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Readers Write: Managing the Complexities of Enterprise Platforms

November 15, 2013 Readers Write No Comments

Managing the Complexities of Enterprise Platforms
By Deborah Kohn

During August 2013, a Mr. HIStalk post reported the storing of patient (protected) health information (PHI) using consumer-grade services (a.k.a., enterprise platforms) that are cloud-based rather than on-premise-based. Disturbed by the post’s report, Mr. HIStalk replied with several rhetorical questions, such as,“What system deficiencies created the need to store [patient] information on consumer-grade services in the first place?” Later that month, Mr. HIStalk asked his CIO Advisory Panel to comment on policies or technologies used to prevent clinicians and employees from storing patient information on cloud-based consumer applications, such as Google Docs or Dropbox. Of the 19 replies, 60 percent block access to such services and / or have policies with random audits or other forms of monitoring.

Consumer-grade service and enterprise platform vendors include Google, Microsoft (MS), Accellion, Box, Dropbox, and others. The services (or applications or tools) provided by these vendors on their platforms include but are not limited to file storage / sharing and synchronization (FSS), mobile content management, document management, and, perhaps, most importantly, project and team collaboration.

For example, Google’s comprehensive suite of cloud-based services, Google Drive (FSS), includes but is not limited to Google Docs (collaborative office and productivity apps, now housed in Google Drive), Google Mail and Calendar, and Google Sites (sharing information on secure intranets for project and team collaboration). Box’s suite of cloud-based services includes but is not limited to mobile content management, project collaboration, a virtual data room, document management, and integration with Google Docs.

Historically, Microsoft SharePoint had been associated with on-premise document management and intranet content management. Over the years, broader, on-premise web applications were added to provide intranets, extranets, portals, and public-facing web sites as well as technologies, which provided team workflow automation and collaboration, sharing, and document editing services. SharePoint 2013 offers services in the cloud (and on-premise) and it includes but is not limited to Office 365 (the famous office and productivity apps, which now can be rented rather than purchased), Outlook (calendar), Exchange (mail), records management, e-discovery, and search.

I have worked with most of the above services and platforms in healthcare organizations. Since today’s digital experience is all about connecting and collaborating with others, I strongly believe the above services and platforms are important and useful for provider organizations, primarily because most of the services (or applications or tools) are not present in provider organization line-of-business systems. For example, with Google Drive, a resident can create a patient location spreadsheet in a cloud application, such as Google Docs, share it with colleagues, edit it on a tablet device, and push revisions to a collaboration site. Blocking access to these services penalizes employees by not allowing them to use robust collaboration tools.

In addition, I strongly believe the internal organizational policies and procedures that are developed for such services are sub-optimal at best. Unfortunately, most FSS services do not encrypt content, possibly exposing content to interception in violation of regulatory obligations, such as HIPAA. Yet organizational policies that manage encryption, backup, and archiving for content sent through email or FTP systems typically are not applied to the content sent through FSS services.

If provider organizations were to deploy formal information governance (IG) principles (e.g., electronic records management principles) with many of these enterprise services and platforms, onerous access blocking could be eliminated and policies and procedures could be improved. Unfortunately, like most services (or applications or tools), deploying IG principles for enterprise services is complex. In addition, deployment requires resources with knowledge of and experience in the information governance principles. However, the trade-off is that provider organizations can meet other legal, regulatory, and compliance requirements, such as e-discovery, without additional resources or effort.

As such, below is a step-by-step, basic, electronic records management guide to help protect what needs to be protected while allowing access to what needs to be shared and to gain value from cloud-based services and platforms while addressing compliance and governance standards.

  1. Clearly define as "documents" all content generated in (for example) GoogleDocs, SharePoint 2013, or Dropbox. A document is any analog or digital, formatted, and preserved "container" of structured or unstructured data or information. A document can be word processed or it can be a spreadsheet, a presentation, a form, a diagnostic image, a video clip, an audio clip, or a template of structured data.
  2. For legal and compliance purposes, declare as “records” those “documents” in GoogleDocs, SharePoint 2013 or Dropbox that 1) follow a life-cycle (i.e., the “documents” are created or received, maintained, used, and require security, preservation and final disposition, such as destruction); 2) must be assigned a retention schedule; and, 3) the content must be locked once the “document” is declared a “record”. Records are different from documents. All documents are potential records but not vice versa.
  3. Again for legal and compliance purposes, designate all the records as either “official” or “unofficial.” Official records include those documents that were generated or received in GoogleDocs, SharePoint 2013 or Dropbox and subsequently declared as records according to the above records characteristics. In addition, official records are created or received as evidence of organizational transactions or events that reflect the business objectives of the organization (e.g., receiving reimbursement for services provided, providing patient care); and qualify as exercises of legal and / or regulatory obligations and rights (i.e., have evidentiary and / or regulatory value). Unofficial records include those documents that were generated or received in GoogleDocs, SharePoint 2013 or Dropbox and subsequently declared as records according to the above records characteristics. However, unofficial records will not further organizational business, legal, or regulatory needs if the records are retained. Typically, unofficial records are retained only for the period of time in which they are active and useful to a particular person or department. Often organizational retention policies allow unofficial records to be retained for x number of years after last modification, but typically no longer than official records. Examples of unofficial records are (what are typically but erroneously called) working “documents”, draft “documents”, reference “documents”, personal copies of documents or records, and copies of official records for convenience purposes.
  4. Retain all the documents and official / unofficial records in GoogleDocs, SharePoint 2013 or Dropbox in separate, physically, but logically-linked electronic repositories. For example, “documents” can be stored on individuals’ hard drives. Once documents are declared “records”, the official records (e.g., patient records [including patient-related text messages / email messages /social media entries], employee records, patient spreadsheets, etc.) must be parsed and placed into a secured electronic repository, similar to the organization’s line-of-business system or systems-of-record repositories; e.g., EHR, Vendor Neutral Archive, financial system — with audit trails, access controls, etc. The unofficial records (e.g., working documents, reference records, etc.) can be stored on organizational shared drives.

Currently, many of the service and platform configurations and capabilities are not intended for long-term electronic record retention and security purposes and should not be used as healthcare organizations’ electronic repositories of official records. For example, no comprehensive, electronic records management, document management, or content management functionality exists on Google Drive. Once the record owners leave the organization and fail to reassign ownership, the official records could be subject to automatic deletion after x number of years. However, Google is introducing new Google Drive tools that might assist in better management of official records.

On the other hand, cloud providers are increasingly supporting content segregation, security, privacy, and data sovereignty requirements to attract regulated industries and are offering service level agreements and HIPAA business associate agreements (BAAs) designed to reduce risks. In September, Google announced a HIPAA BAA for the following Google App services: Gmail, Google Calendar, Google Drive, and Google Apps Vault. Alternatively, Accellion has extended its reach beyond data stored in its application by integrating with enterprise content management (ECM) systems, allowing users to connect right from their mobile devices to secured back end, typically on-premise repositories, such as SharePoint.

Deborah Kohn, MPH, RHIA, FACHE, CPHIMS, CIP is a principal with Dak Systems Consulting.

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November 15, 2013 Readers Write No Comments

Morning Headlines 11/15/13

November 15, 2013 News 1 Comment

Credit-rating agency downgrades Cone Health

Standard & Poor’s has changed its outlook on Greensboro, NC-based Cone Health from stable to negative based on poor financial performance. Despite more than 300 layoffs during 2013, Cone reported a Q3 operating loss of $17 million on $806 million in patient revenue. The S&P has affirmed Cone’s AA credit rating, saying that the financial problems of 2012 and 2013 were are based largely on one-time costs. Cone spent $90 million to implement Epic and $40 million in additional Epic operating expenses over three fiscal years, as well as adding 90 full-time employees to help with maintenance and operation of Epic.

Vendors Rushing to Mark Territory in Population Health Management Land Grab

KLAS releases a report evaluating the emerging population health software market, finding that no single vendor is leading but that a handful of vendors are beginning to emerge as early segment leaders.

IBM to open up Watson to third-party developers

IBM has launched an API that will allow developers to build applications that make use of the Watson Supercomputers ‘cognitive computing’ power. One developer that has already announced intentions of developing an app is Hippocrates, from MD Buyline, that will help clinical users make real time decisions.

DOD Seeks Value, Quality in Modernizing Health Records System

In a press release issued by the Department of Defense, DoD and VA Interagency Program Office director Christopher Miller outlined what has been happening with the DoD/VA integrated EHR project as of late. Miller wears two hats within the DoD, one heading up the DoD’s EHR vendor search and the other overseeing the VA/DoD interagency department responsible for successfully planning and completing the iEHR project. Miller’s letter highlights a focus on interoperability a need to pursue meaningful data exchanges so that the DoD can coordinate not only with the VA, but also with civilian healthcare systems that often provide referral services for active duty service members.

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November 15, 2013 News 1 Comment

News 11/15/13

November 14, 2013 News 7 Comments

Top News

11-14-2013 11-32-20 PM

Moses Cone Memorial Hospital (NC) sees its credit rating downgraded from stable to negative after spending $90 million to implement Epic, with plans to spend another $40 million and to add another 90 employees to support it over the next three years.

Reader Comments

From Head Scratcher: “That Allscripts announcement about implementing Sunrise at two newly acquired Montefiore hospitals comes just days after Montefiore announces the signing with Epic. Interestingly, Jack Wolf is not leading the Epic install.” Unverified.

HIStalk Announcements and Requests

inga_small Are you current with all the latest HIStalk Practice news? Some highlights from the last week include: “better-performing” practices use patient-satisfaction surveys to evaluate and improve practice operations. Doctors blame EMRs for slowing them down and reducing productive face-time with patients. Emdeon reports a Q3 loss of $16.2 million and a nine percent increase in revenues. Practices charge for online access to patient portals. Dr. Jayne’s personal physician shares impressions from NextGen’s User Group Meeting, including a review of the NextGen Patient Portal solution. Thanks for reading.

On the Jobs Page: Director of Business Development, Solution Sales Executive, Sales Excellence Manager.

Acquisitions, Funding, Business, and Stock

RightCare Solutions, a provider of decision support and transition of care technology developed by a University of Pennsylvania Nursing professor, raises $5 million in a Series B funding round.

11-14-2013 10-45-11 AM

Healthcare messaging company docBeat secures $1.1 million in a pre-Series A round.


Signal Health (WA) selects HealthUnity’s HIE, analytics, and PHR platform.

11-14-2013 11-36-12 PM

Albert Einstein Medical Center (PA) will integrate MedCurrent’s OrderRight radiology decision support system Cerner Millennium.

Wentworth-Douglass Hospital (NH) selects PatientKeeper Charge Capture and PatientKeeper Sign-Out solutions for its hospitalists and intensivists.


11-14-2013 4-04-26 PM

The Care Continuum Alliance appoints ICA CEO Gary Zegiestowsky to its board.

11-14-2013 10-47-47 PM

An internal McKesson email indicates that Kevin Torgersen, president of Imaging & Workflow Solutions, resigned this week for personal reasons. IWS will be reorganized under the acute care product line and several personnel changes were announced to employees.

11-14-2013 10-52-53 PM

Kevin Brown (athenahealth) is named VP of West Coast sales for CareCloud.

Announcements and Implementations

Accenture and The Phoenix Partnership deliver the first phase of an EHR across nine NHS systems in Southern England.

11-14-2013 11-26-55 AM

Virtual Radiology releases its free Radiology Patient Care benchmarking metrics.

Orion Health launches Rhapsody 5.5.

pMD announces ICD-10 Converter, which automates ICD-9 to ICD-10 conversion.

Government and Politics

11-14-2013 12-44-49 PM

CMS releases the Virtual Research Data Center, a data sharing tool that provides researchers access to Medicare and Medicaid data from their own workstations for performance analysis and data manipulation.

The Obama administration won’t require insurance companies to upgrade existing individual plans to meet ACA requirements for 2014 as long as the insurers notify consumers what ACA protections their plans don’t include and of the additional options available through insurance exchanges. The announcement comes a day after CMS revealed that 106,185 individuals had selected plans in the first period of open enrollment, only 26,794 of them through the federal exchange.


11-14-2013 1-00-29 PM

inga_small Even if I talked on the phone more I don’t think I would be an early adopter of this technology. Google files a patent for an electronic skin tattoo that sticks to your neck and serves as a hands-free microphone for your cellphone. The tattoo could also carry a lie detector that would detect skin response caused by nervousness. To be clear, I was a “no” before the lie detector part was mentioned.


In Oregon, a university-based pediatric intensivist remotely diagnoses a baby’s life-threatening bacterial infection using a telemedicine workstation controlling a robot-like device. The mother says the telemedicine technology “is the greatest thing ever invented” and does not think her daughter would be alive without it.

11-14-2013 10-39-54 AM

A KLAS report finds that no single vendor leads in the population health management tools market, though early leaders are emerging based on their portfolio breadth, experience, and ability to deliver. Those vendors include The Advisory Board Company, Conifer Health, Explorys, Healthagen, Optum:Humedica, i2i Systems, McKesson, Optum: Care Suite & Impact, Phytel, Premier, and Wellcentive.

Three US organizations win the 2013 Malcolm Baldrige National Quality Award, including Baylor Regional Medical Center at Plano (TX) and Sutter Davis Hospital (CA).

Steven Brady, SVP for administration at SUNY Upstate Medical University, resigns after the university discovers that he received outside income without permission from its affiliate MedBest Medical Management, which has a $22 million contract with the university to implement a PM/EMR system.

Sponsor Updates

  • Gartner positions CommVault in the leaders quadrant of its Magic Quadrant for Enterprise Information Archiving.
  • Kareo launches Kareo Marketplace, a solution center to help private practices identify cloud-based applications and services to optimize their operations.
  • VMware announces it will provide HIPAA business associate agreements to its customers.
  • Visage Imaging will demonstrate new features for its Visage 7 Enterprise Imaging platform at RSNA December 1-5 in Chicago.
  • The ICA-powered Kansas HIN reaches the connectivity milestone of providing access to more than one million patients.
  • Great River Health Systems (IA) shares how Encore Health Resources provided contract review and pre-implementation assistance while transitioning to Cerner.
  • EDCO Health Information Solutions recommends three point-of-care record scanning articles.
  • ICSA Labs offers five tips for keeping enterprises safe from mobile app threats.
  • Wolters Kluwer Health is providing a free emergency resources portal to Philippine hospitals and healthcare institutions in support of typhoon disaster relief efforts.
  • HIStalk sponsors named to Deloitte’s Technology Fast 500 list for 2013  include AirWatch, Awarepoint, Kareo, InstaMed, Etransmedia Technology, Allscripts, Liaison Technologies, SRSsoft, Greenway Healthcare, Halfpenny Technologies, Imprivata, Valence Health, Vocera Communications, and VMware.
  • Impact Advisors principal Laura Kreofsky discusses MU audits at next week’s Oregon & SW Washington Healthcare, Privacy & Security Forum.
  • Elsevier launches Elsevier Adaptive Learning study solution for improved learning and memory retention for healthcare professionals.

EPtalk by Dr. Jayne

I’ve been digging through provider quality reports this week and it’s so tiresome. I have to know which physicians are in jeopardy of missing their bonus targets so that when they call screaming at me that the reports are wrong, I can be prepared. It’s surprising how badly some of them are doing. They receive a package of reports monthly so that they can see where they are, and our chief medical officer works with those that are underperforming to institute changes in the practice to try to increase their success. There’s only one month left in the year, however, and unless providers are only under their targets by a fraction of a percent (or see small numbers of patients), it’s not likely that they can turn things around now.

What kills me is that some of the measures they fail to hit seem to be no-brainers. Our EHR has tons of prompts to make sure that certain services are done – both passive alerts (icons, exclamation points) and “in your face” type modal window popups that they cannot get past without acknowledging. We have standing orders available that providers can print, sign, and institute in their offices (and in the EHR) so that their clinical staff can administer vaccines without individual patient orders. We have signage available reminding diabetic patients to remove their shoes and socks so the providers can examine their feet. Inevitably, though, providers miss the mark.

Sometimes I really wish I had gotten a psychology degree instead of a chemistry one – it would have been much more useful in figuring out what makes my colleagues tick. Why wouldn’t you want certain services to be on autopilot? Why would you want to have to give individual verbal orders (or heaven forbid ,enter them into the EHR yourself) for flu shots or tetanus shots? And what makes some providers very eager to get on board with these kinds of clinical protocols when others dig in their heels? If I could crack this code I could retire early.

Maybe it’s being afraid of “cookbook medicine” or just not wanting to be told what to do by others. In some cases, it’s being in denial of the clinical evidence that shows that standing orders prevent disease and disability. Maybe it’s just feeling beaten down by what the healthcare system has become. Another one of my friends just made the decision to leave clinical medicine – she finished her MBA and is off to work for one of the major health IT vendors.

I’m looking forward to 2014 as a chance to reset. Those providers that missed the mark can start over. We only have to attest for 90 days instead of the full year, so that will reduce some stress, although our impending EHR upgrade and some other payer initiatives are adding to the overall tension. I suspect that CMIOs at other hospitals and health systems are feeling the same kind of pressure, but there is not a lot we can do about it since the forces are largely external.

For me, it’s back to the quality reports. But first, another NextGen User Group special report from our roving reporter. Inga shared comments from my personal physician about the NextGen User Group this week in Las Vegas. Here’s her second installment:

NextGen UGM Update

The customer appreciation parties thrown by vendors on Monday were a lot of fun. My favorite was IMO’s elegant cocktail party held in a suite with a balcony overlooking the strip. They had Monday Night Football showing on the balcony’s big screen TV (that’s the way to live!) and an excellent wine assortment, although rumor was the MGM wouldn’t let them serve reds due to the all-white décor of the suite. The buzz on the street was that Navicure’s party was best and had nearly 1,000 attendee at the Hard Rock. I’m just a little PCP, though, so didn’t score an invite.


I noticed this display appear on Day 2, near the escalators where you enter the conference center. Only in Las Vegas can you get walk-in IV hydration and a B12 shot. It’s a cash practice with no insurance billed, so of course they can do whatever they want. One young IT guy I overheard in a session said he took advantage of it after a night of too much fun. He mentioned that the nurse who administered his IV normally works in a pediatric ER and loves working the “spa” because the patients have big veins.

There were many good educational sessions on ICD-10, Meaningful Use Stage 2, and how to improve revenue cycle and clinical documentation. A fair amount of continuing medical education credit was offered as well. The MGM did a great job with logistics for 5,000 people. This was my first User Group and the build-up to the Tuesday client event was huge. They always keep the entertainment a secret and past musical acts have included Sammy Hagar, Styx, Foreigner, Huey Lewis and some other well-known groups. The first act turned out to be the Brian Setzer Orchestra, which would have been good if the acoustics weren’t so distorted. The second was Big and Rich, which provoked a mass exodus. I was among the scattering crowd so I can’t report after that. Wednesday was a little more low-key with only two education sessions and I suspect many people left early to avoid the chaos that is the Las Vegas airport.


I forgot to send this picture earlier in the week, you have to love an airport with a liquor store in baggage claim. I relaxed on the plane on the way home reading the Twitter feed for the event and some of my favorite tweets were:

  • Either I’m in ICD-10 hell or they have the heat on in room 309

Followed by:

  • Do you know the ICD-10 code for burning up like you are Lucifer’s step sister?

And then:

  • Depends on whether burning is via a coal- or wood-fired oven, nuclear meltdown, etc. Please consult CMS GEM mappings.

You have to make fun of ICD-10 or you’d cry, so I found it particularly funny.

All in all it was a successful meeting. I got some CME, heard some great speakers, and learned some things that should make my EHR documentation quicker and easier. I’ll definitely be back next year!

I’m glad she got to go and I was able to live vicariously through her – I’ve only been to my own vendor’s meeting. I’d love to see how the grass looks on the other side of the fence. Maybe that’s an idea – we could auction off a chance to have Dr. Jayne attend and review your user group meeting (under an assumed name, of course). Proceeds could go to charity. What do you think? Email me.


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

More news: HIStalk Practice, HIStalk Connect.


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November 14, 2013 News 7 Comments

Morning Headlines 11/14/13

November 13, 2013 Headlines No Comments

Blue Cross and Blue Shield of Texas and Tenet Healthcare Corporation Collaborate on Statewide ACO to Improve Quality and Efficiency of Care

Blue Cross and Blue Shield of Texas will launch a state-wide ACO with Tenet Healthcare’s 10 Texas-based facilities in January 2015.

MIT’s shapeshifting display lets you reach out and touch someone

Researchers at MIT have created a prototype of a 3D monitor that it hopes will have implications in medical imaging by providing 3D visualizations of CT scans.

US, UK open public health cloud

The US and UK will begin consolidating de-identified patient data from CMS, the FDA, and the NHS in England. The data will be stored in a UK-hosted health data cloud, where it will be made available to researchers all over the world.

JAMA Delves Deep Into What’s Ailing American Healthcare

The November issue of JAMA delves into some of the critical issues within the US healthcare system and proposals to fix them. Topics included healthcare costs and outcomes, industry consolidation, and the tension between population health and individual healthcare. Ezekiel J. Emanuel, MD, PhD, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, contributed a piece challenging the healthcare industry to shrink US per capita health care cost growth to no more than GDP + zero percent by 2020. He calls for, among many things, an increase in EHR adoption and remote patient monitoring as a means to this end.

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November 13, 2013 Headlines No Comments

News 11/13/13

November 12, 2013 News 21 Comments

Top News

11-12-2013 5-49-15 PM

AMIA announces in an email to members that Kevin Fickenscher, MD will step down as president and CEO on November 30, 2013 to return to industry. He took the position for 20 months ago. The search for his replacement will start immediately.

Reader Comments

11-12-2013 7-57-05 PM

From Pitiful: “Re: U. Arizona Health System. More than 9,500 glitches in its Epic EHR, claims to have solved more than 6,000. The health system is financially precarious.” Unverified. They were scheduled to go live November 1.

Acquisitions, Funding, Business, and Stock

11-12-2013 3-22-35 PM

Vocera reports Q3 results: revenue flat, adjusted EPS -$0.02 vs. $0.13, missing earnings estimates.

11-12-2013 3-26-09 PM

Alan Dabbiere, chairman of mobile device technology vendor AirWatch, expresses an interest in acquiring BlackBerry’s services division and integrating the Blackberry server technology into its device management technology to provide corporate customers a single dashboard for all devices.

Long-term care EHR provider PointClickCare acquires Meal Metrics, the developers of a web-based nutritional management solution.

11-12-2013 7-45-41 PM

AuthentiDate announces a $2.46 million private placement from unnamed investors. The company offers telehealth, referral management, and discharge management solutions, with the VA as a notable customer.


11-12-2013 1-42-31 PM

Star Valley Medical Center (WY) selects Access E-forms on Demand to eliminate paper forms.

11-12-2013 1-40-41 PM

ValleyCare Health System (CA) will implement CareInSync’s Carebook mobile communication platform for care team coordination.

The 11-provider Ocean Eye Institute (NJ) selects SRS EHR.

11-12-2013 1-38-41 PM

Denver Health (CO) selects Besler’s BVerified Screening and Verification solution.

The Nevada HIE will deploy the Orion Health HIE.

Montefiore Health System will upgrade its newly acquired hospitals in New Rochelle and Mount Vernon to Allscripts Sunrise, including EHR, Analytics, Radiology, and Laboratory and implement the FollowMyHealth patient engagement platform.

SummaCare (OH) selects Wolters Kluwer Health’s Health Language to convert ICD-9 codes and DRGs to ICD-10.


11-12-2013 1-55-25 PM

PaySpan names Cheryl King (First Data) CFO.

11-12-2013 1-50-27 PM

Candace Smith (Medline Industries) joins Voalte as CNO.

11-12-2013 3-53-30 PM

The VA appoints Arthur L. Gonzalez (TISTA Science and Technology Corp.) deputy CIO for service, delivery, and engineering.

11-12-2013 4-02-05 PM

Direct Recruiters, Inc. promotes Dan Charney to president.

11-12-2013 6-50-31 PM

Scotland-based Craneware appoints Colleen Blye (Catholic Health Systems of Long Island) to its board.

Announcements and Implementations

Nextgen introduces NextGen Share, an interoperability solution based on the Mirth HIE platform that facilitates clinical data exchange and referrals from within the NextGen EHR.

11-12-2013 1-56-46 PM

CSI Healthcare IT completes a Cerner activation at the University of Tennessee Medical Center.

Merge Healthcare will exit the consumer medical information kiosk business, which reportedly accounted for $10 million of the company’s $250 million in sales last year. Merge, which spent $2.8 million on 500 of the kiosks last year with an ultimately failed plan to roll them out throughout Chicago, said technology upgrades were too expensive and it agreed to get out of the business following a patent infringement lawsuit. The kiosks made up one of 11 deals between Merge and companies owned by its chairman and largest shareholder, Michael Ferro, who stepped down in August 2013.

Westmed Medical Group (NY) reports that its ACO program with UnitedHealthcare and Optum improved nine of 10 health quality metrics, increased patient satisfaction, and reduced costs since its establishment in mid-2012.

DrFirst launches the Patient Advisor Report Card, a medication adherence alert system that provides a physician with medication adherence rates for each patient.

NextGen announces NextPen Voice, a pen that accepts either voice or written input depending on user preferences and activities. It uses digital pen technology from Sweden-based Anoto, which announced three weeks ago that it couldn’t survive another 12 months without issuing new stock rights.

Four large Boston-area organizations – Dana-Farber, Brigham and Women’s, Boston Children’s Hospital, and Broad Institute – form the Joint Center for Cancer Precision Medicine, which will study the genetic characteristics of tumors to choose the best chemotherapy drug treatments for individual patients.

Government and Politics

inga_small The Wall Street Journal reports that fewer than 50,000 people signed up for health insurance through Healthcare.gov during October. Despite my “success” about 10 days ago signing up for insurance, my application now appears to be in limbo. After two support chat sessions, two support phone calls, and an email exchange with my selected insurance carrier, I’ve been advised that the normal 48 hour “acceptance” process has been delayed. I’m trying to remain optimistic that the new plan will be in place in time for me to cancel my current plan so I won’t be stuck paying for two plans come January.

CMS tells industry stakeholders it might reconsider performing external, end-to-end ICD-10 testing with physician offices following recent problems with its Healthcare.gov site. CMS said previously it would not offer external testing and that it was confident with its current internal testing.

11-12-2013 6-23-55 PM

Former National Coordinator David Blumenthal, MD, now president of The Commonwealth Fund, says President Obama’s call for federal government IT procurement reform after the contractor-assisted bungling of Healthcare.gov is necessary because “the federal process is clearly broken.” He says of his experience at ONC:

Our staff would decide what services we needed, write a request for proposals (RFP), and send it off to a totally independent contracting office. That office could be within the Department of Health and Human Services (DHHS), but if the DHHS office was too busy, the RFP could go almost anywhere: the Department of the Interior, the Department of Housing and Urban Development, the Department of Education — whatever contracting office had time to process the work. Officials extensively trained in the details of federal procurement, but lacking familiarity with our programs or field of work, would put the RFP out to bid. An expert panel–over which we had minimal control — would evaluate the responses. Months later, the contracting office would present us with the signed contract. The winner was usually picked from a group of companies with considerable experience working the federal procurement process. If we weren’t happy with the firm, or with their later performance, there was virtually nothing we could do about it. Getting out of this shotgun marriage meant months of litigation, during which the funds would be frozen and the work itself would grind to a halt.

11-12-2013 8-07-25 PM

News I missed from several weeks ago, if it was announced:  CMS awards several companies an $800 million contract to support the Measure and Instrument Development and Support program for healthcare quality measures as part of HITECH.

11-12-2013 8-08-44 PM

It’s not just the federal insurance exchange website that’s having problems. Users report that the Massachusetts Health Connector site won’t accept hyphenated names and requires proof of incarceration for non-prisoners. The spokesperson gave the same response as those for Healthcare.gov – sorry for the problems, we’re fixing them, but in the mean time, pick up the phone or mail a paper form.

Innovation and Research

11-12-2013 8-09-30 PM

The New York Digital Health Accelerator celebrates its first year and the recent success of two graduates of its nine-month mentorship program: Avado (patient relationship management tools, acquired by WebMD) and Cureatr (secure physician messaging, obtained $5.7 million in funding).


11-12-2013 4-34-12 PM

inga_small If you are like me, you may be a little flash-mobbed out. However, this video of a woman dancing with the OR staff minutes before undergoing a double mastectomy brought tears to my eyes. Got to love the doctors, nurses, and techs who busted some moves with Deborah Cohan, an OB/GYN and mom of two who I wouldn’t mind having as a BFF.

Patient Privacy Rights launches a “Save Health Privacy” campaign on crowdfunding site Indiegogo, hoping to raise $10,000 to purchase privacy-friendly technology and to create a privacy education app. Donate $500 and you’ll get a dinner with PPR Founder Deborah Peel, MD.

11-12-2013 6-31-54 PM

The National Patient Safety Foundation releases an online, self-paced course titled “Health Information Technology through the Lens of Patient Safety,” targeting physicians, pharmacists, nurses, and quality professionals who are involved with both IT strategy and patient safety. Topics include organizational culture, transparency, patient engagement, integration of care, and human factors engineering. The course costs $30 and CE credits are provided. McKesson provided an educational grant to make the course possible. I’ll most likely take the course myself and report back.

A Pittsburgh internist sues a local medical billing company after its systems fail with no usable backup. The doctor concludes, “It is all in the cloud, and if the cloud disappears someday, we are all in trouble.”

11-12-2013 8-02-34 PM

Weird News Andy notes the story of an ABC reporter who got her first-ever mammogram on live national TV to call attention raise awareness for Breast Cancer Awareness Month, only to have the test reveal that she has cancer. Amy Robach, 40, will have a double mastectomy performed this week. WNA observes that under new guidelines, she would not have been a mammogram candidate until she turned 50, assuming she had lived that long without treatment.

Sponsor Updates

  • Salar sponsors the Student Design Challenge: Reinventing Clinical Documentation at next week’s AMIA 2013 Annual Symposium in Washington, DC.
  • Amcom Software hosts its annual user conference, Connect 13, this week in San Diego.
  • NextGen Healthcare is hosting 5,000 attendees this week at its user group meeting in Las Vegas. Dr. Jayne’s personal physician offers her impressions of the conference on HIStalk Practice.
  • Hyland Software and Bottomline Technologies will integrate their mobile data capture and ECM technologies.
  • Elsevier adds new content types and an enhanced mobile app to Mosby’s Nursing Consult .
  • Kootenai Health (ID) estimates that its implementation of the Summit Interoperability Platform saved the organization $50,000 to $75,000 in 2012 through the elimination of duplicate interface purchases and maintenance costs and the reallocation of hospital IT staff.
  • ChartMaxx hosts webinars November 13 and 21 discussing ways to provide high quality care while cutting costs and improving revenue cycle.
  • LDM Group sponsors the iPatientCare National User Conference November 15-17.
  • Strata Decision Technology hosts a November 18 webinar on high performance decision support operations.
  • Market research firm Harvey Spencer Associates ranks Nuance Communications the world’s leading scanning and capture software vendor based on market share.


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

More news: HIStalk Practice, HIStalk Connect.


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November 12, 2013 News 21 Comments

Morning Headlines 11/12/13

November 11, 2013 Headlines No Comments

With Enrollment at 200K, VA’s Million Veteran Program Inks Contracts for Genetic Analysis

The VA has enrolled 200,000 veterans in the Million Veteran Program, a long-term genetics research study the VA hopes will uncover genetic links to various diseases and lead to personalized treatment strategies for veterans. With steadily increasing enrollment, the VA has also announced that they have contracted with the BioProcessing Solutions Alliance and BioStorage Technologies to provide genome sequencing for the program over the next five years.

State apologizes for patients’ records posted on Internet

The North Carolina Department of Health and Human Services is apologizing after accidently publishing the names, addresses, and payment information of 1,300 patients to a public website.

NextGen Healthcare Unveils New Interoperability Platform — NextGen Share —at 18th Annual NextGen Healthcare User Group Meeting

NextGen unveils a new secure exchange platform called NextGen Share. The product is the first collaborative product launch with Mirth since acquiring the open-source HIE vendor in September.

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November 11, 2013 Headlines No Comments

News 11/8/13

November 7, 2013 News 6 Comments

Top News

11-7-2013 6-41-31 PM

Allscripts reports Q3 results: revenue down 8 percent, adjusted EPS $0.05 vs. $0.23, missing estimates on both. By GAAP standards, the company lost $48.9 million in the quarter. The company also announced that it has fired Cliff Meltzer, EVP of solutions development since July 2011, and will pay him severance that includes his expected one-year salary and bonus totaling $900,000. A reader’s rumor suggests that former Jardogs CEO Jim Hewitt, named Allscripts SVP of development after the the company acquired Jardogs in March 2013, will replace Meltzer. I interviewed Hewitt in June 2012.

Reader Comments

11-7-2013 11-16-30 AM

inga_small From HerkyHawk: “Shoes. A Symantec representative was wearing these shoes at the Virginia HIMSS meeting. They serve a dual function: conversation starter and castrator for when she gets angry.” Readers often send me photos of fun shoes, for which I am thankful. This shoe earned a rare mention on HIStalk because its owner clearly understands that shoes offer so much more than foot protection.

HIStalk Announcements and Requests

inga_small A few goodies you may have missed from HIStalk Practice this week include: the implementation of HIT in practices reduces the demand for physicians. CMS says it’s not appropriate to charge patients a fee to access their records online. A reader worries about ZocDoc and HIPAA compliance. Lawmakers consider phasing out fee-for-service billing in favor of rewards-based models. The government shutdown delays the release of the 2014 Medicare physician fee schedule. Jaffer Traish of Culbert Healthcare Solutions discusses EHR clinician adoption and change management. Dr. Gregg shares a post-Halloween nightmare. Julie McGovern of Practice Wise offers advice for providers seeking a replacement EMR product. Micky Tripathi’s “Pretzel Logic” post is called Have Sympathy for Your Vendor. Thanks for reading.

11-7-2013 6-45-21 PM

HIStalkapalooza planning has begun for the February 24 event at the HIMSS conference in Orlando. It’s too early to announce the sponsor, venue, and other details (registration won’t start until right after New Year’s) but I always get requests from companies asking about co-sponsoring it along with the primary sponsor. The previous sponsors have always declined to share the limelight, but this one is OK with the idea and has a plan for providing exposure and recognition at the event because it’s going to be really big and impressive. Let me know if your company is interested.

Acquisitions, Funding, Business, and Stock

11-7-2013 6-47-10 PM

Verisk Analytics reports Q3 results: revenues up 10 percent, adjusted EPS of $0.62 vs. $0.54, missing analyst estimates on both measures. The company noted that its “healthcare business delivered growth that was below” plan, but it remains “enthusiastic” about the longer-term outlook.

11-7-2013 5-25-15 PM

Midwest grocery chain Schnucks follows its competitor Walgreens by opening its first 6,500 square foot IV infusion center, offering patients free Internet access, a TV, a snack bar, and evening and weekend appointments. The center’s pharmacist and two nurses can either infuse the medications on site or prepare them for home administration.


In England, BT selects Harris Corporation to supply clinical portal solutions for health and social care organizations across the NHS.

The California Office of Health Information Integrity awards contracts to Humetrix, UC San Diego Department of Emergency Medicine, and the Santa Cruz HIE to participate in a PHR demonstration project.

Huntsville Memorial Hospital (TX) selects StrataJazz from Strata Decision Technology for cost accounting, operating budgeting, long-range financial planning, and capital planning.

11-7-2013 6-50-27 PM

Mammoth Hospital (CA) chooses the MEDHOST emergency department information system.


11-7-2013 9-06-31 AM

Coker Group hires Jeffrey T. Gorke (Castle Gate Management) as SVP of practice management.

11-7-2013 9-20-24 AM

VA’s acting CIO Stephen Warren is named executive in charge of the office of information and technology and CIO.

11-7-2013 3-27-19 PM

Capsule names Didier Argenton (Siemens Healthcare) as VP of international sales.

11-7-2013 4-32-58 PM

Patricia Sengstack, DNP, RN, formerly deputy CIO of NIH and currently president of the American Nursing Informatics Association, is hired as chief nursing informatics officer of Bon Secours Health System (MD). 

Announcements and Implementations

Software Testing Solutions will provide automated testing services for Sysmex WAM decision support software for the clinical laboratory, validating the system’s rules, application settings, and workflow practices.

Surescripts adds 12 Epic health systems to its national clinical network, including Swedish, UCSD, UCSF, and Community Health Network.

11-7-2013 6-56-20 PM

pMD expands its charge capture secure messaging feature with real-time alerts and direct text messaging.

Government and Politics

11-7-2013 5-41-36 PM

CMS CIO Tony Trenkle will leave the agency, according to an internal email sent to CMS employees.Trenkle oversaw $2 billion in annual IT products and services, including the development of the healthcare.gov website. Dave Nelson, the current director of the office of enterprise management, will serve as acting CIO.

11-7-2013 1-49-39 PM

CMS paid $16.5 billion in EHR incentive payments to over 325,000 EPs and hospitals through the end of September. Customers of Meditech, Cerner, and Epic account for almost half of all hospitals that have attested for Stage 1 MU; customers of Epic, Allscripts, eClinicalWorks, and NextGen represent almost half of all EPs that have attested for Stage 1.

11-7-2013 5-45-29 PM

USO CEO Sloan Gibson, the President’s nominee for the VA’s deputy director position, says in his nomination hearing that he will focus on the agency’s disability claims backlog and the integrated EHR (i-EHR) project of the VA and Department of Defense.

The Military Retirement and Compensation Modernization Commission, reviewing the failure of the VA and Department of Defense to create a single EHR, floats the idea of combining the entire health systems of the VA and DoD into a single organization, with former Senator Bob Kerry stating, “If [VA and DoD] can’t work together, put one of them in charge. Pick your poison, I don’t care which one. Create a unified command with DoD or put VA in charge.” Former Indiana Congressman Stephen Buyer agreed by saying, “If you had one chief information officer in charge of budget and line items for both, this problem and many others would not be an issue.”

I signed up on Healthcare.gov this week just to see what all the fuss was about. I have to say it was a pleasant experience – the much-criticized identification system worked great and the entire process to get quotes took maybe five minutes. Once I saw the prices I’m glad I have hospital-subsidized medical insurance. I  wasn’t as pleased with the site when I logged back in later – it seemed to be confused that I had requested quotes without buying insurance, and I kept getting warnings about pending messages when there weren’t any. Trying again just now, all I got was a blank screen with no options, and clicking the “Get Insurance” tab just took me back to the default page.


Jackson Health System (FL), planning how it will spend the $830 million it will get from a just-passed property tax referendum, says it will upgrade rather than replace Cerner with the $130 million that is intended for EMR-related improvements.

An investigative report finds that financially struggling Lifespan (RI) paid its now-retired CEO $8 million in 2011, raising his 14-year total compensation with the organization to $39 million.

11-7-2013 6-33-54 PM

HIMSS, trying to ensure that FDA doesn’t regulate EHRs as medical devices, proposes to HHS a “risk-based oversight framework” that would consider the risk when used as intended and the cost vs. benefit of oversight. It makes sense – HIMSS points out that non-clinical IT that has no patient safety implications doesn’t oversight. They also don’t want vendors to be solely responsible, with surveillance and reporting responsibilities to be shared among vendors, providers, and government. They suggest that vendor responsibility ends once their control of their product ends, such as when users customize it.

Weird News Andy is at a loss for all but one word: unbelievable. A man claims that city police in Deming, NM pulled him over for rolling through a stop sign at Walmart, then decided from his posture and previous behavior that he was hiding drugs in his anal cavity. A judge issued a cavity search warrant but the local ED doc refused to do it, saying it was unethical. The man was then taken to Gila Regional Medical Center, which obliged by performing two sets of x-rays, two rectal probes, three enemas, and a colonoscopy, all without the man’s consent and with no drugs were found. The hospital is adding its own version of anal intrusion to the story by not only billing the man, but threatening to turn his debt over to collectors.

Sponsor Updates

  • Informatica achieves top marks for customer loyalty, overall quality of products, and product reliability in the 2013 Data Integration Customer Satisfaction survey.
  • Halim Cho, director of product marketing for Covisint, will discusses the importance of cloud identity and access management at the November 20 Gartner Identity and Access Management Summit in Los Angeles.
  • Intelligent InSites VP Marcus Ruark presents on the value of operational intelligence at this week’s Data Intelligence for Health Care Conference.
  • QuadraMed will add Health Language terminology management solutions to its QCPR platform.
  • Bottomline Technologies hosts its second annual Healthcare Customer Insights Exchange this week in Del Mar, CA.
  • Airwatch secures additional office space for its UK facility to accommodate recent growth.
  • Verisk Health publishes its schedule of events through the end of the year.
  • Vocera’s chief medical officer Bridget Duffy offers ideas for improving patient satisfaction scores.
  • eClinicalWorks CEO Girish Navani predicts that patient engagement and population health management will become essential components of EHRs.
  • Predixion Software publishes a white paper on embedding predictive analytics into software.
  • PGA Championship winner Jason Dufner gives Greenway employees a putting clinic.
  • Hayes Management Consulting provides details on its monthly webinar series.
  • HIStalk sponsors named to the Thomson Reuters 2013 Top 100 Global Innovator list include 3M, AT&T, Fujifilm, GE, NTT, and Xerox.
  • PeriGen hosts a November 13 webinar on labor progress as part of its inaugural webinar series on excellence in perinatal care.
  • ZirMed’s Betty Gomez discusses risk mitigation strategies for ICD-10 at next week’s WEDI 2013 Fall Conference in Maryland.

EPtalk by Dr. Jayne

News flash: CMS requests public comments on potential Clinical Quality Measures for Stage 3. The measure specifications are published on the CMS website for your review. If you don’t have any exciting social plans for the weekend, I’m sure it will be a good read. The comment period closes on November 25.


You know you’re a clinical informatics propeller head when you find a quote like this one funny. It’s gone somewhat viral in the health care IT universe since being shared on Twitter last week. I have a medical student working with me this month and he almost spit his coffee when I turned my laptop so he could read it. It’s true, though – lots of people are talking about doing it, but the realities of actually doing it are very different.

My own health system has a vision of big data. They’re spending loads of money building various analysis platforms since they never met a homegrown application they didn’t like. There is a herd of project managers and marketing types that has embarked on a road show to extol the virtues of big data. It’s exciting to hear them talk to groups of physicians about the vision for the future, when they will bring together data from our EHR with payer and community data and use it to change the world.

Call me cynical, but rather than pin all our hopes for the future on a project that is just getting started, perhaps it would be a good idea to go ahead and use what we already have to start changing how we practice. We’re fortunate to have selected an ambulatory EHR that has robust reporting capability. It also can automatically send patient-specific tasks to the care team when test results are overdue, when preventive services need to be scheduled, or when clinical values are out of range. A couple of years ago we bought additional hardware to be able to run over 250 clinical reports and tasks from them, but the servers are largely sitting idle.

Why is this happening? My theory is this. Unlike a certain baseball field in Iowa, if you build it, they may not come. Our physicians are deathly afraid of these reports and what they represent. They’re worried about liability – specifically, the liability of having these patient care tasks and not having the staff to work them. They’ve been told that having a report that they don’t take action on is riskier than having no report, so they have not allowed us to enable them for their practices. They feel trapped in a Catch-22 — if they can demonstrate higher clinical quality they hope to negotiate better reimbursement for their services, but they can’t demonstrate quality because they can’t afford the staff to drive it.

It’s easy to say that physicians should cut their take-home pay and hire more staff, but it’s not realistic. In our group, primary care physicians make less than half of what their subspecialty peers make and typically work longer hours in the office and hospital. The bulk of our primary care growth has been with younger physicians who are still paying off student loans debt that is higher than the mortgage on a McMansion. Our starting salary for most new primary care physicians is barely more than IT managers make.

This brings me to the point of why I have a medical student working with me. He’s in his fourth year and is a smart cookie, but is no longer sure he actually wants to be a physician. He sees the long hours that his faculty preceptors put in and the sacrifices their families have made and doesn’t feel it’s worth it any more. So, with over $180,000 in student loan debt, he’s looking for a way to leverage his clinical knowledge and critical thinking skills in the healthcare field. Unfortunately, learning about the complexities of the Meaningful Use program, the transition to ICD-10, billing requirements, documentation standards, the plethora of audits that we face, and the overall anarchy found in the healthcare system may be driving him out of medicine altogether.

One of the more challenging aspects of working with him has been trying to help him make sense of everything. Much of what we deal with defies logic and pushes the bounds of reason. When I delivered his mid-rotation evaluation, I asked what part of our time together he enjoyed most and he said it was the more IT-focused meetings we’ve had. We’ve been through some highly technical discussions the last few weeks about server virtualization, hardware and operating system upgrades, backups, redundancy, and off-site storage. I asked him what he found appealing about that and he said it was the fact that it was logical and made sense.

I’ve got another two weeks with him, so there’s hope, but it’s been interesting to see his reaction to the things that CMIOs deal with every day. At best I want to convince him to complete an internship so he can be fully licensed and will have more options than if he decides not to pursue additional clinical training. But in the mean time, I’m sure I can come up with plenty of sticky hardware and infrastructure issues to keep him occupied.

Do you work with medical students? What do they think about healthcare IT? Email me.


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

More news: HIStalk Practice, HIStalk Connect.


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November 7, 2013 News 6 Comments

Morning Headlines 11/6/13

November 6, 2013 Headlines No Comments

Health Management Associates Announces Restatement of Financial Statements

Health Management Associates will restate all of its financial statements going back to 2010 to correct for $31 million in EHR incentive payments improperly collected by 11 of its hospitals. An internal audit recently found that the hospitals attested for Meaningful Use Stage 1 when they did not actually meet the requirements.

CPSI Announces Third Quarter 2013 Results

CPSI announces Q3 results: revenue up four percent, to $47 million vs. $45 million over the same period last year. EPS $0.66 vs. $0.63.

Community CIS Market Quickly Turning into Replacement Market

KLAS reports that 25 percent of community hospitals would not buy the same HIS again. Epic fared the best in the community hospital space, followed in order by Healthland, CPSI, Meditech, and McKesson.

Rotherham trust revises EPR strategy

In England, Rotherham NHS will walk away from its $50 million Meditech 6.0 system that went live in 2012.

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November 6, 2013 Headlines No Comments

News 11/6/13

November 5, 2013 News 7 Comments

Top News

11-5-2013 9-31-24 PM

For-profit publicly traded hospital operator Health Management Associates will restate its financials going all the way back to 2010 after internal review finds that 11 of its hospitals inappropriately collected $31 million in HITECH money in 2011-2013 due to the corporation’s mistaken application of EHR certification criteria in failing to meet Meaningful Use requirements. HMA has repaid the money. I received a rumor report last Friday from FL IT Guy, which I didn’t run in its entirely because I couldn’t verify it and HMA is publicly traded, that said, “After releasing our CIO and multiple VPs from his organization at HMA, the office has been in a state of chaos. Auditors have been working around the clock including over the weekend capturing any and all documentation. It’s unknown to most of us what they are looking for however it appears serious and it’s easy to speculate that some inappropriate handling of funds was occurring with vendors.”

Reader Comments

From VAInsider: “Re: VA’s latest contracting fiasco. There is more to this story that is likely to be uncovered if an official investigation is launched. This is yet another example of the VA’s flawed IT procurement process and what happens when you let greedy contractors steer the ship.” The VA awards a $162.5 million contract to ASM Research to improve the user experience of VistA on September 30, choosing the vendor whose bid was more than triple that of two competing bids of less than $50 million. The bid was issued under a $12 billion IT contract with vague requirements that let departments use vendors without seeking competitive bids. One month after issuing the bid to ASM, one of the VA technical leads who worked on the contract quit to become chief strategy officer for ASM. The VA cancelled a 2012 $102.6 million contract with ASM due to a conflict of interest with ASM’s subcontractors, one of which is Agilex, which had hired former VA CIO Roger Baker as chief strategy officer in April. Accenture acquired ASM Research just over a month ago

HIStalk Announcements and Requests

11-5-2013 7-10-32 PM

Welcome to new HIStalk Platinum Sponsor BlueTree Network. The Madison, WI HIT consulting company’s network of 300 healthcare IT experts develop their professional equity via contributions to the company’s collaborative network, endorsements from colleagues, and ratings from previous clients. Once BlueTree objectively identifies the best people, they give them the chance to offer services that they’re really good at and enjoy, moving away from staff augmentation toward offering specialized solutions based on client needs. The best people get the best placements. One consultant used her extensive Epic and ICD-10 experience to develop an ICD-10 service package, while another created dynamic tools to help clients optimize their revenue cycle. Clients rate the experts publicly on every project, so there’s nowhere for mediocrity to hide. A happy consultant is a productive consultant and BlueTree’s Consultant Happiness Advocates offer feedback, goal alignment, and making sure work and lifestyle are balanced. If you think you’re up to the challenge of working with the best, create a profile on their site, find projects that interest you (part-time, full-time, remote, on-site, etc.) and see if you can make the cut to bid on and win a choice assignment. Thanks to BlueTree Network for supporting HIStalk.

Here’s an introductory video for BlueTree Network that I found by Googling.

Acquisitions, Funding, Business, and Stock

11-5-2013 6-39-11 AM

Vista Equity Partners, parent company of Vitera Healthcare Solutions, acquires the outstanding shares of Greenway Medical common stock for $644 million, completing the merger of the two companies. The new company will be privately held and operate under the Greenway brand, with Tee Green (Greenway) assuming the role of CEO and Matthew Hawkins (Vitera) as president. We interviewed Green and Hawkins when the merger was first announced in September.

11-5-2013 10-59-44 PM

The Advisory Board Company reports Q2 numbers: revenues up 16 percent, adjusted EPS $0.31 vs. $0.31, beating estimates on both. The company also announced the acquisition of Care Team Connect and the promotion of SVP Glenn Tobin to CEO of the Crimson unit. I asked Chairman and CEO Robert Musslewhite about former Crimson CEO Paul Roscoe, who has been in health IT for years at Microsoft HSG, Sentillion, Sybase, and NEON. According to Robert, “The Advisory Board Company leadership wants to recognize that Paul did a tremendous job of leading Crimson to explosive growth and impact to our member hospitals and health systems. Paul, in working from and living in New England, realized that there needed to be greater presence for the Crimson CEO role in Austin, Texas. We collaboratively initiated a decision with Paul to hand over management of the business to Glenn Tobin, PhD.” Tobin was previously SVP of accountable care solutions, and before that, held COO positions with CodeRyte and Cerner.

11-5-2013 11-00-22 PM

CPSI files Q3 numbers: revenues up 4 percent, EPS $0.66 vs. $0.63, missing expectations by $0.01. The board of directors also declared a regular quarterly cash dividend of $0.51 per share.

11-5-2013 11-01-13 PM

Francisco Partners completes its acquisition of McKesson’s hospital automation unit (the former Automated Healthcare) and renames it Aesynt.

11-5-2013 11-02-04 PM

Compliance information and HR training provider Business and Legal Resources acquires the HCPro and HealthLeaders Media brands.


Fletcher Allen Health Care (VT) selects healthcare enterprise management solutions from Avantas.

HealthCare Partners (CA) will deploy Allscripts EHR across its California medical group sites and will add the FollowMyHealth patient portal and the dbMotion population health management platform.

11-5-2013 9-51-52 AM

Indiana University Health selects Evariant’s Patient Solutions platform for business analytics and patient communications.


11-5-2013 6-35-24 PM 11-5-2013 6-45-40 PM

Kareo hires David Mitzenmacher (Volusion) as VP of customer success and Nitin Somalwar (Flurry) as VP of engineering.

11-5-2013 9-13-06 AM

Vikram “Vik” Natarajan (MDLIVE) rejoins Medfusion as CTO.

11-5-2013 8-05-52 PM

The Dallas Business Journal names T-System CFO Steve Armond private technology CFO of the year.

11-5-2013 8-10-34 PM

Cleveland Clinic Innovations names  acting Executive Director Gary Fingerhut to the permanent position. He was previously the group’s general manager for IT commercialization.

Announcements and Implementations

Ocean Beach Hospital and Medical Clinics (WA) rolls out Healthland for inpatient clinicals and NextGen for the clinics.

11-5-2013 10-01-30 AM

EXTENSION changes its name to Extension Healthcare and rebrands EXTENSION HealthAlert to Extension Engage.

One thousand healthcare professionals in Tennessee adopt Direct secure email technology through the state’s Health eShare Direct Project.

11-5-2013 6-31-26 PM

Bottomline Technologies announces Logical Ink for the iPad, which allows completion and signing of forms electronically and sending discrete data to downstream systems.

Government and Politics

11-5-2013 8-29-01 PM

This is either wickedly funny or a sad indication of just how far partisanship in government has gone. HHS Secretary Kathleen Sebelius, speaking at a healthcare event in Memphis, is presented with the book Websites for Dummies by Tennessee State Senator Brian Kelsey, who you may infer is a Republican. You may also infer from the Secretary’s expression that she was not amused.

And in the daily recap of new  Healthcare.gov problems, a South Carolina man demands that HHS remove the information he entered after another user accidentally pulls it up and e-mails him screen shots to prove it. CMS’s Marilyn Tavenner acknowledged the problem in a Senate hearing Tuesday, explaining, “We implemented a software fix yesterday to fix that.” The man who saw his records says he’s not buying insurance anyway – when he saw that the prices listed on Healthcare.gov were double what he expected, he figured he doesn’t need a doctor very often and decided to save money by going uninsured and paying the federal penalty instead.

Innovation and Research

A study of highly questionable design (and with quite a few product misspellings) from Riverside Methodist Hospital (OH) concludes that medical residents don’t think iPads are worth much for clinical use. It was performed as a satisfaction survey, which is already questionable since nothing was actually measured, but the reasons I suggest ignoring it completely (as well as any site that publishes its conclusions uncritically) are:

  • It asked a lot of questions about using the iPad on rounds and when doing documentation, but the hospital is still hand-writing orders with no CPOE.
  • It didn’t mention the clinical system they use, but the iPad access to it was running VMware View, which I assume means screens designed for seated users who are  typing on keyboards were just dumped onto an iPad.
  • It didn’t distinguish between resident satisfaction with the systems they were accessing vs. satisfaction with the iPad itself.
  • It questioned the residents on their use of the iPads outside the hospital, but the iPads were Wi-Fi only.
  • The app generating the highest number of complaints was ORB Mobile, OhioHealth’s homegrown results browser.
  • Many complaints related to connecting to Wi-Fi, but those complaints weren’t analyzed to determine if the problem was actually the network or authentication rather than the iPad.
  • User expertise wasn’t tested, so they don’t know how many of the residents had used iPads previously.


11-5-2013 10-21-28 PM

ECRI Institute releases its 2014 Top 10 Health Technology Hazards:

  1. Alarm Hazards
  2. Infusion Pump Medication Errors
  3. CT Radiation Exposure in Pediatric Patients
  4. Data Integrity Failures in EHRs and other Health IT Systems
  5. Occupational Radiation Hazards in Hybrid ORs
  6. Inadequate Reprocessing of Endoscopes and Surgical Instruments
  7. Neglecting Change Management for Networked Devices and Systems
  8. Risks to Pediatric Patients from “Adult” Technologies
  9. Robotic Surgery Complications due to Insufficient Training
  10. Retained Devices and Unretrieved Fragments


11-5-2013 12-58-33 PM

One-fourth of community hospitals say they would not buy the same HIS again, according to a KLAS report. No vendor demonstrates a combination of high customer satisfaction and strong sales momentum, though Epic comes closest. Epic is winning the most deals, mostly from larger health systems converting their community hospitals, while Siemens, McKesson, Meditech, and Cerner are losing the most legacy clients.

Epic reveals plans for its fourth campus, which will be called the Wizards Academy and is meant to resemble the traditional look of classroom buildings at older universities in the US and England. Plans call for exteriors with steeples and castle-like notched parapets, as well as 1,580 offices and underground parking for 1,500 cars. The two-story King’s Cross Dining Hall will have 64,000 square feet of space. Epic says the new campus will be filled to capacity the day it opens. The Verona City Council is scheduled to vote on a conditional-use permit next week. Who needs to go to Disney when you can go to Wisconsin to experience Harry Potter, a farm, outer space, and original art?

A Valence Health study finds that more than one-third of Americans will consider non-traditional healthcare plans.

11-5-2013 11-08-44 PM

In England, Rotherham NHS Foundation Trust, which was one of the first hospitals to bail out of the NPfIT program in 2009 to buy its own solution, will dump its $50 million Meditech 6.0 system that just went live last year. The primary reason appears to be that physicians don’t like it and weren’t involved in its selection and rollout. Perot Systems (now Dell Services) did the implementation. The Trust’s board called the project a “catalogue of failure.”

Jackson Health System (FL) had a $832 million bond referendum on the ballot Tuesday, of which $130 million is planned for electronic medical records. UPDATE: Miami-Dade voters approved the measure, which will raise their property taxes to fund facility and equipment upgrades as the hospital hopes to make itself more attractive to patients with insurance. Jackson will build a new rehabilitation hospital and open a dozen urgent care centers. The health system already gets $350 million per year from taxpayers from property taxes and a half-cent sales tax.

Northwestern Memorial Health Care (IL) paid an apparent record price for the Chicago area of around $349 million to buy 900-physician Northwestern Medical Faculty Foundation, or around $400K per doctor.

11-5-2013 11-13-25 PM

Strange: Desert Springs Hospital Medical Center (NV) rolls out a virtual plastic surgery imaging app, hoping that paying customers who like the looks of their photo after they’ve swiped away excess pounds will sign up for bariatric surgery.

11-3-2013 8-08-41 AM

inga_small I am happy to report I was finally able to complete my application on the healthcare.gov website last week. I also finally opened a letter from my current insurance provider (note to self: open mail more regularly) and realized that my existing plan would not be available next year. My choices were to move to a comparable plan that met ACA requirements (about five percent more than this year’s plan) or to a plan that did not include dental (about four percent less.) My 2013 rate, by the way, was about eight percent higher than 2012’s. Bottom line: I’ve secured a new plan that is four percent less than my current coverage and includes a lower co-pay and a significantly lower deductible and out-of-pocket maximum. Once I got through the initial problems logging into the system, I found the site easy to navigate and the amount of data required for the application was minimal, though I did have to provide my Social Security number. Over the weekend I encountered an issue that prevented me from reviewing my initial application and the live chat support advised me to call for assistance (I didn’t.) Without getting into any politics, I am glad the website finally worked for me and am pleased I’ll be saving a few hundred dollars a year.

Sponsor Updates

  • Aventura Founder and CTO Joe Jaudon presented at the International Conference on Awareness Computing and Technology on Monday on the topic of “Advancement in Clinician Efficiency Through Awareness Computing.”
  • First Databank will convene its annual customer seminar in Miami beginning Wednesday.
  • HIMSS Analytics reports that Imprivata is the most widely selected SSO solution in Canadian hospitals with a 34 percent market share.
  • Abraham Verghese, MD provides the keynote address at this week’s 2013 First Databank Customer Seminar in Miami.
  • Andy Smith, president and co-founder of Impact Advisors, discussed employee recognition systems at last week’s Workforce Live! event in Chicago.
  • CareWire discusses how effective communication increases patient safety in surgery centers.
  • Health Catalyst sponsors a November 6 webinar featuring Charles Marcias, MD reviewing cost and quality issues in light of changing payment models.
  • Consultant Micah Solomon recommends direct communication technologies, such as Vocera’s Communications Badge, to improve patient satisfaction.
  • Encore Health Resources selects Compuware’s Changepoint professional services automation solution to manage service engagements.
  • QlikTech and Deloitte co-host a November 6 webinar on the use of analytics to improve capital planning decisions.
  • Sagacious Consultants launches its Strategic Clinical service line to assist organizations with EMR implementations and optimization support.
  • Christine Kalish, national practice director of strategic advisory services for Beacon Partners, shares tips for simultaneously planning and implementing ICD-10. Beacon Partners also hosts a November 15 webinar outlining steps to reduce revenue cycle risks with ICD-10.
  • AirWatch CEO John Marshall discusses the industry’s move away from BlackBerry.
  • CliniComp celebrates its 30th anniversary with a record of near perfect reliability despite technological challenges and various disasters.
  • Hilo Medical Center’s (HI) use of E-forms on Demand from Access helps the organization move towards HIMSS Stage 7.
  • PointClickCare will connect its EHR platform for the long-term care industry to more than 120 labs and imaging departments using the Liaison EMR-Link hub.
  • iCIMS recognizes Intelligent InSites and NTT DATA with Excellence Awards for best company expansions of talent acquisition strategies.
  • Culbert Healthcare Solutions and Greenway co-host a November seminar on how ICD-10 will impact clinical workflow.


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

More news: HIStalk Practice, HIStalk Connect.


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November 5, 2013 News 7 Comments

Morning Headlines 11/5/13

November 5, 2013 Headlines No Comments

Care Team Connect Is Now a Part of The Advisory Board Company

The Advisory Board announces that it has acquired Evanston, IL.-based Care Team Connect, a population health vendor that provides web-based SaaS to help care teams utilize population risk stratification while coordinating care across care settings.

Registry-based clinical trial puts heart treatment to the test

Researchers in Sweden are validating a new post-market clinical trial approach that uses analytics tools to pour through EHR data to substantiate outcomes are matching expectations established in pre-market trials. During their research, they discovered that the use of thrombus aspiration, a common procedure for certain types of heart attack patients, resulted in no difference in 30-day all-cause mortality rates for patients who received the treatment vs. patients who did not. The findings are the subject of a new study published in the New England Journal of Medicine.

New technology helps smaller hospitals identify signs of a stroke

Five remote hospitals across Ohio are using a new telehealth system to connect with stroke specialists at Toledo Hospital. Two more hospitals are expected to join the network by the end of the year.

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November 5, 2013 Headlines No Comments

Advisory Board Acquires Care Team Connect

November 4, 2013 News 2 Comments

11-4-2013 4-03-51 PM

The Advisory Board Company announced this afternoon that it has acquired Care Team Connect. The Evanston, IL company offers an integrated, Web-based care management platform for population health management.

Care Team Connect will be positioned under the The Advisory Board Company’s Crimson organization and the name Crimson Care Management. Crimson offers hospital-physician alignment performance technology that include analytics and business intelligence.

11-4-2013 3-58-11 PM

The Advisory Board Company also announced that SVP Glenn Tobin, PhD, has been promoted to CEO of the Crimson unit, replacing Paul Roscoe. Tobin joined the company in September 2012 and has previously served as COO of CodeRyte and Cerner.

Tobin was quoted as saying about the acquisition, “Care Team Connect (CTC) is a powerful complement to our Crimson physician analytics suite as it makes it easier for caregivers to implement our best-in-class analytics through lightweight and mobile workflows. As in other parts of our broad technology suite, ABC was led to CTC by our progressive members. The research arm of the Advisory Board profiled Care Team Connect as a best-in-class provider of care management technologies in our research for hospital and health system CEOs over the last two years. Additionally, our Crimson member MissionPoint asked the Advisory Board and Care Team Connect to coordinate much more closely to best serve the emerging MissionPoint’s needs for advanced population health capabilities. Through these channels we came to see the unique and valuable capabilities CTC had developed.”

HIStalk interviewed Care Team Connect Founder Ben Albert in May 2013. When asked how the company’s product fit in among analytics offerings such as those of the Crimson business, he said,

But as soon as a client really digs in and says, OK, how are we actually going to manage the population? Not how are we going stratify and identify the population, but how are we actually going to manage the population and all of these care coordinators we’re hiring now? How are we going to power their workflow in a way that we’re sure that they are going to follow the right patients and that we’re going to get the yield out of the initiative that we anticipated getting? It’s the next step. People recognize that as a major need. We sit on front of it to make it all happen. But until there is that understanding of what analytics is really built around — and it’s really built around crunching the data and what we do, which is built around workflow and coordinated care — I think the market does get confused until they understand the difference.

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November 4, 2013 News 2 Comments

Monday Morning Update 11/4/13

November 2, 2013 News 20 Comments

From SNOMED Junkie: “Re: IHTSDO. Don Sweete, executive regional director of the Atlanta Region of Canada Health Infoway, has been named CEO of IHTSDO, the Denmark-based non-profit that manages SNOMED.” Verified. Don must have a graven image-like avoidance of being photographed since despite having held all these high-profile jobs, I can’t find a picture of him anywhere to include here (even on his LinkedIn profile, which is essential these days.)

11-2-2013 11-36-18 AM

From AthenAscendant: “Re: athenahealth. As a former employee, I heard from a colleague that some giddiness has been building regarding recent KLAS performance. She tells me that athenaCollector has established a lead on the score for Epic’s practice management suite and that athenaClinicals is within a fraction of a point of closing the gap with Epic’s Ambulatory EMR.” Unverified. I don’t know that athenahealth stands to gain a lot of Epic business in any case since it’s usually hospitals making those Epic decisions and they won’t give up integration to chase KLAS EMR scores.

From Nila: “Re: unstructured content. I’m curious what the HIStalk audience thinks when they hear that term.” Readers are welcome to leave a comment. What comes to mind for me is clinical documentation, discharge summaries, images, and scanned reports (internal or external). However, I’m not a fan of the term – a programmer would consider Shakespeare’s works “unstructured,” a somewhat derogatory label (i.e. structure is good, so anything that isn’t is bad) that in no way diminishes their usefulness or desirability to everybody else. Some parts of the unstructured information could be structured for portability and searching, but there’s nothing like seeing an actual picture or reading (or hearing) a clinician’s nuanced expression when trying to understand a patient rather than trying to understand a patient’s chart.

11-2-2013 11-29-12 AM

From Brandi: “Re: Health Tech Holdings. Rebranding all of their companies under the Medhost name.” Unverified, but it makes sense. The companies include HMS, Medhost, and Patient Logic. If they are changing, it’s a good time to stop writing MEDHOST in all capital letters. Overzealous marketing people convince companies to capitalize their names (and those of their products) for no reason, which sites like HIStalk ignore because it’s not proper journalism style and it’s also annoying. I’ll leave the all-caps version of the company name if it’s clearly an acronym (like HMS), but I’m going mixed case otherwise (Meditech, Medseek, etc.) Journalism style is also to strip off all of the copyright and trademark symbols the marketeers plaster on everything.

From David Copperfield: “Re: Siemens. Changing leadership in sales, marketing, services, cloud, and legal. This misdirection should keep the German brass looking for the pea for at least another year.” Unverified.

From Opie: “Re: funding rounds. We’re seeing some big numbers in HIT. Some of the recipient companies seem iffy.” The worst thing about big funding rounds is that they lock companies into their specifically stated strategies because that’s what the funders backed. Young companies need to learn from their inevitable early mistakes in strategy or vision as their customers tell them what they should really be doing and push the company into a different business than the ones they planned. If those companies are financially struggling but smart, they will figure it out over time and be better for it as Darwinism weeds out their less-capable competitors who don’t react to the realities of the marketplace. Companies flush with fresh VC money (along with the mandatory loss of control that comes with it) use the cash to charge hard and fast blindly down a path that is very likely not the best one, locking themselves into a strategies and products that were developed before the leaders have had the chance to figure out what they are doing. They can’t just change the plan since that would require telling the investors that they were wrong in the first place. The time value of money dictates finding hares rather than tortoises, but you can bet that the VC guys will deal themselves out within a few years either way. As a prospect, I’d be wary about doing business with a heavily funded but inexperienced company – their major motivator may be to sell the company rather than the product and you don’t really know what kind of company they’ll be when (and if) they grow up. I like what Steve Jobs had to say: “I hate it when people call themselves ‘entrepreneurs’ when what they are really trying to do is launch a startup and then sell or go public, so they can cash in and move on. They are unwilling to do the work it takes to build a real company, which is the hardest work in business. That’s how you really make a contribution and add the legacy of those who went before. You build a company that will still stand for something a generation of two from now.”

11-2-2013 5-38-19 AM

Poll results suggest keeping your expectations somewhere between modest and nonexistent if you’re a company with a hot new application but minimal experience working with hospitals. New poll to your right: which company’s stock would you buy if you had to invest in a healthcare IT vendor?

Listening: The Wrens, an amazingly literate but hard-luck New Jersey day jobber band that hasn’t released anything since 2002 but still has a reputation as one of the best live bands around. I’m playing this song a lot.

I’m changing the rules on the reader-contributed pieces I run as “Readers Write.” I’ve previously run just about any article as long as wasn’t commercial in nature so that any reader, regardless of employer, could express their point of view. I figured the potential negative reaction to lower quality submissions would set the bar to an adequate height. Unfortunately a lot of what gets submitted is PR-ghostwritten, company-friendly fluff pieces that are painfully basic for the HIStalk audience. I’m going to start politely rejecting those articles that don’t contain anything that the the average CIO wouldn’t already know or care about, Articles with personality and humor have a better chance of running, and I’ll always give special consideration to those submitted by providers, which unfortunately are rare.

Talk about scalability issues: only six people were able to successfully sign up for insurance via Healthcare.gov in its first full day of operation in which the administration claimed 4.7 million attempts.

I’m posting this on Saturday, so Monday morning readers will think I’ve erred in wishing luck to the hospital IT and vendor crews managing tonight’s fall-back to standard time. Setting the clocks ahead in the spring doesn’t usually cause as many problems as setting them back in the fall – it’s just not logical for time-dependent software applications to see an hour repeated, as I learned years ago when programming a repeat lab orders routine for my hospital’s order entry system (it mostly worked, but I did miss something that I shouldn’t have when the clocks fell back.) I like having daylight hours artificially manipulated to match the clock-bound schedules of most Americans, but it is a bizarre practice and it causes a lot of confusion if you live in Arizona or Hawaii or try to connect with someone there since they don’t observe DST and the rest of us are supposed to recall that fact.

11-2-2013 6-19-01 AM

Ray Murray (maxIT Healthcare) joins ESD as regional VP.

11-2-2013 6-35-32 AM 11-2-2013 6-36-42 AM

Todd MacCallum (TUC Managed IT Solutions) and Peter Schermerhorn (HealthMEDX) join Beacon Partners as regional directors.

ONC will convene a December 16 meeting of vendors interested in electronic patient identification and matching, with further details forthcoming. UPDATE: Per Lee Stevens, director of ONC’s State HIE Policy Office, the meeting isn’t just for vendors – also invited are HIE experts, state HIE leaders performing patient matching activities, HIE/HIT stakeholder associations, and privacy advocates.

11-2-2013 12-31-36 PM

Standard & Poor’s becomes the second financial rating firm to downgrade the bonds of Wake Forest Baptist Medical Center (NC), announcing its decision the day after the hospital reported a wider than expected $57 million operating loss following a disastrous implementation of Epic.

11-2-2013 12-32-37 PM

I mentioned that Travis from HIStalk Connect and I will be reporting from the mHealth Summit December 8-11 at the Gaylord National Resort just outside of Washington, DC. The folks there are offering HIStalk readers a $75 discount on the full access pass price ($675 general, $215 government, $200 student) if you register using discount code HISTalk (their spelling, not mine).

Here’s a decent SNL sketch skewering Kathleen Sebelius and Healthcare.gov from last week’s show.

11-2-2013 8-26-02 AM

It’s hard to fathom that a healthcare-related website (Healthcare.gov) can attract so much national and political attention, but it will make the November 11 cover of The New Yorker.

An interesting analysis of Healthcare.gov says the problem isn’t the Obama administration, which has successfully launched similarly complex sites under newer government agencies that were willing to fight to get the job done right. The problem, the author concludes, is HHS, which doesn’t have the competition that finally mercy-killed similarly walking dead organizations like Polaroid and Eastman Kodak:

Old organizations definitionally have a lot of longtime stakeholders. And in a sort of ecological process, those stakeholders have been selected for a certain amount of fitness for their environment, which is to say that they are good at doing things the way they have always been done, and they like things the way they are. They are averse to any sort of big change, and they will fight you with every tool at their disposal, from open warfare to passive-aggressively going through the motions on everything you ask them to do. That’s why organizations in crisis frequently need to fire the majority of their staffs to turn things around — and, more than once, an organization that has done so has found that it’s still stuck with the same corporate culture that wasn’t working before.

11-2-2013 11-47-08 AM

Lawyers file a class action lawsuit against Johns Hopkins Hospital over a gynecologist who is accused of wearing a pen-shaped video camera during his examinations, claiming that the doctor recorded up to 9,000 exams and stored them on 10 file servers. The doctor committed suicide earlier this year as investigators reviewed claims involving a variety of inappropriate behaviors. I was curious where you’d get a camera like that and the answer of course is Amazon, which offers the above 30 frames per second, HD-quality model with an 8GB memory card for $70. I saw YouTube video from it and the quality is not bad, although I can’t vouch for its use as alleged. You would think that the last thing a gynecologist would want to watch is movies of his own exams.

11-2-2013 10-42-27 AM

JD Power takes heat for awarding Samsung the #1 rating for customer satisfaction among tablet manufacturers even though Apple beat Samsung in every category except cost.

This is both depressing and uplifting. The California Department of Social Services orders closure of a filthy, unsafe residential care facility whose license had been suspended, so its employees simply walked out after the notice was posted on the door on Thursday and left 14 residents to fend for themselves. The uplifting part is that a cook, a janitor, and two caretakers stayed out of a sense of responsibility even knowing they wouldn’t be paid, finally calling 911 when they realized they couldn’t manage the residents until the Monday deadline for the residents to make new arrangements.

Sponsor Updates

Vince uncovers more great information about HBOC in this week’s HIS-tory. I was curious about former HBOC President and CEO John Lawless and I found that he’s retired in the mountains of North Carolina. I don’t know of anyone who has captured the kind of information Vince has, and the more time that passes since the industry’s early glory days of the 1970s and 1980s, the less chance it will ever be documented.


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

More news: HIStalk Practice, HIStalk Connect.



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November 2, 2013 News 20 Comments

News 11/1/13

October 31, 2013 News 7 Comments

Top News

Health and Human Services Secretary Kathleen Sebelius apologized Wednesday to Americans for the “miserably frustrating experience” caused by problems with the Obamacare website. Congressional leaders grilled Sebelius for 3-1/2 hours about the troubled website rollout and raised security concerns. The secretary said she felt confident the website would be updated and “optimally functional” by November 30.

Reader Comments

From C’mon Mane: “Re: Another Epic sale. Allegheny Health Network is ditching Allscripts Sunrise for Epic. The deal is worth many millions. They think there will be better connectivity as they put the private doctors out of business and hire hospitalists to run their programs.”

10-30-2013 6-36-08 PM

From Jessica: “Re: AHIMA buzz. Had to pass along this wicked shot of our GM, Don Graham, introducing Freddy Krueger to his fist at the Billian booth at the AHIMA conference (where our theme was something along the lines of ‘laying your health market data nightmares to waste’).” Thanks for the great Halloween imagery.

HIStalk Announcements and Requests

inga thumb Just a reminder that Mr. H is still out of pocket so today’s post is all me. Well, me and my BFF, Dr. Jayne.

A few treats from HIStalk Practice this week include: CareCloud will integrate ZocDoc’s appointment booking app into its platform. Physicians are still uncertain how the ACA will impact their workloads or wallets. I’m looking for a few vendor types to participate in a survey.General practice physicians were 1.5 times more likely than specialty practice physicians to have been awarded a MU incentive payment in 2012. In 2011, office-based physicians using EHRs were more likely than non-EHR users to exchange clinical data electronically. My idea of a perfect Halloween treat is having new readers sign up for HIStalk Practice email updates, so thanks in advance. Thanks for reading.

Acquisitions, Funding, Business, and Stock

Merge Healthcare reports Q3 results: sales down five percent, adjusted EPS $0.07 vs $0.13.

10-31-2013 4-48-54 PM

MEDSEEK acquires the Madison, WI-based SymphonyCare, a provider of a population health and care management solution.

10-30-2013 12-09-43 PM

WebMD acquires Avado, a developer of patient relationship technologies, including a patient portal for messaging, reminders, and appointment scheduling tools.

CommVault files Q2 numbers: revenues up 20 percent, adjusted EPS $0.48 vs. $0.38, beating estimates.


10-31-2013 4-50-54 PM

TeraMedica names Nick Donofrio (Merge Healthcare) director of client services, taking over for Greg Strowig, who was promoted to COO.

Post-acute software provider Procura Group promotes Scott Overhill from VP of product management to president. Warren Brown, the former president, has assumed the role of chairman of the board and Bill Bassett (Deyta) joins the company as VP of product management.

10-31-2013 4-52-17 PM   10-31-2013 4-54-04 PM

Allscripts names Rich Berner (Caradigm) president of Allscripts International and promotes Stuart Miller to managing director of EMEA.

10-31-2013 2-53-31 PM

Deloitte names retired Air Force general and former Air Force surgeon general Charles Green, MD a director in Deloitte Consulting and CMO for Deloitte’s federal health practice.

CommonWell Health Alliance announces its board of directors, including Jeremy Delinsky (athenaHealth) as chairman, Rich Elmore (Allscripts) as vice chairman, Bob Robke (Cerner) as treasurer, Rod O’Reilly (McKesson) as secretary, Scott Schneider (CPSI), Justin T. Barnes (Greenway), and Keith Laughman (Sunquest).

Announcements and Implementations

San Diego Regional HIE changes its name to San Diego Health Connect and announces that Sharp Healthcare and Scripps Health have agreed to participate in directing the exchange.

Memorial Healthcare implements Hyland Software’s OnBase ECM solution integrated with its Meditech HIS.

10-31-2013 4-58-38 PM

Mille Lacs Health System (MN) goes live on GE Centricity at its physician clinics.

10-31-2013 5-00-27 PM

The eight-year-old nonprofit organization LCF Research, which is building New Mexico’s HIE, announces that it is now profitable and will be sustainable after its federal grant expires on January 1.

HCA deploys Ingenious Med’s impower platform to more than 4,000 hospital users nationwide.

10-31-2013 1-44-10 PM

Nuance Communications opens its mobile innovation center in Cambridge, MA to house its R&D employees dedicated to voice recognition, natural language, and user interface technologies.

Government and Politics

The Defense Health Agency plans to extend the life of AHLTA though 2018, signaling it will take that long to implement a new EHR.

The House passes a bill that would streamline the VA’s disability claims appeal process and would establish a 15-member commission to seek advice from veteran service organizations, technology companies, and the insurance industry.

Innovation and Research

A pilot demonstration for the ONC successfully demonstrates the use of patient privacy controls over shared medical records. The demonstration showed how externalized patient consent directives can be automatically fetched and applied during the exchange of EHRs.

About half of clinical decision alerts are overridden by providers and about half of overrides are classified as appropriate, according to a study published in JAMIA. The most common alerts to be overridden were formulary substitutions, age-based recommendations, renal recommendations, and patient allergies. While 53 percent of all overrides were classified as appropriate, the likelihood of overriding an alert varied widely by type. The authors recommend refining alerts in order to reduce alert fatigue.


10-31-2013 2-30-09 PM

Nuance introduces an intelligent virtual assistant that uses voice recognition technology to take directives for administrative tasks like ordering medications and labs. “Florence,” which will won’t be launched for another year, will understand the intent of a doctor’s request, actively listen, and respond with facts about how a particular medication or test may affect a patient. Think of the potential if Nuance could tweak this technology to work with spouses.


Healthcare providers outside of the US claim that functionality and support are the top reasons that Cerner Millennium PowerChart exceeds their expectations, according to a KLAS report. Respondents say that despite high costs and contracting concerns, PowerChart is part of their long-term plans.

The Michigan Health & Hospital Association Keystone Center reports that various patient safety and quality initiatives across the state’s 117 hospitals saved more than $116 million (less than one percent) in healthcare costs between 2011 and 2013.

The global market for cloud computing in healthcare is predicted to reach $3.9 billion in 2013, representing 21 percent growth over 2012.

A third (1,099) of Joint Commission-accredited hospitals achieve Top Performer status in the Commission’s annual report on quality and safety. That’s a 77 percent increase over the number of top performing facilities in 2012.

Sponsor Updates

  • The Advisory Board reports that YTD it has extended $1 million in skills-based volunteering to pro bono partners with participation from almost 100 percent of its employees.
  • Vonlay managing partner Aaron Carlock presents a session on portal strategies to improve patient care and business at next month’s HIMSS Midwest Fall Technology Conference in Milwaukee.
  • The Technology Services Industry Association recognizes TeleTracking Technologies  as a Certified Support Staff Excellence Center.
  • England’s Alder Hey Children’s and Liverpool Women’s NHS Trust share details of their implementation of Perceptive Software’s ECM integrated with Meditech.
  • Johnson Space Center will implement Fujifilm Medical Systems’ Synapse Radiology and Synapse Cardiovascular to support NASA’s in-flight and ground clinical care operations.
  • DIVURGENT employees raises $5,000 for Partnership for a Healthier American during its 2013 company retreat in Washington, DC.
  • Vitera announces the availability of Intergy Mobile 2.0 in the Apple Store.
  • Billian’s HealthDATA offers a Porter Research whitepaper on the evolution of consumer engagement in healthcare.
  • Emdeon releases an HTMS whitepaper on modernizing core administration systems and planning a system implementation.
  • CareTech Solutions website security expert James Hunter shares his expertise in a pre-conference education session at next week’s Greystone.Net Healthcare Internet Conference in New Orleans.
  • CTIA-The Wireless Association recognizes AirWatch with MobITS Awards for mobile device management, application development and platforms, and cloud storage and collaboration.
  • HealthMEDX implements INTERACT Tools into its Vision solution to improve early identification, assessment, documentation, and communication about changes in the health status of residents in skilled nursing facilities.
  • Intelligent InSites clients share how tracking software has improved healthcare delivery at their facilities.
  • Levi, Ray & Shoup hosts a secure printing webinar November 5 and 7.
  • Compuware is recognized as one of Michigan’s Healthiest Employers.
  • Vitera introduces Vitera Clinical Exchange, an electronic connection between Florida practices and the state’s online immunization registry, FloridaSHOTS.
  • Impact Advisors principal advisor Laura Kreofsky discusses the two most challenging areas for MU Stage 2.
  • ­­­RazorInsights announces its November conference schedule.
  • Meditech highlights the role of DrFirst in providing its customers e-prescribing functionality.
  • Wellcentive CMIO Paul D. Taylor, MD outlines three mission-critical pieces of network maturity to ensure value-based care.

EPtalk by Dr. Jayne

10-31-2013 5-08-12 PM

I got a chuckle earlier this week when Farzad Mostashari Tweeted about an article on using data to support accountable care efforts: “give MDs info on pts who need A1c, they look at you as though they’re drowning & you’ve just given them a baby.” The line comes from a piece about Memorial Hermann Physician Network (MHPN)and its work to use data to drive population health management.

The network has over 2,000 physicians and functions as an ACO under both Medicare and private-payer frameworks. MHPN is working to bridge the gap between claims-based data and EHR data and I don’t envy them. In working with those two data sources in my own organization, there are plenty of gaps. We continue to deal with practices and service providers that don’t bill in a timely fashion which can skew the claims data. I may have an ophthalmology report back from my colleague so I know I’ve satisfied the patient’s need for diabetic retinopathy evaluation, but the payer hasn’t seen a charge yet therefore the patient’s status is in limbo.

It continues to amaze me that practices can’t bill in a timely fashion even when they are using EHRs. I’m fortunate enough to have very good insurance not only from the patient perspective but from the provider perspective. It reimburses at the top of my fee schedule and also pays timely and accurate claims in a matter of days. As a patient I usually have a paper Explanation of Benefits in my mailbox within two days of when the payment check is cut to the provider, which typically happens within days of the claim. After my recent orthopedic surgery adventures, it took months to receive the first EOB. Based on some of the happenings in the office (such as being charged unnecessary copays during a global period and general disarray with scheduling) maybe I shouldn’t have been surprised. As lean as practices run though it surprised me they wouldn’t do everything possible to get their payments sooner.

In talking to some of my colleagues about the challenges of running an independent practice, it makes sense why so many have been purchased by hospitals and health systems during the last few years. Hospitals sell the vision that they are will deal with practice headaches including OSHA, CLIA, HIPAA, Human Resources, and a host of other issues. Although there are good organizations out there that get the job done, it feels more and more like physicians are being sold a bill of goods.

One of my residency colleagues is part of a small primary care group that was recently acquired. They had a successful EHR installation and were moving forward with Patient Centered Medical Home and other initiatives. Since the hospital medical group was on the same EHR as they were, they figured it would be a smooth transition once their data was migrated. Unfortunately the nightmare was just beginning. The employed physicians had done some significant customization to their version of the EHR, often damaging clinical workflow in the process. Required fields were added in a way that didn’t make sense with how physicians document.

Being a power user of the EHR previously, my friend questioned the way the group was using the system and who had been making the decisions to add the customizations. The group has a policy on change control and decisions are to be made by an IT Committee. Unfortunately its leader is a political appointee who is not actually a user of the system and his chief mode of management revolves around making sure there are no squeaky wheels. When the Compliance department asked for required fields to be added, he complied. When risk and legal made demands, he acquiesced. When specialists wanted fields hidden because they weren’t relevant to them, they vanished. Ultimately a system that could have been highly functional turned into a Frankenstein.

Her new colleagues inundate each other with strings of emails complaining about the system and demanding the administration rip it out and find a new vendor. The EHR has become the scapegoat for a number of problems in the offices, many of which are simply due to poor management. The leadership won’t hit the problem head-on because they are part of the problem. Revenues are down yet many practices have a substantial charge lag. It appears the group doesn’t have a policy on how quickly providers must document their patient visits or when charges are submitted. There are no metrics gathered to show how poorly practices are performing and no accountability to force anyone to change.

I suspect my orthopedic practice is probably managed in the same manner. This brings me back to the quote about giving a practice reports to manage when they’re already drowning. How can we expect a practice to perform population interventions when they can’t finish their documentation? Why can some primary care physicians on a given EHR see forty patients a day and others balk at seeing sixteen? Practices need active (and often aggressive) management to be able to achieve the high goals that are being set out for them. It’s not going to happen automagically and certainly not without a tremendous amount of work.

Medical group management teams need to make sure their physician offices know how to crawl before they push them to run a marathon. Otherwise they’re just setting them up for failure. There is a great quote in the piece that I think I’m going to use to illustrate this point as I discuss these issues with my colleagues: Big data is just making the haystack bigger and not making the needle better. It doesn’t make sense to hand a practice a sheaf of reports to work when they can’t even answer the phones or keep up with refill requests. Why send communications encouraging patients to schedule appointments when the providers have a three month scheduling backlog?

Technology can do wonderful things but it can’t do everything. It doesn’t remove the need for management, structure, and accountability. It won’t replace the basics and we’ve all seen how technology can make dysfunctional processes even more so. If you weren’t billing timely in the pre-EHR world there’s no magic wand that will make it happen just because you implemented a system. Hopefully by now you have some chills running down your spine. After all, it is Halloween. Do you find poor practice management as horrifying as I do? Email me.


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

More news: HIStalk Practice, HIStalk Connect.

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October 31, 2013 News 7 Comments

Morning Headlines 10/31/13

October 30, 2013 Headlines 1 Comment

Sebelius: ‘I apologize, I’m accountable’ for Obamacare website flaws

Amid growing demands for her resignation, HHS secretary Kathleen Sebelius testified before congress today where she took full responsibility for the healthcare.gov rollout and reported that to date the site has cost taxpayers $174 million, which includes $56 million for support. In an unfortunate timing of events, the site crashed again in the middle of her testimony.

HIPAA framework could be expanded, privacy expert says

Modern Healthcare reports that growing concern over the impact mobile health apps and patient portals are having on health information security could lead to another expansion of HIPAA.

NM’s massive electronic health record project finally in the black

After eight years in operation, the nonprofit that built New Mexico’s health information exchange is operating in the black. CEO Bob Mayer reports "Our federal grant runs out in January and we will be sustainable on Jan. 1.”

CommonWell Health Alliance Announces Board of Directors

CommonWell Health Alliance introduces its board of directors which includes: Jeremy Delinsky, Board chairman (AthenaHealth CTO); Rich Elmore, Board vice chairman (Allscripts VP); Bob Robke, Board treasurer (Cerner VP); Rod O’Reilly, Board secretary (McKesson VP); Scott Schneider (CPSI EVP); Justin T. Barnes (Greenway VP); and Keith Laughman (Sunquest EVP).

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October 30, 2013 Headlines 1 Comment

News 10/30/13

October 29, 2013 News 9 Comments

Top News

10-29-2013 8-10-09 PM

CMS Administrator Marilyn Tavenner tells the House Ways and Means Committee on Tuesday that contractors for the HealthCare.gov website “have not met expectations” but that the  troubles were being resolved and the overall program was working, albeit slower and less successfully than hoped.

The problem-plagued rollout of the insurance marketplace website suffered another hiccup Sunday when the data center for HealthCare.gov experienced a connectivity issue, causing the website to shut down for several hours.

Reader Comments

From Swoop: “Focus groups. I’m wondering if you would be able to recommend any market research/focus group companies in the HIT vertical?” Readers, do you have any recommendations?

From Cookie Monster: “Re: AHIMA. We all thought ICD-10 would be hottest topic here. So far, I think the hot topic is clinical documentation improvement.” Cookie Monster also shared that several vendors were showing mobile versions of their products; one she particularly liked was a mobile clinical documentation app from HUFF DRG Review. If you are at AHIMA, tell us the buzz.

HIStalk Announcements and Requests

inga   Mr. H is busy with his day job this week, so I am flying solo. I have a feeling he’s a little behind on his email, too, so please be patient with him. If you have burning HIT issues to discuss in quick order, feel free to drop me a note. I especially love email that contains entertaining news, insightful commentary, and/or flattery. 

Acquisitions, Funding, Business, and Stock

10-29-2013 11-57-10 AM

Dell completes its $24.9 billion buyout by founder and CEO Michael Dell and the investment firm Silver Lake Partners. Michael Dell will own about three-quarters of the newly private company.

Alere turns in Q3 numbers: revenues up 9 percent; adjusted EPS of $0.59 vs. $0.43, beating analyst estimates. Net product and services revenue from Alere’s health information solutions segment fell less than 1 percent.

Kryon, a start-up focused on medial data analytics, closes $3 million in funding from Khosla Ventures.


A local newspaper reports that Highmark will replace the Allscripts system at West Penn Allegheny Health System with a $178.3 million Epic implementation. In 2011, West Penn Allegheny renewed a contract with Allscripts to provide its record system through 2018 for an undisclosed price; Highmark officials say they “reassessed” the contract after purchasing the hospital network in April. A West Penn Allegheny spokesperson added that the organization was “transitioning to Epic to meet the changing nature of our broader enterprise.”

10-29-2013 6-24-14 PM

Carilion Clinic (VA) selects Orion Health Rhapsody Integration Engine to connect its existing HIT infrastructure across 195 facilities.

Sinai Health System (IL) will implement Merge Healthcare’s VNA, radiology, cardiology, and imaging platform. Imaging Healthcare Specialists (CA) will also deploy Merge Healthcare solutions for RIS, PACS, VNA, and interoperability solutions.

10-29-2013 6-25-44 PM

Rush Health (IL) endorses the eClinicalWorks EHR solution for its 300 affiliated private physician members.

Prognosis announces several new customers including Rankin County Hospital (TX), Red Oak Medical Center (TX), Winkler County Memorial Hospital (TX), and three Jane Phillips Medical Center’s satellite hospitals in Oklahoma and Texas.

The VA Midwest Health Care Network selects Visage Imaging’s Visage 7 Enterprise Imaging Platform for diagnostic interpretation and referring physician image access.

10-29-2013 3-40-13 PM

Phelps County Regional Medical Center (MO) will implement standardized order sets from Motive Medical Intelligence.

10-29-2013 6-28-30 PM

Memorial Hermann Health System (TX) selects ClinIntell as it technology partner for ICD-10 physician education.

10-29-2013 6-29-28 PM

Emerson Hospital (MA) will replace its legacy surgical documentation system with Surgical Information Systems’ perioperative platform.

New York Methodist Hospital selects workforce management solutions from Kronos.


Telehealth solution provider AMC Health adds Hon S. Park, MD (Army Medical Department) as CMIO; J. Mark McConnell (Verizon) as SVP of sales, account management, and marketing; Joanne Russell (Optum) as VP of clinical operations; and, Frank Tucker (MicroHealth) as CIO consultant.

10-29-2013 11-48-15 AM

Mike Cromika, director of IT services at Baptist Healthcare and a HIMSS Kentucky Bluegrass chapter board member, died Monday at the age of 56. Condolences to his family.

10-29-2013 6-30-55 PM

Richard J. Gilfillan, MD, the former director of the Center for Medicare and Medicaid Innovation, is named president and CEO of CHE Trinity Health.

10-29-2013 4-22-43 PM

Bruce Bagley, MD, interim president and CEO of the AAFP subsidiary TransforMED, assumes the role of president and CEO.

10-29-2013 4-52-42 PM

CynergisTek names David Holtzman (HHS/OCR) VP of privacy and security.

Announcements and Implementations

10-29-2013 6-32-44 PM

AHIMA presents Truman Medical Centers (MO) its Grace Award for its innovative approach to using health information management to deliver high quality healthcare.

10-29-2013 6-33-57 PM

Montefiore Medical Center (NY) and Streamline Health sign an exclusive 15-year licensing agreement enabling Streamline to commercialize Montefiore’s clinical analytics platform.

FirstHealth of the Carolinas goes live with Wellsoft’s EDIS at Montgomery Memorial Hospital (NC) and Moore Regional Hospital (NC).

The Great Lakes HIE and Michigan Health Connect collaborate to share medical records between their HIEs.

10-29-2013 6-35-22 PM

France’s Hôpital Européen implements the first ICU alarm management system in Europe using medical device connectivity technology from Capsule Tech.

Sutter Health (CA) announces it will go live with the ICD-10 code set on May 31, 2014, though it will not start submitting claims with ICD-10 codes until October.

10-29-2013 6-40-13 PM

Baylor Health Care System (TX) upgrades to Allscripts Sunrise Clinicals 6.1.

Government and Politics

10-29-2013 6-51-55 PM

A Government Accountability Office report finds a large increase in MU incentive payments made to eligible hospitals and EPs in 2012 compared to 2011. EHs and EPs were awarded $6.3 billion in Medicare EHR incentives in 2012, compared to $2.3 billion in 2011. The percentage of EHs awarded payments jumped from 16 percent in 2011 to 48 percent in 2012.


Park Place International announces its Secure Access and Mobility (SAM) solution, a desktop virtualization offering for Meditech hospitals with VMware Horizon View.


An estimated 95 million US residents use mobile health applications, representing a 27 percent increase over last year.

Results from an ICD-10 HIMSS/WEDI pilot project indicate that healthcare coders were accurate only 63 percent of the time, on average, in their documentation from medical records. The study, which ran from April 2012 to August 2013, also found coders averaged two medical records per hour, compared to four per hour under ICD-9. Translation: there is still a lot of readiness work to be done.

10-29-2013 8-07-51 PM

Children’s Healthcare of Atlanta fires and sues its former corporate audit advisor for allegedly taking the hospital’s proprietary information, including PHI and license numbers of over 500 providers. Two days after announcing her resignation, Sharon McCray began emailing the proprietary information to her personal email account. When confronted, McCray stated the information was to be used “as backup records for her new employment with an unidentified employer to use as a reference.” Children’s fired McCray and has asked a federal judge to force her to return the information.

Sponsor Updates

  • Athenahealth will implement Safety Event Manager, a safety reporting solution from Quantros, allowing athenaClinical users to submit patient safety data as part of their EHR workflow to the federally sanctioned Quantros Patient Safety Center
  • Inc. names AirWatch, GetWellNetwork, HCI Group, Imprivata and iSirona  to its Top 100 Job Creators list.
  • Black Book recognizes McKesson’s RelayHealth RCM as the top-ranked RCM, based on customer satisfaction.
  • SuccessEHS will integrate the DataMotion Direct secure messaging service into its EHR platform.
  • HIStalk sponsors named 2013 Top 100 EHR companies based on revenues include Allscripts, NextGen, eClinicalWorks, McKesson, Merge, Vitera, Greenway, Optum, T-System, Aprima, e-MDs, ADP AdvancedMD, Kareo, Wellsoft, RazorInsights and SimplifyMD.
  • The Drummond Group tests and certifies the Summit Express Connect interface engine from Summit Healthcare for MU Stage 2.
  • Nuance introduces enhancements to its Clintegrity 360 platform that integrates clinical documentation improvement and CAC into a single process.
  • HCS will showcase its Interactant platform at this week’s LeadingAge Annual Meeting & Expo in Dallas.
  • DVIDS highlights the Naval Health Clinic Hawaii online system, which uses RelayHealth software for messaging, appointment scheduling, and medication refills.
  • Business Cloud News features Inland Northwest Health Services in an article highlighting the growing use of cloud services in healthcare.
  • Access integrates support for the Wacom STU-530 and STU-430 Signature Pads into its electronic patient signature offering.
  • Bottomline Technologies releases its Logical Ink solution for the iPad.
  • Greenway Medical Technologies is named a finalist for the 2013 Intel Innovation Award in recognition of its PrimeMOBILE app for Windows 8.
  • In an interview, eClinicalWorks CEO Girish Navani shares various observations and predictions for the industry.


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

More News: HIStalk Practice, HIStalk Connect.

smoking doc

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October 29, 2013 News 9 Comments

Monday Morning Update 10/28/13

October 26, 2013 News 10 Comments

10-26-2013 4-13-54 PM

From FL IT Guy: “Re: HMA. CIO Ken Chatfield and two other IT VPs were separated Thursday night. I don’t know the details.” Unverified, but Ken’s bio has vanished from the for-profit hospital company’s leadership page. He took the job in 2010. HMA replaced its board a month ago and is reconsidering its planned $3.9 billion sale to Community Health Systems.

10-26-2013 2-16-06 PM

From Levon Helmet: “Re: interface engine selection. Consultant John Traeger put together a really great guide that includes a grading system. He presented to our user group conference and said he put the guide together because people are using dated questions on their RFPs that often lead to the wrong selection.”

From The PACS Designer: “Re: SAP and the cloud. TPD is very familiar with SAP AG and their database solutions from previous development experiences in healthcare. What is surprising for a stodgy company that SAP is the success they’ve had moving customers to the cloud. It wasn’t that long ago that they announced their desire to sell cloud solutions and they’ve already achieved over $1 billion in Hana cloud business.”

From Twitterpated: “Re: US CTO Todd Park. Hasn’t tweeted since the week before Healthcare.gov went live.” Todd’s last tweet was September 25. I don’t know if that means anything, but his tweets were somewhat regular at 5-10 per month before then, so his month-long absence is unusual. A Reuters article says that like most White House officials, nobody’s saying what is role was in developing Healthcare.gov and the White House has declined to make him available for interviews. A couple of influential Republican members of Congress seem to have him in their sights. Bizarre conservative columnist Michelle Malkin wonders, “What Happened to All of Obama’s Technology Czars?” in ripping the administration along with former US CIO Vivek Kundra, his replacement Steven VanRoekel, former US CTO Aneesh Chopra, David Blumenthal, Farzad Mostashari, and Todd Park. Where were all the critics when BearingPoint’s $500 million CoreFLS nearly shut down the Bay Pines VA hospital in Florida and was trashed after returning zero value to taxpayers? Affecting live patients seems to be more important than limiting sales of insurance policies.

10-26-2013 12-57-42 PM

It’s a toss-up for survey respondents trying to decide if private equity firms are a positive or negative industry influence. My opinion: sometimes the purely business decisions PE firms make aren’t pleasant for employees and sometimes even customers, but they’re trying to save companies in trouble or at least make them return more value to improve their chances of survival. Employees can find new jobs more easily than customers can choose new vendors, unfortunately. New poll to your right: would you buy hospital applications from a company that doesn’t have much hospital experience?

HIStalk Webinars

Two really good upcoming HIStalk Webinars will feature industry-leading CIOs speaking on interesting topics. I saw the rehearsal sessions for both and they are worth your time.

Marc Probst, VP/CIO of Intermountain Healthcare, will present “Fostering Innovation Through Appropriate Government Regulation” on Thursday, November 14 at 1:00 p.m. Eastern. I enjoyed learning about Intermountain and its informatics history as well as Marc’s thoughts about the government’s influence in setting standards and the need for innovation in healthcare. Marc’s presentation is sponsored by Sunquest Information Systems, which commissioned the initial version of this talk for one of its recent executive forums. 

Ed Marx, SVP/CIO of Texas Health Resources, offers “The Lost Art of Mentoring” on Thursday, November 21 at 2:00 Eastern. You know Ed from his “CIO Unplugged” writings on HIStalk, His mentoring posts resonated with many readers and Ed graciously agreed when I asked him if he would provide expanded thoughts on that topic. He will explain how mentoring saved his life, saved his marriage, and transformed his career. You’ve read Ed’s words on the page and now you can hear them live.

I started this Webinar series in the hopes that leaders like Marc and Ed would step forward to bring a new type of inspiring education to a wide audience. Not everybody speaks at conferences or attends them, and this is a way to put new ideas and new voices in front of HIStalk readers. It’s free, paperless, and  greener than flying in planes across the country to watch the same presentation on a screen in a big room. Let me know If you have non-commercial ideas to share on any topic (technology, care delivery, business, informatics, self-improvement, etc.) that would interest my audience. We’ll help by reviewing your presentation, taking you through a rehearsal, providing the online platform, moderating your session, making the recorded Webinar and slide PDFs available afterward, and of course hopefully assembling an appreciative audience. You’ll get exposure and a resume credential if you want those things, but mostly you’ll get the satisfaction of having given something back to the industry. A lot of people who are new to healthcare IT could benefit from your experience and wisdom.

10-26-2013 4-43-36 PM 10-26-2013 4-44-25 PM 10-26-2013 4-45-45 PM

The General Accounting Office appoints three new members to the Health IT Policy Committee: David Kotz, PhD (computer science professor, Dartmouth College); Devin Mann, MD, MS (assistant professor of medicine, Boston University School of Medicine); and Troy Seagondollar, MSN, RN (regional nursing technology liaison, Kaiser Permanente). They will fill positions as a privacy and security expert, researcher, and labor union member, respectively.

10-26-2013 1-54-41 PM

Anthelio Healthcare Solutions names Ken Roderman (Beacon Health Partners) as VP of sales.

HIStalk sponsors earning a spot on “100 Best Places to Work in Healthcare for 2013” are Aspen Advisors, CTG Health Solutions, The Advisory Board Company, iSirona, Health Catalyst, Santa Rosa Consulting, Divurgent, Innovative Healthcare Solutions, Encore Health Resources, Cumberland Consulting Group, Sagacious Consultants, Impact Advisors, Cornerstone Advisors Group, Imprivata, Iatric Systems, ESD, and Hayes Management Consulting.

10-26-2013 2-29-54 PM

10-26-2013 2-30-41 PM

St. Rita’s Hospital (OH) says it’s the pilot for Epic’s MyChart Bedside, a tablet-based app that gives patients and family members access to their health information, lab results, care plan, care team information with photos, and educational material.

10-26-2013 2-33-47 PM

HIT seed funder Rock Health perhaps unintentionally emphasizes the generational and cultural gap that exists between its youthful West Coast team and us experienced non-hipsters who work in hospital IT by quoting an R. Kelly song in a tweet pitching some kind of hackathon.

Bruce Friedman of Lab Soft News points out the potential conflict of interest in hiring QSSI as a major contractor for Healthcare.gov. “It’s owned by UnitedHealth Group which also owns United Healthcare … the general software contractor now for Healthcare.gov is owned by the holding company that also owns the largest health insurance company in the country, UnitedHealthcare. Does the fact that UnitedHealthcare seems to be not participating the healthcare exchange, as most other private insurance companies are doing, change the equation? For me, the answer is no.”

10-26-2013 3-57-36 PM

One person is really happy about Healthcare.gov – the entrepreneur who bought the domain Healthcare.com for $2 million seven years ago and who now runs a vaguely governmental-looking advertising site to get people to request insurance quotes. Clueless Web users have requested 100,000 insurance quotes there so far this month alone. The same guy also owns Healthcare.net and Healthcare.org, the latter of which went from zero visits to 60,000 on October 1 alone. He had originally planned to create a WebMD-like site, saying, “We are not healthcare guys, we are online marketers. But we knew that health care accounted for more than 26 percent of the U.S. GDP.” He says the feds made some dumb mistakes, like requiring visitors to register before searching for quotes. His site is probably giving more quotes than the one the feds put up, so maybe they should make him part of the tech surge. He might be the most brilliant domain squatter since Whitehouse.com was set up as a porn site until the government shut it down in 2004, depriving the electorate of the opportunity to see a whips-and-chains bearing Hillary Clinton leading Bill around by a dog collar right above the porn links.

10-26-2013 3-36-49 PM

Venture capitalist Michael Greeley has left Boston-based Flybridge Capital Partners, which he co-founded in 2001, to join VC firm Foundation Medical Partners. He holds board a board seat at Valence Health. Current HIT investments by Foundation Medical Partners include Explorys (healthcare big data), Predilytics (healthcare analytics), and Rise Health (population health registries). FMP’s previous HIT-related  investments include Humedica and Valence Health. Greeley says early-stage need to be experts in specific sectors, especially in healthcare, and he wants to work with the IT side.

Vince continues his HIS-tory of McKesson some some fascinating background on Peoria-based HBO (before they moved to Atlanta and became HBOC) that includes some first-hand reports as well as personal photos from HBO’s #14 employee, Dan Mowery. This is a labor of love for Vince, so if you enjoy his HIS-tory posts as much as I do, I’m sure he would appreciate it if you’d leave a comment to say so.


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

More news: HIStalk Practice, HIStalk Connect.


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October 26, 2013 News 10 Comments

Time Capsule: The Latest Stimulus Package for Healthcare IT and a Wheezing Economy: H1N1 Reporting

October 25, 2013 Time Capsule No Comments

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

I wrote this piece in November 2009.

The Latest Stimulus Package for Healthcare IT and a Wheezing Economy: H1N1 Reporting
By Mr. HIStalk


You are nobody as an HIT vendor unless you’re doing something fancy with H1N1 flu reporting, including spewing self-congratulatory press releases that brag about your civic contributions.

Cerner started it by sending customer ED data to Washington, supposedly giving Uncle Sam real-time H1N1 outbreak reports, even though H1N1-specific data elements are hard to come by, the vast majority of US hospitals don’t use Cerner, and the vast majority of flu sufferers don’t go to the ED. Not to mention that there’s nothing the government can do anyway except observe ("Man, Lockhart, Texas is really getting pounded.")

You would think H1N1 tracking is right up there with an actual H1N1 cure. Google has its own outbreak map generated from Web searches (they can also assess the prevalence of enlarged mammary glands and propofol overdoes, I’m guessing). Web sites loaded with AdSense ads are hoping for a quick buck from providing questionably useful maps and graphs.

Even Harvard Medical School and Children’s Boston have released their own competing iPhone H1N1 trackers ($2 and free, respectively). It’s not really clear what marginally coherent yet mobile consumers are supposed to do with their newfound information. Wear surgical masks? Do that point-and-wink thing instead of shaking hands? Head to their bomb shelters and fight off infected interlopers like the guy in “Night of the Living Dead?”

(Note to self: have my people contact Harvard to IPO a mash-up between their H1N1 tracker and traffic-enabled GPSs, allowing paranoid motorists to avoid entire swaths of geography where H1N1 is around).

H1N1 is a deadly, hand-wringing pandemic (according to TV people anxious for something somber to talk about between inane banter), even though only about 1,000 Americans have died of it so far compared to the 30,000 to 50,000 who die every single year from the plain old unsexy flu and its complications. Drug companies are licking their chops. Panicked citizens not typically known for following a healthy lifestyle or paying attention to seasonal flu vaccines are fighting each other to get the hyped H1N1 version, with the resulting shortages making them even more hysterical.

The government, meanwhile, is saying the one thing that’s guaranteed to send people into a full-fledged panic: "Don’t panic."

(This is actually Swine Flu II, of course. Gerald Ford got everybody excited about it as his presidential candidacy was flailing in 1976. The pandemic never happened, but 40 million people got the swine flu vaccine at a cost of $135 million, 30 died of its side effects, $3 billion in legal claims were filed, $50 million worth of vaccine was destroyed, Ford lost to Jimmy Carter, and Chevy Chase lost the subject of his only funny bit. It was the lowest point of the year, other than when "Convoy" went to #1 on the pop charts).

So what if you’re a small HIT player without the resources to accurately track (or even claim to track) H1N1? Here’s a plan: hire a bunch of unemployed telemarketers to just call up houses and ask whoever answers if they or anyone they know has H1N1. Put out press releases claiming it was your advanced technology, create a fancy Web page, and find yourself a politician to thank you publicly for your valuable services to a grateful nation.

Just be aware that people exaggerate their own illness for maximal sympathy or as justification for skipping work, so any kind of sniffles or tiredness will convince people to say they have H1N1 because they heard about it on Oprah ("headaches" become "migraines", "a cold" becomes "the flu", and "getting sick from too much Super Bowl beer, wings, and guacamole" becomes "food poisoning"). That’s actually a good thing, though — your H1N1 numbers will be higher than everybody else’s since most flu sufferers don’t need hospital treatment like Cerner is measuring, so you will be widely cited by people trying to prove that H1N1 is the next Black Death.

Those inflated H1N1 numbers are good. When it comes to healthcare IT and the economy in general, you just can’t have enough H1N1 stimulus. It’s what I call "viral marketing."

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October 25, 2013 Time Capsule No Comments

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