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Monday Morning Update 1/7/13

January 5, 2013 News 10 Comments

From Willy Mays Hayes: “Re: Cerner. Our remote-hosted Cerner system just experienced a six-hour downtime that they are attributing to hardware failure in Kansas City. We’re wondering how many other clients were effected.” Unverified, but speak up if your system went down.

From Zorba P: “Re: non-compete agreements. A Wired essay says enlightened companies realize that non-competes hurt the economy.” The article didn’t convince me that companies shouldn’t require employees to sign non-competes, only that allowing employees to freely take their proprietary knowledge to a competitor might increase competition and thus economic output. Maybe it all works out where companies poach each other’s people like a Cold War spy exchange, but the odds of that intellectual property flow being equally balanced among all competitors seem slim and some companies are going to lose. The article tries unconvincingly to make the point that Boston’s Route 128 startup environment lost out to Silicon Valley because California law essentially voids all non-compete agreements, leaving the Massachusetts companies with no-choice lifer employees who stagnated their employers. I might agree with the conclusion that employees should be free to immediately leave and start their own companies since the economy would benefit from having more entrepreneurs and fewer unmotivated corporate clock-punchers, but I’m just not comfortable with the idea that any company with big pockets should be able to steal competitive secrets by simply hiring away insiders.

From The PACS Designer: “Re: Pebble e-paper Smart Watch. Our Travis Good posted in The Year of the Health Gadget about Pebble e-paper Smart Watch, so TPD thought it would be a good addition to the upcoming update of TPD’s List of iPhone Apps. Also found a YouTube preview explaining its use in transferring apps from mobile devices to the wrist watch.” I inadvertently burst out laughing at 0:20 when the company’s “Dream Team” (i.e., stereotypical startup nerds) make a reluctant and un-photogenic appearance, displaying palpable discomfort at being exposed to actual sunlight and fresh air. If your life won’t be complete without a rather ugly but smartphone-connected watch whose least-interesting capability is telling time, you’ll pay around $150 if it ever reaches the market (pre-orders started in May and the company isn’t providing updates), you’ll be buying from a company that failed previously before renaming itself and raising $10 million on Kickstarter, and you’ll be waiting until they find Asian companies willing to build their product cheaply. Not to mention that depending on hard-to-predict fashion acceptance, you’ll either look like the coolest kid around or a clueless idiot flashing a geeky Dick Tracy calculator watch.

1-5-2013 7-27-03 AM

As healthcare IT professionals, we’re even more skeptical than laypeople that providers can keep our medical information secure, with 84 percent of poll respondents saying they lack that confidence. New poll to your right: have you used a patient portal offered by your PCP? I have, and I like it — it’s convenient for making appointments, checking lab results, and pre-paying for a visit and printing a barcoded page that lets me check in at a kiosk instead of waiting in line.

1-5-2013 7-41-43 AM

Welcome to HealthITJobs, sponsoring both HIStalk and HIStalk Connect at the Platinum level. I like the clean look of their site, which has some pretty cool jobs listed. Employers typically need to fill positions in a hurry, and with HealthITJobs.com, positions you post go online immediately. Job hunters can manage the process from their smartphones: checking for openings, receiving real-time alerts when new jobs go up, and even applying for jobs from anywhere. As an employer, I’ve posted hospital IT jobs on some of the big job boards and it’s usually been a disaster, with 95 percent of the applicants having no healthcare experience, no US work credentials, or clearly insufficient capabilities. HealthITJobs focuses on health IT professionals, so you won’t be have Bolivian bricklayers bugging you about your CMIO position. The biggest regret I have about the crappy jobs I’ve held as an employee (thankfully not recently) was that I let inertia keep me from getting serious about moving on. It would have been so easy then and even easier now to find a new gig: register, download the iPhone app, and see what’s out there (hint: it’s a booming industry, so there’s a lot). For employers and recruiters, unfilled positions cost a lot of energy and money, so HealthITJobs is a painless way to post your listings and find that one right person who’s apparently not perusing your listings posted elsewhere. Thanks to HealthITJobs for supporting HIStalk and HIStalk Connect.

1-5-2013 7-43-31 PM

Hackers hit the servers of UNC Lineberger Comprehensive Cancer Center (NC), exposing the information of 3,500 employees and contractors. No patient information was involved. The breach occurred in May, but those affected weren’t notified until after Christmas. University IT employees say their servers are hit with attempted hacks thousands of times every hour.

CMS announces a 90-day extension for meeting Affordable Care Act transaction standards for eligibility and claim status. The reason given: nobody was going to be ready.

1-5-2013 7-44-27 PM

Wolters Kluwer Health completes its acquisition of Health Language, Inc., announced in October.

The fired former president of University of North Texas Health Science Center says he was let go for a variety of not-so-good reasons. One of them was his analysis of an all-campus shared services business center, which he says upset the university’s chancellor because it found that the health science center was paying twice as much as before with reduced quality, including a two-day EMR downtime that affected patients.

1-5-2013 7-33-02 PM

Home medical billing software vendor Brightree LLC acquires CareAnyware of Raleigh, NC, which sells home health and hospice software.

1-5-2013 8-43-06 AM

Reuters covers the recent Critical Care Medicine article in which researchers used plagiarism detection software to determine that most physician progress notes contained at least 20 percent material copied and pasted from elsewhere in the electronic record. I pulled up the original article (thanks to my academic medical center employer for providing remote access to our online journal library) and offer these observations:

  • It was a one-hospital study (MetroHealth Medical Center, Cleveland) of 135 patients admitted to a 14-bed ICU for at least three consecutive days.
  • The EMR system was Epic, which offers built-in functions for copy-paste and copy into a new note.
  • Residents copied more often, but attendings copied more actual text.
  • The threshold for identifying copying was phrases of at least four words and 20 or more total characters that contained at least a 20 percent match.
  • The authors did not interview any of the physicians found to have copied material, did not postulate why they did so, did not ask those involved in care of the identified patients whether the copied material negatively impacted patient care, and drew no conclusions about the potential or actual impact of copying progress note text on patient outcomes.

My conclusion: like many studies that raise a red flag and then run, this one seems to have been thrown together and executed quickly, resulting in a slightly interesting article that has no meaningful conclusion other than that someone with more resources should do a better study. Doctors may well copy progress note material, but that’s not necessarily a bad thing given that EMRs don’t typically offer easy ways to tag highly relevant material from the routine junk that hospital administrators, regulators, and malpractice lawyers require. It should be assumed that bringing material forward has an at least an equal likelihood of being positive for the patient since it might be missed otherwise. And intentional copying is a lot less bothersome than template-generated babble that looks good but says nothing useful.

Everybody wants to armchair quarterback how doctors document. How would you like having a roomful of stern third parties examining every e-mail you write for relevance, insightfulness, originality, and style, looking for opportunities to reduce your pay or sue you? If doctors aren’t complaining about the body of progress notes they work with in caring for their patients (including attendings reviewing the work of residents), then the armchair quarterbacks aren’t likely to find a smoking gun of vast conspiracy or widespread negligence.

If you’re a hospital, set standards on how documentation should be done. Demand that your EMR vendor develop ways to separate the useful from the worthless, and to add logic that considers the age of a documentation element and its graded value from individual providers in predicting its relevance. If you want elegant and thoughtfully composed prose, expect to pay for it in reduced physician productivity. And if you can prove that particular methods or styles of progress notes directly impact patient care, let’s see your data.

I think we can agree that electronic documentation works better in theory than in practice due to poor design and unguided use and therefore could be improved. To that end, I’ll close with a pithy quote from contributor Robert Lafsky, MD: “I’d sure like to see that visiting expert professor try to unravel a difficult case using nothing but the printed output from a typical EMR.”


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

More news: HIStalk Practice, HIStalk Connect.

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January 5, 2013 News 10 Comments

Time Capsule: EMR Vendor Starts Secretive, Lucrative Business: Pimping the Patient Data of its Provider Customers

January 4, 2013 Time Capsule 3 Comments

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

I wrote this piece in March 2008.

EMR Vendor Starts Secretive, Lucrative Business: Pimping the Patient Data of its Provider Customers
By Mr. HIStalk


Genetic medicine company Perlegen Sciences probably never saw the controversy coming. Its March 18 press release innocently and proudly announced an exclusive collaboration agreement with an unnamed EMR vendor to mine that vendor’s database, which is said to hold medical information on four million patients. To egghead scientists who don’t get out much, that sounds like a victorious achievement for medical research.

Perlegen will sift through mountains of data to select patients who meet its research criteria. The company will then contact the providers of those patients, asking them to contact the patient on the company’s behalf and offering them cash for providing a DNA sample. (Everbody’s watched enough CSI to know about the Q-Tip cheek swab thing, of course).

Perlegen’s intentions sound noble, at least when they’re the ones reciting them. The company is hoping to find genetic markers that can predict the individual response of patients to specific drugs. That correlation could improve patient safety and drug efficacy. And boost drug company profits, of course, which is the real point (some of its investors are drug companies).

The fastidiously unnamed EMR vendor is being paid to provide massive amounts of supposedly de-identified patient data (that methodology wasn’t specified). They get a cut of the take. Perlegen gets an ownership stake in the EMR vendor. Everybody’s happy.

Except perhaps those patients whose information is being probed by a company they’ve never heard of. Generously provided by another company they’ve also never heard of. Do they really want a genetic research firm peeking into their medical records, obtained in an open-air bazaar?

You’ll be hearing more about this story. It opens up a number of legal and ethical questions that are sure to tickle the fancy of journalists, privacy advocates, and software vendors.

The document trail will be interesting. Did the providers’ Notice of Privacy Practices indicate to patients that their data would be marketed since this goes well beyond the usual treatment, payment, and operations? Did the EMR vendor’s contracts with its customers reserve the right to not just store their data, but to sell it?

Perlegen drops the words “HIPAA” and “IRB” to make everything sound on the up-and-up. They’re HIPAA-immune, however (they’re not providers) and it’s not clear whose IRB will oversee the project. In other words, it’s not illegal, but it sounds a bit loophole-ish. So much for HIPAA offering broad privacy protection.

The biggest villain here appears to be the EMR vendor. It has no contractual agreement with patients as far as we know, so what is it doing selling their information?

Don’t blame Perlegen – they should have been told ‘no’. Blame lax privacy protections, the unnamed EMR vendor, and poor IT market conditions for leading to such a desperate cash grab. When that vendor is named – and it will be – we’ll know how it worked out such a sneaky deal, how it’s de-identifying the data of its customers, and how it justifies being partially owned by drug company interests.

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January 4, 2013 Time Capsule 3 Comments

Morning Headlines 1/4/13

January 4, 2013 Headlines No Comments

Lexmark Acquires Acuo Technologies

Acuo Technologies, archive and clinical content manager vendor, is acquired by Lexmark’s Perceptive Software unit for $45 million

Welsh, Carson, Anderson & Stowe Completes Acquisition Of GetWellNetwork

GetWellNetwork is acquired by PE firm Welsh, Carson, Anderson & Stowe. GetWellNetwork just signed a deal with the VA last month to provide in-room patient engagement solutions across 21 facilities.

Patient Portals: Providers Choose Path of Least Resistance

A new KLAS report on patient portals shows that most physicians are going with whatever product their EHR vendor is offering. “The existing EMR vendor relationship appears to be more important than any other factor when choosing a patient portal,” said report author Mark Allphin. “While functionality and ease of use are important to providers, they take a back seat compared to providers’ desire to manage fewer vendors and interfaces.”

SRS Receives Substantial Investment from Thoma Bravo

Thoma Bravo, a PE firm which holds equity in Hyland Software and Mediware, invests an undisclosed sum in SRS Software.

TriZetto Acquires Claims Workflow Automation Company To Further Enhance Efficiency of Healthcare Payers And Providers

TriZetto acquires Healthcare Productivity Automation, a Franklin, TN-based vendor of an automated claims administration solution.

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January 4, 2013 Headlines No Comments

News 1/4/13

January 3, 2013 News 2 Comments

Top News

1-3-2013 6-59-26 PM

Lexmark and its Perceptive Software unit announce the acquisition of vendor neutral archive and clinical content management vendor Acuo Technologies for $45 million.

Reader Comments

1-3-2013 5-47-14 PM

From John Galt: “Re: new layouts. Like the new site look and the good folks over at Dodge that lent a hand. But LOVE the slicker presentation on HIStalk Connect!” I like that layout, too. It’s really modern and lightweight, just not quite appropriate for HIStalk since our posts here are longer and need a more text-intensive page. If you haven’t checked out the former HIStalk Mobile lately, Dr. Travis and Lt. Dan have been getting some Twitter love for some recent posts in particular, Top 10 mHealth Stories of 2012 and Connected Health Predictions for 2013, and James Harris has contributed some nice pieces as well. We’ll be announcing new sponsors and new features shortly. We might be able to use more help if you’re big on the topics we cover and you like to write – e-mail me if you’re up for it.

HIStalk Announcements and Requests

This is the last chance for your HISsies nominations. I’m fascinated that all but one nomination for “stupidest vendor action” involves the same company, but for several actions, which will make an interesting HISsies ballot for sure. A few people e-mail every year to complain that I put the same companies and people on the ballot, apparently missing the not-so-subtle point that readers do the nominating, not me. The moral of the story: submit your nominations and feel instantly superior to the complainers.

If your organization has been submitting events to the HIStalk Events Calendar, take note: only to HIStalk Platinum sponsors will be able to submit events from this weekend on. Also, if you miss the Smoking Doctor logo, you can see it there since I forgot about that page when I had the site redesigned, mostly because the events display right on the main page of HIStalk and I don’t go to the full calendar display as often. Fear not – the Smokin’ Doc will live on, free of both political correctness and lung carcinoma.

On the Jobs Board: Marketing Manager. That’s all for the moment since most companies disengage from hiring over the holidays, so Aspen Advisors gets sole billing this week.

1-3-2013 7-40-58 PM

Companies keep asking me to help with Webinars, which I’m considering, but only if I can do them better than everybody else in making them fun and educational. My two-question survey asks what you like and don’t like about Webinars and how I can raise the bar. I would appreciate your thoughts. I have a short attention span, so my Webinar wish list includes sending the slides in advance by e-mail, playing music or chat while I’m waiting for an on-time start, limiting speaker intros to 10 seconds, clearly identifying a program as educational vs. a product pitch at signup, requiring interactivity such as polls, taking questions in advance and in writing and choosing the best ones to answer, and keeping the whole thing to around 45 minutes.

1-3-2013 6-08-11 PM

Thanks to Intelligent Medical Objects, an HIStalk Platinum sponsor for two years that has expanded its support also sponsor HIStalk Practice and HIStalk Connect at the Platinum level. Only a handful of companies have achieved that trifecta. IMO provides a “Common Ground for Health Vocabularies” via terminology mapping tools (ICD-9 and ICD-10, SNOMED, HCPCS, RxNorm) for vendors and vocabulary products for healthcare organizations. A recent offering is a search engine appliance kept current on medical terminology, allowing vendor partners to participate in true semantic interoperability. I can’t decide which physician customer quote I like better: (a) “Installing IMO was the single, most important improvement we have made to our EHR system,” or (b) “I am impressed by my inability to stump IMO.” I like the backgrounds of the company’s executives, too: Frank Naeymi-Rad (CEO and chairman) has a PhD in computer science, they have physicians in a couple of executive roles, and CFO Bac Palomo is not only a Stanford MBA but also a graduate of the United States Naval Academy and a former Naval Aviator. I know I’ll hear from Dr. Jayne since every time I mention IMO she e-mails me to gush about how much she likes its products as a CMIO, so I probably should have just let her write a summary from a customer perspective. Thanks to Intelligent Medical Objects for supporting our work.

1-3-2013 6-26-38 PM

Also extending its support is Divurgent, a three-year HIStalk Platinum sponsor stepping up to also support HIStalk Connect at the Platinum level. The company’s consulting work spans activation management, advisory, clinical transformation, and RCM. You may know Partner Colin Konschak, who is active in HIMSS and has co-authored books on consumer behavior and medicine and ACOs. The rest of the team has a lot of healthcare experience as well, and the company has won awards for growth and being a “best place to work.” The company blog has meaty rather than fluffy posts, critically examining ACOs, the use of physician scribes, and hospital readmissions. We appreciate Divurgent’s ongoing support.

Acquisitions, Funding, Business, and Stock

1-3-2013 5-21-04 PM

PE firm Thoma Bravo, LLC, which holds equity in Hyland Software and Mediware, invests an undisclosed sum in SRS Software.

1-3-2013 5-22-14 PM

Access acquires CPI and merges with Access FSA, developer of the Formatta Electronic Forms Management Suite.

1-3-2013 6-54-29 PM

TriZetto acquires Healthcare Productivity Automation, a Franklin, TN-based vendor of workflow automation solutions. HPA offers Health Mason, which automates claims administration.

1-3-2013 6-57-02 PM

Private equity firm Welsh, Carson, Anderson & Stowe acquires GetWellNetwork, which offers patient engagement solutions that include in-room systems. The Bethesda, MD-based GetWellNetwork is the KLAS leader in the Interactive Patient Systems category.

1-3-2013 8-11-37 PM

Behavioral software vendor Netsmart Technologies, led by former Cerner COO Mike Valentine, acquires Defran Systems Inc., which offers software for human and social services organizations.

1-3-2013 7-47-15 PM

Kyruus, which offers software for physician networks and referral management,  raises $11 million in a Series B funding round, increasing its total to $19.6 million.


Health Inventures selects ZirMed as a preferred business partner and will offer ZirMed’s EDI solution suite to its ASC and surgical hospital clients.


1-3-2013 5-23-33 PM

Health Dialog, a subsidiary of Bupa and a provider of population health management solutions, promotes Robert Mandel, MD to CEO.

1-3-2013 8-53-12 PM

Progress Software names Chris Perkins (Eclipsys, Per-Se, Emageon) as SVP/CFO, reporting to newly hired President and CEO Phil Pead.

Announcements and Implementations

Palisades Medical Center, Engelwood Hospital and Medical Center, and Deborah Heart and Lung Center join the RelayHealth-powered Jersey Health Connect HIO.

1-3-2013 7-08-42 PM

Audax Health signs a five-year strategic alliance with Cigna to develop a digital engagement platform for Cigna customers that will include "fun and engaging health related activities and information.”

Government and Politics

1-3-2013 6-52-03 PM

ONC makes Cypress, its CQM testing and certification tool, available for vendor download. It’s also offering a January 10 online demo.

Innovation and Research

Researchers with Truven Health Analytics project that health plans will incur 4.8 percent growth in allowed medical and pharmacy costs in 2013.

Johns Hopkins researchers find that hospitals that hide inpatient psychiatric records in their EMRs have a much higher readmission rate for psych patients. Says the lead author physician, “If you have electronic medical records, that’s a good step in the right direction. But what you really need to do is share the records with non-psychiatrists. It will really make a difference in terms of quality of care and readmission rates. Let’s not keep mental health records out in the cold.”


1-3-2013 1-44-38 PM

Providers are feeling increased pressure to engage patients at deeper levels because of the urgency surrounding Meaningful Use and accountable care, according to a KLAS report on patient portals. Provides most often select patient portals based on convenience and vendor relationships. Third-party portal vendors earning strong satisfaction scores include Jardogs, RelayHealth, and Intuit.

1-3-2013 2-40-15 PM

The Hospice of North Idaho will pay HHS $50,000 to settle potential HIPAA violations following the loss of a laptop that contained the personal data of 441 patients. The settlement is the first involving a PHI breach affecting fewer than 500 individuals.

UNC Health Care (NC) exploits a collections loophole that allows it to siphon money owed to it directly from the tax refunds of patients. The health system and its physician group took in nearly $8 million by that method in 2012. Says a physician group VP, “It’s a useful tool.” A patient anxious to fight the “facility fee” that UNC tacks on to the doctor bills of practices it has acquired was disappointed to find that he’ll miss his day in court because the hospital didn’t sue him and instead simply docked his tax refund, saying it’s required to do so under state law.

A hospital in Scotland gives a patient 13 times the intended radiation dose, caused by “a software bug as a result of an upgrade.”

1-3-2013 8-19-28 PM

1-3-2013 8-22-28 PM

MedBox, which sells a Pyxis-type dispensing cabinet for medical marijuana, opens an office in Massachusetts expecting big business now that a new state law legalizes medical marijuana. Had you invested $10,000 in the company’s stock six months ago (see chart above), your shares would be worth more than $252,000 today, and for a day or two in mid-November, over $820,000 as exuberant pot profiteers ran up the company’s market cap to more than $2 billion with a single-day advance of 3,000 percent.

The South Florida Business Journal covers the lawsuit filed by an Allscripts MyWay customer against the company. The attorneys claim they’ve received calls from “many doctors” complaining about MyWay since the suit, which seeks class action status, was filed. The article says Healthcare Data Solutions, the largest Southeast reseller of MyWay, is helping its 500-plus MyWay customers migrate to Professional or the competing Aprima product, while HDS itself will become an Aprima reseller.

Weird ICD-10 codes will be worth the painful conversion strictly for parody value, with this Nuesoft video titled “Dumb Ways to Die Parody: New ICD-10 Codes to Try” being a particularly creative effort. Hopefully there’s a code for “getting an simple, annoying, and insanely catchy tune out of your head after watching a video,” referring not to Gangnam Style, but rather to the object of the parody, Dumb Ways to Die, which has hit 36 million YouTube views.

1-3-2013 7-25-54 PM

Weird News Andy has apparently emerged from his sun and sand hiatus to file this story about Vomiting Larry, a robot that simulates a barfing norovirus sufferer so scientist can figure out how far the virus can be spread. A set of the ‘bots, some sorostitutes, and streaming LMFAO music could pass for a homecoming weekend frat party.

WNA’s enthusiasm this week is infectious, as he injects the story of eight employees fired by IU Health Goshen Hospital (IN) for refusing to receive flu shots. WNA notes that one fired nurse questions why employees don’t have a choice but the shot is optional for patients.

Strange: a teacher who suffered spinal cord damage after abusing nitrous oxide for months sues the stores that sold it to him, claiming he’s now the champion of those whose illegal usage has harmed them. According to the manager of one of the head shops he’s suing, “I think it’s kind of a stupid lawsuit, personally. It’s like going to McDonald’s and suing them because you got fat because you ate it every day, or buying a nail gun and nailing your face or your foot.”

Sponsor Updates

1-3-2013 9-19-13 PM

  • Impact Advisors Recruitment Director Amy Reid is featured in a podcast about using social media for effective recruiting.
  • eClinicalWorks hosts roadshows this month in Dallas and Miami to highlight Stage 2 MU requirements.
  • ZirMed offers a free 60-day trail of its Analytics business solution to clients using its claims management and electronic remittance advice products.
  • Fulcrum Methods publishes a case study featuring Community Medical Centers (CA) and its success using Fulcrum solutions to select a new HIT framework.
  • CommVault’s Product Marketing Manager Emily Wojcik weighs in on integrated versus point level approaches to enterprise information archiving in a blog post.
  • The Nashville Post names Agilum Healthcare Intelligence to its list of the top 25 technology companies in Nashville.
  • An API Healthcare blog post discusses how healthcare staffing and scheduling solutions can help facilities focus on patient outcomes and cost reductions while tracking employees’ hours and skills.
  • Care360’s ChartMaxx version 5.6 earns certification through the FairWarning Ready certification program.
  • Santa Rosa Consulting announces its first Best in KLAS ranking, coming in at #5 in the Clinical Implementation Supportive segment with a score of 88.9.

EPtalk by Dr. Jayne


I rang in the New Year with a glitch, as the Google cloud somehow vaporized the post I sent to Mr. H on Monday. For those of you who assumed I was absent due to a little too much celebrating, thanks for thinking of me as your official HIStalk party girl. I learned this year that kissing exercises all 34 muscles in the face (thanks, Twitter!) so I hope everyone was able to get some exercise as the clock struck midnight.

It’s been amazingly busy at work this week, more so than I expected. People actually came in on Wednesday ready to work and didn’t seem as draggy as they usually are. Lots of chatter about the fiscal cliff though. I’m glad that the short-term patch does avoid the 27 percent Medicare payment cut that was looming, but it didn’t do much for the long-term problem of how we finance healthcare in the US. I’m sure there’s more drama to come as the new Congress is sworn in.

As we look at cutting healthcare costs, patients continue to switch from brand to generic medications and also from one generic version to another. A recent study finds that changes in pill color have an adverse effect on medication compliance. When the appearance of the medication changes, patients are less likely to take it as directed. I wonder if there’s a similar impact when EHR vendors change the colors and layouts of screens? Does it make us less facile as users, even subconsciously? I’m a huge fan of changing the user interface to make it more usable, but changing colors without good reason is just annoying. I experienced annoyance and distraction this summer when our ER tracking board inexplicably changed from blue to gray along with some backgrounds and icons that morphed for no discernable reason.

The AMA shares its list of the “most intriguing medical facts of 2012.”  Highlights include:

  • Laughter enhances a person’s intake of air and increases endorphins released by the brain.
  • US rural areas have 25 percent of the population but only 9 percent of the physicians.
  • One-third of new prescriptions never get filled.
  • 58 percent of US office-based prescribers sent prescriptions electronically in 2011.
  • Medical identity theft has become the fastest-growing type of identity theft in the world.
  • 75 percent of physicians with an EHR say the system improved care.
  • 61 percent of patients say they trust information posted by physicians on social media.
  • More than 70 percent of staffers in medical offices say they feel rushed when taking care of patients.
  • Conversion to ICD-10 will increase the number of code sets from 13,000 to 68,000.
  • Chronic diseases account for up to 75 percent of US health spending.
  • Up to 30 percent of US health care spending is spent on unnecessary tests and services.

Grant alert: Although ONC is avoiding formal governance for the Nationwide Health Information Network, grants will be offered to those involved in HIE governance to encourage them to develop and share best practices. Sharpen those pencils, folks.



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

More news: HIStalk Practice, HIStalk Connect.

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January 3, 2013 News 2 Comments

Morning Headlines 1/3/13

January 3, 2013 News No Comments

Hospital groups unhappy with fiscal cliff legislation

Hospitals are left holding the bill as fiscal cliff legislation stops a 26.5 percent payment cut for Medicare physicians, but shifts nearly half of the cost to hospitals by further reducing hospital payments over the next 10 years.

Laptop Stolen From Gibson General Hospital

A laptop stolen from the home of a Gibson General Hospital employee during a burglary compromises the names, addresses, Social Security numbers, and clinical information of 29,000 patients.

Kyruus raises $11M to advance ‘big data’ health IT

Big data startup Kyruus raises $11 million in series B funding, bringing its total to $19.6 million in just its second year of operations. Kyruus uses EHR data and algorithms to figure out which doctors within a network are most efficient at specific procedures and why, hoping to drive better health care outcomes and lower costs. It communicates this information to physicians within the network when they are referring patients for consultations.

Separate may not be equal: A preliminary investigation of clinical correlates of electronic psychiatric record accessibility in academic medical centers

The International Journal of Medical Informatics publishes research findings comparing readmission rates of patients whose psychiatric records are made available to the clinical team via the EHR versus when the psychiatric records are treated as confidential. The study concludes that having a single, merged chart correlates with improved clinical care as measured by lower readmission rates for psychiatric patients.

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January 3, 2013 News No Comments

News 1/2/13

January 1, 2013 News No Comments

From Sal the Stockbroker: “Re: HIStalk. For seven of your 10 years I worked for a healthcare IT company and followed you religiously, even though you trashed our marketing a few times (we deserved it!) I still follow three years after I left IT. While dispensing news, opinion, rumors, and research, you all seemed almost like family. I will still follow, if nothing else but to see the latest Spotify playlist or WNA’s weekly clincher. Thanks to all of you, including Mrs. HIStalk for putting up with your insane work hours, loud music, and blogging obsession.” Thanks for the encouragement – it helps during those long, lonely evenings. Mrs. H probably knows my music only from the bass and drum beats since my room (office? study? den? All sound pretentious) is above the kitchen, although she works in that room only a fraction of the time I’m in mine — she’s often asleep in bed by the time I’m finished. I’ve started using headphones, though, since the sound is cleaner.

Happy 2013. It’s not even 9:00 a.m. Eastern time on New Year’s Day as I’m writing this and the web stats show that 30 people are reading HIStalk online right now. I figured everybody would be sleeping in, so it’s either early-rising go-getters or hard-partying folks who haven’t yet called it a night who are reading Ed Marx’s piece on creating a family plan.

My New Year’s Day plans including watching the Rose Parade with Mrs. HIStalk, the only televised parade I’m willing to watch with her since I have zero tolerance for dull scripted banter, endless product placements, anything related to Disney, and lip-synching, bottom-feeding pseudo-celebrities pitching lame TV shows that are, not coincidentally, airing on the same TV network that’s running the parade. (I repeatedly recite those observations while we’re watching the Thanksgiving and Christmas parades until we’re mutually relieved that I wander off to Netflix or the iPad.) The comes bowl games, which interest me for around 30 minutes until I go do something else, and then we always eat hot dogs as a New Year’s tradition since we were so poor when we were first married that we couldn’t afford anything else to eat on the folding card table and chairs that served as dining room furniture, which was fine because we didn’t have a dining room either. Then it’s back to work tomorrow and the inevitable HIMSS conference ramp-up that awaits through March once I get home each day.

Final December stats for the one reader who asks: 116,659 visits and 224,820 page views, up considerably from December 2011’s numbers.

HIStalkapalooza details and sign-ups will be up on January 19 or thereabouts.

1-1-2013 8-21-47 AM

Pain Clinic of Northwest Florida, Inc. files a lawsuit against Allscripts for pulling the MyWay rug out from under the practice, also seeking to have their complaint certified as a class action lawsuit. The wording of the complaint reads like someone dashed off an angry e-mail and their attorney just pasted it into a Word lawsuit template. It says MyWay was “buggy,” that Allscripts had little ability to bring it up to HITECH standards since they acquired rather than developed the source code, and the company made “fraudulent” statements insisting that the integration of MyWay was going great until the company “admitted defeat” in October 2012. It also claims that Allscripts told MyWay users they would be charged “thousands of dollars in fees” to get access to their own databases if they chose to walk away and that in some cases users were upgraded “without that user’s consent or knowledge” (how is that possible?)  It’s easy to understand why the practice is upset – they bought MyWay four months before it was put on life support.

1-1-2013 8-32-48 AM

Welcome to new HIStalk Platinum Sponsor EDCO Health Information Solutions of Frontenac, MO. The company has been helping healthcare organizations and HIM departments manage their patient information for over 50 years. Its Solarity software creates a complete electronic patient record, indexing and reviewing documents in a single step using proprietary document recognition algorithms instead of bar codes to index documents faster and more accurately. The result is a streamlined HIM process, improved return on investment on EHR systems via increased efficiency and physician adoption, and reduced A/R days due to faster chart turnaround time. The IT people like the integration, while the finance department likes paying as an operating rather than a capital expense. The company also offers the SaaS-based Solcom electronic document management system that allows hospitals to eliminate paper, enjoy seamless viewing of scanned records, and build custom workflows to maximize efficiency, all of which contribute to proactive revenue cycle management, point-of-service information capture, use of remote coders, and a fully electronic chart. Check out the case studies from Allegiance Health, Health First, Ottawa Hospital, and others. Thanks to EDCO Health Information Solutions for supporting my work.

I found this video on EDCO Solarity. It’s a nice 70-second overview.

1-1-2013 8-07-17 AM

It’s a new year, so it’s time for the HISsies Awards to start up. What were the smartest and stupidest vendor actions of 2012? Which companies are the best and worst? What buzzwords are you sick of? If you had a pie, in which industry figure’s face would you like to throw it? And in the more serious categories, who’s your choice for Industry Figure of the Year and the Lifetime Achievement Award? It all starts with the nominations, from which the final ballot will be created. The nominations form is open and your civic duty calls.

This is a chance for you to spare me the frequent and frustrating after-the-fact dialog in which someone claims that I’m clueless or biased because their pet choice wasn’t included on the HISsies ballot. I patiently explain that had they and their like-minded peers spent 30 seconds filling out the nomination form instead of complaining, their preference might well have been on the ballot. It’s simple Civics 101 – the most-nominated choices go on the ballot. Don’t assume someone else will do your work for you in nominating your preference. Nominate now or forever hold your peace. 

I’ll create the final ballot in a week or so. It goes only to readers who have subscribed to the e-mail updates, which prevents the admittedly fun ballot box-stuffing that happened during the first few years of the HISsies. Back then I was just happy that companies wanted a good-category win (“best vendor” or “best CEO”) enough to strong-arm their employees to vote for them.

Last year’s HISsies results are here if you need a refresher. I’ve done the Lifetime Achievement Award for two years and no repeat winners are allowed, so nominate someone other than John Glaser and Judy Faulkner.


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

More news: HIStalk Practice, HIStalk Connect.

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January 1, 2013 News No Comments

CIO Unplugged 1/1/13

December 31, 2012 Ed Marx 141 Comments

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

What Do I Stand For?

But I still wake up . . .
Oh Lord, I’m still not sure, what I stand for
What do I stand for? Oh what do I stand for?
Most nights, I don’t know any more.

I like the tune Some Nights by the indie alternative group fun. You can argue the meaning of the song, but the hook, “What do I stand for?” resonates with millions, including me.

The issue people struggle with most is discovering purpose in life. This is one topic I’m frequently invited to speak on and the one concern for which people often ask my help. In light of this, I’m revisiting a blog from a few years ago that I hope you’ll find practical.

I have no secret formula nor warrant that what worked for me and my family will work for you. Making life easy and eliminating challenge is not my goal. Living out purpose involves inherent trials. What I offer are principles and a process that will facilitate your journey into discovery and could possibly transform your life on different levels. I’ve shared these ideas for many years in different cultures and have witnessed dramatic change.

Let’s set the record straight: resolutions don’t work.

The first thing I ask those who ask for help is, “What’s your plan?” Such as, what is your mission, vision, values, objectives, etc. I’ve never received an articulate first-time response. But when I ask people about their organization’s plan, they’re quick to answer.

The dichotomy is evident. Why would you take the time to memorize and labor to achieve the plans of your organization but not do the same for yourself or your family? The good news: you already possess the tools and experience to close this gap. But it takes time, energy, and determination.

I finished grad school in 1989 with business planning concepts drilled in my brain. My company embraced these concepts, and I knew our execs jetted off to resorts to spend considerable time planning. Market performance confirmed a strong correlation.

For me, the disconnect came in hearing of their struggles on the personal side of the ledger. One particular Fortune article reinforced my thought process: “Why Grade ‘A’ Execs get an ‘F’ as Parents.” Having just started a family and career, I was searching for ways to have success in both.

Could I increase the odds of personal success by adopting business theory?

Our First Family Retreat

The Marx family’s strategic planning adventure began modestly. Short, inexpensive trips away from home reduced distraction and stimulated creativity. These trips morphed into more elaborate excursions, but the focus always remained on strategic planning.

12-31-2012 7-57-23 PM

Our first retreat in nearby Estes Park cost us about $100. We worked on a one-page plan that became known as the “Marx Family Constitution.” Originally written in 1990, it has withstood the test of time.

Since incorporating this process, we’ve all experienced dramatic increases in the quality of our careers and relationships. Our oldest, now age 25, had coached his college peers in these concepts. Not long ago, my wife heard our youngest, age 19, encourage her boyfriend to discover his life purpose and come up with a plan to live it out. Julie and I recently celebrated our 27th wedding anniversary and are still twitterpated.

I don’t have the space to share the numerous examples, but I can share the one that had the most impact. My son, age eight at the time, took a ruler and pointed to the values section of our Marx Family Constitution that hung prominently in our family room. “Dad,” he said, “was that honoring mom when you yelled?” Seven months prior, when deciding which six values needed improvement, he had contributed the word “honor.” He called me on it. Accountability!

We aim to live out what Rick Warren calls The Purpose Driven Life. Decisions on how to spend our time, energy, and resources are guided by past retreats. I could go back through 20 years of documentation and show you at least one significant event that happened each year in my career, marriage, and family. Could you?

Keeping it Fresh

Take annual retreats to focus on your plan. Get out of Dodge and spend time in a setting where beauty can inspire. A place free of distraction. As leader, your job is to facilitate.

WARNING: never force your ideas down the family’s throat. Instead, invite them to dream and evaluate. Kids especially need to think for themselves. Review your plan and encourage transparent dialogue about performance. Record the highlights of the previous year. What are the gaps and how do you close them? Include significant others and engage your kids. Teach them. Envision them — but NEVER do it FOR them. Commission them. Then watch them rock not only your world, but also the world around them.

Disney makes for great vacations. Planning retreats make for enabling identity and significance.

Take Action

Forget resolutions. They don’t work. No organization runs with resolutions. Market share would drop, and eventually you’d go bankrupt.

Schedule your first retreat and prepare to write, because earth-moving ideas existing ONLY in your head haven’t the magic to propel you forward. Write them out. Teach them. Actualize them. You only live once.

There’s nothing worse than going through planning exercises merely to have the plan collect dust. Create a living vision. When someone asks you a career or life question or you face a major decision, your purpose will keep you standing.

What do you stand for?

***If interested in creating a plan for your career, life, etc., leave a comment. I will send you a copy of my one-page strategic plans (personal, career, family). I will include a retreat guide designed to stimulate thoughts and ideas around your mission, vision, values and objectives as you put your plan together.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

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December 31, 2012 Ed Marx 141 Comments

News 12/28/12

December 27, 2012 News 1 Comment

Top News

12-27-2012 9-01-25 PM

A year-long investigation by The Washington Post finds that healthcare is among the sectors most vulnerable to hackers because it lags other industries in fixing known security holes, quoting one expert who said, “If our financial industry regarded security the way the healthcare sector does, I would stuff my cash in a mattress under my bed.” A physician user of OpenEMR, which was called out in the article for its security vulnerabilities, left this comment:

I maintain OpenEMR under Linux at my wife’s medical clinic. Behind two firewalls, not accessible over the public internet. We considered WorldVista, but that is written in MUMPS, and requires Windows clients (not on our network). WorldVista is more suited to megapractices like the VA system it was written for. OpenEMR has many problems, but being open source, the problems are being found and fixed rapidly. Software developers are encouraged to join the effort to improve it. Other alternatives include hugely expensive systems like Epic (which infests most local hospitals) and various Web-based services moving information over the public Internet (dangerous!) That is how Epic works – and anyone with two login/passwords to a megahospital system can get access to hundreds of thousands of patient records. Scary, yes – but if more barriers are added, time is lost and PATIENTS WILL DIE.

HIStalk Announcements and Requests

I don’t need an Official Red Ryder Carbine-Action, 200-Shot Range Model Air Rifle, but I could use some gifts that carry no danger of shooting my eye out: (a) sign up for spam-free e-mail updates, basking in the knowledge that doing to will make you eligible to vote in the upcoming HISsies awards; (b) support HIStalk’s sponsors by reviewing and possibly clicking their ads (now on your right), checking out their listings in the Resource Center, and using the couldn’t-be-easier Consulting RFI form to painlessly solicit consulting proposals; (c) connect our respective social ganglia on Facebook, Twitter, and LinkedIn; and (d) slip us news and rumors via the methods listed under the “Report News and Rumors” box to your right, which includes a new option: call my Rumor Line at 801.HIT.NEWS and leave a message, which thanks to Google Voice will be transcribed and e-mailed to me along with the original recording.

It’s almost New Year’s, so I’m setting my priorities for 2013. I’m looking for HIStalk-related projects or activities that would be more personally satisfying and society-benefiting than just making money, which doesn’t interest me all that much (obviously, since I work for a non-profit hospital). Thoughts?

Acquisitions, Funding, Business, and Stock

12-27-2012 7-26-24 PM

Awarepoint secures $4 million in new financing from an undisclosed investor.

12-27-2012 7-27-19 PM

McKesson says its $2.1 billion purchase of PSS World will be finalized in the first quarter.


12-27-2012 9-38-02 PM

The Oregon Community Health Information Network (OCHIN) names Scott Fields, MD (OHSU – above) CMO, Jonathan Merrell (Cherokee Nation Health Services) VP of performance improvement, Tim Burdick, MD (Fletcher Allen Health Care) CMIO, and D’Angela Merrell (US Public Health Service) clinical improvement professional.

Announcements and Implementations

HIEs Healthcare Access San Antonio and Integrated Care Collaboration begin sharing patient information.

12-27-2012 3-39-49 PM

Mercy McCune-Brooks Hospital (MO) goes live on Epic.

12-27-2012 9-23-15 PM

Texas Health Harris Methodist Hospital Alliance (TX), which opened as a new 50-bed hospital in September, earns HIMSS Analytics EMRAM Stage 7 recognition. I interviewed Winjie Tan Miao, the hospital’s president, two weeks ago.

The NJSHINE (NJ) HIE gets a $1 million grant from the New Jersey Department of Health to connect seven hospitals.


12-27-2012 12-53-37 PM

Consumer Reports rates the performance of 19 Wisconsin medical groups based on quality measurements for cancer screening, care of people age 60 and older, and treatment of patients with heart disease. ThedaCare Physicians and Marshfield Clinic earned the top spots.

The LSU hospital system notifies 416 patients that their information, including checking account numbers, has been stolen. A former billing department employee and six other people have been charged with identity theft after creating and passing counterfeit checks and ID cards from scanned check images stored in LSU’s computers.

Pittsburgh systems UPMC and West Penn Allegheny fight to acquire each other’s affiliated physician practices, leaving patients unaware of the change and sometimes forcing physicians to practice outside of Allegheny County beginning immediately without notifying their patients to satisfy non-compete clauses. The medical records stay with the practice, leaving the patient to figure out their options

University of Michigan Health System notifies 4,000 patients that their information may have been exposed in the theft of an unsecured PHI-containing electronic device from the car of an Omnicell employee.

Efforts by the Metropolitan Chicago Healthcare Council to create Chicago-area HIE may fail as just 18 of 30 targeted health providers agree to join. Money is a sticking point, with some hospitals being asked to pay six-figure annual fees to participate. Health systems are also concerned with the uncertain value of the exchange, especially at a time many are investing heavily in their own IT systems.

12-26-2012 2-44-19 PM

A third of providers say they have experienced varying levels of payment delays during the HIPAA 5010 transition, with clearinghouses causing 52 percent of those delays, according to a KLAS report.

Hospital CFOs look ahead to 2013 with concern, worried about:

  • The resources required to justify admissions
  • Possible payment and cash flow problems due to Medicare changes
  • Funding quality initiatives to support value-based payment systems
  • The high cost, questionable return, and change involved with technology implementation
  • Hiring more doctors
  • Trying to scale physician compensation to what the practice actually produces
  • Engaging physicians who practice only an outpatient setting
  • Managing growth by acquisition
  • Improving clinical documentation for patient safety and quality
  • ICD-10

12-27-2012 9-18-00 PM

A maternity hospital in a Nairobi, Kenya slum admits that it holds mothers of newborns as prisoners until they pay their hospital bills. The hospital is accused by one woman of having guards beat mothers who try to leave without paying. According to the hospital’s director, “We hold you and squeeze you until we get what we can get. We must be self-sufficient. The hospital must get money to pay electricity, to pay water. We must pay our doctors and our workers. They stay there until they pay. They must pay. If you don’t pay, the hospital will collapse.” The charge for a normal birth is $35, while a C-section runs $70 and the daily room charge is $5. A first-person report (from which the above photo came) is here.

Sponsor Updates

  • Vonlay offers tips on how to quickly recycle an IIS application pool in a blog pos.
  • PeriGen hosts a Webcast on improving financial results in obstetrics January 16 and 30.
  • Shareable Ink’s President Stephen Hau discusses mHealth applications and how they can liberate physicians and data in a guest article.
  • Dennis Weissman, founder of Washington G-2 Reports, will deliver the keynote at the Lifepoint Informatics user conference Orlando March 21.
  • Liaison Technologies offers a white paper discussing the use of cloud-based data integration to overcome interoperability challenges in health systems. 
  • API Healthcare executives participate in a giving back campaign.
  • Business NH Magazine names Digital Prospectors Corp a top small company to work for in New Hampshire.
  • Dave Caldwell of Certify Data Systems shares insights on the barriers and issues that need to be addressed in order for the healthcare industry to achieve widespread interoperability.
  • Besler Consulting will participate in next month’s HFMA MA/RI Annual Revenue Cycle Conference in Foxborough, MA and the Region 11 Annual Healthcare Symposium in Las Vegas.
  • Thomson Reuters includes 3M, AT&T, and Fujifilm on its list of the World’s Top 100 Most Innovative Organizations for 2012.
  • Saint Luke’s Health System (MO) shares how Philips Healthcare Consulting helped the organization build an eHealth strategy of regional outreach and physician-to-physician relationships to drive growth.
  • ZirMed releases its 2013 PQRS Suggested Measures and Monitoring tool.

EPtalk by Dr. Jayne

The use of Health Information Exchanges is one of my pet topics, particularly issues around governance. I’m happy to see ONC hosting one of their Town Hall meetings on the topic. It will be held on January 17, so there’s still plenty of time to sign up.

It’s always fun to get together with family over the winter holidays. This year’s hot topic among the Medicare set was the concept of Accountable Care Organizations. They wanted to know my opinion. Unfortunately, I had to give the answer of, “It depends.” Even though there are core principles for ACOs, there seem to be many different flavors out there.

Patients need to realize that a key driver of ACOs is slowing the growth of healthcare spending. Quality and meeting patient needs are also goals. For patients involved in ACOs that have a long history of managing quality and cost initiatives, there may not be much of a difference in care because referral relationships and practice patterns are already established. However, for health systems that have not been functioning in shared care models, there may be trouble ahead. There will be a significant learning curve for participating physicians and their care teams.

The subtleties of the ACO patient assignment regulations can cause situations where providers are ensnared by a single ACO. Patients also need to find out whether they will be able to continue to see all the providers from whom they receive care or whether they will have to change to specialists within the ACO. I also think it’s funny that when seniors are talking about ACOs and their benefits, they refer to the Affordable Care Act. When they’re talking about the negatives, they refer to Obamacare. They’re one and the same, folks.

With the holiday, it was a snow news week. Hopefully as people are trickling back into their offices things will pick up. In the mean time, please give your friends at HIStalk the best gift of all – send your rumors, newsy tidbits, and other reports our way.



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

More news: HIStalk Practice, HIStalk Connect.

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December 27, 2012 News 1 Comment

Morning Headlines 12/27/12

December 26, 2012 Headlines No Comments

HIPAA 5010 Transition: Thirty Percent of Providers Report Payment Delays

KLAS releases a market analysis of claims management and clearinghouse vendor performance through the HIPAA 5010 transition, during which thirty percent of providers reported significant payment delays. Navicure is named Best in KLAS.

OIG Advisory Opinion

OIG has published an advisory opinion clarifying that the federal anti-kickback statute is not violated if a hospital gives a practice free access to an EHR interface for orders and results.

Drchrono: Onpatient to replace Google Health January 1

As Google Health prepares to eliminate access to patient health records on January 1, freeware EMR vendor drchrono releases a PHR alternative that will accept data transfers from still-active Google Health accounts.

Healthcare sector vulnerable to hackers, researchers say

The Washington Post claims  healthcare is among the most vulnerable industries in the country to hackers, though far fewer attacks are carried out as compared to attacks on financial, corporate, and military networks.

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December 26, 2012 Headlines No Comments

HIStalk Advisory Panel: Vendors at the HIMSS Conference

December 26, 2012 Advisory Panel 2 Comments

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

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

This question: Vendors are finalizing their preparations for the HIMSS conference. What are some things they should and shouldn’t do to get decision-makers into their booths and then present their company and products effectively?

Pricing is a touchy topic and I understand the sales logic that you don’t want to share the dollars too soon. However, I may need to understand ballpark pricing to even know if it’s worth my time to talk with you. We’ve all been talking about reimbursement cuts.  Those cuts directly impact how much we can spend for essential and cool tools. If I go to pricing early in the conversation, I’m probably trying to determine if it’s worth my time and your time to continue the discussion. At a recent conference, we encountered a vendor with a unique solution to challenge we were facing. However, my enthusiasm to continue discussions was notably less after multiple conversations that led to a summary of, "It’s really hard to give you an idea of how much it will cost" and "My price will be less than whatever you currently pay." Instead of being on the top of my follow-up pile, this vendor is a much lower priority, in part because I don’t know if my work will all be for naught because the price is more than we consider reasonable.

Coffee works. I don’t care what you say, at every trade show and conference I attend, the longest line is always where the espresso machine is. Cisco usually has a magic show — that makes me leery. Have ample seating available — people are tired of walking around all day. I think that pre-conference mail-outs have minimal success. When I know I am going to a show, I tend to pay more attention to e-mail, but not any more attention to traditional mail.

They should avoid e-mail spam, phone call spam, and otherwise being overly aggressive prior to the conference. I personally tend to avoid those who pre-annoy me like the plague. Likewise, avoid post-conference harassment. The key is to be accessible without nagging or arm twisting. There is no such thing as successful nagging or successful arm twisting – attendees might passively pay attention or pay lip service in response to such tactics, but they have zero chance of landing a "sale" or cementing a meaningful relationship.

Having and being generous with high quality giveaways never hurts. Often these may be collected by attendees to distribute to team members who cannot attend, so it’s almost like viral marketing in terms of who ends up with these and who sees them. Having edible or drinkable enticements to visit a booth is also not a bad idea, but don’t be cheap or stingy with the stuff (it is far better to have nothing than to appear cheap or to be stingy with this type of thing). Throw nice meal meetings and parties – breakfast, lunch, dinner, snack, after dinner, whatever (be creative). The quality with these events is of paramount importance, though. Going cheap on such an event delivers an obvious and lasting message of how important the attendees are to the vendor and reflect also on what an attendee can expect from the vendor’s customer service and support. Also, realize you are competing against places, restaurants, etc. the attendee might want to experience in the host city. Don’t make them feel like they wasted an opportunity to enjoy something else by giving you their time. A memorable positive experience will always create a favorable impression and build some relationship capital. Put yourself on HIStalk’s Bingo or "recommended" list – people pay attention even if they don’t overtly participate.

Don’t monopolize my time with long meetings. I go to HIMSS to get a "broad brush" on available products and technologies for later investigation. Instead, give me the "elevator speech" (what can you tell me while I’m trapped in the elevator with you) answer my questions, and plan to follow up with me later.

Have a crisp, compelling elevator pitch that all of your salespeople know. Tell us why we should invest our time to see you. Make it simple, clear, and easy to understand.

Quite frankly, HIMSS is so large that my senses are on overload when I hit the vendor booth area. They see CIO on your badge and you become raw meat. I have two official titles. One year I tried to have HIMSS put non-CIO title on badge. They refused. I schedule meetings with vendors weeks in advance so as to use my time more efficiently. I also try to visit the major vendors we have contracts with. Lastly, there is a vendor booth that is an actual bar. It’s a must stop.

Focus on the power of three and stories. Everybody in the booth needs to have a library of stories that show the impact of their solutions. Have the customers in the booth if possible. Secondly, everyone in the booth needs to know the three reasons to spend five minutes in the booth, the three reasons why their product has an impact, the three reasons why they are better than competitor, the three reasons customers buy from them.

I cynically assume that whatever I see on the floor is vapor-ware and do not use it in the decision making process. I am able to get 3-6 months of meetings with my current vendors into 1-2 days, which is a great time saver.

Skip the expensive direct mail pieces – most wind up in the trash.  I can’t think of any vendor who has done anything memorable… I suppose that tells a lot of the story.

Don’t send me postcards with the same old prose ("Find out why we are the best / fastest / cheapest / lightest / prettiest… at booth #4321). Do send me something that is tailored to my role (e.g. physician, nurse, pharmacist, IT professional, executive) and tell me how what you do can make life easier for my role or bring real value to my organization (e.g. how does it decrease cost or increase revenue while maintaining or increasing quality.) And of course let me know if you are an HIStalk sponsor, and about any cool giveaways!

The only thing that has worked with me in the past is a special invitation from someone who had researched me and my position and offered a good proposition and a quiet audience. Made me feel special and above the clamoring crowds. Didn’t use the product, but they were in the running.

Send info that is not gimmicky ahead of time. I rarely just pop into a booth, but I will if it looks like something we are interested in. Last year, I was looking for Humedica and had a booth number. When I got there, it was Allscripts and I did not see anything for Humedica. Colocation for a vendor can be a big mistake. I felt like a dolt going all the way around the booth looking for anything with the company name and even asked a booth zombie, but they had no clue. As it turned out, they were there, but not everyone knew it at the booth. Odd and not to be repeated, I hope. On the other hand, I went to the SAS booth, and what made it a great visit is that I had access to all of the right people right away. I was to the point of what I wanted to learn and so were they. Not sales-y at all.

Vendor should bring decision makers to HIMSS. Feedback I am consistently hearing from CIOs and other organizational decision makers is that HIMSS is turning into too much of a sales pitch. Customers don’t feel like they can have meaningful conversations with the vendors. Make sure those people are there. The sales personnel are important to build relationships, heck many of them can have these meaningful conversations, but make sure that you have the right resources available to engage in these conversations, along with the correct non-threatening environment to encourage such conversation. For goodness sake, don’t hire professional talent to deliver a scripted pitch – have the thought leaders in the organization that understand the topic give the presentations and engage their audience in a conversation. It should be two way — listen, challenge, exchange ideas.

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December 26, 2012 Advisory Panel 2 Comments

Monday Morning Update 12/24/12

December 23, 2012 News 18 Comments

From The PACS Designer: “Re: 802.11ac wireless. As we approach 2013, our wireless technology infrastructure will bring a key change that will excite users. The 802.11ac wireless specification is an upgrade to the new communications band called the 5 Gigahertz frequency spectrum. The currently crowded 2.4 Gigahertz frequency spectrum in 802.11n will still be usable as most of the new 5 Gigahertz routers being designed are backward compatible. The 802.11n routers installed everywhere today can remain in place, and the new 802.11ac routers can be placed at key points in the network to improve the overall speed of communications. The 5 Gigahertz spectrum is new and unused with a 1 Gigabit per second speed upgraded from 450 Megabit per second in 802.11n. This faster network technology will bend nicely with 1 Gigahertz Ethernet switches in use today.” The article brings up an interesting fact: the maximum theoretical 802.11ac speed is 3.5 Gbps, meaning that your 4G LTE smartphone could eat up your monthly bandwidth allocation in about two seconds.

12-23-2012 5-00-48 PM

Don’t be startled – you’re in the right place. I’ve given HIStalk a much-needed update. Even its formerly smoking doctor celebrity endorser has received a makeover, surrendering his reader-polarizing pipe while refusing (like a doctor clinging to paper charts) to abandon his favorite reflector headband thingy. I wanted to make the site easier to read, with the design itself being less of a distraction. We will all need a week or so to get used to it, I predict, at which time I may run a screenshot of the old design just to illustrate how much cleaner the new one is.

12-23-2012 4-49-24 PM

Speaking of the reformed smoker doc, thanks to the folks at Dodge Communications for designing the new logo. I asked CEO Brad Dodge if he could recommend someone for logo design and he volunteered to have the company create one, with SVP Brian Parrish taking the lead. I really appreciate that, and I think Brian did a really nice job in creatively accommodating my requests: (a) retain the doc figure and reflector; (b) use a typewriter-like font as a nod to reporting (c) keep it simple; and (d) come up with variants that work for HIStalk Practice and HIStalk Connect.

12-23-2012 11-00-18 AM

Allscripts is further damaging its beaten-down public image by suing NYCHHC for choosing Epic, at least according to 57 percent of poll respondents. New poll to your right, another Allscripts-related one since they’re making all the pre-Christmas headlines:  can Sunrise successfully compete with Epic and Cerner, giving its reps something to wear other than a lapel pin featuring a white flag?

12-23-2012 4-24-26 PM

ONC posted its Patient Safety Action and Surveillance Plan for public comment late Friday afternoon. This is the report that address IOM’s November 2011 recommendations. The proposed requirements challenge vendors to regulate themselves in more structured ways as providers are encouraged to report the patient safety problems they observe. Some highlights:

  • Add certification criteria requiring EHR vendors to include in their products the capability for users to submit EHR-related safety problems using AHRQ’s Common Formats, which includes a new category of “Device with Health IT.”
  • Develop a code of conduct for EHR vendors that will hold them accountable for problems and require them to report their IT-related safety events through a Patient Safety Organization.
  • Require vendors to maintain records of complaints for review by certification bodies.
  • Train CMS surveyors to identify IT-related safety problems.
  • ONC will monitor events submitted to FDA’s MAUDE medical device problem database.
  • Use ONC’s standards and certification criteria to enhance patient safety, including incorporation of human factors and user-centered design.
  • Potentially add NIST-developed usability testing tool results as a certification requirement.
  • IOM’s recommendation for an investigative body such as the National Transportation Safety Board is acknowledged without a specific commitment, but CMS plans to advise state and accreditation surveyors on health IT-related adverse events and HHS may issue public notices for EHR-related safety problems.
  • Establish an ONC Safety Program to coordinate activities and analyze data.

12-23-2012 4-47-16 PM

Aprima announces that the first customer of its Aprima Rescue Plan has successfully moved from Allscripts MyWay and gone live on Aprima’s EHR. The announcement says that Crystal Community ENT (FL) had used MyWay for less than two months when it received notice from Allscripts that the product would not be enhanced to meet Meaningful Use and ICD-10 requirements.

SPi Healthcare names Louis Grujanac, DO (Accretive Health) as VP of HIM solutions.

12-23-2012 6-01-54 PM

Melissa Cruz, CFO of Progress Software and former CFO of Picis, announces her retirement.

12-23-2012 6-21-21 PM

RTLS vendor Versus Technology announces Q4 results: revenue up 77 percent, net income of $3,121,000 vs. $704,000.

12-23-2012 6-07-51 PM

In Singapore, Changi General Hospital develops an iPad-based “patient care communicator” that allows intubated patients to communicate with caregivers.

12-23-2012 5-10-40 PM

RelayHealth acquires Ahi Software, whose AHIQA patient access system is rated #1 in KLAS. It offers applications for registration, wait time tracking, eligibility, demographics verification, and patient responsibility estimation.

12-23-2012 5-35-43 PM

Park Place International recently participated in Meditech’s Adopt-a-Family program, which delivered food, gifts, and supplies to 53 families.

12-23-2012 5-50-55 PM

Weird News Andy is off on a sunny vacation, so I’m happy to step in. The Social Security Administration formally reprimands an employee for excessive workplace flatulence, saying he hasn’t supported his claim of an unspecified medical condition.

Vendor Clinician Compensation

I received the following responses from Vendor Middle Manager’s request relating to what vendors pay their clinical people. Some of those below were reported first hand, while others came from readers asking around. I appreciate the responses.

  • Epic subject matter experts developing clinical content: $150 per hour.
  • Informatics-certified RN: $70K.
  • RN consultant: $90-$120K with bonuses raising the potential to $110-160K. Stock options same as other employees receive.
  • EHR clinicians: $130-180K for work that’s 50 percent consulting and 50 percent design.
  • Demo team physicians and nurses: $150-180K with half of the 20 percent bonus tied to sales success.
  • RN doing demos: $85K base with compensation structure than puts them over $125K on the low end.
  • Vendor CMO/CNO: $300K salary plus bonus of up to 40 percent.
  • Master’s degreed RNs in product management or consulting: $150-185K base with 20 percent bonus.

People celebrate a variety of holidays this time of year. Like most readers, I’m a Christmas and New Year’s guy, but I sincerely hope that whatever holidays, customs, and practices you and your family are observing bring you love and satisfaction. Business and IT stuff is important, but let’s face it, it’s not exactly inspiring material for your tombstone. I appreciate the people who are involved with HIStalk, my hobby of 10 years. That includes everyone who reads, e-mails, writes one-time or recurring guest posts, sponsors, and otherwise provides the many kinds of support that I need to keep it going when I’m questioning exactly why I’m spending most of my free time on the computer. On my side of the monitor are the people I trust with my most valuable asset – my reputation. That would be Inga, Dr. Jayne, Dr. Travis, Dr. Gregg, Lt. Dan, and Donna, all of whom work week in and week out to bring you the information you need. I’m so busy between my hospital job and my HIStalk job that I don’t always express appreciation to everybody involved in this thrilling and totally illogical 10-year run, but they don’t mean a bit less to me just because I don’t say so often enough. Enjoy your holidays, whatever they may be.


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

More news: HIStalk Practice, HIStalk Connect.

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December 23, 2012 News 18 Comments

News 12/21/12

December 20, 2012 News 13 Comments

Top News

12-20-2012 9-11-51 PM

Allscripts shares closed Thursday at $9.14, down over 14 percent since Wednesday’s after-hours announcement that it would not pursue being acquired and instead will replace its executives and forge ahead. The company’s market cap is $1.6 billion. If you had invested $10,000 each in Allscripts and Cerner shares on January 1, 2000, you’d have $1,983 and $157,874, respectively. If you’d made the same investment five years ago, you would be holding $4,560 and $27,982. Obviously the company is hoping that Paul Black had enough influence in Cerner’s success to be able to replicate it at Allscripts. They’re bragging publicly on his background and Cerner’s success, which is odd given that Cerner is perhaps its most direct competitor.

Reader Comments

12-20-2012 6-13-48 PM

From HITEsq: “Re: another patent troll. A Puerto Rico-based company, Ingeniador, is going after GE Healthcare and McKesson for violating a 2006 patent whose claims are as ridiculous as its title – ‘Publishing System for Intranet.’”” I did some digging and found that the “company” is a former Hewlett-Packard software engineer named Marcos Polanco, who developed a database management system for his employer and then sued them for royalties. Since then, he has sued everybody and their brother, including Microsoft, HP, Oracle, Lexmark, and SAP. He apparently bought the patent he’s waving around from an oil services company. He’s big on Puerto Rican enterprise, entrepreneurship, serving as COO of glucometer vendor iCare Medical, and filing ludicrous lawsuits.

12-20-2012 6-45-15 PM

From Top Chef: “Re: Paul Black. I knew him from his Cerner days. Good guy, very smart and affable. Guess he’s ready to jump into it again!” Glen and his loyalists had to be fired, of course, when the PE tire kickers passed on Allscripts, leaving the company desperate to change something (anything) to put the stench of a disastrous year behind it — missing Wall Street expectations; firing the Eclipsys supporters on its board and barely keeping Glen; caving in to a proxy fight by reluctantly adding three HealthCor-nominated board members; watching its share price drop nearly 40 percent in a single day; having word of its private equity courtship leaked publicly; choosing the worst possible time to announce the halt in MyWay development; and having its customers name it as the worst vendor in the country with their KLAS product ratings. Not to mention the final embarrassment of having the potential acquirers walk away from the smoking wreckage. Paul Black has his work cut out for him. I would like to see his first order of business be to drop the company’s ridiculous lawsuit against NYCHHC and provide an update on the Sunrise integration status, which was supposed to have gone to beta in June per Glen. I’m not convinced Sunrise is viable given lack of sales and what must be high R&D costs and a declining user base, so they need a strategy that doesn’t involve going toe-to-toe with Epic and also to re-introduce Sunrise Financial Manager, which got lost in all the juicy company turmoil. The PE guys would have trimmed the product line and headcount (7,000 employees seems like a lot), so with Glen out of the picture, those options are surely on the table. Unfortunately, they’ll have to make those decisions under Wall Street’s microscope and that’s hard. Here’s where you get the chance to play Monday morning quarterback like me: leave a comment with the 2-3 things that Paul Black needs to do first to get Allscripts on track.

HIStalk Announcements and Requests

12-20-2012 10-38-04 AM

inga_small I got my first Christmas present in the mail yesterday from a couple of my favorite gal pals: a daily shoe calendar for 2013. Each day looks better than the next!

histalk practice new

inga_small Mr. H also gave me an early Christmas present with the refresh of the HIStalk Practice site, complete with a new logo (thank you, Dodge Communications) and a sleeker format. Take a peek and let us know what you think. This week’s HIStalk Practice highlights include a don’t miss year-in-review post by Joel Diamond, which I promise is the funniest read of the season. SRS’s EHR takes the top spot in a survey of ambulatory care specialists. The big winners and losers in KLAS’s Physician Practice Solutions categories. KLAS is criticized for favoring big vendors that subsidize KLAS operations. CareCloud names John J. Walsh CTO. Thanks for reading.

On the Jobs Board: Chief Information Officer, Cerner Experienced Providers.

If the world ends today or if I decide that nobody will be reading on Christmas Eve, there won’t be a Monday Morning Update. I’m betting I’ll be right here over the weekend, though.

Acquisitions, Funding, Business, and Stock

Allscripts held a short investor conference call Thursday morning to go over the changes. You can listen to the recording here. My notes:

  • The company still won’t say whether it received any acquisition offers, only that it decided to continue as the current entity.
  • The CFO is aggressively looking at cost controls and productivity plans.
  • Black: “We’re not going to waste any time going to work.”
  • ICD-10 functionality is complete and Meaningful Use 2 is well underway.
  • “Disruptive, open technology,” common user experience, and single patient workflow.
  • “There will be no substitute for results” and “we need to move quickly.”
  • Question: who will lead the product refresh effort? Answer: Cliff Meltzer, who will continue as EVP of solutions development.
  • Question: since the company stopped giving guidance, how’s the quarter going? Answer: we’ll benefit from the clarity around the company’s direction. The lack of clarity this year was a misstep.
  • Question: was the board’s decision to stay independent unanimous? Answer: the board doesn’t comment on their deliberations. There were no dissents on Glen stepping down.
  • Question: is customer attrition running in line historically? Answer: I don’t have the number, but retention is steady in all facets of the business.
  • Question: Glen said earlier this year that the company brought on 400 employees to work on integration. Was it money well spent and are customers happy with functionality? Answer: Not all of our clients are happy and we won’t rest until 100 percent are. I won’t be happy until we don’t need a sales force because they’re beating down our doors and our fax machines are burning up with orders. R&D spend will continue at the current level.
  • Question: what’s the order of strategic initiatives? Answer: solidify the client base; review expenses; step up revenue, engineering, and operations to keep surprises to a minimum.
  • Question: was there a precipitating event that led to the changes? Answer: just the completion of the strategic review.
  • Question: what areas other than product innovation and R&D will be emphasized? Answer: increase emphasis on application hosting, add managed services for the large ambulatory clients, review why home health and patient flow solutions don’t seem to produce as well as the market would suggest is possible.
  • Question: how will the executive suite shape up? Answer: I expect to bring folks in, but review talent and promote from within if possible. I will bring in people I’m comfortable with working with and those I’ve worked with in the past.
  • Question: what’s the lowest-hanging fruit? Answer: the large number of doctors using the systems regularly are the mother lode and the company will build around that core.

Terms of Paul Black’s deal to take over Allscripts include a three-year contract for $1 million per year in salary and a $1.5 million annual bonus target with the 2013 payout guaranteed; a $1.25 million signing bonus; $3 million in shares vesting over three years; $3 million in incentive-based shares; $2.5 million in service-based restricted shares vesting over four years; and $2.5 million in a performance-based equity award. If he quits or is fired, he gets two years’ of severance including his bonus target (total of $5 million) and an extra year of vesting. Glen Tullman and Lee Shapiro get a parting gift that includes a year’s salary, their target bonuses, and acceleration of vesting. If the company sells itself within a year, they’ll get two years’ salary plus their target bonus.


12-20-2012 5-44-05 PM

HealthEast’s (MN) board of directors approves the $135 million purchase of Epic, which will replace seven platforms.

The US Navy and Army award Dell, BRIT Systems, and Acuo Technologies a $45 million contract to create a Unified Clinical Archive for PACS to be used by 49 medical facilities.

Meadowlands Hospital Medical Center (NJ) and Urban Health Plan (NY) choose eClinicalWorks Care Coordination Medical Record and EHR solutions to advance their ACO initiatives.

12-20-2012 5-41-02 PM

Colorado Springs Health Partners will implement the Professional Charge Capture solution from MedAptus for inpatient professional services coding and billing.

Hometown Health (NV) will deploy MedHOK’s care management, quality, and compliance platform.

SAIC wins a one-year, $17 million contract to support the Coast Guard’s Integrated Health Information System, which is the name of its implementation of Epic.


12-20-2012 9-37-25 AM

Harris Corp. names Vishal Agrawal, MD (McKinsey and Co.) president of Harris Healthcare Solutions.

12-20-2012 9-40-56 AM

Bob Hajek (Humanscale) joins Divurgent as a VP of client services.

12-20-2012 10-00-11 AM  12-20-2012 3-28-26 PM  12-20-2012 5-47-28 PM

PatientSafe Solutions names Frank Pecaitis (GE Healthcare) SVP of sales and Bruce Eklund (AHM) SVP of operations, also promoting Joseph Condurso from president/COO to president/CEO.

12-20-2012 8-18-15 PM

Tom Bang (A-Life Medical, Cardinal Health) is named CEO of post-acute care systems vendor BlueStep Systems. Former CEO Roy Rasband will move to the CTO role.

Announcements and Implementations

12-20-2012 10-56-37 AM

The 500-member American College of Medical Coding Specialists votes to join AHIMA.

The Texas Organization of Rural & Community Hospitals announces the Phase 1 go-live of its TORCH HIE at Wilbarger General Hospital (TX). It uses the CollaborNet interoperability solution from Holon Solutions.

Government and Politics

HHS’s Office of Inspect General advises hospitals that they are not violating anti-kickback statutes when they provide community physician practices a free interface to support exchanging orders and results.

12-20-2012 8-28-08 PM

Charles Boustany, Jr. MD (R-LA), chair of House Subcommittee on Oversight, sends a letter to HHS Secretary Kathleen Sebelius asking her to provide the department’s policies on archiving electronic messaging. Whistleblowers have alleged that HHS’s political appointees are intentionally using instant messaging to avoid leaving a discoverable record of their communication with department employees.

The government’s Space and Naval Warfare Systems Center, charged with developing a Department of Defense database for tracking medical examinations for officer candidates, is found to be $7 million over budget and may never deliver a working system. Administration of the contract, which was issued an Alaska firm under a government requirement that Alaska native companies receive preferential treatment, has been taken over by the General Services administration.

Innovation and Research

12-20-2012 8-11-38 PM

Yet another healthcare IT accelerator fans to life, this time in Miami. Project Lift Miami will offer 10 to 15 startups seed funding, office space, and mentoring in a 100-day program.

Microsoft is working with the military to offer Kinect-powered home physical therapy treatments to injured soldiers and veterans using the ReMotion 360 software from InfoStrat. Microsoft is also working on a Kinect-based based system for conducting online group therapy sessions for patients with post-traumatic stress disorder.


The Wilmington, DE VA hospital rolls out a visitor way-finding kiosk system that features a talking avatar named Val, which stands for “Veterans Affairs locator.” The system, which also allows visitors to pre-plan their visit online, was developed by LogicJunction.

12-20-2012 7-57-11 PM

A public radio station profiles Syracuse-based startup Simple Admit, which allows patients to complete their forms online before their provider visit.

12-20-2012 8-00-31 PM

Griffin Technology offers the AirStrap Med, a $90 sling case that makes it easier to use an iPad during rounds.


A poll finds that only a third of health system leaders are confident in their organization’s readiness for Meaningful Use Stage 2.

An interesting vision of how clinical documentation could be performed by the rounding teams of academic medical centers, offered by by John Halamka on his blog:

The entire care team jointly authors a daily note for each patient using a novel application inspired by Wikipedia editing and Facebook communication. Data is captured using disease-specific templates to ensure appropriate quality indicators are recorded. At the end of each day, the primary physician responsible for the patient’s care signs the note on behalf of the care team and the note is locked. Gone are the "chart wars", redundant statements, and miscommunication among team members. As the note is signed, key concepts described in the note are codified in SNOMED-CT. The SNOMED-CT concepts are reduced to a selection of suggested ICD-10 billing codes. A rules engine reports back to the clinician where additional detail is needed to justify each ICD-10 code  i.e. a fracture must have the specifics of right/left, distal/proximal, open/closed, simple/comminuted. You can imagine that the moving parts I’ve described are modular components provided by different companies via cloud hosted web services (similar to the decision support service provider idea).

Medical device manufacturers are blaming the Affordable Care Act’s 2.3 percent tax on their products for industry layoffs, but economists say companies were already bloated in a slow market and would have had to cut jobs anyway. The manufacturers‘ trade group is trying to have repeal of the tax included in fiscal cliff negotiations, but the President says he’s not a fan of that idea.

12-20-2012 8-42-53 PM

Pediatric patients at Geisinger Medical Center (PA) receive iPad-based visits from Santa Claus in the hospital’s “Santa Cam” program.

Weird News Andy summarizes this story as “Good news, bad news.” A 27-year-old cystic fibrosis patient receives a long-awaited lung transplant, but then dies of lung cancer 16 months later. The lungs she received were from a donor who smoked heavily, which is apparently the case in 40 percent of lung transplants. The hospital trust has apologized for not disclosing that fact in their explanation of the risks involved, saying that patients almost always want whatever lungs they can get.

Sponsor Updates

12-20-2012 7-22-24 PM

  • Sunquest hosted a December 7 fundraiser to provide foster children with Christmas gifts. The cookout, Hostess Twinkie raffle, and company donation raised over $7,000 for Aviva Children’s Services.

12-20-2012 7-25-22 PM

  • CTG Health Solutions launched its Holiday Military Appreciation Campaign for military family members of its employees, sending gift packages both to those serving and to their families. The company also continued its tradition of taking the money that would have been spent on customer greeting cards and instead donating it to Operation Homefront, which provides support to military families.

12-21-2012 6-37-35 AM

  • Cornerstone Advisors establishes Cornerstone CAres, a charitable giving program funded by employee contributions and matching company donations. Its first project was to help employees of long-time client Chilton Hospital (NJ), which was severely impacted by Hurricane Sandy. Receiving the donation was Chilton VP/CIO Mark Lederman (above).
  • SIS employees raised over $12,000 to purchase gifts and supplies in support of Embracing Arms home for girls, The Empty Stocking Fund, the Secret Santa Ministry, and Toys for Tots.
  • Liaison Technologies shares its 2013 forecast for cloud adoption, business integration, and managed services.
  • Levi, Ray and Shoup offers a white paper on enhanced document printing and viewing in the healthcare industry.
  • A White Plume blog post called “Healthcare’s Wake-Up Call for 2013-2014” warns of the urgency needed to prepare for PQRS, MU2, ICD-10, and HIX.
  • Fulcrum Methods provides details of how it helped NorthBay Healthcare successfully attest for Meaningful Use.
  • Raymond Fabius, MD, chief medical officer of Truven Health Analytics, warns employers that moving to  an exchange-only health benefits model based on cost alone.
  • Business NH Magazine names Bottomline Technologies a “Best Company to Work For” for the fifth consecutive year.
  • Northwest Michigan Surgery Center shares how its implementation of Versus Advantages IR/RFIF RTLS has helped it perform as one of the nation’s top ambulatory surgery centers.
  • Medseek will incorporate the Healthwise Patient Engagement solution into its health content offerings.
  • InteliChart and RelayHealth develop a health information exchange platform that integrates with InteliChart’s suite of connectivity solutions and provides bi-directional exchange between the ambulatory and hospital settings.
  • Humedica and Pfizer announce a multi-year strategic alliance to use Humedica’s de-identified healthcare data to improve drug effectiveness.
  • EMRConsultant offers a free survey for practices interested in improving efficiency and reducing expenses.
  • Modern Healthcare names MedAssets as the largest revenue cycle company.

EPtalk by Dr. Jayne

CCHIT will develop an IT framework for Accountable Care Organizations, hoping to identify the infrastructure needed. An advisory panel is being formed to develop the framework, which will ultimately lead to additional CCHIT certification programs.

ONC seeks applications for two new consumer-focused HIT FACA Workgroups: the HIT Policy Committee’s Consumer Empowerment Workgroup and the HIT Standards Committee’s Consumer Technology Workgroup. Applications are due by January 14, 2013.

As if this week’s predicted apocalypse isn’t enough, a recent article cites ICD-10 as causing shock, awe, and fear. Seriously, people, we’ve known it’s been coming for years, and warning of “apocalyptic-type scenarios” is a little much. Remember Y2K? A staffer at UnitedHealth Group is quoted as saying that use of both ICD-9 and ICD-10 together will cause “mass hysteria.” Guess what? Using both will be reality for many of us, because not all payers are switching over. There’s no requirement for non-covered entities or those using paper claims to change.


I received a fair amount of feedback on my recent discussion of the Meaningful Use smoking status measure.

From Under the Mistletoe: “Dr. Jayne, you are not a hair splitter at all, and I think these descriptors are absurd. This is the calculation we always use: pack years. Certainly closer to quantifiable, not perfect, but I am really disappointed in what you described from SNOMED. How disappointed was I? Well, I could say ‘extremely,’ or would you prefer on a 1 to 10 scale with 10 as the worst possible – a 10?”

Mr. H hinted to one correspondent that I may have been “cranky” when I wrote that piece, which I guess is true. Like a reported 77 percent of physicians, I’m at least somewhat pessimistic about the future of medicine and exhibit a higher degree of pessimism after a day of seeing patients. When you’re dealing with parents who can’t figure out how to pay for a $4 antibiotic for their child (and who bring her to the ER because they don’t have Tylenol at home), some of the things we do in the informatics office seem pretty ludicrous.



HIMSS created a word cloud showing the educational offerings for the upcoming HIMSS13 meeting in New Orleans. In response, I offer up my own.



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

More news: HIStalk Practice, HIStalk Connect.

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December 20, 2012 News 13 Comments

News 12/19/12

December 18, 2012 News 2 Comments

Top News

12-18-2012 9-07-23 PM

A Wells Fargo Securities analysis of EHR attestation data finds a surge in the number of hospitals and practices qualifying for Meaningful Use money, which it expects to continue through the February deadline. It also notes that Epic is starting to dominate in all measures, leading in the number of physicians that have attested in with a success rate of 35 percent and representing 21 percent of the total attestations. Athenahealth was also noted as performing at an above-average rate, with neutral numbers for Allscripts and slightly negative numbers for Quality Systems. I ran the cumulative percentages by vendor and found that 80 percent of attesting providers are represented by just 22 of the 391 vendors listed: Epic, Allscripts, eClinicalWorks, NextGen, GE Healthcare, McKesson, Greenway, Cerner, Practice Fusion, athenahealth, Vitera, e-MDs, Community Computer Service, Eyefinity, Amazing Charts, Compulink, BioMedix Vascular Solutions, MedPlus, Medflow, Aprima, Partners HealthCare, and MedInformatix.

Reader Comments

From The PACS Designer: “Re: X-rays using your phone. Two engineers from California Institute of Technology have developed a microchip that can produce images inside objects without using the normal radiation method. The circuits operate with existing mobile phone technology but use the terahertz operating region to produce the viewable image for the phone. Terahertz radiation can penetrate through the body without damaging the tissue it passes through.”

From Vendor Middle Manager: “Re: clinician compensation. Can you ping the vendor community on the levels of compensation (salary, bonuses, options, etc.) being paid to clinicians? It’s hard to find out because of inherent reluctance to disclose compensation and the variety of titles that don’t reflect true roles. It would be great to hear anonymous examples of physician and nurse compensation with the primary role specified (doing demos, designing user interfaces, developing content, etc.)” I’ll collect and anonymously report your responses if you would care to either e-mail me or use the anonymous Rumor Report.

12-18-2012 8-50-42 PM

From Mini Me: “Re: iPad Mini. I’m interested to know how doctors are using the iPad Mini.” Me, too. If you are a clinician using an iPad Mini or an IT person involved in its rollout for clinical use, let me know why you chose the Mini and how it’s being used.

Acquisitions, Funding, Business, and Stock

12-18-2012 9-10-39 PM

Investment firm Elliott Management offers to buy Compuware for about $2.4 billion, a 15 percent premium over last week’s closing price. Elliot, which owns 8 percent of the company, says Compuware’s “execution, profitability, and growth have meaningfully underperformed.” Above is CPWR’s five-year share price (blue) vs. the Nasdaq (red). Compuware filed for a possible IPO of its Covisint Corp. unit last week and could conduct the IPO in three to six months.

12-18-2012 8-52-26 PM

Revenue cycle software provider Recondo Technology acquires eHC Solutions, an Indianapolis-based developer of EDI solutions.

pMD releases a mobile version of its patient handoff product.

12-18-2012 8-23-03 PM

PatientSafe Solutions (formerly IntelliDot) raises $13.3 million in equity financing, about half of the amount it is seeking, raising its all-time financing total to $83 million. The company offers bedside scanning solutions for medications, specimens, and breast milk along with documentation and caregiver messaging.


Rideout Health (CA) selects McKesson’s Paragon HIS as its financial and clinical solution.

ARcare (KY/AR) selects SuccessEHS PM/EHR for its 45 community health center locations.

12-18-2012 5-45-14 PM

MemorialCare Health System (CA) will implement the KnowledgeEdge Enterprise Data Warehouse from Health Care DataWorks.

12-18-2012 5-46-33 PM

Trustees of St. John’s Medical Center (WY) decide to spend $240,000 to buy eClinicalWorks as a replacement for McKesson Practice Partner, which it has been running for five years. They say Practice Partner is not user friendly and makes it difficult to document office visits.


12-18-2012 6-16-28 AM

The Premier Healthcare Alliance names Gary S. Long (Surgical Information Systems) chief sales officer.

12-18-2012 12-19-39 PM  12-18-2012 1-03-17 PM  12-18-2012 5-50-41 PM

CCHIT adds Janet M. Corrigan (National Quality Forum) and Grace E. Terrell, MD (Cornerstone Health Care) to its board of trustees and promotes Executive Director Alisa Ray to CEO.

12-18-2012 1-05-52 PM

The National Quality Forum names Christine K. Cassel, MD (American Board of Internal Medicine) president and CEO effective mid-summer 2013.

12-18-2012 5-52-59 PM

James D. Morris (Western Digital) joins Harris Corporation as group president of the Integrated Network Solutions business, which includes Harris Healthcare Solutions.

12-18-2012 3-19-21 PM  12-18-2012 3-22-14 PM

The SSI Group appoints Brian Campbell SVP of sales and Tom Myers chief strategy officer. Both will maintain their roles with MedWorth, an SSI subsidiary.

12-18-2012 6-55-56 AM  12-18-2012 5-54-36 PM

Meditech promotes Carol Labadini to associate VP for development, implementation, and support of Meditech’s ambulatory solution and Hoda Sayed-Friel to EVP of strategy and marketing.

12-18-2012 3-24-10 PM  12-18-2012 3-25-37 PM

Billing company PatientFocus adds Philip Hertik (Windsor Health Group) and Lucius E. Burch, IV (Burch Investment Group) to its board of directors.

12-18-2012 7-06-41 PM

Ormed names Bill Hockstedler (Connance, Inc.) VP of sales and marketing.

12-18-2012 8-37-05 PM

Imprivata names Carina Edwards (Nuance) as SVP of its new Customer Experience Group.

Informatica names Margaret Breya (HP) chief marketing office and EVP.

Announcements and Implementations

New Horizons Health Systems (KY) goes live on Healthland Centriq EHR.

12-18-2012 9-15-59 PM

Hutchinson Clinic (KS) exchanges CCD from its Allscripts EMR to the Kansas Health Information Network using the ICA CareAlign Exchange platform.

Orion Health announces the release of Orion Health Mobile, which allows users of Orion Health HIE to view real-time patient information on their iPhones and iPads.

Ormed sells its Canadian business to a subsidiary of Constellation Software, saying it will now focus on selling it ERP, HR, and decision support products to the US healthcare market. Constellation has completed several acquisitions this month, including buying documentation and charge capture systems vendor Salar from Nuance. Constellation also owned 21 percent of Mediware, or about $40 million worth, when that company was acquired by Thoma Bravo last month.

12-18-2012 7-22-18 PM

A profile of NewYork-Presbyterian Hospital SVP/CIO Aurelia Boyer, RN, MBA describes the organization’s use of Caradigm Amalga to analyze quality measures in real time, which she says saved $1.5 million in discovering CHF treatment variations.

Medecision’s Aerial care management system earns NCQA disease management certification.  

Government and Politics

ONC recognizes Ohio for coordinating its Regional Extension Center, HIE, and Beacon Community in supporting Meaningful Use and interoperability. More than 8,200 Ohio providers have met Meaningful Use requirements, receiving $368 million in federal payments.

In England, the chair of the Public Accounts Committee says paying trusts to implement CSC’s Lorenzo system are “bribes.” An earlier report from eHealth Insider says that CSC has offered $1.6 million each to the next 10 hospitals who sign up for Lorenzo, with funds coming from the Department of Health and CSC. CSC says the report contained factual errors, while Department of Health denies the suggestion that the incentives give CSC an advantage over competitors.


An article in a North Carolina newspaper illustrates why hospitals are snapping up medical practices. Simply by buying the practice, hospitals can bill up to double or more what the same physician in the same office would have been paid for performing the same service. Non-profit hospitals argue that they deserve to bill extra because of Medicare underpayment, a higher level of regulation, treatment of the uninsured, and a higher level of staffing. The article says North Carolina Attorney General Roy Cooper is considering using of antitrust laws to keep hospitals from raising healthcare costs by buying up their practice-based competitors. It cites an example of a patient’s echocardiogram, whose cost to her jumped from a $60 co-pay to a $952 bill even though the same technician performed the same test. In the Charlotte area, more than 90 percent of cardiologists are now hospital employees, spurred by a decline in their incomes of 30 to 40 percent in the past three years.

Weird News Andy says this baby was saved by scissors, but not like you’d think. UK doctors decide to save a baby born after 23 weeks of gestation (within the limit of legal abortion in almost all US states) because she weighed the minimum one pound to be considered viable. Only later did they realize that she had been weighed without removing a pair of scissors from the scales, with her actual weight being only 13 ounces. She’s been discharged after six months (after what must have been a monumental taxpayer expense) and is doing fine.

Sponsor Updates

12-18-2012 1-42-58 PM

  • Several Marines pay a visit to eClinicalWorks’ Westboro, MA headquarters to collect donated toys for Toys for Tots.
  • CommVault will pay $5.9 million for land in Tinton Falls, NJ to build its new headquarters.
  • A Wolters Kluwer Health survey finds that 80 percent of consumers believe they would benefit from have more control of their healthcare, though only 19 percent have a PHR. Nineteen percent also say that the most important consideration when selecting a physician is the practice’s level of technology.
  • Surgical Information Systems showcased its AIMS solution at this week’s PostGraduate Assembly on Anesthesiology in New York City.
  • PSS World Medical will offer Wellcentive’s population health management and analytics platform to its customers.
  • GetWellNetwork integrates Stanley Healthcare’s RTLS with its interactive patient care solution to identify caregivers entering patient rooms.
  • Dx-Web will offer LDM Group’s PhysicianCare and ScriptGuide products to its network of EMR vendors, expanding the relationship between the companies.
  • The Center for Medicare and Medicaid Innovation awards the Mayo Clinic, Philips Research North American, and the US Critical Illness and Injury Trials Group over $16 million to improve critical care in the ICU.
  • Billian’s HealthDATA offers strategies for providers to reduce re-hospitalization rates in a blog post.
  • AirStrip Technologies will add secure messaging to its applications using Diversinet’s mobiSecure SDK.
  • RazorInsights will incorporate Health Language, Inc.’s software into its EHR system to support standard terminologies.
  • Clinithink publishes the seventh installment of its seven-part blog series entitled, "Clinical NLP in Plain English."
  • DrFirst is ranked by Black Book as the #1 vendor of standalone electronic prescribing systems.

Report from the Healthcare Privacy and Security Forum
December 2-3, Boston, MA
By MrVStream

If you are not serious about your patient information security and privacy issues, the Office of Civil Rights (OCR) is, and it will have both financial and legal consequences for the entity. Just check out the Case Examples and Resolution Agreements (more on OCR to follow.)

I had the very good two days attending the inaugural Security and Privacy Forum sponsored by Healthcare IT News and HIMSS in Boston last week. It was well attended with over 250 registrants and 15 corporate sponsors. It does remind me of the early days for HIMSS (I won’t tell you how many years ago that was). It was serious, interactive, and had relevant subjects.

Here are some of the highlights and noteworthy points.

  • The keynote was delivered by Tim Zoph, SVP of administration of Northwestern Memorial Healthcare. He shared the greatest impact of a lack of focus on patient security and privacy is the erosion of confidence from patients and consumer towards healthcare providers, with the reported 435 breaches that affected 500 or more individuals since September 22, 2009, now totaling more than 20 million impacted individuals. Tim offered hopes and guidance to healthcare leadership that through creating a culture of security, simplifying the technology environment, using a standards-based security model, being proactive, and most importantly applying the right governance structure that is multidisciplinary, we can avoid security as one of these blind spots outlined in How the Mighty Fall by Jim Collins.
  • Barbara Demster, chair of the HIMSS Patient Identity (PI) Integrity Work Group, outlined that PI Integrity has direct impacts to privacy and security in the areas of operations and finance. She offered a HIMSS white paper from the Patient Identity Integrity Toolkit. The current estimate is that records are duplicated in the eight to 12 percent range, with institutions experiencing 47 percent false negative and 51 percent false positive (more problematic). The financial impacts range from administrative, regulatory, and patient care-safety. Barbara also suggests that PI integrity processes need to include stakeholders across the organization. Barbara emphasized that commitment and explicit organizational guidelines towards data governance are imperative.
  • Lisa Gallagher (senior director of privacy and security for HIMSS) and Bob Krenek (senior director of Experian Data Breach Resolution) presented the summary results of the 2012 HIMSS Security Survey, released December 12. Summary: (a) security budgets hold steady at 3 percent of the IT budget; (b) those organizations not conducting formal risk assessments will not qualify for MU incentives; (c) organizations need to establish a robust patient information secure environment in order to be able to safely share data externally; and (d) physician practices are not as advanced as other healthcare organizations in many areas of data security.
  • Sharon Finney, corporate data security officer for Adventist Health System, shared that her approach in meeting the needs and prepare for an OCR audit is moving her department from internal audit functions to risk assessment, focus on the potential risk impact, quantifying the financial risk, and engaging other departments. She also urged understanding people and process and to focus on the connecting points between each steps. She said she expects MU audits to be performed on all the institutions received funding.
  • Edward Ricks, VP/CIO of Beaufort Memorial Hospital suggested that to prepare for an OCR audit is to simplify the process and use outside consultants for support.
  • Mobile access and BYOD in healthcare are still major issues for patient information security and privacy with no single strategy, especially in the areas of device-to-device communication of PHI and home or consumer data collection. Sample strategies: Kaiser (do not allow any BYOD), Partners (restrict to technology standards — iOS only), Children’s Hospital of Central California (provide a virtual desktop environment), and others using network security to limit information access. The general agreement is that leadership is required to create a culture of patient information security. There is plenty of work to be shared by all the functional roles, but the reality is, a low amount of resources devoted and focused on the efforts of patient information security and privacy from both the administration and the white coats.
  • Jennings Aske (CISO of  Partners HealthCare) and Darren Lacey (CISO and director of IT compliance of Johns Hopkins University and Johns Hopkins Medicine) discussed the role of cloud computing. They suggested that it is necessary for the cloud supplier to sign a BAA, disclose underlying infrastructure, obtain third-party certification, and to demonstrate disclosure transparence. They did suggest that hybrid cloud services architecture is a good compromise.

Leon Rodriguez, director of the Office for Civil Rights (OCR), made these statements in an interview:

  • HHS OCR enforces the HIPAA Privacy and Security Rules as well as the HITECH Breach Notification Rule.
  • The final HIPAA Privacy and Security Rules are expected very soon.
  • The greatest challenge is the transformation of the agency from a regulatory body to an enforcement agency, where the scope is expected to be broader in nature.
  • The director position requires a balance of business needs and the need to comply with the regulations.
  • OCR expects from providers a well-documented procedure and we expect the entity to follow the process. The focused is on encryption, encryption, and encryption.
  • The awareness of management is still lacking, which makes it difficult for healthcare organizations to meet the regulations.
  • OCR has to work to help  consumers to understand privacy violations.
  • OCR is starting to move from a reactive mode to proactive audits based on risk analysis.
  • OCR expects more monetary restitution in the future and to expand the agency using the proceeds of the fines. $4 million was collected in 2012, but that is expected to grow.
  • OCR most likely will offer technology guidance, but will focus on the process.
  • OCR is still trying to assess the level of resources necessary to complete the audit.
  • Healthcare entity leadership will separate the successful implementation of a security and privacy plan from the unsuccessful ones.

Do you hear the OCR coming down the chimney to your facility? Plan to attend the Forum next year. I think you will find it worthwhile, and it may get you on the official Good List.


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

More news: HIStalk Practice, HIStalk Connect.

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December 18, 2012 News 2 Comments

Morning Headlines 12/18/12

December 18, 2012 Headlines No Comments

CCHIT plans to develop and share IT framework for ACOs

CCHIT announces that it will develop and publish healthcare IT framework recommendations to support an ACO model.

Community Hospital CIS Market Share 2012: Small Hospitals, Big Changes

KLAS releases a new report on community hospital market share shows the largest growth for Epic, Cerner, CPSI and Healthland in the under-200 bed market segment.

Piedmont Healthcare and WellStar Health System Partner on Health Plan

Piedmont Healthcare and Wellstar Health System announce plans to offer a health system-based insurance plan starting in 2014. Hospital executives report a need for greater access to patient data to support a population health model of care.

New Horizons Health Systems, Inc. Moves Away from Current HIT Provider and Selects Healthland EHR Technology

New Horizon Health System, a 25-bed critical access hospital in Owenton, Kentucky selects Healthland’s Centriq EHR.

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December 18, 2012 Headlines No Comments

Curbside Consult with Dr. Jayne 12/17/12

December 17, 2012 Dr. Jayne 1 Comment


ONC released the 2014 Edition Test Method for EHR Certification on Friday. In case you didn’t have anything to do over the holidays, now you can curl up in front of the fire with some cute and cuddly Test Procedures.

I have to be honest. I still struggle with Meaningful Use. I completely understand the goal. I also understand that there are a number of baby steps that must be taken in order to make data more transparent and transferrable. It’s extremely frustrating as a clinician, however, to have to codify data in ways that are seemingly meaningless.

Take the certification criteria for smoking status, for example. The Test Procedure document includes the approved SNOMED CT concepts “to assist the developers and implementers of EHR technology in the implementation of this requirement.” The concepts are:

  • Current every day smoker
  • Current some day smoker
  • Former smoker
  • Never smoker
  • Smoker, current status unknown
  • Unknown if ever smoked
  • Heavy tobacco smoker
  • Light tobacco smoker

For a minute, I’m going to take of my informatics hat and put on my average primary care provider hat. Let’s assume the only thing I know about SNOMED is that it’s some kind of coding system that sits under my EHR (if I even know that much, which I might not). Although the coding allows each of these to be uniquely identifiable, I’m not sure any of these (other than “Never smoker”) have specific levels of meaning to the majority of primary care physicians without detailed explanation.

For example, what is the definition of a heavy vs. light tobacco smoker? There are significantly different clinical risks to the former smoker depending on whether they’re a former heavy smoker vs. a former “only when I drink with friends” type of smoker.

There is a clarification that “smoking status includes any form of tobacco that is smoked, but not all tobacco use.” There are different risks to pipe smokers and cigar smokers than to cigarette smokers, but we’re not required to capture that nuance. In the old world, I could write TOB: 2ppd x 20y and 99 percent of clinicians would translate that to “cigarette smoker, two packs per day for twenty years” and could appropriately assess the patient’s risk. Now, to meet Meaningful Use, I’m going to be steered towards selections that don’t have a lot of clinical meaning.

Some vendors who had detailed and granular ways of documenting this information prior to Meaningful Use have kept their ability to gather that useful data and mapped it to the required codes. I can’t help but think that this will cause the data to lose something in translation.

Other vendors who are focused more on certification have added the new fields alongside their old ones. This forces clinicians to document the data twice – once for clinical significance and once for a federal program. Although it meets the letter of the law, it makes for unhappy users and poor design. I know of at least two products out there, however, which function in this way.

ONC works through the paradox of mapping on page 3 of the smoking status document. It gives the sample of a “pack a day” smoker that the Certified EHR maps to “current heavy smoker.” It notes that when the transition of care document is created, the additional text description and any other metadata could be included along with the SNOMED. It continues”

Note that “heavy smoker” is not the only concept that is appropriate here, and we leave the decision regarding which of the eight codes is the most accurate descriptor of clinical intent to the judgment of those implementing the form, template, or other EHR data capture interface.

I’m not sure that makes me feel much better. Unless they have dedicated clinicians working through these design specifications, it leaves us with software developers deciding how to best document clinical intent.

As the document continues, they include language from the 2011 preamble of the Health Information Technology standards document. It specifies the definitions of the various selections:

… we understand that a “current every day smoker” or “current some day smoker” is an individual who has smoked at least 100 cigarettes during his/her lifetime and still regularly smokes every day or periodically, yet consistently; a “former smoker” would be an individual who has smoked at least 100 cigarettes during his/her lifetime but does not currently smoke; and a “never smoker” would be an individual who has not smoked 100 or more cigarettes during his/her lifetime. The other two statuses (smoker, current status unknown; and unknown if ever smoked) would be available if an individual’s smoking status is ambiguous. The status “smoker, current status unknown” would apply to individuals who were known to have smoked at least 100 cigarettes in the past, but their [sic] whether they currently still smoke is unknown. The last status of “unknown if ever smoked” is self-explanatory.

I wonder how many of my primary care peers have read this language and share this definition? It’s been awhile since I was in medical school and residency, but I’m pretty current on my continuing education classes and haven’t seen this emphasized in recent articles about the risks of smoking. What’s magical about 100 cigarettes? Is there solid data that shows a difference in risk once a smoker hits that number? Maybe I need to go back to school.

Continuing on, the document clarifies the cutoff of “heavy vs. light” smoking as being more than 10 or fewer than 10 cigarettes per day, “or an equivalent (but less concretely defined) quantity of cigar or pipe smoke.” What if they smoke exactly 10 cigarettes per day? They don’t meet either definition.

I realize I’m splitting hairs here and some of you may have tuned out by now, but that’s the point. We’ve taken data that had clinical meaning and was easily understandable and turned it into data that is confusing and potentially meaningless. I’m not sure if that’s really taking us forward. The data is only as good as the staff entering it and the likelihood of physicians understanding the concepts (let alone training their staff to understand the concepts) may be low.

Compared to other parts of MU, the documentation of smoking status seems fairly straightforward. That’s not very reassuring considering a program which will continue to become more complex as we move forward. We’re not even to Stage 2 yet and I need a break. As they used to say, smoke ‘em if you got ‘em.


E-mail Dr. Jayne.

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December 17, 2012 Dr. Jayne 1 Comment

Morning Headlines 12/17/12

December 17, 2012 Headlines No Comments

2014 Edition Test Method

ONC releases the 2014 Edition Test Method which outlines testing steps for EHR certification

HealthTrio Sues Aetna for Patent Infringement in Colorado

HealthTrio sues Aetna and its ActiveHealth Management and Medicity subsidiaries for violation of its patient portal patent.

New Medicare fraud detection system saves $115 mil

A new CMS report claims it has realized $115 million in savings after implementing a $77 million fraud detection system.

2 Chesco companies report combined 168 layoffs

Medecision announces that it will lay off 83 employees from its software development and technical support divisions, effective February 3.

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December 17, 2012 Headlines No Comments

Monday Morning Update 12/17/12

December 15, 2012 News 16 Comments

12-15-2012 3-08-24 PM

From John: “Re: ONC. What happened to its announced intention to publish an EHR safety action and surveillance plan? It was announced in November 2011 and was supposed to be finished within 12 months.” 

12-15-2012 5-29-57 PM

From California Dreamin’: “Re: MMRGlobal’s patent trolling lawsuits for patient portals. I hear ONC and the California Attorney General are interested in the company’s reason for e-mailing individual hospitals about its patents. The company seems to be going after hospitals rather than vendors for patent infringement.” The former is unverified, while the latter does seem to be the case as the company’s lawyers cast the net wide, apparently including just about every hospital as a potential patent violator.

From Former Allscripts Employee: “Re: HHC lawsuit. I know for a fact that Glen and many others at Allscripts (as well as many outside of the company) are convinced that Epic is fleecing its customers. They feel Epic’s costs – especially the undisclosed long-term costs of operation – are outrageous and are hurting healthcare. As a former employee who participated in many C-level conversations, I’m guessing that they hope to use the lawsuit to bring those costs to light through the discovery process. Moreover, Allscripts has in fact demonstrated the integration of its ambulatory and inpatient EHRs at least one live site. And I’m sure they feel HHC could benefit from connectivity to Allscripts systems currently in place at Columbia, NewYork-Presbyterian, Memorial Sloan-Kettering, North Shore Long Island, and other NYC-based health systems serving millions of local patients whose records would be helpful to HHC providers. So while I agree it’s a dumb PR move for Allscripts, it’s not necessarily a bad business decision.”

12-15-2012 6-57-36 AM

Most poll respondents don’t think FDA should create an Office of Wireless Health, which opens up another question: if you feel that way, why? Leave a comment with your thoughts. New poll to your right: how has the Allscripts lawsuit against HHC and Epic affected your opinion of the company? As always, click the Comment link on the poll once you’ve voted to explain your position.

12-15-2012 4-52-08 PM

Speaking of the Allscripts lawsuit, the company sent over this statement in response to Friday’s HIStalk write-up:

Allscripts filed the lawsuit because NYCHHC failed to even address, much less resolve, significant concerns that Allscripts’ raised in its agency-level protest concerning the propriety of HHC’s iCIS award decision. Documents produced by HHC indicate that the agency failed to follow the rules governing the competition and overlooked hundreds of millions of dollars in potential savings offered by Allscripts’ proposal. In these times, it is critical that public procurements be awarded through the conduct of fair competitions that objectively assess the merits of competing proposals and document a reasonable basis for the decision. From all available information, the HHC award to Epic is lacking in all of these respects. Allscripts’ product is currently being used by some of the most prestigious organizations in New York, we offered substantial cost savings over the life cycle of the project, and we committed to creating more than 100 new technology jobs in the City. Had proposals been evaluated properly, we believe that our offer was clearly the best value for the City. Our goal remains the same: We want transparency in the process… we want the bid process reopened so that the competing proposals can be reviewed fairly, consistently and side-by-side to ensure that the taxpayers of NYC obtain the best value Electronic Health Record solution.

HIStalk Practice joins HIStalk Connect in receiving a design facelift, although not an identical one because of the length and type of articles. HIStalk is next and it will look very much like HIStalk Practice, which I think is easier to read and less claustrophobic than this 2007-era layout you’re reading that has served nobly for all those years.

I made a new Spotify playlist with old and new cool stuff from The Cult, Superchunk, Guided By Voices, Grizzly Bear, and others. It’s a work in progress since I may add more as I keep listening.

12-15-2012 1-48-45 PM

QxMD releases its free medical literature app, which allows browsing through topic reviews, reading journals, searching PubMed, and sharing articles via social media.

12-15-2012 1-54-14 PM

ONC announces the release of the 2014 Edition Test Method for EHR Certification.

In England, a government spending watchdog considers a review of the Department of Health’s payout to CSC for terminating its sole provider status as NPfIT was being dismantled. The Department of Health has said its ongoing support payments to CSC are funding centralized support, which critics say gives CSC a competitive advantage. Cerner has already raised concerns.

12-15-2012 1-57-02 PM

Baylor Health Care System announces that it will merge with Scott & White Healthcare, creating the largest not-for-profit health system in Texas with 34,000 employees, 42 hospitals, 4,000 physicians, and $8 billion in annual revenue. They created Vision for Texas Care site to explain the rationale.

NextGen Healthcare over sent an explanation of Michael Lovett’s new role mentioned in Friday’s post: “Michael Lovett is the senior vice president and ambulatory division manager for NextGen Healthcare. This is a newly-created role and Michael is responsible for developing and implementing the division’s strategic plan and ensuring that this plan is aligned with the company’s strategic direction.”

Just in case you missed Inga’s Friday morning post, here are the Best in KLAS winners for 2012. Notable factoids from it: (a) it was not surprising that Epic was by far the highest-ranked product suite, but McKesson Paragon beat Cerner to come in at #2, while the usual other big-hospital contender Allscripts finished next to last at #8; (b) McKesson came in last in physician practice rankings, with Cerner, Vitera, and Allscripts rounding out positions 7 through 9 ahead of it; (c) in the all-important inpatient EMR category, nobody’s even close to Epic, while Allscripts and Meditech populate the bottom; (d) Siemens Soarian takes the #1 spot for community EMR, although Prognosis, Meditech C/S, and RazorInsights had similar scores but were excluded because of confidence levels or because that’s not their primary market; (e) Epic is easier to beat in departmental systems, where it lagged other vendors in ED, scheduling, and anesthesia. The top three vendors overall were Epic, Wolters Kluwer, and 3M, while the bottom three were Agfa, McKesson, and Allscripts.

12-15-2012 2-35-08 PM

HealthTrio files a patent infringement lawsuit against Aetna and its ActiveHealth Management and Medicity subsidiaries, claiming that its patient portal patents have been violated.

Healthland will make the FollowMyHealth Universal Record Solution from Jardogs available to customers of its patient engagement portal.

12-15-2012 4-56-32 PM

A jury returns a $140 million medical judgment against an Alabama hospital following the 2008 death of one of its patients by insulin overdose. The patient’s physician had dictated the results of his medication reconciliation, and since his original paper form was being scanned, the offshore-prepared transcription was used by a nurse as an order. The patient was given 80 units of Levemir insulin — 10 times the prescribed dose — and died. Testimony in the trial indicated that India-based transcription companies like the ones involved follow more lax standards. Precyse Solutions, the American company to which the hospital had contracted its transcription services, claimed that its Indian subcontractors follow American error standards, but deposed officials from those companies testified that they do not. The defendant’s attorney said the mistake should never have happened because the nurse should not have used the unreviewed transcription document to create an order. He also says hospital employees and physicians did not know that transcription work wasn’t being performed in-house, adding that the hospital’s executives did not know even the names of the Indian companies until the deposition. Those companies had previously settled with the plaintiff.

12-15-2012 5-02-54 PM

Conservative commentator Michelle Malkin calls HITECH a "big fat bust," saying it is not adequately supervised, it has created cronyism, and it has negative effects on job creation and privacy. There’s not a single original thought in the entire piece, as it was obviously just assembled from readily available Internet content. It claims that Epic "lobbied loudest for the mandates" as one of the dated "hard-drive dependent software firms." She also makes the classic but nearly unforgivable mistake of editorializing loudly about providers who are fraudulently receiving payments for using EMRs they already owned, apparently unaware that HITECH was written precisely to encourage that practice. Unlike Cash for Clunkers, EMR drivers get paid for driving their same old cars.

An article in Iowa newspaper says that the i-PHACTS system developed by the state’s Department of Public Health in 2010 to track available hospital beds is nearly useless for placing patients because it’s only updated daily. A medical student is creating his own version, but it has the same limitation — integration with hospital systems is complex and hospitals aren’t willing to manually update their information on unoccupied beds regularly.

A North Carolina business paper profiles Greensboro-based Intellect Resources, which it says has quadrupled sales in each of the last two years as it provided consulting and recruiting services for hospitals implementing electronic medical records.

Health Management Associates, the subject of a "60 Minutes" report claiming its hospitals admitted patients needlessly, says the program’s sources were disgruntled former employees, one of them a physician who used court-sealed information provided to him by the program to amend his lawsuit afterward. The doctor changed his 2010 lawsuit when he saw sealed details claiming that the company’s ED software was being used to increase admissions, adding that claim to his own already-filed suit. HMA says its ED doctors don’t make admission decisions and they’ve stopped using the software.

12-15-2012 5-04-45 PM

An armed visitor shoots a police officer and two employees of St. Vincent’s Hospital (AL) on a nursing floor at 4:00 a.m. Saturday. Their injuries are not life-threatening. The suspect was shot dead by a second police officer.

Medicare’s $77 million fraud detection system, widely panned after audits found it had prevented only around $8,000 in fraudulent claims, is now claimed by CMS to have saved $115 million, although the report does not indicate how many providers were suspended from Medicare as a result. The report also indicates that the actual savings was $32 million, with the higher total being claimed as the future value of fraud that would have happened otherwise.

12-15-2012 5-06-37 PM

Health management and analytics systems vendor Medecision will lay off 83 employees in Wayne, PA headquarters, according to WARN act documents filed with the state. The company says those affected work in software development, program management, and technical support.

12-15-2012 2-39-03 PM

Weird News Andy is tickled by this story, which he snickeringly subtitles, “Little Angel.” Doctors eventually figure out what’s causing the swollen jaw of a seven-month-old girl: a two-inch feather embedded in her cheek.

Here’s Vince’s holiday gift for you, “The 12 Days of Go-Live.”

AMDIS Lover provided this message from the AMDIS listserv taking a tongue-in-cheek view of the Informatics Board Certification exam that launches in 2013. He says not all readers will appreciate it, but it captures the essence of existence of CMIOs. The original came from Joe Boyce, MD, CIO/CMIO of Heartland Health (MO).

Communications. Combine the following medical, cultural, and technical TLAs and FLAs  into a meaningful sentence. You may use one pronoun, one verb, two prepositional modifiers, and a gerund.  Ex: IMHO, CMIO NCQA PCMH FAQs without LOINC, HL-7, or SNOMED FYIs were DOA and SOL. SNAFU. 

PS: if you know all these, you do not need to complete the rest of the test.


Patient management. Who will have the most useful problem list?

  1. Five different hospitalists, NPs, and nurses using a combination of ICD9/10, SNOMED, and homegrown synonyms, with no one in charge
  2. A 70-year-old GP using free text
  3. Surgeon – two items for 84-year-old ICU patient
  4. Neonatologist — 27 SNOMED items for a three-day-old
  5. Patient’s PHR

Training. Which of the following techniques works least badly?

  1. Day-old pizza and handouts in the lunch room
  2. Department meetings at 7 a.m. on a Monday
  3. E-mails from people no one has heard of
  4. At-elbow support by people who just heard about  the project yesterday

Leadership. You have 15 hospitals over four states. Which model of leadership works best?

  1. Central (disconnected, jet lagged, and intermittent)
  2. Local (random, quirky, and adversarial)
  3. Democratic (but only certain people can vote)
  4. A CMIO with no direct reports, graded on “influence”

Fill in the correct phrase or words.

  1. CFO is to Budget as Sphincter is to __________.
  2. Twitter is to Communications as Static is to ____________.
  3. Regulation is to Efficiency as Friction is to ____________.
  4. ACO is to HMO as Deja vu is to ___________.

Order management. You are leading a CPOE installation and want to use the latest evidence-based guidelines. What is the right approach?

  1. Call a meeting of department leads, take two years, then make them up yourself
  2. Use third-party content, send to department leads, wait six months, then make them up yourself
  3. Use your paper-based content and sneak in the latest content with the one guy who comes to your meetings (i.e., make them up yourself)
  4. Google

Support. You are stopped in the hall and asked to design a new system that will save this physician maybe 2 –3 clicks a week, but will take your team at least two months of design, development and testing, two more months of training the entire staff, along with disrupting everyone else’s workflow. What is your response?

  1. Ask them to send you an e-mail describing the effort, knowing that they are “too busy” to get around to it
  2. There is no other correct answer

Software selection. You have been asked to select a new EMR for your 200-bed hospital. What  are the first steps you should take?

  1. Change your bed number to 500 so Epic will talk to you
  2. Watch the Cerner salespeople twitch when you ask one of them to demo the entire “standard implementation”
  3. Read KLAS, develop detailed requirements, do reference visits, then cave in to the most powerful docs (that couldn’t be bothered to come to demos) because they heard that System X was hard to use
  4. Go to HIMSS for wine and dine, then play spin-the-pocketbook and pray you get the “mature” implementation team promised by a sales guy you will never see again

Statistics. Which of the following principles are true?

  1. Pareto principle – 20 percent of the producers will make 80 percent of the product, but they will not be paid like it
  2. Death panel principle – 5 percent of the population consumes 50 percent of the costs, but you can’t do anything about it
  3. Incentive principle — the other 80 percent (see Pareto) will spend more energy gaming the system than producing
  4. Software development principle – 3 percent of the use cases will drive 80 percent of the timeline delays

Meetings. As CMIO, you are invited to a 2.5 hour mandatory budget meeting. What is your response?

  1. Attend with iPhone and iPad charged and catch up on e-mail
  2. Dial in while getting work done from your office, knowing that the CFO’s secretary will not be able to figure out the teleconference link
  3. Attend, listen closely, and wait for the moment when a physician’s fiscal wisdom will be most appreciated
  4. CMIOs do not get invited to budget meetings, and if they do, that is when you use the spam filter excuse.

Alerts. What is the most effective method of providing meaningful alerts to busy clinicians?

  1. Goldilocks – community-based balanced approach that will still get you eaten by the bears, and the “ community” will be nowhere around
  2. Overalerting — as determined by docs who just want to know when they are definitely going to kill someone
  3. Underalerting — as determined by your legal representation
  4. Individually tuned for relevancy, with actionable orders easily accessible within the order, highlighting only important info that you didn’t know and makes a difference in this unique patient (available in the next release)
  5. Horror stories in the physician’s lounge

User interface. Which of the following is the most effective modality for communicating key clinical information?

  1. A 24-inch LCD monitor with 5,347 elements in three-column view, vertical scrolling, and 23 colors
  2. An iPhone with no information on the top screen, but multiple branching links which will eventually lead you to YouTube
  3. An angry nurse that  you have not returned pages to for over an hour
  4. An intern whose pre-med major was theatre arts

13.  Pa55Words. Which of the following is optimal policy?

  1. Same password for all your applications “HckerPLsDoEmails2OK?”
  2. Four factor – iris scan, voice profile, 10-character randomly generated password changed every three months, with RFID embedded chip, Comrade
  3. Three strikes, you get pepper spray
  4. Prefilled sticky notes attached when shipping monitors


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

More news: HIStalk Practice, HIStalk Mobile.

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December 15, 2012 News 16 Comments

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