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December 10, 2012 Readers Write 6 Comments

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

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

Baseball Traditionalists: Whose “Use” was More Meaningful?
By Robert D. Lafsky, MD

Isn’t it fascinating to follow the daily progress of a battle that pits traditionalists against digitally-armed insurgents? On the one side are deeply-entrenched practitioners of an ancient art dependent on subjective judgment calls that, in their view, can only be described in descriptive natural language. On the other side are advocates of a granular hard data approach that, although tedious and opaque to the untrained, reveals insight into previously unseen trends and realities.  

Ain’t baseball something?  

You do have to admit, if you’ve read the sports pages lately, that the battles in the sport eerily reflect arguments that run through the pages and comment sections of this blog. I cite as the crowning example the brouhaha over the naming of Miguel Cabrera as this year’s National League Most Valuable Player.

The traditionalists have a powerful argument for Cabrera. For one thing, his Detroit Tigers won their division and went to the World Series, while second place Mike Trout’s LA Angels finished third in their division. And Cabrera was the first Triple Crown winner (highest batting average, most homers, and runs batted in) in 45 years. He had a knack for hitting when it really counted, and he selflessly agreed to move to third base from first when the Tigers acquired the powerful but slow Prince Fielder. The traditionalists say it’s obvious he’s the MVP.

But the “Moneyball” guys have their points about Trout. Using highly sophisticated and detailed data, they determined using a measure called “wins over replacement,” — using not only batting statistics, but defensive and even individual ballpark factors to compare Trout to an average replacement player — he accounted for 10.7 additional wins for the Angels over 6.9 Tiger wins for Cabrera. And that, to them, is what matters. All that other stuff is dismissed by these “Sabermetricians” as mere “narrative.”

But the traditionalists could ask, I suppose, the following cogent question:  whose “use” during the season was more “meaningful”? 

That’s an obvious parallel  to current trends in medical computing, right? Well, let’s not forget an obvious point. Baseball has always been a thing entirely made up by humans. Before these high-end statistics were developed, it had a clear-cut set of rules and a clear-cut goal–scoring the most runs in the most games.  

Medicine’s rules, on the other hand, are essentially defined by nature, and after more than 40 years in the field, I still wonder what the goals of practice really are. Fewer deaths, of course, but that’s really hard to count. And we know that people focus on a lot of other things that don’t affect critical outcomes like death and disability.

So, no — it’s way more complicated.  And advocates of evidence-based practice make valid points. We won’t settle any arguments here. But I know that obtaining and analyzing data is hard.  

Which is why we need baseball.  Go ahead and break for home, Bryce Harper. When that happens, we don’t need no stinkin’ statistics.

Robert D. Lafsky, MD is a gastroenterologist and internist in Lansdowne, VA.

The EHR Conversion Staffing Dilemma: Cost vs. Go-Live Disaster
By Don Sonck

12-10-2012 6-50-14 PM

With the window to initiate participation in the Medicare EHR Incentive Program expiring in 2014, the next two calendar years are certain to be chaotic within the EHR arena. With an ever-increasing number of hospitals and physician groups already scheduled to implement an EHR and still others in the final selection stage, internal and external resources necessary to staff these critical and expensive projects are already at a premium.

Particularly on the acute support side of these projects, professional consultants (internal and external) who possess clinical experience and know firsthand the inner workings of a hospital or ambulatory environment should be utilized. Ratios of one acute EHR professional for every four to five core clinical staff members is optimal. Any ratio greater typically results in frustration and morale decline, extended end user adoption, residual training, and of course, increased expense.

Far too often I’ve encountered healthcare systems of all sizes (as well as physician practices) that underestimate the importance of clinical support staff. During EHR post-mortem discussions, leadership rues the fact they overlooked or underappreciated the skill and expertise that clinical resources bring to the table, particularly during the critical 4-6 weeks just prior and subsequent to go-live. Too often, the main focus and budget allocation is on the EHR build and associated infrastructure costs. IT consultants are justifiably a majority slice of the overall project budget pie, but these same resources are ill prepared for and lack the “soft” skills to prosper as super users with core clinical staff during that chaotic go-live window.

My advice? Do not rely solely on overtime utilization of existing staff, the float pool, or seasonal staff. Make sure you pay for the ala mode on top of that budget pie in the form of nurses, therapists, and physicians who are seasoned in both go-live experience and the particular EHR vendor software to which you are migrating. When blended with existing core staff, these clinicians can assist in both patient care and technical guidance on the electronic charting process, easing your clinical team’s anxiety, reducing overtime, minimizing the need for additional EMR training consultants, and accelerating the adoption and knowledge of the EHR software.

When considering the employment of third-party clinical support staff, avoid the pitfall of waiting until the eleventh hour to pull the trigger. Human resources and nurse recruiting teams have enough on their plate without the added burden of answering these questions for themselves:

  • How will nurses and physicians learn the system and treat their patients at the same time?
  • What scheduling challenges will we experience due to the temporary decrease in productivity?
  • Who will handle my core employees’ technology aversion?
  • Will overtime compensate for coverage during classroom training time?
  • What will be our electronic charting standards be day one, week two, and month one?
  • Who will be taking care of orientation, credentialing, and my other duties during implementation?
  • What will my patients experience be during go-live?

Be an early adopter of the clinical staffing question, at least six months prior to go-live. Your CFO, CIO, and CNO will all thank you.

Don Sonck is director of EMR staffing solutions of AMN Healthcare of San Diego, CA.

Questions for ONC and the Obama Administration
By John Gomez

The Meaningful Use program requires technology to be adopted and utilized by healthcare providers and payers throughout the United States. The funding for these programs is coming from federal tax dollars  All that is well and good. In the long term, we will hopefully see a good return on these investments through standardized care, lowered administrative overhead, and a reduction in medical errors that affect patients.

The technology that is designed, developed, tested, and deployed to support Meaningful Use requires literally thousands and thousands of engineers, consultants, product and program managers, not to mention all the system administrators, network managers, and others. It is perplexing to me though, that in these times of economic hardships, many healthcare software vendors and secondary software service providers offshore these positions. 

For instance, companies like Allscripts have huge staffs in India and smaller presence in Canada. Some companies are offshoring to Israel, China, and Europe. Given that we as taxpayers are funding the Meaningful Use program, shouldn’t there be a provision requiring that those companies benefiting from these programs only utilize US-based resources? 

There is potentially a silly argument that could be made that if were to require these companies to use US resources, they would need to charge more for their products and services and that would ultimately cause a deeper burden to the taxpayer. That is an accurate knee-jerk response based on lack of information and research.

We could keep these jobs here in the United States and not increase the cost of operations for these companies if these companies fill these positions in areas of the United States that are hardest hit by the current state of our economy. The level of talent, required training, and other factors would be similar if not better then that which is encountered outside our borders.

I realize that this is not a simple problem. Wall Street and private equity firms are more interested in margin improvement then really considering the long-term benefit to our country. But in my eyes, I think that creating jobs here is a priority. 

We should do what we can to get more Americans working, even if it impacts the margins of healthcare software companies or slightly raises the cost of software or services. When you have a program as big as Meaningful Use, the benefit should be well beyond that of its primary objective.

John Gomez is CEO of JGo Labs of Asbury Park, NJ.

Stage 2: You Ain’t Finished ‘till the Paperwork is Done
By Frank Poggio

Many years ago I saw a cute little cartoon that pictured a three-year-old climbing off a commode. Standing next to him was his mother, instructing him that he wasn’t finished until his paperwork was done. Well now, the characters in that cute cartoon can be replaced by a vendor and the ONC, respectively.

Two new Stage 2 test scripts for certification will require vendors to supply documentation previously not needed under Stage 1. They are:

  1. Safety Enhanced Design – 170.314(g)(3), and
  2. Quality Management System – 170.314(g)(4)

Safety Enhanced Design (SED). In early drafts of Stage 2, this criterion was referred to as User-Centered Design. The primary impetus for SED came from the November 2011 IOM report (Health IT and Patient Safety: Building Safer Systems for Better Care) that lamented the lack of built-in safety elements in many clinical software products.

An excerpt from the ONC test script describing SED follows:

This test evaluates the capability for a Complete EHR or EHR Module to apply user-centered design for each EHR technology capability submitted for testing and specified in the following certification criteria:

§ 170.314(a)(1) Computerized provider order entry

§ 170.314(a)(2) Drug-drug, drug-allergy interaction checks

§ 170.314(a)(6) Medication list

§ 170.314(a)(7) Medication allergy list

§ 170.314(a)(8) Clinical decision support

§ 170.314(a)(16) Inpatient only – electronic medication administration record

§ 170.314(b)(3) Electronic prescribing

§ 170.314(b)(4) Clinical information reconciliation

The Tester shall verify that for each EHR technology capability submitted for testing and specified in the above-listed certification criteria, the Vendor has chosen a user-centered design (UCD) process that is either:

A) UCD industry standard (e.g.; ISO 9241-11, ISO 9241-210, ISO 13407, ISO 16982, and ISO/IEC 62366); and submitted the name, description, and citation or,

B) Not considered an industry standard (i.e. may be based upon one or more industry standard processes); and submitted the named the process(es) and provided an outline and description of the process(es)

The Tester shall examine each Vendor-provided report to ensure the existence and adequacy of the test report(s) submitted by the manufacturer. The Tester shall verify that the report(s) conform to the information specified in NISTIR 7742 Customized Common Industry Format Template for Electronic Health Record Usability Testing.

Full EHR vendors must address this new requirement, while EHR Module vendors can skip it if your certification request does not include any of the above criteria. On the other hand, if your EHR Module includes even one of the above, you then must address the SED for that criteria.

The second new criterion questions the use of a Quality Management System 170.314(g)(4). The ONC-published test script states the following:

For each capability that an EHR technology includes and for which that capability’s certification is sought, the use of a Quality Management System (QMS) in the development, testing, implementation and maintenance of that capability must be identified.

- The Vendor identifies the QMS used or indicates that no QMS was used in the development, testing, implementation and maintenance of each capability being certified

- The Tester verifies that for each capability for which certification is sought, the Vendor has

  1. Identified an industry-standard QMS by name (for example, ISO 9001, IEC 62304, ISO 13485, ISO 9001, and 21 CFR, Part 820…)
  2. Identified a modified or “home-grown” QMS and an outline and short description of the QMS, which could include identifying any industry-standard QMS upon which it was based and modifications to that standard
  3. Indicated that no QMS was used for applicable capabilities for which certification is requested

Clearly ONC is interested in learning more about what QA tools vendor use (if any) for each of the submitted Stage 2 criteria. Under Stage 2, per step 3 above, you do not have to have a formal (or any) QA process available. No QMS is an acceptable answer. But, you can easily guess what will happen in Stage 3. Words to the wise: if today you do not incorporate in your systems development a formal and documented QA process, better get one soon.

Last year in a previous HIStalk post I referred to the FDA coming to EMR systems through the back door. SED is a big step in. I fully expect the criteria covered to expand in Stage 3, and expect the depth and extent of the documentation submission to expand as the test agencies (ACB) gain more experience in 2013.

Lastly, if your staff is not familiar with the ISO and IEC standards, better do some homework. I suspect that the best of breed /specialty and new HIT startup firms would have a more difficult time in addressing SED than the large legacy firms. Documentation and QA are typically not their strongest suits.

All the new Stage 2 criteria and test scripts can be found here.

Frank Poggio is president of The Kelzon Group.

The Jury is No Longer Out
By Nicholas Easter

Very recently, I was a summoned to District Court for my civic responsibility of jury duty. Unlike many Americans, I relish the opportunity to sit for a jury trial, as it affords me the great opportunity to assist in the beautiful process of democracy. Unfortunately, the attorneys did not choose me this time around. But there is always next week, when I will be summoned to return.

Due to my freedom from this specific trial, I can comment on some of the particulars, but the important message from this trial comes from the other panelists as the voir dire was conducted.

In short, the case was/is an inmate at a federal detention facility (prison) attempting to sue members of the healthcare team at the facility for negligence in treating his life-threatening illness. A mix of guards, nurses, PAs, and a doctor being sued by an inmate for violation of the 8th Amendment to the US Constitution, since it is a constitutional question, was remanded to Federal District Court.

Eighteen lucky people were selected to move from the pews to the comfy seats in the jury panel. Each was interviewed by the judge and asked a series of questions to whittle the number down to 10 jurors.

Among the questions was a seemingly innocuous one: “What is your opinion on the healthcare provided to inmates?” Each of the 18 responded that they believed it was a right for each and every prisoner to receive fair and adequate medical attention. Of the panelists, there were teachers, engineers, consultants, unemployed persons, and the director of a local emergency room’s nursing team. I repeat, every single one thought it was the duty of the Federal Department of Corrections to provide ample and adequate healthcare to its inmates.

I believe it is time to formally reaffirm that a majority of this country believes that access to quality healthcare is a right afforded to each and every citizen, even felons. It is this basic comment on the structure of our society that gives a full and formal mandate to our leaders in Washington DC to complete the process of unifying the delivery of healthcare in America to make it accessible and affordable for all Americans.

If 18 randomly selected Americans above the age of 18 without any prior convictions for felonies can confirm that this basic right is required for criminals, then it ought to signal that it is high time to continue to find ways to make this an affordable reality for the remainder of Americans.

Social scientists agree that the “Social Strain Theory” is accurate. The greatest impetus to criminal behavior is poverty. America’s healthcare system can easily push even the most well-heeled patients into poverty. Hopefully the healthcare system of tomorrow will recognize the sharpness of its sword as it begins to eradicate a lot of ills that befall our society.

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December 10, 2012 Readers Write 6 Comments

Monday Morning Update 12/10/12

December 8, 2012 News 8 Comments

12-8-2012 10-47-35 AM

From HITEsq: “Re: Epic. It appears they aren’t happy with some consultant, suing two individuals and three similar sounding entities (KS Information Technologies). They were granted a motion to seal the complaint to protect sensitive information. Maybe someone knows more.”

12-8-2012 7-55-53 AM

The government should get more proof that providers have met Meaningful Use requirements before sending them a check, according to 72 percent of poll respondents. New poll to your right: should FDA create an Office of Wireless Health as proposed by Rep. Michael Honda (D-CA)? I’ve generously included a “don’t know/don’t care” option for those anxious to participate despite indifference to the topic.

My latest Spotify playlist includes the usual mix of music I like, including Villagers, This Providence, Gov’t Mule, Faith No More, and going back decades, Mountain, Throwing Muses, and even the virtually unknown 60s Detroit band Frijid Pink. I spend a fair amount of time choosing what I think is worth listening to and then play the list several times to make sure it makes sense, not that I’m in need of extra work. Give it a listen if you’re stuck in a musical rut.

12-8-2012 8-23-29 AM

I never look at (and in fact am annoyed by) infographics, those trendy, huge, multi-font pictures that fool short attention span Internet skimmers into thinking they understand a complex topic, often created by someone who hopes their agenda will be accepted as truth instead of opinion because it’s easier to stare at dumbed-down pictures instead of using your brain to read something more challenging and informative. If you don’t feel that way, cruise over to ONC’s EHR infographic for consumers. At least theirs is footnoted.

The secretaries of Veterans Affairs and Defense say they will present a plan in January to speed up the VA-DoD EHR integration. The planned go-live date of 2017 may be moved up. 

Manitoba’s eChart HIE  will allow users to hide their information even though they can’t opt out of the service. It will contain prescription information, immunization histories, demographics, and lab results.

The Jewish Healthcare Foundation, the Pittsburgh Regional Health Initiative, and Health Careers Futures form the Pittsburgh-based QIT training center, funded by the foundation and the County tourism office. It will offer training to healthcare executives and workers on emerging technology. ONC Deputy Director Jason Kunzman is former CFO of the foundation. Also announced was the QIT Health Innovators Fellowship program for graduate students in the health professions, who will submit IT solutions for judging in a 10-week program.

Healthcare provider CIOs on the 2013 Computerworld Premier 100 IT Leaders list:

  • Horace Blackman, Department of Veterans Affairs
  • George Brenckle, UMass Memorial Health Care
  • Thomas Bres, Sparrow Health System
  • Sonya Christian, West Georgia Health
  • Chad Eckes, Cancer Treatment Centers of America
  • Randall Gaboriault, Christiana Care Health System
  • Theresa Meadows, Cook Children’s Health Care System
  • Mark Moroses, Continuum Health Partners Inc.
  • Stephanie Reel, Johns Hopkins Health System
  • Kathleen Scheirman, Kaiser Permanente
  • Thomas Smith, NorthShore University HealthSystem

12-8-2012 9-11-37 AM

A new KLAS report on revenue cycle performance finds that Meaningful Use, reduced payments, and ICD-10 fears are forcing providers to examine their revenue cycles more closely for efficiency and effectiveness, with many of them engaging outside assistance.

RSNA attendance was down 9 percent this year, with possible reasons being lack of technology breakthroughs and a new policy that required guest attendees to pay.

12-8-2012 9-47-54 AM

A technical school in the Philippines creates a telenurse training program, preparing nurses to offer their patient consultation services via smart phones. ClickMedix, an online health company is participating, offering the nurses access to its smart phone application, doctors, and medical library in return for a percentage of their billings. Experts say it’s time to create business models for nurses to become online health consultants. I tracked down ClickMedix, which turns out to be a US-based company (Rockville, MD) formed by faculty and students of MIT and Carnegie Mellon to address global healthcare challenges. The company’s mHealth platform offers modules for delivery of medical services, patient management, administration, and healthcare services purchasing.

Ergonomics researchers warn that the increased use of EMRs and other keyboard-based technologies for long periods of time raises the risk that providers will sustain repetitive stress injuries as happened when offices computerized in the 1980s. A small study found that more than a third of doctors reported RSI-related pain in their neck, shoulders, back, or wrists. In what could be an indirect measure of the uptake of EMRs, another small provider study found that more than 90 percent use a computer, averaging more than five hours a day.

12-8-2012 10-07-12 AM

An article in the Rochester paper describes the use of contracted scribes in the ED of Rochester General Hospital, which says its 60 ED scribes cost $1 million annually but save the health system $1.6 million per year. According to the associate ED chief, “When you come to see the doctor, you want to see the doctor. You want eye contact. You don’t want us standing at a computer screen. I care for people. I’ve never been trained to be a good typist or a data entry specialist.”

An Atlanta nephrologist serving as the medical director of a clinic owned by dialysis provider DaVita files a whistleblower lawsuit against the company under the False Claims Act after noticing that its computer systems showed large amounts of wasted drugs. His suit claims DaVita overcharged Medicare for up to $800 million over eight years by intentionally using oversized vials of medication and discarding the remainder, billing Medicare for unavoidable waste. The doctor was noticed by his fellow whistleblower, a nurse who says the company was pushing employees to increase their drug revenue. The company says CMS approved all of its practices.

12-8-2012 10-22-02 AM

Scheurer Hospital (MI) renovates its patient rooms to include technology improvements, placing a computer in each room to allow nurses to document at the bedside. They also added a new patient call system that alerts nurses on cell phones.

The former executive director of Syringa General Hospital Foundation (ID) is sentenced to six months in prison and is ordered to pay $115,000 in restitution after pleading guilty to using the hospital’s computer system to transfer money to her personal accounts.

Aetna will pay $120 million to settle lawsuits claiming that it used databases from UnitedHealth Group’s former Ingenix unit to intentionally underpay insurance claims for members using out-of-network medical services. UnitedHealth paid $350 million in 2009 to settle a similar lawsuit in New York, at which time Aetna also settled by agreeing to stop using the Ingenix database and paying $20 million to help create an independently developed replacement for it.

Weird News Andy says he now knows how your mom always knew what you were thinking. Researchers find that a mother’s brain often hosts living cells from her children born decades earlier. WNA also digests new medical research as being an explanation for crazy cat ladies: a common cat parasite is found to have the ability to enter the human brain and to possibly cause behavioral changes.

More on CPSI in this week’s HIS-tory from Vince, putting it into current perspective by reviewing the MU success of its customers and how its practices parallel those of Meditech and Epic. Next up is NextGen’s inpatient division, so connect with Vince if you can help him out with background information.


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

More news: HIStalk Practice, HIStalk Mobile.

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December 8, 2012 News 8 Comments

News 12/7/12

December 6, 2012 News 8 Comments

Top News

12-6-2012 4-57-11 PM

Reuters reports that PE firms Thoma Bravo LLC, Thomas H. Lee Partners LP, and Francisco Partners have submitted revised takeover offers for Merge Healthcare and are awaiting a decision from the company.

Reader Comments

From Nasty Parts: “Re: MedeAnalytics. Oracle backed out of a deal to buy the company, so they’re re-orging and putting a number of folks on the street.” Unverified.

12-6-2012 6-20-02 PM

From Spamalot: “Re: funny vendor spam. The ridiculous image and hilariously misspelled text caught my eye before I could hit the delete key.” Could it be that the company has decided to offend as many of the senses as possible, with your delayed “delete” validating their cunning premise of turning your head like a gruesome car wreck? Surely it was not a native English speaker who composed the pitch for business “coninuity” and referred to network security as a “new sexy term.” The company’s two addresses appear to be mail drops, and the Facebook link in the spam goes to a marketing person’s personal page that features family photos and cutesy kitty porn. I’ll hazard a guess that their incoming lines won’t be overwhelmed by clamoring prospects.

HIStalk Announcements and Requests

inga_small In case you have missed any HIStalk Practice posts in the last week, here are some highlights. Most physicians who e-prescribe believe it reduces prescription fraud and facilitates decision-making. Vermont’s eight FQHCs go live on five different EMRs. OIG finds that physicians who protest the denial of Medicare claims win their cases 61 percent of the time. Spring Medical Systems will offer its EHR clients an analytics solution from Clinigence. The AMA argues that pre-payment MU audits would be too burdensome for physicians. None of this news can be found on HIStalk, so if you are interested in the ambulatory HIT world, make sure to sign up for the HIStalk Practice e-mail updates. Thanks for reading.

On the Jobs Board: Director of Reimbursement, Cerner Activation Consultant, Director of Marketing, Marketing Programs Manager.

I’m not really interested in two front teeth for Christmas since I don’t have a spot for them, but I could use some holly jolly reader gifts that cost nothing: (a) take 10 seconds max to sign up for spam-free e-mail updates from HIStalk, HIStalk Practice, and HIStalk Connect; (b) sleuth us out on Facebook, LinkedIn, Twitter and make the electronic connection; (c) support the companies that pay the bills by checking out their ads to your left, reviewing their offerings in the Resource Center, and sending out an effortless request for consulting information via the RFI Blaster; and (d) graduate from spectator to player by sending me news, rumors, and guest posts. I note that Dann’s HIStalk Fan Club on LinkedIn now has 2,881 members, all of whom get extra attention when requesting something because I’m reassured that they aren’t ashamed of reading HIStalk. A reminder: we’ve got the top headlines each weekday morning on HIStalk, courtesy of the newest crew member, Lt. Dan. You won’t get an e-mail blast to remind you since I figured that would be really annoying, so just head over to the main page and you’ll see what’s new before you head out for work (like I do).

Acquisitions, Funding, Business, and Stock

12-6-2012 4-53-27 PM

Toronto-based Constellation Software purchases 100 percent of the fully diluted shares of Salar from Transcend Services, a division of Nuance. Transcend purchased physician documentation and charge capture systems vendor Salar in July of 2011 for $11 million, followed by Nuance’s acquisition of Transcend for $300 million in March 2012. We ran an accurate reader rumor report of the then-unannounced sale on November 30.

12-6-2012 4-55-35 PM

EMR vendor Modernizing Medicine raises $12 million in Series B financing to expand into the orthopedic and ENT markets.

12-6-2012 8-32-42 PM

SAIC announces Q3 results: revenue up 3 percent, EPS $0.33 vs. –$0.28, missing on expectations of $0.35. The company said it signed over $100 million in contracts from its recent acquisitions, maxIT Healthcare and Vitalize Consulting Solutions. SAIC also announced that it will cut 700 jobs in advance of possible fiscal cliff federal spending cuts that would decrease defense spending. Shares that were at $20 in early 2010 closed Thursday at $11.26, valuing the company at just under $4 billion.


Presbyterian Healthcare Services (NM) signs a multi-year agreement with IT service provider T-Systems to manage the health system’s data center operations.

Martin’s Point Health Care (ME/NH) selects athenahealth to provide EHR, billing, PM, and care coordination services for its 90 providers.

Catholic Health Initiatives will partner with Encore Health Resources to create a suite of electronic healthcare intelligence solutions focused on quality, performance, and risk analytics.

12-6-2012 5-01-20 PM

Indiana University Health selects Healthcare Quality Catalyst’s data warehouse platform for reporting and analytics.

Mercy Medical Center (IA) will implement iSirona’s device connectivity software to automate the flow of patient data from more than 150 devices into Epic.

12-6-2012 5-04-33 PM

Abington Health System (PA) selects the Surgical Information Systems perioperative IT solution for its two hospitals.

WellSpan Health (PA) subscribes to the CapSite Database to improve its purchasing processes.

Maury Regional Health System (TN) selects Medseek’s patient portal solution.

Ophthalmic Consultants (MA) adopts the Professional Charge Capture solution from MedAptus.


12-6-2012 5-05-37 PM

Interoperability software provider Compressus names Joe Lavelle (Results First Consulting) as COO.

12-6-2012 5-07-09 PM 12-6-2012 5-07-53 PM

Clinithink hires Fiona Lodge, PhD (Microsoft) as director of technical operations and Nathan Skorick (Altos Solutions) as business development executive.

12-6-2012 5-09-04 PM

Huntzinger Management Group VP William Reed (above) joins the company’s board of directors, along with Richard Sorensen (US Health Holdings.)

12-6-2012 5-14-31 PM 12-6-2012 5-15-26 PM

Emdeon adds former Allscripts Chairman Philip Pead and former Harris Corp. CEO Howard Lance to its board.

12-6-2012 7-56-26 PM

Hospitalist Fred Chan, MD is named to the newly created position of CMIO for GBMC HealthCare System (MD).

12-6-2012 8-01-31 PM

Jardogs names Ken Mikesh (MyHealthDIRECT, above) as SVP of strategy and business development and Brenda Stewart (Merge Healthcare) as SVP of marketing.

12-6-2012 7-00-24 PM

Homer Warner, a cardiologist and medical informatics pioneer, died November 30. He started developing clinical software at University of Utah and Intermountain Healthcare in the mid-1950s and wrote Intermountain’s ground-breaking and still-used HELP system in the 1970s, one of the first electronic medical records and clinical decision support systems. He was chair of University of Utah’s Department of Medical Informatics, the first such program offered by a medical school. Intermountain opened the Homer Warner Center for Informatics Research at Intermountain Medical Center in 2011. He remained active, vital, and humorous until his death at age 90, as evidenced by this video interview conducted a few weeks ago.

Announcements and Implementations

Vitera closes its hardware support business unit through a partnership with DecisionOne, which will hire Vitera’s field technicians. Vitera notes that it has added more than 270 employees this year and anticipates filling another 200 positions.

12-6-2012 1-59-53 PM

The University of Texas at Austin launches the country’s first HIE laboratory, which is funded by ICA, Orion Health, eClinicalWorks, and e-MDs.

DrFirst announces Akario, a free secure clinical messaging system.

GE Healthcare launches its Centricity Business 5.1 RCM solution.

Allscripts releases Sunrise Financial Manager, a revenue cycle solution designed for accountable and value-based care payment models.

The HIEs of West Virginia and Alabama, both customers of Truven Health Analytics, earn federal recognition for reaching milestones for full query-based and directed information exchange.

MModal opens a medical transcription center in Mysore (India), where the company plans to create 100 jobs over the next two years.

12-6-2012 8-15-10 PM

Cisco Systems is providing video calls with Santa to patients at 31 children’s hospitals (including Children’s of Alabama in a photo from Tuesday, above) via its Santa Connection Program, which runs through December 21 .

Government and Politics

The IRS releases a final rule subjecting the sale of medical devices to a 2.3 percent tax beginning in 2013, which is expected raise $29 billion in tax revenue through 2022.

Innovation and Research

Independence Blue Cross, Penn Medicine, and DreamIt Ventures create Philadelphia-based DreamIt Health, yet another digital healthcare accelerator. It offers $50,000, a four-month boot camp, office space, mentoring, and a demo day. It gets 8 percent of the equity in return.


12-6-2012 5-22-44 PM

Athenahealth will buy the 29-acre, 11-building, 760,000 square foot Arsenal on the Charles complex in Watertown, MA from Harvard University for $169 million. The company was already leasing 330,000 of space in the complex for its headquarters.

 12-6-2012 3-34-57 PM

A CapSite survey finds that one-third of US hospitals have adopted a vendor-neutral archive, while another 19 percent plan to do so.

Kaiser Permanente will open a new IT center in the Denver, Colorado area and will hire 500 IT employees by 2015.

A survey finds that 94 percent of healthcare organizations suffered at least one data breach in the last year. Other findings: (a) 69 percent don’t secure PHI-containing medical devices such as insulin pumps, and (b) almost all of them use cloud-based solutions and allow employees to use their own medical devices even though half of the organizations question the security of those technologies.

12-6-2012 3-22-22 PM

The CDC reports that 40 percent of office-based physicians now use an EHR with a basic level of functions, up from 34 percent a year ago.

At a dermatologist appointment this week, I noticed signs on the window urging patience, as the one-doc practice had just changed EMR systems. I asked the doctor and got an earful in return. He had already attested for Meaningful Use Stage 1, but was convinced by a salesperson to trash his EMR and move to GE Centricity. He said it’s the worst business decision he has ever made, not because Centricity is bad, but because he spent a lot of money, he’s being hit constantly with additional upgrade and maintenance fees, and to top it all off, he now realizes that he has no chance of collecting Stage 2 money because the bar is set too high for his practice. Not to mention that as a specialist, the EMR is not providing much patient value. He says he’s hoping to hold on for the 2-3 years it will take to get his practice back on its feet again, as the EMR is now his single largest expense. I can only describe his behavior as ashamed, followed by relieved as he realized from our discussion that he’s not the only one struggling to pay for something that he probably should never have bought in the first place. Needless to say, he’s not exactly thrilled with the HITECH program. It’s an eye-opener to realize that these little practices are cash-strapped businesses run by folks who may be excellent clinicians, but who are also marginal, accidental businesspeople just trying to keep the doors open and their employees paid. Derms are usually well paid and minimally stressed thanks to acne and Botox, so I can only imagine what it’s like for a primary care practice.

In Canada, Vancouver Coastal Health fires a long-time clerical employee for looking up the electronic records of five local media personalities out of curiosity.

Hello, Doc, Internet porn is free: a female employee of a doctor’s practice notices a red light glowing behind supplies in the restroom. She finds a video camera pointed at the toilet. The doctor finds his career potentially in that same toilet, as police executing a search warrant find the camera-controlling software on his computer. Maybe he should claim that the restroom doubles as a telemedicine station.

A privacy “weakest link” example. MC and Mel, a couple of morning zoo-type deejays from Australia sporting the worst fake British accents in history, call up the London hospital treating the Duchess of Cambridge for morning sickness, doing hilariously unskilled and giggling impersonations of Queen Elizabeth II, Prince Charles, and barking Corgi dogs. They get through to a nurse who provides a full update on the former Kate Middleton’s condition, learning that Kate “hasn’t had any retching with me.” The hospital is evaluating its privacy practices. UPDATE: in a not-so-funny ending to the story, the nurse who took the prank call has apparently committed suicide.

Sponsor Updates

12-6-2012 6-54-18 PM

  • Billian sponsored the December 4 Health IT Leadership Summit at the Fox Theater in Atlanta, which attracted 600 attendees. Above are Ellen McDermott (University of West Georgia), Jennifer Dennard (Billian Inc.), David Hartnett (Metro Atlanta Chamber of Commerce), and Cynthia Porter (Porter Research).
  • AT&T adds a remote interactive patient monitoring solution from Ericsson to its ForHealth remote patient monitoring platform.
  • Mercy Regional Hospital (KS) implements a paperless employee time off request process using Access Evolution.
  • Healthcare Clinical Informatics offers ten tips for realizing the value of EHR.
  • Shareable Ink will exhibit at next month’s ASA Conference on Practice Management in Las Vegas.
  • Beacon Partners and its employees donate over $9,500 in support of the Red Cross’s Hurricane Sandy relief efforts.
  • ChartWise Medical Systems will integrate TruCode’s grouper, pricer, and editing Web Services into its ChartWise:CDI software.
  • Imprivata publishes a white paper highlighting best practices for realizing care team collaboration and productivity benefits using HIPAA-compliant texting.
  • CPU Medical Management Systems, a MED3OOO company, partners with RISARC Consulting to provide CPU customers an option for secure electronic document exchange.

EPtalk by Dr. Jayne


ONC holds its annual meeting on Wednesday, December 12 in Washington, DC and also accessible by webcast. It will include sessions on HIE and interoperability, patient engagement, and of course Meaningful Use.

A study in the December issue of Pediatrics lists five key features needed for pediatric EHRs: well visit tracking, support of growth chart analysis, immunization tracking, immunization forecasting, and weight-based drug dosing. Although the article notes that “it’s nearly impossible to find an EHR that meets those standards,” I guess I’m lucky because my system supports all of these. One of my friends is looking to replace her system and I’m attending a demo with her over the holidays. We’ll have to see how that vendor stacks up.

Over on HIStalk practice, Inga mentioned a survey on e-prescribing. Although I’m optimistic about its potential, I’m skeptical about the ability of pharmacies to keep up. Case in point: e-prescribing of controlled substances. Although the DEA finally approved this and several vendors piloted it in a handful of states, there is still a lack of awareness. I happened to stop by the pharmacy at a local supermarket chain and ask if they’re ready to receive such scripts (because I’m more than ready to start transmitting them) and received a stern lecture from the pharmacist about how he’s been told it’s illegal to do so.

Weird news story of the week: A New Orleans ambulance crew finds their vehicle immobilized with a parking boot, applied while they were on the scene with a patient.

I previously mentioned Scanadu, the startup that hopes to make a Star Trek-style medical scanner a reality. The company unveiled its SCOUT product, which is headed to the FDA for approval as a home diagnostic device. If it really delivers what it says – five vital sign results in 10 seconds with 99 percent accuracy – I think they’re missing a major market. For physician practices where rooming patients quickly is essential, this would be a killer app.

One of my favorite Tweeps is @MeetingBoy. Since I shared my holiday party recipes, I’ll share his piece on Eight Reasons Why I’m Skipping the Office Christmas Party.  I’ve never been to a real-life office Christmas party – we don’t have those in non-profit land. The closest we have is the holiday potluck. I’d love to live vicariously through HIStalk readers and of course promise to keep you anonymous. Bonus points for anyone who has received a corporate logo holiday gift worse than what I received one year: jumper cables.

Flu season has arrived early. If you haven’t received the vaccine, there’s still time. Whether you’re vaccinated or not, please keep covering those coughs, stay home when you’re sick, and keep washing those hands. And in case you wondered, paper towels spread fewer germs than drying your hands with a blower.



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

More news: HIStalk Practice, HIStalk Mobile.

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December 6, 2012 News 8 Comments

Readers Write 12/5/12

December 5, 2012 Readers Write 3 Comments

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

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

Hey Healthcare, ‘I Dare You to Do Better’
By Nick van Terheyden, MD

12-5-2012 6-48-19 PM

I was reading “Dream Big, Start Small: NYU Startups Disrupt Big Industries” when a quote from Mana Health caught my attention: “We want to make the job as easy as possible for doctors … We want to be Apple in [the] health industry.”

This quote got me thinking about the role of simplicity in healthcare. Part of what makes Apple unique is its simple approach to consumer technology. While bells and whistles are buried beneath the surface, what the user experiences is the ability to pick up a piece of Apple technology and interact with it without reading a verbose manual or watching a “How-To” YouTube video.

Clearly, a team has already taken the time to anticipate how people will use this technology, what questions they might have, where they might get hung up, and what’s really going to “wow” consumers and keep them engaged. There’s something mystical and awe-inspiring about this type of simplicity, particularly if you compare it to what clinicians have to do in order to get up to speed on the most basic healthcare technologies.

Maybe it’s because The Official Star Trek Convention was recently held in San Francisco, or the fact that I just recently heard that a nine-minute teaser for the latest Star Trek movie, “Star Trek Into Darkness” will be available in 3D IMAX theaters on December 14, but in addition to “simplicity,” I’ve also been thinking a great deal about how advancements in technology can help the healthcare industry “boldly go where no one has gone before.” And more importantly, to get “there” without asking clinicians to fight Klingons.

Over the past year, there has been an array of studies and stories pointing to frustrations associated with electronic health records and Meaningful Use. This is compounded by additional pressures putting the heat on the healthcare industry — a looming physician shortage, an aging population with increased care demands, and changes in the reimbursement model.

Still, for every problem, there’s a solution. What keeps me up at night, though, is the fact that all too often we try to slap a new coat of paint on a problem in an effort to mask the issue as quickly and efficiently as we can. More often than not, we approach problems — especially in healthcare — with a fast and furious desire to make things right in the moment instead of aiming to make things right for the long term.

The fast fix in healthcare is often not the real solution to the problem. Take the transition to ICD-10, for example. At first, some healthcare providers wanted to keep doctors as far from the transition as possible. And at first glance, I can understand why. No one wants to take the focus off of the patient. Still, the transition to ICD-10 can’t be simplified without having doctors on board as part of this massive personnel and technological overhaul.

See, the problem with simplicity is that to get to that type of Apple approach in healthcare, you have to take into consideration the myriad of players that will be affected. You have to take the time to test and tweak, test and tweak in an iterative process that while challenging and time intensive, will ultimately be rewarding. In other words, to get to “simple,” you have to trudge through the difficult for quite some time.

As we head into the holiday season and take a look back at the accomplishments and failures from the past year, let’s agree to remain focused on integrating a new sense of simplicity into the complexity of all things healthcare in 2013 – whether it’s technology, health insurance, or patient communication. One particular “Star Trek” quote mapping back to the simplicity theme that seems like a fitting request for all healthcare players in the coming year is this: I dare you to do better.

Nick van Terheyden, MD is chief medical information officer at Nuance of Burlington, MA

Humble Suggestions from an Allscripts Pro Client to Ease Transition Pain for MyWay Clients
By Cathy Boyle, RN, BSN

12-5-2012 6-56-30 PM

By now, I’m sure everyone who uses Allscripts MyWay is aware that the company is transitioning customers to the Professional Suite. You’re probably overwhelmed sorting through options as you decide whether to upgrade to the new product or to jump ship and start over with another EHR company. 

Starting over with another company may be painful, but it’s also somewhat vindicating. On the other hand, agreeing to upgrade to the Professional product may be the easier road because you’re exhausted and don’t want to start over with someone new. 

Let me offer a little perspective …

Three years ago, our practice learned Misys was merging with Allscripts and we would need to move to the Allscripts product. No choice.

We were miffed, to say the least, and jumped ship to a competing product. Within three months, we realized it was a serious mistake. We ate a little crow and made the decision to return to Allscripts. 

We implemented the Allscripts Pro EHR/PM system and came to the conclusion that even though not all of our experiences with Allscripts have been perfect, it was the right choice. Like it or not, Allscripts is the leader in the EHR world for a reason. They haven’t always gotten it right. Unfortunately, no one does. 

I will not pretend to understand how any of you feel as a MyWay client. The only thing I can offer is my perspective from moving to another product and realizing the grass is not always greener on the other side. 

My suggestions are threefold:

  1. If you haven’t already, sign up for Allscripts Client Connect and check out the resources available for people upgrading to the Pro EHR and for those considering other options. You’ll find links to webinars, product demos. and lots of other info. Can’t hurt, right?
  2. Go to the Pro ARUG (Allscripts Regional User Group) page for your state and start asking questions of Pro users in your area. They’ll answer you honestly. They are not paid by Allscripts and have real-life, in-the-trenches perspectives on the Pro product.
  3. Find out who in your local community has the Pro product and go take a look at it. See it for yourself firsthand as you make the best decision for your practice.  

Then, if you don’t like what you see and hear, feel free to explore other options.

I wish you the best in this world of healthcare changes – I really do!  But if you come to realize, as we did, that the Pro solution is right, I would personally like to welcome you to the Pro family! We will help you, support you, cry with you, teach you, bang our heads (at times) with you, and celebrate the victories that come with finding a system and a family of users from which you can benefit. It’s not always easy going, but you will be heard and you will not be alone.

I am not paid by Allscripts and do not reap any personal benefit from writing this post. Just concerned with what is happening to fellow clinicians in the Allscripts community. Feel free to contact me directly if you have questions. I will not mince words and am happy to help in any way I can. 

Cathy Boyle, RN, BSN  is clinical director at Heiskell King Burns & Tallman Surgical Associates, Inc. of Morgantown, WV.

OCR’s Guidance for De-Identifying Health Data
By Deborah Peel, MD

12-5-2012 7-03-09 PM

The federal Office of Civil Rights (OCR), charged with protecting the privacy of nation’s health data, has released guidance for “de-identifying” health data. Government agencies and corporations want to de-identify, release, and sell health data for many uses. There are no penalties for not following the guidance.

Releasing large data bases with the de-identified health data of thousands or millions of people could enable breakthrough research to improve health, lower costs, and improve quality of care — if de-identification actually protected our privacy so no one knows it’s our personal data. But it doesn’t. 

The guidance allows easy re-identification of health data. Publicly available databases of other personal information can be quickly compared electronically with de-identified health data bases to reattach names, creating valuable, identifiable health data sets.

The de-identification methods OCR has proposed are:

  • The HIPAA Safe Harbor method. If 18 specific identifiers are removed (such as name, address, and age), data can be released without patient consent. Still, 0.04 percent of the data can still be re-identified.
  • Certification by a statistical expert that the re-identification risk is small allows release of databases without patient consent. There are no requirements to being called an expert. There is no definition of small risk.

Inadequate de-identification of health data makes it a big target for re-identification. Health data is so valuable because it can be used for job and credit discrimination and for targeted product marketing of drugs and expensive treatment. The collection and sale of intimately detailed profiles of every person in the US is a major model for online businesses.

The OCR guidance ignores computer science, which has demonstrated that de-identification methods can’t prevent re-identification. No single method or approach can work because more and more personally identifiable information is becoming publicly available, making it easier and easier to re-identify health data. See Myths and Fallacies of Personally Identifiable Information by Narayanan and Shmatikov, June 2010. Key quotes from the article:

  • “Powerful re-identification algorithms demonstrate not just a flaw in a specific anonymization technique(s), but the fundamental inadequacy of the entire privacy protection paradigm based on ‘de-identifying’ the data.”
  • “Any information that distinguishes one person from another can be used for re-identifying data.”
  • “Privacy protection has to be built and reasoned about on a case-by-case basis.”  

OCR should have recommended what Shmatikov and Narayanan proposed: case-by-case “adversarial testing” in which a de-identified health database is compared to multiple publicly available databases to determine which data fields must be removed to prevent re-identification. See PPR’s paper on adversarial testing.

Simplest, cheapest, and best of all would be to use the stimulus billions to build electronic systems so patients can electronically consent to data use for research and other uses they approve of. Complex, expensive contracts and difficult workarounds (like adversarial testing) are needed to protect patient privacy because institutions — not patients — control who can use health data. This is not what the public expects and prevents us from exercising our individual rights to decide who can see and use personal health information.

Deborah C. Peel, MD is founder and chair of Patient Privacy Rights Foundation of Austin, TX.

Evolution in your Data Center
By Axel Wirth

12-5-2012 7-12-23 PM

The change of a biological organism through a combination of mutation and natural selection over a number of generations was first articulated as the Theory of Evolution by Charles Darwin. In short (and with my apologies to the great scientist), if a change occurs and the next generation is more successful, it will have a higher probability of passing on its characteristics to future generations.

Survival of the fittest, survival of the smartest, or plainly a strategy to adapt to a changing environment. Whichever way you look at it, it has enabled the human race to populate the earth from our origins in Africa to the icy north.

But evolution works in both directions. Think, for example, of the problems caused by antibiotic-resistant infections like MRSA. We can also apply a similar thought model outside of biology. Let’s have a look at the scary and complex world of computer viruses and malware.

A recent example. In mid-2009, W32.Changeup, a polymorphic worm written in Visual Basic, was first discovered, but was not really anything special. It wasn’t harmless, but in general, it was classified as a medium damage, medium distribution, and easy to contain worm.

But then evolution came to play (granted, this was not evolution by mutation, but evolution by design). As of recently, we have seen over 1,000 variants of W32.Changeup, some of which much more aggressive and successful than the original. Some variants recently showed an increase in activity of over 3,000 percent in a single week.

What is even more concerning is that based on some of the characteristics of this worm, it is especially dangerous for the typical healthcare infrastructure. We have already seen several hospitals hit hard over the past weeks.

Why now and not back in 2009? Just like MRSA, W32.Changeup evolved and became more resistant and dangerous.

There are a number of malware threats which, due to the way there are designed, are affecting healthcare IT more than others. Downadup, also known as Conficker, was one of them. It looks like Changeup is joining the club. Here is why:

  • It spreads through removable drives. Devices and subnets which are perceived to be protected through isolation and may not have sufficient malware protection and resilience are at risk.
  • It infects old and new versions of Windows on workstation and server platforms. Certain devices on hospital networks with older or unpatched operating systems (e.g. medical devices, dedicated workstations, and servers) may be especially vulnerable.
  • It uses multiple propagation methods through removable drives and shared network drives. Once a system is compromised, Changeup’s main purpose is to download various additional malware. Among it is a Downloader Trojan, which in turn will download even more malware.
  • Changeup is polymorphic in nature. As it copies itself to other devices, it maintains its function, but changes it look. This makes it difficult to detect with traditional signature-based antivirus software. Modern anti-malware software provides more functionality than signature-based protection, but proper configuration of your endpoint protection combined with a layered security approach are required to detect and protect against a sophisticated worm like Changeup.
  • Changeup copies itself to removable and mapped drives by taking advantage of the AutoRun feature in Windows, which should therefore be prevented for all users and devices, including network shares.

This brings us back to the initial point made about evolution. We now have diseases which are resistant to a single antibiotic and require a complex, multi-pronged approach. Similarly, with computer malware like Changeup, a single approach (e.g. relying on signature-based antivirus alone) is not sufficient any more. At a time where we are seeing well over 10 new viruses and variants being created per second, we need to take a strategic “defense in depth” approach.

Of course, traditional and signature-based antivirus is still part of that picture, but it needs to be complemented by system and network intrusion detection, peripheral security (firewalls), system configuration and controls, security event monitoring, and URL filtering to prevent connection to known C&C (command and control) URLs.

Axel Wirth is national healthcare architect for Symantec Corp. of Mountain View, CA.

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December 5, 2012 Readers Write 3 Comments

News 12/5/12

December 4, 2012 News 19 Comments

Top News

12-4-2012 9-55-58 PM

The Atlanta newspaper covers the case of an internist whose stolen identity was used to apply for a National Provider Identification number, then used to incorporate a fictitious Buckhead medical clinic using a UPS Store mail box as an address with “Olga Teplukhina” named as the clinic’s CEO. The paper then did its own investigation, finding 131 CMS-registered medical providers that used an Atlanta UPS Store as their practice location, resulting in OIG looking into at least two dozen of them. One UPS Store-based company was found to have billed Medicare for $1.2 million in fraudulent injections, but is still in business because companies that are barred from billing Medicare can still bill private insurance. Despite the fact that the newspaper created the list of 131 practices using minimal effort and desktop software, CMS says it doesn’t have the technology to recognize private mailboxes since they carry a regular street address. The article says CMS pays claims that it really should deny under existing regulations because it worries that legitimate provider mistakes would unduly delay payments. One doctor complained to CMS that his name was being used to bill Medicare fraudulently, but two years later, the phony provider still has an active NPI that uses the doctor’s name.

Reader Comments

From Diminutive Avian: “Re: Epic. Most people don’t know that Epic has one final implementation check. Judy has to personally give the go-ahead. If she doesn’t like what she sees, she tells the customer she’s pulling out and gives them their money back. That’s another reason why the company has only successful implementations. Unlike publicly traded vendors, Epic is more than willing to walk away if the client is botching the install and ignoring Epic’s recommendations.” I’ve been told that at least two big academic medical centers are in precisely this predicament as we speak. From what I’ve heard, Judy gives the client two choices: (a) agree to let Epic send in a SWAT team to take over the project, or (b) find themselves another vendor.

From BubbaLove: “Re: Duke University. Heard they’re being sued by Deloitte for breach of contract due to mismanagement of the Epic implementation.” Unverified. Perhaps HITEsq or another attorney reader can scour the legal databases and report back. UPDATE: two well-placed sources and one even better second-hand source contacted me to say there’s no truth to this rumor. I’ve also had no volunteers tell me they’ve turned up any legal documents. I’m concluding that the reader’s report report, which they admitted was second hand, is inaccurate –the Duke and Deloitte working relationship hasn’t changed as the project continues.

12-4-2012 7-18-57 PM

From Current Epic Employee: “Re: Epic’s employee ages. In the November staff meeting it was announced that Epic’s #2 Carl Dvorak has worked for Epic for 25 years. He showed a slide saying that 42 percent of the current employees weren’t born then — i.e. are under 25 — and 78 percent are under 31.” People get nervous at the idea of fresh graduates telling major medical centers how to run their business, but it seems to work and it’s brilliant on Epic’s part. You take new graduates whose career prospects are negligible, plant them in Wisconsin where there aren’t many other jobs, and pay them more than they would make otherwise but less than everybody else pays their more senior HIT people. You train them in skills with minimal value elsewhere, like MUMPS programming, and give them job perks that make them feel like they’re working for Google. The young folks don’t complain much, they don’t bring in all the bad habits they learned working for less successful vendors, and by following the formula they almost always get the job done. That makes Epic almost infinitely scalable unless Midwestern universities stop graduating liberal arts majors with high GPAs. Nobody seems to mind except the experienced people who Epic won’t hire.

From UKnowMe: “Re: IBM. Seems like several high-ranking healthcare people are getting very connected on LinkedIn lately. A sign of change to come?” I don’t know, but I think your observation has business merit for LinkedIn. They could sell the names of companies that have a large percentage of current employees updating their profiles (preparing to bail) or companies newly added to a lot of profiles (on a hiring binge).

From HC IT Advisor: “Re: AeroScout, recently acquired by Stanley Black and Decker. Has issued a cease and desist order to Centrak and will be filing a patent infringement suit. Apparently Centrak is using the patented CCA capability in their new WiFi tags.” Unverified. Calling HITEsq again, either that or I need to sign up for one of the lawsuit databases like PACER so I can look these up myself.

Acquisitions, Funding, Business, and Stock

Health analytics and research company Decision Resources Group acquires the UK-based Abacus, a health economics consulting firm.

12-4-2012 10-02-32 PM

Talent management software provider HealthcareSource acquires NetLearning, which makes learning management software for the healthcare industry.

12-4-2012 9-37-29 PM

Nuance acquires Accentus, an Ontario-based transcription, documenting imaging, and remote coding technology vendor.

An article in the San Antonio newspaper questions whether Gene Powell, chairman of the University of Texas Board of Regents and co-founder of AirStrip Technologies, should have disclosed that Vanguard Health Systems, which the board chose to launch a new $350 million children’s hospital in San Antonio, had a pending business deal with AirStrip at the time. Powell did not vote on the issue, did not recommend Vanguard, and was not legally required to make any disclosure since he owns no Vanguard stock and is not a Vanguard employee, so perhaps it was a slow news day.

The former Big Five accounting firm Arthur Andersen, driven out of business in 2002 for its role as Enron’s auditor, is ordered to pay an additional and final $9.5 million for its similar auditing involvement in the 1999 merger of McKesson and HBOC. Andersen agreed to pay $73 million to settle McKesson HBOC-related class action claims in 2006, with the possibility of contingent payment claims.


12-4-2012 12-33-35 PM

Children’s Hospital of Central California will implement athenaClinicals, athenaCollector, and athenaCommunicator across its 127-provider system.

Marietta Memorial Hospital (OH) extends its IT services contract with CareTech Solutions for an additional three years.

Twenty-one VA medical centers will implement GetWellNetwork’s interactive patient care solution, including the new Interactive Patient Whiteboard.

12-4-2012 12-26-37 PM

Memorial Health System (IL) purchases the Omni-Patient enterprise master data application and the WebFOCUS BI platform from Information Builders.

MemorialCare Health System (CA) renews and expands its relationship with MedAssets to include GPO services for supplies and purchased services and MedAssets Capital and Construction solutions.

12-4-2012 10-08-07 PM

Huntsman Cancer Institute at the University of Utah selects Wolters Kluwer Health’s ProVation MultiCaregiver EHR.

Contract resource organization NCGS selects Merge’s eClinical OS and clinical trial management solution.

Consulting firm AmpliPHY will provide Wellcentive’s data analytics platform to primary care practices.

Managed care company Amerigroup Corporation chooses McKesson Clear Coverage for point-of-care utilization management, coverage determination, and network compliance.

Michigan Health Information Network Shared Services signs with HIPAAT International for technology that allows patients to control the sharing of their PHI and allow them to view an audit log of who has viewed it.


12-4-2012 7-09-38 AM

Qualis Health hires David Chamberlain (Cardiac Science and Criticare Systems) as CIO.

12-4-2012 11-56-27 AM

Saint Francis Hospital and Medical Center (CT) names Sudeep Bansal, MD as the organization’s first CMIO. 

12-4-2012 7-49-18 PM

Todd Johnson, former president and CEO of Salar and SVP of Transcend Services/Nuance after Salar’s acquisition, is named CEO of HealthLoop.

12-4-2012 8-41-37 PM

Michael Waldrum, whose roles at the UAB Health System included a five-year stint as CIO through 2004, is named CEO of University of Arizona Health Network.

12-4-2012 9-43-44 PM

Charlie Baxter, AVP of Iatric Systems and former Army captain, died Friday at 48. The guest book is here.

Announcements and Implementations

Allscripts EHR customer Primary Physician Partners (CO) becomes the first practice to connects to the CORHIO.

The Indiana HIE says that more than 750 physicians and 174 practice sites have agreed to publicly post their clinical quality measure scores on the Quality Health First Program’s public reporting website.

12-4-2012 10-09-35 PM

Imprivata announces that more than 250 healthcare organizations enrolled in its Cortext HIPAA-compliant, pager-replacing text messaging solution its first 60 days of release. Pricing ranges from free (unlimited users, unlimited messaging, unlimited photo messages, standard support, 30 days’ archiving) to $5 per user per month (upgraded support and archiving).

Elsevier integrates its ExitCare library of discharge instructions and patient education with Meditech’s EHR.

ICSA Labs and IHE USA unveil a certification program to test and certify the security and interoperability of HIT, with three tiers of certification: conformance to IHE profiles, demonstrated interoperability among disparate systems, and validated implementations of deployed certified technologies. Participants in January’s 2013 NA Connectathon in Chicago can register for testing at the event.

12-4-2012 6-46-59 PM

Montrue Technologies releases a free version of its Sparrow EDIS iPad-based emergency department information system. I interviewed Co-Founder and CEO Brian Phelps, MD earlier this year.

Government and Politics

12-4-2012 11-34-27 AM

Recovery auditors collected $2.2 billion in overpayments in fiscal year 2012 and gave providers $109 million in underpayments. Net 2012 corrections were $2.4 billion, compared to 2011’s $939 million.

Congressman Mike Honda (D-CA) introduces the Healthcare Innovation and Marketplace Technologies Act to foster more healthcare innovation through the development of marketplace incentives, challenge grants, and increased workforce retraining. The bill would also establish an Office of Wireless Health at the FDA.

Innovation and Research

A Microsoft Research documentary shows the organization’s work in using technology to fight tuberculosis in India, including development of a biometric monitoring system to make sure patients keep their healthcare appointments and systems that trigger an SMS message to a manager when a patient misses scheduled medication doses. Treatment is effective and straightforward, but requires more than 40 clinic visits in six months. Non-compliance causes TB spread, drug resistance, and nearly 1,000 deaths per day in India.

12-4-2012 8-49-58 PM

UCLA engineering school researchers create BigFoot, a software package that allows people with chronic foot problems to track their conditions using a PC and flatbed scanner.


Streamline Health, which acquired Atlanta-based Interpoint Partners a year ago, will move its corporate headquarters from Cincinnati to Atlanta. The company will continue to operate the Cincinnati and New York City offices.

12-4-2012 8-28-41 PM

Cerner analyst Staci Klinginsmith is crowned Miss Kansas USA.

University of Virginia Medical Center warns patients that a mobile device used by on-call IV pharmacists in its home health agency is missing and contains patient information, including diagnoses, medications, and Social Security numbers used as health insurance ID numbers.

HIMSS, responding to OIG’s recommendation that the bar for Meaningful Use payments should be raised via pre-payment reviews, improved EHR MU reporting, and improved EHR reporting certification, supports CMS developing guidelines that will help providers prepare and retain audit-related documentation. In other words, like CMS, HIMSS isn’t a fan of pre-payment reviews.

I’ve spent a considerable amount of money and energy on programming workarounds required to make HIStalk work on the incredibly buggy and standards-breaking Internet Explorer, but I’ve noticed its gradual improvement. I’m encouraged that Microsoft gets the lack of browser love it receives and can even poke fun at itself with a fun “it sucks less” video (above) and a new site, www.browseryoulovetohate.com. I’m checking it out in Firefox, of course, since I’m not that forgiving of IE’s past transgressions, but I may download the IE10 beta just to see what all the fuss is about.

A new JAMA article finds that the average dentist now out-earns the average physician, with pharmacists not too far behind.

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Lyle Berkowitz, MD (Northwestern University) and Chris McCarthy, MPH, MBA (Kaiser Permanente Innovation Consultancy) are editors of the newly published Innovation with Information Technologies in Healthcare. DrLyle says it tells the stories of 20 organizations who are HIT innovators in improving care quality and value, with details that he describes as “a big cookbook of recipes on how to innovate with HIT” divided into sections covering electronic medical records, telehealth, and advanced technology. I took a quick skim over a couple of the sample chapters he sent over and it’s meaty, without the usual fluff that makes some HIT books seem like a handful of good ideas and thoughts that were shamelessly padded to justify an author credit and a higher selling price. The book is $74.14 on Amazon and you can use the Look Inside! option to try before you buy.

A Colorado Public Radio article covers EMR adoption, showcasing a five-physician practice that expected its new EMR to increase patient capacity by 25% and get its bills out more quickly. That turned out to be wishful thinking on the salesperson’s part. They never got back up to more than 80 percent of their pre-EMR workload, they found that their Medicare patient volume was too low to qualify for incentive payments, one doctor quit over frustration with the EMR, and the remaining four partners were on the hook for the $200,000 they had borrowed to buy it. The end result: they had to sell their practice.

Use of mobile technology to view patient information and to access non-protected health information is on the rise, according to a HIMSS mobile technology survey. Key uses include collection of data at the bedside, bar code reading, monitoring data from medical devices, and capturing visual representation of patient data. Funding and security concerns are the top barriers to mobile technology adoption.

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Athenahealth’s Jonathan Bush channels Dr. Mostashari on Fox Business wearing a holiday-red bowtie and pitching healthcare technology.

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A local paper shares the story of a clerical supervisor in a British Columbia hospital who was conducting training on the Vocera communication system when the device issued a Code Orange, warning of an impending flood. Clinical staff moved patients to safety just before a wall collapsed in a flood of water, while the supervisor scrambled to save paper charts and the hospital’s stockpile of 75 Vocera badges.

Weird News Andy is really fired up about use of the Liverpool Care Pathway for palliative care in the UK. An audit of records from 178 NHS hospitals finds that nearly half of the dying patients who had life-saving treatment (drugs, fluids, food) withdrawn via the protocol weren’t told that fact, 22 percent had no documented evidence that their care and comfort was maintained, and a third of the families didn’t receive literature explaining the process. A proposal is on the table to require consulting with the patient or family before initiating the pathway, which leads to patient death in an average of 29 hours.

WNA could contribute only a “sheesh” to this article, which finds that Dallas mothers and daughters are bonding over cosmetic surgery procedures, often motivated by reality TV shows that make that practice seem normal.

A former Microsoft manager takes advantage of newly legalized marijuana in Washington by opening a “premium marijuana” retail business, expressing his desire to position his brand of weed like fine brandy or cigars to high-income baby boomers. He says, “Think of us as the Neiman Marcus of marijuana … the buzz is in the air.” He says he came up with the plan while high and will name the business after his marijuana-farming great-grandfather.

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In Brazil, an apparently computer-savvy thief robs an ATM by replacing its USB security camera with a Plug and Play keyboard and a USB stick, then restarts the machine and keys commands to withdraw all its cash. He was caught. The article mentions the recent discovery of several ATMs at Inova Fairfax Hospital (VA) that were rigged with “ATM skimmers” that fit over the card slot, capturing the card’s number and in some cases using video recording to capture the user’s PIN.

Sponsor Updates

12-4-2012 12-10-39 PM

  • Aspen Advisors hosted 62 associates at its annual retreat in Fort Lauderdale, which included a run fun that raised $1,000 for the University of Miami Health System.
  • Besler Consulting representatives will present at upcoming New Jersey and Metropolitan Philadelphia HFMA seminars.
  • Santa Rosa Consulting announces E2E Activation Support, a service line that will provide elbow-to-elbow EMR go-live support.
  • The Black Book Rankings names DrFirst the top vendor for e-prescribing and recognizes Emdeon for outstanding developments in clinical exchange solutions. Other HIStalk sponsors earning honors include Allscripts, e-MDs, Vitera, Aprima, SRS, Quest MedPlus Care 360, and McKesson.
  • A local paper profiles eClinicalWorks CEO Girish Kumar Navani and the success of his company.
  • AT&T names its top five healthcare trends for 2013, which emphasize growth in mobile apps and telehealth.
  • Sacred Heart Health Systems (FL/AL) shares how Iatric Systems’ Security Audit Manager has aided privacy compliance by capturing audit log data from its Siemens, McKesson, and Picis systems. 
  • Three Informatica customers win Ventana Research Leadership Awards, including HMS Holdings (IT Leadership Award for Analytics and Overall IT Leader); Moffitt Cancer Center (Business Technology Award for Big Data); and  Ochsner Health System (IT Leadership Award for Information Management.) Informatica’s PowerCenter Big Data Edition also won the Ventana Research Technology Innovation Award.
  • Mark Van Kooy, Myra Aubuchon, and Dawn Mitchell of Aspen Advisors present a December 5 Webinar on addressing EMR value with a hospital board.
  • 3M Health Information Systems offers a Webcast featuring 3M CMIO Sandeep Wadhwa’s presentation on improving ACO efficiency and outcomes.
  • Cumberland Consulting promotes Charles Taylor to principal and Jose Gonzalez to executive consultant.
  • The Advisory Board Company’s Southwind program recognizes Dignity Health (CA), Adirondack Region Medical Home Pilot (NY), and Lancaster General Health (PA) for successful physician partnerships.
  • Covisint releases a white paper that outlines the evolution, growth, and future of HIEs.
  • Beacon Partners employees assemble 108 care packages for troops during the company’s annual meeting.
  • Wellcentive’s VP of Product Strategy Mason Beard discusses interface strategies for population health management in a blog post. 


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

More news: HIStalk Practice, HIStalk Connect.

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December 4, 2012 News 19 Comments

EHR Design Talk with Dr. Rick 12/3/12

December 3, 2012 Rick Weinhaus 6 Comments

The Snapshot-in-Time Design

There are two basic EHR designs for presenting the patient information that accumulates over time (see my last post).

By far, the most common EHR design solution is to display a summary screen of the patient’s current health information, organized by category (Problem List, Past Medical History, Medications, and so forth). Past information is available in date-sorted lists or indicated by start and stop dates.

The other design solution is to display a series of snapshots that capture the state of the patient’s health at successive points in time. While this design was at the core of paper-based charting (see Why T-Sheets Work), it is an uncommon EHR design.

In my opinion, the snapshot-in-time design has three advantages:

  • It supports our notion of causality – we see how earlier events affect subsequent ones.
  • The patient’s story is presented as a narrative that gradually unfolds. Humans excel at using narrative to organize and make sense of complex data.
  • Perhaps most importantly, a series of visual snapshots allows us to makes sense of abstract data by organizing it in visual space.

The following EHR screen mockups display a patient’s story as snapshots in time. While these illustrations are for an ambulatory EHR, the design works equally well for hospital-based systems.

To see the mockups, click on the PowerPoint link below. Once PowerPoint is open, expand the view by clicking on the full screen button in the lower right corner (indicated by arrow).



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

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December 3, 2012 Rick Weinhaus 6 Comments

Monday Morning Update 12/3/12

December 1, 2012 News 12 Comments

11-30-2012 6-26-29 PM 

From NoNamesPls: “Re: MD Anderson. They will replace not only their in-house developed EMR, but also commercial systems for pharmacy, lab, RIS/PACS, and ADT/Scheduling. Epic and Cerner are the frontrunners.” Another reader forwarded me the internal e-mail from the deputy CIO and the CMIO, which says MDACC spends $20-$30 million per year on its homegrown ClinicStation but still can’t keep up with federal regulations. The RFP goes out in January. It’s interesting that the e-mail suggests that they’re happy with the patient benefits of their existing system, but will spend hundreds of millions of dollars to replace it for non-patient reasons. Somehow you have to wonder if that’s really a good thing.

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From Upon Further Review: “Re: three hospitals of Dignity Health (formerly CHW). Scrapping their Meditech 6.0 and Medhost implementation that was supposed to start going live last week and moving to Cerner. Go-live required by January 1, 2014.” Above is part of Friday’s letter sent to employees by Chuck Cova, president and CEO of Marian Regional Medical Center, which says, “We are not confident in the Medhost and Meditech system’s meaningful use and ability to perform at a high level for optimal use.” It went down to the wire: Medhost was to supposed to be brought live starting November 26, but the project was delayed on November 13 and then killed on November 30.

DZA MD replied to my Time Capsule editorial from 2008 in which I suggested that patient encounters be recorded on video now that multimedia storage is cheap (security cameras are running everywhere, after all, and your encounters with Las Vegas card dealers are recorded in multi-angle splendor). Here’s what DZA MD had to say:

Imagine how well behaved everyone would suddenly be! Patients and caregivers. Both are in need of civility IMHO.

Though certainly not the first, I proposed this solution to patient care documentation to interested academics at my institution  round the millennium. It was not taken seriously and was viscerally scary in a dot.gov sort of way, but the time has arrived. Some consequences (positive):

  • Documentation. Real-time video and audio. Obvious. Supplement with dictated or keyed notes into the EMR, capturing decision-making and care coordination / consults. Even online research pertinent to the visit (can sarcoidosis cause GI symptoms?) could be incorporated into the record (browser history), supporting decision making and due diligence. These AVI files are completely portable without need for interface language.
  • Billing. How about simply paying an hourly rate for time spent, like lawyers? Time stamps on audio and video, post-visit data entry and online patient care research would serve as indisputable evidence of billable time.
  • Legal. ‘Nuff said. Patients who opt in to AV documentation assent to legal arbitration. And benefit from reduced insurance costs associated with this documentation product. Patients who opt out must use the traditional tort pathway, but are exposed to the added expense of that course of action.
  • Patient education and self care. An electronic copy (edited or not) of the visit can be provided to the patient. Presumably the interaction involves patient education elements from the clinician.
  • QA. NLP can sort through audio files for key words related to quality metrics. AV files can be used for clinician feedback for both physical exam skills as well as interpersonal behavioral skills.
  • Cost.  Memory is cheap. AVI files are portable, searchable, and easily indexed and archived. Insurers could develop pilot programs using this technology to study cost impacts in preparation for wide release if promising.

I hand-picked this week’s Spotify playlist with music sharing only one attribute: I like everything I included. On it: Pond, RPWL, The Killers, Band of Horses, Marina and the Diamonds, Turtle Giant, and a searing live version of “Little Wing” from Clapton/Winwood. Here’s a trivia throw-down: what movie (one of my favorites) opens with Tune #13 as buses drive by in the night? If you want to play along at home, I also created this empty playlist to which you can add your song du jour — I’ll listen to them and choose some for next week’s playlist (it’s like a clinical inbox for music referrals).

 11-30-2012 6-45-18 PM

Welcome to new HIStalk Platinum Sponsor Fujifilm, which offers the Synapse product line (RIS, PACS, 3D suite, virtualization, managed services, and teleradiology RIS). The Web-based Synapse radiology management solution provides hospitals and outpatient imaging facilities such capabilities as integrated dictation, a referring physician portal, electronic dashboards, mammography reporting, peer review that meets ACR guidelines, and critical result notification, all included at no extra cost. Users can craft their own workflows via built-in tools for instant messaging, automated e-mail notification, and digital forms creation. They can also use drawable consent forms, inventory tracking, and real-time eligibility checking. The RIS integrates with every PACS on the market, including of course Synapse PACS. It even includes teleradiology capabilities. You can choose Synapse RIS as a turnkey system that includes software, hardware, hosting, system management, upgrades, and optional disaster recovery services and off-site archiving. Customers pay by exam volume rather than per user or per site, which makes it affordable for facilities ranging from small imaging centers to multi-facility enterprises. Thanks to Fujifilm for supporting HIStalk.

Here’s an overview of Fujifilm’s Synapse RIS that I found on YouTube.

Thanks to the following sponsors, new and renewing, that have recently supported HIStalk, HIStalk Connect, and HIStalk Practice. Click a logo for more information. 

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 11-30-2012 6-00-37 PM

The vast majority of survey respondents believe that transcription is a commodity service differentiated primarily on price. New poll to your right: should the government require more upfront proof of attaining Meaningful Use before before sending payments?

Few people buy traditional software (i.e. PC programs in a box instead of apps in a Web store) these days, and those who do are rarely delighted. I’m happy to report an exception. I bought the just-released Dragon Naturally Speaking 12 and it’s amazing. The accuracy approaches 100 percent and it’s quite fast. I bought the premium version from Amazon for $126, which also includes the ability to transcribe pre-recorded dictation, sort of like Nuance’s eScription server-based speech recognition (the Home Version is only $50). You can speak at least three times faster than you can type, not to mention saving your wrists. I’ve used previous versions as well as the Windows 7 speech recognition and Siri and there’s no comparison. (Disclosure: Nuance is a sponsor and has offered me free copies several times, but I paid out of my own pocket so I wouldn’t feel bad about saying I hated DNS if that was the case). DNS 12 is one of the most amazing things I’ve ever seen run on a PC, although as critics always point out, you can’t use it with an EMR since that requires the more expensive medical version. But if you want to feel like Bill Shatner sprawling back in a chair on the Enterprise bridge and barking out orders for the computer to obey, you need it. It must be a miracle for people with handicaps who can’t use computers in traditional ways.

Scanadu, the 20-employee company whose tagline is “Sending your Smartphone to Med School,” announces that it will release three consumer tools by the end of 2013. The $150 Scanadu Scout is held to the temple and in less than 10 seconds, checks pulse, heart activity, temperature, and pulse oximetry and sends the results via Bluetooth to its smartphone app. Project ScanaFlo is a disposable cartridge that turns a smartphone into a urine analysis reader (pregnancy complications, gestational diabetes, kidney failure, or UTI). Project ScanaFlu is a saliva tester that detects cold symptoms by checking for strep, influenza, adenovirus,and RSV. Scanadu is best known for working on a tricorder-like health assessment device and these modules are the first components of it. Above is a Friday interview with the co-founder and CEO, who seems to be at a loss of how to explain medical principles to the sing-songy twenty-something interviewer who nods intently while saying “sort of “ and “you know” a lot while clearly not understanding most of what he’s saying.

It appears that Blackstone Group has become the frontrunner to acquire Allscripts, although the company is rumored to be holding out for more money than Blackstone thinks it’s worth. Shares dropped 11 percent Friday, having lost most of the gains that occurred after rumors of the company’s sale slipped out in late September. The other bidders were claimed to be Carlyle Group LP and TPG Capital Management LP. I don’t understand SEC rules, but this business of running newspaper stories quoting insiders about who’s making offers and at what price sure seems to open the door for cheating, like intentionally leaking out news that will move the share price up or down in a way that will benefit the leaker.

CareFusion announces that Children’s Hospitals and Clinics of Minnesota has gone live on wireless connectivity between its Alaris smart IV pumps and Cerner Millennium.

Health Management Associates warns investors that a “60 Minutes” report is expected to claim that the for-profit hospital operator’s contracted ED doctors were pressured to admit patients who didn’t need to be hospitalized. Both HMA and Community Health Systems have disclosed in SEC filings that several government agencies are following up on whistle-blower allegations by requesting admissions information. HMA says it thinks authorities want to know how more about its vendor-provided ED software and whether it was programmed to admit patients unnecessarily. Tenet Healthcare had accused competitor CHS in early 2011 of using ProMed Clinical Systems software to boost its admissions in a lawsuit, but a judge dismissed the claim. HMA is also a user of ProMed’s Web-based vEDIS software, which is ONC-ATCB certified. I seriously doubt that ProMed makes admission decisions that the ED docs can’t override, so if there’s a smoking gun, I’d expect to find it in internal e-mails, meeting minutes, or in interviews conducted with the actual ED docs.

12-1-2012 7-52-49 AM

Kansas Health Information Network becomes the first HIE to connect directly to the CDC’s BioSense outbreak tracker, allowing hospitals to quickly share information about threats and report them to CDC to investigate possible outbreaks.

Advanced Data Processing announces that it has fired an employee who admitted stealing data from an ambulance billing system it runs and selling it to a criminal group suspected of using the information to file fraudulent tax returns to collect refunds. The information came from Cape Fear Valley Hospital Health System (NC). The same scam has led to the arrest of three people in Florida, at least one of them an employee of Florida Hospital Tampa, who used hospital patient billing information to collect $1.5 million in IRS tax refunds.

Why can’t American healthcare strikers be this much fun? Public health workers in Spain protest government spending cuts and healthcare privatization by performing a flash mob dance outside La Paz Hospital in Madrid.

GE CEO Jeff Immelt says, “The next holy grail is about decision support and analytics.”

A rare Weird News Andy weekend update: in France, a man is awarded $250,000 in his lawsuit against GSK, maker of the Parkinson’s drug that he claims caused him to become addicted to gay sex and gambling. The suggestion that gay sex is a shameful addiction that requires compensation is kind of insulting, but apparently the jury bought it.

Bizarre: a pharmacist pleads guilty to planting mercury in areas of Albany Medical Center Hospital (NY) in the hopes that the ensuing panic would drive patients away. Police searching the home of the man, who was upset that the had hospital billed him for treatment, found child pornography, Nazi memorabilia, and a stockpile of guns and ammunition.

Also bizarre: a Washington veterinarian and aspiring EMT is charged with animal abuse after former employees claim he punched and choked animals under his care. He had already admitted to stealing and using drugs from his practice. The owner of one animal that was allegedly mistreated summarized, “Well, I wouldn’t want him to be my first responder. Golly.” The doctor’s Facebook blames disgruntled former employees and lawyers trying to change the state’s veterinary malpractice laws, which limit plaintiffs to recovering the “market value” of their animal with no pain and suffering award available for the lawyers to skim their 33 percent of.

Vince covers the fascinating HIS-tory of CPSI this time around, getting some help from Troy Rosser, SVP of sales there.


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

More news: HIStalk Practice, HIStalk Connect.

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December 1, 2012 News 12 Comments

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

November 30, 2012 Interviews No Comments

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

11-30-2012 4-03-08 PM

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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November 30, 2012 Interviews No Comments

News 11/30/12

November 29, 2012 News 7 Comments

Top News

11-29-2012 8-05-24 PM

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

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

Acquisitions, Funding, Business, and Stock

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

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

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


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

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

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

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

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

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

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

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

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


11-29-2012 1-30-21 PM

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

11-29-2012 2-34-35 PM

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

11-29-2012 6-29-52 PM

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

11-29-2012 6-45-31 PM

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

11-29-2012 9-47-40 PM

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

Announcements and Implementations

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

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

11-29-2012 7-51-45 PM

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

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

Government and Politics

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

11-29-2012 3-09-34 PM 

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

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

11-29-2012 6-48-13 PM

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


11-29-2012 8-44-55 PM

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

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


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

11-29-2012 1-56-22 PM

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

11-29-2012 2-58-34 PM

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

11-29-2012 8-18-21 PM

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

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

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

11-29-2012 7-52-48 PM

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

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

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

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

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

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

Sponsor Updates

11-29-2012 9-57-58 PM

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

EPtalk by Dr. Jayne

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

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

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

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


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

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



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

More news: HIStalk Practice, HIStalk Mobile.

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November 29, 2012 News 7 Comments

HIStalk Interviews Kobi Margolin, Founder and CEO, Clinigence

November 28, 2012 Interviews No Comments

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

11-28-2012 4-02-40 PM

Tell me about yourself and about the company.

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

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

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

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

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

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


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

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

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

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

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

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


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

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

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

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

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

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

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


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

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

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

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


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

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

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

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

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


Is it hard to get physicians to follow your recommendations?

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

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

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

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

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

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


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

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

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

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

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

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


Any concluding thoughts?

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

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

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

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

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November 28, 2012 Interviews No Comments

News 11/28/12

November 27, 2012 News 16 Comments

Top News

11-27-2012 1-34-54 PM

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

Reader Comments

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

11-27-2012 7-00-21 PM

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

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

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

HIStalk Announcements and Requests

11-27-2012 8-50-43 AM

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

11-27-2012 9-04-09 PM

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

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

11-27-2012 5-55-07 PM image

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

Acquisitions, Funding, Business, and Stock

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

11-27-2012 9-08-13 PM

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

11-27-2012 6-25-21 PM

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

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


11-27-2012 9-02-58 AM

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

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

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

11-27-2012 9-11-52 PM

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


11-27-2012 9-50-11 AM

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

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

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

Announcements and Implementations

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

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

11-27-2012 9-59-23 AM

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

11-27-2012 10-04-07 AM

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

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

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

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

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

11-27-2012 6-35-21 PM

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

11-27-2012 6-54-44 PM

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

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

11-27-2012 7-55-29 PM

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

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

Government and Politics

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

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

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

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


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

11-27-2012 4-15-16 PM

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

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

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

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

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

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

11-27-2012 8-16-43 PM

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

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

Sponsor Updates

11-27-2012 12-55-37 PM

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


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

More news: HIStalk Practice, HIStalk Mobile.

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November 27, 2012 News 16 Comments

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

November 26, 2012 News 2 Comments

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

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

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

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

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

The rules in this case refer to insider trading.

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

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

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

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

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

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

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

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

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

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

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

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

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

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November 26, 2012 News 2 Comments

Curbside Consult with Dr. Jayne 11/26/12

November 26, 2012 Dr. Jayne 5 Comments


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

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

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

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

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

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

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


Hot buffalo chicken dip

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

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

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

Main Dishes

White Chicken Chili

Cranberry Cocktail Meatballs

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

2 pounds lean ground beef

1 cup cornflake crumbs

1/3 cup finely chopped parsley

2 eggs, lightly beaten

¼ teaspoon pepper

garlic powder to taste

1/3 cup catsup

2 tablespoons thinly sliced green onions and soy sauce

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


1 can whole cranberry sauce

1 12 oz bottle tomato based chili sauce

1 tablespoon each brown sugar and lemon juice

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


Libby’s Pumpkin Roll 

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

Insanely Good Chocolate Cake

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

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


Christmas Punch

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

Christmas Punch

Cooks.com style.

Sherbet Punch

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

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


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


E-mail Dr. Jayne.

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November 26, 2012 Dr. Jayne 5 Comments

Morning Headlines 11/26/12

November 25, 2012 Headlines No Comments

RSNA 2012 Begins

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

GP blames computer for man’s death from ulcer

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

Welsh First Minister Opens Clinithink’s Development Centre

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

Matching DNA With Medical Records To Crack Disease And Aging

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

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November 25, 2012 Headlines No Comments

Monday Morning Update 11/26/12

November 24, 2012 News 6 Comments

11-23-2012 9-15-15 PM

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

11-23-2012 9-38-53 PM

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

11-23-2012 8-29-06 PM

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

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

11-23-2012 8-46-54 PM

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

11-23-2012 8-54-12 PM

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

11-23-2012 8-58-33 PM

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

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

11-23-2012 10-36-47 PM

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

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

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

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

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

11-23-2012 10-22-34 PM

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

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

11-24-2012 7-05-09 AM

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

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

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

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

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

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


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

More news: HIStalk Practice, HIStalk Mobile.

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November 24, 2012 News 6 Comments

News 11/21/12

November 20, 2012 News 9 Comments

Top News

11-20-2012 8-06-30 PM

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

Reader Comments

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

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

11-20-2012 6-47-24 PM

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

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

HIStalk Announcements and Requests

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

Acquisitions, Funding, Business, and Stock

11-20-2012 5-33-03 PM

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

11-20-2012 6-12-45 PM

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


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

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

11-20-2012 11-13-02 AM

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

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

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


11-19-2012 7-23-45 AM

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

11-20-2012 8-56-21 AM

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

Announcements and Implementations

11-20-2012 11-14-34 AM

White Plume Technologies releases its AccelaMOBILEmobile charge capture product app.

11-20-2012 11-15-40 AM

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

11-20-2012 5-43-37 PM

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

11-20-2012 5-52-53 PM

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

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

Government and Politics

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

11-20-2012 6-44-34 PM

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

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

Innovation and Research

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

11-20-2012 8-11-44 PM

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


11-20-2012 5-45-23 PM

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

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

11-20-2012 7-54-25 PM

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


11-20-2012 11-52-23 AM

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

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

11-20-2012 5-49-42 PM

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


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

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

Sponsor Updates

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


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

More news: HIStalk Practice, HIStalk Mobile.

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November 20, 2012 News 9 Comments

Readers Write 11/19/12

November 19, 2012 Readers Write 1 Comment

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

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

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

11-19-2012 3-48-25 PM

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

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

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

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

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

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

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

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

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

Defining a Complete Patient Engagement Solution
By Jordan Dolin

11-19-2012 3-54-04 PM

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

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

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

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

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

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

11-19-2012 3-32-35 PM

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

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

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

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

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

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

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

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

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

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

11-19-2012 4-04-51 PM

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

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

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

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

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

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November 19, 2012 Readers Write 1 Comment

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