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Morning Headlines 10/9/13

October 8, 2013 Headlines No Comments

Software, Design Defects Cripple Health-Care Website

The federal government has acknowledged for the first time since the October 1 launch of the federal insurance marketplace healthcare.gov that coding and architecture issues are causing the site’s poor performance. Until Sunday, the administration was maintaining that the site was technically sound, but could not keep up with traffic demands.

Nuance Adds Two Icahn Associates to Board

After months of pressure from activist investor Carl Icahn, Nuance names two Icahn delegates to its board: Brett Icahn, Carl Icahn’s son, and David Schechter, a longtime business partner.

PatientKeeper CPOE Rated the Easiest-to-Use CPOE Solution by KLAS Research

KLAS gives PatientKeeper’s CPOE system an ease-of-use score of 8.3 (out of 9), placing it almost a full point above Epic’s second-place score of 7.4.

WellStar launches massive project to merge data, improve access

WellStar Health System, a five-hospital system based in Marietta, GA, is covered by the local news as it begins a $125 million Epic implementation that will integrate its hospitals, urgent care centers, practices, home health agencies, nursing homes, and hospice.

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October 8, 2013 Headlines No Comments

News 10/9/13

October 8, 2013 News 5 Comments

Top News

10-8-2013 7-28-00 PM

US CTO Todd Park tells USA Today that the Healthcare.gov insurance marketplace wouldn’t be failing if the site hadn’t drawn five times the expected number of simultaneous users. “Take away the volume and it works,” he said. Former National Coordinator and Republican appointee David Brailer wasn’t impressed with the Democratic appointee’s explanation: “Whoever thought it would draw 60,000 people wasn’t reading the administration’s press releases. The Medicare Part D site was supposed to have 20,000 simultaneous users and was (built for) 150,000, and that was back when computing was done on an abacus. It isn’t that hard.” A Wall Street Journal investigation finds that an Experian identity module is crashing frequently, the site contains orphan programming code that appears to do nothing, and caching was not employed for efficiency. It estimates that up to 99 percent of those people who try to register can’t complete the process. The previously chatty government contractors involved are now declining to return calls.


Reader Comments

From Patient Presents Without Comment: “Re: ICD 10. I wish I could see when, You’d be part of my past, and be gone; Your codeset is fine, but look: I prefer Nine. It’s opinion- how can it be wrong? There’s just under a year- it’s a while, but I fear, That there’s yet quite some Gantt chart to go; Could you install yourself? It’d be good for my health. So please MYOB, IMO.”

From Beer Reviewer: “Re: Monday morning news. The posts have been short. Is the news in short supply?” It is, actually. I go through the same steps every weekend to put together the Monday Morning Update, just like I’ve been doing since 2003. Lately news has been nearly non-existent. I could do like everybody else and pad it out with worthless, self-serving press releases masquerading as useful information, but I assume you would rather me not waste your time. Nobody has pointed out anything important that I’ve missed, a test I apply every single day to what I write.

From More Please: “Re: anonymous CIO interview. Fascinating! I would like to see more.” So would I. All I need are CIOs who are willing to be interviewed anonymously. If that’s you, let me know.


HIStalk Announcements and Requests

Everybody knows that most everything Yahoo is hopelessly antiquated crap, but I’ve stuck loyally with the paid version of Yahoo Mail for nearly 10 years because I like it better than the alternatives. No more. Yahoo is having a spam-related spat with Spamcop blacklisting that was causing my emails to fail and despite all the hoopla about improving the user experience, Yahoo has apparently removed every possible way of contacting support (even via an online form – thanks, Marissa Mayer). The best way to get me now is mr_histalk@histalk.com.


Acquisitions, Funding, Business, and Stock

10-8-2013 7-17-51 PM

Luminate Health, which offers a patient-friendly lab results portal, raises $1 million.

Nuance gives in to activist investor Carl Icahn by adding two of his nominees to its board in return for his support of the company’s slate.


Sales

Sacramento Family Medical Clinic (CA) is implementing Forward Health Group’s PopulationManager as it joins forces with The Guideline Advantage to improve quality outcomes and patient care.

Partners HealthCare (MA) selects InterSystems HealthShare to replace several integration engines as it consolidates to a single EHR.

The Valley Hospital (NJ) will implement Merge Healthcare’s CTMS for Investigators solution to organize and centralize its clinical research operations.

Aegis Sciences will implement Passport Health’s OrderSmart and PaymentSafe to automate transactions between its CBO and U.S. locations.

10-8-2013 7-33-50 PM

Washington Health System (PA) selects eClinicalWorks EHR for its 87 physicians and 21 residents in its family practice residency program.

In Brazil, Hospital Israelita Albert Einstein chooses Cerner Millennium.


People

10-8-2013 3-40-00 PM

St. Francis Medical Center (CA) names Judi Binderman, MD, MBA, MHSA (Encore Health Resources) as CMIO. 

10-8-2013 3-51-08 PM

Former ONC Principal Deputy Director David Muntz will join GetWellNetwork as CIO. We ran this as a reader rumor last week.

10-8-2013 3-57-23 PM

Encore Health Resources promotes Steve Eckert to partner of client services.

10-8-2013 5-40-50 PM

Alameda Health System (CA) names Dave Gravender (Kaweah Healthcare District) as CIO.

Clinovations hires Brian Morton (Halley Consulting) as VP of physician networks, Kim Tombragel (maxIT-Vitalize) as SVP of business development, and Robin Walters (Halley Consulting) as business development manager.


Announcements and Implementations 

10-11-2013 7-14-30 PM

A KLAS report finds that PatientKeeper is the most user-friendly standalone CPOE system on the market, with its 8.3 score on a nine-point scale beating Epic inpatient by almost a full point. All PatientKeeper customers interviewed by KLAS said they would buy it again, with an overall company performance score of 86.4 and reported physician user training time of as little as 10 minutes.

Nuance announces its Clinic 360 suite, an outsourced transcription service and application for physician practices and ambulatory clinics that manages dictation, review, editing, and sign-off for specialties such as oncology.

ADP AdvancedMD introduces its business intelligence solution AdvancedInsight during MGMA. The company also ADP releases its iPhone app.

Harris Healthcare achieves critical milestones while deploying its Service Oriented Architecture Suite across the US Department of Veterans Affairs and the DoD.

Vitera is previewing Intergy V9.00 at MGMA this week.

Capario introduces CaparioOne, its redesigned web portal application for revenue cycle management.

10-8-2013 4-49-11 PM

Next Wave Health launches Next Wave Connect, a problem-solving social network for healthcare organizations. Drex DeFord will serve as CEO and Mike Davis as EVP of research and analytics.

VHA Mid-Atlantic will offer its hospitals mobile patient satisfaction and experience tools from Marbella Technologies.

10-8-2013 5-32-04 PM

Peer60 offers HospitalTCO.com, which allows hospitals to determine total cost of ownership for IT systems over 10 years. It’s free.

Athenahealth announces its readiness for Meaningful Use Stage 2.

Mediware says it will expand the CPR+ platform it acquired in July 2013 to create a management tool covering home medical equipment, home infusion, specialty pharmacy, and home health.


Other

10-8-2013 7-38-52 PM

Officials of Dane County (WI) Regional Airport are planning a $30 million parking deck expansion to handle the increasing number of Epic Systems travelers.

10-8-2013 6-11-43 PM

HIMSS releases a photo of its Innovation Center inside the just-opened Global Center for Health Innovation in Cleveland.

The local newspaper covers the $125 million Epic project of WellStar (GA).

10-8-2013 7-39-44 PM

UNC Health Care (NC) says it expects to post an operating loss for the fiscal year due to reduced volumes caused by its Epic go-live. 


Sponsor Updates

  • T-System launches two solutions to assist EDs overcome negative aspects of EHRs, including a paper-based note-taking tool (Doc Notes) and an ED physician documentation application (EV for physicians).
  • InstaMed says use of its Member Payments solution, launched earlier this year, will exceed $100 million in patient payments.
  • CareTech Solutions signs its first long-term care facility to its Clinical Service Desk support service.
  • PeriGen will offer an October 9 Webinar, “Uterine Tachysystole: How much is really too much?
  • The HCI Group is honored as the fastest growing private company in Florida by the Florida Business Journal.
  • Billian’s HealthDATA will host an October 16 webinar offering three perspectives on patient and provider engagement.
  • Predixion Software CEO Simon Arkell briefs the Boulder Business Intelligence Brain Trust on V3.1 of Predixion Enterprise Insight and its Machine Learning Semantic Model.
  • Genesis Health System (IA) discusses the performance efficiencies they’ve experienced since the integration of Vocera’s wireless communication system with their Cerner EHR.
  • Intermountain Healthcare and Craneware will present “Structuring Multidisciplinary Teams for Revenue Cycle Improvement” during the 2013 HFMA MAP Event October 28 in Ft. Lauderdale, FL.
  • Elsevier and Jefferson Medical College (PA) are co-sponsoring the “Art + Medicine: How Art Can Make Better Doctors” conference November 2-3 in Philadelphia.
  • Health Care Software participates in the AHCA/NCAL 64th Annual Conference and Expo in Phoenix this week.
  • Intelligent InSites will present “The Why’s and How’s of Reforming Healthcare Operations” on October 9.
  • NextGen Inpatient Clinicals V2.6 receives 2014 ONC HIT certification as a complete EHR.
  • Aspen Advisors Jody Cervenak is moderating a panel on the optimization of physician documentation during the CHIME13 Fall CIO Forum in Scottsdale this week.
  • ZirMed signs over 900 clients processing over 2.2 billion transactions while launching three additional products in the first nine months of 2013.
  • Greenway supports the national eHealth Exchange by joining Healtheway.
  • Dan Charney, managing partner of Direct Recruiters, Inc. / Direct Consulting Associates, is named a “Forty under 40” honoree by Crain’s Cleveland Business.
  • Orchestrate Healthcare is hosting an October 17 business intelligence Webinar.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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October 8, 2013 News 5 Comments

HIStalk Interviews Steve Levin, CEO, Connance

October 7, 2013 Interviews No Comments

Steve Levin is CEO of Connance.

10-4-2013 5-01-36 PM

Tell me about yourself and the company.

I’m a reformed consultant. I spent 15 or 20 years doing consulting in and around healthcare and places like that. I spent a fair amount of time with one provider in particular, and they had some interest in applying predictive analytics to enhance their business. As a consultant, I was able to get them to realize some gains, and if you fast forward, ultimately they initiated this idea of founding Connance and getting me to come into that company to help organize an industry platform, an industry solution to help providers  engage on and leverage predictive analytics proudly.

 

How would you describe how predictive analytics work? What data do you use and what comes out?

The secret sauce to predictive analytics, what’s in it and what comes out, is one of those things that no one will ever tell you down to the variable. But the way we think of it and the way we talk with folks about it is, look, let me try to put predictive analytics in context. The industry is familiar and comfortable with business intelligence and BI platforms, which are good at snapshotting where we’ve been and what we have in our inventory. We’re good at having workflow systems and operations that can queue up accounts for follow-up and pursuit.

There’s a layer between those two, which is about what’s the best next step on this account and why. Predictive analytics and predictive solutions live in that layer there, which is about figuring out what’s the right or best next step to take. It’s contextual. In a revenue cycle, it may be about the cash or the operating cost in a discharge planning structure. It could be about the risks in the patient engagement. What you’re predicting and what you’re trying to manage differs and is contextual. But in every situation, what you’re trying to do is you’re looking at what information do I have available at the moment of application. What’s available about this account in the file? What do I know about the patient when they’re standing in front of me?

What might I find, if I had time, if I were to look out on the World Wide Web, and all those databases in the world, and whether it’s public records or all those catalog marketing databases, or for some people, we need credit bureau files, credit files, and that’s a longer conversation. What else do I know based on having looked at similar types of patients over the years across the industry and across providers? 

That’s three pools of insights — the situation at hand, that which you can find out from the world at large, and that which you know from experience. That gives you the input to figure out what’s the right next step on this account. Predictive analytics is just massive. It’s a massive buzzword right now. But the way I think of it and what we try and do is, we try and help people think about what, you know, making sure accounts get into the light next work step, and those people going for those lists are doing them in the right order.

 

On the clinical side, it’s polarizing to where you’ve got the giant data sets for managing populations and making broad, sweeping decisions. But then there’s also that need to take what you can get from that and use it for that person that’s standing right in front of you as a patient. Is that true with financials as well?

Yes, it is. It’s an interesting continuum from the individual account. What do I want to do on John Smith’s account right now as he walked into my doctor’s office or walked into the dentist office? All the way up to, what do I think I’m going to experience from the 10,000 John Smith accounts that I’m likely to see over the next 60 days or six months, whatever it is? Predictive analytics is a realm of predicting the future. You predict either individual or populations and you do it based upon pattern recognition of the history.

 

Self-pay patients used to be those without insurance. How is that changing, and what do hospitals need to do to manage it effectively?

The industry as a whole has to become proactive in what I think of as patient relationship management. Almost anybody that walks into a doctor’s office or a clinic or a hospital these days, whether they aren’t insured or they’re insured, they’re likely to have some co-pay and deductibles, some co-insurance, they’re going to have some financial skin in the game.

What we’re seeing and what providers are saying to us is, almost every time we engage a consumer, we have to think of managing that relationship. They’re looking for the question of, how do I best engage these consumers? The days of, “Let’s send three letters and make phone calls at 6:00 PM to every single account” are over. Similarly, the days of assuming that the patient balance has got no value, we’re just going to not even bother pursuing it, are over. Every penny, every dollar counts. Every patient relationship matters. 

We do a little research every now and then. We ask consumers about their satisfaction with the financial processes and how well they do connecting with providers. Not every patient has a great experience when they get the bill or when they try to figure out their insurance coverage. It can be complicated. 

What we have seen is that if you ask a patient when they had a really good experience with the financial systems if they’d be willing to recommend that hospital clinician to a friend. There’s a real strong correlation. The Net Promoter score is positive when we’re doing a great job engaging them in the financial relationship. The reverse is also true, though, which is very compelling. When we do a bad job, when we make a mistake in the system, when we don’t explain it to them, when we’re less than respectful and responsive, they will tell a friend to go somewhere else. It’s a big negative. What we see providers talking about is, how do I maximize the value from that patient relationship? It’s about today’s bill and it’s about their needs in the future.

 

When hospitals use Net Promoter scores with its single “would you recommend” question, do you think they recognize that it could be measuring something more than satisfaction with doctors and nurses?

No, they don’t. This is an industry problem, because the age gap and the various services the government have don’t go beyond the discharge. The questions they ask are all focused on was the room quiet, how was your pain managed. Those are really important things, but we go in on Monday, we get discharged on Wednesday. The rules say I have to have that survey within six weeks of discharge. The fact of the matter is, the patient might not see their portion of that bill for another eight weeks. The financial relationship and the financial thing goes on much longer than that engagement, and I think the way the industry thinks about satisfaction based on some of the government measures is a little short-sighted.

Everyone talks about the revenue cycle. But when they draw this picture, what they really draw is they draw a revenue process. On the left side of the page, they start with pre-registration and scheduling. They put treatment in the middle. On the right, they put billing and self-pay and the bad debt agencies. That goes right to left. That’s not a cycle, that’s an end-to-end process.

What we started thinking about, and we’re seeing lots of writers get into this, is a real cycle. Which is, draw a circle and at the top is a patient or a home that’s healthy. They go down to 2:00 on the circle here and say, I have a need for a clinical interaction, whether I have a broken arm or it’s a check-up if you’re not feeling so great. Then at 4:00, they get the clinical treatment. Then at 6:00, they get discharged, and at 8:00, they get the bill sent. At 10:00, the bill’s resolved and it’s all paid off. And they go back to 12:00, hopefully, which is happy and healthy and home. That’s a cycle. That’s a closed loop. 

If we look at the dynamic, we realize a whole bunch of things about what we create — the types of loyalty, the types of relationship, the types of engagement, the type of referral pattern that we want. That’s much more consistent with the way that Best Buy or Ritz Carlton or some of these people who we think of service excellence would think of the world. We need to embrace that. But a lot of what’s in the industry in terms of the regulatory, the measurement systems out there, there are lots of good reasons to focus on the clinical experience, which is really important, but we lose sight of some of the other stuff.

One of the things I always remember is, I don’t do a really good job of taking advice from people or organizations that I find kind of upsetting. If as a provider or an organization, I want my patients to really engage and have this deep relationship with me, I better make sure that every engagement is reinforcing to a positive.

 

Hospitals aren’t always good at recognizing the marginal cost versus marginal revenue of chasing down accounts that are probably not going to be paid. Do they recognize those accounts as not being worth the effort?

That was a pretty sophisticated question. My view is similar, but different. Hospitals do a pretty good job of believing they know who won’t pay and therefore where they shouldn’t put any money. Where they don’t do a good job is thinking about when they’re trying to follow up and get money from someone, they think is worth everything, but in fact they’re spending when they don’t have to. I think hospitals tend to overspend in places where they don’t need to, and underspend in places where they should.

 

Tell me about presumptive charity and how that changes with the Affordable Care Act and the changes in the Form 990 requirements.

The world of presumptive charity and charity classification is going to change. With Affordable Care and some of the new health reform, clearly we hope we’re going to get a lot more folks who currently are uninsured into some government program. A lot of the uninsured are going to migrate to some form of insurance. I think the number’s 50 million uninsured today and it will go down to 20 or 25 million, whatever the gross estimates they keep moving around.

That’s going to change the box that we think of today as charity. Charity being those accounts which can be either documented as living in poverty and therefore meriting financial assistance, or accounts that for lots of reasons choose not to engage and we can’t document, but can be presumed charity. Health reform is clearly going to move a bunch of people uninsured into the insured box, which is great. There’s still a sizeable patient portion in almost every one of those plans whether it’s co-pays, deductibles, uncovered procedures, etc. We’re still going to have a bunch of folks that are not buying insurance, for whatever reason. We’re still going to have a bunch of folks that are in Medicaid plans where they’ve got some co-pay, some deductible, etc.

There’s still going to be a bunch of patient responsibility running around. What the whole charity presumptive or documented is about is making sure that for the people that are living in difficult household income situations, that our hospitals, who are pillars of the community, in fact are thoughtful about their policies with them. There’s a large chunk of Medicare, Medicaid patients that might have coverage and deductibles are actually charity-qualified. The future of presumptive charity and the charity space generally is going to be about making sure we’re being thoughtful about amongst these insured patients, and even amongst those who are uninsured, are we being responsive to their situations? 

It’s not going to go away as an issue. It’s going to become even more under the spotlight. The regulators, the consumer protection organizations, state and federal, are going to start saying things like, look, we’re subsidizing a vast chunk of the care for these people. You are not paying taxes, and you have a responsibility on the residual piece to give them a break. And if we see that you’re not carrying through on that part of the bargain, maybe we have to rethink this relationship.

 

It’s tough for hospitals being non-profit good citizens and big employers, yet they have to collect payment for the services they’ve rendered. Do you see that getting tougher as budgets are squeeze and as the rules become blurred about who’s uninsured and who’s charity care?

Absolutely. Predictive analytics is probably one of the critical levers in the system. Predictive analytics can help them get more nuance on an account-by-account basis in a structured, consistent, standardized way to understand the real nuances between who’s living in poverty, who needs financial assistance, who is simply a reluctant payer, what’s the right way to process accounts. The future is going to demand predictive analytics and demand sophistication in understanding the gradations here. Every dollar’s going to count. I haven’t heard any provider come to me yet and say, you know what, I’ve got an extra five percent in the budget with nothing to do with it.

 

Any concluding thoughts?

As we keep talking to providers around the industry, as far as we can see, the dollars in the industry are getting tighter. Hospitals and providers are on the hook for a lot more. They’re on the hook for a lot more of the outcome and they’re integrating across the continuum. They own the risk when the patient goes home. They’re going to own the risk when they go to the clinic.

We don’t have any more money. We have more risks and more responsibilities. We’ve got a very large IT investment going on around EMR and some of the patient systems out there. 

There are some competency implications in the industry that are interesting. You have to be good at managing these patients. You have to understand the difference amongst patients. You have to understand how to engage patients and how to move them across venues and over time. We’re going to have to be good, if we’re going to do that, at applying data. It’s not that we have to get more spreadsheets and more dashboards, it means we have to take data and automate what’s the next best step. It’s the predictive application of data.

It also means we have to come to a point of view on revenue cycle. For a lot of folks, the revenue’s cycle is either going to be a source of a competitive advantage, because it’s going to be a place for relationship management, or we need to figure out how to commoditize it because they can’t afford to not do it well.

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October 7, 2013 Interviews No Comments

Monday Morning Update 10/7/13

October 5, 2013 News 2 Comments

From Insider: “Re: David Muntz from ONC. Will join GetWellNetwork’s leadership team.” Unverified.

From The PACS Designer: “Re: iOS7. Now that the hoopla has subsided over the 5C/5S, thought it would be good to reveal what are the improvements that Apple brings us with iOS7. They say, ‘It has a new structure, applied across the whole system, that brings clarity to the entire experience. The interface is purposely unobtrusive. Conspicuous ornamentation has been stripped away. Unnecessary bars and buttons have been removed. And in taking away design elements that don’t add value, suddenly there’s greater focus on what matters most: your content.’ Other features are improved graphics, audio, and many other areas to numerous to mention here. With Apple’s acquisition of Cue, a personal assistance app, the solution will surely find is way into iOS7 healthcare communications software.”

10-5-2013 4-21-58 PM

From THB: “Re: Northwestern Memorial in Chicago. Leaving the Cerner fold and going to Epic, but I don’t see it mentioned in searching your site. Am I missing something? It’s been going on for the last several months, so is this a big secret, or is it hiding in plain sight?” I ran a reader’s rumor about the switch a year ago, and another reader’s rumor before that.

10-5-2013 9-01-10 AM

Most poll respondents don’t see customers of either Vitera or Greenway benefitting from their single ownership. New poll to your right (which is actually an earlier poll that few saw since it wasn’t the featured poll): how will hospitals handle liability and workers comp insurers that won’t accept ICD-10 data until 2015?

Thanks to the following sponsors who recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.

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Kyle scored an interview with Aaron Levie, co-founder and CEO of Box, at Health 2.0.

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Sunquest announces two new executives: Jonathan Pierson (MedAssets) as VP Solution Adoption Center of Excellence and Keith Laughman (MedFusion) as EVP of Community Care Solutions.

10-5-2013 4-18-37 PM

CaroMont Health (NC) announces a breach involving the records of 1,310 patients that were sent by an employee via unsecured email.

10-5-2013 4-26-57 PM

Weird News Andy says it’s usually a brother-in-law: a two-year-old boy in China with a swollen stomach and difficulty in breathing is found to have a parasitic twin with fully formed spine and limbs growing inside his stomach. Doctors removed the eight-inch-wide twin.

Vince identifies several vendor C-suite executives of long ago this HIS-tory edition, but he seeks help filling in some of the blanks.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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October 5, 2013 News 2 Comments

Morning Headlines 10/4/13

October 3, 2013 Headlines No Comments

Lexmark acquires PACSGEAR for $54M

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

Providers Demand More Than Just Regulatory Reporting From Quality Management Systems

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

Google Glass in hospitals? Royal Philips, Accenture think so

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

HIMSS Analytics Releases 2013 Inpatient Revenue Cycle Management Study

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

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October 3, 2013 Headlines No Comments

News 10/4/13

October 3, 2013 News 6 Comments

Top News

10-3-2013 5-38-48 PM

Lexmark International acquires PACSGEAR, which provides connectivity solutions for sharing medical images with PACS and EMRs. The price was $54 million in cash. The acquisition will be operated from Lexmark’s Perceptive Software.


Reader Comments

From Frank: “Re: certification scoreboard. A check of the certified inpatient systems still shows some big names missing. For full EHR certified systems missing are two biggies, Cerner and Siemens. Also no shows are Healthland, QuadraMed and NTT-Keane. A week ago Dr. Mostashari was quoted as saying that two-thirds of the systems in use were already 2014 (Stage 2) certified. That’s hard to believe with Siemens and Cerner still out, and McKesson only certified for Paragon. That’s got to cover at least half the hospitals in the country. Also somewhat ironic is Siemens is not certified. Remember John Glaser was a key member on the HIT Committees that set up the criteria for Certification/MU program. I remember him being quoted two years ago in an HIStalk interview saying that the program was not going to be easy and some organizations just won’t make it. Well he’s proving himself a prophet now!”


HIStalk Announcements and Requests

inga_small Some news you might have missed this week from HIStalk Practice: CareCloud and Box integrate Box’s content-sharing capabilities into the CareCloud platform. My top educational session pick for MGMA, plus my tentative party agenda. Most physicians are satisfied with the e-prescribing workflow for controlled substances. Medicare awards Arch Systems a contract to validate the accuracy of data submitted to the eRX and PQRS programs. Physicians claim EMR use is stressful. If you are headed to MGMA, you’ll want to peruse our annual list of Must See Vendors. The guide includes essential details such as vendor booth numbers, product offerings, and fun giveaways. Thanks for reading.

inga_small I’ll be reporting from MGMA beginning on Sunday so keep reading HIStalk Practice (or sign up for email alerts) for all the conference updates. Feel free to email me if you have any recommendations for conference sessions, exhibit booths, or after-hours festivities.

On the Jobs Board: Chief Medical Officer, Clinical Analyst, Epic Revenue Cycle Project Director.


Acquisitions, Funding, Business, and Stock

Mobile healthcare communications provider Duet Health secures an undisclosed investment from Baird Capital.


Sales

PIH Health (CA) selects Allscripts Sunrise EHR for its newly acquired PIH Health Hospital-Downey and extends its hosting and managed services agreement.

10-3-2013 6-03-42 PM

Southern Regional Medical Center (GA) engages MedAssets for A/R services and revenue cycle consulting.


People

10-3-2013 3-41-21 PM

AirStrip promotes Matt Patterson, MD from chief transformation officer to COO.

10-3-2013 5-14-25 PM

MaineHealth names interim CIO Andy Crowder as CIO.

10-3-2013 5-30-19 PM

Farzad Mostashari, MD will join the Engelberg Center for Health Care Reform of The Brookings Institution as a visiting fellow.

10-3-2013 5-33-17 PM

NorthCrest Medical Center (TN) promotes Randy Davis as president and CEO. He had previously served as VP/CIO.

Shelia Mitsuma, MD, who holds positions with Brigham and Women’s Hospital and Massachusetts General Hospital, joins EBSCO Information Services as deputy editor of its DynaMed clinical reference tool.


Announcements and Implementations

Newton Medical Center  connects its Meditech EHR to the Kansas HIN using ICA’s CareAlign interoperability platform.

inga_small Cerner announces a strategic relationship with Shawnee Mission Medical Center and TMC Lakewood and designates the organizations “Certified Maternity Partners” for its KC-area employees. Cerner says the arrangement is designed to “improve infant and maternal health outcomes,” while “managing rising healthcare costs for its associates.” I suppose that means that many Cerner employees or their covered spouses may need to change providers in order to receive full maternity benefits. I’ll be curious to see how receptive Cerner employees are to this change since my experience is that women in particular prefer to exercise maximum control over their own health issues, including their choice of providers.

The Georgia Department of Community Health launches its statewide HIE network with the Truven Health Analytics platform, powered by CareEvolution.


Government and Politics

ONC reports that as of July 31, 1,115 critical access hospitals and small, rural hospitals had attested for MU, which exceeded ONC’s goal of 1,000 by 2014.

The VA warns that the federal government shutdown will reverse its progress on decreasing the backlog of disability claims because claims processors cannot be paid overtime.


Innovation and Research

10-3-2013 10-13-22 AM

Inpatient providers report a high level of adoption for eligibility and scheduling solutions from RCM vendors, according to a HIMSS Analytics study. Many respondents say they intend to replace or purchase new RCM solutions to handle pre-certification, address validation, and bill estimation. The most-considered RCM vendors include Passport, RelayHealth, Emdeon, and MedAssets.


Technology

Athenahealth and Epocrates introduce Bugs + Drugs, a free app to identify the most common bacterial infections recorded in a geographic region using data collected  from athena customers.


Royal Philips and Accenture demonstrate a proof of concept for the use of Google Glass to aid in surgery. Researchers successfully transferred patient vital signs from Philips Intellivue software to Google Glass, giving surgeons continual access to patient data hands free.


Other

10-3-2013 1-02-38 PM

Xerox, provider of the Midas+ product,  is named the “vendor to beat” in a KLAS report on quality management solutions. Nuance and Premier earned the next-highest performance scores. Providers say they want more from their vendors than just regulatory reporting functionality and are looking for solutions that will facilitate operational and financial improvements to drive better outcomes.

A multi-day systems outage at a Scottish hospital trust that forced cancellation of hundreds of appointments is blamed on a corrupted Microsoft Active Directory.

A man who gave a phony name in his hospital admission rips out his IV, steals another patient’s iPhone and iPod, and slips out of the hospital. The man is a suspect in several similar incidents at other hospitals.


Sponsor Updates

  • CTG Health Solutions publishes a white paper with recommendations and steps for setting up executive dashboards to manage EHR implementation project issues or risks.
  • Elsevier names five winners of its third annual Mosby’s Suite Superheroes of Nursing contest.
  • Vocera Communications previews its Vocera Collaboration Suite at the ANCC National Magnet Conference this week in Orlando. Also at ANCC: GetWellNetwork will demonstrate its new patient user interface.
  • Levi, Ray & Shoup opens a Paris, France office to provide support for its LRS Output Management software.
  • Truven Health Analytics establishes a Singapore-based regional office as its Asia Pacific headquarters.
  • Infor CMIO Barry Chaiken, MD and Infor customer Joel Vengco, CIO at Baystate Health, will discuss learning to leverage social networking and user experience optimization tools to drive patient-centered clinical workflow at next week’s CHIME 13 Fall CIO Forum in Scottsdale.
  • Aventura earns Gold status in the Golden Bridge Awards for its innovative, secure, and effective IT awareness computing platform.
  • Forward Health Group reports it is poised to nearly double the number of deployments of its PopulationManager platform within a matter of weeks.
  • HCS will exhibit at next week’s AHCA/NCAL 64th Annual Conference and Expo.

EPtalk by Dr. Jayne

The past week has been uncharacteristically low key for me.  Our IT teams have been working hard to knock out strategic projects because we know our EHR vendor is on the cusp of releasing their ICD-10 ready package to the general public. Once that happens, it’s going to be all hands on deck and full speed ahead.  Luckily we’ve been more efficient than usual so we have a bit of a lull while we wait.  It feels a bit like they describe the eye of a hurricane as we wait for the beating that’s surely coming.

I’ve been catching up on email, reassuring providers that we’re going to meet all our deadlines, and trying to stay away from any new projects the operations people try to sneak in. We’ve had a terrible time prioritizing new initiatives and finally have a good process in place, but there is one administrator who is always pushing a pet project. It usually doesn’t have funding or a well-defined scope, so I’m avoiding him at all costs.

I guess I shouldn’t be shocked anymore at how far some of his initiatives make it before someone finally says no. It seems like our hospital administration is increasingly reactive, responding to the squeakiest wheel or the sparkliest thing dangled in front of them regardless of its lack of purpose in context of our long term goals. There were a lot of strategic planning apple carts upset over the last few years as hospitals struggled to plan for upgrades and other initiatives around Meaningful Use and ICD-10. The only unknown on the horizon now is Meaningful Use Stage Three and I think we can at least make some reasonable plans based on what we think will make it in the final requirements.

I have appreciated the opportunity we’ve had to roll up our sleeves and take care of all the things we put on hold over the last few years. On the technical front we’ve expanded interface capabilities for our ambulatory sites, implemented some great new reports, and increased our patient outreach efforts. On the workflow front, we have had fewer new implementations so we can actually spend time going back to retrain staff and reinforce best practices. Our operations teams have actually had time to do some process redesign work and build on the clinical transformation we started with EHR.

Of course, we’re still doing all the day to day “care and feeding” activities such as maintenance and patches but it’s been nice to feel like we’re making up some of the ground we lost with all the focus on MU. Our compliance teams are starting to train ICD-10 in earnest and I’ve enjoyed fielding questions from colleagues who seem to have been under a rock or locked in a biodome for the last few months. Somehow they missed all the demos we did showing that yes indeed the system will be capable and ready come October next year.

I wonder if vendors are experiencing any of the lull that we are. It would be great to know that they’re able to focus on greater usability, expanded content, and designing the next best way to document patient visits rather than checking the box on regulatory requirements. Many of our vendors have been through the wringer during the last couple of years. It will never be the way it was before Meaningful Use, but I’m looking forward to a new normal where we can again collaborate rather than scrambling madly in the same general direction.

I figure I’ve got about two weeks of the good life left and then I’m going to be back in an upgrade cycle with all the standing meetings that entails. I’ll be back in the trenches testing workflows and trying to find defects as quickly as possible so that our vendor can roll them into patches before we go live. Every time we upgrade it reminds me more and more of some kind of military assault. I’m not sure if it’s just the way we run them or a little bit of post-traumatic stress. Maybe it’s a little of both.

Are you in the calm before the storm? Planning an upgrade or just trying to stay afloat? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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October 3, 2013 News 6 Comments

News 10/2/13

October 1, 2013 News 16 Comments

Top News

10-1-2013 11-09-42 AM
10-1-2013 3-30-46 PM

10-1-2013 4-21-38 PM

All but four of 184 ONC staffers are furloughed as a result of the October 1 government shutdown, along with about 40,000 (52 percent) HHS employees. ONC has also put on hold its Standards and Interoperability work, privacy and security policy activities, clinical quality measure development, and maintenance of the Certified Health IT Product List. Tweeting is apparently considered a non-essential service.


Reader Comments

10-1-2013 4-48-54 PM

From Ole: “Re: David Muntz. He won’t be returning to Baylor Scott & White. Matt Chambers is the new CIO, reporting to COO Bob Pryor. Both are from Scott  White. Vic Richey is the newly appointed CIO for the Baylor (Northern) division.” Verified from the LinkedIn profile of Matt Chambers (above).

10-1-2013 4-50-16 PM

From HIT Pundit: “Re: Leidos, the former maxIT-Vitalize. Major changes in leadership. The website confirms that people are gone.”

From Clafouti: “Re: Dr. Jane’s comments about Greenway. It was not only biased toward sponsors (which I understand to a point) it was verbatim of what Tee says in his speeches. Next time you claim to be independent, don’t quote the CEO and call it your own words.” Dr. Jayne has never met Tee or heard him speak. She wrote that post a year or so ago and decided it wasn’t appropriate to run at the time, but the Greenway acquisition made it more timely.


HIStalk Announcements and Requests

10-1-2013 3-48-00 PM

Welcome to new HIStalk Platinum Sponsor pMD. You may note and appreciate, as did I given the dearth of it in healthcare IT, pMD’s appreciation for whimsy. The San Francisco company lets doctors record charges in seven seconds on a mobile device, or as one hospitalist says, “If you can hold a beer, then you can use pMD”  (many testimonials are here). Users report an increase in Medicare payments for post-discharge follow-up appointments and improved care coordination driven by its handoff tools. Native apps are provided for Android, iPhone, BlackBerry, and iPad and support is provided 24×7 by actual employees. Thanks to pMD for supporting HIStalk.

A YouTube cruise turned up this video describing pMD’s mobile charge capture solution.


Acquisitions, Funding, Business, and Stock

10-1-2013 4-51-58 PM

Evolent Health, which offers a population health and risk management platform, secures $100 million in Series B funding led by The Advisory Board Company and UPMC Healthcare, bringing the company’s total funding to $124.5 million.

10-1-2013 4-53-21 PM

 

Baylor Health Care System (TX) and Scott & White Healthcare (TX) complete their merger and form Baylor Scott & White Health, the state’s largest not-for-profit health system with $8.3 billion in assets.

Tenet Healthcare closes on its $4.3 billion acquisition of Vanguard Health Systems.

10-1-2013 4-54-54 PM

Healthrageous, a Center for Connected Health spinoff that offered patient engagement tools, sells off its assets to an unnamed “leading healthcare companies.” Even the website is gone.


Sales

Knoxville Comprehensive Breast Center (TN) will implement Sectra breast imaging PACS and RIS.

10-1-2013 4-56-00 PM

Adirondack Health (NY), Baylor Health Care System (TX), Mission Health (NC), North Shore Long Island Jewish Medical Center (NY), and University of Chicago Medical Center (IL) select Vocera’s Care Experience Suite.

 


People

10-2-2013 5-42-31 AM   10-1-2013 1-49-14 PM

Emdeon appoints Neil E. de Crescenzo (Oracle – on left) president and CEO, replacing George I. Lazenby, IV (right), who will become a senior advisor for Emdeon’s majority investor, Blackstone Capital Partners.

10-1-2013 3-00-40 PM

McKesson names James A. Beer (Symantec) EVP/CFO.

10-1-2013 1-51-22 PM

Johanna Epstein (Mount Sinai Doctors Faculty Practice) joins Culbert Healthcare as VP of strategy and executive leadership services.

10-1-2013 10-28-26 AM

PeriGen hires Rebecca Cypher (Madigan Army Medical Center) as chief nursing officer.

eHealth Ontario appoints its chairman Ray Hession to serve as interim CEO following the departure of Greg Reed, who quit six months into the job and left with a $406,250 severance package.

10-1-2013 1-53-10 PM

SRS names Peter Bennfors (Asset Control) CFO.

10-1-2013 4-04-17 PM

Infina Connect names Mark Hefner (Allscripts) as CEO.

MedData appoints appoints Stephen Ghiglieri (NeurogesX) CFO and Dustin Whisenhunt (Prognosis) VP of client services and sales.

Amy Amick (MModal) joins MedAssets as president of the company’s RCM segment.

 


Announcements and Implementations

The 25-bed Cobre Valley Regional Medical Center (AZ) goes live on Meditech 6.0.

The New York Giants converts the medical records of its players to eClinicalWorks.

10-1-2013 11-16-19 AM

Saint Luke’s Health System (MO) goes live on Covisint’s cloud engagement platform.

Family Service of Madison (WI) implements Forward Health Group’s PopulationManager to identify and monitor progress in patients with substance use disorders and depression.

Summit Healthcare adds Summit Care Exchange to its interoperability suite, allowing hospitals to exchange PDQ and XDS messages in sending continuity of care documents to external entities.

AirStrip announces the launch of AirStrip ONE Cardiology for Windows 8.1.

Health Catalyst receives the highest grade in the clinical analytics market in a Chilmark Research report.


Other

A Xerox survey (conducted online, and therefore with shaky statistical certainty)finds that more than two-thirds of American adults don’t believe their physicians gave them a good explanation about the switch to EMRs. Most are also concerned with the security of their records and less than a third want their records to be digital. However, 62 percent believe that EHRs will reduce healthcare costs and 73 percent think they’ll get better service from practices that use EHRs. In case it wasn’t already obvious, Americans are confused.

10-1-2013 5-00-02 PM

Cerner expects more than 10,000 attendees at its 25th annual conference in Kansas City that runs October 6-9.

John at EMR & EHR Videos will conduct a Google+ Hangout with Kareo CMIO Tom Giannulli, MD, MS on Thursday, October 3 at 1:00 Eastern.

An MGMA survey finds that medical practice IT spending has risen from $15,211 in 2008 to $19,439 in 2012.

10-1-2013 9-23-52 AM

10-1-2013 9-25-13 AM

10-1-2013 9-26-59 AM

inga_small I don’t know why this bothers me so much, but I continue to be annoyed by articles in the main stream press that suggest EMRs are a requirement of the Affordable Care Act. I’ve even noticed recently a few vendors have made this statement in their marketing materials. As a reminder: ARRA (specifically the HITECH ACT) was the legislation that included the requirement for EMR adoption and provided the groundwork for incentives and penalties. Maybe some of the confusion stems from the fact that the ACA includes provisions for the secure exchange of electronic health information. Regardless, I have read so many articles that tie ACA to EMR and Meaningful Use that I had to do some fact checking just to be sure I hadn’t incorrectly rewritten history.

10-1-2013 9-38-46 AM

inga_small While I am ranting, I am self-insured, so I decided it might be worth my while to investigate available options on the Health Insurance Marketplace. I first attempted to get on the site at 8:00 a.m. EST and despite multiple attempts, I’ve yet to be able to create an account (the security questions never appear). Several hours later, I’ve still not gotten a response from anyone using the online chat feature. I realize it is only Day 1, but so far I have to call the online process a failure.

10-1-2013 1-39-59 PM

inga_small On a much happier note, my veterinarian sent me an email to inform me that I can now set up a PHR for my pets. It took about three minutes to register and now I can see health histories online. I’m not really sure why I need online health records for pets, but it’s still cool to say it’s there.

10-1-2013 10-00-15 AM

inga_small Someone please assure me that none of my tax dollars were used to fund this study that developed BAPS (Belief About Penis Size Scale).

The family of newborn delivered at 24 weeks gestation creates a video thanking Fletcher Allen Health Care. I’m trying to preserve the feel-good moment by not thinking about the healthcare resources consumed by a 98-day NICU stay and the fact that similar babies are intentionally aborted at that same 24-week mark.

Here’s an Intermountain video describing its Cerner selection.


Sponsor Updates

10-1-2013 4-06-10 PM

  • ESD sponsored Sunday’s Northwest Ohio Susan G. Komen Race for the Cure, with participating employees raising $1,500 in donations.
  • Medseek partners with Vitals to help healthcare organizations connect consumers with providers and facilities.
  • The Web Marketing Association recognizes CareTech Solutions with an Information Services Standards of Excellence Award and presents 2013 WebAwards to 10 CareTech customers.
  • NCQA awards GE Healthcare’s Centricity Practice 11 Solution PCMH pre-certification status.
  • Gartner places Perceptive Software in the Leaders Quadrant for enterprise content management solutions.
  • INHS reports that its use of IBM server and storage technology has improved its delivery of cloud-based EHR services to physicians and medical facilities.
  • Predixion Software launches an OEM program aimed at embedding its predictive analytics solutions into BI and analytics programs.
  • Beacon Partners hosts an October 17 webinar on using data to optimize clinical and financial systems.
  • Summit Healthcare adds Summit Care Exchange to its interoperability suite and introduces enhancements to its current Express Connect and Provider Exchange products.
  • Divurgent will participate in the CHIME13 Fall Forum October 8-11 in Scottsdale, AZ.
  • Hospitals that have implemented ProVation Order Sets by Wolters Kluwer Health report clinical benefits and ROI in as little as 13 months.
  • Seamless Medical Systems posts a case study highlighting how a geriatrics practice streamlined patient workflow, reduced operational costs, and improved the patient experience though its use of SNAP Practice.
  • Wellsoft will exhibit at the 2013 ACEP Scientific Assembly October 14-16 in Seattle.
  • Dave Himes, IS group director for Billian’s HealthDATA, delivers a Letterman-style list of top ten CRM integration tips.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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October 1, 2013 News 16 Comments

Monday Morning Update 9/30/13

September 28, 2013 News 12 Comments

9-28-2013 3-13-26 PM

9-28-2013 3-15-26 PM

From Cerner Rules: “Re: Intermountain. Finally the Epic backlash has begun.” I wouldn’t make that assessment without a review of the Cerner-Intermountain agreement since I don’t know the price or the concessions Cerner gave to earn the business. We heard similar partnership hype in 2005 when Intermountain struck a 10-year, $100 million collaboration deal with GE Healthcare to develop new technologies around Centricity that would “set the standard for the industry to follow.” The net result is that nothing ever happened, Centricity slid even deeper into irrelevance, and Intermountain bailed out early over dissatisfaction with the result and courted its next bedmate. Intermountain is a development shop with a long IT history and an unhealthy allegiance to its antiquated HELP system, which I would bet makes them a pain as the development partner of a bureaucratic and publicly traded vendor like either GE or Cerner. I don’t recall many examples like this where the vendor ended up with commercial software with wide appeal, not to mention that it’s the federal government that’s driving the development agenda anyway with prescriptive rules for Medicare payments, Meaningful Use, and ICD-10, most of which provides no benefit to patients at all. It’s a good deal for Cerner from a PR perspective and they may fare better than GE Healthcare, but I wouldn’t hold my breath in anticipation of a flood of amazing new Millennium functionality since Intermountain is hardly Cerner’s only smart customer (that’s another risk – alienating the lesser-anointed longstanding customers). Probably the best bet is analytics since Intermountain is strong there and Epic got a late start. I’m talking to Neal Patterson this week, so I’ll let you know what he says. Intermountain Health Care changed its name to make the “Healthcare” part one word and eliminated the previously acceptable “IHC” designation later in 2005, so the GE Healthcare announcement spelled it right even though it looks wrong. Now if we could just convince the “HealthCare” holdouts to spell it right …

From BigMoneyInPatient Portals: “Re: patient portals. A report says the market will jump from $280 million to $900 million in the next five years. I guess HCIT corporate development people have found their next acquisition target.” I don’t pay the slightest attention to those come-on press releases from market research firms that claim to know how big a particular market will be, information they will gladly share with you for several thousand dollars. I don’t see many follow-up press releases extolling the accuracy of their previous predictions, the reason for which you can probably infer. I think the patient portal hype is overblown given that every vendor offers one, meaning patients are supposed to log on to several depending on what system their providers use. Kaiser can do great things with MyChart because most of the encounters are within their system and the patient can get everything in one place, but I don’t think the concept will work in most areas. Imagine if your bank had separate portals for deposits, checks, loans, and investments, all with their own look and feel and log-in credentials. Not only would nobody use them, the banks would irritate their customers for even suggesting that they should. Portals are a proprietary distraction to interoperability, not a solution for it.

9-28-2013 5-27-33 PM

From Raj: “Re: UMass Hospital System. Missed the deadline to go live with CPOE and missed out on millions of dollars from the taxpayers. They have unionized nurses who stood up and demanded HIT accountability like in Ohio and California.” Unverified. I will say that I’ve worked rather uncomfortably with unionized nurses and that’s an experience I’d rather not repeat (or experience as a patient). The visual memories of watching nurses trashing hospital equipment and blocking ambulance access during an ugly labor dispute soured me for good on their concern for patients.

9-28-2013 5-28-13 PM

From IsItTrue: “Re: David Muntz. Rumor is he will return to Baylor to lead the newly merged Baylor Scott & White IT organization.” I wouldn’t be surprised. Quite a few of the departed ONC folks have gone back to their previous jobs after finishing their abbreviated government service. Baylor Health Care and Scott & White Healthcare agreed to merge in late June to create Baylor Scott & White (I’m really annoyed at the omitted commas), which will have 40 hospitals, $6 billion in annual revenue, and 34,000 employees.

From Patient Advocate: “Re: EHRs. My ophthalmologist appoint ran 90 minutes late. The doctor said it was because they were converting to a computer system, but nobody told that to the waiting patients. She started whining that it had been a month, they were still delayed, and she was working until 6 every night. I told her the practice should adjust the patient load to reflect the number they can actually see. She said, ‘We have to see patients’ and didn’t seem to agree as she stashed her iPad mini into her lab coat. I finally left two hours later, and as I fought rush hour traffic, I thought, you chose this profession. I did not choose to need an eye specialist. Don’t tell me how rough your life is with a computer system implementation for which someone set the wrong expectations. I left without making a follow-up appointment since I couldn’t find the energy.”

9-28-2013 1-19-31 PM

Most poll respondents expect population health and analytics opportunities to kick in within four years. New poll to your right: which customers benefit from combining Vitera and Greenway under a single private equity owner?

Upcoming HIStalk Webinar: “Strengthen Financial Performance: Start with Lab Outreach” on Wednesday, October 16 at 2:00 p.m. Eastern. Presented by Liaison.

9-28-2013 4-04-13 PM

Friday’s quarterly report from BlackBerry will probably form its epitaph as it announces a $1 billion quarterly loss, almost all of it due to unsold Z10 touch phones on which the company had bet the farm. It’s hard to believe people still actually work there, but the former RIM (renamed in January to distance the stench of failure) will hack another 4,500 jobs and move its focus to corporate customers. The one-hit-wonder company has evaporated $75 billion in market value in the past five years.

A Toronto surgeon develops an “OR Black Box” that records every aspect of surgical procedures by video and audio, although he points out that it probably couldn’t have happened in the lawsuit-happy USA.

9-28-2013 5-21-11 PM

Bridgeport Hospital goes live on Epic, completing Yale School of Medicine and Yale New Haven Health System’s $300 million project on time and under budget as CEO Bill Jennings throws the ceremonial switch.

9-28-2013 5-29-36 PM

Administrators at  at one of England’s highest-mortality hospitals open up staff access to Twitter and Facebook, with the intention of promoting “openness and transparency” but causing critics to warn that “the last thing this hospital and its patient needs is staff getting distracted by Facebook and Twitter whilst at work.”

Government subcontractor programmers are being pushed to fix the health insurance exchange software that is scheduled to go live October 1 whether it’s ready or not. Known problems include delays in the Spanish version, specific exchanges that can’t calculate federal subsidies, and erroneous displays. Oregon is so worried that it won’t let anyone try to enroll in insurance plans without the help of a trained agent. The system integrator is India-based Infosys. The saving grace is polls that show two-thirds of Americans have never heard of the insurance exchanges anyway.

9-28-2013 4-31-58 PM

Truven Health Analytics names Mason Russell (inVentiv Health) as VP of strategic consulting.

Private equity firm KKR will acquire Panasonic’s healthcare unit for $1.67 billion

9-28-2013 2-38-08 PM

Weird News Andy provides a “Man Bites Dog” story. A 33-year-old medical student falls onto a Boston subway track in a drunken stupor after celebrating passing his board exams. Onlookers jumped down to pull him to safety.


Sponsor Updates

  • PeriGen will demonstrate the PeriCALM fetal surveillance system at the MedAassets Technology & Innovations Forum in Orlando this week.

Vince’s HIS-tory this week is about the people who founded and ran the early healthcare IT vendor firms. If you’ve been around for awhile and are good at matching names to faces, Vince is looking for help in identifying some of the industry pioneers pictured.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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September 28, 2013 News 12 Comments

Intermountain Healthcare Chooses Cerner

September 27, 2013 News 11 Comments

9-27-2013 10-20-33 AM

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

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

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

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

I will interview Neal Patterson during the conference.

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September 27, 2013 News 11 Comments

News 9/27/13

September 26, 2013 News 11 Comments

Top News

9-26-2013 11-24-53 AM

9-26-2013 8-02-35 PM

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


Reader Comments

9-26-2013 8-49-59 PM

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

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

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

9-26-2013 9-26-52 PM

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


HIStalk Announcements and Requests

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


Acquisitions, Funding, Business, and Stock

9-26-2013 7-48-13 PM

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

9-26-2013 7-51-27 PM

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

9-26-2013 7-52-33 PM

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


Sales

9-26-2013 7-55-06 PM

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

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

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

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

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


People

9-26-2013 8-18-07 PM

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

9-26-2013 8-19-47 PM

Aventura appoints acting CEO John Gobron to president and CEO.


Announcements and Implementations

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

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

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

9-26-2013 11-58-25 AM

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

9-26-2013 8-30-55 PM

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

9-26-2013 8-31-56 PM

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

9-26-2013 11-33-51 AM

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

9-26-2013 9-15-47 PM

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

National eHealth Collaborative opens board member nominations.


Other

9-26-2013 8-47-07 PM

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

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

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


Sponsor Updates

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

EPtalk by Dr. Jayne

9-26-2013 7-44-23 PM

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

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

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

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

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

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

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

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

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

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

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

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

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


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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September 26, 2013 News 11 Comments

Morning Headlines 9/26/13

September 25, 2013 Headlines No Comments

Fewer certified EHRs for Stage 2 may pose problems for hospitals, doc

Modern Healthcare reports that only 79 EHR vendors have certified Stage 2 EHRs, far less than what was available in Stage 1 prompting additional calls for a delay October 1 start to the stage 2 reporting period.

Nondefense Discretionary Science 2013 Survey: Unlimited Potential, Vanishing Opportunity

A recent report published by 16 science foundations, primarily representing the life sciences field, finds that one-in-five researchers have considered moving overseas due to the lack of federal research funding available in the US since the sequester.

Children’s National and Cerner Collaborate in First Pediatric Health Information Technology Institute in the Country

Cerner enters into a seven-year agreement with Children’s National Health System to form The Bear Institute, a research organization that will focus on developing health IT innovations that lead to improvements in evidence-based pediatric care delivery.

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September 25, 2013 Headlines No Comments

Morning Headlines 9/25/13

September 24, 2013 Headlines 3 Comments

GOP senators seek one-year delay of EHR requirements

17 Republican Senators have sent a letter to HHS Secretary Kathleen Sebelius asking for a one-year delay in MU Stage 2, arguing that "this time pressure has raised questions about whether such a short period for Stage 2 is in the best long-term interest of the program. In order to achieve interoperability, it is critical that Stage 2 be as successful as possible."

Free Electronic Health Record Provider Practice Fusion Raises $70 Million In Oversubscribed Series D Funding

EHR freeware vendor Practice Fusion raises a $70 million series D investment round on a $700 million valuation. The company has found a revenue stream through monetization of its de-identified patient data. Pharmaceutical companies are primary customers and pay for weekly updates on aggregate prescribing trends.

eClinicalWorks and Epic Work Collaboratively to Make EHRs Interoperable

eClinicalWorks announces a partnership with Epic that will bring bi-directional interoperability between the two EHR systems. The interface enables cross-platform medical record matching, and then enables the exchange of problem lists, allergies, medications, discharge summaries and Continuity of Care Documents.

MyMedicalRecords Files Patent Infringement Complaint Against EHR and PHR Vendor Allscripts

MMRGlobal has filed a patent infringement lawsuit against Allscripts seeking monetary damages as well as a permanent injunction over the patient portal that Allscripts acquired from Jardogs earlier this year. The company also has a lawsuit filed directly with what remains of Jardogs.

KLAS report examines EMRs in the 1–10 physician practice segment

The small practice EHR replacement market is picking up. Cloud-based solutions like athenaHealth and Practice Fusion are picking up new customers, while GE, Allscripts, Vitera, and McKesson are seeing the bulk of the customer loss.

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September 24, 2013 Headlines 3 Comments

News 9/25/13

September 24, 2013 News 3 Comments

Top News

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


Reader Comments

9-24-2013 10-50-48 PM

9-24-2013 10-51-55 PM

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

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

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

 


HIStalk Announcements and Requests

9-24-2013 8-25-41 PM

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


Acquisitions, Funding, Business, and Stock

9-24-2013 10-11-21 PM

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

9-24-2013 10-12-33 PM

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

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

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

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


Sales

9-24-2013 10-15-55 PM

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

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

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

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

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

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

 


People

9-24-2013 9-02-35 AM

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

9-24-2013 11-28-48 AM

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

9-24-2013 11-35-20 AM

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

9-24-2013 10-30-10 PM

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


Announcements and Implementations

9-24-2013 10-19-20 PM

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

EClinicalWorks and Epic develop bidirectional interoperability between their EHRs.


Government and Politics

9-24-2013 2-46-58 PM

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


Other

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

9-24-2013 9-31-53 AM

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

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

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

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

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

 


Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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September 24, 2013 News 3 Comments

How Not To Spend $1.3 Billion: A DoD/VA Interoperability Summit Recap

September 23, 2013 News 3 Comments

Lt. Dan is a veteran who works in healthcare IT and writes the morning headlines on HIStalk and daily posts on HIStalk Connect.

9-23-2013 12-45-12 AM

“I’m asking the Department of Defense and the Department of Veterans Affairs to work together to define and build a seamless system of integration with a simple goal: when a member of the Armed Forces separates from the military, he or she will no longer have to walk paperwork from a DoD duty station to a local VA health center; their electronic records will transition along with them and remain with them forever.” – President Barack Obama April 9, 2009


Last week I attended the DoD/VA EHR Integration and Interoperability Summit. It was an insightful opportunity that offered a lot of lessons on how stubborn and narrow-minded leadership can derail even the best intended projects being worked on by a committed and talented staff. It also served as a primer on how not to spend $1.3 billion.

The conference was only two days long, promised big-name speakers, was held in Washington DC in early fall, and still drew a crowd of under 100. I was surprised. Maybe the iEHR saga isn’t as interesting to others as it is to me. Everyone in healthcare IT is understandably distracted with MU2 and ICD-10.

Still, iEHR was an important program, not only to veterans and soldiers, but to anyone working in healthcare IT. iEHR would have been the single largest integrated EHR in the world, shared jointly between the VA and DoD’s combined 209 acute care facilities. It would have supported the largest group of employed clinicians in the country, with the VA employing more nurses and clinical social workers than any other organization and ranking as one of the largest employers of physicians and PAs as well. With military personnel, qualifying veterans, and all of their families eligible for care, iEHR would have contributed to the care delivery of up to 25 percent of the nation’s population.

iEHR was a promise made to develop a modern EHR that would pull clinical data from two large and complex organizations through a single application and into a single database, a platform that would have been capable of incorporating advanced tools like population health and telehealth, all while satisfying the workflow needs of the largest employee base of clinicians in the country. The cherry on top is that it was to be coded in an open-source environment, meaning that iEHR would be free to install at any facility in the country, private or public. Sound like something that would be valuable in healthcare today?

After spending $1.3 billion pursuing this promise, the VA’s CIO and CTO resigned and the DoD announced that they would be pursuing a commercial option instead of an open source option. The plan was unofficially abandoned. Thus far, no one has stepped up with a Plan B that would delivery anything resembling the initial promise.

Fast forward six months, and to my surprise, a conference is announced featuring some relevant, and high-ranking speakers:

  •  Frank Kendall, Undersecretary of Defense for Acquisitions, responsible for issuing the DoD’s commercial RFP and running the DoD’s EHR vendor search.
  • Seong Mun president of OSEHRA, the organization responsible for programming the VA’s current VistA platform and in line to take on coding of the new iEHR platform.
  • Major Hassan Zahwa, Chief in the DoD/VA Interagency Program Office. The department is led by a DoD Director and a VA Deputy Director and is responsible for overseeing the development of iEHR and delivering on the president’s mandate for an integrated system.
  • Patrick Sullivan, Director of the Lovell Federal Healthcare Center in North Chicago, the nation’s first fully integrated DoD/VA medical facility.

Frank Kendall was the big name that everyone came to see. Unfortunately, the Friday before the conference, he cancelled. Maybe it was just a conflict of schedules, but it set an undertone at the conference that the DoD just wasn’t as invested in the project as the VA or general healthcare IT community.


9-23-2013 12-53-31 AM

Seong Mun, President of OSEHRA

Seong Mun’s presented on the work that OSEHRA is doing with VistA. He described a project being developed to standardize the VistA code set across all 151 VA facilities. A common critique of open source systems is that there are as many variations within the code as there are users of it – meaning that everyone customizes it a bit here and there and it results in a rat’s nest of code to manage and integrate at an organizational level.

Seong Mun explained that the VA is actually well into a project that is standardizing the VistA code sets installed at VA hospitals and maintaining it with a new versioning control system. When he explained this, Major Zahwa – who works in the Interagency Program Office on the iEHR program – raised his hand to clarify, asking Mun exactly what the program is and what its goals are. He was impressed with the program, as we all were, but it’s disappointing that he found out about it only now and at a public conference. This program is already well underway and the key DoD iEHR representative, a chief in the Interagency Program Office, had just found out about this plan at the same time that I had.

The DoD was supposed to evaluate both the iEHR project and the VistA alternative during the famous 30-day “We didn’t know what the hell we were doing” Chuck Hagel reset. Had they done so with any seriousness, the VistA Standardization Initiative would not have been news to someone working so closely to the core of the iEHR project. The fact that VistA is standardizing its entire code set across all VA facilities should be common knowledge among anyone holding a leadership position in the government’s Interagency Program Office.


Major Hassan Zahwa

“Lead the Departments into the future DoD/VA inter-agency electronic health record. Bridge the gap between the functional and acquisition communities though active communication and interpersonal skills.” – LinkedIn

Major Zahwa himself presented at the conference earlier in the day. He chose to focus on the value HIEs could play in the path forward, and to that end, his presentation covered the work being done in BHIE (Bi-directional Health Information Exchange).

BHIE is an old DoD/VA HIE system installed in 2004 to replace an even older VA/DoD HIE program called FHIE. The system was in place when the need for iEHR was defined and funding was approved. But to Major Zahwa’s credit, there have been significant enhancements since that time and BHIE has grown into a fairly robust exchange, facilitating one million queries every month. It’s capable of sending and receiving patient demographics, problem lists, home medication lists, allergy data, lab results, radiology reports, and consult notes. If you were looking to put a rosy shine on the level of interoperability available between DoD and VA systems, the BHIE would absolutely be your topic of choice.

At this point in the conference, it was clear that the VA and OSEHRA wanted a single, integrated EHR, and that they had been working hard and effectively to fix any perceived weaknesses in the VistA platform to eliminate DoD objections to their system. It was just as obvious that DoD wanted the freedom to buy a commercial solution and was working on a sophisticated information exchange to validate that approach as a viable long-term solution. With BHIE, the DoD was working just as hard and effectively, making significant advances that support the validity of this strategy.

It was sad that all that impressive work was being done toward two opposite ends and that these clearly very talented and task oriented teams couldn’t have aligned their goals. I suppose the silver lining to it is that no matter what happens, everyone is better of if VistA has a single code set across all the VA facilities, and everyone is also better off if the Interagency Project Office develops a robust information exchange suite that interfaces with that VistA platform. If iEHR is going commercial, as everyone seems to think it will, then both of those tools will be useful down the road. If it does not go commercial, and DoD agrees to a single VistA architecture, it will be just as useful to have versioning control for VistA and an HIE capable of pushing data out of those EHRs and into commercial systems.


Patrick Sullivan, Director of the Lovell Federal Healthcare Center

The conference closed on what was supposed to be a happy story. A shared DoD/VA hospital was opened in North Chicago and it was being held up as a model of interoperability. The hospital was used to physically examine new recruits, treat active duty sailors, and provide care to local veterans and their dependents. To the public (and in the video above) it was advertised as a true, fully integrated VA/DoD facility. Clinicians work on a mixed patient population, and an integrated EHR was necessary. It was a setting prime for a happy ending story.

Unfortunately, behind the scenes, the VA and DoD could not agree on which EHR to use, so they implemented both. Care providers now have to switch back and fourth between the two systems depending on which type of patient they are seeing. Data does not flow between the two systems much better there than it does in most other VA or DoD facilities. At the end of 2012, an Institute of Medicine report identified a laundry list of serious HER-related inefficiencies. They issued a concluding recommendation that no new joint DoD/VA hospitals be opened until an interoperable or joint EHR system was made available.

The “good news” in this story was that the IT department had created a registration routine that auto-registered the patient in both systems, saving administrators a good deal of time. They had also created a single sign-on solution that opens both EHR systems in split-screen mode, so that users could navigate and have a view of both systems in a single window. Lastly, they created a view-only display that aggregates data elements from both systems and displays it on one screen. It was not actionable data, meaning that clinicians still needed to go to the primary EHRs to place orders or document notes or take any tangible action, but it was a single location where combined data could be viewed together to tell a complete story.

The North Chicago project was a $100 million IT investment and is still operating under these conditions. When you think about that, makes it easy to understand how $1.3 billion was spent on a national iEHR program with so little to show for it.


9-23-2013 1-48-44 AM

My walkaway impression from this conference was that there does not seem to be an empowered leader running the iEHR program. Technology projects of this scale need a clear vision that stakeholders believe in and a well-established and empowered leader to bring the project to completion. There isn’t now and hasn’t ever been any one person who was given ultimately responsibility and sole authority over the iEHR program.

There are too many cooks in the kitchen. The DoD leaders ultimately fight for DoD interests while the VA leaders lobby for VA interests. In the middle, programmers at OSEHRA are trying to code an entirely new EHR with no clear direction. Someone should have been put in charge of the entire project, empowered to lead and answering only to Congress, funded independently of either organization’s budget, and with the authority to make the sweeping changes that neither organization seems willing to compromise on.

In an environment so ripe with amazing leaders, I can’t believe it would be hard to find a good candidate to properly lead this project. Someone to define the vision, unify the team, and pursue it as efficiently as they’ve pursued the standardization of the VistA code or the the expansion of the BHIE structure. At the very least, the staff at Lovell Federal Medical Center should be using one HER. That alone is something worth fighting for.

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September 23, 2013 News 3 Comments

Monday Morning Update 9/23/13

September 21, 2013 News 9 Comments

9-21-2013 6-03-19 PM

From HIS Junkie: “Re: ONC. I find it absolutely depressing that the government has created a monster bureaucracy to test and certify healthcare software and spends over $70 million a year to do that,  yet these same people cannot release one piece of software that works right from the get-go. There is an article in the Wall Street Journal entitled ‘Pricing Glitch Afflicts Rollout of Online Health Exchanges.’ Another buggy system brought to you by Uncle Sam. If that was the only  glitch, I could look past it. But consider that over the last two years ONC has issued three software systems to support the vendor certification process and all have bombed more than once. They were – POP Health, Cypress, and the Transmission Transport Test tool. They eventually killed POP Health. All were needed to pass ONC certification. Each one created major delays and resubmits for vendors, not to mention the related wasted time and costs. Amazing that a federal agency that can’t get relatively simple software right the first time is telling vendors of mission critical complex software how to build theirs. I think we need to create another federal agency to certify ONC software before we let them move to Stage 3.”

9-21-2013 6-21-51 PM

From Vandy Watch: “Re: Vandy VPIMS lawsuit. I wonder if other facilities could be at risk? According to Acuitec’s website, ‘Acuitec’s flagship products are VPIMS, an integrated clinical solution for the perioperative continuum of care, and Vigilance, a customizable remote presence monitoring solution. Our strategic relationship with Vanderbilt Medical Center (VMC) enables us to ensure our products are thoroughly tested and clinically verified.’" I wouldn’t be too worried. The government hasn’t proven their rather broad claims against VUMC and even if they really did use VPIMS to intentionally overbill Medicare, that doesn’t mean anyone else would be forced to use VPIMS in the same way. It’s unlikely that fraud was baked into the product.

From The PACS Designer: “Re: Google Glass. The Yale football team got a chance to test Google Glass in a practice game and found the experience exciting from a quarterback perspective. The Internet link could present some interesting uses in healthcare for physicians seeking to inform others of their daily wants and needs.”

9-22-2013 5-49-14 AM

Poll respondents say the most valuable part of an electronic medical records system is clinical decision support. New poll to your right: when will vendor opportunities for population health and analytics really kick in?

Listening: new from The Sadies, Canadians who offer a compelling blend of American music styles like country, surf, and psychedelia. One of the members is Travis Good, no relation as far as I know to Travis Good, MD from HIStalk Connect.

9-21-2013 4-33-20 PM

Welcome to new HIStalk Gold Sponsor AirWatch, the leader in enterprise-grade mobility and security solutions. More than 8,000 customers across the world trust AirWatch to manage their most valuable assets: their mobile devices. The company’s highly scalable solution provides an integrated, real-time view of an entire fleet of corporate, employee-owned, and shared iPads, iPhones, Androids, Toughbooks, and more. With AirWatch, healthcare IT can automate the management and tracking of all mobile assets; reduce the cost and effort of device deployments; improve the technical support experience for device users; and enable and enforce IT security and compliance policies that secure the device and its data. Thanks to AirWatch for supporting HIStalk.

Here’s a YouTube video I found on AirWatch’s mobile device management.

9-21-2013 3-52-02 PM

The local paper covers the move from Healthland to Epic of Heart of 20-bed Heart of America Medical Center (ND).

9-21-2013 5-18-49 PM

I interviewed a patient about her use of the Good to Go recorded discharge instructions system from ExperiaHealth.

The HCI Group creates an integration and testing services division, naming Scott Hassler and Mark Jackson as VPs of integration services.  Both were previously with Information Technology Architects.

ABC for Health, a Madison, WI-based nonprofit healthcare advocacy law firm, receives a $1.2 million NIH grant to develop software that determines if a patient is eligible for government health programs.


Upcoming Webinars


9-21-2013 6-01-04 PM

Speaking of Webinars, I said when I started doing them that I wanted to showcase fresh ideas, giving a voice to folks who don’t usually do conference presentations. I’m really happy that several of those Webinars will be coming your way soon. I’m certain you will enjoy the topics and the presenters. Vendor-sponsored webinars make it possible to offer these non-commercial ones where everybody can use the Webinar platform I’m already paying for. If you have a great message that needs an audience, let me know.

9-21-2013 6-02-31 PM

FDA issues a rule requiring medical devices to bear manufacturer tracking codes. FDA will used the IDs to create a publicly searchable database. The likely next steps: (a) FDA, Joint Commission, Medicare, and insurance companies require logging the ID of each device implanted, and (b) vendors of systems used in the OR or elsewhere will be pressured to make recording and recalling this information easier.

Vince finishes up his HIS-tory of Cerner this week. Next up will be McKesson, which should be interesting.


Craig Richardville on the Future

Carolinas HealthCare SVP/CIO Craig Richardville followed up his September 13 interview on HIStalk with thoughts on the future.

As you look ahead over the next several years, one thing we can count on — it will be here and gone before you know it. The boost of HITECH has made technology more than an enabler as it has become a foundational element for all future endeavors. It is the common thread that not only provides the glue within service lines and organizations, but also connects the care, the care team ,and our patients across the continuum. 

The financing challenges of healthcare requires us to be more selective in our ideas, as only the best of the best will survive, and more innovative in how we deliver care and maintain the health of our consumer. As part of the Triple Aim, a main focus is on quality and high quality will become the norm to play in the game, and the other two elements — service and pricing — will become equally dominant as the industry continues its movement towards consumerism and choice. 

Healthcare will start to take on other characteristics of other consumer industries such as retail and banking. Online services will become the routine. Consumers will access a variety of comparative sources to make decisions, the same that we do today for other personal products and services, such as Consumer Reports, Angie’s List, Google Reviews, etc. Technology will be used to transform operations to be more efficient and provide access and engagement for the consumer, wherever and whenever it is required or requested. 

The care offered will continue to travel rapidly to the patient. Self-service tools will be a necessity. We will connect to patients via mobility, instant access, and migrate monitoring for fixed devices to smartphone apps and wearable devices. We will go to the patient, wherever they are and whenever they need us — the workplace, the home, across state boundaries, and while in motion. We will see competitive communities becoming connected and unifying for the benefit and health of the patient and of our populations.

Historically competitive organizations will start to share data and collaborate to ensure that we are reducing duplication and providing all information necessary to treat the patient. We will not compete on data, but rather on how we use the data. Predictors and analytics will be a core competency and those who get their first, will have a small advantage as others will get there as well, and then we will need to quickly move to the next prospect. 

Expectations will continue to rise and new innovations discovered and the ability to be agile and collaborative will create a competitive advantage. Look to the use of data, ensuring privacy and security, development of new evidence, analytics, genomics and be prepared for the next unknown and seize the opportunity not to compete on transactional data, but predicting and engaging. 

There is not a day that goes by that new opportunities to optimize and advance arise, times will be challenging, and also very opportunistic. The best of times are ahead for all of us, especially our patients.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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September 21, 2013 News 9 Comments

Time Capsule: A Day in the Life of IT-Visionary Hospital VPs: Laying Out CPOE Benefits to Luddite Doctors

September 20, 2013 Time Capsule 3 Comments

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

I wrote this piece in July 2009.

A Day in the Life of IT-Visionary Hospital VPs: Laying Out CPOE Benefits to Luddite Doctors
By Mr. HIStalk

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Doctors are such whiners when it comes to computers. Everyone can see that. Resisting the use of CPOE and EMRs is just silly in this day and age where everything is done on computers.

This recently came to a head at my hospital. The CEO got a voice mail from a peer at St. Roxy Hospital, left on his desk by his executive assistant, who transcribes all of his messages.

St. Roxy was mandating CPOE, he read, underlining the word “mandatory” since it was important. Doctors need to do all their work on computers instead of the paper chart. There were too many errors and too little opportunity to oversee their work by monitoring electronic databases.

My CEO responded decisively, leaving his executive assistant a Post-It note on her monitor right beside the one holding her current password, asking her to schedule a meeting with all his VPs about CPOE. She was asked to prepare a relevant PowerPoint presentation and attend the meeting to run the laptop.

The executive assistant e-mailed all the VPs to ask them when they would be free for an hour in the next two weeks. It took a week to get all their replies since some were out of town and hadn’t set their vacation alerts.

One was late in responding because her top-of-the-line hospital laptop had failed after her teenaged son had used it for several consecutive hours of doing Internet research for a school project in his locked room, necessitating a call to the VP-only IT support hotline so that a technician could be dispatched to her house on a Friday evening.

Once the meeting finally occurred, everyone agreed that it was time to take a hard line with CPOE-resistant doctors. The marketing VP took minutes, asking to have someone type them up because he doesn’t have a PC in his office since it clashes with his executive furniture.

The CPOE software vendor was the problem, the COO decided. He had his assistant arrange a Webex with the vendor after having her call the CIO to find out what vendor had provided the $20 million system. It started late because several of the VPs needed personal help getting connected. Once on, the vendor’s sales VP apologized that he would be not be able to see the PowerPoint because he was on the road, where he doesn’t like carrying a laptop.

The solution, it was decided, involved tablet PCs and speech recognition software. The CIO had never used either, but recommended that the CEO order some of both for doctors to try. Since the CEO was running late for his 5:30 tennis match, he asked his executive assistant to get on “The Google” and order some copies. She asked if it was OK to work an hour of overtime to get it done since she was responding to a Wackovea request to send in her account’s user name and password to avoid having access to her checking account frozen. He agreed, telling her to draw up a check request and leave it in his inbox to sign.

The CIO was tasked with putting some kind of graph on the executive dashboard to monitor the progress. He wasn’t too worried about it since executives rarely looked there anyway. He had asked them whether they found the Intranet useful, but all the VPs replied that as leaders, they relied on instinct and their skills at understanding people to make decisions rather than graphs.

Everyone felt good about the progress that had been made in helping doctors understand their vision of shifting their income-earning patient care activities to computers. So good, in fact, that the CEO decided to publish his thoughts on CPOE to his widely read blog, which will happen just as soon as his executive intern finds the time to write something up for him.

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September 20, 2013 Time Capsule 3 Comments

News 9/20/13

September 19, 2013 News 12 Comments

Top News

 

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


Reader Comments

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

9-19-2013 6-42-43 PM

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

9-19-2013 6-51-57 PM

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

9-19-2013 7-02-35 PM

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

 


HIStalk Announcements and Requests

9-19-2013 12-02-32 PM

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

9-19-2013 5-49-04 PM

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

9-19-2013 5-58-56 PM

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

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

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


HIStalk Webinars

9-19-2013 6-26-20 PM

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

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


Acquisitions, Funding, Business, and Stock

9-19-2013 4-05-53 PM

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

9-19-2013 8-45-00 PM

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

9-19-2013 6-21-15 PM

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


Sales

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

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

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

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

9-19-2013 9-00-19 PM

Self Regional Healthcare (SC) selects McKesson Paragon .

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

9-19-2013 9-01-28 PM

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


People

9-19-2013 4-20-31 PM

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

9-19-2013 4-31-22 PM

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

9-19-2013 7-31-25 PM

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

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

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

 


Announcements and Implementations

Fairfield Memorial Hospital (SC) goes live on Cerner.

9-19-2013 9-03-45 PM

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

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


Government and Politics

9-19-2013 7-32-34 AM

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

9-19-2013 10-14-53 AM

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

9-19-2013 10-45-36 AM

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

Here’s a new ONC video on interoperability.


Other

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

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

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

9-19-2013 6-55-36 PM

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

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

9-19-2013 7-25-27 PM

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

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

9-19-2013 8-27-04 PM

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


Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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

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

What do you think about Calico? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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September 19, 2013 News 12 Comments

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