of them specifically saying it happened last week with no public announcement planned. Wednesday morning update: I’ve confirmed via a reader that the company has been sold to Optum. I’m happy to say that my mini-vacation consisted of the latter and not the former, as I took Mrs. HIStalk out of the country for some magnificent and rare downtime sprawling under 80-degree blue skies, swaying palms, and very small paper umbrellas that didn’t protect our white-to-red skin but did make our tropical drinks look even more fetching. I’m paying for the break today after getting home in the early morning, heading off to work just five hours later, and now sitting here with no break or bedtime in sight after 17 hours of non-stop catching up.

1-22-2013 6-57-28 PM

1-22-2013 6-55-10 PM

From EHR Watchdog: “Re: MedLink. See attached. Unfortunately customers can’t reach the company as its top two executives are being investigated by the SEC. The company’s EHR is certified and customers are no doubt trying to figure out what to do. One physician has a contractual requirement that records for his 6,000 patients will be available digitally, but he’s having to go through them one by one to either print or save to an external device as he shops for another EHR after spending thousands of dollars on MedLink.” The reader attached the SEC’s October 2012 complaint against Medlink and its two executives, Ray Vuono and Jameson Rose. It claims the company filed a Form 10-K audit report bearing the name of an auditing firm that had in fact not audited the company’s books, with that same SEC form bearing the electronic signature of one of the company’s directors who had not reviewed the form or authorized that his signature be attached. Lastly, the SEC claims an investor asked to have his check returned, but the company deposited it instead. In the SEC’s words, MedLink “purports to be a healthcare information technology company” and Vuono is “a recidivist securities law violator.” I know what that word means because Raising Arizona is one of my all-time favorite movies.

1-22-2013 7-23-52 PM

From Iconic Reader: “Re: Allscripts. The smoking doc, at least the reflector part of his attire, is apparently the model for the isolation icon in an Allscripts product!” I give them the nod for going old school, with a doc sporting a reflector thingy and a nurse wearing a starched white cap with a red cross on it.

From Pinky Toe: “Re: vendor shakeup. The vendor is Allscripts. Major reorg in the development group, which includes product management and testing, in which 200+ remote employees are being required to move to Raleigh, Chicago, or Burlington VT or face termination. This move not initiated by Paul Black, but he has sanctioned. This is a RIF, but instead of calling it a RIF, management is calling it a consolidation of resources to ‘centers of excellence.’” More convincing (but also unverified) were reader declarations that the vendor referenced in a reader’s earlier comment about employee layoffs is in fact NextGen, but I don’t have confirmation on anything since companies rarely announce or confirm personnel actions.

From Ben Dover: “Re: NextGen. Cutting personal days for employees, sent out the week of January 16 but backdated to January 1, which means employees who took personal days for the holiday will be back-charged for vacation.” Unverified, but the source is non-anonymous and has a copy of the internal communication. The backdating, which adds a bit of sting to the slap in the collective employee face, seems indicative of either an impulsive management decision or inability to get the corporate act together.

1-22-2013 10-03-32 PM

From THB: “Re: Edward Hospital & Health Services. Merging with Elmhurst Memorial Healthcare to create a $1 billion system that would be among the largest in the Chicago area. Edward is going through an Epic implementation.” Verified in a Tuesday announcement. I interviewed Edward VP/CIO Bobbie Byrne a year ago. Edward seems to be the dominant would-be partner, so I expect the Epic implementation will continue and Elmhurst will drop Meditech.  

From Idol Observer: “Re: Greenway’s announcement of meeting ONC 2014 criteria as an EHR Module. According to the announcement, they only met two criteria, a safety-enhanced system and a quality management system. The first requires the vendor to simply name their testing methodology for the features already required by the 2011 feature – no programming is required. The second is to just identify the quality management system being used, with no programming required there either. In other words, it’s just meaningless PR that will get physicians even more confused.” I get lost in all the certification minutiae, so I’ll defer to Frank Poggio.

From Rand Reader: “Re: the recent Rand report. It said EMRs remain costly without good outcomes because doctors haven’t re-engineered their workflows to accommodate electronic systems. Why would they want to do that when the change could be averse to safe care? Just an idea for your next poll.” My opinion is that many doctors will never accept EMRs because to do so would implicitly accept the idea of process standardization and repeatable processes everywhere, and doctors are trained to be confident in their individual abilities and wary of any process that doesn’t involve their own brains and hands. Patients are usually on the side of doctors since everybody likes to think they’re getting extra-special treatment and not being managed by a corporate algorithm. I don’t know that either side has proved its point convincingly.

From Just Wonderin: “Re: ONC’s HIT Safety and Surveillance Plan of December 21. The ‘public comments’ solicited by HHS are not so public after all since they are not being presented for the public to see. Is it because HHS and ONC don’t want the public to see the comments offered by the Cerner and Epic ilk?” It appears that comments can be submitted only via e-mail.


HIStalkapalooza 2013, Sponsored by Medicomp

1-22-2013 8-02-29 PM

1-22-2013 7-56-06 PM

1-22-2013 7-55-27 PM

1-22-2013 8-59-24 PM

HIStalkpalooza will be Monday, March 4, 2013 at Rock ‘n’ Bowl, New Orleans, LA. Medicomp CEO Dave Lareau, one of the coolest guys I know, wanted to bring you some real New Orleans flavor for Medicomp’s return as HIStalkapalooza sponsor. He’s ably assisted by the ultra-professional crew who engineered the 2011 event: Patrice at bzzz productions, Shannon and Cindy from Thomas Wright Partners, Anthony from Istrico Productions, and of course the Medicomp stars like Roy and James that you saw on the stage and at the Quipstar event on the HIMSS show floor.

Medicomp sponsored the 2011 event at BB King’s in Orlando (video is here, although I doubt anyone has forgotten that bash). They said then they wanted to return this year, so naturally I’m super happy to have them back and expecting them to rise to the challenge of a superb 2012 HIStalkapalooza in Las Vegas courtesy of ESD (I still play their video every now and then because it’s so cool).

Rock ‘n Bowl is equal parts bowling alley, dance hall, live music venue, and old-school Cajun-Zydeco shrine, which sounds kind of low-brow until you notice that it has earned a 4.5 average review on both Yelp and Tripadvisor. Beats the heck out of a cookie cutter hotel ballroom or a Disney-like fake Cajun place. It’s a big place even though the layout makes it hard to tell in pictures. Some details:

  • Buses will take HIStalkapaloozans from the convention center to Rock ‘n’ Bowl and back to the key hotels.
  • You’ll be offered the chance to once again execute your perfect red-carpet strut while having an Ingatini thrust into your parched palm and being surrounded by industry glitterati.
  • You will have the option to sip (or guzzle) the aforementioned Ingatinis and Typhoon Janes, not to mention just a lot of drinks in general. The ladies are providing guidance on how they want their namesake potions prepared (I’ll bet there’s a lot of alcohol involved), so details on those will come later.
  • You’ll be entertained by Brian Jack and the Zydeco Gamblers, with instructors leading you in Zydeco dance lessons if you so choose.
  • You’ll be fed you authentically and well with red beans and rice, jambalaya, crawfish etouffee, and retro bowling alley food like pizza, wings, and fried seafood. No tray-passed mini-quiches or two-per-person drink tickets here, folks.
  • Inga will be overseeing our usual shoe and attire contests, best bowling shirt judging, and some other categories I’m not privy to but that I expect will result me spending excessive money on beauty queen sashes and prizes. She can chime in later on the particulars.
  • The inestimable Jonathan Bush will once again preside over the not-to-be-missed HISsies awards at 7:30, the role he created at the first HIStalkapalooza in 2008 and has held since. I have it on good authority that the people you chose for all of the important and serious awards (Industry Figure of the Year, Lifetime Achievement Award, etc.) will be there, which would be quite an assemblage of industry talent.
  • There will be a fun bowling tournament, but since I haven’t bowled since college (translation: I’ve never bowled sober nor seen any reason to) I’ll let Medicomp explain how that will work later. I know some of Medicomp’s partner companies will be hosting individual lanes, so I’m sure we’ll have some fun folks there.
  • You will have networking opportunities like crazy given the remarkable number of CEOs, VPs, investment bankers, press, and lower-ranking but generally amiable grunts like me who’ll be hanging around and lowering their guard to conduct frank and possibly slightly slurred conversations. Deals will be made, jobs will be offered, and a variety of propositions will be extended and considered. A good time will be had by all.

The registration page is now open. Since demand always exceeds supply, registration puts your name on the “I want to come” list. If we have enough capacity, everybody on the list will get an invitation in mid-February. If not, then I’ll have to channel my velvet rope bouncer technique in choosing who gets an invitation (providers and long-time HIStalk supporters get picked first, then I just try to make it interesting by employer and role). Every HIStalk reader is important to me, so I sure hope we can squeeze everybody in since it’s your night.



Acquisitions, Funding, Business, and Stock

1-22-2013 10-10-31 PM

Kareo raises $20.5 million in series F funding led by Stripes Group.

1-22-2013 10-09-55 PM

Shares in Scotland-based revenue software vendor Craneware jump after the company said it expects half-year revenue to increase by seven percent.

1-22-2013 10-11-09 PM

Compuware reports Q3 results: revenue up two percent, EPS $0.12 vs. $0.10. The company says its Covisint HIE business grew 30 percent. The board says it will make a decision shortly about an unsolicited takeover offer of $11 per share, equal to the current share price.


Sales

1-22-2013 6-23-52 AM

King Saud University in Saudi Arabia contracts with Cerner to provide Millennium to two of its hospitals.

Lowell General Physician Hospital Organization (MA) selects HDS, athenahealth’s healthcare data management service for population-based cost and quality data analysis and reporting.

The New Mexico Health Information Collaborative will implement Orion Health’s HIE platform for its statewide exchange.

1-22-2013 3-09-01 PM

Henry Mayo Newhall Memorial Hospital (CA) selects Accent on Integration’s Accelero Connect platform to integrate its Philips IntelliVue patient monitors with its Meditech HIS and EDM solution.

Hong Kong and Tsuen Wan Adventist Hospitals select First Databank’s International Drug Knowledge.

El Camino Hospital (CA) chooses data warehouse and analytics solutions from Health Care DataWorks.


People

1-22-2013 3-24-15 PM  1-22-2013 3-25-26 PM

Mobile health provider Glooko hires Rick Altinger (Intuit Health) as CEO and Dean Lucas (Epocrates) as VP of product development. Glooko, which Dr. Travis included in a recent review of tools for diabetics, just received FDA 510(k) clearance for its mobile logbook device.

1-22-2013 3-27-40 PM

Amplion Clinical Communications names Tom Stephenson (Health Management Systems) president and COO.

1-22-2013 5-40-06 PM

Wendy Penfield (RealMed) joins Intellect Resources as VP of consulting services.

1-22-2013 3-31-25 PM

The Carroll County Chamber of Commerce (GA) names Greenway Medical founder W. Thomas Green as its 2012 Entrepreneur of the Year.

1-22-2013 9-23-59 PM

Rich Boehler, MD (MedeAnalytics) is named president and CEO of St. Joseph Healthcare (NH).


Announcements and Implementations

HIMSS awards 10 scholarships to students enrolled in HIT and management system degree programs.

1-22-2013 9-15-06 PM

Kansas City area hospitals form the Cerner-hosted Lewis and Clark Information Exchange (LACIE), originally created by Heartland Health.

Wheeling Hospital (WV) deploys PeriGen’s PeriCALM Plus in its obstetrical department.

1-22-2013 3-38-03 PM

UNC Health Care’s Rex Hospital (NC) implements Merge Hemo to automate cath lab processes into its EHR.

1-22-2013 3-39-57 PM

UPMC Beacon Hospital (Ireland) implements BridgeHead Software’s integrated backup solution for Meditech.

Neighborhood Health Plan and Partners HealthCare (MA) will provide $4.25 million in grants to 49 community health centers to expand HIT systems, train on Meaningful Use and medical coding, and train and build capacity for performance improvement.

HealthSparq launches its consumer health shopping platform (patient reviews, cost estimator, provider search, and social media forum) to health insurers.

1-22-2013 9-28-57 PM

The Government of Cantabria, Spain will deploy the initial phase of a European-wide e-health service from Texas-based Prodea Systems.


Other

Brian Ahier and a couple of privacy experts will discuss the new HIPAA rules in a Google Hangout streaming video session on Wedneday, January 23 (which is “today” for most readers) at 2:00 p.m. Eastern.

1-22-2013 5-46-13 PM

KLAS looks at clinical decision support tools and finds that more providers are turning to third-party order set and care plan vendors. Key findings:

  • Almost half of providers using third-party products previously tried to build a solution from scratch.
  • Among providers using third-party order sets, half use for reference content only because of an inability to move built pieces into the EMR.
  • Most providers would like more ability to customize medication alerts.

Sponsor Updates

  • SRS reports a 94 percent increase in revenues from 2011 to 2012 and the addition of 56 new employees.  
  • AT&T Healthcare’s Christine Furjanic will speak at the Western Physicians’ Alliance (NV) January 29 seminar on accountable care.
  • Orchestrate Healthcare expands and relocates its corporate headquarters to Carbondale, CO.
  • Greenway Medical Technologies, Inc., announces that Greenway PrimeSUITE 2014 (17.0) is compliant with the ONC 2014 Edition criteria and has earned certification as an EHR Module.
  • Shareable Ink reports 300 percent year-over-year growth and a twofold increase in employees since January 2012.
  • PatientPay CEO Thomas Furr offers advice on managing practice A/Rs and cash flow in a guest articl.
  • API Healthcare announces a 60 percent increase in year-over-year sales bookings and record bookings in the fourth quarter of 2012.
  • T-System will offer the PayRight Health Solutions patient collection system with its RevCycle+ solution.
  • CynergisTek and managed security service provider Solutionary partner to offer outsourced security monitoring.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 22, 2013 News 5 Comments

Morning Headlines 1/21/13

January 20, 2013 Headlines 1 Comment

athenahealth and MedOasis to Provide Comprehensive, High-Value Anesthesia Billing Solution for Hospital Departments and Independent Practices

athenahealth and MedOasis will partner to provide an anesthesia-specific billing solution that combines athenahealth’s claims processing solution with MedOasis’ anesthesia coding, charge-entry, contract management, and compliance capabilities.

UCSF Medical Center throws a great outside curve ball, keeps EMR rollout under wraps

The local paper profiles University of California San Francisco’s $160 million Epic implementation, which quietly reached its completion one year overdue and $100 million over budget. In May of 2011, then CIO Larry Lotenero was shown the door after implementation costs ballooned to three times expectations.

Identifying Personal Genomes by Surname Inference

A group of fifty men who anonymously donated DNA to genome research have been positively identified by scientists who were able to identify the patient, their address, and their relatives by taking the little demographic information maintained on the donors, and supplementing that with the wealth of information extracted from the donors genome.

Allscripts to Announce Fourth Quarter and Full Year 2012 Financial Results on February 19

Allscripts announces that it will report year-end financials during a February 19 investor call.

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January 20, 2013 Headlines 1 Comment

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