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An HIT Moment with … Patricia Stewart, Principal, Innovative Healthcare Solutions

November 30, 2012 Interviews No Comments

An HIT Moment with ... is a quick interview with someone we find interesting. Pat Stewart is a principal with Innovative Healthcare Solutions of Punta Gorda, FL.

11-30-2012 4-03-08 PM

What kinds of projects are clients looking for help to complete these days?

Many clients are struggling simply to meet such basic IT objectives as maintaining and increasing IT services to support the organization’s business and clinical strategic goals, optimizing investments in IT so the organization receives maximum value for their investments, and mitigating risks to business processes and patient care associated with IT. All while pushing to meet Meaningful Use requirements, dealing with the impact of healthcare reform, and understanding the developments in the purchaser and payer arena. These are broad initiatives and there is pressure to move forward in all of them concurrently.

Organizations are being bombarded with a host of industry changes — accountable care and medical home models, Meaningful Use and health information exchanges, ICD-10, and the call for business intelligence. Now more than ever, healthcare organizations need solid IT strategies. Typically, however, there are limited IT resources to support these strategies. This has created many opportunities for our consulting services.

The majority of our engagements fall into three main categories. Engagements to help clients implement one or more of McKesson’s Horizon suite of products with the goal of reaching MU. Engagements to help clients implement a new system, such as Epic or Paragon. Engagements to help clients transition and support their legacy McKesson applications while they convert to a new vendor, such as Epic or Paragon. We are also seeing more requests for assistance in system and workflow optimization and analytics projects.

What are some innovative implementation ideas you’ve used or seen?

It’s still not common to manage a project from start to finish according to an overall business strategy. Or for IT groups to collaborate with stakeholders to understand their needs and challenges. These practices create innovation and success.

One of our clients created co-management arrangements with each physician service line that included quality of care, patient satisfaction, value analysis studies, and EMR adoption. They established strong teams with lean experts to develop implementation approaches for issues that affect physicians directly, such as CPOE, bedside barcoding, and medication reconciliation. The teams design the implementation approach, success factors, and metric-driven financial rewards for physicians.

Clients have created dedicated teams for testing and identifying build and process issues. They have pulled operations people into a workflow and process team to identify gaps between current and future state, to make decisions about process changes, and to provide go-live support. Some clients have cut back on classroom training and instead allocated those resources for "at the elbow" user support during go-live, which also makes financial sense since these resources can be cheaper than the cost of implementation specialists. 

The company has been around for several years. During that time, the Epic business has taken a big swing up and lots of people have formed small consulting companies to take advantage of the demand. How do you see that market and your competition changing in the next few years?

Our management team has been working in the HIT environment for many years and we have never seen the kind of market growth we’re seeing now. This demand has led to a rush of people entering the consulting profession, and — as you mentioned — a lot of new consulting companies. While we’ve seen more people choosing to become consultants, we haven’t seen a corresponding increase in the experience and skill levels these individuals bring to the table.

Unfortunately, financial opportunities instead of missions, goals, and aptitude are leading people to the market. We think it is inevitable that the market will slow down, and when it does, there will be consulting companies that drop out of the market. Few are built for long-term survival.

We credit our success to a corporate mission, culture, and identity based on simple core values: do the right thing for our clients, do the right thing for our consultants, and never forget there is a patient at the end of what we do. 

What are the best jobs in healthcare IT right now, and which ones would you advise industry newcomers to prepare for?

System and process optimization. Implementations over the last few years have occurred under stressful conditions with short timelines and limited resources. System implementations have not aligned with an organizational strategy. For organizations to be successful, they must understand how their systems impact business operations. Organizations must answer the questions: what value are we getting from the systems and how are they supporting our strategic goals? What processes must change to maximize our investments and achieve our goals?

One way facilities can meet system optimization resource needs is by creating transitional programs that take strong clinical experts and train them in application support roles. With shrinking inpatient census and greater focus on clinical quality and readmission initiatives, organizations can put clinical experts with IT aptitude on a path to IT knowledge. Facilities can grow bench strength from within. It is a long-term strategy and requires investment, but we believe it’s better than searching for talent – expensive talent – that isn’t part of the organization’s culture.

Jobs that leverage data to manage patient populations and outcomes. These jobs require an understanding of the system design so the right information is captured. Their roles and responsibilities will include using predictive analytics to proactively manage outcomes and maintain reimbursement.

What subtle industry trends are you seeing now that will become important down the road?

Systems and IT resources must support initiatives that allow healthcare to transition into community settings. We must focus on managing population health and creating effective support systems to transition patients into community care settings

The emergence of the Chief Clinical Information Officer. The melding of CMIO and CNIO for a less siloed approach.

Increased ability to adopt and manage change. With the implementation of so many complex systems, healthcare organizations and providers now have a wealth of data. With it comes a greater responsibility to respond quickly to conditions that affect patient outcomes, positively or negatively. To meet that responsibility, healthcare organizations and providers must be more nimble than ever. They must adapt efficiently and effectively to changing conditions. Having years or even months to implement changes and gain adoption will not be an option.

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November 30, 2012 Interviews No Comments

News 11/30/12

November 29, 2012 News 7 Comments

Top News

11-29-2012 8-05-24 PM

The Office of the Inspector General finds that CMS has not implemented adequate safeguards to verify the accuracy self-reported EP and hospital data for the MU program. It also says that the audits CMS plans to conduct after the fact may not work, either. OIG recommends that CMS randomly select providers to provide supporting documentation for pre-payment; issue guidance detailing the types of documentation that providers should maintain to support compliance; and require certified EHRs to produce reports verifying the achievement of MU measures. Medicare hasn’t audited any of the $3.6 billion it’s paid out so far. Acting CMS administrator Marilyn Tavenner doesn’t like the idea of pre-payment review, saying it could “significantly delay payments to providers” and “impose an increased upfront burden on providers.”

Reader Comments

inga_small From Uncorked: “Re: MyWay switch. I’ve learned the upgrade that Allscripts is offering  its customers from MyWay to Pro does not include a detailed conversion of financial data, meaning users have to work the old balances in MyWay. Sounds painful.” The details on the MyWay to Pro upgrade are on the client-only section of the Allscripts Web site, so I can’t verify. However, since detailed conversion of financial data between disparate systems can be quite complicated and time consuming, maybe the balance forward option is actually the lesser of two pains.

11-29-2012 7-45-21 PM

From NoNamesPls: “Re: MD Anderson. To release an EMR RFP in January.” Unverified.

From Lucille Carmichael: “Re: Nuance. Planning to spin off Salar, which it acquired with its Transcend acquisition, possibly as early as Friday.” Unverified.

HIStalk Announcements and Requests

inga_small If your week has been anything like mine, you are still recovering from all your thankfulness last week. In case you missed any HIStalk Practice news, here are some highlights. ONC says the percentage of physicians e-prescribing on the Surescripts network through an EHR has jumped from seven percent in 2008 to 48 percent as of June 2012. Almost 10 percent of US residents now receive their healthcare through an ACO. The highest-rated EMRs in an AAFP-member survey are Praxis, Medent, Healthconnect, Amazing Charts, and SOAPware. Pediatricians lag other specialties in EHR adoption. Practice Wise’s Julie McGovern offers key points for selecting an EMR vendor. Dr. Gregg muses about corporate chaos and HIT. Thanks for reading.

On the Jobs Board: Marketing Programs Manager, Meditech Clinical Trainer, National Sales Director, Ambulatory Implementation and Deployment Managers — athenaclinicals.

Acquisitions, Funding, Business, and Stock

The mobile interactive health advice platform HealthTap acquires the health business of Avvo, including its directory and network of providers.

11-29-2012 9-32-47 PM

Ginger.io, which analyzes sensor and patient-entered smartphone data to for the equivalent of a “check engine light” for patient populations, raises $6.5 million. The investor is Khosla Ventures, whose founding partner Vinod Khosla famously predicted several weeks ago that machines will replace 80 percent of doctors (some of his other investments include iPhone attachments for heart monitoring and diagnosing ear infections). Ginger.io is based on research conducted at the MIT Media Lab. The company acquired another startup, Pipette, earlier this year for its technology that claims to reduce hospital readmissions by reviewing patient-reported outcomes. Travis reported the acquisition on HIStalk Connect back in March, where he concluded,

Ginger is a company we are going to hear a lot more about in the coming years. They have a clear focus on learning about patient behavior and proactively trying to address potentially costly events. The main question will be how much money can Ginger make quickly from pharma research or how much money can it raise to sustain itself until the healthcare industry is ready to pay for services like this. Either way, this acquisition is good for mobile health startups and Rock Health.


Stormont-Vale Healthcare (KS) selects Hyland Software’s OnBase enterprise content management solution for integration with its Epic ambulatory EMR.

Yale-New Haven Hospital contracts with Mediware for its Transtem software for tracking the use of stem cell products in providing patient care.

OnFocus Healthcare adds 75 hospital clients of its OnFocus | epm software during the company’s fourth quarter.

11-29-2012 7-47-52 PM

Pomona Valley Hospital Medical Center (CA) selects Dell and Siemens Healthcare to provide diagnostic image archiving and sharing services.

BJC Healthcare (MO) expands its use of the Surgical Information Systems perioperative information system to Saint Louise Children’s Hospital and Barnes-Jewish West County Hospital.

11-29-2012 7-50-45 PM

Santa Clara Valley Health and Hospital (CA) awards CSI Healthcare a contract to support its Epic initiatives.

Beaufort Memorial Hospital selects the Medseek Empowered solution to expand its patient engagement initiatives.

St. Joseph Health System (TX) chooses GroupOne Health Source for EHR medical billing services.

Ophthalmic Consultants of Boston (MA) deploys MedAptus for professional charge capture in its office and ambulatory surgical center locations.


11-29-2012 1-30-21 PM

SPI Healthcare appoints Ken Christensen (Health PCP) SVP of operations.

11-29-2012 2-34-35 PM

CareTech Solutions names Robert M. Johnson (Palace Sports & Entertainment) CFO.

11-29-2012 6-29-52 PM

Joseph Kvedar, MD, director of the Center for Connected Health of Partners HealthCare,  signs on as a principal with Wellocracy, but will continue in his role at CCH. The new company will focus on personal activity trackers and motivation tools that integrate healthy activities into busy lifestyles, initially producing books. He’ll be joined by a self-help author, a personal trainer turned physician, and a media relations expert.

11-29-2012 6-45-31 PM

Bill Bria, MD (Shriners Hospital for Children) is named chief medical officer of business intelligence software vendor Dataskill.

11-29-2012 9-47-40 PM

Peter Henderson (PatientKeeper) joins social networking-based employee wellness vendor ShapeUp as COO.

Announcements and Implementations

Washington DC Mayor Vincent Gray announces the go-live of Direct Secure Messaging in the district using Orion Health’s technology platform.

RelayHealth announces that it will provide an open, vendor- and payer-neutral platform for patient identity management, patient consent management, and other technology services to enable a longitudinal patient record. The technology will allow providers to embed a cross-entity MPI into their native systems and enable patient identification across multiple systems.

11-29-2012 7-51-45 PM

Jennie Stuart Medical Center (KY) goes live on Ingenious Med’s Impower charge capture solution.

The Kansas HIN and ICA share patient data with the CDC’s Biosense public health tracking system.

Government and Politics

An opinion piece in The Wall Street Journal written by former US Senator George LeMiuex (R-FL) says the government is doing little to stop the estimated $100 billion per year that Medicare loses to waste, fraud, and abuse. He had proposed a credit card-like fraud prevention system that would stop questionable claims before they’re paid, but that’s the $77 million system developed by Northrop Grumman and Verizon that had stopped less than $8,000 in questionable payments in its first eight months. He concludes that the problem is “bureaucrats hiding in their own ineptitude.”

11-29-2012 3-09-34 PM 

CMS has paid more than 150,000 EPs and 3,238 hospitals $8.4 billion in MU incentives through the end of October.

CMS extends the Medicare MU attestation deadline for New York and New Jersey hospitals affected by Hurricane Sandy. Eligible hospitals must submit to CMS and extension application to extend the attestation deadline from November 30, 2012 to the spring of 2013.

11-29-2012 6-48-13 PM

HHS issues a guide for de-identifying patient data to meet HIPAA privacy rule requirements.


11-29-2012 8-44-55 PM

British troops in Afghanistan are using a portable 3D camera to assess battlefield injuries and send images around the world for second opinions.

Surgical Theater LLC sells its first 3D imaging surgical rehearsal platform. It generates statistical models from an individual patient’s scanned images, providing life-like feedback using flight simulator technology that allows the surgeon to practice the procedure hands on. The first customer is University Hospitals Case Medical Center (OH), which isn’t surprising since its co-originator is the chair of the hospital’s neurosurgery department and the product bears his name. FDA approval is pending. The co-founders are former members of the Israeli Air Force, with my reason for calling out that fact becoming more clear as you read further down the page.


The California Department of Public Health fines Prime Healthcare Services $95,000 after determining that Shasta Medical Center violated patient confidentiality when it shared a woman’s medical information with journalists and sent an e-mail about her treatment to several hundred hospital employees. The disclosures were made when the hospital was seeking to respond to a news story featuring the woman and the hospital’s alleged overbilling of Medicare.

11-29-2012 1-56-22 PM

Philips moves from last place to first place in KLAS’s review of the MRI market.

11-29-2012 2-58-34 PM

A survey finds that promoting EHRs and mobile health are a low priority for voters compared to other healthcare issues. When asked where federal healthcare spending should be cut, 50 percent of voters said payments to providers should be reduced, while 42 percent said the government should spend less on healthcare IT.

11-29-2012 8-18-21 PM

Leapfrog Group’s second round of hospital safety ratings show significant swings in the months since the original report after it changes its methodology and uses newer data, with 103 hospitals moving from a C to and A, two changing from A to D, and an overall 8 percent moving at least two grades. Ronald Reagan UCLA Medical Center earned an F grade along with 24 other hospitals, while Cleveland Clinic took home a D. Predictably, the high-profile hospitals with the bad grades denounced the methodology when stung by local press coverage of their embarrassing results, claiming they’ve improved vastly in the 1-3 years since the information was collected.

The Bureau of Labor Statistics predicts that IT positions in healthcare and social assistance will account for about 28 percent of all new jobs by 2020.

A New Zealand sleep expert blames mobile devices for a 50 percent jump in sleeping pill consumption by young people, saying, “People go to bed with their iPhones and iPads and expect to be able to then go straight to sleep, but realistically, you can’t do that. You really need to put these devices down about an hour before you go to bed.”

11-29-2012 7-52-48 PM

I was interested in the answer Kobi Margolin gave to my interview question about why Israel produces so many healthcare IT companies that sell products to the US. He suggested reading Start-Up Nation, which describes the business climate there. I plan to do so, but from the Amazon reader comments, some of the reasons that the country is so successful despite being constantly at war, surrounded by enemies, and devoid of natural resources are: (a) mandatory military service that encourages innovation and forges early social networks; (b) Jewish tradition; (c) open immigration that encourages brilliant innovators to come there; (d) a tradition of young people traveling all over the world due to the small size of the country; (e) government policies and culture that supports entrepreneurism and the questioning of authority; (f) a flat hierarchical society; (g) acceptance of failure in the quest for success; (h) early maturity and lack of belief that people shouldn’t start businesses without a lot of experience, emphasizing instead agile, problem-solving generalists; (i) mashing up technology with other disciplines in fresh ways; and (j) great universities. In other words, pretty much exactly opposite what we have in the US except for the great universities part. If you’ve read the book, feel free to chime in.

An article in The Wall Street Journal raises the question of the ownership of data created by implanted medical devices like defibrillators. It’s your body, but only the device manufacturer (and possibly your doctor, if you see one regularly) can see what it’s emitting. A Medtronic spokesperson says, “Our customers are physicians and hospitals” and says demand is low and patients couldn’t make sense of their data anyway, but then admits that the company is thinking about selling its patient data to health systems and insurance companies. Another senior Medtronic executive calls the information it collects “the currency of the future.” The company has created a data unit specifically charged with creating a business around selling patient data, working the loophole that only providers are covered by the 17-year-old HIPAA regulations, not device manufacturers. One patient paid $2,000 to take a technician’s class for reading the reports, but still has to pay his cardiologist for a visit to get the data.

Remedy Health Media launches a service that will send electronic newsletters to patients with specific conditions under the name of their doctor, who pays the company for use of its patient data management system. The company says health reform gave them the opportunity, while advertising drug companies give them their profit. It’s a double-opt in service due to comply with spam laws, meaning patients need to sign up and then click a link on a welcome e-mail indicating their interest to receive further e-mails. Some of the company’s brands include HealthCentral, The Body, RemedyMD, and My Refill.

Attendees of an auction at a bankrupt and closed Pennsylvania hospital claim to have seen unattended medical and employee records and computers up for bid that were displaying patient information. The bankruptcy trustee claims the medical records were in roped-off areas and the computers had been wiped clean, but a bidder says that’s not the case.

An excellent article in the Toronto newspaper questions whether e-health will ever deliver a return on investment in Canada. It calls out the massive spending on eHealth infrastructure, implying that it’s a desperate shot at addressing the question, “Could the elderly bankrupt Canada?” but points out that for all the investment, Canada is still well behind most of the industrial world, with 80 percent of its physicians still using “a fax machine running full blast against a ceiling-high backdrop of manila files.” It says that Canada’s efforts are looking a lot like those of the UK, where ambitious and expensive programs tanked with little to show for it other than billions of taxpayer pounds transferred to consultants and contractors. A former deputy health minister had an interesting thought: instead of buying EHRs for everybody, which he says will cost more than the healthcare services they consume, he suggests providing them only for seniors and people with chronic disease since 1 percent of Ontario patients have been found to consume 50 percent of hospital and nursing home costs.

Weird News Andy wonders if this is where we’re headed. In England, sick babies are being put on “death pathways,” with the rather lurid newspaper article quoting one doctor who admitted that he took part in “starving and dehydrating ten babies to death in the neonatal unit of one hospital alone.” A hospital nurse calls it “euthanasia by the back door.” An investigation will determine whether hospitals earned bonuses for hitting death pathway targets.

Sponsor Updates

11-29-2012 9-57-58 PM

  • Nuance gives the $73 (at Walmart) Philips Digital Voice Tracer dictation recorder its highest rating for recording and voice recognition accuracy with Dragon Naturally Speaking.
  • 3M announces details of its 2013 Client Experience Summit, set for April 2-4 in Tysons Corner, VA.
  • Liaison Healthcare announces that four out of five global pharmaceutical companies use its integration and data management services.
  • The Orlando paper spotlights Kony Solutions and its “cutting edge” app development.
  • Levi, Ray & Shoup publishes a case study highlighting the benefits that Memorial Hermann Healthcare (TX) realized simplifying output management.
  • SuccessEHS integrates the Midmark IQvitals device with its EHR.
  • BridgeHead Software releases a white paper highlighting the crucial concerns of image availability.
  • Besler Consulting offers a free comprehensive summary of the Hospital Outpatient Prospective Payment System final rule.
  • API Healthcare offers five tips for payroll success in hospital mergers and acquisitions.
  • Informatica introduces a global messaging routing capability for the Informatica Ultra Messaging environment.
  • The Tampa Bay Technology Forum honors MedHOK with the 2012 Emerging Technology Company of the Year Award.
  • Ingenious Med releases software upgrades for its Web and mobile solutions that include a Virtual Superbill to improve charge capture.
  • Health Language Inc. releases new terminology mapping to support providers and EHR vendors meeting Stage 2 MU requirements for SNOMED-encoded problem lists.
  • iSirona releases Software Makes Sense, a five-part video series detailing the specific configurations and their advantages used by iSirona’s hospital customers to sync medical devices and EHRs

EPtalk by Dr. Jayne

Friday is the last day for HIMSS 2013 Interoperability Showcase submissions. Demonstrations must include health information exchange between at least three healthcare organizations.

Friday is also the last day for Eligible Hospitals and Critical Access Hospitals to register and attest for incentive payments in fiscal year 2012. CMS has a tutorial on YouTube which, strangely, enough seems to have been filmed in front of a green screen that wasn’t replaced by graphics, rendering it nauseatingly distracting.

Finally, a data breach that doesn’t involve a lost laptop or stolen hard drive. A resident physician terminated from the University of Arkansas for Medical Sciences kept patient lists and notes after being terminated in 2010. The resident began to produce the records during a lawsuit against the residency program, leading to a court order to prevent further release.

Discussions at RSNA reveal mixed opinions about releasing radiology results directly to patients. I think many providers would prefer to release only annotated results to patients – those results to which the ordering physician has added comments that explain the clinical significance of the radiologist’s interpretation. There are a lot of vague terms used by some radiologists (clinical correlation recommended, questionable presence of something, etc.) and that leads to fear of patients misunderstanding, which leads to fear of being transparent with results. If health systems are going to release without annotation, maybe they should require radiologists to document results at the 5th grade reading level: “Your chest x-ray looks like the chest x-ray of every other person who lives in your part of the country. I don’t see anything that doesn’t belong there.”


For those whose providers have embraced transparency and are offering patient portals and other engagement platforms, the Family Caregivers Video Challenge offers a chance to tell how health information technology or eHealth tools have helped manage a loved one’s care. Video submissions are due by December 10 and prizes worth $8,350 are at stake.

My hospital has been lucky that this hasn’t happened to us (yet). A NYU staffer inadvertently sends an e-mail that allows a student to accidentally “Reply All” to nearly 40,000 of his classmates. Thousands of students jump on the bandwagon, creating what some termed the “replyallcalpyse.” It’s only a matter of time before it happens here.



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

More news: HIStalk Practice, HIStalk Mobile.

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November 29, 2012 News 7 Comments

HIStalk Interviews Kobi Margolin, Founder and CEO, Clinigence

November 28, 2012 Interviews No Comments

Jacob “Kobi” Margolin is founder and CEO of Clinigence of Atlanta, GA.

11-28-2012 4-02-40 PM

Tell me about yourself and about the company.

I’m the CEO and founder Clinigence, my third venture in healthcare IT. I am semi-Americanized, an Israeli originally. In the mid-1990s after seven years in an intelligence branch of the Israeli Defense Forces with a group of colleagues that I met in the military, we started Algotec, a medical imaging company. With Algotec, I came to Atlanta in 1999 to start US operations. 

We sold the company to Kodak in 2004. I then joined a startup at Georgia Tech that focused on the Software-as-a-Service (SaaS) model in medical imaging.

At my first company, Algotec, we were pioneers of bridging web technologies into the PACS market. These were days when medical imaging went through the electronic revolution. Our technology was all about distributing clinical images across the enterprise and beyond. My second company, Nurostar Solutions, capitalized on this electronic revolution and the SaaS model to facilitate new business models for imaging services. In those days, teleradiology was exploding and we became the leading technology platform for these services.

In 2008, I started on a path that led me to Clinigence today. 2008 was an election year. In the days leading to that election, I looked at what was going on in the market and thought that there might be new opportunities opening up around electronic medical records. I had followed the EMR market since my first HIMSS in 1997 in San Diego. The market was advancing, as one of the analysts put it, at glacial speed. Then in 2008 or 2009, suddenly an explosion of funds was allocated for this market. I started thinking about what was coming next. Let’s assume that the market is already on electronic medical records. What impact is that going to have?

That led me to the concept of clinical business intelligence, which in essence is, how do we make sense of the data in electronic medical records from both the clinical and business or financial standpoint for the benefit of healthcare providers, for the benefit of medical practices and their patients? This is when we started Clinigence.

Officially started in 2010, we had our first beta in February 2011 and our first commercial installation in October 2011. Today we are in over 70 medical practices with about 400,000 patients on the platform, with two EMR companies as channel partners. We just signed our second partner a few weeks ago and our first ACO customer just a few days ago.


How do you position yourself in the market and who do you compete most closely with?

In the clinical analytics industry, we are unique in that we are entirely provider centric. We jumped into clinical analytics with the vision that everything is going to be inside clinical operations and everything is going to be electronic. We have created a technology foundation that uses electronic medical record data as its primary source.

If you look at clinical analytics, that is a multi-billion dollar industry. Pretty much all of that industry has focused on healthcare payers or health plans. The technologies are based on administrative or claims data. There are specific benefits ,we believe, in the use of EMR data as your primary source. The number one differentiator for us is in the use of EMR data, which allows us to do three things.

Number one, our reports are real time. We create a real-time feedback loop that takes the data from the provider system and goes back to the providers and helps them change the way they deliver care to their patients in more proactive ways.

Number two, our reports are very rich in outcomes. We all know that the ultimate goal of everything we’re doing in health reform today and healthcare transformation is patient outcomes. Yet a lot of the reports you look at today in the market don’t give you any outcomes in them, because the data that’s used to generate them is data for billing purposes that doesn’t include clinical outcomes.

Number three, because we focus on the system that comes from the healthcare provider organization itself, we give providers the ability to break the report all the way down to individual patients and individual clinical data elements. The reports are not anonymous for them. The reports are something that they can trust, something they can work with. With that, we have the power to change the behavior of providers and affect behavior change in their patients, which improves outcomes.


If a physician is receiving reports from your system, what kind of improvements might they suggest?

The reports from our system drive a process, the process of improvement. It’s like peeling layers of an onion. We focus today almost exclusively on primary care. When we go to a primary care practice, we first have the physicians look at how they document clinical encounters today. 

Oftentimes the outer layer of the onion is helping the practice or the individual physicians with their documentation practices — making sure that they’re documenting everything that needs to be documented. We often find that physicians say, “Oh, we do these things,” but when you look down at their report, it doesn’t show it. It turns out that they’re doing things, but they’re not always documenting them or not documenting them correctly.

Then the second layer is we help the practices compare their performance, the compliance of their staff, with medical guidelines, recommended care, and sometimes their own protocols within the organization or the practice. You go into a practice and you ask the doctors, “Do you follow these protocols?”

For example, in family medicine, diabetes is chronic disease number one. The recommended guidelines, recommended care protocols for diabetes are pretty well established. We know the things we need to do. You go in and ask the physicians and they always say, “Of course we follow medical guidelines. Of course we do all the things that we’re supposed to.”

Then you start breaking the data down to reports across the organization, across the staff within the practice. Almost inevitably you find that there are variations in care, differences among providers and their compliance with these protocols which lead to gaps in individual patient care. We help them find these variations in process compliance, close these gaps, and improve their compliance with those medical guidelines and protocols.

The deepest layer of the onion, which only a few of the practices we’re working with are at that level — certainly in the ACO market we think that there’s going to be more of that — is about going into the effectiveness of your protocols within the practice in driving outcomes and that goes both to patient outcomes and eventually to business or financial outcomes for the practice. In this context, we give the customer the power, essentially, to do things like comparative effectiveness, look at various protocols that they use and see which ones are driving the outcomes or the results that they want.


The ACO concept is new enough that I’m not sure anybody really understands how they’re going to operate. Does anybody know how to use the data that you’re providing to manage risk, specifically within an ACO model? Or is it just overall quality and that’s what ACO should encourage?

I think that the ACO market is indeed still a baby. OK, it’s a newborn. Everybody is at the beginning of a journey. Even some of the organizations that have been doing this for the longest, like the pioneer ACOs, are still in very early stages.

We are focusing in the ACO market on finding organizations that we think have the best shot of going through this journey and being successful in going through this journey. We come to them and offer them a partnership in the journey, where we become somewhat of a navigation system for them with the kind of reports I mentioned earlier. Then really all that our technology can do — empower them with those navigation tools to find the roads that lead to the holy grail of accountable care, to find the roads to the triple aim of health reform.

As I’ve said, we’ve just closed our first ACO customer, so it’s going to be presumptuous of me to say, “Yes, the answers are already there.” But with the three things that I mentioned earlier, specifically, primary care driven and physician-led ACOs have unique potential of identifying, figuring out the ways to get to that holy grail. We think that our technology is a critical piece that can help them and then accelerate them in their path towards that holy grail.


Describe the patient-centered medical home model and the data capabilities physicians need to operate under that.

In primary care, we are doing much more work on medical homes than ACOs because ACOs are still few and far between. There is great interest in the patient-centered medical home model.

The patient-centered medical home model in itself is only a care delivery model. It does not come with a payment model attached to it, but there are certain markets where payers actually offer incentives to those practices that go to the patient-centered medical home model.

To become a patient-centered medical home, there are specific areas that the practice needs to address. NCQA offers a certification process that has become the de facto standard in certification as a medical home. They don’t necessarily force you to have an electronic medical record, so you can potentially become a patient centered medical home even without one. But what we would say is, as you look at your goals in the patient-centered medical home — specifically goals around continuous quality improvement, goals around population health management — using electronic medical records becomes necessary, a prerequisite to your ability to engage seriously in those kinds of efforts. 

We typically come in with our technology after the practice implements or adopts electronic medical record technology and help them take the data in their electronic medical record and translate that into a clear path towards quality improvement.


Is it hard to get physicians to follow your recommendations?

Most physicians are independent. They don’t like to be told what to do. Before I started Clinigence, I looked at clinical decision support and decided not to jump into it, basically because I didn’t want to be in a position to tell physicians what to do. Instead, I selected clinical business intelligence. It was more around telling physicians how well they’re doing and how well their patients are doing. 

One of the unique aspects of what we’ve built is that we created a “declarative classification engine,” which in essence means that the physicians can ask the system whatever question they want about their operations, about their patients, about their quality. We give them flexibility to go around the medical guidelines that come from the outside sources, build their own protocols, and then look at compliance and look at their performance relative to the protocols that they have set up for themselves.

You have to be somewhat careful when you do that. If you’re looking for success under a specific pay-for-performance program, then you have to abide by whatever the payer or some outside authority has set for you, and it is not uncommon for us to have variations or flavors of the same guideline. One that measures performance for the outside reporting purpose, and then a second one or even a number of them that give the practice the ability to create their own flavor of protocols. 

Then it’s no longer somebody telling you – Big Brother telling you — what to do. You have the power to determine what to do. I think the ACO model — and to some degree, also the patient-centered medical home as a step towards the ACO model – puts the physicians within those ACOs in the driver’s seat. Nobody is telling them where to go or what road to try in order to drive the success of the ACO.

There are 33 quality metrics for an ACO that are defined by Medicare. We say, “Is this sufficient?” Clearly these metrics are necessary; you have to report on those to Medicare. But are these sufficient? Will these guarantee your success? 

It is clear to everybody in the ACO market that the answer is no. These may provide a starting point, but nothing more than that. You have to carve your own way to achieve the outcomes. We know what outcomes are desired, but as far as how to get there, much is still unknown. There’s great need for innovation in fact in the market to figure it out.


A number of Israel-based medical technology companies have come in to the U.S. market, a disproportionate number based on what you might expect. Why are companies from Israel so successful in succeeding here?

My personal story may be a bit of a reflection of the success story of Israeli medical technology. Israel has become a Silicon Valley, an incubator of technology. Israel has more technology companies on Nasdaq, I think, than all of Europe combined. A lot of it is around the medical field.

Why has Israel has become that? I can speak from my own personal experience. There’s a book called Start-up Nation that was written by Dan Senor that looked more generally at this same question. His thesis in the book is that the military in Israel is the real incubator, the real catalyst for innovation.

I can say from my experience it really was like that. In my first company, Algotec, we started fresh out of the military. We were a group of engineers in the military. We knew very little about healthcare, certainly not healthcare in the US.

What we knew — and what the military instilled in us — was the desire to do something, to innovate, to create something. Beyond the desire, also the confidence to think that at the early age and early in our careers as we were back then, that we could do something like that. We could go and make a difference like that. 

There’s a lot of that going on in the medical field. I joke around that every Jewish mother wants her kid to be a doctor. Certainly there’s a lot of that here in the States. When I was growing up, somehow I was never really attracted to that. I was more on the exact scientific side. For my undergrad, I chose math and physics. In grad school, medical physics for me was a way to bridge the gap, to fulfill at least a portion of the wishes of my mother.


Any concluding thoughts?

You asked me about the process that we go with practices and I said it’s like peeling layers of an onion. Today, mostly with our clients we focus with them on some of the outer layers. We help them comply with pay-for-performance or create a patient-centered medical home. 

But where I think all of this gets really exciting and interesting is when you start getting to the deeper layers. We took great efforts to build a platform that’s very flexible. The unique piece I mentioned earlier in this context was the declarative classification engine. We also built what we believe is the first commercial clinical data repository that’s based on semantic technologies. Now this may sound to some folks like technology mumbo jumbo, but what’s important here is the ability to get data — any type of data — and make sense of it, so the system can understand the data even if it has never seen data like that before.

We think that over time, as our healthcare system goes through this journey of figuring out how to deliver more effective and efficient care, we can with technologies like that drive or create a bridge in between medical practice and medical science or medical research. Imagine that all of medical research — pharmaceuticals that go to the market or new devices that go through clinical trials — where they test the devices on hundreds or thousands of patients. We are building a system that can collect data from many millions of patients. Already today we are collecting data on hundreds of thousands of patients every day in medical practices.

Imagine what kind of insights we can get out of the data that we’re collecting, and then how this can then accelerate medical knowledge. Not just in the context of the holy grail of accountable care – helping deliver care that’s more efficient and effective – but really advancing medical science, identifying new things, new treatment protocols that otherwise we would never know about or would take us generations potentially to find.

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November 28, 2012 Interviews No Comments

News 11/28/12

November 27, 2012 News 16 Comments

Top News

11-27-2012 1-34-54 PM

OIG includes “integrity and security of health information systems and data” as one of the top management challenges faced by HHS for 2013.

Reader Comments

11-27-2012 9-01-37 PM
From Image Is Everything: “Re: RSNA. As a vendor, some of us had to go to Chicago the Monday before Thanksgiving and work through the weekend. The trick was to take your spouse, since the Magnificent Mile had beautiful displays, shopping, tourists from around the world, and lots of nice people. The problem was Thanksgiving dinner – think the Chinese restaurant in ‘A Christmas Story.’” I accompanied Mrs. HIStalk to a Chicago conference a few weeks ago, the first time I’d been there since the wintry HIMSS conference of 2009. We had a pretty good time this trip – stayed at the Hyatt on the river, ate at semi-touristy places (XOCO, the Walnut Room, South Water Kitchen, and the Metropolitan Club in Willis Tower), bought Frango Mints, and tried to stay warm since the temperature dropped from the mid-70s the first day to the 40s the rest of the week, ruling out the architecture boat tour. I wouldn’t say Chicago is my favorite city (I think Seattle and San Diego probably top my list), but I at least liked it better than when snow and fellow HIMSS attendees were swirling around me.

11-27-2012 7-00-21 PM

From The PACS Designer: “Re: 3D printing. TPD has posted about 3D software solutions in the past, and now you’ll become aware of a retail 3D printer called MakerBot. This company reminds TPD of when Xerox was first to introduce a new way of high quality printing decades ago. MakerBot just opened the first 3D Photo Booth in NYC, its home base, and I’m sure when the photos are viewed, word will spread across the country quickly. Healthcare could benefit by employing this 3D solution to view images of the anatomy, especially the heart, by practitioners and patients undergoing treatment.” 

From Keystone: “Re: EMR. I’m involved with five practices being implemented and all are complaining that their efficiency is going backwards because of extra keyboarding. Do you think this is due to added documentation that they should have been doing all along, poor system design, or both? These are mostly primary care physicians and they are definitely seeing fewer patients per session. Also, do you know of bolt-on products to support dictation or other simpler input tools?” Readers, I’m sure Keystone would welcome your comments, which you can add at the end of this post.

From Cloud Dancer: “Re: PACS. Your blog is incredible! Was wondering about your coverage of cloud imaging solutions like Merge as well as other trends in PACS going cloud.” One thing I excel at is recognizing my innumerable limitations, among them being paucity of in-depth knowledge about imaging and lack of time to learn since I’m a full-time hospital employee. I could use an expert contributor if anyone is interested in taking HIStalk a bit deeper into that area. The other areas that people seem to want more coverage about include HIT-impacting federal policy activity, patient-centered technologies, and startups and other innovation. You might think it would be easy to find and engage experts to contribute to HIStalk, but it’s not – they’re either too busy or not all that interested in writing regularly since it’s harder than it looks.

HIStalk Announcements and Requests

11-27-2012 8-50-43 AM

inga_small I am back from my Thanksgiving break, which included a bit of holiday shopping. I was remarkably restrained in my purchasing, though I did note quite a few items for my letter to Santa. Topping the list: Christmas tree ornaments for the shoe lover.

11-27-2012 9-04-09 PM

Thanks for the nice comments folks have sent about the redesign of HIStalk Connect (the artist formerly known as HIStalk Mobile). Next up: a revamp of HIStalk Practice and HIStalk, which will have a different look that’s more appropriate to longer posts. I haven’t changed the appearance of the sites since 2007, so hopefully nobody will be too jarred by the change (me included).

Just in case you have any doubts about the financial literacy of the average American, check out the lines of people waiting to buy tickets for the $500 million Powerball lottery. These are the folks who couldn’t be bothered to play when the prize was only a couple of hundred million. Does that make sense? Do you suppose a lot of statisticians are plunking down their cash given the impossible odds of getting it back? Maybe the feds should run a lottery to help pay down the smothering national debt – it’s like a tax that nobody complains about.

11-27-2012 5-55-07 PM image

Welcome to new HIStalk Platinum Sponsor Innovative Healthcare Solutions. The 12-year-old Punta Gorda, FL-based company offers clinical and revenue cycle implementation services, with a focus on Epic and McKesson (ambulatory and inpatient EMR, STAR, Pathways, and Horizon, including upgrades and optimization.) They’ve been a Best in KLAS winner for the past two years in the Clinical Implementation – Supportive Work category. They also do assessment, optimization, testing, and strategic planning. Their approach is proven and cost effective, with the recognition that healthcare organizations are required to focus on both financial and clinical excellence for success. The principals have lot of industry experience – Robin Bayne was at McKesson for many years and Pat Stewart has been in healthcare for more than 30 years. Thanks to Innovative Healthcare Solutions for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Healthrageous announces that Partners HealthCare participated in its recent $6.5 million round of Series B financing.

11-27-2012 9-08-13 PM

Hello Health, which offers an EHR platform that’s paid for by patients ($5 per month, according to its site) instead of doctors, secures $11.5 million in financing.

11-27-2012 6-25-21 PM

VisionMine launches a service and Web portal that will match small startups with big companies trying to solve specific technology problems. The company will grade startups for the review of the large companies and will coordinate introductions when there’s mutual interest.

Merge Healthcare files a lawsuit against orthopedics PACS vendor Medstrat, claiming the company’s false claims and unfair business practice have cost Merge tens of millions of dollars in revenue. The suit claims that Medstrat sent e-mails and advertisements to Merge customers implying that the company’s announced plan to seek strategic alternatives was an indication of instability, tagging one e-mail with the phrase, “Why go through more pain? Converting is simple.” MRGE shares closed Tuesday at $3.31, down more than 50 percent since February.


11-27-2012 9-02-58 AM

Valley Medical Group (MA) contracts with eRAD for its PACS and speech recognition solution.

Intermountain Healthcare (UT) signs an $11.7 million, multi-year contract for Siemens Image Sharing and Archiving.

Adventist Health System will expand its use of Cerner’s P2Sentinel solution for auditing clinician access to patient data.

11-27-2012 9-11-52 PM

Virtua (NJ) implements the Vergence and proVision identity and access management solutions from Caradigm.


11-27-2012 9-50-11 AM

Cadence Health (IL) names Dan Kinsella (Optum Insight) CIO and EVP, replacing the recently retired Dave Printz.

11-27-2012 1-24-59 PM  11-27-2012 1-23-57 PM  11-27-2012 1-23-05 PM

Orion Health names Tracey Sharma (Baxter) sales director, Sergei Maxunov (Bell Canada) senior solutions consultant, and Health Linkletter (EMIS) project manager of its Canadian eHealth team.

Announcements and Implementations

HIMSS honors the family practice of Jeremy Bradley, MD (KY) as a winner of the 2012 Ambulatory HIMSS Davis Award of Excellence.

Cerner and telecommunications information company Global Capacity partner to deploy Cerner Skybox Connect, a high availability private network for the healthcare industry.

11-27-2012 9-59-23 AM

Children’s of Alabama implements Accelarad’s medical image sharing network to enhance care coordination with referring facilities.

11-27-2012 10-04-07 AM

Jefferson Radiology (CT) deploys Repair, a remote MPI management service from Just Associates.

NextGen Healthcare and Microsoft launch NextGen MedicineCabinet, a free app for the Windows 8 platform for the management of personal medication records.

Nuance Healthcare announces Assure for Powerscribe 360 | Reporting, which uses clinical language understanding to QA radiology reports before they’re signed.

Medsphere marks its tenth anniversary by noting that more than 70 percent of its OpenVista customers have achieved Meaningful Use Stage 1 so far.

Wellcentive announces that its Advance Outcomes Manager population health management and analytics solution has earned NCQA certification.

11-27-2012 6-35-21 PM

GetWellNetwork and Sharp HealthCare (CA) develop and launch what they say is the first in-room collaborative patient whiteboard. It identifies care team members, tracks visits and family questions, provides a daily schedule and plan, and allows patients to communicate with their family members.

11-27-2012 6-54-44 PM

University of West Georgia in Carrollton, GA, whose graduates make up a third of Greenway’s employees, names its new sports stadium building “Athletic Operations Building, sponsored by Greenway, Inc.” and adds the company’s logo to the building.

Cerner lists all of its customers that have successfully attested for Meaningful Use Stage 1.

11-27-2012 7-55-29 PM

Chicago-based Valence Health, which offers population management and reimbursement risk management tools and services to providers, announces that its 2012 revenue will increase by 75 percent to over $30 million compared to 2011. The announcement mentions new hires Eric Mollman (Staywell Health Management) as CFO, Kevin Weinstein (ZirMed) as chief marketing officer, and Prasanna Dhungel as VP of product development.

The Panama City, FL paper writes up the expansion of local business iSirona,which also announces that Mercy Medical Center (IA) has contracted for its medical device integration in the OR.

Government and Politics

CMS awards a 10-year, $15 billion contract to eight vendors to compete to build various aspects of a virtual data center for the agency’s IT infrastructure, including claims processing and hosting services for a national data warehouse application.

CMS picks the Kansas City Improvement Consortium, the Health Improvement Collaborative of Greater Cincinnati, and the Oregon Health Care Quality Corporation to be the first organizations to participate in a Medicare claims sharing initiative to assess provider performance.

November 30 is the last day for eligible hospitals and critical access hospitals to register and attest for an EHR incentive payment in fiscal year 2012.

Tennessee’s Medicaid program requests $9 million to replace its obsolete IT system with the VA’s VistA.


The Madison, WI paper looks at the growth of Epic and its impact on the region. Epic left Madison several years ago for Verona, which has seen huge jumps in property values, but Madison has also benefited by increased demand for rental property and more employment opportunities. Madison city officials say Epic visitors are driving revenue to the hospitality industry, resulting in a 30 percent increase in city room tax receipts from 2010 to 2012.

11-27-2012 4-15-16 PM

A new KLAS report concludes that the top global radiology PACS vendors vendors are those offering meaningful and timely upgrades with expanded usability. Infinitt and Intelerad rated highly as innovators, along with DR Systems, McKesson, Novarad, and Sectra.

A Weird News Andy literature review notes that two new studies conclude that “flu vaccine is a heart vaccine” since people in the study who got a flu shot experienced 50 percent fewer cardiac events and 40 percent lower heart-related mortality. I’d need to review the original research to feel good about that conclusion, about which I’m skeptical otherwise.  

Also from WNA: in the UK, ministers are warned that a plan to implement “virtual clinics” powered by Skype will save billions of pounds immediately, but could leave less technology-savvy patients behind. The Health Minister expects video visits to reduce unnecessary hospital stays, saying that a third of patients can be managed without a face-to-face appointment, leaving more capacity for those who need to be seen in person.

WNA also notes this nugget: the Cincinnati-based TriHealth health system fires the 150 of its 10,800 employees who did not get a mandatory and free flu shot.

I’ve mentioned Italian brain cancer patient (and artist, engineer, and TED fellow, as it turns out) Salvatore Iaconesi several times for his “My Open Source Cure” appeal for treating his condition, much of which involves the struggle to share his records electronically with experts around the world who volunteered to help. CNN ran his story on its main page Tuesday morning. You should watch his newly published TEDx talk above on the challenges created by the medical establishment and his views on wellness and cures (the human being, not the “patient”). I don’t agree with everything he says, but he will definitely make you think, especially if you’ve been a patient with a serious condition. He is exchanging information with 15,000 people and 60 doctors and reviewing 50,000 strategies sent to him with the help of 200 volunteers.

MMRGlobal is awarded a fifth EMR-related patent, proudly proclaiming that despite having supposedly harassed companies into signing $30 million worth of license agreements for its newly-issued patents, the company is not a patent troll since the patented technology is part of products it sells itself. Or tries to, anyway – according to this month’s quarterly filings, the company’s total quarterly revenue was $346,000 with a net loss of $1.5 million, with current liabilities exceeding current assets by $8 million and only $42,000 cash in the bank as it seeks additional financing from its founder and anybody else willing to loan it money. OTC-listed shares are at $0.0147, valuing the whole enterprise at $7 million and obviously reflecting serious market doubt about the company’s banking the $30 million it claims to be owed for its newly created intellectual property portfolio.

11-27-2012 8-16-43 PM

Cleveland Medical Mart announces that it has signed Cleveland Clinic and GE Healthcare as tenants. HIMSS, which had signed on with a similar project in Nashville that went bust, has toured the facility, which is three-quarters complete and scheduled for a September 2013 opening.

The local paper in Edmonton, Alberta gets its hands on the expense records of the former CIO of the Capital Health region, whose boss there was found to have been reimbursed $350,000 for questionable expenses that included opera tickets and a butler. Donna Strating, who like her boss was billing $2,700 per day as a consultant, was reimbursed for large restaurant tabs, movie tickets, and snacks.

Sponsor Updates

11-27-2012 12-55-37 PM

  • Employees of Digital Prospectors supply 30 Thanksgiving meals to the New Hampshire non-profit Families in Transition.
  • MModal releases software updates to its Fluency for Imaging Reporting technology platform to support report creation and clinical documentation workflow.
  • Merge Healthcare makes its iConnect Enterprise Clinical platform available through EMC Select.
  • The GPO Yankee Alliance offers its healthcare members connectivity solutions from Lifepoint Informatics.
  • Frost & Sullivan honors Acuo Technologies with its 2012 Market Share Leadership Award in Imaging Informatics.
  • Visage Imaging announces a new video about its enterprise imaging platform, Visage 7 – Speed is Everything, at RSNA.
  • Frost & Sullivan awards TeraRecon its 2012 New Product Innovation Award in Medical Imaging Informatics.
  • Telus Health executives Francois Cote and Brendan Bryne are quoted in a newspaper article on the digital transformation in healthcare.
  • The Web Marketing Association awards Imprivata its 2012 WebAward for Outstanding Achievement in Web Development in the Best B2B Website category.
  • The Detroit Free Press recognizes CareTech Solutions with its fourth consecutive Top Workplace award in the large company category.
  • Frost & Sullivan awards Humedica the 2012 North American Health Data Analytics Customer Value Enhancement award.
  • BridgeHead Software releases a white paper outlining strategies for addressing concerns about image availability.


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

More news: HIStalk Practice, HIStalk Mobile.

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November 27, 2012 News 16 Comments

Healthcare IT from the Investor’s Chair 11/26/12

November 26, 2012 News 2 Comments

A reader recently asked me about the mechanics of insider trading – out of pure curiosity, I hope, with no criminal intent! When do companies “know” what their quarterly numbers will be? How do they maintain them in secret? What prevents in-the-know employees (not to mention any NDA’d companies doing diligence) from taking advantage of what they know?

At the risk of providing a how-to guide to insider trading, today’s post answers these questions and gives some pointers on what’s permissible to ordinary knowledgeable people.

First, let’s consider Google’s recent leak of a draft third quarter earnings report as an example. That was a classic “oops” moment, when someone at its financial printing company pushed the wrong button and the data were filed with the SEC (and hence the wire services) before they should have been. Typically this information is “embargoed” properly (just like with PR firms and news outlets), so a mistake like this doesn’t happen. But let’s talk about the key issue here.

Don Berwick, former head of CMS, made a remark in a totally different context, but highly relevant to insider trading (and much more) at the Health Evolution Partners Leadership Summit this year:

“When values are strong, rules aren’t necessary; when values are weak, rules are ineffective”.

The rules in this case refer to insider trading.

SEC rules clearly prohibit “beneficial insiders” (such as corporate officers) from buying or selling stock based on “material non-public information”, of which clearly an earnings release would be a textbook example. It also requires others, such as a printer, investment banker, or PR agency employee to be considered “insiders,” thus owing a fiduciary duty of confidentiality.

In a case of a PE investor doing diligence on a target company, before even disclosing the name of the target, the banker typically requests the investor to sign a NDA (non-disclosure agreement) specifically stating that they would be a beneficial insider and bound to certain rules. In the case of corporate employees below the officer level, information is kept on a strictly need-to-know basis and public companies typically have codes of conduct and even blackout periods during which time the company’s stock can’t be traded.

That said, insider trading is a fact of the equity markets and simply can’t be completely prevented. In my experience, information often leaks. I’ve seen stocks move up or down in anticipation of good or bad news too many times to believe it’s a coincidence or simply an example of market efficiency. The SEC is focusing more on this phenomenon, and with the help of Big Data, is getting ever better at locating suspicious trades and catching more perpetrators.

The recent high profile case of Rajat Gupta – the former leader of McKinsey (of all firms) who sat on multiple boards and was convicted of passing secrets to the Galleon Partners hedge fund — is a case in point. The Gupta case involved wiretaps and a lengthy investigation, though. What about everyday cases? They, too, can be detected in the data. 

For example, if you’ve never shorted a stock (sold it, anticipating it will go down) and then suddenly do so for an unusually large amount of money, and then by great coincidence, it then does go down, you might get a call from the SEC. Because options allow even greater leverage (you can buy or sell options for many more shares for the same amount, because they have expiration dates), options activity is scrutinized even more heavily. The SEC has made some fairly impressive busts, even tracing Eastern European shill buyers to Goldman Sachs junior bankers.

In spite of the SEC’s increasingly sophisticated watchdog activities, we don’t know what we don’t know. In a recent conversation I had with a former US Assistant Attorney General who focused on white collar crime, she estimated that less than 1 percent of insider trading is actually caught.

Even so, it’s a bad idea and I recommend against it. If the unethical nature of insider trading doesn’t stop you, consider that the penalties are harsh and the publicity career-destroying. Further, it’s not the victimless crime some see it to be. Information asymmetry to this extent is patently unfair, and further, it erodes the public’s faith in the capital markets that drive our economy.

A better (and entirely legal) way to trade on semi-proprietary knowledge is one which I expect most readers of HIStalk can easily do. If you think, “Wow, this EMR strategy is terrible. There’s no way it can be sustained,” or, “Wow, this is the best product I’ve seen in my career,” and you do some research on the stock and see it’s expensive or cheap relative to its peers and historical trading range, maybe it makes sense to buy or short the company.

If you do it, though, spend only amounts you can afford to lose. This is high risk, and sometimes an investment thesis takes longer to play out than you expect.

A cautionary note to the physician readers of this blog. If you’re participating in a clinical trial and have knowledge about the compound and its manufacturer, trading on that knowledge is another no-no, as the even more recent case of SAC Capital trading on a clinical trial result showed (or will show once the indictments are finalized).

This was a great question. My thanks to the reader to who asked it! If you’re curious about another investment, Wall Street, or investment banking-related topic, please let me know and I’ll use it as a future blog topic.

As we recover from Thanksgiving, I wish everyone a great holiday season. Near-term events that are investor-relevant include the RSNA conference this week, the ever-popular JP Morgan Healthcare Conference, and the bet-worthy question of who’s going to buy Allscripts and what they will pay.

Ben Rooks spent a decade as an equity analyst and six long years as an investment banker. In 2009 he formed ST Advisors to work with companies on issues that don’t solely involve transactions. He has been a beneficial insider countless times (but never traded inappropriately) and appreciates e-mail.

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November 26, 2012 News 2 Comments

Curbside Consult with Dr. Jayne 11/26/12

November 26, 2012 Dr. Jayne 5 Comments


Last week Mr. H took a break from compiling the news, which meant that I took a break as well. Baking is one of my hobbies, so I used the free time to turn out a couple of “oldie but goodie” recipes. I’ve been making one of them since I was in junior high school but hadn’t done it in a couple of years and it was a nice treat. I find working in the kitchen to be therapeutic. The steady rhythm of knife work and the stress-relieving properties of making pastry are good reminders of getting back to the basics.

I’ve been doing more traveling lately than usual, so the downtime this week was much appreciated. The perfect storm of my specialty society meeting, a tech conference, and MGMA hit entirely too close together. Although tiring, the upshot of hitting three meetings in two months was being able to see (actually in person!) a lot of people that I typically only interact with in the virtual world. In this age of emerging communications tools, I think that the concept of friendship has evolved as well.

Although I have plenty of local friends, some of my best friends are those that I may only see once or twice a year. It’s easy to stay close when you’re only a few keystrokes and a mouse click away. The things you previously had to wait to hear in the annual Christmas letter are now presented real time via Facebook. When you meet in person, it’s almost like no time has passed since your last get-together and that is a wonderful thing.

I find that I’m closer to work friends because we interact through social media. Although I don’t like my News Feed clogged with pictures of what people ate for lunch or which beer they’re drinking tonight, I enjoy seeing what colleagues are up to when they’re not at work and seeing their children grow up. I’m thankful to be able to keep in touch with people who have moved on to new challenges or to other parts of the country.

Our HIStalk readers provided some extra special Thanksgiving moments by reaching out to say how much they appreciate our team. Sometimes it still seems a little unreal that we do this every week – IT workers by day, bloggers by night. It’s good to hear that you think we’re making a difference.

My favorite e-mail of the week was one asking me for a favorite Christmas punch recipe, and I’m excited to be thought of as the Martha Stewart of the health IT world. Let’s face it, I’ll never keep up with Inga as the fashionista, so I’ll settle for being the happy homemaker.

Since Thanksgiving seems to be the official start of the holiday office party season, I offer up Dr. Jayne’s Holiday Recipe Guide. Having spent most of my career in non-profit healthcare, I’m used to partying in the potluck style. Since HIStalk is your virtual water cooler for IT news and gossip, we’re happy to be part of your office potluck as well. Choosing something from the list below will allow you to avoid another year of shame after being labeled as “that guy who brought the case of White Castle Hamburgers.”


Hot buffalo chicken dip

Best made in a small crock pot on your desk since I’ve never worked in an office that has an oven.

Super-lazy cheese and crackers (perfect for purchasing on the way to work)

Unwrap a block of Neufchatel cheese (might be labeled as “light cream cheese”) and place on a rimmed serving dish. Pour Bronco Bob’s Roasted Raspberry Chipotle Sauce liberally over the cream cheese and around the dish. Serve with Wheat Thins or similar crackers.

Main Dishes

White Chicken Chili

Cranberry Cocktail Meatballs

(thanks to Mr. Z. – and I totally appreciate the notes on how you actually make them vs. what the recipe says)

2 pounds lean ground beef

1 cup cornflake crumbs

1/3 cup finely chopped parsley

2 eggs, lightly beaten

¼ teaspoon pepper

garlic powder to taste

1/3 cup catsup

2 tablespoons thinly sliced green onions and soy sauce

Thoroughly mix all ingredients. Roll into balls (about 1 to 1 ½ inches). Bake on cookie sheet at 500 degrees. It says five minutes, I think I do about seven. They are great as is for spaghetti.


1 can whole cranberry sauce

1 12 oz bottle tomato based chili sauce

1 tablespoon each brown sugar and lemon juice

Warm in pot, drop in meatballs. I make my meatballs ahead of time and nuke them on medium to bring to room temp and drop in.


Libby’s Pumpkin Roll 

It’s a little tricky to make without it cracking, but it looks (and tastes) like a million bucks. And yes, a seventh grader can make it.

Insanely Good Chocolate Cake

It goes by a variety of names and with subtle variations.

Bake a dark chocolate cake in a 9×13 pan according to package directions. Before it cools, poke holes all over the cake (using a serving fork or a bamboo skewer) and pour on a 14 oz can of sweetened condensed milk, then pour on an 8 oz jar of caramel topping. Refrigerate overnight. Immediately before serving, cover with whipped topping and sprinkle with crushed Heath bars.


Christmas Punch

Martha Stewart Style and not for the office party, unless your office lets you have vodka.

Christmas Punch

Cooks.com style.

Sherbet Punch

Good for when you have to throw an office baby shower, too.

Place ½ gallon of sherbet in a punch bowl – I like raspberry personally. Slowly pour over 1 liter ginger ale and ½ liter of Fresca or Sun Drop. You can change the colors by changing the sherbet, but know that rainbow sherbet turns an unappealing color if you try to use it.


If you have favorite office party recipes, be sure to share. I’m always looking for something new and delicious. See you around the water cooler and in the buffet line.


E-mail Dr. Jayne.

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November 26, 2012 Dr. Jayne 5 Comments

Morning Headlines 11/26/12

November 25, 2012 Headlines No Comments

RSNA 2012 Begins

The 98th Annual Meeting of the Radiological Society of North America  begins this weekend under a unifying “Patients First” theme.

GP blames computer for man’s death from ulcer

A UK physician blames the poor usability of his practice EMR as the root cause of a patients death after he failed to prescribe the patient a medication to treat a stomach ulcer.

Welsh First Minister Opens Clinithink’s Development Centre

First Minister of Wales Rt. Hon Carwyn Jones opens Clinithink, a Healthcare IT R&D firm based in Bridgend, Wales.

Matching DNA With Medical Records To Crack Disease And Aging

A recently published research project is matching DNA sequencing data with information from Kaiser Permanente EHR data to identify at risk patients before chronic diseases develop.

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November 25, 2012 Headlines No Comments

Monday Morning Update 11/26/12

November 24, 2012 News 6 Comments

11-23-2012 9-15-15 PM

From Non Sequitur: “Re: UNC. I told you I would submit the official Epic announcement when it was released. Since you have already mentioned this, it’s not really newsworthy.” Au contraire – it’s nice to get official verification, which apparently came from UNC Health Care System (NC) on November 19 with its Epic announcement. Cerner and Siemens were the also-rans. Assembly of the implementation team will start early in 2013, with 80-120 folks tapped to begin the rollout of Epic to UNC Hospitals, Rex Healthcare, Chatham Hospital, the UNC Physicians Network, and UNC Physicians & Associates.

11-23-2012 9-38-53 PM

From Max Headroom: “Re: CES Unveiled. The consumer electronics show had a lot of Fitbit-type companies, but the coolest and most Thanksgiving relevant was the HAPIfork from a Hong Kong company. The USB-connected fork tracks how many bites you eat over what time, with the premise that eating more slowly has more positive effects on metabolism. It even has a reminder to eat more slowly, so people can get alert fatigue from eating.” That sounds somewhere between creepy and  pretty smart, at least if you believe that eating slower means eating less and if you don’t eat a lot of fork-free sandwiches or soup. The fork records everything without being USB connected, then uploads to an online dashboard and to Facebook if you want (I guess that would be social net-forking). 

11-23-2012 8-29-06 PM

Welcome to new HIStalk Platinum Sponsor Acuo Technologies of Bloomington, MN. The company offers Universal Clinical Platform (a vendor-neutral archive) and clinical data migration solutions that let customers liberate their clinical content from departmental silos (including enterprise medical images). The result: putting patient information where it’s needed, with customers executing their own clinical strategies instead of meekly following those dictated by their technology vendors. It often makes sense to pursue a selective best-of-breed strategy for wound care, pathology, and neurosurgery, and Acuo’s technologies allow making data from those systems liquid while ensuring vendor independence and multi-site support. The benefits include lower TCO, built-in business continuity and recoverability, better network utilization, implementation of IHE-profile standards and vendor neutrality, and the ability to monitor system health via a single dashboard. Not to mention that the client owns both the data and the archive. The DoD chose Universal Clinical Platform a few weeks back to consolidate images from 62 Army and Navy PACS sites located around the world – UCP works with every major radiology and cardiology PACS. The company just released a white paper that describes how three of its hospital customers weathered Hurricane Sandy, along with an overview of the business continuity possibilities offered by UCP. If you’re at RSNA this week, drop by booth #7146 and tell the Acuo folks that you saw them mentioned in HIStalk. Thanks to Acuo Technologies for supporting my work.

From my usual YouTube cruise, here’s a video featuring customers talking about their Acuo implementation.

11-23-2012 8-46-54 PM

HIMSS and vendor user group conferences are those national meetings most commonly attended by poll respondents, with the other events lagging far behind them. New poll to your right, following up on a Dr. Jayne question: is transcription a commodity service that’s differentiated mostly on price? Feel free to click the poll’s Comments link after you’ve voted to editorialize your position.

11-23-2012 8-54-12 PM

I’ve been revamping HIStalk Mobile over the last several days. The site has a new look and a gradually changing name – HIStalk Connect. Travis is posting from the physician and entrepreneur perspective while Lt. Dan is handling the daily news posts. If your interests include startups, cool technologies, consumer health IT, and telehealth, you might consider becoming a regular contributor, a guest author, an interview subject, or a news tipster. I’ll have some new sponsors to announce shortly.

11-23-2012 8-58-33 PM

The First Minister of Wales opens Clinithink’s research and development center in Bridgend, emphasizing the government’s commitment to stimulate economic growth by supporting technology companies. That’s Rt. Hon. Carwyn Jones SM on the left, Clinithink CEO Chris Tackaberry on the right (he wrote a Readers Write article a week ago). The company offers the CLiX clinical language indexing engine for ICD and SNOMED that turns medical notes into coded data.

I create an eclectic music playlist every week in the hopes that folks who’ve been stuck in a musical rut going back to their college days (or since computers took over most musically related chores) will find something fresh to listen to. The one for this week includes a mix of genres and vintages: Soundgarden, Auf Der Maur, Zip Tang, Morrissey, Lana del Rey, and some cool surf tunes. Some of the tracks were recommended by readers. Let me know if anything speaks to you.

11-23-2012 10-36-47 PM

I was thinking about HP’s accusation that its recent acquisition target Autonomy had fraudulently misstated earnings, forcing it to write down $9 billion as announced last week. I’m beginning to be skeptical that Autonomy was the lone gunman. HP has been a train wreck in every conceivable way, so it seems suspicious that the company chose the day of a bad quarterly report to trot out excuses from an acquisition that closed a year ago. Peering deeper into the numbers, HP says the magnitude of the alleged accounting fraud was a few hundred million dollars, which caused it to pay $5 billion too much. That would seem to imply that the other $4 billion that was written down was because HP vastly overpaid (which was why companies better than HP had already passed on the deal). All of this happened before Meg Whitman took over as CEO (she was hired September 22, 2011), but the (literal) bottom line is that the company peed away $9 billion, with the only question being which aspect of HP’s due diligence stupidity (valuation or forensics) was at fault. It would appear that HP’s bragging rights for hiring (and most puzzlingly, retaining) the least-competent board of directors in the country remains unthreatened.

An NIH-funded project to match DNA samples from 100,000 volunteer Kaiser Permanente patients with their electronic medical record information is creating a “playground of incredibly rich data” that is already turning up medical discoveries. Researchers have discovered genetic variations that seem to influence the effectiveness of statin drugs. They’ve also found something that sounds like a like a palm reader’s life line – a specific genetic component whose physical length seems to correlate with lifespan.

Accretive Health writes $4,000 checks to 90 Minnesota patients who complained that the company harassed them with abusive medical collection practices.

A UK doctor blames the death of one of his patients on the practice’s EMR, saying he failed to notice that the patient had stopped taking proton pump inhibitors and died of a stomach ulcer as a result. The doctor says of the since-replaced system, “In a highly-charged meeting with a patient, when you’re discussing very important matters, I failed to notice the absence of a D on the computer screen. The systems fail to flag up under-use in an adequate way. It’s a hazardous system.”

Also in the UK, a patient dies after an erroneously programmed IV syringe pump delivers a 24-hour narcotic dose over just 12 hours. The nurse who set the pump admits that she isn’t sure that she understood the pump instructions another nurse gave her.

11-23-2012 10-22-34 PM

UC Davis Children’s Hospital (CA) tries its hand at crowdfunding, seeking donations for the purchase of specific items that range from $30 toys to a $12 million NICU wing. A “medical computer suite” costs $2,210 just in case you’re up for providing a stocking stuffer.

Decision support tools from Dallas-based cardiology software vendor Emerge Clinical Decision Solutions are chosen by the HeartPlace cardiology practice for use in 31 clinics and 25 hospitals. Software algorithms review patient symptoms and histories, with the company claiming that identification of some cardiac conditions is increased by 300 percent.

11-24-2012 7-05-09 AM

I noticed a drug study authored by a pharmacist from Cerner Research. That reminded me that Cerner mines and sells the patient information stored by its hosted EMR clients.

I’m annually amazed that RSNA convinces 60,000 people to leave their families Thanksgiving weekend to head off to chilly Chicago. If you are there, enjoy the conference.

The Milwaukee business paper takes a field trip to Children’s Hospital of Wisconsin to check out its $129 million Epic implementation. At 263 beds, that’s a truly Epic cost of almost half a million dollars per bed.

As more Americans get fatter, so does their mental picture of what ideal weight should be. Sixty percent of people think their weight is about right despite CDC statistics showing that 69 percent of Americans are overweight. I theorize that foreign travel will suffer as junk food eating and expandable pants wearing Americans realize that they stand out like lumbering giants when immersed into a culture of svelte locals in Asia, Scandinavia, and almost everywhere else. I blame vanity sizing, where clothing manufactures make everything several sizes bigger than the label says so customers can pretend their mirrors are defective. Not appropriate post-Thanksgiving talk, I know.

Strange: an air conditioning technician files a $1 million negligence suit against Kingwood Medical Center (TX) after stinging bees cause him to plunge through the hospital’s skylight.

The re-domesticated Vince picks up where he left off with the HIS-tory of CPSI, founded by Denny and Kenny (one of them really was a rocket scientist). Vince thrives on memory-refreshing reader e-mails, so if you have interesting nuggets or current contacts from the sepia-toned HIT of yesteryear, he would enjoy hearing from you.


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

More news: HIStalk Practice, HIStalk Mobile.

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November 24, 2012 News 6 Comments

News 11/21/12

November 20, 2012 News 9 Comments

Top News

11-20-2012 8-06-30 PM

Nuance reports Q4 results: revenue up 28 percent, adjusted EPS $0.51 vs. $0.42, beating expectations of $0.48. In the earnings call, Chairman and CEO Paul Ricci said the company’s healthcare business will generate more than $1 billion in 2013, making the company one of the largest HIT vendors. He also said that the recent Quantim and JATA acquisitions will contribute $90-100 million in annual revenue.

Reader Comments

inga_small From Samantha Taggart: “Re: giving thanks. I am very grateful and thankful to all of you for doing what you’ve done for this (our/my/your) industry. Healthcare is a precious thing and I can’t imagine what HIT would be like today if you all hadn’t somehow provided the transparency and insight into what’s really going on in this industry. We ALL thank you so very much. Enjoy your holidays and feel very good about what you do.” On behalf of Mr. H, Dr. Jayne, Dr. Travis, Dr. Gregg, Donna, and Lt. Dan, a big thank you for the kind words. I will save this note for those days I find myself thinking I can’t possibly read one more thing about healthcare and technology. I am thankful that I lucked into the greatest job ever in HIT, that I work with such fun and smart people, and that people continue to read and support HIStalk week after week. Best wishes to all for a great holiday. I’m off for the rest of the week off to spend time with family and friends, eat too much food, watch some football, and perhaps buy a couple of pairs of new shoes.

From MDRX Scrooged: “Re: Allscripts. Everyone is expecting huge cost cutting if Allscripts is sold to a private equity firm, but what may not be expected is that the cost cutting will start in the next couple of weeks. Between 70 and 130 employees will be let go, mostly from services and engineering. Happy holidays to us!” Unverified. I’ve received a few rumors on where the possible acquisition stands, pretty much split between: (a) talks are at an impasse because the PE people won’t pay above $15 per share and the board won’t accept that offer with shares trading at $12.35, and (b) a deal has already been finalized but not yet announced. In other words, I don’t know any more than you do.

11-20-2012 6-47-24 PM

From Force Majeure: “Re: Allscripts. A practice that requested termination of its MyWay agreement was turned down even though its contract says Allscripts will comply with any CMS requirements to meet MU and any other standards, with the explanation that the practice was offered a free upgrade to Professional. What about costs for infrastructure, equipment, and possible lost productivity? The contract didn’t say they company will meet the requirements by making the customer switch products. They’re going to be flooded with these requests.” Unverified, but FM provided a copy of the purported e-mail above, where the company takes the position that moving a customer to a completely different product than the one they bought is contractually acceptable since it’s a free switch to a more expensive product. I think I’d probably side with the company legally, although as a customer I’d still be ticked that I have to spend money and energy because of the company’s business decision. Obviously your options as a customer are limited if you recently signed up for the five-year lease – you’re going Professional unless you’re willing to lose a lot of money (either by not collecting Meaningful Use money or in paying off your lease while buying a competitor’s product). I assume the leases work like they do for a consumer transaction – a third-party financing company buys the contract at a discount and handles the payment collection, meaning it’s not up to Allscripts to let customers out of their lease agreements. Leasing terms might make an interesting topic for Bill O’Toole in a future HITlaw column given this example.

From Nasty Parts: “Re: [company name omitted]. They were apparently shocked to see former employees working for competitors at MGMA and offered a bounty to current employees to identify them so they can be send cease and desist letters.” Unverified. I’m sure someone must have proof if this claim is accurate, so I’ll fill in the blank if someone will provide that proof.

HIStalk Announcements and Requests

I will most likely not do news this Friday unless I get bored since I doubt anyone would read anyway. Enjoy your holiday. I’ll be back at the keyboard Saturday as usual putting together the Monday Morning Update.

Acquisitions, Funding, Business, and Stock

11-20-2012 5-33-03 PM

Medical education firm Pri-Med, a division of Diversified Business Communications, acquires EHR provider Amazing Charts.

11-20-2012 6-12-45 PM

Shades of McKesson-HBOC: shares of the perpetually bumbling HP drop 12 percent Tuesday after the company announces that it will take an $8.8 billion write-down on its 2011 acquisition of British software vendor Autonomy. HP says Autonomy had cooked its pre-acquisition books by counting low-margin hardware sales as software income and claiming that resellers were customers. Details have been shared with US and British regulators to pursue criminal and civil charges. If HP is right, nice work by Deloitte, to whom it paid big money for pre-acquisition due diligence. The previously fired CEO of Autonomy denies everything, defers to Deloitte’s audits, and says HP destroyed the company’s value by raising prices and lowering sales commissions, adding that, “The difficulty was that the company [HP] needed a strategy, and I still couldn’t tell you what that is.” HP’s now-irrelevant Q4 numbers: revenue down 5 percent, adjusted EPS $1.16 vs. $1.17 but more dramatically –$3.49 vs. $0.12 including the write-down. The ugly five-year chart above plots HP shares (blue) against the Nasdaq index, indicating that you’d probably have been better off burning dollar bills to keep warm. Oracle was smarter: they passed when Autonomy made a “please buy us” pitch – see the hilarious Another Whopper from Autonomy CEO Mike Lynch post from September 2011 on Oracle’s site, placed there after Lynch denied trying to convince Oracle to buy his company. The always-feisty Oracle, in response to his denials, posted the PowerPoint slides Lynch used in the meeting, which seemed to jog his memory of the conversation.


The National Football League signs a 10-year contract worth $7-$10 million with eClinicalWorks to implement an EHR that can help the league research and treat player head injuries.

DoD awards Acuo Technologies a nine-year, $40 million contract for its vendor neutral archive solution.

11-20-2012 11-13-02 AM

Huntington Memorial Hospital (CA) selects the Merge PACS iConnect Enterprise Clinical Platform for its hospital inpatient EHR and its Huntington Health eConnect HIE.

Sharp HealthCare selects 3M’s 360 Encompass System for medical records coding, clinical documentation improvement, and performance monitoring across its four hospitals and affiliated medical groups.

Aurora Health Care (IL, WI) will deploy Humedica’s MinedShare analytics platform to support its ACO initiatives, improve coding accuracy, and develop ambulatory physician scorecards.


11-19-2012 7-23-45 AM

CareCloud hires Ralph Catalano (athenahealth) as VP of operations.

11-20-2012 8-56-21 AM

Health monitoring company Medivo appoints David B. Nash, MD (Jefferson School of Population Health) to its medical advisory board.

Announcements and Implementations

11-20-2012 11-14-34 AM

White Plume Technologies releases its AccelaMOBILEmobile charge capture product app.

11-20-2012 11-15-40 AM

McKesson will give $1 million in free Practice Choice EMR licenses to 100 small-practice physicians who practice in primary care, internal medicine, gynecology, or pediatrics and who have a history of providing unreimbursed care to low-income patients.

11-20-2012 5-43-37 PM

MedCentral Health System (OH) expands its system-wide use of the Surgical Information Systems solution to include anesthesia automation, perioperative analytics, patient tracking, and integrated tissue tracking.

11-20-2012 5-52-53 PM

NextGen Healthcare releases its 8 Series EHR content, which includes a new user interface, standardized framework for templates, and streamlined navigation.

Children’s Hospital Association goes live a contract with Baltimore-based mdlogix to provide an informatics platform that will support its Hospital Survey of Patient Safety tool.

Government and Politics

The GAO finds that CMS is behind schedule on the implementation of its Fraud Prevention System for analyzing Medicare claims data for fraudulent behavior.

11-20-2012 6-44-34 PM

CMS releases Meaningful Use Stage 2 spec sheets for EPs and hospitals.

The Tampa paper covers the power struggle between dueling startup HIEs, the state-run one and a local, for-profit HIE that has the Hillsborough Medical Association as a member. The article suggests that the organizations are fighting for the potential profits involved with selling HIE-collected de-identified patient data. The local HIE says the state HIE is not seeking physician input, noting that the average hospital doesn’t see most of the patient population and also generates only 10 percent of patient health records.

Innovation and Research

The Consulate General of Canada in Philadelphia will launch a healthcare IT accelerator in early 2013, hoping to increase growth opportunities for Canada-based companies as similar efforts have done for companies in Israel. The 4th Annual Canada-US eHealth Innovation Summit will be held November 28 in Philadelphia, featuring presentations from Canadian companies Caristix, EDO Mobile Health, Evinance, Input Health, HandyMetrics Corporation, Mensante Corporation, Memotext, NexJ Systems, Nightingale Informatix Corporation, Orpyx Medical Technologies, TelASK Technologies, and VitalSignals Enterprises.

11-20-2012 8-11-44 PM

A JAMA-published study finds that patients using a patient portal had a higher number of office visits and telephone encounters than non-users. The study, which reviewed the use of MyHealthManager by patients of Kaiser Permanente Colorado, concludes that just putting up a portal doesn’t reduce demand for clinical services, and in fact may have the opposite effect.


11-20-2012 5-45-23 PM

ADP-AdvancedMD introduces a charge capture app for EHR for use on the iPad and iPad mini.

Nurses at Phoenix Children’s Hospital create the Journey Board discharge teaching app, funded by a $5,000 donation from former hospital patients. It’s available free for Android and iOS.

11-20-2012 7-54-25 PM

Massachusetts General Hospital Emergency Medicine Network launches EDMaps.org, a national ED locator for travelers, and a new version of its EMNet findER app.


11-20-2012 11-52-23 AM

Key findings from the eHealth Initiative’s 2012 Report on HIE:

  • Support for ACOs and PCMHs is on the rise
  • Federal funding still supports many HIEs, raising concerns about their long-term viability
  • HIEs worry about competition from other HIEs and from HIT vendors offering exchange capabilities
  • Other challenges for HIEs include privacy, technical barriers, and addressing government policy and mandates
  • Support for Direct is growing, particularly to facilitate transitions of care and the exchange of lab results.

11-20-2012 5-49-42 PM

The National eHealth Collaborative publishes a five-tier framework of strengthening patient engagement strategies that includes steps entitled Inform Me, Engage Me, Empower Me, Partner With Me, and  Support My Community.


An Imprivata roundtable on the healthcare impact of technology and mobility featured Boston-area healthcare IT executives, with their discussion summarized in the eight-minute video excerpt above.

Weird News Andy says “This doc was da bomb.” A 60-year-old doctor and Occupy Wall Street protester who was fired by his hospital employer in 2007 for suspected stalking of a nurse is arrested when police find assault rifles and large quantities of bomb-making chemicals in his basement.

Sponsor Updates

  • MedAssets CEO John Bardis wins a Community Leadership Award for driving and supporting the volunteer activities of his employees.
  • Greer Contreras, T-System’s VP of revenue cycle coding, discusses revenue integrity and the need for organizations to have a holistic view of their revenue cycle processes in a guest article.
  • Compressus integrates MModal’s speech understanding solution into its MEDxConnect suite.
  • Vitera Healthcare introduces Hands-On Lab for virtual product training.
  • Shareable Ink is spotlighted for assisting The Center for Orthopedics (OH) capture MU data.
  • Zirmed releases a white paper on the use of technology to manage rising levels of patient responsibility.
  • PeriGen posts its November and December Webinar schedule.
  • David Caldwell, EVP of Certify Data Systems, discusses opportunities offered by HIEs that can enhance revenue and improve patient care in a guest article.
  • Besler Consulting’s CTO Joe Hoffman reviews challenges in complying with the CMS exclusion list during a November 28 Webinar.
  • Dell ships its PowerVault DL2300 appliance with CommVault Simpana 9 software for enterprise-wide data protection.
  • SCI Solutions recognizes Mountain States Health Alliance (TN) with its Most Innovative Use award for best adoption and implementation of its self-scheduling tool.
  • Levi, Ray & Shoup releases an enhanced version of its Enterprise Output Management software that includes mobile access and support for Windows 8.


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

More news: HIStalk Practice, HIStalk Mobile.

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November 20, 2012 News 9 Comments

Readers Write 11/19/12

November 19, 2012 Readers Write 1 Comment

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

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

Paying Attention to How NLP Can Impact Healthcare
By Chris Tackaberry, MB, ChB

11-19-2012 3-48-25 PM

Unstructured clinical narrative is increasingly being seen as the primary source of sharable, reusable, and continually accessible knowledge, essential in helping providers make informed decisions, reduce costs, and ultimately improve patient care. While form-driven EHRs readily leverage and share captured structured data, the richest patient information remains locked inside EHR databases as unstructured notes.

Natural Language Processing (NLP) technology is becoming increasingly recognized in healthcare as a powerful tool to unlock this vital clinical data and turn it into analyzable, actionable information. While many have heard of NLP, there is significant confusion about what it actually means for healthcare.

In short, NLP means recovering computable data from free text. Even though most of the world’s knowledge is documented in some form of written narrative, we increasingly rely heavily on computers to analyze the world around us, and computers work better with well-defined, structured data rather than unstructured text.

Google has clearly proven that simple text search allows us access to vast amounts of information, but it still requires humans to determine meaning in the results. NLP is the science and art of teaching computers to understand the meaning in written text in order to extract data from narrative for reporting, analysis, etc.

NLP, typically embedded within other solutions, can help deliver significant benefit to providers and their patients by:

  • Improved reporting and monitoring. Many administrative tasks in healthcare depend on structured data, including the submission of billing codes that describe diagnoses and procedures to insurance companies. The identification of billable concepts in clinical narrative is probably the most common application of clinical NLP because it is the most direct path to delivering financial benefits.
  • Improving utilization of clinician time, resulting in more efficient care delivery. Doctors and nurses are accustomed to carefully documenting the condition and care of each patient in clinical notes. Without computable data, however, hospital operations, physician reimbursement, and patient care are all compromised. By pulling data directly from notes with NLP, even in real time at the point of care, we can save clinician time and frustration while identifying more data and detail to support clinical decision making, efficient care delivery, better public monitoring, and more.
  • Improved physician understanding of patients. NLP provides the level of clinical detail necessary to provide quicker access and review of patient histories. Revealing key information in existing notes that would be invaluable for more timely, better-informed clinical decisions.
  • Better research and monitoring. Existing studies have looked for correlations between patient genes or proteins and characteristics identified in the patient’s medical record. Conducting similar studies with the greater volumes of so-called phenotypic data, which can be pulled from patient records using NLP, will reveal far more about what makes our species tick – or sick.
  • More efficient clinical workflow. There is an intrinsic inefficiency in EHRs because so much of the information must be documented repeatedly. As a result, there has been significant physician pushback against EHRs, despite their acknowledged advantages.
  • Embedded NLP tools can facilitate EHR redesign for more efficient and intuitive documentation of patient information in a manner already natural to the traditional physician workflow.

Done well, there are countless ways NLP can be leveraged in healthcare to deliver benefit by improving efficiency, driving outcome-based performance, promoting access, facilitating research, and supporting population-based healthcare delivery models.

The application of NLP technology to healthcare will transform what we know about disease, wellness, and healthcare performance, enabling major improvement in efficiency and outcome. At the heart of this data-driven transformation is clinical narrative, a powerful and valuable asset. We need to recognize that.

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

Defining a Complete Patient Engagement Solution
By Jordan Dolin

11-19-2012 3-54-04 PM

A few years ago it was somewhat rare for a technology vendor to pitch the benefits of patient engagement. Today it seems that everyone is claiming to be a “leader in patient engagement technology.” This has led to a good deal of confusion in the marketplace. 

Patient engagement can deliver significant financial and clinical results, but to actually achieve these benefits, organizations need to select a "complete" solution.  A complete solution is one that addresses the needs of all constituents. It engages patients on their terms and also contains the content, technology, and regulatory considerations sought by providers to support care in every setting across the continuum. 

Simply stated, a solution that satisfies these eight critical elements has the ability to improve clinical and financial outcomes.

  1. Understands how to synthesize and deliver actionable information to patients. An effective solution must impart information to a patient in a manner that will actually change behaviors and improve outcomes. Addressing a spectrum of learning styles, literacy levels, and cultural relevance requires a tremendous amount of expertise across multiple communication methodologies.
  2. Facilitates engagement along settings across the continuum of care. A complete solution must support the needs of the patient and the provider in care settings across the continuum as well as the transitions between them. This includes addressing clinical, operational, and regulatory needs of providers in addition to supporting new models of care such as ACOs and PCMH.
  3. Engages patients at their convenience. Historically, healthcare technology solutions have always targeted the convenience for the provider, not the patient. Patients must have the ability to receive information when they want, where they want, and on the devices they already own.
  4. Seamlessly integrates into IT systems and workflow. Organizations are no longer willing to accept disruptions to their infrastructure or existing processes. To be successful, solutions must be complementary and additive, not disruptive or distracting.
  5. Results measured down to the individual patient. The single unifying goal that now pervades healthcare is accountability. A solution must contain tools that allow providers to measure their impact from multiple perspectives. The ability to confirm that a patient received and reviewed information prescribed by their clinician is a fundamental measure needed to quantify impact.
  6. Measures and delivers an economic return. Healthcare organizations are accountable for outcomes and their partners should be as well. Clients should expect hard dollar ROI studies and vendors should impartially fund and conduct them.
  7. Backed by an organization with the requisite knowledge and experience. Investing in an engagement solution to support key business objectives is a critical decision. The vendor selected should have the appropriate experience and staff to support the success of their clients and their clients’ employees and patients.
  8. Effectively supports the near-term and long-term objectives of the organization. The partner selected must understand the challenges of health systems and have a track record of delivering solutions that effectively address them. In addition, it should be clear that investments are being made in new solutions and innovations that will continue to address the needs of an ever-changing market.

Jordan Dolin is co-founder and vice chairman of Emmi Solutions of Chicago, IL. This article contains an abbreviated list due to space limitations; the complete list is available by download. 

Physician Compensation: The Accountable Care Challenge
By John C. Roy

11-19-2012 3-32-35 PM

As healthcare systems and physician groups across the country grapple with definitions and implications of “accountable health care” and “value-driven contracting,” physician compensation based on a fee-for-service model is irrational. Pioneering institutions have already incorporated quality and outcomes into their compensation plans. Similarly, payment for health care services is shifting into fee-for-value models.

As these models evolve, compensation plans must reward physicians for meaningful quality improvement and patient outcomes. Key questions emerge. How can clinical and other data help providers enhance value in the most strategic ways? What measurement strategies, and which data, can be used to reward provider teams that contribute the highest value?

In a fee-for-value world, physicians and hospitals will have to focus on quality, outcomes, and cost (or efficiency) requiring a true culture of quality improvement. Physician engagement is critical in shaping that culture. Physicians will have to assess and agree upon outcome measures and practice standards and change practice based upon valid, practice-specific data.

Today, many health systems struggle with the absence of such data. Essential data supporting such a transformation is often stored in disparate clinical and financial databases, including multiple electronic medical record systems and homegrown software solutions.

One universally challenging example is accurately attributing patients to individual physicians. Accurate attribution is central to reporting outcomes, but all too often proves extremely difficult. If physicians don’t trust that the data accurately reflect their practice, they cannot invest adequate time and energy in improving quality of care.

On the other hand, when physicians trust data that truly does reflect their practice, the data spur meaningful conversations around quality and outcomes. They see improvements in real time. The ability to correctly assimilate, align, and attribute patient data to individual physicians is a fundamental issue today and a cornerstone of reimbursement and compensation tomorrow.

As payment for health care shifts from “caring for sick” to “maintaining health,” providers will need extremely effective, efficient care management strategies for chronic disease patients. They will rely on patient data that is strategically aggregated to identify interventions around priority patient populations. They will direct sophisticated, well-coordinated management plans to help insure appropriate patient management, appropriate testing, control complications, and improve direct attention to that patient. They will have the ability to report improvements in quality, demonstrating the value of their work over time. All of these efforts deliver significant value that needs to be monitored and rewarded when achieved.

In a fee-for-value world, the provider groups who use population-level data to create and implement successful strategies for effectively managing their chronic disease patients will command higher compensation, regardless of their RVUs. Successful systems and groups will design physician compensation models around elements that matter most in a new, risk-based health care environment. To do this, patient data needs to be more physician-centric, with improving population health as the primary goal.

John Roy is vice president of Forward Health Group of Madison, WI.

Six Facts You Should Know About Stage 2 Meaningful Use and Data Interoperability

11-19-2012 4-04-51 PM

In the world of care delivery, having access to the right information at the right time can be a matter of life or death. Anyone who has been a patient or cared for one understands that the transfer of medical information – whether current or historical – among providers is not readily happening today.

The Stage 2 Meaningful Use requirements, which begin as early as fiscal year 2014, call on eligible providers and hospitals to increase the interoperability of clinical data and adopt standardized data formats to ensure disparate EHR systems are capable of information sharing.

The following are six high-level areas of the Stage 2 rules to consider during your preparations. These areas underscore how clinical data interoperability will change and impact IT infrastructure:

  1. Interoperability of clinical data is no longer optional. Hospitals are required to connect with disparate EHR systems and send clinical information electronically for at least 10 percent of its discharges.
  2. Vendor software certified for 2014 clinical data interoperability criteria will produce and consume a consolidated CDA (C-CDA) document (one specification). The C-CDA document must contain medications, allergies, and problem list elements as well as many other clinical data elements. The majority of the clinical data elements in the C-CDA have single, well-defined coding system requirements. For example, the SNOMED CT July 2012 release for a problem list. Thus, all vendors will speak the same language.
  3. Transmission specifications to other systems for Stage 2 include only “e-mail” (SMTP) and cross-domain sharing format (XDS). These do not require costly and complex HL7 interfaces and instead just configuration to make connections for data flow.
  4. Vendor software certified for 2014 clinical data reconciliation criteria will be able to import and reconcile home medications, allergies, and problem list elements as discrete, codified data. The ability to reconcile discrete, codified data in conjunction with the C-CDA and transmission standards nearly eliminates vendor and technical obstacles to clinical data sharing. The coding standards also eliminate some of the complexities. Vendors will likely have to map the data into their systems to support drug-to-drug and drug-to-allergy checking.
  5. Hospitals must have ongoing submission of reportable labs, syndromic surveillance, and immunization information unless there is no entity present that can accept and exchange this data. This bi-directional information sharing is largely at the local level, meaning the abilities on hand to perform this function in a production state will vary. The requirement of these three submission measures is a significant change from Stage1, which only required one data sharing test and failure of that was an acceptable option.
  6. Patients must have electronic access to their records within 36 hours of discharge. Eligible entities must provide a patient portal that enables the patient to view, download, and transmit information. This Stage 2 criteria now mandate providers to encourage patients to make behavioral changes accessing their own data. The information that feeds these patient portals must be available within 36 hours of discharge. Therefore, key workflow modifications ensuring appropriate timing are a top priority.

Ali Rana, MBA, MCITP, CISSP is manager of implementation and integration services and client services for T-System, Inc. of Dallas, TX.

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November 19, 2012 Readers Write 1 Comment

Morning Headlines 11/19/12

November 18, 2012 Headlines No Comments

Healthcare Information Technology: Trends and Transformations

Greenway releases results of an expansive survey of the HIT marketplace, including within its findings that 50 percent of surveyed hospitals say they have no ACO plans.

US firms drawing a line on after-hours email

The Advisory Board Company is featured in an article about its corporate e-mail policy which prohibits employees from checking company e-mail after business hours.

Health Information Technology; HIT Policy Committee: Request for Comment Regarding the Stage 3 Definition of Meaningful Use of Electronic Health Records (EHRs)

ONC initiates a 45-day Request for Comment period for Stage 3 Meaningful Use rules, starting this week and ending on January 14.

Quest Diagnostics’ CEO Hosts Investor Day

Quest Diagnostics, parent company of ChartMaxx and Care360EHR, announces that it will re-evaluate its EHR business strategy in an effort to focus on its core business, diagnostic information services.

Epic Systems Corporation, Applicant v.McKesson Technologies, Inc.

Epic receives a 30-day extension for a Supreme Court appeal request it is preparing in response to the recent “induced infringement” case it lost in the Federal Court of Appeals.

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November 18, 2012 Headlines No Comments

Monday Morning Update 11/19/12

November 17, 2012 News 9 Comments

11-17-2012 8-41-47 AM

From Documented: “Re: Cerner Content360. Does this represent somewhat of a minor strategic shift for Cerner, or is just a re-branded aggregation of existing document imaging solutions (such as Cerner ProVision Document Imaging)? When I worked at Cerner (a few years ago), it was practically a cultural taboo to suggest the need for document imaging (especially clinically, as in meds ordering) because it stood in philosophical contradiction to CPOE and its closed-loop meds process. Anyway, I was just curious if any Cerner clients or other wise luminaries among the HIStalk audience knew much about it.”

From The PACS Designer: “Re: healthcare and Windows 8. In a past HIStalk post I covered Microsoft’s Healthcare in Silverlight software. Now, with the release of Windows 8, we get to see Microsoft Flexible Workstyle for Health utilizing Sharepoint for rounding and other data viewing. Partners HealthCare has an interesting case study demo that could generate an 80 percent reduction in desktop image management efforts.”

11-17-2012 8-33-10 AM

From HITEsq: “Re: Epic. Appears ready to file for review of the McKesson case. They filed an extension for their writ (i.e., the document where they asked the Supreme Court to take the case). Nothing is a sure thing, but my guess is this has a really good shot at being accepted. The Federal Circuit was really fractured and went in an unexpected direction. The Supreme Court is good at addressing these things.” This is the years-long legal battle over whether MyChart violates a McKesson patient portal patent. The appeals court’s decision in September troubled some legal experts who are uncomfortable with its interpretation that companies (Epic in this case) can be held accountable for “inducing infringement” even when the infringement itself hasn’t been proven.

11-17-2012 8-34-57 AM

From MT Hammer: “Re: MModal. Word on the street is that they have acquired transcription provider MxSecure. No official announcement.”

From Shhh: “Re: Epic. They must have finally chosen a new CFO – the job listing is gone from all the career sites.” I was slightly aware that Anita Pramoda was the company’s CFO, but I see from her LinkedIn profile that she moved on this year as a co-founder of California-based TangramCare (I guess she didn’t have to sit out a year). I can find next to nothing about that company except that it’s some sort of technology-enabled homecare provider. From a LA Craigslist job posting, she’s taken some Epic principles out West: the “do good” motto, the hiring of “brilliant people,” and the need for candidates to state their GPA in their application. The “who are we?” section says, “Healthcare today is conducted like a horribly inaccurate Markov chain. That is, each piece of healthcare is siloed from one another, at all times with incomplete information. None of pieces the mesh well, the left hand doesn’t know what the right hand is doing/has done. This results in inefficiency, inaccuracy and unbearable patient experiences. We wake up every morning working to solve this problem, make healthcare more affordable, and save lives.” Jim Sweeney, founder of Caremark, Bridge Medical, and CardioNet, is involved and talks about the company in the video above. He has an interesting point: hospitals were created to make it convenient for physicians to see patients, but being aggregated with other sick people isn’t so great for the patients.

11-16-2012 8-52-42 PM

Half of my survey respondents are indifferent to CHIME, while the remainder are equally split in seeing the organization as positive or negative. New poll to your right: which annual conferences do you routinely attend? Check all that apply and feel free to leave a comment.

Here’s new Spotify playlist of some odds and ends that might give you some new music ideas. On it: Toad the Wet Sprocket, Broken Bells, Veruca Salt, Neon Trees, and quite a few more. If you like country music, computer-generated dance tunes, classical, or jazz, you’re out of luck since I don’t listen to those.

Speaking of music, a reader sent a link to the early 1980s company promotion album You Respond to Everyone But Me: Songs for the EMT, which seems to be the only album dedicated to EMS. Stream some of the very well done country/bluegrass tunes and see if you agree with me that it’s way better than you would expect. I’m desk-drumming to #11 – EMS Express.

11-17-2012 6-09-05 AM

ONC publishes the Request for Comments for Meaningful Use Stage 3. The comment period will open this week on Regulations.gov and will end on January 14.

The Advisory Board Company’s e-mail policies are featured in an article about companies that encourage (or mandate) employees to stop checking e-mails after hours. CEO Robert Musslewhite, saying that “e-mail has gone too far and that is now impeding productivity,” also issued guidelines that include summarizing the topic in the subject line, limiting the number of recipients, and considering the use of instant messaging instead. The company imposed an e-mail moratorium over Labor Day weekend.

11-17-2012 9-08-10 AM

Lucile Packard Children’s Hospital (CA) provides iPads loaded with kid-friendly apps in all nine of its pediatric ED rooms. The unit’s director says that “one iPad is worth 10 milligrams of morphine.” Parents can also check e-mail and FaceTime with hospital specialists, guest services employees, and interpreters.

The Columbus, OH newspaper writes about Ohio hospitals that use EHR information to tailor their marketing campaigns to specific patient populations. At least one system (OhioHealth) admits that it screens out lower-income patients in mailings encouraging patients to schedule health maintenance visits.

11-17-2012 10-00-34 AM

CVPH Medical Center (NY) lays off 17 employees after losing $400,000 in September, but says the cuts would have been a lot more severe had it not banked $3.2 million in Meaningful Use money that was counted as revenue. 

A series of Greenway surveys finds that:

  • 76 percent of practices either aren’t sure about participating in an ACO or have decided they won’t participate, while 50 percent of hospitals say they have no ACO plans
  • 16 percent of practices will stop taking Medicare and Medicaid patients if payments are reduced
  • 39 percent of hospital CIOs say technology has improved the efficiency of their organizations
  • 45 percent of patients say they would change doctors if they’re kept waiting too long
  • Seven percent of patients say technology gets in the way of their interaction with their doctor vs. the 56 percent that believe it helps the physician improve their care
  • Patients view paper and electronic-based systems as equally safe and secure
  • More than half of consumer respondents believe it’s the government’s job to improve the healthcare system, with hospitals and physicians a distant second and third place respectively

From the Investor Day transcript from the CEO of Quest Diagnostics, parent of MedPlus (ChartMaxx, Care360 EHR):

…We are redirecting our EHR Information Systems business. We believe that business needs to be focused on helping Diagnostic Information Services. We believe there is an opportunity for that business to complement enterprise EMR strategies that companies like Cerner and Epic and that McKesson have, and we need to participate in helping them with them and be with them when they present their strategy to integrated delivery networks in hospital systems. And therefore, we’re focusing the plan in the business around that segment in the marketplace and having a proactive program to work with the enterprise EMR companies going forward.

11-17-2012 9-42-48 AM

The $5.99 BabyDoze smartphone app plays Doppler-recorded mother’s womb sounds that the company says are 98 percent effective in calming crying babies. Its author recorded his wife’s uterine sounds in 1985 with the help of hospital staff, selling the original version as an audio tape.

A study finds that goofing off at work every now and then may improve work performance. Top-performing subjects in a four-hour simulation session of piloting military drones were found to have been distracted 30 percent of the time by their smartphones, having a snack, or reading something nearby.


Vince and Mrs. Vince have been re-honeymooning in Europe, so he compares how technology has changed in the 40 intervening years. He has returned and his regularly scheduled HIT programming will do likewise next week.

Sponsor Updates

11-17-2012 5-30-46 AM

  • Jardogs recently attended the University of Iowa’s Engineering Career Fair. That’s recruiter Nicole Baer meeting with a student above. The company offers FollowMyHealth patient access solutions that include the Universal Health Record and patient kiosk.
  • Intelligent Medical Objects releases its IMO Terminology Browser for Android smartphones.
  • We missed a sponsor who made the Inc 5000 in our list last week. Toledo-based ESD, which you may remember as the force behind HIStalkapalooza in Las Vegas earlier this year, was recognized for its three-year revenue growth of 172 percent.
  • Award-winning IT staffing firm Digital Prospectors is raising funds for Hurricane Sandy victims. The company will match donations and chip in $5 for each Facebook share and $1 for each Facebook like.
  • An article by Emily Ruffing of Lifepoint Informatics describes ways that laboratory information systems can be integrated with EMRs.
  • Nordic Consulting, the KLAS-ranked #1 Epic service provider and the largest Epic-only consulting practice in the country, publishes a guide for Epic-certified consultants interested in joining the Madison, WI-based company.
  • SayIt Clinical Notepad from nVoq,  a cloud-based iPad speech-to-text app that allows users to capture quick patient notes on the go for later addition to the EMR, is available on iTunes.
  • Liaison Technologies, the Atlanta-based cloud integration and data management leader, is recognized by the Deloitte Technology Fast 500 as one of the fastest growing companies in North America.
  • Bottomline Technologies recently held its Healthcare Customer Insights Exchange in Sausalito, CA with its experts and customers providing insight about mobile technologies, process automation, payment solutions, and advanced forms management. The company offers a case study of Alamance Regional Medical Center’s move to a Logical Ink-powered tablet-based patient registration solution.


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

More news: HIStalk Practice, HIStalk Mobile.

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November 17, 2012 News 9 Comments

HITlaw 11/16/12

November 16, 2012 News 2 Comments

Exit Shmexit

When healthcare provider entities merge, whether physician practices or hospitals, there is usually a misalignment of technology. It is not typical that the merging entities operate the same vendor systems, which means that ultimately one vendor is out and the other gains a new (merged) customer.

Here is a real-world example recently brought to my attention. Physician Practice A merges with (larger) Physician Practice B, which basically means Practice B bought out Practice A. The two practices use different EMR products and Practice B dictates that its current EMR technology will remain the standard. Practice A will have to transfer its operations to the other vendor’s EMR technology. Not surprising and not a big deal, many are thinking as they read this, because practices convert to different systems all the time.

However, the vendor being replaced at Practice A is not playing nicely and refuses to provide the EMR data in a format that satisfies the technical requirements for conversion. Setting aside the fact that Practice A will have serious record retention issues, they will be unable to access historical patient records (unless they continue to pay for support or subscription to keep the old system, a very unnecessary cost) and will have to start from scratch in the new system. Really?

One would think that bad PR would be enough to persuade the ousted vendor to provide the practice data ready for conversion, but we have seen enough strange stories about sore losers recently to unfortunately have to consider this possibility and behavior.

About the title of this posting – Exit Shmexit? Every software contract should have a section devoted to data rights and extraction at termination. Frequently labeled in conversation as “Exit Procedure” or “Exit Strategy,” this type of language is absolutely essential. I take the tone I do because it is clear that unfortunately many practices, and to a lesser extent, some hospitals, do not take the time to carefully review and negotiate the terms and conditions under which they are investing in technology.

Evident in my HITlaw postings is the emphasis on the critical need to review and negotiate your software agreements. “Exit Shmexit” is my personal rebuke to those that consider vendor license agreements as merely “paperwork” and hurriedly review and sign what is put in front of them. Inclusion of a few sentences in Practice A’s EMR license would have prevented the present angst and difficulty for that entity.

Although not as pertinent to hospitals due to the size and expense of the technology investment (and corresponding recognition and cooperation by vendors), I am made increasingly aware of instances where physician practices are courted, quoted, and commanded. The first two everyone knows. Commanded refers to the attitude of some vendors at the contract stage. Sign here. We don’t negotiate.

Editorial comments now aside, here is the help.

To repeat, every software contract should have a section devoted to data rights and extraction at termination.

Critical inclusions that should be in the software license:

  • As between vendor and customer, all data entered into the software database is the property of the customer. This is my nod to the notion that medical records are truly the property of the patient, but that is a topic for another day. The point here is that the customer owns all the data, not the vendor, and the vendor must recognize this.
  • Transition must be accommodated. Upon termination of the software contract for whatever reason, all data must be immediately made available to the customer. This is to be provided without question in industry standard format and at no additional cost. This is part of the price of doing business and I have no problem advising my healthcare technology company clients that this must be done.
  • The vendor must also agree to provide the data, for an additional cost if necessary, in whatever format is required by the replacement vendor, with a reasonableness factor included regarding technical feasibility.

Dust off your existing EMR license agreement or review the proposed agreements in front of you for that new EMR, PACS system, or HIS as the case may be. No exit procedure? For existing relationships, think about this before you sign with the new vendor. Go back to the existing vendor and address the issue. Far better to do so when there is still a working relationship than after you have told the vendor they will be replaced. For prospective business relationships, get agreement from the vendor as described above (as well as many other important considerations).

Going back to my editorial comments, any customer presented with a contract and the statement that “we do not negotiate” should politely show the salesperson the door. There will be another one from another vendor ready and willing to discuss your needs and listen to your contractual concerns.

This is not to say that vendors must negotiate all terms and conditions as requested by the customer prospect. Vendors are completely within their right to protect their business and intellectual property, limit their liability, and keep sacred the things most important to them. However, to place a contract in front of a prospect with the message “take it or leave it” is not good for business. Unless of course the agreement is written so fairly that it considers not only the company’s interests but also the interests of its customers in equal measures. That would be very rare.

Repeated many times in my HITlaw postings is the advice that contract review, at least for major terms and conditions, is a critical part of the vendor selection process. Do not select a vendor and then look at the contract. When you have the search down to a select few vendors, review the contracts in front of you. Look for the smoldering sections that need attention. Recognize the absence of sections of vital importance for your protection during and after the business relationship.

In the example above, the absence of a “data rights at termination” section should be immediately brought to the vendor’s attention. If the vendor provides language suitable for your protection, keep them in the game. If they refuse where others cooperate, take them off the list.

Please see my quick tips for an EMR Contract, as well as my paper Selection and Negotiation of EMR Contracts for Providers. Hopefully my general insight and advice will help avoid problem situations such as the one involving unfortunate Practice A.

Previous HITlaw postings were fairly infrequent and arose only when I found a seriously weighty topic. Look forward to more frequent postings on important issues in shorter format. E-mail me with questions and suggestions for future HITlaw writings, whether provider side or vendor side.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA. You may contact him at wfo@otoolelawgroup.com and follow him on Twitter @OTooleLawHIT.

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November 16, 2012 News 2 Comments

News 11/16/12

November 15, 2012 News 10 Comments

Top News

11-15-2012 5-46-14 PM

Sixty-nine percent of US primary care physicians report using EHRs, up from 46 percent in 2009, while about a third of doctors say their patients have the ability to e-mail the practice and have online tools to request appointments, referrals, and prescription refills. The study of 10 “high-income” countries also finds that despite health reform initiatives, a high percentage of physicians in all countries complain of untimely access to information from hospitals and specialists.

Reader Comments

11-15-2012 7-06-04 PM

From Mango Mel: “Re: UNC. As you mentioned, they are going Epic.” I heard that rumor again today from an excellent source. If it’s true, that gives Epic all of the big hospitals in the Triangle area of North Carolina, which is almost all of the beds there now that they’ve recently added Duke and the just-announced WakeMed. Other NC users of Epic are New Hanover, Vidant, and Novant.

From The SFTreat: “Re: GE Healthcare layoffs. True – a number of staff from the Seattle office are gone.” We’ve run several rumors suggesting that the layoffs were going to happen Wednesday. A Boston article says the company confirmed that 10 percent of its Vermont workforce has been let go, but the company declined to give specifics. Our GE contact said that fewer than 50 employees were impacted and no office closures or product retirements were involved. According to the official response:

“In fact, GE HCIT is maintaining its focus on the needs of integrated care delivery, and in conjunction with our strategy, we are making choices to redeploy some portions of our resources and capital into new areas of product and service innovation. While these types of decisions are never easy in the near term, we are confident that they are necessary to meet the current and future needs of our customers.”

From Candace: “Re: research and think tank institutions for healthcare technology. What do you think of IDC Health Insights? Can you recommend other research centers? I’m a recent college graduate doing a research project.” I don’t have any experience with any of them, so I’ll open the floor to readers willing to help. Don’t they sound like swell places to work, though, just sprawling back at your desk thinking in a swanky office park?

From DeanInsider: ”Re: rumor of doctor resignations. Not the case. Dean is pleased to have become an Accountable Care Organization and has always put patients first.” I assumed that was the case, but several hospitals have announced layoffs they’re blaming on PPACA. The latest: Wake Forest Baptist Medical Center, which will eliminate 950 positions. A local professor there says hospitals must plan for at least one year of lower payments, reductions in federal grants, and the high cost of EHRs.

HIStalk Announcements and Requests

HIStalk Practice highlights from the last week include: MGMA members give Medicare the highest marks among seven top payers. The country will be short 52,000 family physicians by 2025. An 87-year-old doctor who charges $5 an office visit says he didn’t select his profession for the money. Physicians must participate in PQRS in 2013 to avoid 2015 penalties. A list of the worst passwords for 2012. Rob Drewniak of Hayes Management Consulting discusses the need to educate board members on the ACA and its implications for their organization. Dr. Mostashari, by the way, gave Rob’s post a thumbs up. If Dr. Mostashari is reading HIStalk Practice and you aren’t, maybe it’s time to consider what you’re missing. Thanks for reading.

We ran a link to the draft Meaningful Use Stage 3 rules earlier this week, but just to be clear, this is a draft document not yet available for public comment even though its title is “HITPC Stage 3 Request for Comment.” You’re seeing it as it came from the Policy Committee.

Inga’s been a good girl this year, so here’s her Christmas list for your consideration: (a) sign up for spam-free e-mail updates to HIStalk, HIStalk Practice, and HIStalk Mobile; (b) friend, like, and connect with us on all the social not-working sites; (c) send us news and rumors; (d) review and impulsively click some of the much-appreciated sponsor ads to your left, search and navigate to their details in the Resource Center, and send your consulting RFI viral with the RFI Blaster; (e) tell other folks you read our sites because when it comes to our marketing channels, you’re all we have; and (f) give yourself one of those wrapping-your-arms-around-yourself hugs and pretend it’s Inga since it will take her awhile to get to each reader personally. I’m just happy reading down the list of 2,850 impressive folks who have signed up for Dann’s HIStalk Fan Club and thinking how cool that is. That’s the first place I look when considering somebody’s request for an HIStalk-related favor.

On the Jobs Board: Workflow Automation Project Manager, Technical Trainer, Product Analyst, User Interface Engineer.

The most common grammatical crutches I have to edit out of the interview transcripts I run, sometimes in truly startling numbers: (a) “really”; (b) “sort of”; and (c) starting sentences with “so” like someone telling a bar stool yarn. I was at a doctor’s presentation today and counted the number of times she said “sort of” and was up to 79 in the first 30 minutes before I tired of the exercise. I’m not annoyed, just sorry that the power of what she was saying was needlessly diluted by subconscious speech tics.

Acquisitions, Funding, Business, and Stock

11-15-2012 9-38-00 AM

CACI will acquire Emergint Technologies, a provider of HIT services and analytics solutions.

WellStar Health System pays $20,000 for the trade name, trademark, and other assets of the bankrupt Center for Health Transformation, the for-profit healthcare think tank founded by Newt Gingrich. WellStar intends to convert it to an independent, nonprofit collaborative of 20 non-competing health systems in the Southeast, focusing on sharing ways to improve quality and reduce costs. 

Salt Lake City-based Remedy Informatics gets a $6 million investment from Merck. The registry and research informatics company is headed by Gary Kennedy, so I assume it’s related to the former RemedyMD. I interviewed him in early 2007 and was pretty impressed, although the hospital-type database products seem to have been de-emphasized in favor of the life sciences ones.


11-15-2012 7-10-33 PM

WakeMed Health & Hospitals (NC) will invest $100 million over five years to implement Epic.

The DoD and VA award Document Storage Systems an EHR integration subcontract.

Oakwood Healthcare (MI) renews its multi-year IT outsourcing contract with CareTech Solutions for $120 million.


11-15-2012 11-08-18 AM

Harry Jacobson, MD, former vice chancellor for health affairs at Vanderbilt and CEO of Vanderbilt University Medical Center, joins digiChart as chairman, replacing G. William Bates, MD, who was recently named chairman emeritus.

11-15-2012 11-26-46 AM

Net Health systems, a provider of IT systems for wound care, hires Kelley J. Schudy (Allscripts) as VP of sales.

Announcements and Implementations

11-15-2012 5-35-45 PM

The National Basketball Association will use Cerner’s HealtheAthlete health management platform for all of its teams.

11-15-2012 1-12-48 PM

The LSU Interim Hospital and 11 clinics are live on the Greater New Orleans HIE, which will connect to the state-wide Louisiana HIE by the end of the year.

11-15-2012 1-13-42 PM

The Pennsylvania eHealth Collaborative signs up 3,449 providers for DIRECT messaging, exceeding the federal government’s goal of 1,000.

Lakeland Regional Medical Center (FL) goes live on Cerner clinical applications with implementation assistance from Healthcare Clinical Informatics.

Elsevier announces the launch of Health Care: The Journal of Delivery Science and Innovation. It will focus on applied healthcare IT and health reform. Founders and co-editors are Amol Navathe, MD, PhD (Brigham and Women’s, Harvard Medical School, Wharton School) and Sachin Jain, MD, MBA (Boston VA, Harvard Medical School, and Merck).

North Mississippi Health Services (MS) wins a Baldrige Award. 

Innovation and Research

11-15-2012 6-23-40 PM

Got a flair for design and patient-friendly medical information? ONC and VA are running a Health Design Challenge for creative types who can make CCD/Blue Button information easier for patients to understand. Three prizes are offered in each of four categories (Best Overall Design, Best Medical/Problem History Section, Best Medication Section, and Best Lab Summaries) ranging from $1,000 to $16,000. The deadline is November 30.


11-15-2012 7-03-28 PM

A CapSite study finds that almost one-third of hospitals plan to invest in patient flow solutions within the next two years. Leading vendors include TeleTracking, McKesson, Epic, and Meditech, while the vendors most often being considered are listed in the graphic above.

Speaking of CapSite, a HIMSS webinar this Friday afternoon will cover “The CapSite Acquisition and What It Means to You.”

Bill Hersh provides an update on the clinical informatics subspecialty for physicians. Details are being worked out about the grandfathering and initial exam process, but Bill says the first candidates will sit for their test in October 2013.

Allscripts responded to our reader’s question about whether MyWay users will be released from their contracts if they decline the company’s offer of a free upgrade to Professional.

“Allscripts is providing a free upgrade, and the contract does not allow for cancellation of current leases. Allscripts is dedicated to working with our clients to help them succeed, and we believe the upgrade provides the right benefit for the long term.”

11-15-2012 6-41-32 PM

Weird News Andy says this never happens to him while listening to NPR. A former Doctor of the Year ED doc faces a long list of charges after hitting several cars in a parking lot while allegedly under the influence of drugs and alcohol with NPR cranked up loud in her Outback. She says her accelerator got stuck on her way to Whole Foods to buy a Thanksgiving turkey, but police found pills and prescriptions she had written for herself.

WNA labels this story “Hello Terry Schiavo.” Scientists performing a functional MRI on a man who has been in a vegetative state for 10 years find brain wave patterns that suggest he is answering the questions they’re ask him. The scientists believe the patient is aware of who and where he is.

Sponsor Updates

11-15-2012 8-17-00 PM

  • Leslie Kelly Hall, SVP for policy at Healthwise, joins a panel discussion on patient engagement framework at next week’s National eHealth Collaborative Webinar.
  • Visage Imaging will demo its Visage 7 processing technology, including work-in-process capabilities, at this month’s RSNA meeting.
  • Merge Healthcare will unveil its mobile and Internet platform for patients during RSNA.
  • Greater Baltimore Medical Center (MD) reports a reduction in paper output and waste since deploying Access Intelligent Forms Suite and Wacom STU-500 signature tablets.
  • TeraRecon previews a pay-as-you-go option for use of its iNtuition advanced visualization tools by physicians who perform aortic repair procedures.
  • Kareo offers tips for increasing practice revenue in its November newsletter.
  • The Canadian Health Informatics Association awards TELUS Health Solutions its Corporate Citizenship Award for achievements in health and technology to improve patient outcomes.
  • McKesson will combine its Episode Management software with the Prometheus Payment model to support large-scale bundled payment programs.
  • DrFirst will embed Halfpenny Technologies’ Integrated Technology Framework for CPOE and results delivery within its Rcopia e-prescribing platform.
  • White Plume Technologies’ Laura DeBusk and MED3OOO’s Cindy Cain will discuss the impact of ICD-10 on operations, compliance programs, and cash flow in a November 29 Webinar.
  • Aprima will integrate Alpha II claim scrubbing technology into its EHR and PM solutions.
  • HIStalk sponsors earning a spot on the 2012 Inc. 5000 List of America’s Fastest Growing Companies include Beacon Partners, Culbert Healthcare, Cumberland Consulting, Digital Prospectors, eClinicalWorks, Enovate IT, Etransmedia Technology, Greenway, GetWellNetwork, Hayes Management Consulting, Kareo, Iatric Systems, Impact Advisors, Ingenious Med, iSirona, maxIT Healthcare, MED3OOO, MEDSEEK, Passport Health, Virtelligence, and Vocera.
  • HIStalk sponsors included on Deloitte’s 2012 Technology Fast 500 ranking include Etransmedia Technology, Greenway Medical, MModal, MedAssets, NexJ Systems, and Vocera.
  • Sandlot Solutions unveils the final results of eHealth Initiative’s 2012 Annual Survey of HIE Initiatives.

EPtalk by Dr. Jayne

The American Academy of Family Physicians releases a summary of the 2013 Medicare Physician Fee Schedule. Increases will only occur if Congress takes its annual action to block the reduction that is scheduled for January 1.


AAFP also publishes (subscription only) its 2012 EHR User Satisfaction Survey. Of 3,088 viable responses (as in previous years, several hundred responses were excluded because respondents said they did not use EHR or didn’t identify their systems) 31 vendors account for 92 percent of the systems. The highest counts (over 200 responses) were reported with Allscripts, Centricity, eClinicalWorks, Epic, and NextGen. As someone who has been documenting with EHRs for more than a decade, I find some of their survey questions suspect. For example, “This EHR helps me see more patients per day (or go home earlier) than I could with paper charts.” They certainly didn’t control for the dramatic increase in federal, regulatory, and payer scut work that has added to the bottom line of my work hours. Even if I was on paper, I’d be seeing fewer patients and going home later just for that reason.

The authors recognize that “practice size is independently related to satisfaction,” noting that except for a few systems, the majority of “large practice” vendors fall towards the bottom and “small practice” vendors hit near the top of satisfaction scores. The cutoff for vendor inclusion was 13 responses, so there is question on whether they are statistically significant. Some of the highest ranking systems are relatively untenable in enterprise environments, so I feel for administrators whose physicians will be marching into the office with the article in hand, demanding that Cerner be de-installed in favor of Praxis, SOAPware, or my favorite: Point and Click EHR.

Another doomsday prediction finds that we’ll need 52,000 more family physicians by the year 2025. I can almost guarantee that if you figure out how to pay them what a cardiologist makes, you’ll get them.

A good friend sent me a link to the “Jane and the Doctor” YouTube video. It’s an oldie but a goodie if you haven’t seen it. For those of you in the implementation trenches, know that you are not alone and there are many others of us who hear the same tired complaining from physicians all day long.



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

More news: HIStalk Practice, HIStalk Mobile.

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November 15, 2012 News 10 Comments

Readers Write 11/14/12

November 14, 2012 Readers Write 2 Comments

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

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

Formal HIT Education
By Deborah Kohn

11-14-2012 6-59-16 PM

I read with interest HIStalk’s news regarding Georgia Tech’s free online health informatics class in the cloud and Mr.HIStalk’s comment, "This looks really good, especially for folks who don’t have a lot of formal healthcare IT education on their resume."

This led me to research four-year baccalaureate degree programs in health information technology (HIT), where I expected students in such programs to earn a BS degree, a Health Information Technologist title, and, perhaps be ready to sit for a rigorous certification exam.

No such programs exist in US colleges and universities – online, on-campus, or combination – as far as I know, except perhaps one at Miami (Ohio) University’s regional campuses. (note: I am not referring to four-year baccalaureate degree programs in health information management or HIM, which are complementary to but different from four-year baccalaureate degree programs in HIT.)

Largely due to 2009 ARRA/HITECH dollars (workforce training), many two-year, community college-based HIT programs exist (before the dollars run out), where students earn an AA degree (or similar), a Health Information Technician title, and are ready to sit for the Department of Health and Human Resources’ HITPro exam. (A certification is not conferred upon successfully passing the HITPro exam.) Unfortunately, contrary to expectations and because of lack of experience, most of these students cannot find jobs.

Many excellent one-to-two-year, post-baccalaureate degree programs exist in health informatics (e.g., Georgia Tech), whereby graduate students (typically clinical) earn either a MS degree or similar or a certificate, allowing the student to officially wear the Health Informaticist title (Nurse Informaticist, MD Informaticist, etc.).

As a college undergrad, I earned a BS degree in medical record science (today, health information management). My program in medical record administration was part of the university’s Allied Health Professionals Division. General Arts and Sciences Division requirements (English composition, sociology, chemistry, biology, etc.) plus anatomy and physiology consumed our freshman and sophomore years. Many of our junior and senior year courses were shared with the Allied Health Professionals Division’s undergrad nurses, pharmacists, lab technologists, dieticians, etc. The remaining courses were specific to HIM (ICD coding, records management, etc.). All Allied Health Professionals Division students experienced a minimum of four months practice in a hospital in the nursing, lab, pharmacy, dietary, and medical records departments.  

I graduated the university with a Medical Record Administrator title and was prepared to sit for a rigorous exam that, upon passing, allowed me to be certified as a Registered Record Administrator (today, Registered Health Information Administrator – RHIA). Similarly, my fellow student nurses, pharmacists, lab technologists, dieticians,etc., became RNs, RPhs, RDs, etc.  In general, we went directly into good-paying jobs as entry-level — but at least semi-experienced — healthcare professionals.

As a graduate student, I had few options except to pursue a masters degree in Health Services and Hospital Administration (or similar), which I do not regret. However, today, those with BS degrees in the healthcare professions can pursue advanced degrees in health informatics, highlighting advanced skills, knowledge, and experience in healthcare and in IT. 

Consequently, I am proposing that four-year colleges and universities, working with or without existing two-year college HIT programs promoting Health Information Technicians, consider offering sorely-needed, workforce HIT programs promoting Health Information Technologists (like lab technologists). Subsequently, graduating students could sit for certification exams and become registered. (This is a subject for another article that would address those associations that would be able and willing to manage the testing.)  

These healthcare information technologist programs would allow the BS-degreed, graduating Health Information Technologist (registered or not) to gain required experience in the HIT industry and, if interested, to choose an HIT advancement and graduate path in health informatics.

In addition, I propose that these four-year, baccalaureate degree programs be incorporated into universities’ existing four-year, Allied Health Professional Divisions. Unfortunately, I learned from one public university with such a division that it is difficult to get the right parties to agree to offer new degree programs at the undergraduate level. I learned from one private university with such a division that undergraduate programs do not generate enough revenue to justify adding new programs, and only post-graduate programs do. Perhaps an accredited online university that is willing to keep the cost reasonable and can quickly establish a program also should be proposed, although program quality might be a concern.

Who or what entity is willing to take me up on my proposal? 

Deborah Kohn is the principal of Dak Systems Consulting of San Mateo, CA.

Value of Meaningful Use Funds Debated at IHT2 Conference
By James Harris

11-14-2012 6-53-38 PM

“History will not look positively on how the meaningful use funds were spent,” said Dale Sanders, senior vice president, Healthcare Quality Catalyst, at a November 7 IHT2 Conference in Los Angeles.

The panel was discussing the current status of healthcare analytics. Several panelists, including Sanders, said the $30 billion federal program had erred by not including more incentives for providers to use analytics.

Sanders said a “substantial” proportion of the EHR Meaningful Use fund had gone to large hospitals which had already purchased or planned to purchase an EHR system. “The program has served to further entrench Epic and Cerner” as the dominant systems in the hospital industry, Sanders said. This is unfortunate because neither company has shown a willingness to “opening their API” to outside vendors with analytic programs.

All of the panelists agreed that analytic programs held significant potential to reduce both clinical and administrative costs in hospitals.

According to Steve Margolis, MD, MBA, chief medical informatics officer of Adventist Health Systems, the newest types of analytic programs will offer “visual discovery tools,” which he described as being like Amazon’s system of suggesting additional purchase items based upon the consumer’s buying habits.

Margolis said in the future analytic programs will give “each individual provider, whether she’s in the ER, kitchen, or NICU, will get her own individual ‘dashboard.’” This dashboard would contain specific KPIs for the individual position to help in decision making.

Sanders noted that the most significant barrier to widespread adoption of analytics was the current economic model in healthcare. “Until we move to paying for quality, not quantity,” there is little incentive for hospitals to use analytics.

He added that the “I” in CIO should stand for “analytics.” Margolis countered that many CIOs felt the “I” stood for “insecure.”

In the conference’s opening keynote speech, Brent James MD, chief quality officer and executive director of  Institute for Health Care Delivery Research of Intermountain Healthcare, noted the vast amount of waste in the US healthcare system.

James said $2.83 trillion was spent on healthcare in one recent year and about 50 percent, or some $1.5 trillion, was “wasted.”

He said studies showed that 32 percent of all clinical care was “inappropriate,” meaning unnecessary or without proven clinical benefit.

James said “nobody in healthcare believes we will not be seeing major payments cuts” in the future. He urged healthcare executives to study the principles of W. Edward Deming, the famed engineer and management theoretician.

James said the old advice to American manufacturers, “Do Deming or Die,” takes on new meaning in US healthcare. He said the retail and auto industries have shown that “quality drives down costs.”

James Harris is president of Westside Public Relations.

It Takes One Bad Apple…
By Fernando Martinez, PhD, FHIMSS

11-14-2012 6-40-38 PM

I recently hosted an information assurance webinar that focused on security and audit and control functions that are frequently overlooked by healthcare organizations. In order to establish the appropriate context for the discussion, I began by reviewing notable trends and statistics regarding experiences around data security in the industry.

For example, in recent years, almost 21 million patient records have been implicated in reported breaches of electronic protected health information (ePHI). The statistics included a brief review of civil and criminal penalties for HIPAA-related violations which apply to covered entities and business associates alike.

Although the primary industry and regulatory focus has been on covered entities such as providers and healthcare organizations, compliance expectations have also matured and expanded to now include business associates. While business associate agreements are by design typically an affirmation that the business associate agrees to comply with some degree of security and related controls, not until recently have audits been directed specifically to business associates. The expectation is that the business associate has the same level of accountability as the covered entity when it comes to safeguarding ePHI.

Although it seems that some of the impetus for the heightened focus on business associates is related to consumer complaints about HIPAA violations or perceived violations, it is safe to conclude that regulators recognize the need to audit business associates simply because a relationship exists with one or more covered entities. Business associates are expected to conform to the same level of HIPAA compliance as covered entities where applicable, which in turn suggests that a properly designed, executed, and monitored management program must be in place by the business associate.

At the annual NIST/OCR conference held in June 2012, several presentations reinforced the point that a dedicated focus is going to be directed toward business associates. Evidence of this heightened focus is demonstrated in a Wall Street Journal article which appeared late July 2012. A complaint was initiated by the Attorney General of Minnesota directed at a service provider that was implicated in a security breach associated with patients from two local hospitals. The article reported that without admitting to any of the allegations, the service provider agreed to settle out of court. The terms of the settlement speak to the significant risk of not adequately managing compliance with security and privacy standards.

The settlement included the following terms:

  1. The provider will pay $2.5 million to the state of Minnesota as part of a restitution fund to compensate patients
  2. The provider must cease operations within Minnesota for a two-year period (the company voluntarily decided to cease operations in the state)
  3. If the provider wants to do business within Minnesota after the two-year exclusion period, it must first obtain the consent of the state’s Attorney General

The fallout from the incident also resulted in the resignations of several of the provider’s executives, the loss of an estimated $20-$25 million in projected annual revenue, and a 56 percent drop in the stock price of the company.

Fernando Martinez, PhD, FHIMSS is national practice director, enterprise information assurance at Beacon Partners of Weymouth, MA.

The Seven Most Important Soft Skills for Healthcare IT Consultants
By Frank Myeroff

11-14-2012 6-47-34 PM

Google “soft skills” and you’ll find that they are defined as the cluster of personality traits, social graces, communication, language, personal habits, friendliness, and optimism that characterize relationships with other people.

While soft skills are a fairly new emphasis in healthcare IT, today’s job candidates and project consultants are either landing or losing positions based on them. Healthcare IT hiring managers regularly ask me about our consultants’ soft skills and consider them as important as their occupational and technological skills.

Therefore, in the event you are interviewing people or even currently seeking a new healthcare IT position yourself, you will need to understand or even demonstrate that there are a number of the soft skills required to be successful on the job. So my best advice to you — get in touch with your soft side and hone these skills quickly!

With that in mind, here are seven top soft skills considered vital for healthcare IT consultants:

  1. Excellent communication skills. Emphasis is being placed on IT professionals who are not only articulate, but who are also active listeners and can communicate with any audience. Good communicators are able to build bridges with colleagues, customers, and vendors.
  2. Strong work ethic. Organizations benefit greatly when their people are reliable, have initiative, work hard, and are diligent. Workers exhibiting a good work ethic are usually selected for more responsibility and promotions.
  3. Positive work attitude. Wanting to do a good job and willing to work extra hours is highly valued. In general, a person having a positive work attitude is more productive and is always thinking how to make things easier and more enjoyable. Plus a positive attitude is catchy.
  4. Problem-solving skills. Today’s businesses want IT professionals who can adapt to new situations and demonstrate that they can creatively solve problems when they arise. To be considered for a management or leadership role, problem-solving skills are a must.
  5. Acting as a team player. Clearly a worker who knows how to cooperate with others is an asset. They understand the importance of everyone being on the same page in order to achieve organizational goals.
  6. Dealing with difficult personalities. Businesses want people who are capable of handling all types of difficult people and situations. Healthcare IT workers who succeed in this area are in great demand.
  7. Flexibility and adaptability. The business and IT climates change quickly. Job descriptions are becoming more fluid. Therefore, professionals who are able to adapt to changing environments and take on new duties are becoming more valued in the workplace. Those who rely on technical skills alone limit how much they can contribute.

The importance of soft skills in a healthcare IT environment cannot be stressed enough. Healthcare organizations link them to job performance and career success. Having the right soft skills mean the difference between people who can do the job and those who can actually get the job done.

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

My View from the Other Side
By Vendor Nurse

I have worked in and around the vendor world for about 13 years now. But last month was my first experience as a patient in a practice just going live on an EMR (Greenway). In one day, I experienced two doctor visits. Both had recently adopted an EHR.

The first was a dermatologist using Greenway. My appointment was at 1:00 p.m. I arrived a bit early, was asked to fill out several pages of forms, including patient registration forms, PMH, ROS, etc. I was called back to the front desk window four times to answer questions about race and ethnicity, insurance, and I forget what else.

My nurse (MA, really) finally took me back to the exam room at 1:35 p.m. and started to ask me all the questions I had just filled out. When I said, "It’s all on the forms," she said, "I know, but I have to ask you anyway." As she typed into the laptop, she sat at a diagonal but did not face me or make much eye contact and seemed more interested in entering the documentation than me. Of course, I get that, but geez it didn’t feel good.

The second appointment was with my PCP for URI symptoms. They are a major academic healthcare center and are going live on Epic (who isn’t?)…their third EMR! This doc was a little more fluent with an EMR, but sat with her back to me the whole time. She handed me a patient care summary and e-prescribed my medications, but forgot to print the referral for a mammogram.

Somewhere during that visit I was given information about the patient portal, which I had been waiting for a long time. As it happened, I had a couple of questions come up within the week and absolutely loved being able to send a message and get a response within an hour or two. This rocks! No more automated phone messages that go on so long I can’t even remember why or who I called.

Anyway, just thought I’d share my personal experience with EHRs. I have to say it will help me as I work with other physicians going live on their EHR.

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November 14, 2012 Readers Write 2 Comments

News 11/14/12

November 13, 2012 News 7 Comments

Top News

11-13-2012 5-20-42 PM

ONC releases the draft of the proposed Stage 3 Meaningful Use rule.

Reader Comments

11-13-2012 12-52-14 PM

From Minnie Mouse: “Re: NextGen User Group meeting. Over 4,400 attendees have descended on five Disney resorts in Orlando.” The NextGen folks sent over a few pics and we are running a Twitter feed box with meeting updates. The company honored the winners of its innovation awards Monday evening, which included the Flemington, NJ-based Hunterdon Healthcare Partners (above) as Grand Champion. Attendees tweeted positive comments about the food, the presenters, and the enhancements being previewed.

From SideWays: “MyWay contract. Will Allscripts let MyWay users out of their contract if they choose not to migrate to Allscripts Professional?" We’ve asked Allscripts for clarification.

From Peter Potamus: “Re: Allscripts. John Gomez has been consulted by some PE companies asking for guidance and insight into MDRX, and possibly the idea of his returning as CEO. He is getting tremendous pressure to step up, take the helm, and reinvent the company as he did during his early tenure at Eclipsys. I wish he would take it on, but so far he has been resistant. In the Sunrise XA days, he galvanized the client base, rallied the employees, and delivered all he said he would, inventing the App Store, Helios, Objects Plus, and much more.” I’m going to keep my response guarded since Allscripts is publicly traded. I have reason to believe that one or more of the PE companies with an interest in bidding for Allscripts may have approached John for advice that may or may not have included discussion of a possible role if the acquisition moves forward. That’s hardly surprising – if I were a PE guy, l would be calling up departed executives such as John, Jay Deady, Phil Pead, Bill Davis, and maybe even John McConnell for an arm’s length opinion about what they think needs to change to make the company successful. They could also read the advice of the HIStalk Advisory Panel. Or yours, if you’d care to leave a comment – I have a lot of readers who are VCs, equities analysts, etc. so make me proud by showing them how insightful you are.

11-13-2012 6-13-43 PM

From Stock Doctor: “Re: cartoon. Thought this was amusing.” I like it.

11-13-2012 7-51-34 PM

From Country Lane: “Re: Geisinger. I’ve heard rumors that they will release a commercial product aimed at the ACO market.” Geisinger Consulting Group offers software-related services, but I don’t know if the health system is selling software directly. It doesn’t seem like their core competency, but that doesn’t mean they aren’t doing it.

From G.E. Smith and the SNL Band: “Re: GE Healthcare IT. Layoffs coming, the third large one this year. The Centricity Business line is rumored to be heavily impacted again. Software development for various imaging product lines will likely also be cut. Tragic for employees, unfortunate for customers. In any competitive industry, failure to innovate=death. In this case, GE Healthcare has chosen assisted suicide at the hands of Epic and other more agile competitors.” Unverified.

From Fly on a Wall: “Re: GE Healthcare IT. Rumor has it they’re dumping people (layoffs Wednesday) and capital to prepare for a potential acquisition of a large healthcare IT company that McKesson was rumored to be acquiring last week.” Unverified. The subjects of the McKesson rumor that appeared here were athenahealth and Greenway. Monday’s stock market action gave no hints that ATHN is in play (shares were down in a down market), but GWAY shares rose 2 percent on no news other than a management overview. That’s interesting, but probably means nothing.

11-13-2012 6-12-31 PM

From HITEsq: “Re: American Hospital Association. They’re very litigious, with dueling complaints filed in federal court with SSI Group. SSI Group seeks declaratory judgment that the UB-04 codes are not valid copyrights or that any protection ‘is extremely thin.’ AHA filed suit against SSI Group for copyright infringement.”

From Karl Marx Brothers: “Re: ONC. It would seem like a good time to look at the return on investment of ONC. In 2009, this office had a budget of $67 million. I am told that in FY 2012 the budget was over $2 billion. While I understand some increase was needed, this seems excessive in a time where a balanced budget is becoming increasingly important. Do we really need masses of beltway bandit consultants working on HIE interoperability issues, such as communicating lab results, that were solved 10 or more years ago?” According to FY2013 budget documents from February 2012 (the only documents I found), ONC requested 191 FTEs and $66.3 million for 2013, up $5 million from 2012.

From EpicBuzz: “Re: HCA. One HCA hospital went live on Epic earlier this year and now Epic is quietly assembling an implementation team to begin rolling out more facilities. Can they be successful with this huge win? As a former Epic employee, they already seemed stretched to meet customer needs – I was working 70+ hour weeks when I left. This large of a commitment will be a test of their strength for sure.” HCA hasn’t confirmed plans for further Epic rollouts beyond the pilot, or at least the several HCA people I asked said they didn’t know anything about it. Epic is the only vendor that has demonstrated an ability to rapidly ramp up without apparently loss of quality, but HCA has a couple of hundred hospitals and that would indeed provide the ultimate test of turning thousands of brand new liberal arts grads into healthcare IT experts via a short company training program. I don’t think the already-stretched Epic-certified talent bank can even begin to handle a multi-year HCA rollout if it happens, so that probably means a salary war to lure people over. That might throw some disarray into Epic’s carefully managed centralized contractual control over people seeking new opportunities without a waiting period. I don’t have enough fingers to count the percentage of US patient volume that Epic will have if indeed it does land the HCA whale. 

11-13-2012 7-54-51 PM
Photo: Michael Henninger/Post-Gazette

From Grizzled Veteran: “Re: UPMC. How is this possible?” UPMC reports Q1 revenue of $2.5 billion, up $39 million, but the real eye-opener is its $300 million net revenue swing from –$120 million a year ago to $180 million. Kaiser Permanente also turned in good quarterly numbers, with $12.7 billion in revenue vs. $11.9 billion and operating income of $561 million vs. $320 million. KP’s net non-operating income got a huge pop from investments, swinging from a $365 million loss last year to a positive $242 million in Q3.

From MadisonHIT: “Re: Dean in Madison. I’ve heard indirectly that they are laying people off and blaming Obamacare because 100 doctors are leaving because ACA doesn’t let them place patients first. Supposedly this is a nationwide occurrence since the election. Anyone hearing anything similar?” I haven’t heard that, but I’m all ears.

HIStalk Announcements and Requests

I’m running “Morning Headlines” early each weekday on HIStalk, a quick summary of the handful of most important news items you should know about. You won’t get an e-mail blast – just go right to the site. If you’re in a hurry or need a quick smartphone HIT news check while eating breakfast at your hotel, this is the place.

Acquisitions, Funding, Business, and Stock

11-13-2012 7-47-56 PM

A Reuters report quotes unnamed sources who say that three private equity companies placed bids last Friday to acquire Allscripts: Carlyle Group, Blackstone Group, and TPG Capital. The sources said that Allscripts is asking for a premium to the current share price and a deal isn’t guaranteed for that reason. It also said that Bain Capital declined to bid because of unreasonable price expectations and company management turmoil. Shares closed Tuesday at $12.32.

11-13-2012 3-55-50 PM

EarlySense Ltd., a maker of patient monitoring sensors, completes a $15 million Series E financing round.

11-13-2012 5-06-35 PM

Emdeon reports Q3 loss of $15.2 million, which represents a 341 percent decline over a year ago. Revenue was up 5.3 percent to $297 million. Emdeon attributes the loss to increased interest expenses and costs associated with the company’s acquisition by Blackstone a year ago.

InterSystems opens an office in Riyadh, Saudi Arabia to support its TrakCare EMR system.

QualComm Life announces availability of its cloud-based health device connectivity solution in Europe.


11-13-2012 3-57-14 PM

Lake Health (OH) selects Accelarad’s SeeMyRadiology.com imaging management and storage solution.

11-13-2012 3-58-22 PM

Orlando Health contracts with Phytel for its Atmosphere population management suite, including the Outreach, Insight, Coordinate, and Transition products.

11-13-2012 3-59-31 PM

Erie County Medical Center (NY) selects Merge Healthcare’s iConnect Enterprise Archive and iConnect Access for real-time access to images and information from Meditech.

Medina Regional Hospital (TX), Red River Regional Hospital (TX), Ward Memorial Hospital (TX), and First Street Hospital (TX) choose Healthland Centriq, adding to the company’s total of more than 70 rural Texas hospital customers.

Central Washington Hospital (WA) selects patient privacy monitoring tools from FairWarning.


11-13-2012 1-14-58 PM  11-13-2012 1-13-39 PM

Zynx Health announces that President and CEO Scott Weingarten, MD (left) has resigned to return to Cedars-Sinai Health System. He will be replaced by First Databank President Greg Dorn, MD (right), who will run both of the Hearst organizations.

11-13-2012 5-08-45 PM

Awarepoint names Vanguard Health Systems Vice Chairman Keith B. Pitts to its board of directors.

11-13-2012 3-50-41 PM

Apprio names H. Allen Dobbs, MD (HHS) CMIO.

Announcements and Implementations

McKesson renames Horizon Surgical Manager to McKesson Surgical Manager to convey that the product is not specifically tied to the Horizon product line.

FDA issues Cerner 510(k) pre-market clearance for its Cerner FetaLink+ mobile fetal monitoring solution for the iPad and iPhone.

Piedmont Healthcare and WellStar Health System (GA) create the Georgia Health Collaborative, a partnership which includes 10 hospitals and over 700 physicians. The organizations will remain independent, but will partner to share best practices and create innovations and cost reductions through economies of scale.

Intelerad will offer Nuance’s PowerScribe 360 voice-enabled reporting radiology system to customers of its imaging solutions.

Galaxy Health Network will offer its 400,000-member physician network iMedicor’s SocialHIE, a NHIN Direct-powered secure messaging service that the company calls “the social network for healthcare professionals.”

Steward Health Care System (MA) expands its use of Craneware’s Chargemaster Corporate Toolkit and InSight Audit across 10 hospitals.

Over 1,000 physicians across 422 practices have joined Michigan Health Connect and are using Medicity’s iNexx Referrals app.

The Upper Peninsula HIE goes live on ICA’s CareAlign CareExchange interoperability platform.

An article in the Sarasota newspaper profiles Voalte, including its $6 million in recent funding, the planned tripling of its headcount and physical space, and hints of major new sales in 2013. It says the smartphone hospital communications system vendor is doing $10 million in business annually. Sarasota Memorial Hospital nurses are sending 600,000 text messages and 6,000 telephone calls through the system each month.

11-13-2012 6-21-49 PM

Visage Imaging’s mobile viewing app has been enhanced to support the iPhone 5/iOS 6. It’s available in the Apple App Store.

Government and Politics

HHS announces the first class of the HHS External Innovation Fellows, who will spend the next six to 12 months building systems and infrastructure to solve such issues as the acceleration of clinical quality measures for the Affordable Care Act, building technology to withstand natural disasters, and devising electronic tracking and transport systems for the national transplant system. 

Innovation and Research

11-13-2012 8-20-34 PM

A Detroit TV station covers research commercialization at University of Michigan, including a profile of real-time patient monitoring software vendor AlertWatch. AlertWatch, used by UM Hospitals and awaiting FDA marketing approval, was developed by a UM doctor who also invented the pulse oximeter.


The president of New York’s public hospital system says it will cost more than $300 million to repair damages from Hurricane Sandy. Full restoration of the hard-hit Coney Island and Bellevue Hospitals will take two to three months.

Here’s a time lapse video of the audience filing in for Monday’s opening session at NextGen UGM 2012 in Orlando.

11-13-2012 9-04-34 PM

London-based Future Lab Group launches the FlipPad, a medical grade, ruggedized case for the iPad that’s being piloted in several NHS hospitals.

11-13-2012 8-15-46 PM

Bart Harmon MD, chief medical officer for Harris Healthcare Solutions and former Military Health System CMIO, writes a Forbes Veterans Day editorial on the use of healthcare IT to deliver care “both in the field and when they return home.”

In Greece, several hospitals lose their connection to the outside world when protesting students break into the data center and disable servers.

Employees and patients of Cincinnati Children’s Hospital create a video dubbed to Flo Rida’s “Good Feeling.”

Steve Sinofsky, the president of Microsoft’s Windows division and one-time CEO heir apparent, is leaving the company just a few weeks after the launch of Windows 8.

11-13-2012 8-44-49 PM

Guaranteed doctor blood pressure raiser: Lawsuit Settlement Funding Company hires a marketing company to help it find medical malpractice victims. The company offers malpractice plaintiffs quick-approve loans of up to $250,000 as an advance against their potential court winnings.

The son of a woman who died after knee surgery at a Massachusetts hospital files a HIPAA complaint, saying that rounding students visited her room without the family’s permission. He also tries to file homicide charges against the hospital and doctors, but police said it’s a civil matter. The son’s song tribute to Fenway Park is played before Red Sox home games, while his mother starred in the song’s video along with William Shatner just before she died.

11-13-2012 8-49-34 PM

One Medical expands to Boston, offering concierge medicine for $199 per year whose consumer-friendly experience includes online appointments and e-mail contact with physicians. Unlike most organizations of that type, they accept insurance.

11-13-2012 3-17-10 PM

inga_small A Chinese man sues his former wife after she gives birth to an “incredibly ugly baby.” He initially accused the mother of having an affair since the baby did not resemble either of them, but later found that his wife’s beauty was due to the $100,000 in plastic surgery she had prior to their marriage. The judge ordered the woman to pay her ex $120,000 for tricking him into marrying her. I hope she hits up the plastic surgeon for a loan in exchange for all the free publicity.

Sponsor Updates

11-13-2012 6-06-25 PM

  • Transplant solutions vendor OTTR Chronic Care Solutions exhibited at last week’s National Marrow Donor Program conference in Minneapolis. That’s Joy Nock above.
  • Five care management solutions providers featured in a recent market report use consumer health education tools from Healthwise.
  • Versus offers a Webinar  that highlights the use of Versus RTLS by Northwest Michigan Surgery Center.
  • MedHOK enhances its care management, quality, and compliance system by incorporating HTML5.
  • Informatica introduces Cloud Winter 2013, which includes enhancements in master data management and end-user integration.
  • Prognosis Health Information Systems will integrate Health Language’s provider-friendly terminology and Language Engine into its EHR suite.
  • Frost & Sullivan recognizes Humedica for its innovative approach to clinical data analytics and the value it provides to clients.
  • Emdeon exhibits its Edge payment solution suite and offers educational sessions during this week’s National Health Care Anti-Fraud Association conference in Anaheim, CA.
  • T-System’s VP of Revenue Cycle Management Compliance Greer Contreras discusses the value of relevant clinical documentation to ensure proper reimbursement in a guest article. 
  • UK HealthCare (KY) licenses Vendor Selection, Systems Implementation, and Program Management Methodologies from Fulcrum Methods.
  • Merge Healthcare updates its Merge Eye Care PACS to support video and the DICOM OPT standard.
  • The Nashville Chamber of Commerce and Entrepreneur Center recognizes Cumberland Consulting and Emdeon with 2012 NEXT awards for their significant growth in revenue and employees.
  • BridgeHead Software’s file archiving data and storage management systems for PACS is successfully tested by Fujifilm.
  • The Huntzinger Management Group streamlines its services offering to include RCM offerings from both its Advisory Services and Managed Services segments.
  • CareTech Solutions introduces CareWorks, an out-of-the-box content management system for smaller hospitals.
  • Brad Levin and Malte Westerhoff, PhD of Visage Imaging were featured in an Imaging Biz article called “The High-performance, High Speed Enterprise Viewer.”
  • Worcester Business Journal awards eClinicalWorks top honors for its employee rewards and recognition.


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

More news: HIStalk Practice, HIStalk Mobile.

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November 13, 2012 News 7 Comments

News 11/9/12

November 8, 2012 News 4 Comments

Top News

11-8-2012 5-13-39 PM

Allscripts reports Q3 results: revenue down 1 percent, EPS $0.23 vs. $0.24 excluding special items, missing consensus revenue estimates by 4 percent but beating adjusted EPS estimates by a penny. Earnings were down by more than 50 percent on asset write-downs and slipping margins. CEO Glen Tullman confirms earlier reports that the company is evaluating strategic alternatives, adding that the company will not comment further on the issue and will not issue financial guidance for the next quarter.

Reader Comments

From Curious in Cleveland: “Re: Lyman Sornberger, executive director of revenue cycle management at Cleveland Clinic. Two confidential informants confirm that he’s out – any idea why? I’m a loyal reader and ex-Epic. Judy had me scared stiff to report anything to any blog, so this is a real thrill for me even if you don’t publish it.” Unverified. We’ll see if anyone confirms. I get basically no reports from anyone at Epic, so you’re not alone there.

From Coyote: “Re: McKesson. Half verified – they will acquire Greenway and athenahealth.” Unverified and unlikely given that those are two publicly traded vendors of competing systems with market caps totaling more than $2.5 billion. However, experience has taught me to at least mention even bizarre rumors just in case they happen to come true. If this rumor is accurate, it would easily be the most bizarre. Color me even more skeptical than usual.

HIStalk Announcements and Requests

11-5-2012 12-43-17 PM

This week’s HIStalk Practice highlights include: CMS adds a couple of new hardship exemptions for the e-prescribing rule. As more hospitals buy physician practices, facility fees for routine office visits are expected to increase Medicare spending $2 billion a year by 2020. The number of physicians in independent practices is predicted to drop to 36 percent by 2013. Occasional HIStalk  contributor Lyle Berkowitz, MD earns a spot on the list of Top 25 Clinical Informaticists. The most commonly deferred Stage 1 menu objectives by EPs include providing patients with a summary of care at transitions, using EHRs for reminders, and reporting data to public health agencies. NYeHC Executive Director David Whitlinger provides an overview of his organization and its initiatives. Stop by HIStalk Practice to get the latest ambulatory HIT updates, and while you are there, check out a few of our sponsor offerings and sign up for e-mail notifications. Thanks for reading.

On HIStalk Mobile, the talented and knowledgeable Lt. Dan is putting up several news items each day, while Dr. Travis has written an immediately popular post called Where I Would Invest. We don’t want to overload your inbox with the news posts, so you’ll get notification only of Travis’s longer posts if you sign up for updates. Thanks to HIStalk Mobile’s sponsors: 3M, Access, AT&T, Imprivata, Kony Solutions, Truven Health Analytics, Vocera, and White Plume.

11-8-2012 6-47-17 PM

Welcome to new HIStalk Platinum Sponsor Clinovations. The advisory practice of the DC-based company targets ambulatory and inpatient provider organizations, non-profits, and federal and state government. Their expertise includes patient safety, quality, and all phases of electronic medical records implementation. I mentioned Pitt County Memorial as one of the North Carolina academic medical centers running Epic and I’ve learned two things about that since yesterday: (a) Clinovations provided go-live support, EMR optimization, and physician engagement services for their implementation; and (b) the hospital changed its name earlier this year to Vidant Medical Center, with the 10-hospital system now going by the name of Vidant Health. I first connected with Clinovations a few weeks ago when I interviewed CEO Trenor Williams, MD, recommended to me by Travis from HIStalk Mobile, who knows him. More than half of the company’s 100 employees are clinicians, Trenor told me. In fact, read the interview to get a feel for how the company works (hint: they’re big on upfront optimization planning, wringing value from EMR implementation, and using data to improve care delivery). Thanks to Clinovations for supporting my work.

On the Jobs Board: Systems Engineer, Epic and Cerner Resources, Senior Certified Epic Analyst, Senior Quality Engineer. HIStalk Platinum Sponsors post their jobs for free, while everybody else watches enviously because they aren’t allowed to post jobs there at all.

11-8-2012 7-41-58 PM

It’s unfortunately unfashionable to divert one’s attention from self-absorbed activities to take a moment to think about members of our military, living and dead, whose sacrifices (ranging from modest to ultimate) provide us with the illusion that the world is full of caring people who wish us no harm. Sunday is Veterans Day, the eleventh day of the eleventh month that is set aside to honor every man and woman who has served this country in uniform. It’s a real shame that most cities don’t bother to have Veterans Day parades any more, but chances are you know a veteran or will see someone in uniform this weekend who would be grateful for nothing more than a nod and a “thanks for your service” instead. If you served, thank you. If not, thank them.

Acquisitions, Funding, Business, and Stock

11-8-2012 5-12-54 PM

Cerner will acquire Anasazi Software, Inc., a provider of behavioral health technology.

11-8-2012 9-04-55 PM

Accretive Health’s Q3 numbers: revenue up 2 percent, EPS $0.03 vs. $0.07. They signed some new revenue cycle management deals despite being run out of Minnesota for harassing ED patients to pay up. Amusing: their AR days jumped from 48 to 56 due to “delayed payments from a few customers.” They must not have strong-armed their own customers like they did those of their hospital clients, although they did take “action relative to the resources that were local in the market and focused on the clients in those areas,” i.e. fired their Minnesota employees once the company got the boot from there.

11-8-2012 9-06-55 PM

A Reuters article says that Merge Healthcare has attracted the interest of at least five private equity firms as it contemplates taking itself private. Named as suitors Thoma Bravo LLC, GTCR LLC, Welsh Carson Anderson & Stowe, Francisco Partners, and Avista Capital partners. Sources say the company hopes to have offers by today (Friday).

For-profit hospital operator Vanguard Health Systems announces that it will consolidate its IT operations in San Antonio. They will move to the Inner City Reinvestment/Infill Policy zone, which sounds great for corporate tax credits but lousy for night shift computer operators.


11-8-2012 11-13-52 AM

SAIC subsidiaries maxIT Healthcare and VCS close a combined $102 million in contracts from several North American hospital and clinics.

Summit Radiology Associates (NJ) selects Merge Healthcare’s radiology suite.

The DoD awards Evolvent Technologies a $20.5 million contract to build additional coding, database uses, and mobile applications into AHLTA-Theater.


11-8-2012 7-53-38 AM

Lakeland Regional Health System (FL) names J. Scott Swygert, MD chief quality officer and CMIO.

11-8-2012 2-55-02 PM

Vermont Information Technology Leaders appoints John K. Evans (Strategic Alliance Advisors dba s2a) president and CEO of its statewide HIE.

Announcements and Implementations

Wellmont Health System (TN) will begin file building for its Epic implementation in January and will phase its go-live throughout 2014.

11-8-2012 8-21-12 AM

The 17-provider Reedsburg Physicians Group (WI) goes live next week on GE Centricity EMR.

11-8-2012 9-07-52 PM

Park Nicollet Health Services (MN) goes live with Levi, Ray & Shoup’s VPSX software solution for document and printer management.

RamSoft will integrate MModal’s Speech Understanding technology into its PowerServer RIS/PACS, PACS, and Tele Plus Systems.

Government and Politics

11-8-2012 10-27-38 AM

CMS releases updated reference grids for Stage 1 and 2 MU requirements, including details on how MU objectives align with EHR certification criteria.

HRSA (Health Resources and Service Administration) offers a November 16 Webinar called Patient Charting and Documentation in an Electronic Health Record for Nurses and Allied Health Professionals, with presenters that include practicing nurses.

11-8-2012 9-09-52 PM

El Camino Hospital (CA) considers a legal challenge after voters narrowly pass Measure M, which will limit the pay of its executives to twice the governor’s annual salary, or around $350K. CEO Tomi Ryba, CFO Michael King, and CMO Eric Pifer, MD would all see major pay cuts if the legality of the measure is upheld. Meanwhile, an SEIU-UHW union steward admits that the union proposed the measure only because hospital officials declined to meet with its leadership in last year’s labor negotiation in which the union was unhappy that its members were no longer being offered free healthcare (that perk has since been reinstated).

Innovation and Research

A study published in the Journal of General Internal Medicine finds that clinical decision support tools in EHRs can help reduce the inappropriate use of antibiotics for acute respiratory infections.

Chicago startup MetisMD offers radiology second opinions for $75 (report review) to $250 (MRI, CT, PET, mammography, nuclear medicine, echocardiograms). Patients get a copy of their study, upload it to the company, and get a written report and a conversation with the radiologist within 1-2 days.


11-8-2012 6-27-29 PM

Healthcare venture capitalist Lisa Suennen says healthcare reform will create business opportunities for companies offering tools that can help manage chronic care and that keep people out of hospitals. She mentions one of her investments, SeeChange, which pays patients if they get annual blood work and agree to follow customized prevention guidelines that are generated from a mash-up of the lab results, personal health record information, and claims data. She says hospitals and insurance companies are vulnerable to marginalization if they are slow to react to the changes:

We are going from fee-for-service to not-quite-fee-for-service, in a pretty broad way, where you are paying fixed amounts for cases. Hospitals don’t know how to deal with that. The profit now will come from being efficient instead of being prolific. So they will need tools and programs and analytics to help them make that transition. The other area is the whole “retailization” of insurance. There is a huge, fundamental shift in the business, as individuals are driven more and more to buy their insurance from exchanges. Insurance companies don’t sell that way. They don’t have good brands from a consumer-satisfaction standpoint; in fact they have some of the worst brands in the world. So organizations that work on consumer brands are coming into the marketplace.

11-8-2012 8-40-18 PM

Motorola Solutions rolls out the HC1 Headset Computer, a self-contained wearable computer with a boom-mounted viewer that simulates a full-sized monitor, a two-way headset, and the ability to respond to voice or head-movement commands. It came out too late for making a fashion statement at AMIA.


Aprima announces that it has settled the lawsuit brought against it by Allscripts, which had claimed that the wording of Aprima’s advertised “MyWay Rescue Upgrade Program” violated state and federal laws. Aprima agreed to changed its advertising, but will continue to market its product to users of the Allscripts MyWay EHR. Allscripts previously announced that MyWay will not be upgraded to handle ICD-10 or Meaningful Use Stage 2, but customers will be offered a free conversion to its Professional product.

11-8-2012 6-39-47 PM

Athenahealth Chairman, CEO, and President Jonathan Bush appeared  on CNBC Thursday morning in a discussion about healthcare reform.

You’re going to get more rules and innovation anyway when the healthcare costs are going up faster than GDP. Everyone is going to force some innovation. In this next stretch, it will come from the government … Medicare first and the commercial health plans are falling nervously behind the tank that is Medicare … If you’re a buyer of healthcare, an employer or consumer, you’re going to see two things. You’re going to see some markets where hospitals rally around and buy up doctors. We’ve seen half the doctors in the country become employed in the last three years in preparation for this. And then jack up commercial rates and say, “I got this huge group of Medicaid rates coming in, I’m going to jack up” … we saw this in Massachusetts, the first state that did this. Commercial rates went up 50 percent for the same coverage over a five-year period just for the commercial side … The hospitals bought all the doctors and said, “You can’t have any of us unless you go up.” There will be others who figure out how to get cheaper. They’ll get more efficient. They won’t need to raise rates. And then the third group will be the ones who go bust … they’re supposed to go bust. Please, no bailouts for the hospitals that go bust.

Here’s a new video on the Texas approach to a statewide HIE that involves 12 local HIEs.

11-8-2012 9-12-22 PM

Heisman winner runner-up and Indianapolis Colts rookie quarterback Andrew Luck signs his first big endorsement deal … with Riley Hospital for Children.

A new study finds that doctors, like most people, are subconsciously biased against the two-thirds of Americans who are overweight. If you’re obese, your best bet for compassion is to find a fat female doctor, the study results suggest.

FDA urges that providers writing prescriptions write neatly, minimize the use of abbreviations, and consider using e-prescribing instead. The practitioners being addressed are veterinarians.

inga_small This is nuts: genital injuries send 16,000 men and women to the ER each year.

Bizarre: a California couple lose a real estate fraud lawsuit when the husband, the director of pathology and clinical laboratories of Community Regional Medical Centers, admits that he faked the death of his wife, a former National Raisin Queen. The purchaser of their horse ranch, an anesthesiologist, says the couple faked her death to increase the value of their property to $2.3 million. The wife, a former waitress, changed her name from Genevieve Sanders to Genevieve Marie de Montremare and claimed to be a physician and French-born royalty. Their transgressions will cost them $1.55 million.

Sponsor Updates

  • API Healthcare CEO J.P. Fingado offers insight on how the results of the presidential election will affect the healthcare workforce.
  • Prognosis maintains its 100 percent success rate among its eligible clients achieving and attesting for MU.
  • GetWellNetwork launches Transformative Health, an online publication covering the intersection of patient engagement and technology.
  • 3M hosts a Webinar on the critical need to start ICD-10 education now.
  • White Plume offers advice on creating interoperability in preparation for the ICD-10 deadline in a blog post.
  • The IT director and a senior systems analyst from Henry Mayo Newhall Hospital will lead a November 14 Webinar on their use of solutions from Access to create a paperless admissions and bedside consent system, send completed forms automatically to their Meditech system, and maintain electronic registration and clinical activities when the hospital system is down.
  • Shareable Ink hosts a Webinar on preparing anesthesiologists to qualify for MU.
  • An article by T-System VP Greer Contreras highlights the need for physicians to describe their thought process when documenting to help prevent denial of payment.
    Bottomline Technologies publishes a case study that highlights Alamance Regional Medical Center (NC) and the efficiencies it has gained since implementing the Logical Ink e-form solution.
  • The Canadian Health Informatics Society honors Orion Health and eHealth Saskatchewan as Project Implementation Team of the Year for the successful integration of Orion Health’s Clinical Portal with four eHealth Saskatchewan applications.
  • Liaison Healthcare’s Gary Palgon, VP of healthcare solutions, discusses cloud-based solutions for big data during this week’s 12th Annual BMS IT Symposium in Princeton, NJ.
  • Robin Mitchell, MD (WA) shares how her practice has improved patient care by leveraging EMR support services from INHS in a company profile.
  • Ingenious Med becomes one of the most downloaded apps for Android.
  • SAIC subsidiaries maxIT Healthcare and Vitalize Consulting Solutions will exhibit at the NextGen User Group Meeting next week.
  • Fulcrum Methods recognizes new Meaningful Use-EP Tracker users, including Duke  Private Diagnostic Clinics (NC), Greenville Hospital System (SC), Lucile Packard Children’s Hospital at Stanford (CA), Physicians Medical Group of Santa Cruz County (CA), and University Hospitals-Cleveland (OH).
  • IT staffing company Digital Prospectors Corp ranks #9 on “Top 100 Private Companies for 2012” by Business NH Magazine.
  • Besler Consulting will participate in the HFMA Region 9 conference in New Orleans November 11-13.
  • Carl C. Jaekel of Santa Rosa Consulting offers five ingredients for successful ICD-10 activation in the company’s team blog.
  • Jason Fortin, a senior advisor with Impact Advisors, weighs in on meeting Stage 2 menu objectives.
  • MModal’s chief scientist Juergen Fritsch discusses ways for healthcare organizations to obtain a holistic view of patients’ health in an article published in the Allscripts Newsletter.
  • The latest version of Imprivata’s OneSign technology includes Fade to Look walk-away security for shared workstations, No Click Access for Citrix XenApp, and support for Epic 2012.
  • Florida State University student Bill Blough takes first place and a $1,500 prize in iSirona’s e Code-A-Thon competition.
  • Bottomline Technologies hostted a November 8 Healthcare Customer Insights Exchange to foster collaboration between healthcare organizations using its technology.
  • Wellcentive highlights Borgess Health (MI) and its use of Wellcentive’s Advanced Outcomes Manager solution for population health management and clinical analytics. 

EPtalk  by Dr. Jayne

I worked double shifts in the emergency department this week as a result of another physician defection. In case there’s any question, I can attest to the fact that the front-line physician shortage is very real, especially if patients are on Medicaid or are uninsured. Out of an entire day’s work, only two patients actually belonged in the ED – a child with a laceration and an adult with a fully dislocated finger. There were multiple patients there for medication refills, work notes, and plenty of malingering.

I think stationing a Boy Scout with a first aid kit outside the door of the hospital would have not only have provided great cost savings, but also also would have helped patients learn that many of their conditions could be treated at home with basic first aid training and a little common sense. Until we figure out how to educate patients on these things, we will continue to have unnecessary ED visits.

Other countries seem to do a better job with this. A friend who lives in Germany keeps telling me about the baby nurse that comes to her home to do basic parenting and health education (how to handle fever, why babies are fussy, what to do when your child falls and hits his/her head, etc.) Having something like that here would be fabulous. However, that would require what many interpret as government intrusion and it would certainly require government funding, so I don’t see it happening here anytime soon.

Here are some pearls of wisdom from last night’s adventure:

  • Influenza season is here. If your child has a fever, doping them up on Tylenol and sending them to daycare to infect everyone else is a bad idea.
  • When your child shoves something in her ear, do not try to get it out with a cotton swab. You will jam it in further. What I could have removed quickly and painlessly has now become a procedure that requires us to sedate your child and quadruple your hospital bill. And BTW, please do not call an ambulance for this.
  • Pain in a wrist you broke 10 years ago is not an emergency condition. I will screen you and send you home.
  • Asking me to diagnose a rash that is no longer present is just silly.
  • When you’re a homeless guy who just wants a warm place to hang out and a sandwich, it’s best not to strip naked and sexually harass the nurses and physician. We will call security. But if you keep your clothes on, we’ll board you for a little while.

I did have some downtime in the wee hours of the morning and tried to keep up on the massive stream of social media and correspondence that was flowing my way. One of my Tweeps mentioned that BlackBerry 10 looks “promising.” Unfortunately, the hospital firewall blocked my attempts to read the article. but I did find a blurb on YouTube. Anyone seen it and have good intel? It sounds like it has a slick camera feature that lets you go back in time to modify faces when someone blinks.


Inga’s not-so-secret admirer Dr. Lyle Berkowitz makes Modern Healthcare’s list of Top 25 Clinical Informaticists. Of all the honorees, he’s got one of the best-looking head shots. Being an anonymous blogger, I know I will never make the list, but it’s fun to see lots of HIStalk friends on it.

I ran across another first-hand account of the evacuation of NYU Medical Center, this time from a medical student. It depicts situations which would make great scenarios for your next disaster preparedness drill.

There have been lots of good tweets coming from attendees of the AMIA 2012 Annual Symposium. Lots of thoughtful ponderings on “real” interoperability and what data elements really need to be tracked across disparate care settings. Not a lot of photos, though. If you were there and have some good ones to share or general thoughts about the meeting, feel free to send them along.


Speaking of meetings, the NextGen Annual Users Group Meeting starts Sunday in Orlando. Hope to see some good pics and tweets from readers who are enjoying the warm weather and getting in some quality time with The Mouse.


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

More news: HIStalk Practice, HIStalk Mobile.

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November 8, 2012 News 4 Comments

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