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

August 6, 2012 Interviews 3 Comments

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

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Tell me about yourself and the company.

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

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

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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

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

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

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

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


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

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

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

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


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

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


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

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

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

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


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

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

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

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


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

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

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

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8-5-2012 1-22-10 PM

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


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

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

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August 6, 2012 Interviews 3 Comments

News 8/3/12

August 2, 2012 News 7 Comments

Top News

Even though the Stage 2 MU final rule has yet to be published, the HIT Policy Committee MU Workgroup releases its preliminary draft recommendations for Stage 3 MU. Among them:

  • Threshold requirements are higher in several areas, including the percentage of EP prescriptions sent electronically (50%), percentage of hospital discharge medications sent electronically (30%), percentage of lab results that must be stored in the EHR as structured data (80%), and percentage of patients using secure messaging communications with providers (15%).
  • More clinical support interventions are required (15 related to five or more clinical quality measures).
  • New EHR certification standards, including requirements that EHRs maintain up-to-date and accurate problem and medication lists.
  • Increased emphasis on patient and family engagement, including requirements to provide patients an option to submit data online and to offer additional patient education material in languages other than English.
  • Expanded requirements to improve care coordination and population and patient health.

Reader Comments

8-2-2012 10-40-06 PM

From Hilltopper: “Re: AHA Solutions endorsement. Two years we (naively) responded to an AHA RFP to become an endorsed solution provider for a specific category of consulting services. We were down-selected, went to Chicago for a presentation, and were eventually named their vendor of choice for the prescribed consulting services. We then found out they wanted way in excess of six figures for their endorsement (advertising, promotion over a three-year period) and a percentage of new business, we declined. What a waste of time, and it was not disclosed earlier in the process.”

From Benny Hanna: “Re: MUMPS. It’s ugly and I despise it, but like XML, DB2, or NoSQL, it works. If you index properly (or at all) and your storage is fast, the database will perform. The biggest news around MUMPS was your item about Dell/Epic to allow virtualization of their servers, both application and database. Now you can throw a whole farm of processing and storage power behind that old flat file database.”

From Lovelietuva: “Re: Adventist Health System vs. Moleski. The pre-trial hearing is October 8, 2012 at the Orange County Courthouse in Orlando. AHS is the Goliath that owns the Orange County justices.” This is the “Death by Deletion” former Adventist Health System risk manager and whistleblower who claims she was ordered to deleted electronic patient information to cover up errors and who also says AHS’s Cerner system caused incidents of patient harm. She should definitely press for a change of venue.

From BlueDog: “Re: Community Health Systems contractors. The rumor is true, although the number seems high. I know that they sacked roughly 80 contractors working on Allscripts Enterprise EHR projects and scaled back a lot on Allscripts and athenaclinicals implementations. All eyes within CHS IT are on an Oklahoma City Allscripts Enterprise EHR implementation that begins in five days.” Unverified.

HIStalk Announcements and Requests

8-2-2012 3-32-29 PM

inga_small I’ve been struggling with badminton today. I admit there probably has been a time or two I intentionally threw a gutter ball while bowling in order to commence happy hour, and I do recall a certain strip poker game in college. But intentionally losing at the Olympics makes no sense to me. Maybe my real issue is that I dislike badminton since it conjures images of sixth grade PE and those horrible one-piece uniforms we had to wear. Speaking of images, if you haven’t seen one of US rower (and Wilhelmina model) Giuseppe Lanzone, he’s worth a Google.

inga_small HIStalk Practice highlights from the last week: as mentioned below, a few observations  from the just announced Stage 3 MU draft recommendations. Medicare and Medicaid issue $6 billion in MU payments through the end of June. Dr. Gregg whines about his unread EMR prose. My thoughts on why some crunching of MU attestation numbers may be meaningless. The ONC says the TOC is higher for a SaaS EHR than an in-office solution. I’ll keep it simple this week: go to HIStalk Practice, read good stuff, and sign up for e-mail updates. Thanks for reading.

Listening: new Rush, thanks to reader Mark, who tipped me off that Amazon is running it as a $0.99 full-album download.

Acquisitions, Funding, Business, and Stock

8-2-2012 10-31-30 PM

Visage Imaging signs a definitive agreement completing the sale of its Amira Division to Visualization Sciences Group for $15 million.

8-2-2012 10-32-02 PM

Quality Systems, Inc. continues its public spat with big shareholder and director Ahmed Hussein, who has nominated his own slate of directors to be considered at the upcoming shareholder meeting. Management says he’s trying to take the company over without paying a premium via a proxy fight and hasn’t made a convincing case that his nominees would enhance shareholder value, also calling out the company’s historically successful (until recently) share value growth, its sales opportunities, and its opportunity to focus on revenue cycle management. They also say Hussein has violated the company’s insider trader policy by pledging all of his company shares as collateral for margin accounts, requiring him to liquidate 2.24% of the company’s shares and further driving share price down. They also comment that his track record in creating value for his other businesses is poor. His press release says as a board member, he’s never heard anything about the strategies the company says they’ll follow and that his gripes aren’t with management, but rather with the current board.

8-2-2012 10-32-44 PM

MedAssets reports Q2 results: revenue up 11%, adjusted EPS $0.28 vs. $0.23, beating consensus estimates of $0.22. Shares jumped 20% Thursday on the news.

8-2-2012 10-33-12 PM

Vocera reports Q2 numbers: revenue up 30%, non-GAAP EPS of $0.09 vs. $0.00, beating expectations of $0.01 and raising guidance. 


The Purdue REC will use SA Ignite’s MU Assistant for client MU reporting.

Franciscan Alliance chooses Merge Healthcare’s iConnect Access to image-enable its EMR.


8-2-2012 3-38-15 PM 8-2-2012 3-38-42 PM 8-2-2012 3-39-11 PM

AirStrip Technologies hires Lori Jones (McKesson) as chief commercialization officer, Matthew Patterson MD (McKinsey) as SVP of business transformation, and Rudy Watkins (GE Healthcare) as SVP of business development.

8-2-2012 4-18-51 PM

NexJ Systems appoints former SAP North America president Robert Courteau to its board.

8-2-2012 4-27-31 PM

Cumberland Consulting Group promotes Amy Meiners from principal to partner.

8-2-2012 5-10-22 PM

Kelley Schudy, group SVP at Allscripts, announces that he’s leaving the company.

8-2-2012 9-51-57 PM

Baptist Memorial Health Care (TN) promotes chief nursing officer Beverly Jordan to VP/chief clinical transformation officer, leading its Epic implementation.

Precsyse appoints former IDX CEO James H. Crook, Jr. to its advisory council.

Announcements and Implementations

St. Francis Medical Center (CA) goes live with electronic medical records from QuadraMed, including medical device integration using iSirona.

Government and Politics

Medicare’s fraud unit opens a $3.6 million command center in Baltimore that includes a giant video screen that two Republican Senators are labeling a boondoggle, saying that the fraud unit is not implementing common sense recommendations in claiming that they are understaffed. The unit’s computer system went live last summer, but by Christmas had only stopped one suspicious payment totaling $7,600.


Providers are concerned about vendor training and readiness for hybrid OR suites when selecting interventional systems, according to KLAS. Toshiba earned top scores for overall satisfaction, though Siemens had the greatest market penetration.

8-2-2012 10-35-18 PM

About 50 unionized transcriptionists at The Ottawa Hospital (CN) complain about losing their jobs to Dragon Voice Dictation, trying to get doctors on their side by sending them a Christmas card saying they were being let go and including an instruction book for Dragon. According to the union’s spokesperson, “Not only was technological change implemented without any canvassing of staff, but an interesting fact is that at the end of a transcription, the voice recognition software adds a disclaimer stating that the document ‘may contain errors.’ There has got to be a better solution, especially when it comes to patients’ health.”

Olympus, fresh off accounting fraud problems, informs the Department of Justice that its physician training program in Brazil may have violated the Foreign Corrupt Practices Act. The company says that DOJ was already asking questions, potentially indicating that Olympus and perhaps other companies were being investigated following DOJ’s multi-million settlements with Biomet and Smith & Nephew over bribing foreign doctors to use their medical devices.

8-2-2012 9-41-28 PM

The TV program “In Focus with Martin Sheen’” will cover electronic medical records in a series of reports. The show doesn’t say it’s a paid infomercial that runs between PBS programs, but it seems like that might be the case.

8-2-2012 10-37-36 PM

In Canada, patients at St. Joseph’s General Hospital have been without TV since mid-May after Healthcare Resource Group shut down its prototype touchpad-driven bedside entertainment system. The company restructured and found that its server licenses from Microsoft, Adobe, and Dell had been illegally registered under the name of their former CTO. The hospital says HRG missed their final deadline to sort out their problems and will be replaced.

8-2-2012 10-03-19 PM

Strange: a blind Native American man files suit against a hospital, several doctors, and others, claiming he’s the victim of a racial hate crime because his non-blind friends are telling him that scars from his emergency stomach surgery kind of look like the letters KKK.

Also odd: the family of a deceased man files a $2 million lawsuit against a New York medical school, claiming the school humiliated them by declining to accept the man’s donated body as a medical cadaver because he was too heavy.

Sponsor Updates

  • TELUS Health Solutions and Sun Life launch an eClaims solutions for extended healthcare providers in Atlantic Canada.
  • BridgeHead Software and the European Centre of Expertise for the Health Care Industry EEIG partner to provide a cloud-based archiving solution for European hospitals.
  • Lippincott Williams & Wilkins, part of Wolters Kluwer Health, launches an EHR learning tool to prepare nurses for new practice requirements.
  • GE Healthcare IT reports that its customers have received more than $100 million in MU incentive payments since the program’s inception.
  • CommVault and Fujitsu expand their partnership to offer an integrated solution with Fujitsu’s ETERNUS DX storage arrays powered by CommVault Simpana 9 software.
  • Kareo CEO Dan Rodrigues advises physicians on the use of technology to thrive in business.

EPtalk by Dr. Jayne


HIMSS issues its call for proposals for the HIT X.0: Beyond the Edge “conference within a conference” at HIMSS13. No, that’s not a mistake in the link – it’s a HIMSS12 link. If they can get their act together, they will accept proposals from August 1-31. I’m pretty burned out on HIMSS between the annoying mailbox clutter and the feeling that they’re not really doing anything new or different these days. But I am looking forward to getting my New Orleans on, whether I actually attend the meeting or not.

Northwestern Memorial Hospital’s Home Hospice office was burgled last week, resulting in the theft of laptops and tablets. Supposedly their security controls were suspended because they were receiving upgrades. They are offering credit monitoring services to affected patients. Luckily the authorities do not suspect that PHI was specifically a target of the theft. That’s a good thing, because I can’t imagine anything more pathetic someone preying on hospice patients.

In a reminder that they’re not just a software company, McKesson is ordered to pay $151 million in a legal settlement involving related to Medicaid drug price inflation. Although New York State Attorney General Eric Schneiderman issued a statement that, “This settlement holds McKesson accountable for attempting to make millions of dollars in illegal profits,” the company denies price manipulation or illegal activity.


News outlets continue to report that there will not be enough physicians to meet the country’s health care needs in coming decades. I don’t disagree, yet I don’t see people dangling money in front of me to convince me to return to traditional primary care practice. I’m not hopeful for the next generation, either. A high school student I have been mentoring decided that he wouldn’t be meeting with me any longer because he had decided on a new career path. His choice: game warden.

I’m a sucker for technology stories of all kinds, so I was interested to hear today about a Dark Matter detector in a former gold mine in South Dakota. Here’s to unlocking more mysteries of the universe right in our back yard.

No, it’s not Las Vegas: Cerner partners with the town of Nevada, Missouri (pronounced Ne-VAY-da) to reduce costs and improve care. The project will involve health education via the local school district, construction of sidewalks and bike lanes, and digitizing health records at Nevada Regional Medical Center.

As the world comes together at the Olympic Games, I am reminded of the vast disparities still present in world healthcare with two sad stories from Uganda. Ebola virus is causing an outbreak of hemorrhagic fever, and this is on top of a mysterious illness called nodding syndrome that has killed more than 300 children and neurologically devastated more than 3,000. Even with all the negative things about our healthcare system, we should be reminded of how lucky we really are.



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

More news: HIStalk Practice, HIStalk Mobile.

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August 2, 2012 News 7 Comments

News 8/1/12

July 31, 2012 News 15 Comments

Top News

7-31-2012 9-55-13 PM

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

Reader Comments

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

7-31-2012 6-44-11 PM

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

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

7-31-2012 9-57-01 PM

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

7-31-2012 10-00-14 PM

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

7-31-2012 10-01-30 PM

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

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

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

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

HIStalk Announcements and Requests

7-31-2012 9-34-41 PM

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

7-31-2012 10-03-51 PM

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

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

Acquisitions, Funding, Business, and Stock

7-31-2012 10-04-53 PM

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

7-31-2012 10-05-36 PM

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


7-31-2012 10-08-02 PM

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

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

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


7-31-2012 5-41-41 PM

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

7-31-2012 5-44-37 PM

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

Announcements and Implementations

7-31-2012 10-09-46 PM

Yavapai Regional Medical Center (AZ) implements Cerner.

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

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

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

7-31-2012 10-10-57 PM

Jacksonville Medical Center (AL) goes live on CPSI.

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

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

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


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

7-31-2012 10-15-08 PM

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


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

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

7-31-2012 9-43-15 PM

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

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

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

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

Sponsor Updates

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


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

More news: HIStalk Practice, HIStalk Mobile.

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July 31, 2012 News 15 Comments

Curbside Consult with Dr. Jayne 7/30/12

July 30, 2012 Dr. Jayne 1 Comment

This is the final piece in my series about vendors using physicians and other clinical experts in design, implementation, and support. I heard back from a few individual physicians working for vendors who asked not to be named. I’ve paraphrased their responses as well to give them a little more anonymity.

Miriam works for a top-tier ambulatory vendor. Although she does primarily go-live support and physician-to-physician training, she also works with content designers on specific specialty-related projects. Although there are a large number of physicians in her company, she thinks that the physicians are underutilized in the development process.

I would like to be involved more upstream in the development cycle. Since we’re in the field so much, we know better than the development teams as far as how the users work.

She notes a high degree of physician turnover due to the 75% travel schedule her company requires.

Jae is an internal medicine physician working as a consulting firm subcontractor. Although he would like to work for the vendor directly, he previously worked for a client and an anti-poaching agreement prevents him from being hired. He was involved in what sounds like a fairly messy practice breakup and the remaining partners would not give him a release, so he’s spending a year in what he calls “independent contractor limbo.” Although he does the same type of work as other physicians employed by the EHR vendor, his services are passed through the consulting firm to avoid actual employment.

I do a lot of liaison work with sales prospects, especially sales demos since I still do some locum work and can say I am a practicing physician. I can also technically say I’m not on the company payroll, although I’m not crazy about how the sales team sometimes plays that. The contractor thing isn’t all bad, though. I probably make about the same salary as the employed physicians once you figure the difference in hourly wage vs. paying for my own benefits, but I probably have a lot more control over my schedule this way. I don’t think I have as much influence in development, though.

There’s more to his very interesting story, and I must say I admire the vendor’s way of intentionally working around their no-hire agreement. Given the recent reader comments about a certain vendor’s no-hire agreements, it’s interesting to see it work the other way.

I’ve been saving this early submission for a strong finish. Dr. Ryan Secan of HIStalk sponsor MedAptus sent information about his work as chief medical officer, including an action photo.

I share many of your concerns about medical software, as I’ve often noted that the applications I’ve needed to use don’t seem to have had any input at all from a practicing clinician and are not designed with my workflow in mind. This is why I joined up with MedAptus last year. It was chance to help create software for physicians from the point of view of a practicing clinician. While my role at MedAptus includes participation in the sales process and acting as a liaison with client physicians, I also have an integral role in the design process. I understand physician needs for clean, simple, and intuitive interfaces that facilitate their work rather than hamper it. At MedAptus, we believe that our software should fit itself into physician workflow rather than forcing physicians to change their workflow to match the software. This has been particularly important as we prepare for ICD-10 implementation and the sheer volume of codes threatens to overwhelm the provider. Leveraging my clinical experience has allowed us to continue to put out a product that remains easy for clinicians to use despite the increasing complexities of medical billing and coding.


The above photo is me with James Scott, who is the vice president of engineering at MedAptus. James and I meet regularly to discuss feature enhancements, usability design, and navigation. This was taken during a meeting in which we were reviewing changes to the physician interface of our professional charge capture application to support end-user ICD-10 code searching and selection.

There were a few respondents who said they were going to obtain permission to send something but then never got back with me, so I assume the marketing and communications gatekeepers were not big fans of the idea. Or maybe, like my experience last week, they were pulled to work a double shift at the hospital. If they ever make it through the PR gauntlet, I’ll be happy to run their pieces.


E-mail Dr. Jayne.

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July 30, 2012 Dr. Jayne 1 Comment

Monday Morning Update 7/30/12

July 28, 2012 News 27 Comments

7-28-2012 9-23-13 AM

From Meaningful Juice: “Re: GAO report from last week. Of 4,855 eligible hospitals, 776 were awarded eligible $$$ juice for 2011. Phew – my tax dollars are not being wasted!” Among the GAO’s recommendations was that CMS needs to beef up its scrutiny of whether providers really were eligible to get their payouts.

7-28-2012 3-12-03 PM

From Dave: “Re: Michael Stearns, before being fired as e-MDs CEO. See this document.” This is old news that has been mentioned here before. The Maryland State Board of Physician Quality Assurance suspended the medical license of Dr. Stearns in 1997 after he pleaded guilty to four counts of assault and battery in a US Navy court-martial case in which four female patients claimed “inappropriate sexual touching” during his examinations of them. David Winn, who as e-MDS board chair fired and replaced Stearns as CEO on July 2, defended him in this 2011 write-up, saying that Stearns was never convicted of a felony and was perhaps misled by poor legal counsel in a Tailhook-sensitive environment and inconsistent behavior by the Maryland board after the fact. Mike Stearns says he will address this and other issues in an HIStalk Readers Write article in a couple of days. He hasn’t said that he’s suing his former employer even though he claims the allegations behind his termination are meritless, but one might assume that’s his only remaining option. I’ve heard from several folks who extolled the character and capabilities of both Dr. Stearns and Dr. Winn, so hopefully they will avoid the public debate, reach some kind of agreement, and move on without further embarrassment.

From Happily Hosted I Hope: “Re: host environment performance. Do any of your readers have language around system performance and high availability in a hosted environment that they could share? We’re going to be installing an EMR through a hosting arrangement with a local hospital and I’m looking for advice.” Given the high-profile downtimes that have come up recently, I think it’s a great topic to address. If you’ve put terms and conditions into a contract with an EMR hosting provider and would care to share details, please send them my way. I won’t mention either client or vendor and will strip out anything identifiable, so your non-disclosure terms are safe.

7-28-2012 2-09-17 PM

From EHR Warrior: “Re: NextEHR. Looks like it’s finally dead as the company that bought the intellectual property changed its name to iPenMD.”

From ITKnowsTheScoop: “Re: [vendor name omitted.] Under FDA review regarding surgery and anesthesia solutions. They had to remove or reclassify features, which halted sales for four months.” Unverified, so I’ve omitted the company’s name.

From IT Director: “Re: Cerner. I have an unfortunate trove of horrid experiences related to extended planned or unplanned service interruptions, some of them due to a shoddy corporate implementation of Cerner Millennium. Our implementation spanned time zones, so we had a six-hour downtime twice a year when Daylight Saving Time changed. We has spectacular outages where the entire hospital system went dark with no local backup whatsoever. The corporate implementation was insistent on a paperless workflow, so we weren’t even allowed to print periodic paper backup copies of order synopses or MAR summaries. During our first major downtime, a little girl was left in writhing pain for most of the night because the house officer didn’t know the timing and dose of her pain meds. This downtime was rumored to have been caused by a profound error in hardware sizing, but poor database design didn’t scale well even with additional hardware. I don’t blame Cerner as their staff were truly engaged and helpful, but rather a centrally managed health system corporate mentality of arrogance and ignorance that discounted the local reality and specialized workflows. Perhaps the morale of the story is simply that any given implementation is only as good as its implementation team. If they’re evil, then the implementation will be similarly evil. In some ways, Cerner as much as a victim as the hospitals of setting poor implementation leadership.” Your experience matches mine. Unless every vendor’s implementation has been a disaster, it can’t be their fault alone (i.e., one successful comparable client means the stuff basically works). The main problems usually involve: (a) lack of customer technical and implementation resources; (b) poorly developed, self-deceiving project budgets that don’t support enough headcount, training, and hardware to get the job done right; (c) letting IT run the project instead of getting users involved, which is especially problematic if the corporate IT people are clueless; (d) unreasonable and inflexible timelines as everybody wants to see something light quickly up after spending millions; and (e) expecting that just implementing new software means clearing away all the bad decisions (and indecisions) of the past and forcing a fresh corporate agenda on users and physicians, with the vendor being the convenient whipping boy for any complaints about ambitious and sometimes oppressive changes that the culture just can’t support. I might also mention sloppy contracting on the client’s side, since I’ve seen hundreds of contracts and am often amazed that the interests of the vendor weren’t legally aligned with those of their customer via a few standard terms and conditions.

From Commando: “Re: Cerner. Cerner has two electronic downtime solutions for remote hosted clients. The read-only methodology referred to requires the user to be able to log into the system back in KC, which wouldn’t be possible with the DNS servers out of business. There is another level of downtime service – something I guess his/her organization decided not to purchase. That next level dumps patient information to local computers (at our hospitals, at least one on each floor) at regularly scheduled intervals. i.e. updated every 5 minutes. That way, even if all connection with KC is lost, staff has information (including meds, labs and more) locally on each floor which is accurate up to the time of the last update. Finally, since this outage was due to a DNS problem, anyone logged into the system at the time it went down was able to stay logged in. This allowed many floors to continue to access the production system even while most of the terminals couldn’t connect.” Assuming this is an accurate description of the available options with Cerner hosting, it might be a good time to check out the local caching option. That would be protection against even internal network problems, which in a lot of hospitals is not uncommon. I recall that Kaiser uses that with good success for its Epic/HealthConnect system that’s deployed regionally. You could probably create a poor man’s solution by running specific reports (MAR, active orders, recent lab results, etc.) to a PDF file and dropping them in specific folder locations on a frequent schedule, like maybe once an hour.

7-28-2012 4-50-48 PM

From West Coast: “Re: John Muir Health. Hires a CIO.” The internal memo sent my way indicates that Jim Wesley has been announced as SVP/CIO of John Muir Health. He was most recently a consultant, but has healthcare CIO experience. John Muir’s hot button is getting Epic up and running.

From Maryann: “Re: Epic. I work directly for a hospital that is implementing several Epic modules over the next 5-7 years. I have two Epic certifications. I applied to several consulting companies and each one told me that they couldn’t hire me if my hospital was in the middle of an Epic implementation because of an agreement with Epic. Is this legal? How long to I have to wait if I leave my hospital before a consulting company will hire me?” Welcome to the murky world of Epic non-competes and recruitment restrictions. Epic controls your opportunities with potential employers via separate agreements and/or implied punishment for poaching Epic-certified people. Is their practice legal and binding? Almost certainly not, but you’d need a lot of lawyer money to find out, and by the time you got a ruling, you could have just sat out your time as an untouchable by working in a non-Epic role somewhere (I think it’s a two-year timeout, but it may just be a year … I seem to remember there was discussion about changing it.) Epic’s practices are designed specifically to thwart exactly what you want to do – use your short-term Epic experience and certification to bail out on your employer and cash in with a consulting firm. Even if you had the financial resources and extended timeline needed to mount a legal challenge, there’s still no guarantee that you’ll get hired, because legal or not, nobody wants to cross Judy for fear of choking their own particular gold egg-laying goose. Not to add more rain on your parade, I’m not sure you can even easily move to another Epic hospital, but I’ll let those who have first-hand experience explain how all of this works.

From The PACS Designer: “Re: waterproof accessories. If you want to limit infection from entry devices, there’s now a solution from Seal Shield. They feature waterproof keyboards and other computer input devices that are easily washable and ready for reuse, thus reducing the spread of infections that could come from multiple users of those devices.” I’ll say this – they make a fantastic commercial. You can waterproof your iPad for $30 or your iPhone for $20.

7-28-2012 3-53-48 PM

Welcome to new HIStalk Platinum Sponsor M*Modal. The company’s cloud-based Speech Understanding solutions that are used by 2,400 customers include Fluency (converts physician’s narrative into electronic documentation that can be integrated into workflows, in effect speech-enabling EHRs); Catalyst (retrieving information from unstructured encounter documentation, with the first in a series of tailored versions being Quality and Radiology); and SpeechQ (dictation capture for radiology). The company also offers transcription services via its 10,000 transcriptionists (it’s the largest in the US) as well as coding services for clients struggling with Discharged Not Final Billed accounts and the possibility of negative audit findings. We know from recent headlines that M*Modal is a very successful company since arguments have been made that JP Morgan is getting too good of a deal in acquiring it for $1.1 billion, so that’s a nice debate to be having. Thanks to M*Modal for supporting my work.



Here’s an M*Modal video I found on YouTube.

Listening: new from Citizen Cope, which is primarily singer-songwriter Clarence Greenwood. A uniquely American mix of soul, blues, and roots music. Eric Clapton is a fan.

TPD has updated his list of iPhone apps.

I have zero interest in the sprawling commercial spectacle of the Olympics for a variety of reasons (athletes itching to bag endorsement deals the day the flame and their short-lived fame are simultaneously extinguished, smug US cheerleading, glorification of photogenic participants and sports to the exclusion of most of the others, participation of state-sponsored and chemically altered participants and richly compensated professionals like LeBron James that make a joke of the phony, feel-good “amateur” aspect) so I won’t have anything to add to the already smothering media coverage that I won’t be following (except for articles involving widespread Olympic Village debauchery.) Inga bah-humbugged me and says she’ll pipe in with anything HIT-related (like the frequent GE commercials she’s already mentioned to me), so we’ll count on her to make it interesting.

Speaking of Inga’s Olympics chime-in, she sent this newspaper article criticizing the UK’s NHS promoting itself to a worldwide audience just after several high-profile incidents of patient harm that occurred under its supervision:

Sitting in a home somewhere while fireworks lit up the Olympics opening ceremony would have been the family of Kane Gorny. They watched their cherished teenage son die of thirst at the hands of incompetent doctors and nurses … The letters ‘NHS’ dazzled in bright red like some triumphant advert. All around these pranced self-indulgent nurses who had volunteered to take a few days off to be part of the ceremony … That such a politically divisive subject was included at all is utterly shocking. Not least because it glossed over the cracks in a system that is creaking at its seems crying out for urgent reform.

And speaking of NHS, it apologizes to the family of a 76-year-old hospitalized cardiac patient who died right after her son discovered three workers drilling holes in the ceiling above her head to install a patient entertainment system.

7-28-2012 9-01-39 AM

Readers say the future of public HIEs is bright, at least if you count dying a screaming death in a giant nuclear fireball of failure as bright. New poll to your right: in which HIT-related company would you invest $100K today? (assuming you have to choose one).

7-28-2012 5-02-52 PM

Defense Secretary Leon Panetta disappoints a House committee by advising them that integration of the respective electronic medical records systems of the DoD and VA (AHLTA and VistA) won’t be finished until at least 2017, and he didn’t even sound confident about that date. VA Secretary Eric Shinseki observed that simply reaching DoD-VA consensus on a open architecture system was quite an accomplishment given previous discussions with “a proprietary contractor.” Rep. Bill Johnson (R-OH) wasn’t happy with that answer: “I understand that you can’t account for the last 10 years, Mr. Secretary. And I understand that you’ve got two bureaucracies that don’t necessarily like to be told what to do and (don’t) get along all the time. But I will submit to you that another five years is unacceptable (and) ought to be unacceptable to you.”

HIE Networks and Hillsborough County Medical Association (FL) announce their collaboration to deploy a county HIE. HIE Networks operates the Florida Health Data Network.

Some quotes I highlighted from the McKesson earnings call:

  • The clinical conversions — when we talked about our Horizon to Paragon strategy, we talked about the fact that we believe it is a viable solution for our customers, and that over time they need to evaluate that as an alternative because of its more tightly integrated infrastructure and its lower cost of operations … we’ve seen many of our Horizon base evaluate the products. We’ve seen some of that base already contract to move to Paragon, and some already have moved because of whatever remaining development is necessary and Paragon was not of import to those customers. Others have said, you know what, we’re going to go, but we want you to build out another module or we’re going to go after we get our Meaningful Use dollars settled.
  • We are really pleased with our position in RelayHealth. I have to admit that the e-prescribing portion of the market’s transition is not a particular profit driver for us. We’re in that transaction both in our electronic medical record businesses as well as in Relay. But that’s not really where the opportunity lies. The opportunity lies in the continued build out of our financial systems.
  • And if it’s a surprise to anyone that clinical buying is beginning to wane, they must not be deep in the industry. We believe that our customers have largely made their clinical decisions … We’re in the implementation phase now. Actually if you look at our results under the cover, you actually will see that our hospital buyers are beginning to come back to purchasing other solutions beyond clinicals. And I think those companies that don’t have a portfolio beyond clinicals are probably feeling the effect of a pipeline that is probably headed in a different direction.

Some quotes I highlighted from the Cerner earnings call:

  • While there is one competitor that remains a challenge, our competitive position against them continues to strengthen. At the same time, their weaknesses are becoming more known in the marketplace. As we’ve discussed, our significant improvements to our physician solutions and the workflow is neutralizing one of the primary areas they used to compete. And we believe the capabilities we are rolling out in Millenium+ and PowerChart+Touch surpass their capabilities. In addition, our investments in our operability, data analytics and population health management are becoming an increasingly important differentiator against them as their platforms make interoperability and data analytics very challenging. We also believe they will face an inevitable upgrade from their MUMPS-based platform that is needed to catch up in these areas, and this will be very disruptive and expensive.
  • Currently, approximately 45% of our core hospital clients have attested for Stage 1 Meaningful Use, and we expect approximately 85% of them to have attested for Stage 1 by the end of the year.
  • As background, our experience with data and analytics dates back to 1996 when we started Health Facts, which is a research database that now has over 150 million patient encounters and nearly 2 billion lab results. While in the past this data has largely been used to support pharma and biotech research, our server map organization is now using it along with published evidence to accelerate the development of predictive clinical agents.
  • But we clearly have a significant amount of cash on the balance sheet. We think we are in a situation in kind of part of the market that there could be some interesting opportunities for us to deploy that cash in a way that could be — either supportive of Millennium, get us more quickly into some of the new businesses that we’re looking at. I think, relative to the existing traditional HIT market, the window is getting very close to being closed for that being interesting to us. So I think the status of many of those competitors are a little bit on the downhill side of the hill.
  • I think probably the one country that’s got a lot of demand is going to really be — just a funding issue — is the UK. As more and more of those trusts are becoming foundation trusts, which means they control their capital outlet — outlay as opposed to the government putting the dollars out there, we think that’s going to turn into a more normalized US- type market where each trust is going to go out to the market and look to acquire technology. In 2015, the current NHS contracts expire. So almost all of those trusts are going to be looking in the market in some form or fashion, probably depending on their access to capital.
  • The RFP volume, I’d attribute a lot to the failures of many of our competitors to be ready for the changing landscape. And so they’re in the midst of either — they’ve done acquisitions and they’re trying to put things together, they’re trying to move to new platforms, they’re sunsetting existing platforms, they are on old technology. And those types of things, as people look to what the future is, they know that they have to have data liquidity, their systems have to be interoperable, and they’re going to need that data no matter where the person is in the entire care cycle, inclusive of the home … the recognition that Cerner can do that work, that their current providers can’t do that work.

Vince’s HIS-tory continues with the story of Keane and its Threshold product that could run on any hardware vendor’s UNIX platform.

E-mail Mr. H.

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July 28, 2012 News 27 Comments

Time Capsule: Google Health: Does Anyone Still Care?

July 27, 2012 Time Capsule 1 Comment

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 September 2007.

Google Health: Does Anyone Still Care?
By Mr. HIStalk


I like just about everything about Google. I like its products, its offbeat style, its innovative products, and it’s "we’re really just geeks like you" winking acknowledgment of its own cool technology.

Notice I said I like "just about" everything Google. What I’m sick of hearing about is Google Health, whatever it is (if it’s anything at all).

Everybody’s atwitter because the company’s health guy, Adam Bosworth, either quit or got fired last week. Google kept it mighty quiet, not admitting it until a blogger ran the story from a tip. The acknowledgment was terse, so you might well figure that he either got canned or went off to start a competitive business.

Google’s entire health output so far is, well, zero. The company hasn’t even announced anything. Googlers don’t show up at conferences, don’t write white papers, and don’t dazzle us with their usual brilliance. Maybe the company got embarrassed and cleaned house.

Of course, most Googlers are engineers. They are a great asset in solving purely technical problems, like writing search algorithms. Could it be that they’re ill equipped to understand the rat’s nest that is US healthcare, much less do anything to improve it, or even more importantly to shareholders, profit from it?

Everybody assumes Google’s healthcare people have been sequestered while creating a world-beater personal health record. I wasn’t so sure since it seemed like an odd business for them (and everybody else) to be in. Leaked screen shots of a cheesy (not sparsely elegant) prototype weren’t encouraging. This is the best that a $164 billion market cap company could come up with? It looked like one of those "$40 on a USB stick" spare bedroom programmer products that are giving the PHR genre a bad name.

It wouldn’t surprise me a bit to see the company get back to what it knows best: advertising. Google doesn’t know EMRs, PHRs, or HISs, but it knows how to jam context-sensitive ads in your face and get you to click on them. Why would Google want to get into the ugly Vietnam of clinical systems and low-rent PHRs when it could simply find new places to serve up more of those ads that effortlessly bring in billions? Like in front of doctors who have already amply proven to be influenced by obnoxious drug company advertising, for example.

You’ve seen the faltering first steps of ad-powered physician systems, healthcare social networks, and online references. The approaches have been amateurish, but I guarantee somebody will figure out that the real money will be made by giving drug and medical device companies access to prescribers at the point of decision-making. Pay-per-click gets much more valuable when presented in context to free EMR content and patient-specific information. Say, do you really want to order Drug A? Why not try Drug B instead, especially since this patient has renal problems and we’re offering a special price? Click here for our convincing medical references. In fact, we’ll buy your whole office lunch if you’ll just click OK instead of Cancel.

Many big company toes have been dipped into the healthcare waters over the years. Most got drawn back quickly, burned by an industry in which even deeply experienced organizations often fail. Fresh healthcare ideas are a dime a dozen, but the bigger the company, the more ludicrous the results have been.

At this point, I’m past whatever interest I had in Google’s healthcare efforts. They’ve had plenty of time to dazzle me. I don’t care any more. Just stick those AdSense ads in clinical software and let’s move on.

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July 27, 2012 Time Capsule 1 Comment

HIStalk Interviews Linda Peitzman MD, Wolters Kluwer Health

July 27, 2012 Interviews 1 Comment

Linda Peitzman MD is chief medical informatics officer of Wolters Kluwer Health.

7-27-2012 5-25-45 PM

Tell me about your job and the company.

Wolters Kluwer is a large company that started as publishing of information. It now creates software and information to help with workflow and decision support in the verticals of tax accounting, legal, and health to help the professionals in those areas with their decisions and information needs. 

I’m with the healthcare division. I’m a physician who worked for a long time as a full-time practicing clinician trying to figure out ways to solve problems and make things go better and help the systems that I was using.

I got myself involved in the IT side way back and started working with ProVation Medical. I came into Wolters Kluwer through the acquisition of ProVation Medical. Since that time, I have been working with the health division and spending most of my time with the Clinical Solutions Group at Wolters Kluwer Health, which provides workflow software, information, and decision support at the point of care for healthcare professionals.


You’ve worked a lot with order sets, which early on were just collections of commonly used paper orders that somebody keyed in to a CPOE system. What’s the state of the art in the use of order sets today and what’s coming in the future?

That’s a big question. There are a lot of things going on with order sets, for many reasons. There’s a lot of regulatory and other pressure to implement CPOE systems, so there’s a lot of work effort being focused on order sets.

As you say, they’ve been around for a long time because they help doctors with time and efficiency, and they’ve been around in paper form. But one of the big problems has always been once you get all those orders set out there, how do you maintain them? How do you make sure they are evidence based? How do you make sure they’re driving the right behavior in terms of quality patient care?

Some of the things that are going on right now with order sets include the use of tools to help with all of those things. To help with the complex governance process in your organization, to go through all of the review, the review of the evidence, the review of the order sets, the agreement upon what should be done at that hospital and in that organization, making sure it’s consistent with the hospital’s formulary and the types of tests and drugs they think should be ordered for that condition. Then I’m making sure that gets into the CPOE system and is used by the clinicians at the point of care.

All of that depends upon the processes and tools that an organization has and the culture that an organization has. A lot of it depends upon the capabilities as well of the CPOE system that the hospital happens to use.


It seems like hospitals generally struggle with the whole idea of evidence-based process, like formularies or trying to consolidate their medical devices into the most cost-effective ones. Everybody likes the concept of evidence-based order sets, but hospitals don’t seem to be ready for them yet. Do you think that’s the case?

I don’t know that that’s the case. I think that most hospitals really want to use evidence-based medicine. It’s just complicated to maintain that, to know exactly what’s going on in the literature, to make sure that you keep everything current. I think it’s also complicated sometimes in the culture of an organization to go through the process of review by all the people that need to do that and then get it done in a timely fashion. 

There’s a lot of tools out there to help organizations with that now. I think that some of the regulatory and payment pressures are focusing hospitals in certain areas and certain medical conditions, to make sure they are doing certain things for that care of patients that are consistent with evidence as well.

I think that just about every hospital is focused on evidenced-based medicine, particularly with order sets, at least in some areas. That’s why they’re doing what they’re doing – to provide the best care they can for their patients.


Efforts are being made to put clinical content in the clinical workflows, such as with the Infobutton standard. What changes do you think we’ll see in the next few years to make clinical content more available when it’s needed and to make it more specific to the clinical situation at hand?

I think there are a lot of things happening. A lot of groups that are working on experimenting with getting the right information at the right time. Alerts are popping up all the time when you’ve seen it a hundred times has really been discouraging for some clinicians. They haven’t really done as much as people thought initially they might do.

There are other things that have really been successful, like some things in the background in terms of drug information and drug interactions. drug dosage, and getting the right medications dispensed. Some things have been really successful. I think the work continues to try to figure out how you get the right nugget of information into the clinician’s hand at the time that they are thinking about it and deciding what to do. 

There are a lot of forms of clinical decision support. One of them is an order set. Having the right order set when you’re admitting the patient and you have to be using an order set anyway. Having the right information there that really takes you through the workflow and helps you make the right decisions that’s helpful. Having really smart rules and alerts than can be configured to provide benefit, but not get in a clinician’s way. 

That’s a real hard nut to crack, but a lot of people are working on it. Even having smart documentation, when you’re documenting something and going to the next step of deciding what the next thing to do is, being able to walk you on the right path.

There’s a lot of work going on. The technology is starting to evolve to allow some of that. If an EMR now has the capability of sending out to a clinical decision support system information about the patient that is very specific, then the information sent back can be much more specific and can be more focused right on what the clinician might want to know instead of  having more broad-based alert that might be more of an annoyance than a help. As those things continue to evolve and more and more EMR systems have those capabilities, I think organizations like Wolters Kluwer and others can help provide more focused information right at the right time into that workflow.

We have a group called the Innovation Lab. It’s partnering with several organizations looking at just that. How can we get clinical information right at the right point of care into the workflow of a clinician when they have to be ordering or when they are opening a problem, a record of a patient if that patient isn’t on a critical medication that is called for by virtue of the fact that they have these six conditions and they’re already on these other two drugs? Can there be a really smart alert that says hey, have you thought about this, and maybe a link to the supporting evidence to show the clinician? 

There’s a lot of work going on. I don’t think anyone has solved the problem completely by any means, but it’s really exciting to think that we could help clinicians make decisions at the right time in the point of care.


Going back maybe 20 years ago, you had publishers of journals you put on your shelf, but early electronic order entry systems that didn’t look at clinical content at all. Those systems were happy to just get an order entered and routed correctly. Is there still a lot of work to be done to take all that information that’s in almost limitless supply in research and publications and turn it into something that can be used at the bedside?

I think it’s an almost impossible task for an organization like a healthcare provider organization by themselves to accomplish that. Clinical information is said to be doubling every three to five years, and unfortunately my brain isn’t growing at that rate — just the task of managing all that and sorting through the literature. 

Part of our organization has a group of clinicians on the UpToDate team does that for their product, sorting through hundreds of the journals every month to try to identify the real changes in practice. By partnering with organizations where we can separate the wheat from the chaff and provide the real nuggets of clinical information as to what might really matter in terms of changing practice and then do work to try to figure out how to get that information into the hands of the clinician at the right time in the point of care, it can really help.

There’s so much going on and so many things published to be able to identify, first of all, what has changed? What really matters to my practice or the practice at the hospital? And now that we know that, where are the order sets that matter? How do I update them? Where are all the education pieces that I need for the physician? How are the patient education materials and how do I update them? As we were talking about before, I think maintenance of evidence-based practice is the big thing we need to solve. I think there’s a lot of people working on tools to help organizations with that.


The company’s doing some work to support Meaningful Use requirements. Can you describe that?

Meaningful Use requirements include quite a few different things. In this first phase, you need to be able to be report on certain measures. That requires certain systems in place that you have purchased, and you have to show that you’re using them in a meaningful way. We have a wide variety of products, including one that is a documentation product that helps to document and report some of those measures. In a broader sense, all of our products and other organizations’ products that are working in clinical decision support are trying to help support hospitals in the work they’re doing. 

One of the things that they’re really focused on right now is Meaningful Use and core measures. In all of our product lines from our order sets to our other types of clinical decision support, we try to point out the areas that matter for those things. For instance, in our order sets, we have quality indicators with each order set that show what the CMS measures are or Joint Commission or other kinds of areas that would matter for regulatory organizations for this particular order set or this particular condition. We try to help tie the works that hospitals are doing for things like Meaningful Use into other product lines. 

We are trying to assist organizations with implementation of CPOE systems, which is one of the things that they are working on doing towards that goal by providing the tools to help them come to consensus with their order sets, release their order sets, and then also provide some integration into their CPOE system so they can go live with CPOE and meet their measures of providing orders in the CPOE environment for things like Meaningful Use.


You mentioned that you were involved with ProVation before it was acquired. That’s a product that basically owns the gastroenterology market, a very specialized product. Will the idea of having specific documentation products for specialties continue or will the market push specialists toward standard products whose weaknesses they’ll have to live with?

We started in GI, in gastroenterology, but ProVation MD expands many other specialties for documentation. We have products in cardiology, cath lab, echo, nuclear, and surgical areas such as general surgery, plastic, ENT, eye, OB/GYN, and a variety of other surgical sub-specialties, orthopedics, and pulmonology as well. We span most clinical procedural specialties with ProVation MD.  That’s used in a variety of specialty areas to allow people to document and report on procedures in those areas, including in the cath lab, echo, cardiac, etc.

However, in a more general way, I would say that there are pressures on both sides. There are pressures to try to get one system to do as much as you can, because if you are working on the IT side of a hospital, you don’t want to have thousands and thousands of systems that you have to maintain and integrate and update and keep current with each other.

On the other hand, I think it’s becoming more and more clear that standard EMRs are not going to be the providers of everything for a hospital IT environment in terms of particularly current information and content and sometimes even very specific workflows for clinicians. I do think that there will be partnerships with the EMR systems that are the systems in place that are storing that patient record and information and workflow software providers that can join together to meet the needs of the various clinicians in the various workflows they need to complete.

However, the problem has been integration and ability to pass information back and forth. Also ease of use, in terms of having a provider needing to go from one system to the other. There’s a lot of pressure now on trying to make sure that there’s adequate integration involved and that an end user does not have to know that they’re in one system vs. the other – they can just do their work and then all the information can go to the right system and go to the EMR to be stored and viewed as the patient’s record. I think there’s a lot of work going on there. 

I do not believe that any one system is going to solve all the needs, for many reasons. One is because there is just huge tasks involved with understanding which workflow involves different clinicians and managing all that clinical information that’s happening in all of those clinical specialty areas.


That acquisition of ProVation is interesting, but I’m not sure most people realize how long the list of other Wolters Kluwer acquisitions is. There was also UpToDate, Lexi-Comp, Pharmacy One Source, and even a joint venture in China. What’s the company’s strategy?


The ones you mentioned are all within the Clinical Solutions business unit of Wolters Kluwer Health. That’s the group that is working at the point of care to provide workflow software and content solutions for clinical decision support for healthcare professionals.

We have a variety of products, from providing the answers to the clinicians with a product like UpToDate, providing tools to manage order sets like the Provation Order Sets product, and clinical documentation with ProVation MD. With the acquisition of Pharmacy One Source, also are working in the areas of the workflow of the clinical pharmacist and in surveillance. We now have tools available to help hospitals with real-time surveillance, looking for patients that might have indications that they need something done. For instance, watching for earlier signs of sepsis to make sure that the hospital can intervene in appropriate time and help provide morbidity and mortality associated with that. Many other things as well, including antimicrobial stewardship. 

We also have a lot of drug information products. Lexi-Comp, Facts & Comparisons, and the database of Medi-Span, which does alerts and reminders and drug-drug interactions, etc. for drugs used in the clinical setting. Each of those products represents a form of clinical decision support and help to the hospital environment.

But what we are really working on is looking across them and trying to find ways to do two things at a very high level. One is to integrate those products together in ways that are helpful to our customers that have more than one of them. UpToDate information is embedded inside of order sets, and if you have both products, there are ease of use issues across order sets and UpToDate that help the clinicians and helped the hospitals. We do that with many of our products. We try to integrate, so we have UpToDate patient educational materials inside of ProVation MD and other things such as that.

At the second level, what we’re working on trying to do is to really look at the problems, the current problems that our hospital and clinical customers are having, and say what can we do, not just with one individual product, but maybe with pieces of products and with our expertise from those product lines to bring them together in a new way to try to solve those problems? 

As I mentioned earlier, we have a group called the Innovation Lab at Clinical Solutions that has a steering team that represents the clinicians and informaticists and technical folks across all of those products that we just mentioned. We are a partner with hospital systems to try to solve very specific problems and are taking to the pieces of both content and technology to try to come to bear on problems that hospitals are having in new ways. 

We are working now in the area of mobile devices to help with early detection of sepsis. We are looking at providing, as I said earlier, ways to get nuggets of clinical decision support into a clinician’s hand at the right time and the workflow, which will be in EMR setting, through APIs and other things. We’re really excited about that and have quite a few hospital partners that are working with us to try to solve some of their problems in that way.


The old Internet saying was that “content is king.” Does the content piece get enough recognition when people talk about EMRs and Meaningful Use and how these products will actually deliver the benefit they’re supposed to?


People that are focused on one side or the other tend to have less of an understanding of the technical versus the content side. I believe it’s both. If you don’t have the right content and have the capabilities of understanding all of the changes in clinical practice and sorting through all the literature and making sure you keep your order sets current with evidence-based medicine, then you’re not doing your patients or your organization a service.

On the other hand, if you don’t have am EMR or a CPOE system that allows ease of use for the physician to be able to order something, or even has capabilities of being able to override things and be able to say why and track why are certain things were not ordered, you really can’t provide the best care. You also can’t measure what you’re doing well enough to be able to go back and improve it in a continuous improvement cycle. 

Content is king, because without the content, without knowing what you should do for patients, it’s hard to do it. On the other hand, if you don’t have systems and a workflow on place that makes that easy to use for a clinician and then can track what’s actually been done so you can improve it, then it’s also a really next to impossible as well. Both things have to continue to improve, and the ability to manage the content and get it into the workflow of the technologies is what really it has to happen. There are a lot of things being done towards that goal now, but there’s a lot of work that remains to be done.


Do you have any concluding thoughts?

It’s a really exciting time right now in healthcare IT for many reasons. It’s also a very frustrating time for people on the front lines in healthcare IT. There are so many pressures both currently and coming down the pipe, from switching from ICD-9 to ICD-10 and Meaningful Use and core measures and value- based purchasing and ACO pressures. Trying to manage all that and figure out what to do first and how to best accomplish it and still have systems that are maintainable and manageable in your hospitals is a really overwhelming task. 

There are tons of opportunities. There are tons of ways we can help make things more efficient and improve patient care. There’s just so much going on right now that sometimes it can be a little overwhelming. That gives organizations like mine an opportunity to try to identify what those top priorities are for our customers and try to help solve them in a variety of innovative and unique ways.

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July 27, 2012 Interviews 1 Comment

News 7/27/12

July 26, 2012 News 9 Comments

Top News

7-26-2012 9-40-39 PM

Quality Systems Inc. (NextGen) reports Q2 numbers: revenue up 18%, EPS $0.26 vs. $0.32. The company also eliminates future guidance, apparently burned in this case by impending deals that didn’t close by the expected dates. CEO Steven Plochocki blames the drop in net income on fewer higher-margin software system sales. Shares dropped 33% (Nasdaq’s biggest percentage loser of the day) on the news to their lowest price since November 2008, dropping the company’s market cap to under $1 billion. In the conference call, President Scott Decker said the loss of long-term client HMA was caused by HMA’s lack of resources to roll out its product, and said HMA won’t replace NextGen completely but that HMA wasn’t contributing all that much revenue anyway. The company says it will move more work to India to reduce costs. It also predicts that Meaningful Use Stage 2 and ICD-10 will take out a bunch of its competitors. When asked about pressure on hospital-owned practices to move to competitive products, Scott Decker said he wasn’t worried about Cerner, Siemens, or Meditech, but Epic is “a challenge for us like it is for everybody in the market” that “causes a little bit of pain.” Above is a one-year share price chart, with QSII in blue and the S&P 500 in red.

Reader Comments

7-26-2012 6-56-59 PM

From Winning: “Re: Microsoft. It will sign now business associate agreements with partners for Azure storage and core services (their cloud offering). That means Microsoft will shoulder some of the burden of ensuring HITECH and HIPAA compliance in the cloud. Hosting costs are high for a startup like us since HIPAA requires the database to be logically separated from the Web server, meaning we need at least two servers. That’s not cheap with .NET/MS SQL. The value proposition from a major player like MS Azure is pretty high. I wonder if we’ll see more of this from other vendors?” I appreciate that update. I would have put in a little plug for Winning’s company to return the favor, but I was running too late to ask if that was OK. The topic might make a good Readers Write if he’s inclined to write one. That’s a nice move by Microsoft.

7-26-2012 7-44-44 PM

From Jonathan Grau: “Re: AMIA 2012 Annual Symposium. We’re in Chicago this year from November 3-7.” Jonathan, VP of corporate relations and development for AMIA, keeps me in the loop about their activities. I couldn’t help but notice that five of the seven conference sponsors are also HIStalk sponsors (CAP, FDB, IMO, Philips, and nVoq).

7-26-2012 8-04-07 PM

From IT Director: “Re: Cerner downtime. Just so you know, it lasted about six hours … and you didn’t hear it from me.” According to the purported Cerner communication attached, a Cerner network administrator received an error when trying to update DNS records via the management console, so he or she made the change manually and inadvertently deleted a DNS zone while doing so, an unfortunate change that was then replicated to all servers. Anything using that zone was instantly hosed, and the tools needed to fix the problem were also not available because of the error. They had to restore the file from backup and replicate it manually to all the controllers.

From Doc Down: “Re: Cerner downtime. I’m a doc at a Cerner remote hosted site. We got our first e-mail about a ‘performance problem’ at 12:45 p.m. and the downtime was resolved at 5:35 p.m. In between, we got an e-mail that referred to some sort of DNS issue, but it was a bit confusing to understand what actually transpired. We got one message saying it should be fixed by 4 p.m. then another saying it would be fixed by 5 p.m. We have the read-only product for use during downtimes, but that couldn’t be accessed either. We recently moved our inpatient physician documentation to electronic, so reverting to paper with no access to anything recent was a nightmare. Don’t know anything that could have been done any differently on the hospital end, but it would be nice if Cerner would be transparent and describe to organizations and interested users what really happened as it doesn’t inspire much confidence. Unanticipated things do happen, but I’ve personally been unimpressed by the software or support. Though I have met a few topnotch Cerner folks, most seem fixated on selling us new modules, consulting and programming devices, etc.” Downtime is going to happen despite best intentions and known ramifications, but I’d be concerned that the read-only option, which exists solely for that eventuality, didn’t work.

HIStalk Announcements and Requests

inga_small This week’s HIStalk Practice includes a statement from former e-MDs CEO Michael Stearns regarding his recent firing. Epic, Allscripts, and eClinicalWorks lead other vendors in the number of ambulatory EHR attestations. ONC says the total cost of ownership of an in-house hosted EMR is less that the SaaS option. A Florida ACO uses Craigslist to recruit physicians and offers up to $100,000 a year in shared savings. Julie McGovern of Practice Wise points out a few considerations for practices moving their applications to the cloud. When you pop over to HIStalk Practice, click on an ad or two because you might find a sponsor offering a solution that will make your world better. And sign up for the e-mail updates because it could be the only way I know you care. Thanks for reading.

On the Jobs Board: Manager Systems Development, Database Administrator, Services Implementation Project Manager.

The HIStalk vital signs consist of measurements that you can actually influence: number of readers, number of e-mail subscribers, and the vitality of reader interaction in the form of comments and news tips. That means that you get to control our electronic destiny, which makes you a pretty powerful force with which to reckon (cue some tears-inducing Sarah McLachlan heartfelt warbling to move you to action). Actions that will stave off our eventual demise include (a) signing up for my spam-free e-mail updates, so you’ll be the first to know when I dig up some incredibly juicy industry gossip or random sophomoric humor that I can’t resist sharing; (b) electronically mate with Inga, Dr. Jayne, and me on Facebook, LinkedIn, and all that truck; (c) peruse the fun Resource Center, where you can search and navigate through a bevy of benevolent sponsors who crave your electronic attentions just as much as I do; (d) use the Consulting RFI Blaster to … well, that one’s pretty self-explanatory; (e) get off your figurative couch and out here on the healthcare front lines with us and participate with your comments, insight, or anonymous tips (e-mail works, but so does the nauseatingly green Rumor Report button glaring spitefully from the right side of the page); and (f) play a few rounds of Sponsor Roulette, scrolling the page and randomly clicking the ads to your left to see where you land, assured that it will be among friends since only the cool companies sponsor HIStalk instead of the boring alternatives. Inga, Dr. Jayne, Sara McLachlan, and I appreciate your participation in our continued non-flatlining. Every day we wake up and the page is still displaying is a good day.

Speaking of the three of us working in healthcare day jobs, Dr. Jayne’s healing talents were required for an encore shift in her local hospital’s ED, meaning she didn’t have time to contribute this time around. I suppose saving lives and all that stuff is a good enough excuse to let her slide this time.

Acquisitions, Funding, Business, and Stock

7-26-2012 6-06-14 PM

Compuware releases Q1 numbers: revenue down 2%, EPS $0.05 vs. $0.08, beating consensus earnings expectations of $0.04. Revenue for the company’s Covisint business unit grew 27% to $21 million.

7-26-2012 6-07-17 PM

McKesson announces Q1 numbers: revenue up 3%, adjusted EPS $1.55 vs. $1.27, beating expectations of $1.49. Revenue in Technology Solutions was up 4%, with adjusted operating profit of $109 million.

7-26-2012 6-24-27 PM

Clinithink secures multi-million dollar investments from Finance Wales and existing investors to fund ongoing technology development and establish the company’s US operation.

7-26-2012 6-25-15 PM

Cerner reports Q2 numbers: revenue up 22%, adjusted earnings $0.59 vs. $0.44.

7-26-2012 9-21-03 PM

CPSI announces Q2 results: revenue down 6%, EPS $0.75 vs. $0.72.

7-26-2012 6-26-51 PM

Facebook’s first earnings report wasn’t so hot, with revenue increasing 32% to meet expectations, but growth was the slowest in 18 months and the company doesn’t appear to be monetizing heavily increasing mobile usage very well. Shares dropped 9% Thursday and are down another 11% in after-hours trading Thursday evening. In the mean time, shares in Facebook-dependent game maker Zynga (FarmVille) continue their toilet orbit after a bleak Q2 earnings report, knocking another 40% off the share price and dragging shares down to 70% less than their December IPO price to the embarrassment of idiotic stock pickers who somehow thought Zynga had a real, sustainable business instead of a hyper-annoying fad with a low barrier to entry.

The CEO of HealthStream says the education and HR technology company may move into related healthcare business such as long-term and behavioral care.


7-26-2012 9-45-17 PM

Cedars-Sinai Health System (CA) chooses Health Care DataWorks to provide a clinical data warehouse and analytics solution.

The Commonwealth of Virginia’s Department of Medical Assistance Services awards HMS a contract to provide a customized Medicaid fraud and abuse detection system.

Norton Healthcare (KY) contracts with CSI Healthcare IT to provide 100 resources for the second wave of its Epic activation.


7-26-2012 6-29-04 PM

Healthcare analytics company ArborMetrix appoints former Covisint VP Brett Furst as CEO.

7-26-2012 6-33-44 PM

The Commonwealth Fund, a private healthcare-focused foundation and think tank, names former National Coordinator David Blumenthal MD its next president, effective January 1, 2013. He is chairman of the organization’s Commission on a High Performance Health System. Blumenthal will replace Karen Davis, who announced previously announced plans to step down at the end of the year.

7-26-2012 7-26-35 PM

Luther Nussbaum, retired chairman and CEO of the former First Consulting Group, is elected to the board of consulting firm MedSys Group.

Healthcare billing and payment systems vendor Zepherella names David Bond (A4 Health Systems, Allscripts) as EVP of sales and marketing.

Announcements and Implementations

St. Francis Medical Center (CA) and O’Connor Hospital (CA) go live on iSirona’s device integration solution that connects medical devices to their QuadraMed EMR.

7-26-2012 6-43-06 PM

Transitional care provider Remington Medical Resorts (TX) goes live on HealthMEDX Vision at all of its Texas facilities, including rolling out a paperless environment that allows physicians to work from iPhones or iPads.

7-26-2012 7-07-51 PM

The new Palomar Medical Center (CA) will open next month, a 288-bed, $956 million “hospital of the future” that has been under construction since December 2007. Space was pre-built to allow expansion to twice the number of beds if needed.

In Australia, New South Wales completes the initial phase of the rollout of TeraMedica’s Evercore imaging exchange in 12 hospitals.

Government and Politics

HIMSS proposes language for inclusion in the Democratic and Republican National Committee party platforms in support of HIT to improve healthcare efficiency, quality, and outcomes:

“In order to improve the quality of healthcare for all Americans while reducing costs, the Party will continue its strong support for the rapid, nationwide adoption of Health Information Technology including electronic health records and secure health information exchange capabilities.”


The Ventura County Board of Supervisors (CA) approves an additional $5.75 million for its $41 million Cerner EHR implementation, which is scheduled to be operational at two county hospitals by July 2013

Compared to physicians, physician assistants, APRNs, and RNs spend more time online for professional purposes, use smartphones more during patient consults, and more frequently access pharma or biotech Websites.

A Milwaukee newspaper article notes that Wisconsin hospitals are charging victims of sexual assault up to $1,200 for the cost of collecting evidence to identify and prosecute their attacker. Sometimes insurance pays, sometimes the hospital knows to bill the government fund that was set up to cover the cost, but in some cases the patient ends up getting stuck with the bill.

A Harvard health economist says that 90% of the country’s economic growth over the past 10 years got sucked up by increased healthcare spending, but the CEO of Marshfield Clinic says at least some parts of the Affordable Care Act (though he declined to guess which ones, but IT is mentioned) will eventually slow the increase. As I always say, everybody’s for reducing excess costs as long as they don’t personally have to take a pay cut.

Weird News Andy found this story, in which Mayo Clinic apparently fired a pediatrician who wrote a Arabic blog post advocating female circumcision. Mayo says female genital mutilation not only has no medical justification and thus can’t be performed in its facilities, but is also considered a felony-level child abuse crime in the US.

The University of Missouri School of Medicine will use a $13.3 million HHS grant to create electronic dashboards that will allow physicians to get a quick read on how individual patients or groups of patients with a single condition are being managed. The project has been christened LIGHT2.

Kiplinger’s Personal Finance ranks Madison, WI as the best city for young adults, with UW-Madison and Epic helping push it to the top. Rounding out the Top 5 were Austin, Boston, Washington DC, and Denver.

It really bugs me when PR-seeking hospitals decide to magnanimously waive their bloated, cost-shifted charges for high-profile victims. Three Colorado hospitals say they won’t charge victims of the Dark Knight shootings, some of whom had no medical insurance, for their care. I’m all for generosity, but I like it better then it’s less self-serving and selective. I’d rather they take it out of their executive salaries instead of just pushing the cost onto those who have insurance and less-publicized medical problems. Everybody struggles to pay for their healthcare, and fuzzy accounting like this isn’t helping.

In Canada, Eastern Health fires a nurse for inappropriately accessing and sharing the records of 122 patients. She’s the fifth employee the hospital has terminated for privacy violations so far this year.

Some bored newspaper folks apparently decide to check whether former HHS Secretary (and former lobbyist and current Senate candidate) Tommy Thompson ever had a VeriChip implanted in his arm as he said he would in 2005 when he joined that company’s board. Answer: no. His reason: hospitals didn’t buy the technology to read the chips, so the company tanked. He sure was pitching it hard on Squawk Box back in the day, but he’s a politician after all.

Sponsor Updates

7-26-2012 7-38-14 PM

  • Software Testing Solutions will have an active presence at the Sunquest User Group conference August 6-10 in Scottsdale, AZ. STS will demo Version 4 of its Test Manager product; CEO Jennifer Lyle (above as your HIStalkapalooza co-host in Las Vegas) will conduct an automated testing cost justification session on August 8; and the company will offer its popular Breakfast with the Puppies event on Thursday to collect donations (which the company will match) for Home Fur Good, a Scottsdale-based no-kill shelter.
  • Santa Rosa Consulting is named to Modern Healthcare’s Best Places to Work in Healthcare for 2012.
  • Trustwave and Microsoft partner to support additional Web server platforms, including Microsoft’s Internet Information Services and Nginx.
  • Certify Data Systems earnsMajor Player distinction in IDC Health Insights’ HIE vendor assessments report.
  • Consulting firm ESD (your gracious HIStalkapalooza sponsor last time) earns a Healthcare’s Hottest award recognizing fast-growing established healthcare companies. ESD also was named by Modern Healthcare as one of the Best Places to Work in Healthcare for 2012, the second year in a row.
  • Prognosis participates in this week’s Texas Healthcare Trustees Annual Conference in San Antonio.
  • NextGate’s continued growth requires a second move into larger space in Monrovia, PA.
  • The Huntzinger Management Group reports significant growth in 2012 as it helps organizations address regulatory compliance issues, changing reimbursement models, and IT demands.
  • MedAssets heads to San Antonio next month for the AHRMM 12th Annual Conference..
  • Wellcentive introduces Provider Benchmarking capabilities within its Advance Outcomes Manager solution.
  • Macadamian CEO Frederic Boulanger is selected as a Quebec finalist for Ernst & Young’s 2012 Entrepreneur of the Year in the Technology and Communications category.
  • FTI Consulting signs a five-year licensing agreement with Streamline Health for its OpportunityAnyWare business analytics and patient financial services solutions.
  • NextGen Healthcare selects Health Language to provide standardized terminologies within its ambulatory product suite.
  • Culbert Healthcare Solutions publishes a white paper on centralizing patient access and revenue cycle functions.


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

More news: HIStalk Practice, HIStalk Mobile.

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July 26, 2012 News 9 Comments

News 7/25/12

July 24, 2012 News 8 Comments

Top News

Cerner had an apparently significant disruption of its remote hosting service on Monday, leading to extended downtime for clients all over the country (and possibly outside of the country as well, according to some reports.) Information is hard to come by, so feel free to leave your comments if your organization was affected. Would you do anything differently next time in terms of preparation or downtime procedure?

Reader Comments

7-24-2012 6-29-36 PM

From Mr. Allscripts: “Re: Surescripts outage. I have more info.” Mr. A included a document suggesting that the Surescripts network had connectivity problems over about an hour last Thursday, during which time prescription routing and medication history transactions may have failed.

From Kaplan: “Re: Cerner. Remote hosting is down – it’s all over Twitter.” Apparently true, but I got just one reply to my Twitter inquiry of affected users for more information. Judging from the timing of some of the tweets, it looks like it was down for at least four hours. You can imagine the disruption of having your entire hospital go offline at once without warning, but at least it’s someone else’s problem as the IT folks sit and wait along with their users. I’d want an explanation, of course, and hopefully those affected were smart enough to have put a downtime penalty clause in their agreements.

From Mister X: “Re: Cerner downtime. Communication was an issue during the downtime as Cerner’s support sites was down as well. Cerner unable to give an ETA on when systems would be back up. Some sites were given word of possible times, but other sites were left in the dark with no direction. Some sites only knew they were back up when staff started logging back into systems. Issue appears to have something to do with DNS entries being deleted across RHO network  and possible Active Directory corruption. Outage was across all North America clients as well as some international clients.” I’ve lived through a lot of downtime it’s the same story as in this case. You don’t know when the systems will come back up until right before they do in most cases – 90% of the time required is diagnosis, not treatment. Users always want to know “how much longer” and you as the IT organization hate to tell them, “Beats me” even though that’s usually the case. Not to mention that when resources are stretched trying to get the problem fixed, there’s nobody sitting around to shoot the breeze with users wondering how it’s going (the user-to-geek ratio is about 1,000 to one, and you haven’t lived until you kill your pager battery within about 15 minutes with the constant pages demanding an individual briefing on what’s going on.)  And I can also say from experience that the worst problem isn’t server or power failure since those systems are backed up – it’s something like this, where Active Directory gets trashed, your name server dies, or you lose IP connectivity inside your data center. It takes forever to diagnose and fix.

From HERSS: “Re: mHealth Summit. I got an e-mail from HIMSS saying a certain company ‘will make their first appearance at the 2012 mHealth Summit as a Platinum sponsor and as such will have a significant role in the summit program and a key presence on the exhibit floor.’ I head to read twice to make sure this wasn’t from the basement sweatshop World Healthcare Congress sales reps and their over-the-top spamming. HIMSS has dropped to a new and very disturbing low. I would never have come out and said that a vendor will play a significant role in the program – that hardly inspires me to spend my hard-earned money for a conference pass. ‘A key presence on the exhibit hall floor’ means the vendor paid their prostitution dues to the pimp and are being properly rewarded for it.” Most of the HIMSS e-mails I get these days are just another form of vendor spam, pitching products, Webinars, or urging political action to interfere with the free market in healthcare IT. To be honest, I’ve twit filtered them into oblivion. When HIMSS speaks, it’s like a bad ventriloquist act – it’s easy to spot the arm up their backside. I really think they mean well and they have some honorable and dedicated people working there, but like a politician pandering to special interests, they lost their connection to the average provider once the dollar signs filled their eyes.

7-24-2012 7-17-42 PM

From Colorado Health Exec: “Re: Aurora shootings. While I was not involved, I want to extend my thanks to the healthcare professionals that did a great job in the early hours of Friday morning.  There were many heroes that day, from people in the theater, to the police, firefighters, and last but not least the nurses and doctors that treated the patients injured and consoled families trying to make sense of a senseless act. My thoughts and prayers go out to the victims and their families. Say what you want about the politics of healthcare these days, but professionals like these are the reason I am proud to be in healthcare.”  The above is from Denver Broncos tight end Jacob Tamme, who continues to tweet about being moved by his ongoing visits to Swedish Medical Center to visit with hospitalized survivors.

HIStalk Announcements and Requests

7-24-2012 7-28-08 PM

Welcome to new HIStalk Gold Sponsor CIC Advisory. Their tagline is “trusted informatics experts” and you probably really would trust them – the principals are Cynthia Davis, RN, FACHE (who’s been a CIO and has led several EHR/clinical transformation projects) and Marcy Stoots, MS, RN-BC (who has an interesting history of being an ICU nurse, wrote her master’s paper on data mining, is finishing a DNP in informatics, and led the EHR implementation at BayCare and other places). They’ve also just co-authored a HIMSS book called A Guide to EHR Adoption: Implementation Through Organizational Transformation. Testimonials are here. I was impressed that both ladies are members of the HIStalk Fan Club on LinkedIn, which always scores points with me. If you need help with EHR projects, informatics issues, Meaningful Use, business intelligence, or strategic planning, Cynthia and Marcy would be happy to speak to you. Thanks to CIC Advisory for supporting HIStalk.

It’s not quite as pervasive as squeezing “sort of” into every sentence, but what’s with everybody suddenly leading off a thought with the word “so” like they’re telling a story in a bar? You ask someone when they’ll finished a particular task and you get, “So we’re working on the documentation …” I’m also noticing that the young folks (who raise their inflection to a painfully high pitch at the end of every sentence as though they’re asking a question even when they aren’t) are also prone to sticking a confusing “no” in front of their “yeah” when excited. Example: “I just heard this great new band …” and they burst in with, “No – yeah, they were dope.” Curious.

I was thinking about the “deceased” flag in everybody’s EMR system after reading a story about a dead patient receiving an appointment in the mail in the UK. I assume that field populated only if the patient dies while admitted and someone keys in the discharge disposition. For research and population management purposes, it would be nice to know whether the patient is actually still alive, not just whether they went home that way last time from your own facility. If there was a national patient identifier, state and national death records could update everybody’s system. Seems pretty basic if we’re really going to try to account for patients between episodes. Or maybe somebody’s already doing this. Seems pretty basic: “Is this patient still alive?” “All I know is that he was the last time he came to the office.” Small-town doctors used to peruse the newspaper obituaries to send condolences and archive charts when appropriate.

Acquisitions, Funding, Business, and Stock

The senior management team of Quality Systems (NextGen) sends shareholders a letter voicing their strong support for the QSI board nominees. This move follows actions by dissident director and board member Ahmed Hussein, who is attempting to gain control of the board by nominating his own director candidates. The letter urges shareholders to support the QSI board nominees at next month’s annual meeting.

7-24-2012 9-44-49 PM

The FTC grants early termination of the waiting period for the acquisition of M*Modal by One Equity Partners, clearing the way for the deal to close.

7-24-2012 9-45-52 PM

HealthStream announces Q2 numbers, which were in line with estimates: revenues up 23% to $25.8 million; net income up 33% to $2.4 million.

7-24-2012 9-45-23 PM

Philips reports Q2 numbers, with earnings beating expectations and healthcare leading the way with a 7% jump in sales.

Apple misses Q2 expectations, turning in its second quarterly miss in year and setting lower guidance for the next quarter. iPhone sales were way down, which could be attributed to the lack of the iPhone 5 rollout, a struggling world economy, or impatient users moving to hotter new phones like the Samsung Galaxy S3.


Providence Health & Services will deploy Nuance’s Dragon Medical 360 voice recognition technology across its 250 clinics and 27 hospitals, integrating it with Epic for the health system’s 8,000 clinicians.

Centura Health (CO) selects the Explorys platform and Enterprise Performance Management applications for their ACO and PCMH initiatives.

Jordan Hospital (MA) selects dbMotion’s interoperability platform to connect multiple acute and ambulatory HIT systems throughout its local medical community.

7-24-2012 9-48-28 PM

Pomona Valley Hospital Medical Center (CA) selects ProVation Order Sets.


7-24-2012 6-17-46 PM

The Missouri Health Connection names Mary Kasal (Cornerstone Advisors) president and CEO of its statewide health information network.

7-24-2012 6-19-38 PM

HIT Application Solutions hires Richard Crook (onFocus Healthcare) as VP of consulting services.

7-24-2012 6-20-11 PM

Rodney M. Hamilton, MD (PointClear Solutions) joins ICA as its CMIO.

7-24-2012 7-10-05 PM

Floyd Medical Center (GA) names Jeffrey D. Buda (WellStar) as CIO.

Announcements and Implementations

The SE Michigan HIE announces that it has completed all milestones to provide its e-disability claim filing service to the Social Security Administration, which will accelerate the processing of disability claims from 457 days by paper to six hours electronically.

Canada’s Eastern Health goes live with NexJ’s Disease Screening solution for its Colorectal Screening Information and Reporting System project.

7-24-2012 6-36-48 PM

Military robot maker iRobot, worried about losing profits due to reduced military spending, decides the time is right to jump into the healthcare market with a new product in a partnership with InTouch Health. iRobot, which also makes the Roomba room vacuum cleaner, says the head of its new robot head is a moveable monitor that can be controlled, allowing the remote physician to look around the room. It comes with a stethoscope that it doesn’t know how to use, which makes it very doctor-like if you’re talking about psychiatrists, dermatologists, and physician executives who haven’t actually listened to anybody’s chest since residency, but who strut around in a white coat and draped stethoscope so they look more doctorly.

7-24-2012 8-25-32 PM

The chief administrative officer of Northwest Imaging (MT) develops a shift-budding app that he plans to complete and commercialize.

Cleveland Clinic and The Ohio State University announce a partnership to commercialize products that include medical software.


7-24-2012 7-04-49 PM

HELO announces its new TabletStrap PRO, a rotating leather hand strap for 10-inch tablets. Looks pretty cool for $60. Holding the iPad is awkward for me, especially when walking and poking at it, and this looks like it would be more comfortable and secure.


7-24-2012 7-57-49 AM

inga_small A reader last week asked if we were aware of updated MU attestation data by vendor. As it turns out, CMS published new information last week that includes details through the end of May. I used Excel to play with the numbers a bit, but a more robust reporting tool would probably be more efficient. EHRs by Epic, CPSI, Cerner, and Meditech were the most widely used products by attesting hospitals, which really isn’t much of a surprise. If you are interested in ambulatory EHRs, I created a similar chart on HIStalk Practice showing EP attestations by vendor, with Epic, Allscripts, and eClinicalWorks leading the pack.

Cerner partners with the city of Nevada, MO to focus on creating a culture of health in the community through education, incentives, infrastructure, and partnership with local employers and community organizations. Cerner will also deploy its CommunityWorks critical access clinical suite at Nevada Regional Medical Center.

7-24-2012 8-47-44 PM

AHRQ issues an RFI pertaining to quality measures enabled by healthcare IT.

Sponsor Updates

7-24-2012 9-51-08 PM

  • Stockell Healthcare Insight client Cooper Green Mercy Hospital earns $2.1 million for meeting Alabama State Medicaid’s EHR adoption, implementation, and use requirements.
  • A Calgary newspaper highlights TELUS Health and its remote patient monitoring tools.
  • MED3OOO’s chief medical executive, Paul McLeod, MD tackles the question of bundled payments in the company’s July newsletter.
  • Orion Health HIE is named to the Leader category in IDC’s MarketScape Vendor Assessment report.
  • Holon Solutions will install its CollaborNet interoperability solution at George Tech’s Interoperability and Integration Innovation Lab.
  • Aspen Advisors produces a white paper on assisting Frederick Regional Health System (MD) develop a business intelligence strategy.
  • Hayes Management Consulting offers a free white paper on patient portal design and implementation.
  • Over the last 15 months, Emdeon has boosted its employee count by 300 as a result of acquisitions and organic growth.
  • Informatica Corporation joins the Google Cloud Platform Partner Program as a Technology Partner.


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

More news: HIStalk Practice, HIStalk Mobile.

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July 24, 2012 News 8 Comments

EHR Design Talk with Dr. Rick 7/23/12

July 23, 2012 Rick Weinhaus 7 Comments

Pane Management — Part 2

The human visual system evolved over tens of millions of years to help our ancestors keep track of and interact with real objects in the physical world. To the extent that an EHR user interface design can harness our finely honed visual-spatial capabilities, using it will be intuitive and nearly effortless, even though the "space" we are navigating is that of data and the "objects" we are manipulating are abstract concepts.

Unless acted upon, objects in our physical world don’t move around, get larger or smaller, or change their orientation in relation to other objects. The human visual system "understands" these properties of the physical world. We are very good at constructing mental maps of what we see and using those maps to keep track of how objects are organized in space.

Unfortunately, graphical user interface (GUI) designs are not bound by the laws of physics and the constraints of the physical world. When we manipulate one object on the screen, other screen objects, for no apparent reason, can disappear and suddenly re-appear in different locations or radically change their shape and orientation.

While we might enjoy an altered set of physical rules as part of the challenge of playing a video game, it would be disconcerting, to say the least, to encounter such behavior in an EHR user interface.

Consider the EHR design below, by a well-known healthcare software toolkit developer.


Above is the physician’s home screen for a particular patient. Six panes are used to display six categories of patient data — Most Recent Activities, Medications, Patient Charts, Risks, Lifestyle, and Current Care. For clarity, I have enlarged the font size and drawn red boxes around the title bar of each pane.

Each pane is assigned to a particular location on the screen. One at a time, each pane can be expanded and then contracted by using the mouse cursor to click on the "maximize" button at the far right of its title bar (see Risks pane above).

So far so good. But look at what happens to the other panes below when I do expand one pane, such as the Risks pane (purple arrow). For clarity, I have significantly shortened the horizontal span of the screen in the next two figures:


When I expand the Risks pane, all the other panes close so that just their title bars are displayed. Worse, they all change their position, size, and orientation. The Most Recent Activities pane (red arrow) and the Medications and Patient Charts panes (blue arrows) are now oriented vertically along the far left of the screen. The Most Recent Activities pane is twice the width of the others.

The Lifestyle and Current Care panes (yellow arrows) maintain their horizontal orientation and relative position, but have been shifted to the bottom of the screen and stretch along its entire extent.

If I need to expand another pane, such as the Medications pane (indicated by the blue arrow below), all the other panes again change their position, size, and orientation:


With the Medications pane expanded, the Most Recent Activities pane (red arrow) is now oriented horizontally instead of vertically and extends along the entire top of the screen.

The Patient Charts pane (bottom blue arrow) keeps its vertical orientation, but now is displayed on the right side of screen, elongated to span the entire screen height. The Lifestyle and Current Care panes (yellow arrows) change from horizontal to vertical orientation as does the contracted Risks pane (purple arrow). In addition, the Lifestyle pane has been stretched vertically.

In fact, whenever any pane is expanded, the other, non-expanded panes somewhat arbitrarily change their position, size, and orientation in this way. This is a poor mapping. It doesn’t correspond to our mental model of the physical world. It doesn’t take advantage of our highly evolved ability to organize objects in visual space.

Instead of the design above, why not use a small overview map for orientation and navigation, as in the figure below?


This is a more natural mapping. The positions of the six panes in this small overview map correspond to those of the home screen (first figure) and those positions remain constant regardless of which pane is expanded. Furthermore, this overview map (overlaid below, for comparison, in the lower right corner of the expanded Risks pane) takes up less than 3% of the screen area, whereas the vendor’s design (outlined by the yellow border below) uses almost 20%:


It’s not that physicians and other users can’t work with problematic EHR interfaces such as this one. Humans are remarkably adaptable and flexible, but it requires cognitive effort. It’s not just the extra second or so that it takes to find a pane in its new location. That’s the least of it.

The real problem is that, unlike computers, humans have extremely limited working memory. Having to deal with the shifting location, size, and orientation of data objects is disorienting.

Whenever we use a slot in our visual working memory for these kinds of tasks, we can no longer use that slot for clinically relevant information. It’s easy to underestimate how much this kind of EHR interface can interfere with our ability to make sense of complex patient data in the clinical setting.

Rick Weinhaus MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

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July 23, 2012 Rick Weinhaus 7 Comments

Monday Morning Update 7/23/12

July 21, 2012 News 9 Comments

From So SARry: “Re: Epic stock ownership. My information is a bit dated, but here’s how it used to work, anyway. Two classes of stock were issued – A and B. Judy owned all the B stock, which I suspect is how she controls the company. In the beginning, anybody could own A stock, and there actually is some stock floating around privately that’s never been owned by an employee, but selling stock like this was discontinued a long time ago. Employees received stock as well, but originally, there was no rule to sell stock when you left. Shares still trade privately, but later employees must sell their stock when they leave the company. At some point, they must have hit the 500-shareholder limit or foresaw this and created Stock Appreciation Rights. New employees from that point got SARS. While they advertise that they are the same as stock, the rules are quite different, mainly in that you can only hold a SAR for so long, which limits its appreciation. Pretty scammy, actually. Employees getting SARS get pretty small numbers. No new employee gets stock, and with the older employees leaving and being forced to sell their stock in most cases, the ownership of the company is increasingly concentrated into certain long-time employees (certainly not all) who get the repurchased stock from the other employees as bonuses. They don’t advertise that, either. There are probably in the neighborhood of 150 employee shareholders or less now.”

7-21-2012 6-46-10 AM

From Ossia: “Re: Surescripts. Was offline this week.” Unverified, but above is a snip of an explanatory e-mail that clients supposedly were sent.

From Emu: “Re: MU attestations by vendor. Do you know of anybody keeping these stats up to date and publicly available?” I don’t follow it much, so I’ll defer to Inga or readers who may know.

Listening: Baby Woodrose, a dead ringer for fuzz guitar / organ / tambourine paisley psychedelic rock bands from the Sunset Strip in the late ‘60s (The Seeds, 13th Floor Elevators), surprising since it’s basically one guy from Denmark with occasional rotating backup musicians. Luckily nobody was in the vicinity when I fired up the first few tunes on Spotify because someone could have been harmed by my involuntarily spastic desk drumming. This tune ought to be hit, other than nobody listens much to real music these days. Baby Woodrose just rips it up and leaves it on the stage. I like it a lot. Similarly good but from Sweden: The Maharajas.

7-21-2012 5-03-15 AM

Most readers think the loosely defined “telehealth” will improve quality and costs. New poll to your right: will public HIEs survive?

7-21-2012 5-25-03 AM

Welcome to new HIStalk Platinum Sponsor Accent on Integration. As the Texas-based company’s name suggests, its raison d’etre is eliminating data silos via intelligent data exchange, giving hospitals better access to clinical information and thus helping them improve patient care. Areas of focus include interoperability (EMR integration, HIE to HIE integration, accountable care), device integration (monitors, OB and ECG systems), and systems integration (HL7, IHE, CCD, CCR, XML, Web services). Accelero Connect is the company’s enterprise-class clinical data integration platform (vendor-neutral, manufacturer-neutral, and modality-neutral) that connects patient care devices to hospital clinical systems and EMRs, an FDA-registered Medical Device Data System that passed all tests in the Patient Care Device Domain of the 2012 IHE Connectathon. Hospitals that use bedside monitoring systems from multiple manufacturers or that need to capture data from multiple modalities (IV pumps, ventilators, wired or wireless patient care devices, etc.) get a consistent message structure for sending information from those devices to their clinical systems. Clinicians can choose specific incoming data points to include in their EMR documentation (since most EMRs can’t handle a constant barrage of frequent data readings) or the whole process can be placed on autopilot by setting IHE’s device observation filter to pass through only the desired information. Stillwater Medical Center (OK) chose Accelero Connect after an ICU monitoring system upgrade to automatically integrate patient information into the EMR, reducing the time and errors involved with having nurses document manually and giving physicians a real-time view into patient condition to allow faster intervention. Thanks to Accent on Integration for supporting HIStalk. 

I’ve warned a couple of times that Meaningful Use attestation is based on the honor system only to a point: HHS has said from the beginning that audits would be done after the fact. They’ve started, apparently, despite the lack of a formal announcement. Providers are getting letters from Medicare cost auditors Figliozzi and Company (check out their ultra-cheesy 1990s FrontPage site, which will shatter any confidence you may have had in them as technologically astute auditors) requesting specific MU-related documentation: a copy of their product’s certification, an explanation of how they calculated ED admissions, and supporting documentation to back up meeting the core and menu set items claimed. CMS awarded Figliozzi a three-year, $3 million contract in April to do the job.

Integrity Transitional Hospital (TX), a 54-bed long-term acute care hospital, chooses HCS INTERACTANT EMR and financial solutions.

7-21-2012 7-03-46 AM

Shares in Quality Systems Inc. continued their slide this week on news that the physician network of Florida-based Health Management Associates will replace QSI’s NextGen products with those from athenahealth. QSII shares that were trading in the $45 range in mid-March closed at $23.41 Friday. Over the past year, ATHN shares are up 78% (they jumped nearly 7% on Friday alone), while QSII’s are down 48%. That’s a one-year chart above. Athenahealth’s market cap is now $3.3 billion, with Jonathan Bush holding about $29 million worth. That makes athenahealth worth only a little less than Allscripts ($1.89 billion), Quality Systems ($1.39 billion), and Greenway ($445 million) combined. You would have more than quadrupled your investment if you’d bought ATHN shares two years ago.

In the athenahealth earnings call, Jonathan Bush outlines some of the company’s strategies: Jedi (adding services such as provider credentialing and denials); Beautiful (improving the user experience in working with the company and engaging design firm IDEO on “future medical record user experiences” and design philosophy); Coordinate (not really explained except to say it’s not working yet); and More Disruption Please (working with other disruptive technology entrepreneurs). Worth reading just to pick out fun JB quotes, which must have the stock guys linting up their suits while rolling on their floors:

  • “I had our Physician Advisory Board in yesterday. The biggest thing that they said is, ‘Listen, it makes perfect sense, both as a receiver and as a sender, to be on this Coordinator service. The problem is it’s not really worth doing as a sender unless there’s a lot of receivers, and it’s not worth really doing as a receiver unless there are a lot of senders.’ So I bought five chickens, and I am going to figure out how these freaking eggs get going.”
  • [on the replacement system business] “Well, Ryan, thank you for bringing up one of my favorite parts of the athena hospital, the Burn Unit. No question about it, the Burn Unit is getting busier and busier across all segments. I actually saw the KLAS survey did something recently, 30% to 50% — was it 40% to 50%? — of large groups are engaged now in replacing the EMR that they rushed out to buy because they rushed out to buy the one that they knew when the Obama administration told them they needed one, and that was the software-based Flock of Seagulls-era EMR system that they had looked at and chose not to buy in the early 90s.”
  • [on increasing sales rep productivity] “So you have a small group guy who’s in her 20s, shows up and she plugs into a desk. It’s like getting on a bull, and the demos come pouring in. And she’s doing demos like the Beatles when they worked at those strip clubs back in the ’60s. They do 10 to 15 shows a day. They get very good very quickly. And you see their close rates pop up into the normal sort of 20% close rate range within a quarter, two quarters max.”
  • [on terms of the HMA deal] “They can all leave whenever they want, but hopefully, we don’t get boring. We keep changing our outfits, and they stay forever. We cut our hair short, we let it grow long.”
  • [on competing with Allscripts] “I call it O-negative day, that earnings call from Allscripts when they became a universal donor.”
  • [on competitors] “It’s our business model that’s on the side of history. Now I am not smarter than those other guys. We didn’t start out better, we’re not better people, we don’t work longer hours. We’re attracting the next generation of brilliant developer because the business model makes sense to people. So over time, we might actually end up with a better raft of people and a more inspired raft of customers. But I really think it really boils down to just the accident of our stumbling upon to this business model, lo those 13 years ago.”
  • “We are a nation of shoppers. And the reason healthcare sucks so much, both from a satisfaction and a cost perspective, is nobody’s allowed to shop. It turns out, the way policy has gone, the consumer will not be shopping for a while. That was on the rise. Since the inauguration, that has been on the fall. But it turns out the doctor could shop. The doctor could be the first generation of American shopper for healthcare.”
  • “I think this quarter speaks for itself. I do think that we took on, as I said in the beginning of my prepared remarks, more than we could chew. And so we won’t be done chewing by the end of the year in terms of our bolder projects. But anyway, that makes it less hard to figure out what to do next year. And we get the joy and the binding experience that comes from a little bit of failure along the way, which keeps us real because we are so much smaller than this mission we’re on, and we have so much, so much farther to go.”

7-21-2012 7-18-10 AM

NIST releases a guide on EMR usability for delivering care to pediatric patients. It’s a free download.

Weird News Andy finds this story interesting. The hospital technician who was charged with infecting at least 30 New Hampshire patients with hepatitis C (he was injecting himself with drugs and then re-using the syringes) was an agency traveler, having worked in at least six states in the past five years. He’s apparently good at sounding sincere – he was reported by a co-worker as “foaming at the mouth” while on the job, but made up a story about crying over a dead relative. What WNA liked is his response to questioning about how all those patients contracted hepatitis: “You know, I’m more concerned about myself, my own well-being.”

Visage Imaging’s server-side rendering and support for Windows, Mac, and iOS platforms is mentioned in an AuntMinnie article covering the technology approaches to developing mobile apps for medical imaging.

7-21-2012 5-22-26 PM

Political attack ads aimed at Missouri State Senator Brad Lager, a candidate for lieutenant governor and a part-time Cerner employee, challenge, “While Kinder fights Obamacare, Brad Lager profits from it. Records show a healthcare company that’s made billions from Obamacare pays Lager thousands.” His opponent, the incumbent lieutenant governor, fared even worse – an ad questioned, “Skipping work to hang out at the Horny Toad?”, referring to his admitted visits to a St. Louis strip club of that name and his rumored involvement with a stripper who was plying her trade there.

GE announces Q2 numbers: revenue up 2%, EPS $0.38 vs. $0.35. GE Healthcare contributed profits of $711 million, up from $661 million quarter-over-quarter.

Vince starts his HIS-torical coverage of Keane and its acquisitions over the years.

Beth Israel Deaconess Medical Center (MA) notifies 3,900 patients that their PHI has been exposed after a physician’s personal laptop is stolen from hospital property. The hospital was already encrypting its own laptops, and prompted by the incident, now requires non-owned devices to be encrypted before using them to access patient information.

Philips recalls 226 of its Xcelera Connect interface systems after a hospital reports to the FDA that it was sending incomplete cardiology test data to EMRs. The company found that if a physician hit Enter in the summary section of their interpretation, any following information in the report was sometimes lost. Xcelera Connect exchanges data to and from cardiac-related modalities to hospital information systems.

Meditech cloud hosting services provider Park Place International signs on as the first client of CyrusOne, which operates a new Texas data center that it says is ideally located to minimize geographic risk, is connected to highly available electrical and cooling systems, and is hardened with physical security controls.

The 5,800 square foot Memphis house that Steve Jobs secretly bought in 2009 to prepare for his liver transplant there was owned by the University of Tennessee and used as a residence for the chancellor of its Health Science Center. It was appraised for $1.3 million, but the university, anxious to shed some of its residential real estate and spooked by the tanking real estate market and lowball offers on the property, sold the house to Jobs for $850K. After Jobs went back to California, the house was sold to his transplant surgeon.

7-21-2012 7-37-07 AM

This amuses me, but then again, it doesn’t take much.

E-mail Mr. H.

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July 21, 2012 News 9 Comments

News 7/20/12

July 19, 2012 News 14 Comments

Top News

7-19-2012 9-28-02 PM

WorldOne acquires the 130,000 physician-member Sermo, which adds to WorldOne’s global network of 1.7 million healthcare professionals across 80 countries.

Reader Comments

inga_small From Simple Simon:Re: ambulatory EMR satisfaction. First the CDC reports that 55% of US doctors are using some type of EHR and 85% of those claim to be somewhat or very satisfied with its day-to-day operations. Now KLAS says that 49% of practices with existing EHRs are considering replacing their systems. Somebody has to be wrong.” Perhaps, but keep in mind the sample sizes and methodologies were quite different. CDC’s findings are based on the results of a mail-in survey from 3,200 physicians. KLAS used a  smaller sample of 302 practices. KLAS suggests that practice consolidation may be contributing to the high replacement figure as entities search for a single solution to replace disparate EHRs. In other words, a good number of providers may be perfectly happy with their EHR, even as the organization searches for a new system. As a whole, I think you can draw some broad conclusions that adoption is up, that support and product issues are creating discontent among some users, and that the replacement EHR market will continue to flourish. I am reminded of the advice that Mr. H regularly administers: be leery of the conclusions drawn by many of these surveys because methodology and biases sometimes make them questionable.

7-19-2012 6-00-03 PM

From CDMer: “Re: DoD-VA Interagency Program Office. They’ve issued an RFI to survey the market for vendors who can meet the specs of the future iEHR that will allow them to replace AHLTA and VistA. It’s always nice to have 100-year goals!”

7-19-2012 8-23-50 PM

From Wurka Round: “Re: NYU Langone. Paper checklists are being deployed to keep results from being silo-bound in the ER.” The hospital, stung by media coverage of the death of a 12-year-old boy who was discharged from the ED despite available lab results showing significant infection, now requires ED employees to complete a pre-discharge checklist indicating that they have reviewed labs and vitals one last time. The hospital also says it will make sure that any post-discharge abnormal lab values are communicated to the referring physician, which also didn’t happen in the boy’s case.

7-19-2012 7-00-20 PM

From Clownface: “Re: Epic. What qualifies as an employee-owned company? In my training class, Epic says it’s employee owned, but SEC reporting of financial data is required for more than 500 shareholders and Epic does no reporting. With more than 5,000 employees, that means less than 10% of them are shareholders. How is that employee ownership? Does the CEO just have to be an employee to count?” Good question. From what I can tell, SEC requires detailed financial reporting for private companies exceeding $10 million in revenue and 500 shareholders. Meditech is a good example. I don’t see any Epic filings on EDGAR, but maybe they use a less-obvious name to avoid prying eyes. Or, you could be right that most employees will never get a shot at owning shares. Maybe someone who works there can enlighten us, although I’m not counting on that happening.

7-19-2012 8-26-49 PM

From Albert: “Re: UC Health, Cincinnati. Ambulatory applications went live in big bang fashion last week, replacing an extremely customized GE Centricity. Nearly 100 clinics and 3,000 users are up and running!” I believe they’re implementing Epic.

From MT Hammer: “Re: M*Modal. Nuance tried to buy them?” An interesting blog post makes a strong case that Nuance was the unidentified company that offered $17 a share for M*Modal in June, an offer that was rejected because the unnamed company had just purchased an M*Modal competitor (presumably Nuance’s acquisition of Transcend), leading to uncertainty about whether the deal would actually close due to antitrust issues. Quite a few folks (some of them working for securities class action law firms) say M*Modal sold out to JP Morgan Chase too cheaply, so they will undoubtedly point to this news to support their position.

HIStalk Announcements and Requests

inga_small I am back from my semi-vacation and still busy cleaning out my inbox. If you haven’t had a chance to read the recent HIStalk Practice posts, here are a few goodies you might have missed. Highlights from KLAS’s recent report on ambulatory EHRs, including the most replaced and most considered vendors. NCQA extends a “Distinction” designation to 60 PCMH primary care practices. Greenway publishes a cool infographic that overviews the MU process. MGMA’s tips for practices considering a social media presence. New payment methodologies may have helped primary care physicians increase their 2011 compensation by more than five percent. Aaron Berdofe discusses health record banks in the third part of his series on healthcare infrastructure data models. Dr. Gregg explains the commonality of clubbing, EHRs, and religion. Brad Boyd of Culbert Healthcare Solutions highlights the great promise of centralizing patient access and revenue cycle. Take a moment to cool yourself from the summer’s heat with HIStalk Practice’s refreshing ambulatory HIT news. Sign up for the e-mail updates while you are there. And, thanks for reading.

Here’s a gentle reminder for PR folks anxious to get the executive hires of their clients listed in the “People” section of HIStalk. I like including a photo since it’s 100 times easier for someone to recall if they know someone if they’re looking at a photo (can you imagine a text-only high school yearbook?) Every executive should have a LinkedIn profile that includes a high-quality, professionally made head shot (not resized down to the tiny, low-resolution thumbnail – LinkedIn does that automatically, but the high-res version still pops up if you click the thumbnail.) No full-length dramatic pose shot at an angle, no tiny head in a big picture that can’t be cropped without an astounding loss of quality. And of course, as I always preach, don’t bother sending me a press release that hasn’t been posted to the news services or the company’s own site – I can’t use it unless I have something to link to. I’m not in the PR biz, but all of this seems pretty obvious to me.

7-19-2012 7-47-32 PM

Welcome to new HIStalk Platinum Sponsor ICSA Labs. The company, which is an independent division of Verizon, offers testing and certification of EHRs and health IT technology. They’ve certified over 100 health IT products since launching ONC-ATCB services in March 2011. Vendors (and self-certifying providers) have a choice of testing and certifying partners, so why choose ICSA Labs? (a) their folks have a lot of healthcare and/or interoperability experience (every employee has at least 10 years’ worth); (b) they make sure their clients are prepared for testing, providing them with documents that include sample code, interoperability tips, and step-by-step instructions; (c) they offer low prices, flexible payments, and any needed re-testing within two business days at no extra charge; (d) they help their clients market their certification. Fresh news this week is that ICSA Labs was just accredited by ANSI as a permanent certification body for ONC, meaning they can certify complete EHRs and EHR modules after the temporary program (ONC-ATCB) expires. They created a cool web page just for HIStalk readers, and based on e-mails Inga and I have swapped with some of their folks, they actually read what we write (that isn’t always true of sponsors, although thankfully it usually is.) Thanks to ICSA Labs for supporting HIStalk.

You know what’s coming next: I went to YouTube to scrounge for ICSA Labs videos that would give you a visual on what they do. Here’s a recent and nicely done webcast covering the 2014 Edition Security and Privacy criteria. I was just going to post it and move on, but I got kind of hooked on it and ended up watching a good bit of it.

On the Job Board: McKesson HSM and MAC Activation Support, Account Executive – NE and Mid-Atlantic.

Acquisitions, Funding, Business, and Stock

7-19-2012 5-50-44 PM

Gateway EDI, a subsidiary of The TriZetto Group, expands into the hospital and large-practice base with the acquisition of ClaimLogic. Terms were not disclosed, but Sermo had raised $40 million in its seven-year history.

Microsoft reports its first quarterly loss in 26 years as a publicly traded company, triggered by the full write-down of the $6.3 billion it paid to buy ad platform company aQuantive.

Application development tools vendor Progress Software names former Allscripts board chair Phil Pead as non-executive chairman. It also hires former Picis CFO Melissa Cruz as SVP/CFO.

7-19-2012 9-40-13 PM

Athenahealth reports Q2 numbers: revenue up 33%, adjusted EPS $0.24 vs. $0.12, beating consensus earnings expectations of $0.23.


The Denver Hospice selects HEALTHCAREfirst for its clinical and business operations.

Health Management Associates will implement athenahealth’s solutions for its 1,200 employed providers. athenahealth will also offer services to the 10,000 independent physicians affiliated with HMA hospitals.

In the UK, Royal Berkshire NHS Foundation Trust signs a $26 million contract with Cerner for Millennium hosting and system support.


7-19-2012 6-34-23 PM

MedVentive appoints Bernard Chien (Radisphere) chief technology officer.

7-19-2012 7-11-20 PM

John Lynch (Provena Health) is named VP/CIO of Greater Hudson Valley Health System (NY).

Announcements and Implementations

7-19-2012 9-41-45 PM

Duke University Health System (NC) goes live on the first phase of its $500 million Epic implementation this week at 33 primary care practices.

ANSI announces the first accredited certification bodies for the ONC’s Permanent Certification Program for HIT. They include CCHIT, Drummond Group, ICSA Laboratories, InfoGard Laboratories, and Orion Register.

7-19-2012 9-43-57 PM

CareTech Solutions releases BoardNet 4.0, a new version of its Web-based portal for hospital board members.

7-19-2012 6-09-35 PM

Healthcare Growth Partners releases its healthcare IT and services quarterly report.

Three Sentara hospitals are scheduling inpatient procedures in its Epic system, which the apparently detail-challenged local newspaper interpreted as being synonymous with “smart room technology” because the words were close together in announcement’s headline.

Government and Politics

A House Appropriations subcommittee votes to cut $1.3 billion in HHS funding and eliminate all funding for AHRQ.

CMS announces the 15 ACOs that will participate in the Advanced Payment ACO model and receive upfront and monthly payments to invest in their care coordination infrastructure.


Demand for HIE consulting services is on the rise, according to KLAS. However, hospitals are struggling to differentiate among the 13 firms that offering the service.

7-19-2012 7-18-35 PM

A KLAS report on ambulatory EMR perception finds that there’s a lot of rip-and-replace going on, especially in larger practices. Systems from Allscripts, GE, and McKesson are the most replaced (not surprising since they have a lot of customers and have been around for a long time.) Most often chosen as replacement systems are eClinicalWorks, Epic, and Greenway. In addition, the win rate for vendors outside the most popular group increased significantly in the past year. Common reasons for replacement are poor support, hidden costs, and products too technically complicated for a small practice to keep running.

Vermont leaders express frustration with lack of results from $70 million in healthcare IT investment, even though most of that money came from the federal government. A Senator said, “I hear genuine frustration from providers who are spending time and resources trying to modernize and make their offices more efficient, and prepare for the future, and yet every one of them feels like they’ve been burned. Basically we’re not getting any results for these millions and millions of dollars that have been pumped into IT. We should be a lot further along. I just don’t think the leadership’s in place.”

A study finds that registered dietitians can enter physician-approved nutrition orders faster and more accurately than RNs and clerical employees. The original research article, which appeared in a nutrition journal, urges that dietitians be given access to electronic diet order systems.

A pretty funny Gawker article entitled If You Go to a Hospital in July, Get Ready to Die covers The July Effect, which fascinates laypeople because they think we hospital folks try to hide the bungling that happens when clueless new residents first try out their medical wings (we do actually try to hide that, but nobody really denies it.) Gawker’s gonzo journalism summarizes, “Being a doctor is one big game of Operation to these punks. You go in with a headache and all of a sudden they’re trying to remove your Wish Bone with a pair of tweezers, being real, real careful not to touch the sides. The stethoscopes around their necks are made of plastic. Their doctor’s coats are just one of their dad’s white dress shirts.”

Bloomberg covers a California surgery center chain that bills insurance companies exclusively at out-of-network rates, allowing its surgeon-investors earn up to 200% rate of return. The chain’s seven centers bring in $100 million per year in revenue. Aetna is suing the chain, saying it gouges on rates, excessively rewards surgeons for referrals, and defrauds health plans. One surgeon says his partnership was terminated because he didn’t refer enough patients whose insurance had extensive out-of-network coverage, or as the text message the company sent him explained, “Simple rule of thumb is Aetna, United, Cigna, and Blues with no daily max.” The company’s marketing pitch to surgeons was that their $10,000 investment would give them monthly payouts of $6,709. The Iranian immigrant who started the company did so after being inspired by her sister and brother-in law, who were making $10,000 for each out-of-network colonoscopy they performed from a rented office.

Three Chicago-area men contemplate filing lawsuits against Northwestern Medical Faculty Foundation, whose sperm freezers and alarm systems failed in April, ruining the men’s sperm samples they had stored there before undergoing fertility-affecting medical procedures.

Sponsor Updates

  • GetWellNetwork creates a highlights video from its May user conference in Orlando. It’s far more interesting and entertaining than you might expect.
  • eClinicalWorks was the most-used EHR among respondents to an OIG survey research the use of EHRs, the company says.
  • Beacon Partners expands its HIPAA and HITECH privacy and security services into an Enterprise Information Assurance practice.
  • Park Place International receives Meditech’s approval to provide OpSus|Connect and secure Meditech VPN support connectivity.
  • Billian’s HealthDATA releases its report on the Ten Busiest Home Health Agencies.
  • BridgeHead Software demonstrates that its Healthcare Data Management Solution meets the requirements of Integrating the Healthcare Enterprise at the European Connectathon.
  • Boca Raton Regional Hospital (FL), The Independent Physicians Association of Nassau/Suffolk Counties (NY), The Huron Valley Physicians Association (MI) and The Arizona State Physicians Association are some of the new health systems and IPAs choosing Greenway’s PrimeSUITE EHR/PM solution.
  • The Illinois Department of Healthcare and Family Services expands its contract with Optum to include an expanded data warehouse for advanced analytics.
  • OTTR releases details of its September OTTR Users International 2012  meeting in Omaha, NE.
  • MDeverywhere selects Health Language’s Language Engine and provider-friendly terminology to integrate with its charge capture software.
  • Peoria Tazewell Pathology Group (IL) selects McKesson Revenue Management Solutions to provide RCM services.

EPtalk by Dr. Jayne

CMS publishes a new guide for Eligible Professionals seeking to demonstrate Meaningful Use through the Medicaid program. Although the 94-page length is a little off-putting, it’s written at a high level and is a reasonable entry-level document. If you haven’t figured out your MU strategy and you see a fair number of Medicaid patients, check it out.

The Joint Commission releases a statement on the use of unlicensed persons acting as scribes. Although it is specifically targeted at Critical Access Hospitals, it makes several good points relevant to all settings. You’d think these are largely common sense, but I often see behaviors that don’t quite meet these standards:

  • The job description clearly defines scribe qualifications and responsibilities
  • The employer offers specific orientation and training
  • Employment is contingent on competency assessment and performance evaluations
  • Physicians must authenticate notes after the scribe enters them (and do so before leaving the patient care area, since others are using the information)
  • Scribes should not enter orders (it’s CPOE, not CSOE)

Especially in the ambulatory setting, I see physicians who think they can take a medical assistant or nurse and add “scribe” to their already-full list of duties. These staffers may be pushed outside their comfort zone with little or no training. They may be expected to document according to “understood” physician intent rather than fully scribing the visit, which is never a good idea. I use scribes in one of my practice settings and a good scribe is worth his or her weight in gold. It doesn’t remove the need for the physician to know the system and be able to assimilate data, however.

I ran across a piece on the “clickiness” of EHRs. I deal with doctors day in and day out who refuse to come to training, yet expect to be instantly proficient in use of EHR, CPOE, and other systems. When they’re not, they blame it on the software. Having been a user of most of the major EHR vendors out there at one time or another, I know that they all have their issues. My favorite comment:

We don’t assume that someone can step up to a piano and play all the right notes to a complicated piece of music with no training. Yet for some reason, we think that a doctor can step up to a complicated piece of software (EHR for those following at home) and quickly navigate all of the features of the software. Training matters and can make the world of difference in how you feel about the number of “clicks” you have to do in your EHR.

Too true. Even with the most intuitive design, physicians who try to leap into seeing patients without adequate training will feel stressed and likely fail. The requirements of documentation (thanks to CMS, payers, regulators, and uber-conservative compliance departments) have become so cumbersome that documenting a visit is like playing a video game – you just have to figure out how to get to the next power-up. Those that recognize it for what it is (just another hoop we have to jump through to get paid) seem to do much better on the learning curve. Yelling at the IT department is not going to change what CMS thinks about documentation bullets and correct coding.



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

More news: HIStalk Practice, HIStalk Mobile.

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July 19, 2012 News 14 Comments

HIStalk Advisory Panel: Best Ways for Vendors to Engage Hospital Leadership 7/18/12

July 18, 2012 Advisory Panel 4 Comments

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

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

This report involves these questions, submitted by a vendor CEO. What are the most effective ways you learn about products and companies? What advice would you give that CEO about using his salespeople and other resources effectively to explore areas of mutual interest with hospital IT decision-makers?

What are the most effective ways you learn about products and companies?

  • HIStalk for one. HIMSS is another.
  • HIMSS national and local chapter meetings. Peer suggestions. Company website review. Google searches. Healthcare system / physician leader blogs. If I am still interested in learning more, then, and only then will I contact the vendor.
  • #1 HIStalk (kudos to you and your team – indispensable!) #2 HIMSS and other more specialized expos. #3 Occasionally through listservs and other blogs I follow.
  • Internet research if I am looking for a particular service or product. Trade shows if I am interested in what’s new on the market.
  • I read a lot. As problems arise or as I see something that piques my interest, I will contact a local partner to see how we get more info. White papers are a good thing and healthcare-specific press is good, too.
  • HIStalk, of course! Really, nice capsule summaries from blogs are more effective than glossy brochures, webinars, or other such efforts to snag my time.
  • CHIME’S CIO Fall Forum offers vendor access to many CIOs and other key resources through their program to engage through small groups forums. These sessions often are around how to market a new or different service or how to package a product. They are also good lead generation tools. Similarly, regional HIMSS and similar meetings, relationships with other vendors to offer a solution to a problem that crosses disciplines, can be effective. Sales cold calls either in person or by telemarketing are at best an irritation and at worst a total turn-off. E-mail is little better. I do look at sponsorship of HIStalk as a positive. The absolute best is a CIO acquaintance testimonial.
  • This is tough. There is so much noise you have to figure out a way to rise above it. A box in the mail always attracts my attention – I know it’s shallow, but it works. I get 100 junk e-mails (that get through my filters) every day — e-mail doesn’t work any more.
  • Honestly, I find out about companies through your blog. Not through the ads, but through the notice of implementation. I’m a buyer rather than a shopper, so I’m more likely to look at a product that has mentioned several times. Also, I don’t go looking for something until I need it – again, a buyer mentality rather than that of a shopper.
  • From my staff. Vendors often want to get right to the CIO or the CEO, but mostly we block these cold calls. Get someone on my staff excited about something and they can get to me.
  • Several recommendations. First, ensure you take time to learn about the provider organization… key clinical / business challenges as well as the current landscape of IT priorities. Nothing more annoying than a vendor who shows up and asks, “What are your challenges?” Second, ensure proposed / new product / service has a fit – innovative ideas that create real value for patients, offer a true opportunity to enhance operating margin. We’ve heard the other  pitches before and are overwhelmed with folks offering EMR skills, offering to “outsource” our data center or application teams. Nothing new there. We want to hear the new, innovative ideas, and don’t be shy about telling us where in the development cycle something is. If it’s new and we’d be the first to implement, just let us know upfront that you’re proposing more of a partnership. 
  • I pay attention to CHIME and HIMSS updates. I read all updates from Advisory Board and Healthcare IT News. The problem comes when I need a specific solution and have nowhere to turn. I know it is out there somewhere, but where? It is kind of like the red car syndrome — when you buy a red car, you suddenly see them everywhere. When I need a solution, all of a sudden I pay attention to the direct mail campaigns that bombard me. Most of the time they are irritating and quickly discarded, but always at least looked at from a cursory perspective.
  • Beside HIStalk? Word of mouth, other CMIOs.
  • CHIME sessions, introductory 1:1 meetings, regional seminars.
  • By researching on my own, speaking with peers, or working with my colleagues. Have to start with a business issue or need realized throughout the organization first.
  • Whatever they do, don’t cold call me. Trade shows are not bad as long as there is an introductory e-mail or mail piece sent ahead of time. I also like the vendor speed dating events, as I can learn more in 15 minutes of focused time with a company than any other way (effectively).
  • Often word of mouth from colleagues. Occasionally at a show like HIMSS. I do like HIStalk’s interviews and reviews on HIStalk Mobile because they seem to be more candor than fluff.
  • Websites such as HIStalk, Information Management Direct, Data Governance Institute, etc. White papers, with real case scenarios not fluff, distributed via websites.
  • I learn from reading blogs like HIStalk and in talking to friends at other practices (most of those opinions are very negative).
  • Throwaway magazines. Word of mouth from other CMIOs. News articles. Meetings (e.g., AMDIS). This is obviously not a great system, but it’s true.
  • Trade shows and conferences. The exhibit floor is a great resource, as are the networking events. 
  • Reading stories about their success. Conferences.

What advice would you give that CEO about using his salespeople and other resources effectively to explore areas of mutual interest with hospital IT decision-makers?

  • We have a local HIMSS meeting once a month that is always looking for a sponsor. A local EMR user group is always looking for a sponsor also. Another way is to figure out a way to get to the IT staff and have them sell it to the boss. Instead of trying to get on that CIO calendar or get through that CMIO door, network until you find the lead tech or application person and sell them first. The "C" folks have people beating down their doors and free lunches galore. A little attention to the folks in the trenches can go a long ways.
  • I have to go back to HIMSS and other ways of getting in the door without taking time out of their busy schedule. It is not easy and it is getting harder, so you have to be open to thinking outside the box. A "lunch for the IT staff" like the clinicians get every day. How about free education combined with selling?
  • Get to the point. What exactly does your system do and how does it avoid my pain? And Dear Lord, skip the buzzwords of industry-leading, complete platform solution, etc. I can’t tell you how many product descriptions I’ve read in entirety and still had no
    idea what they did. Videos take too much time – don’t bother. The message has to be something that can be delivered in a quickie pitch, single e-mail, single web page, etc. Provide more info if desired, but any extra required steps puts off that many more execs. Possibly ask for a simple e-mail address but not much more.
  • First, understand our business and local relationships. Second, DO NOT cold call or e-mail requesting to introduce yourself. I rarely read or listen to the entire message and immediately delete. I do not have time to participate in “fishing expeditions.” Third, get involved with local tertiary organizations (sponsorships) and events. You first have to establish a relationship, then understand us before we will then seek to understand you or your company.
  • Fairly simple: ask what problems they want to solve. Don’t offer a solution and try to find a problem it can solve. Be prepared to not see an immediate ROI or anything and at the same time be ready to experiment with a few new areas where you might not see the payoff.
  • As someone in the same shoes as this CEO (i.e., a vendor), we’ve been lucky in that we can typically get in the door for a brief conversation based on our benefits of revenue enhancement and similar “hot button” issues that are top of mind for them. That said, given they are incredibly busy and operate at broader stroke level, once you’re in, your team will need to deliver your message very clearly and succinctly in a way that they can grasp the concept and benefits quickly and basically make the decision your solution is worth pursuing or at least exploring further to get it to the next step or person who’ll dive deeper. We’ve been very successful with this model.  a. Internet research if I am looking for a particular service or product. Trade shows if I am interested in what’s new on the market.
  • I could write a book on this topic. It’s more about what not to do. Here are a few suggestions. (a) Respect the CIO’s time. Whether its voicemail or e-mail, get to the point quickly and tell me how you are going to solve my problems and intrigue me enough to contact you. Of course to do that you need to know something about my organization, so do your homework on me and my organization before contacting. If you can find out what keeps me up at night and provide a solution, I’m all in. We constantly live in fear of something. Find out what that is or convince me I should be afraid. (b) Find someone who knows me. You’ll have a better chance if a trusted colleague introduces you. (c) Do not sell to users or go over the CIO’s head. Most CIOs have big egos, so this is a non-starter and will only tick them off. (d) Try starting lower down in the IS organization. Most CIOs will listen if a subordinate leader feels that CIO should meet a particular vendor. (e) Offer a free trial or some sort of risk-sharing proposal. If I know you are offering to put skin in the game, I am more likely to listen.
  • I know I don’t meet with new vendors often. I don’t listen to cold call voice mails and don’t really read spam e-mail. It has to be through a mutual contact or something I am looking for if I am going to talk to a new vendor. The best way in is through partners or resellers. All IT departments have them and they work closely with the management team. That is the best inroad to the department. Local HIMSS groups or industry groups like that would be a great way in also.
  • The cold call approach will not work. The cold e-mail approach won’t either. Finding a method that can present a forum for general questions, before any specifics are identified for commonalities, is most productive, and lets me weed out those with whom I can find no area(s) worth pursuing.
  • No hard sell. Solve a problem for me and be respectful of my time and the organization’s limited resources.
  • From a vendor perspective, direct access to the C-suite is difficult. In many cases when you do get access, you have a very small window of time to make an impression. If that C-level doesn’t have what you are pitching on her radar at that particular moment, your chances of progress are greatly diminished. What I have always tried to do, and coach our sales people to do, is become part of the community in which we sell. Participate (not just join) in organizations that support the local medical delivery area. Attend meetings and offer to speak about subjects (not a sales pitch) that interest the participants. Help make connections with other executives. Get to know the executives and let them get to know you as a person who is helpful and a thought leader. Once something appears on their radar that you can help with, the chances are pretty good they will remember you and reach out. It sounds like a really slow way to build a pipeline, but that is not the point. Opportunities happen every day, and if you are connected, you will find them by being a known quantity. Executives in any market leverage their network of contacts and associates to get things done when they need it. Healthcare is no different. The best sales people I know are those that build the best relationships. Nobody really sells ice to Eskimos.
  • We almost all participate in some kind of association. HIMSS is obviously the big one, but there are local organizations that offer more meaningful networking opportunities. This is where the vendor needs to hire experienced people. They already have the relationships established.
  • Offer white papers and case studies. Please don’t call me or send me e-mail because I will just delete it. Don’t call, because I won’t call you back. Partnering with a customer to present a Webex of a business problem that they solved together is appealing.
  • Google. So much about our organization is in the public domain. Look at a map—see what hospitals are close to us and then investigate what they are doing. Chance are good that we know and care about our competitors.
  • Set up a focused briefing with multiple decision-makers in the room. Nothing is going to happen without CIO insight, consent, alignment. We have found, however that briefing sessions, if well-coordinated and with the right IT and clinical resources in the room, are a good use of time. Education for the provider team plus exposure to the right audience for the vendor. In a large provider organization, what’s not effective is having lots of one-off conversations with local hospital folks. Understand the provider’s governance and decision-making process.
  • Make the investment to attend conferences. At these small conferences (IHT2 ,for example, in Fort Lauderdale a few weeks ago) I spoke to every vendor there. It was a good event.
  • I would see it as an iterative process. You get one customer, give them a good deal, use their story (and people) to get the next, larger, bigger name customer, and repeat. Write articles for blogs, "throwaway" journals, newsletters. If your niche is small, a well-titled article in a throwaway will catch my eye. I can delete about 100 unsolicited e-mails a minute and my secretary doesn’t take cold calls. It would be sneaky, but you could get your first CMIO (your first customer) to go to the appropriate meetings and shill.
  • The least-effective way is the cold call—can’t delete those fast enough. HIMSS has lost its charm for me, so a booth in the nether regions of the exhibit hall is not a good use of limited funds IMHO. A short, well-written e-mail that clearly identifies the problem the vendor is seeking to solve with a link to a web site/demo video is often an effective first encounter. An article in one of the trades can be a good route too. Obviously, the best answer is to network and know the potential customer’s situation and needs. AKA, targeted marketing.
  • Work with someone in the industry such as an ex-CIO who can open doors for 1:1 intro meetings or small group events in local markets with a select group of CIOs to discuss the product offering in an intimate, non-high pressure environment.
  • It is not easy for salespeople to reach me – that is by design. I get more cold calls than I can care to listen to and delete voicemails as soon as I realize it’s an unsolicited call. As much as it can be irritating to me and the rest of the IS department, it’s best for vendors to connect with the business units that may benefit from their offering. I look at the IT role as one of guidance and support. We can run a project, crunch numbers, negotiate contracts, evaluate technology, etc. We aren’t the ones to evaluate the true business need, but we can lead our internal customers through the process of evaluation.
  • There needs to be a compelling reason for me to become educated on the product and to see if it fits a need that we have. Sales is tough. Getting in front of a CIO is tougher. And going around IT to get the message out if it is a tech play is the kiss of death. Companies have to be patient, too. Just because you have the greatest thing since single malt scotch does not mean we are ready to consider it.
  • Every CMIO and CIO these days is totally deluged with requests from all kinds of vendors, large and small. It’s overwhelming, and almost impossible to determine who is selling a useful product. To be honest, I rarely make time for salespeople any more. I’m more likely to talk to a company CMO or clinical resource if they reach out to me.
  • We are busy and don’t have time for drop-in or sales calls. Sending information i.e. white papers is an easy way to generate interest. Have one or two current users present when you attend or present product at local / state / national meetings- they can give real life examples of why the product is good.
  • Cold calls are never good – best to leverage if some kind of relationship to the company already exists or leverage a conference where leaders are there to be looking at other vendors and technologies. Larger health systems are increasingly placing emphasis on ‘vendor management’ departments within IT and working through this groups can be useful since they are usually involved in determining partner vendors and vendor selection processes.
  • Acknowledge to me that you understand that I’m busy and that I may already have the equivalent of what you are selling (at least I think so). Offer to look at what I already have to see if there’s ways that you can help me. If no, say so, retreat and fight another day. Don’t ask the CMIO about things that are the CIO’s realm and vice versa – nothing I hate more than when a vendor has talked to my CIO about systems that impact clinicians without talking to me first or talking with us together. If you’re talking to a CMIO or CIO in a hospital system, don’t go directly to the docs or to individual hospitals – that’s a real no-no.
  • My number one rule is that all messaging from sales to CXO level needs to be focused on the business issues of the CXO and their organization in their market. Not focused on me, the vendor, my cool product, my cool customer base, my cool technology. Cut out all the buzz talk, marketing speak, tech speak, and really study the provider and their town. Who are their competitors? What is their market share? What are their financials like? What do their physician customers and patient customers think of them?They need to open their conversations with a provocative message that shows they have done their homework and know the business. Let that conversation flow until the customer says, “Hey, can you help me with that issue?” Salespeople need to be customer experts, not product experts.
  • This is an interesting question in that the answer has changed drastically in the last five years. It used to be easier to engage with management, no matter how busy, because it could be done after hours – dinner, a sporting event, drinks. Now, however, more and more facilities have purchasing guidelines in place that prevent employees from taking anything from vendors, including meals. This means that all meetings have to take place during already jam-packed days, resulting in fewer opportunities to build relationships. It has become more of a 15-minute elevator speech opportunity rather than a relationship-building opportunity. Because of that, an effective plan seems to be: e-mail contact, phone contact, correspondence through e-mail with questions and answers, in-person meeting, follow-up information through e-mail and calls. Much less personal, but still effective.
  • His salespeople better know his clients really well.
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July 18, 2012 Advisory Panel 4 Comments

News 7/18/12

July 17, 2012 News 2 Comments

Top News

7-17-2012 5-59-27 PM

Shareholder materials from Quality Systems, Inc. (NextGen) indicate that “dissident shareholder and current Board member” Ahmed Hussein has launched his fourth attempt to gain control of the company by nominating his own slate of director candidates. In announcing his action, he said, “I am confident in the potential of Quality Systems, but a hand-picked board is allowing the non-executive chairman to be declared an independent director and act in an inappropriate executive capacity.” Most interesting is that one of his director candidates is Pat Cline, the former Quality Systems president and chief strategy officer who retired in 2011.

Reader Comments

From HIT Guy: “Re: shifting capacity in the Madison market. I know there is some behind-the-scenes software that looks for doctors making referrals out.” Insurance company Physicians Plus says it will save $30 million per year in moving services from UW Hospital to Meriter.

From Stephen Yoder: “Re: prescription drug abuse. Do you think efforts like this will help?” Any solution that involves restricting the supply and not the demand is doomed to fail – all that does is raise prices and thus profits for those selling drugs. Much of the country has been blasted out of its mind since the 1970s when Valium and Librium became the mother’s little helper of choice. Drug companies have convinced patients and doctors that everything from difficulty sleeping to minor pain requires immediate pharmacologic intervention, and you don’t hear patients complaining about popping pills. Even if you completely shut off the flow of illegal drugs, you’d still have millions of people altering their consciousness with legal ones. I don’t know the answer since routine drug use no longer carries much of a stigma when everybody’s grandma is doing it.

7-17-2012 5-21-36 PM

From Doc Martin:“Re: Martin Memorial in Florida. I’ve heard their Epic installation is not going well. Supposed to cost $80 million and now north of $100 million and still climbing. The stuff is not working well and their A/R and billings are a mess.” That’s not the case, VP/CIO Ed Collins says. They hit a few snags early, but are now meeting their budgeted revenue and A/R targets. The $80 million number was spread out over 10 years and they are pretty sure they’ll meet or beat that number. Martin successfully attested for MU Stage 1 for Medicaid and Medicare last week.

7-17-2012 5-27-09 PM

From HITEsq: “Re: McKesson lawsuit. A small Texas practice is suing McKesson for a failed EMR install. It’s not clear what happened, but there are complaints about failing to transfer patient histories, a weird HIPAA violation, and the price of hardware. They’re seeking less than $100K in damages.” It’s something about copying records from one practice to another when the former office neighbors went their separate ways, but only for patients that were moving to the new practice. The new practice’s doctor says McKesson couldn’t copy just the specific records, so they copied everything. We haven’t heard McKesson’s side of the story, but it sounds like the doc should have done more due diligence, as evidenced by complaining the lawsuit that the contract required the practice to buy the “severely overpriced” hardware from McKesson. I would hope the parties will settle instead of making their lawyers rich.

From A CEO: “Re: ambulatory healthcare IT market. Lots of rip and replace. Significant teasers from investment bankers on EHR deals. Practices that sold their souls to hospitals are getting a peek at reality.”

HIStalk Announcements and Requests

Today’s post may be a bit less comprehensive and more likely than usual to contain grammar or spelling errors. I missed work today (which almost never happens) with a temperature of 101.5 and I’m feeling less than stellar, but I’ll do what I can despite fuzzy cognition and sweat dripping onto my keyboard.

Here’s a brief Listening, involving the singer-songwriter genre, which I usually detest because I don’t like warbled twee love songs. My one and only exception: John Dawson Read, who had a modest hit or two in the 1970s and then disappeared from the music industry. I first heard this song, which he wrote about his friend Tommy Davidson (not the guy from In Living Color) going blind from muscular dystrophy, many years ago on late-night radio when it was already old, and I never forgot it despite only one listen. I just happened to run across it on YouTube this week. Pure genius. He’s even making new music after a three-decade break.

7-17-2012 6-02-30 PM

Welcome to Wellcentive, joining HIStalk as a Gold Sponsor. The Roswell, GA-based company offers solutions for population management, care management, Patient-Centered Medical Home, and accountable care. Consider its Advance Outcomes Manager, an open, cloud-based data aggregation platform that provides analytics, risk modeling, and a clinical rules engine for management population health and quality (here’s a case study from Lakeshore Health Network). Clinical decision support capabilities include care gap alerts, medication reconciliation, patient report cards, and secure messaging. It’s pretty cool that the company announced its sponsorship, although making me blush by calling HIStalk a “thought leader” (although maybe it’s my pyrexia that’s causing the blushing.) Thanks to Wellcentive for supporting HIStalk.

My predictable YouTube foray turned up this recent video on Wellcentive’s Advance Outcomes Manager, which explains it in two minutes.

Acquisitions, Funding, Business, and Stock

7-17-2012 4-37-48 PM

Zebra Technologies acquires LaserBand LLC, a maker of patient ID wristbands.

Internet-based transcription provider iMedX completes the acquisition of the medical transcription assets of Electronic Medical Transcription Services (eMTS).


Epic Medical Center (OK) selects RazonInsights’ ONE solution for inpatient clinicals, financials, and ambulatory practice management.

Hacienda HealthCare (AZ) purchases Healthland Centriq EHR for its 15-bed hospital and long-term care facility.

Pacific Health Corporation (CA), Physicians for Healthy Hospitals (CA), and Optim Healthcare (GA) select McKesson’s Paragon HIS.


7-17-2012 4-42-32 PM

The SSI Group announces the retirement of Bobby Smith, its founder, CEO, and president. VP/CFO James M. Lyons will replace him.

7-17-2012 4-44-00 PM

Former Vitera SVP Lee Horner joins Eliza Corporation as SVP of sales for the company’s health engagement management segment.

7-18-2012 7-40-40 AM

EnovateIT appoints Mike Wilson (Compuware) as its chief strategy officer.

Huron Consulting Group promotes Hazel Seabrook to lead the company’s clinical operations solution within Huron’s healthcare practice.

Maxim Healthcare Services appoints Andrew Friedell (Medco Health Solutions) as VP of government affairs.

Announcements and Implementations

The Hawaii Island Beacon Community announces the expansion of its Alere Wellogic HIE following a successful pilot at North Hawaii Community Hospital.

Hunterdon HealthCare Partners establishes an ACO with Aetna using Medicity’s HIE technology.

ADP AdvancedMD deploys its 2012 Summer release, which includes an iPad app, new ICD-10 tools, and workflow improvements for pediatrics.

ICA announces the launch of Kansas Health Information Network’s direct messaging capabilities.

7-17-2012 4-47-26 PM

NCHICA and Oak Grove Technologies create a mobile app of the HITECH Act Breach Notification Risk Assessement Tool. Its $1.99 on iTunes.

Amcom Software releases Version 5.0 of its critical test results solution, which it recently acquired from IMCO Technologies. It has earned FDA’s 510(k) clearance as a Class II medical device.

Botsford Hospital (MI) joins the Michigan Health Connect HIE.

Orlando Health’s neurologists use Polycom’s RealPresence to assess and treat stroke patients from their tablets. The health system will expand its use of the technology to trauma collaboration.

Aprima announces an app to provide mobile EHR access on iPhone or Android devices.


The CDC finds that 55% of US doctors use some type of EHR, with 85% of them reporting being either somewhat or very satisfied with its day-to-day operations.

Weird News Andy says this is what happens when the government runs healthcare. In the UK, NHS addresses budget cuts by suggesting that all provider contracts be redrafted, to include pay cuts, elimination of overtime and holiday pay, and reduced vacation. If they don’t like it, they’ll be let go.

Two UK hospitals say that problems with their Cerner Millennium implementation caused appointments to be cancelled or were mailed to patients with incorrect dates, requiring the spending of $7 million to fix the problems. However, an independent review says the hospitals themselves were the problem – they didn’t have enough skilled employees, training was inadequate, they let IT run the project instead of operational leadership, and the trust ignored outside advice and declined to follow its own governance processes.

Sponsor Updates

7-17-2012 6-20-40 PM

  • Allscripts VP of Strategic Initiatives Rich Elmore provides details of his one-year leave of absence serving as ONC coordinator for Query Health.
  • MedHOK achieves 2012 Disease Management performance measures certification for its 360Care software.
  • University of Louisville Hospital is using Access Intelligent Forms Suite to import electronic documents into Siemens Soarian without manual indexing.
  • Beacon Partners offers a hospital roundtable discussion white paper on ICD-10.
  • Surgical Information Systems releases the results of its survey showing that surgeons view technology as a tool to reduce errors and improve quality of care.
  • eClinicalWorks, Allscripts, GE, NextGen, and Greenway are named among the top nine EHR vendors the Office of Inspector General in a report on the progress of EHR implementations.
  • Alfa Insurance selects Kony Solutions to launch its Alfa2Go mobile app.
  • Streamline Health Solutions and nTelagent enter into a joint marketing agreement to support revenue cycle improvements and patient access.
  • INHS announces that 16 of its clients have been named “Most Wired” hospitals for 2012.
  • Cloud-MD contracts with DrFirst to integrate DrFirst’s e-prescribing capabilities into Cloud-MD’s PM/EHR.
  • Iatric Systems highlights how its PtAccess solution enabled Griffin Hospital (CT) to successfully meet Meaningful User criteria.
  • Digital Prospectors Corp receives three awards in the Top 2012 Businesses of New Hampshire.
  • Macadamian’s Director of Research Lorraine Chapman presents best practices at the 9th Annual Healthcare Unbound Conference in San Francisco this week.
  • Culbert Healthcare Solutions promotes Tom Gantzer and Jason Drusak to managers of Epic Consulting Services.
  • An AT&T-sponsored physician practice technology survey finds that 37% of practices have fully implemented an EHR. Expense continues to be the top reason practices say they’ve not done so.


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

More news: HIStalk Practice, HIStalk Mobile.

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July 17, 2012 News 2 Comments

Curbside Consult with Dr. Jayne 7/16/12

July 16, 2012 Dr. Jayne No Comments

Last month, I threw out a challenge for vendors to brag about their use of physicians and other clinical experts in design, implementation, and support. I’m a bit surprised that certain vendors were so quiet. I know of at least a handful that have large physician teams in addition to significant numbers of other clinical professionals, but I didn’t hear a peep out of them.

I offered priority placement to companies with witty submissions and was not disappointed. The grand prize goes to this one. While I must keep them anonymous, their piece left me grinning like a Cheshire cat. I’ll let them speak up and claim it if they decide to get approval from The Powers to make a public statement:

As the IS department of a multi-specialty group practice, we are bucking the trend of buying vendor software and living with the consequences. Instead, we develop the majority of our clinical software in-house, which provides tremendous advantage and incentive. We eat our breakfast 300 yards from 4,000 medical staff who are trained to kill us, so don’t think for one second we can code with apathy, charge for upgrades, and not be nervous.

When you develop software for an aggregate group of faceless customers, you come to work with a different perspective than when you develop software for the physicians that will sign off on IS raises. The age-old question posed by efficiency expert Bob Slydell, “What would you say you do around here?” to engage physicians in software design is tackled next.

7-16-2012 4-14-24 PM

Last year, IS made the organizational transformation from Waterfall to Agile development. To better facilitate and support active provider involvement, we implemented new technologies and architectural platforms, remodeled our workspace, and completely changed the way we work with operations (including providers and support staff.) We created transparency in everything we do and greatly enhanced our channels of communication, transforming from a culture of “Us vs. Them” (operations vs. IS) to a culture of “We” collaboration and teamwork. (we habitually hold hands and break into stirring renditions of Kumbaya!)

Our providers now work closely with us throughout all stages of development, often meeting one or more times per week and are also readily available via e-mail – both our product owners (the providers ultimately responsible for driving the solution) as well as other members of the workgroups created to support the product owners. These cross-functional workgroups are composed of other providers along with members of various operational departments, including care coordinators, administrators, patient financial services, HIM, support staff, ancillary departments, and more. (we even include fictional characters to keep the meetings lively.)

As we develop working prototypes, we regularly engage willing providers, residents, and support staff in focus groups and usability testing in our state of the art usability lab (the unwilling are goaded by inviting them to the same lab under false pretense of providing pizza and light snacks.) In addition, our user experience design research team comes in to give a green light to the product or send it back for more iterations. (reminds me a lot of French class, Fait Encore!)

Requirements workshops, interviews, surveys, and design workshops are yet other methods we utilize to give our providers a voice in our projects. They, in turn, provide a plethora of much appreciated input.

Happily serving our providers so we can still afford to eat,

The IS Department

It’s hard to top that, so I’m going to leave this team standing on the first-place podium. More to come in next week’s Curbside Consult.



E-mail Dr. Jayne.

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July 16, 2012 Dr. Jayne No Comments

Monday Morning Update 7/16/12

July 14, 2012 News 4 Comments

7-14-2012 3-29-33 PM

From The PACS Designer: “Re: Bromium Microvisor. An interesting concept is forming at Bromium in the development of a micro-web browser within your main web browser. The Bromium Microvisor encapsulates e-mails, PDFs, and other documents within a micro-visor so that malware can’t infect your operating system. When you delete an e-mail or other document, the malware is deleted as well, and your operating system is protected. This concept may be a solution to consider for healthcare institutions who have to daily deal with numerous mobile devices.” Bromium is a lightweight and transparent hardware-based utility that limits what a launched malware application can do, isolating it so it can’t infect anything outside of its own assigned micro-virtual machine even if the malware penetrates company e-mail or secured sites. A standard laptop can run hundreds of simultaneous micro-VMs, each of which run in their own little world without running a separate instance of the operating system. It would be great for bring-your-own-device security, but only if your own mobile device runs Windows on an Intel processor (not likely) since that’s all Bromium supports at the moment.

7-14-2012 2-31-10 PM

From The Borg: “Re: resistance is futile, you will be assimilated – signed, Epic. This may have always been out there, but in the 2012 release, they have renamed ‘Now Showing’ as Epic Earth.”

From DBD: “Re: video. See Death by Deletion.” I think I’ve mentioned this before since it’s an old story. Whistleblower and risk manager Patricia Moleski claims her former employer, Adventist Health System, manipulated electronic patient information for various reasons to protect itself against liability. She also claims that a bug in AHS’s Cerner system caused patient injury and death. She says she was then fired, legally bullied, and intimidated by gunshots to her house and the burning of her car. That’s her side of the story, which I would be cautious about taking at face value without hearing the other side. She’s not mentioned on the Web very much, other than by sites catering to workers’ rights and those who claim the Adventist faith is a cult, so I don’t know what happened with her claimed involvement as an informant with the FBI, which she says was investigating her charges. This incident is a couple of years old, so you would think it would have been resolved one way or another by now.

Listening: new from Marina and the Diamonds, which is really just quirky Welsh-born singer-songwriter Marina Diamandis and her backing band. She’s intentionally playing the character of a witty, cynical, and insightful pop star with an American celebrity attitude, fronting music that ranges from faux bubblegum to 80s New Wave. Good for fans of Florence + The Machine, although the less-concepty first album (The Family Jewels) is probably a better starting point.

7-14-2012 1-33-28 PM

Go after insurance companies if you want to control healthcare costs, said respondents to my most recent poll (though they are also suspicious of malpractice attorneys). New poll to your right: will telehealth improve healthcare quality and/or reduce costs? Before complaining that I should have included 20 other answer choices (as a few folks always do when faced with the polarizing characteristics of questions with a Boolean answer choice), note that you are not only permitted but actually encouraged to add a comment after you have been forced under duress to choose one answer or the other. That’s where you may opine more extensively than your allotted one click allows.

7-14-2012 12-57-00 PM

Thanks to new HIStalk Platinum Sponsor CommVault, whose Simpana solution allows its health system clients to protect, manage, and access their organizational information. Hospitals use Simpana’s single console to manage all of their enterprise information: application data, messaging, files, and databases, from laptops to the cloud. Simpana bundles backup, archiving, and reporting into a single platform. The company is partnering with EMR and PACS vendors to simplify healthcare data management, ensuring security and compliance, managing data growth, cutting storage costs by up to 50%, and supporting the establishment of a common set of data and information management policies. Data growth has messed up the backup and restore capabilities of many organizations, motivating 16,000 users to save time and money by leaving NetBackup, Networker, and TSM behind and moving to Simpana (CommVault has conversion tools). If you run legacy backup software, CommVault suggests that you ask these five questions before renewing your maintenance agreement. Thanks to CommVault for supporting HIStalk.

I headed over to YouTube to look for a CommVault Simpana overview, so here’s a webcast that explains it. I also found this Gartner video that includes an interview with CommVault customer Sharp HealthCare, as VP Teri Moraga talks about the health system’s storage needs and solutions at around the 6:30 mark (and why they switched to Simpana at around 9:15).

7-14-2012 1-37-09 PM

Dr. Jayne has previously pontificated on both the zombie apocalypse and smartphone addiction, so I thought of her when I saw this.

7-14-2012 2-08-48 PM

The Florida National Guard hosts representatives from five Caribbean islands to discuss the military’s use of electronic medical records.

7-14-2012 2-36-30 PM 7-14-2012 2-38-22 PM

Penn State Hershey Medical Center names Rod Dykehouse (ProHealth, UCLA – left) as CIO. Former CIO Tom Abendroth MD (right) will become the hospital’s first chief of medical informatics, leading efforts to use its EMR to improve care and research.

Former Mediware COO John Damgaard is named president of nursing home software vendor MDI Achieve.

Huntington Memorial Hospital (CA) chooses Infor’s Lawson solutions for financial management, supply chain, and analytics.

7-14-2012 4-25-52 PM

Representatives of a local hospital district in Minnesota are “reeling” after the breakdown of talks with executives of Essentia Health, which leases the 25-bed critical access hospital. Hospital board members complained that Essentia isn’t investing in Essentia Health – Sandstone and gave notice that the board was cancelling Essentia’s lease that expires in August. Essentia then fired the top two hospital executives and said it would exercise its option to buy the hospital outright. The two main issues are hospital oversight and the EMR system used by the hospital, which they want to keep instead of replacing it with Essentia’s system (which I believe is Epic.)

The San Francisco business paper mentions that Washington Hospital Healthcare System (CA) is halfway through its $86 million Epic implementation.

The Joint Commission revises its standards pertaining to the use of scribes in hospitals, adding Physician Assistant as a professional for which scribes may perform EMR documentation under their supervision (along with physicians and advanced practice nurses.) TJC also specifically said that scribes should not enter orders directly into CPOE systems.

7-14-2012 3-10-15 PM

A BMJ article says the British government is premature in advocating the widespread use of telehealth as a way to cut cost and improve care, claiming that preliminary findings are inconclusive. One of the authors says her own hospital trust has looked at everything that might reduce hospital admissions and none of the potential solutions, including telehealth, has reduced the rate of increase. A previous study by the same trust concluded that increased efficiencies in discharging patients may have simply opened up more beds for doctors to fill, allowing them to admit more patients. I noted, however, that despite the imposing BMJ (the former British Medical Journal) on the article and a list of academic-looking citations, this particular article is a feature written by a freelance journalist. The same issue has several articles on telemedicine, though.

7-14-2012 4-06-30 PM

I’ve reported this previously: FDA launched electronic surveillance of its own scientists, intercepting the e-mails of those on its “enemies list” who criticized the agency. The FDA’s document imaging subcontractor botched the project by inadvertently posting the intercepted documents to the Internet, allowing anyone (including The New York Times) to read e-mails that had been sent to members of Congress and even the President. The scientists found out and are suing. Senator Chuck Grassley, upset that e-mails of one of his employees turned up in the surveillance database, called FDA “the Gestapo.” FDA used parental monitoring software sold commercially for $99.95 to spy on its scientists, who they suspected of leaking confidential vendor information about medical imaging equipment which they believe exposes patients to excessive radiation.

7-14-2012 4-15-13 PM

A Mississippi oncologist, her office manager, and her billing clerk plead guilty to overbilling Medicare and Medicaid by $15 million for cancer drugs. Prosecutors say the cancer clinic administered drugs while the doctor was overseas and also reused needles and diluted chemo drugs. The clinic was shut down and $6 million was seized from the doctor, but she has been held without bond because she has plenty of money left and is considered a flight risk to head back to her native India.

7-14-2012 3-55-13 PM

An editorial in The Australian says the government’s Model Healthcare Community Roadshow is guilty of misleading advertising in pitching that country’s $1 billion personally controlled e-health record (PCEHR). The critique says PCEHR may contain a few physician-uploaded medical summaries, but there’s no way for hospitals, EDs, specialists, or pharmacies to add information, and any updating that occurs is not real time. The road show truck shows diagnostic images even though PCEHR can’t accept images yet. The article concludes that as a voluntary system, doctors have already said they won’t rely on its information for making treatment decisions.


7-14-2012 2-44-27 PM

A Weird News Andy find: a California urgent care doctor suspected of writing prescriptions for cash examines an undercover officer, studying the x-ray the patient brought in and helpfully pointing out the bones causing the pain for which the doctor recommended “Roxicodone? Or oxycodone? Or whatever you want.” His diagnostic acumen might be questionable, however, given that he missed the fact that the patient had a tail, according to the x-ray (which was actually of a German shepherd and was clearly labeled as coming from an animal hospital). The doctor, who was previously convicted of taking kickbacks for Medicare home health referrals, was arrested for improper prescribing.

Vince ties up loose ends on HMS, including taking an interesting peek into what systems the under-100 bed hospitals use and what they cost. For the next HIS-tory, Vince will start a series on Keane. He’s looking for help from anyone with details about the companies Keane acquired over the years — Source Data Systems, Infostat, PHS Patcom, CHC, or Pentamation / Ferranti. If you can help out with fun anecdotes or yellowing documents, e-mail Vince. He is always effusive with his thanks and generous with his acknowledgments.

E-mail Mr. H.

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July 14, 2012 News 4 Comments

News 7/13/12

July 12, 2012 News 10 Comments

Top News

7-12-2012 10-36-00 PM

University of Virginia settles its $47 million breach of contract lawsuit against GE Healthcare over what it claims was a botched IDX implementation going back to 1999 (the suit wasn’t filed until 2009.) UVA wanted a refund of the $20 million it paid IDX (later acquired by GE Healthcare), but GE said UVA violated the contract by neglecting its own responsibilities related to project staffing and workflow analysis. UVA signed an Epic contract, then terminated its agreement with GEHC. Terms of the settlement were not disclosed.

Reader Comments

7-12-2012 8-18-02 PM

From HITEsq: “Re: Allscripts and Cerner. Both sued by RLIS for patent infringement. Based solely on the complaint, it appears that RLIS tried its hand at the EMR industry in the late 1990s and failed.” I’ve never heard of the company, but they did file the lawsuits.

From Lindy: “Re: MD Anderson. They got tired of trying to build their own EMR over the past eight years when everyone around them is up on Epic or Cerner. Their new president probably forced a fresh look at the huge costs and minimal results from their internal software development effort.” Unverified, and I assume speculative based on the wording provided. If it’s true, I would add one comment – the vendor pickings were slim back when MDA first started developing ClinicStation. Then-CIO Lynn Vogel wrote on HIStalk about their development work in January 2009.

7-12-2012 10-38-37 PM

From Newport: “Re: Capsule. Acquired by JMI Equity. The press release makes it sound like this was simply an investment, but it is an outright acquisition of 100% of the shares.” Capsule announces a strategic investment from JMI Equity and the appointment of Gene Cattarina as CEO, replacing Arnaud Houette (who will remain on the company’s board). Cattarina’s background includes executive roles at Impulse Monitoring, Lynx Medical, E&C Medical Intelligence, Landacorp, Medicode, and TDS Healthcare Systems. Some of JMI’s other healthcare IT holdings are Navicure (revenue cycle management),  Courion (identity management), and PointClickCare (EHR for long-term care.)

From Ross: “Re: reading suggestions. I’m a relative newcomer to HIStalk and to the industry in general. I’m interested in reading suggestions to deepen my understanding of the field. I’d love to know what readers are reading, even if it’s not about healthcare.” Leave a comment if you’d care to pass along suggestions to Ross.

HIStalk Announcements and Requests

I’m back from vacation, sort of. Even though I posted several times that Inga and I would be out this week in a rare but unavoidable simultaneous absence, a few folks kept e-mailing the same requests every day, apparently either unwilling to believe that we aren’t hard wired to e-mail 24×7 or thinking that a lack of immediate action on our part meant we were being unresponsive and thus in need of a more forceful request (I really dislike that about post-iPhone electronic communication – expectations for e-mail are what they used to be for instant messaging, where a delay of more than a few hours is perceived as being irresponsible.) I figured I might as well forget the rest of vacation, come home early, and get back to work. I was annoyed enough that I cancelled a new sponsor who was e-mailing me daily wanting one thing or another immediately, even though I replied every time that I was on vacation and would get to it when I got back. For everybody else, I will most likely spend the weekend catching up before going back to work at the hospital on Monday. At least I got to take a short break, working only a few hours early in the week while enjoying time away with Mrs. HIStalk.


Parkland Hospital (TX) selects M*Modal Fluency for Coding(TM) in preparation for ICD-10.

Memphis Obstetrics & Gynecological Association (TN) chooses MED3OOO’s InteGreat EHR for its 24 providers.

South Hills Radiology Associates (PA) will implement McKesson Revenue Management Solutions for its 13-physician practice.

Jacobs Engineering Group announces a $20 billion contract award it won to provide a variety of IT support services to NIH and other federal agencies.

Announcements and Implementations

INTEGRIS Health (OK) deploys Amalga from Caradigm.

Quintiles and Allscripts partner to develop solutions improving processes for clinical and post-approval drug research.

Ten-bed Guadalupe County Hospital (NM) goes live on Medsphere OpenVista.


7-12-2012 7-55-57 PM

Here’s the latest cartoon from Imprivata.

KLAS announces a new enterprise imaging report, finding that the top two strategies are vendor-neutral archive and PACS enterprise archive solutions. Those surveyed mentioned GE and Philips most often as strategic enterprise imaging partners, while Agfa and Merge are mentioned most often for the VNA-centric strategy.

CSC begins laying off employees involved with the failed NPfIT project in the UK.

7-12-2012 10-44-59 PM

The local TV station covers the $70 million implementation of Epic (which they inexplicably spell EPIC) at Lee Memorial Health System (FL). It’s the typical TV piece, light on research and heavy on anecdotal chat, but aimed appropriately for laypeople with marginal interest.

7-12-2012 10-45-42 PM

FDA’s Jeffrey Shuren MD, JD, in an NPR interview, says some apps that behave as medical devices (like those that turn a smartphone into an EKG machine) need FDA’s review before marketing, but the agency has no interest in overseeing apps related to lifestyle, wellness, and management of personal medical conditions.

7-12-2012 10-47-55 PM

Weird News Andy finds this news cool, but scary (and asks, “First Amendment, anybody?”) The Department of Homeland Security has developed a laser-based scanner that can analyze people at the molecular level from up to 164 feet away, detecting everything from illegal substances to high adrenaline levels. It’s the last paragraph of the article that gets WNA’s attention: “Although the technology could be used by ‘Big Brother,’ Genia Photonics states that the device could be far more beneficial being used for medical purposes to check for cancer in real time, lipids detection, and patient monitoring.”

Sponsor Updates

  • Imprivata receives a patent for its “biometric authentication for remote initiation of actions and services.”
  • TeleTracking announces enhancements to its capacity management software to help hospitals manage length of stay and increased transfer center volume.
  • AlliedHIE (PA) and ICA announce the go-live of Allied-DIRECT allowing AlliedHIE to recruit providers to join the statewide DIRECT grant program established by PA eHealth Collaborative.
  • The Salvation Army and MedAssets partner to provide healthier choices in food and nutritional items at a better cost through MedAssets buying contracts.
  • OTTR will host a July 18 webinar demonstrating its soon-to-be released OTTR Mobile.
  • Merge Healthcare will offer OrthoPACS, its new image management and digital templating solution for orthopedics, as a subscription model.
  • A military-specific version of the Vocera Communications System earns the Department of Defense’s Joint Interoperability Test Command certification.

EPtalk by Dr. Jayne


NCQA offers a seminar on facilitating PCMH recognition. It will be held on August 21 and 22, with a session on PCMH Best Practices and Lessons Learned to follow. I guess that’s like a stiff drink with a chaser. I’m not sure I could handle three full days of PCMH, especially with the steep price.

The Institute of Medicine reports that as baby boomers age, the nation is unprepared to deliver mental health services to that population. I would argue that based on the decline of primary care and the challenges of Meaningful Use as well as the continued problem with Medicare payments, we’re pretty much going to be unprepared to deliver a lot more services than just mental health.

Wisconsin-based Asthmapolis receives FDA approval for its asthma inhaler sensor. The prescription device captures timestamp data on asthma attacks and transmits it to the company. Patients can use mobile and web software to track asthma symptoms and triggers. Additional features include text messaging for medication reminders.


IT staffers beware: a recent study links sitting more than three hours each day to a shorter life span. I wonder if they controlled for various different types of sitting? I think sitting in meetings viewing endless badly-done PowerPoint presentations will take much more off one’s life expectancy than sitting on the beach with an umbrella-bearing cocktail.

Hallucinogenic club drug ketamine (known as Special K) is being tested as a potential treatment for depression. Ketamine is used as a horse tranquilizer and as a sedative for pediatric patients. In adults, it can give them disturbing hallucinations. One scientist comments, “If not used carefully, we could end up curing depression with schizophrenia.” Anyone want to volunteer for that clinical trial?

According to a recent report, fear of errors in computer-aided E&M coding may lead physicians to code visits manually. The CEO of the American Medical Association is pushing for testing of coding recommendations during EHR certification. How about this: we convince CMS to institute a fair system for compensating physicians instead of giving them games to play with two different coding schemes and a nauseating array of arcane rules and aggressive auditors.

I appreciate the number of readers who were able to identify the photo of Harney Peak (also known as Black Elk Peak or Saint Elmo Peak) and especially those readers who didn’t cheat and load the link associated with the photo. The structure in question is a fire lookout tower – correctly identified by several other readers even if they didn’t know the specific location. Two readers tried to identify it as a fire tower near El Centro, CA which tells me there must be one pretty similar. Another thought it looked like an 18th century European signal tower, and having seen a few of those, I tend to agree. Our winner is Richard S., who gets the bragging rights.



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

More news: HIStalk Practice, HIStalk Mobile.

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July 12, 2012 News 10 Comments

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Reader Comments

  • Ex-Epic: Re: GDG's Epic List Pretty good stuff but I think 8 is questionable. Sure, there may be internal politics but it's on...
  • BostonHITman: Two things which would help expedite the realization of this paradigm: 1) A National Health ID - Enough with the para...
  • JT: The epic information is amusing but item 7 is a bit dicey. I sat in a benefits engine (billing backbone) class in 2007 w...
  • rxpete: Inga, Sad that you needed to make fun of those wearing Google Glass at HIMSS. Somebody with different tastes than you ...
  • The Alchemist: RE: Lois Lane. For one of the best free mapping tools on the Internet, please visit http://www.icd9data.com/. I...

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