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Monday Morning Update 2/10/14

February 8, 2014 News 16 Comments

2-8-2014 3-16-29 PM

From EpicConsulting: “Re: Epic going into the consulting business. What’s being said internally at Epic is that the program will be limited to employees with 4+ years of experience, it will provide some location independence, and the intention is to undercut in price most of the Epic consulting industry. It’s an attempt to give Epic employees less incentive to quit, sit out their one-year non-compete, and then come back doing the same job making twice the pay for half the hours. Epic has talked about doing this for years, formerly calling it Ongoing Services, but hasn’t actually gone this far until now. Consulting firm reaction has been, ‘Why would you want the same person who dug you into a hole to be the one to dig you out?’ but can they compete when Epic sells services at $75 per hour and they’re billing $150? Would a CIO pay double for a non-Epic voice? Will hospitals gain negotiating power with another option in the market? Fun question, too: will KLAS rate Epic’s consulting and will companies like Nordic, Sagacious, etc. score higher than Epic itself?” All unverified, but interesting.

From Please Please Me: “Re: HIStalkapalooza. I’ve never requested an invitation, so I’ve never been refused. But it sounds like fun and you guys are great to do that – don’t let the poor souls who don’t get in discourage you.” Inga reminded me that despite reader Gary’s insistence that he didn’t get an invitation for three years straight, we sent one to every single person who registered in 2013 and 2011, and I’m pretty sure we invited everyone in 2012 as well. Gary either didn’t register in time those years or his company’s spam filter trashed our emailed invitation, which happens a lot (and creates extra work for us because people always email us wanting individual assistance.) Demand this year was unprecedented – it will be the largest HIStalkapalooza yet, but around 900 more people asked for invitations than we have available. And to address the most commonly asked question, sorry, but we have no way to accommodate guests even though I’m sympathetic to those who want to attend with a spouse or friend – we’ve already had to turn away hundreds of loyal HIStalk readers.

2-8-2014 8-38-18 AM

Two-thirds of poll respondents haven’t been promoted in the last two years. New poll to your right: generally speaking, are the vendors and products named in the “Best in KLAS” report really the best ones? You won’t win favor for your position by simply clicking yes or no, but you might if you click the Comments link after voting to explain your rationale.

2-8-2014 9-02-48 AM

I mentioned that I decided to run an occasional ad at the top of the HIStalk page only so I can donate most of the proceeds to the DonorsChoose, which supports teachers whose classrooms need help buying books and supplies or paying for educational projects. I’m indifferent at best toward most charities (including hospitals) because they are inefficient, ineffective, and overly generous with executive compensation, but years ago my research led me to DonorsChoose and it has become (along with the Salvation Army) my charity of choice. I’ll be funding the first projects this week and updating the HIStalk giving page so we as readers and sponsors can feel good about the results – you’ll be able to see project details, status, photos, and the teacher’s letter of thanks and description of the outcome. I’m really excited about this. You are making it possible by reading HIStalk, for which I am grateful.

Listening: Blondfire, a Michigan-based dreamy indie pop brother-and-sister band that has new album coming out Tuesday.

2-8-2014 2-08-04 PM

Welcome to new HIStalk Gold Sponsor MEA | NEA of Norcross, GA. The company’s cloud-based solutions allow health plans and providers (both medical and dental) to electronically request and deliver images and documents that would previously have been printed and mailed. FastAttach improves revenue cycle management by allowing providers to submit documents to support their electronic medical claims via a Windows-based application that’s compatible with all practice management and revenue cycle systems. FastAttach also allows providers to quickly and securely respond to RAC and other audits through the company’s participation in Medicare’s Electronic Submission of Medical Documentation program (esMD) using the CONNECT gateway to send scanned images, print capture, screen capture, uploads, files, and mobile capture. Thanks to MEA |NEA for supporting HIStalk.

HIMSS Conference Social Events

Send us your event details if it’s a good one (i.e., free food and drinks at minimum) and you promise that all HIStalk readers are welcome to attend, even if they work for your most hated competitor as a given reader might well do.

2-8-2014 10-36-25 AM

Nordic is sponsoring an open house at King’s Bowl Orlando, International Drive, Tuesday from 6-8 p.m. Email to sign up.

Upcoming Webinars

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.

February 13 (Thursday), 12 noon ET. Advancement in Clinician Efficiency Through Aware Computing. Sponsored by Aventura. In an age of information overload, a computing system that is aware of the user’s needs becomes increasingly critical. Instant-on roaming for virtual and mobile applications powered by awareness provides practical ways to unleash value from current HIT investments, advancing efforts to demonstrate meaningful use of EHRs and improve clinical efficiencies. The presenters will review implementation of Aventura’s solution at Orange Coast Memorial Medical Center.

February 18 (Tuesday), 1:00 p.m. ET. Epic 2012 Training and Support: Building Your Team. Sponsored by MBA HealthGroup. The webinar will present a case study of creative staffing solutions for an Epic 2012 upgrade at an academic medical center, describing the institution’s challenge, its out-of-the-box solution, and the results it obtained working with a consulting firm.


I’m hearing buzz about REST and FHIR Web-based programming coming from various vendors and from ONC. It sounds important for future healthcare IT development and interoperability, so I decided to look up the concepts since I don’t know anything about them. This is my cartoonish, stick-figure understanding that certainly could use more informed (but simple) explanation from knowledgeable readers about what it means in healthcare and who’s using it.

REST (representational state transfer) is the architecture that runs the Internet, where your browser sits there waiting for you to enter data or click a button and then something cool happens. Applications developed using RESTful programming respect the fact that the Internet works perfectly fine without individual programmers screwing around with tricky or proprietary techniques. Your browser knows how to process your Amazon order even though you don’t know or care how Amazon’s servers are set up, the Firefox people didn’t customize their browser to work with Amazon.com, and Amazon didn’t develop its site so that it only works with Firefox. REST-built systems can interact with each other with minimal overhead. It’s pretty much the opposite of how most healthcare applications were built, in other words, since it presumes that all boats are equally floated when applications work and communicate in a common way using existing infrastructure and methods, making life easier for programmers and users alike.

FHIR (fast healthcare interoperability resources, pronounced “fire”) is an HL7 framework that further defines REST for specific building blocks for developing healthcare applications. Applications developed using FHIR are theoretically easier to develop and support, are inherently interoperable, and follow Web standards.

I’m not as interested in the technical underpinnings as the possible benefits. REST and FHIR concepts are new to healthcare IT and probably aren’t ready for prime time. I can understand why vendors would be cautious about chasing trendy standards that not only threaten their proprietary existence but also could go out of fashion faster than the Harlem Shake, but it’s still an interesting design that could make life better for everyone (including patients and providers) if everybody used it.

This is the cue for an reader who is unbiased, technical enough to understand what all this means strategically, and blessed with the ability to describe it simply (but not simplistically) to enlighten the rest of us who just want stuff to work.

iHealth 2014 Report

2-8-2014 9-07-37 AM
2-8-2014 9-06-52 AM

The only conference I attend regularly is HIMSS for a variety of reasons  — cost, time required, and often because I don’t even know when or where a given conference is being held with enough lead time to plan. I always invite readers to provide a summary of their experiences.

Here’s ADG’s writeup of AMIA’s iHealth conference:

iHealth 2014 was a good excuse to get away from the cold and snow of wherever you were and come to Orlando for some warm rain. Farzad Mostashari in particular was seen immediately after the PBS-style fireside chat of the four previous national coordinators without a bowtie and in the company of a couple of cute kids. Getting the four on the same stage was a logistics coup and they were immensely personable. The two with the initials “DB” — David Brailer and David Blumenthal — cheerfully referred to each other as DB1 and DB2. Their themes included the coming penalties for non-compliance with MU, and DB1’s very sharp insights, which included the observation that he expects FDA regulation of EMRs within “single digit” years. Their advice to the current ONC coordinator Karen DiSalvo seemed to be a version of “buckle up.” DB1 in particular was praised by the others for his sharp organizational and entrepreneurial skills in getting the office started on the right foot.

We came to Orlando to get practical advice (and to get out of the cold, see above) and there is some comfort that all are struggling — large and less-large, academic and less-academic — with rapid change. Most noticeable was a sharp divide between the academics and the operational types, with the academics suggesting that if you do the right things, the “regulators will catch up,” which is an actual quote. The operational types knew that regulators will deny payment for any failure to cross the T and dot the i and that their organization would be out of business for lack of money by the time the regulators “caught up” to the “right thing.” There was a terrific dinner hosted by AMIA for recent diplomates of the board of Clinical Informatics, and we discovered we all have frighteningly similar backgrounds and tastes. Blackford Middleton, chair of the board of directors of AMIA, gave an excellent short toast. There were no grand insights, but lots of one-on-one incremental gains from each other, and HIStalk was mentioned at least a couple of times from the stage(s).

2-8-2014 9-54-04 AM

Jim Hansen of Lumeris / Accountable Delivery System Institute knows I like what we call “Judy-isms,” little nuggets of cynical wisdom from Epic’s Judy Faulkner. He culled these from last week’s HIT Policy Committee meeting:

  • “Be careful about prescriptive standards. If there was a usability committee for the iPhone, there wouldn’t be one.”
  • “We see a huge international move to EHRs without incentive money. We can’t test it here, but would it have happened anyway?”
  • “With regard to Meaningful Use and providers saying, “I paid for an EHR, therefore you as the government owe me,” I think of girls on dates and I don’t think that’s a good idea.”

2-8-2014 2-33-17 PM

Brian Ahier provides the full text of the SGR Repeal and Medicare Provider Payment Modernization Act that proposes to move the Meaningful Use program into the Merit-Based Incentive Payment System.


From athenahealth’s Friday earnings call:

  • Jonathan Bush talked up athenaCoordinator for Enterprise, “our first truly hospital-facing service” that will tie together the company’s services for pre-certification, pre-registration, scheduling, and population health management. It will cost hospitals 1 percent of revenue.
  • “The on-ramp that is turning out to be Epocrates” will be enhanced to include secure text messaging, a provider director, and clinical decision support tools and the rollout of Epocrates Prime that will allow non-physician secure messaging participants and referral capability.
  • New company locations include Austin, Atlanta, and San Francisco.
  • Sales to small hospitals, the only underperforming area, will be better supported by teams that include operational analysts rather than just a single salesperson.
  • Bush, responding to an analyst’s question about how cost-shifting to patients will affect the company, said, “As long as they don’t become uninsured self-payers and they keep their financial selves tangled up in impossible-to-understand bureaucratic health plans, which is now the law of the land, it doesn’t hurt us.”
  • Bush says the company may need to create a patient-facing division because patient portal use is low industry-wide.
  • In describing the company’s patient engagement efforts, “The goal is to just do everything possible for the doctor over the cloud, to the patient, at home where they get better answers to clinical questions. Like tell me about your diet and your life and all the things you need to know for the doctor, all your smoking, your seatbelts, your sex life. All those things are much easier to talk about at home or in private than sitting in the freaking waiting room, or worse, on that butcher paper with your knickers off. So we’re going to use the social good created by all of our increasingly sophisticated patient outreach to be way better than we are.”
  • Enterprise Coordinator will include the patient facesheet from athenaClinicals and clicking on the patient’s name, even by a practice that doesn’t use athenahealth, will launch a session of the hospital’s EHR.
  • Bush described the company’s future strategy as, “The goal here is to get into the front door and the back door of the hospital and work our way through the wards and departments with cloud-based services that allow them to virtualize, get business from more places, and focus more of their resources on actual clinical care. Other places we need to go is we need to go to patients. So every patient in America needs to have something in their wallet and something on their wrist, some sort of 2D barcode or in their iPhone that says, ‘This is me. Zap this thing and pull me up on athenaNet if I’m unconscious.’ So that’s some sort of patient outreach. I don’t know if it’s a partnership with the big dogs out in California, the Facebook or whatever — maybe I have to meet the Zuck, who knows. And then the other one is to get into the finance side. So health plans have been largely kind of strapped down and held still by regulation. They can’t be responsive to their customers. They need new ways of underwriting healthcare and a partner that could bring a claimless healthcare network where nobody sends a claim or receives a claim. All of this is instantaneous intelligence built into the wire. That should be us.”
  • In summarizing 2013, Bush said, “That wraps up a fantastic year. And over the last few days, we have given out beautiful crystal things, checks, and stock options. And if that wasn’t enough, we gave a few people hangovers so that they knew that what they had done in 2013 and then we took all their needles and returned them to 0. And we noticed last night that you all got excited about how the year went and the stock went up. And we want you to know that we have turned our needles with you to 0. We have a very long way to go and it is only to us about how we journey. There will be a healthcare Internet and we will be the ones who have created it. ”

Speaking of athenahealth, ATHN shares jumped 25 percent on Friday, the second-largest percentage gain on the Nasdaq, after Thursday’s earnings announcement, valuing the company at $6.5 billion. A $10,000 investment five years ago would be worth $52,000 today.

CMS extends the deadline for EPs to attest for MU 2013 by a month to March 31, 2014.

2-8-2014 3-50-08 PM

The White House Office of Science and Technology Policy announces that several drug chains have pledged to support or expand their use of the Blue Button initiative to allow patients to access their prescription information: Walgreens, Kroger, CVS Caremark, Rite Aid, and Safeway. Walgreens, always the technology leader in retail pharmacy and arguably in healthcare, says it will adopt BlueButton+ guidelines to allow customers to share their data and use third-party health applications.

2-8-2014 4-14-28 PM

The Federal Trade Commission approves a settlement with IP-based video camera vendor TRENDnet over a software vulnerability that allowed anyone to view a camera’s live feed over the Internet without a password. One marketed use of the secure video systems is monitoring hospitalized patients.

In England, a privacy group criticizes West Suffolk Hospital after it reports 20 documented breaches since 2010, including seven in 2013. All of breaches last year involved paper records that were filed or mailed incorrectly.

Weird News Andy includes an actor’s name pun in titling this story, “He’s a Lauriette.” A German doctor diagnoses a patient’s cobalt poisoning caused by a broken artificial hip after recognizing its symptoms from an episode of the TV series “House.” The doctor says he’s not thrilled at being called “the German Dr. House” since he finds rude behavior unacceptable, but concedes, “It’s important to be nice, but you don’t get patients healthy just by being nice.”

Sponsor Updates

2-8-2014 3-14-17 PM

  • Clinical Architecture announces Symedical for the iPad, which provides mobile access to map administration.
  • John Gomez of JGo Labs is working with investment bankers interested in investing in healthcare IT companies with $5 million to $30 million EBIDTA, a proven business model, and good revenue growth. He’ll be available to meet with interested companies at HIMSS. 


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

More news: HIStalk Practice, HIStalk Connect.


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February 8, 2014 News 16 Comments

News 2/7/14

February 6, 2014 News 6 Comments

Top News

2-6-2014 8-50-45 PM

Athenahealth reports Q4 results: revenue up 48 percent, adjusted EPS $0.57 vs. $0.29, beating analyst expectations for both and sending ATHN shares up 19 percent in after hours trading Thursday. Above is the one-year performance of ATHN (blue) vs. the Nasdaq (red).

Reader Comments

2-6-2014 11-18-52 AM

From OnTheFringe: “Re: KLAS. Sponsoring a Best in KLAS TweetChat Friday. Oh my, I think I might have a few beers and fire up my Twitter account.”

2-6-2014 11-49-01 AM

inga_small From Faithful Sponsor: “Re: HIStalkapalooza attire. While I did not make the cut to attend HIStalkapalooza 2014, one of my executives did and I wanted to touch base to see what the theme was this year.” Let me start by saying that no one is sadder than Mr. H and me that we were not able to accommodate all our faithful readers and sponsors due to capacity limitations. The only HIStalker more sad than us is probably Dr. Jayne, who was unable to score an invite for her “+1,” a gentleman that Dr. Jayne assures me  is terrific, even if he did just cancel his HIStalk subscription over the perceived snub. Next year I am proposing we rent Soldier Field so we have plenty of room for anyone (though I suppose we might need to wear snow suits.) As for this year, we will once again be seeking contenders for the Inga Loves My Shoe contest, so please bring your A game. Overachievers who are able to pull off the whole package may be in the running for HIStalk King or Queen. If that’s not specific enough, here’s a good rule of thumb: leave the “just off the exhibit floor” company golf shirt in your hotel room and come adorned in something fun, flirty, and suitable for sipping Ingatinis. You’ll see some long gowns, a tux or two, plenty of cocktail dresses, and the occasional pair of blue jeans. It’s going to be fun.

From Gary: “Re: HIStalkapalooza. Rejected third year in a row. I have concluded that this is a hand picked, very political event, your own version of the Good Ole Boy network.” Every year I swear I’ll never do another HIStalkapalooza because of the endless complaining about who gets invited and the time and energy it takes to wade through hundreds of emails begging for (or demanding) invitations, insistence on bringing uninvited guests, or asking me to personally repeat event details that have already appeared several times in HIStalk. The event is a really nice, free party for maybe 1,000 people and neither the sponsor nor I get anything out of it except a ton of work, but somehow we end up being the bad guys when demand for invitations exceeds supply. The invitation process is clear and hasn’t changed since 2008: employees of non-profit providers (hospitals, practices, universities – hardly “political”) who request invitations come first. This year a huge number of providers signed up, leaving around 1,000 others without spots no matter how cool they are or how much I like them. It’s no different than a popular show or sporting event – not everybody is going to get a seat. Next thing you know scalpers will be lined up outside of the House of Blues.

Speaking of HIStalkapalooza, every year at least 40 percent of those invited don’t show up. This year I’m keeping a database of no-shows who don’t let me know in advance so that I can give someone else their spot – that will be the last HIStalkapalooza invitation they’ll get. A few invitees have already emailed to say their plans have changed and I really appreciate that.

From Reader: “Re: HIStalk. Thank you again for the wonderful service you offer our healthcare industry. So many of us wake up each morning to stay informed to the latest news via HIStalk. I am amazed at how well your content remains timely, fresh, and complete. We hope to see you at HIMSS, where we will release the next generation of our solution. Wishing you continued success in 2014.” Thanks. I don’t usually have enough time to watch demos at the HIMSS conference, but I will try to swing by at least briefly and anonymously.

From Silent: “Re: Epic. Going into the consulting business. This will greatly disrupt the current vendor marketplace.” Unverified.

From WildcatBelievers: “Re: The University of Arizona Health Network’s Diamond Children’s Hospital. Went live on Epic in November, recently put together this fantastic video with special guest band American Authors to celebrate the tremendous and impactful work they are doing to improve the lives of the children of Arizona.”

HIStalk Announcements and Requests

A few HIStalk Practice highlights from the last week include: Epic, eClinicalWorks, and Allscripts own 30 percent of the physician EMR market. Physician practices are far from ready for ICD-10. HHS finds that few health centers have the capacity to meet MU data sharing objectives. Reimbursements remained flat in 2013 for existing patient visits and declined for new patients. EHR alerts show promise in changing physician behavior when treating obese and overweight children. Dr. Gregg recommends taking time to step across the divide to reinvigorate your viewpoint. Culbert Healthcare’s Brad Boyd offers tips for optimizing clinical documentation. Thanks for reading.

2-6-2014 9-43-34 PM

Welcome to new HIStalk Platinum Sponsor CitiusTech, a leading healthcare technology services and solutions provider with 1,400 professionals (including 500 certified in HL7) serving over 50 leading healthcare organizations. The company has grown 55 percent year-over-year for the past five years and has won awards for being a great place to work. Its BI-Clinical healthcare business intelligence and clinical decision support system has been deployed at over 1,200 provider locations, with pre-built clinical, financial, operational, and regulatory reporting apps and 600 pre-built KPIs. Services include software product engineering, professional services, QA and test automation, and technology consulting. Specific practice areas are Meaningful Use compliance, interoperability, BI, consumer health, care management, and cloud and mobile health.  The company serves all healthcare markets – vendors, hospitals, medical groups, medical device companies, HIEs, health plans, and pharma. Thanks to CitiusTech for supporting HIStalk.

Here’s an overview of CitiusTech.

HIMSS Conference Social Events

Aventura, Nordic Consulting, Avent, and IHS Consulting will host the Row 1800 block party from 4:00-6:00 p.m. on Tuesday, February 25. All will be serving food and drinks and Aventura will feature a magic show at booth 1831. All hated competitors are welcome.

Upcoming Webinars

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.

February 13 (Thursday), 12 noon ET. Advancement in Clinician Efficiency Through Aware Computing. Sponsored by Aventura. In an age of information overload, a computing system that is aware of the user’s needs becomes increasingly critical. Instant-on roaming for virtual and mobile applications powered by awareness provides practical ways to unleash value from current HIT investments, advancing efforts to demonstrate meaningful use of EHRs and improve clinical efficiencies. The presenters will review implementation of Aventura’s solution at Orange Coast Memorial Medical Center.

Acquisitions, Funding, Business, and Stock

2-6-2014 9-37-29 PM

Private equity firm Thoma Bravo acquires supply chain solutions vendor Global Health Exchange.

2-6-2014 1-27-57 PM

Praesidian Capital invests $8.3 million in Etransmedia Technology.

2-6-2014 1-29-56 PM

Alere announces Q4 results: adjusted revenue up two percent, ajusted EPS $0.68 vs. $0.55, beating estimates. Net product and services revenue from Alere’s health information solutions segment was flat.

2-6-2014 1-30-53 PM

Bottomline Technologies will pay $8 million for Rationalwave Analytics, an early-stage predictive analytics company.

From Cerner’s earnings call:

  • The company signed 25 contracts over $5 million in the quarter
  • President Zane Burke says half of the market will reconsider their EHR supplier in the next few years, most of them will choose Cerner or Epic, and Cerner’s win rate against Epic has doubled in the past three years.
  • Cerner says it replaced 18  ambulatory competitors in signature accounts.
  • It says it sold an HIE to a 600-bed Epic hospital because Epic was “was unable to effectively connect to other systems.”
  • The company says providers are consolidating and Cerner hospitals are buying smaller ones at quadruple the rate of Epic hospitals.


2-6-2014 1-31-50 PM

FirstHealth of the Carolinas selects Truven Health Unify for population health management.

2-6-2014 1-32-56 PM

Bozeman Deaconess Hospital (MT) will implement Merge Healthcare’s VNA and interoperability solutions.

Metro-North ACO (PR) selects eClinicalWorks Care Coordination Medical Record to advance its physician-led ACO objectives.

Adventist Health System selects HealthMEDX to automate Adventist Care Centers, its long-term care division.

2-6-2014 1-39-21 PM

Genesis Medical Center (IA)  will implement Wolter Kluwer Health’s ProVation Medical software for cardiology procedure documentation and coding.

Covenant Health Systems (MA) adopts MedeAnalytics’ analytics platform to manage population health for its employees.

Athens-Limestone Hospital (AL) selects Besler Consulting to assist in the identification of Medicare Transfer DRG underpayments.

Providence Health & Services and Swedish Health Services (WA) will implement care transition and utilization review solutions from Curaspan Health Group, as well as Xerox’s Midas+ Care Management platform.


2-6-2014 1-03-52 PM

Axiom EPM hires David Janotha (Loyola University of Chicago Medical Center) as VP of healthcare.

2-6-2014 8-59-17 PM 2-6-2014 9-01-32 PM

Parallon names Scott Armstrong (OptumInsight) SVP and Wendy Penfield (Intellect Resources) as AVP, both in revenue cycle consulting services.

2-6-2014 9-06-26 PM

Surgical supply chain software vendor Solstice Medical hires Todd Melioris as CEO.

Announcements and Implementations

2-6-2014 1-44-43 PM

Geisinger Health System (PA) deploys Courion’s identity and access management solutions.

St. Luke’s University Hospital Network (PA) implements Get Real Health’s InstantPHR patient portal, which will be connected to Caradigm’s HIE platform.

HIMSS announces a Latin American version of its annual conference that will be held September 18-19 in Sao Paolo, Brazil.

Government and Politics

The Army and Air Force contract with a division of Goodwill Industries to scan and transmit to the VA the service treatment records of veterans discharged this year.

2-6-2014 8-43-51 PM

The DoD and VA collaborate to develop a way for the VA to review the scanned images of the DoD electronic medical records of disability claimants.

2-6-2014 10-16-45 PM

Farzad Mostashari tweets out a section of the proposed SGR bill that would roll Meaningful Use and PQRS incentives into a new value-based payment system that would start in 2017.  Additional language would require EHRs to be interoperable.

The former CFO of Shelby Regional Medical Center (TX) is indicted for Medicare fraud, charged with falsely attesting that the hospital met Meaningful Use requirements for 2012. The hospital was mostly paper-based, but ordered its software vendor (eCareSoft) and employees to manually enter information into the EHR months after discharge to earn $786,000 in incentive payments. The hospital was part of a now-defunct for-profit chain that collected $18 million in Meaningful Use payments before being dismantled after reports of serious patient care issues.

The governor of Massachusetts apologizes for the state’s dysfunctional insurance exchange website as a non-profit research firm finds the site loaded with “technical infrastructure and data stability problems.” The governor says that contractor CGI, which was also responsible for Healthcare.gov, was  not reliable and relieved CGI overseer University of Massachusetts Medical Center of further responsibilities.


New York officials report that the state’s online database for drug prescriptions has reduced doctor shopping by 75 percent since its August 2013 implementation.

The World Health Organization postpones the rollout of ICD-11 until 2017, two years later than planned.

Sponsor Updates

  • AirWatch opens an Australian headquarters in Melbourne.
  • Allscripts announces the general availability of Sunrise Version 14.1.
  • Jed Shay, MD shares how his use of AdvancedMD’s EHR and PM services have contributed to improved cash flow, productivity, and patient tracking.
  • T-System files a patent application for an ICD-10 feedback feature that helps clinicians document for ICD-10 without an interruption in workflow.
  • Huron Healthcare will integrate predictive analytic technologies from Connance into its revenue cycle solutions.
  • Russell Green, VP of research operations and engagement manager for Porter Research, discusses the mixed messaging of HIEs in a blog post.
  • Kelsey Creveling from Sagacious Consultants clarifies changes in the Safe Harbor regulation in a blog post.
  • MyCatalyst will use Liaison Healthcare’s Data Management platform for its myCatalyst Provider Portal and Population Health Reportal solutions.

EPtalk by Dr. Jayne


The pre-HIMSS mail bonanza has started. It seems a little earlier than last year. Today’s winner is GCX Mounting Solutions, whose “scratch and win” card fell victim to the Postal Service’s automated mail handling machines. A fair number of mailings arrive mangled every year. I wonder if the marketing and promotional companies ever consider doing a test mailing to make sure their items will arrive as intended?

Several vendors have shared invitations to their client appreciation parties and I’m looking forward to writing them up. I haven’t heard from very many EHR vendors, so either they don’t want sassy women in fabulous shoes to attend or they’re just behind. Inga will be sharing invitations from those vendors willing to open their events to HIStalk readers. I appreciate their willingness to let everyone share in the fun. After slogging through 500,000 square feet of exhibit space and 1,200 exhibitors, the opportunity to unwind and partake of a cocktail is more than welcome.

Something I’ll be on the lookout for in the exhibit hall: devices that use the new Corning antimicrobial Gorilla Glass. When I think about all the devices I come into contact with each day in the hospital compared to the variable handwashing behavior of some of my colleagues, it seems like a good idea. I see more people wiping down equipment at the gym than I see on the wards and that’s not a good thing. I haven’t seen any evidence-based reports on how well it works, so if you have any inside scoop, let me know.

The World Health Organization is postponing the rollout of ICD-11. Originally slated for 2015, it will be delayed until 2017. Hopefully this will quiet those voices advocating that we skip ICD-9 and go straight to ICD-11. ICD-10 was approved in May 1990 and first came into use in 1994, so based on the historical timeline, the United States should be ready for ICD-11 in 2038. Thank goodness I’ll be retired by then.


Several readers emailed about this week’s Curbside Consult on wearable tech. One mentioned the lack of interest in a mobile healthcare enterprise device. Manufacturers are focused on selling directly to the masses, but it would seem like there is a place for enterprise devices in the Accountable Care or HMO spaces. Another lamented the lack of integration among devices — “I feel like a nurse with 50 devices being a kangaroo.”

When I was in residency, we used to refer to the group of pagers that you had to wear when you were on call as the Batman Utility Belt. There was the on-call pager, the code team pager, and your personal pager. You also had to carry the elevator keys (because who wants to run up 17 floors when a patient needs CPR?) Throw on a bulky cell phone, and if you were extra lucky, the labor and delivery pager, and you were ready to go. I almost forgot – some also had a Palm Pilot, although I was partial to the Pocket PC.

We’ve certainly come a long way. Some of us are down to one device if we work in a BYOD environment. I’m still toting a corporate phone and a personal phone, but it certainly could be worse. Have you been able to shed the utility belt? Email me.


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

More news: HIStalk Practice, HIStalk Connect.


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February 6, 2014 News 6 Comments

Morning Headlines 2/6/14

February 6, 2014 Headlines No Comments

New MGMA research: industry coordination lagging; less than 10 percent of physician practices ready for ICD-10

According to a new study from MGMA, less than 10 percent of physician practices have made significant progress on their transition to ICD-10.

EHR incentive payments soar beyond $19 billion

$19 billion in EHR incentive payments have been distributed thus far, with 88 percent of all eligible hospitals and 78 percent of eligible providers having received a share.

Innovative Collaboration to Address Shared Challenges in Health Care

Kaiser Permanente and the VA have announced that they will pool resources and develop best practices for key emerging fields such as genomics, population health, and telehealth.

A.G. Schneiderman Applauds Success Of New York’s Innovative Program To Prevent Prescription Drug Abuse

A law in New York that requires pharmacists to update on online database anytime a narcotic prescription is filled, and then requires physicians to check the database prior to issuing new prescriptions to patients, is being credited with reducing "doctor shopping" by 75 percent. The same law mandates state-wide e-prescribing by March 2015.

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February 6, 2014 Headlines No Comments

News 2/5/14

February 4, 2014 News No Comments

Top News


Castlight Health files plans for an IPO that values the company at $2 billion. The employee health management software company was formed in 2008 with now-US CTO Todd Park as a co-founder.

Reader Comments

2-4-2014 1-26-07 PM

inga_small From Jack Flash: “Re: Dick Derrick. The HCIT world will miss the smiling face of Dick Derrick of eClinicalWorks, who announced his retirement after 40 years in our business.” Dick was kind enough to share with Mr. H and me that he remains “addicted” to HIStalk and will continue reading in between his travel, volunteering, and family time. He also asked us to send his best to his industry friends.

HIStalk Announcements and Requests


Supporting HIStalk as a Platinum Sponsor is Aperek (pronounced uh-PARE-ik) which you may remember as Mediclick (with earlier roots in Global Software) since the healthcare-only, all US-based company changed its name along with introducing new products in November 2013. The Raleigh, NC-based company offers highly ranked solutions for supply chain, financials, mobile, technology, spend aggregation / contract management, and implant tracking. CEO Mike Merwarth explained in my interview last week that 80 percent of a hospital’s supply expenses are managed by clinical people rather than materials management professionals (particularly in the OR, where high-dollar implant products are used) and thus aren’t touched by typical ERP packages. A new Aperek solution is Pulse, an iPad app designed for clinicians who record implant item usage in the OR. Hospitals are looking at the supply chain and thus to Aperek to get their costs under control. Thanks to Aperek for supporting HIStalk.

HIMSS Conference Social Events

inga_small Send us your event details if it’s a good one (i.e, free food and drinks at minimum) and you promise that all HIStalk readers are welcome to attend, even if they work for your most hated competitor as a given reader might well do. Inga and Dr. Jayne especially like free cocktails and are happy to give your company a shout-out if we have the chance to stop by.

2-4-2014 10-17-40 AM

Divurgent will be sponsoring a Havana Nights themed event at the Funky Monkey (International Drive) Sunday night at 8:00 p.m. on Sunday. Click here to register.


Upcoming Webinars

February 5 (Wednesday) 1:00 p.m. ET. Healthcare Transformation: What’s Good About US Healthcare? Sponsored by Health Catalyst. Presenter: John Haughom, MD, senior advisor, Health Catalyst. Dr. Haughom will provide a deeper look at the forces that have defined and shaped the current state of U.S. healthcare. Paradoxically, some of these same forces are also driving the inevitable need for change.

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.

February 13 (Thursday), 12 noon ET. Advancement in Clinician Efficiency Through Aware Computing. Sponsored by Aventura. In an age of information overload, a computing system that is aware of the user’s needs becomes increasingly critical. Instant-on roaming for virtual and mobile applications powered by awareness provides practical ways to unleash value from current HIT investments, advancing efforts to demonstrate meaningful use of EHRs and improve clinical efficiencies. The presenters will review implementation of Aventura’s solution at Orange Coast Memorial Medical Center.


Acquisitions, Funding, Business, and Stock


Cerner announces Q4 results: revenue up 12 percent, adjusted EPS $0.39 vs. $0.34, meeting analyst expectations.


ZappRx, developers of a mobile e-prescribing platform, secures $1 million in additional funding.

2-4-2014 1-30-39 PM

Imprivata confidentially submits a draft registration statement with the SEC to conduct an IPO.

2-4-2014 1-31-32 PM

Streamline Health Solutions completes its acquisition of Unibased Systems Architecture.

2-4-2014 1-32-26 PM

Endo Health Solutions completes the divestiture of HealthTronics to Altaris Capital Partners for total consideration of up to $130 million.

BlueStep Systems, a clinical platform provider for the long-term and post-acute care market, merges with  BridgeGate Health, a system integration provider.


2-4-2014 1-34-40 PM

Spectrum Health (MI) selects PerfectServe’s Clinician-to-Clinician and DocLink platforms for direct and secure clinician communication.

The 14-hospital Baptist Memorial Health Care System selects Voalte smartphones for system-wide caregiver communication.



2-4-2014 8-02-56 AM

HIMSS awards CACI International’s Keith Salzman, MD its 2013 Physician IT Leadership Award.

2-4-2014 1-36-23 PM

AT&T appoints Eric Topol, MD ((Scripps Health) chief medical advisor.

2-4-2014 1-37-24 PM

CTG Health Solutions hires Linda Lockwood (Encore Health Resources) as its advisory services solutions director.

2-4-2014 11-29-53 AM

HIMSS names Pauline M. (Hogan) Byom (Mayo Health System) the recipient of the 2013 SHS/HIMSS Excellence in Healthcare Management Engineering / Process Improvement Award.


Colette Weston (ADP AdvancedMD) joins Aviacode as VP of client services.

Emdeon hires Randy P. Giles (Coventry Health Care) as CFO/ EVP of finance, replacing Bob A. Newport, Jr.

Announcements and Implementations

The University City Science Center in Philadelphia begins accepting applications for its Digital Health Accelerator, which will provide up to $50,000 in funding and other benefits for as many as six companies in the digital health or HIT sector.

2-4-2014 1-40-14 PM

Fleming Island Surgery Center (FL) goes live with Anesthesia Touch from Plexus Information Systems.

Bread for the City (DC) and the Family and Medical Counseling Service (DC) implement The Guideline Advantage, a quality improvement program that leverages population health management tools from Forward Health Group.

Government and Politics

CMS authorizes laboratories to provide patients with direct access to their lab reports, rather than requiring patients to obtain results from their physicians.

2-4-2014 9-49-33 AM

A veterans advocacy group calls on the VA and DoD to take aggressive steps to reduce the remaining backlog of 400,000 disability claims, deliver on the long-promised joint VA/DoD EMR, to standardize VA claims forms, and to encourage VA raters to process claims correctly the first time.


Innovation and Research

2-4-2014 12-56-58 PM

Hospitals rank cost reduction as their top innovation priority, according to a HIMSS/AVIA survey on healthcare provider innovation. The report also reveals that chief innovation officers are not yet mainstream roles within hospital and health systems, though 64 percent of organizations with annual revenues of at least $5 billion have a chief innovation officer. Though dedicated funding for innovation is modest, providers are making progress implementing innovative solutions related to population health management, patient follow-up, predictive analytics, clinical decision support, and care coordination.


2-4-2014 1-17-48 PM

HIMSS expects more than 1,200 exhibitors at this year’s conference and will offer longer exhibit hall hours with more overlap between education sessions and no mid-day break.

Weird News Andy titles this story “A Shot for a Shot.” A startup invents a device that it claims can stop bleeding from a gunshot wound in 15 seconds. It injects dozens of tiny sponges into the wound, or as the article breezily written for those skimming rather than actually reading, “like a tampon for bullet wounds.”


Sponsor Updates

  • PACS blogger Dr. Dalai banters with Brad Levin of Visage Imaging about the latter’s suggestion that a savvy hospital IT department could assemble its own PACS system from off-the-shelf components.
  • NCQA certifies that Verisk Health’s Quality Intelligence solution contains HEDIS Certified Measures that are ready for 2014 HEDIS reporting.
  • Oracle Health Sciences will integrate medical speech recognition technology from Nuance Communications with its e-clinical software.
  • MedHOK achieves NCQA certification for its HEDIS Certified Measures in 360Measures.
  • TriZetto launches a collaborative care solution powered by Wellcentive to facilitate payer/provider collaboration in accountable care initiatives.
  • PeriGen introduces Category II Management Algorithm, a free web-based tool to support the management of patients in labor during FHR category II.
  • Coastal Healthcare Consulting introduces Convergence, an offering that combines NextGate’s Enterprise Master Index with Coastal’s project implementation.
  • HIMSS selects InterSystems HealthShare as the official health informatics platform for the Intelligent Hospital Pavilion at the HIMSS14 conference.
  • Gartner positions Informatica as a leader in its January 2014 Magic Quadrant for Enterprise Integration Platform-as-a-Service report, based on ability to executive and completeness of vision.
  • Elsevier introduces MethodsX, a concept methods journal that provides researchers a home for their unpublished works, allowing them to receive public credit and citations.
  • First Databank commences publishing of an initial draft of New York State Acquisition Cost drug prices.
  • CareSync is selected as a finalist in the Community category for the 2014 SXSW Interactive Awards for its efforts in building meaningful communities for patients, their families, and care teams.


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

More news: HIStalk Practice, HIStalk Connect.


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February 4, 2014 News No Comments

Morning Headlines 2/4/14

February 3, 2014 Headlines 3 Comments

HHS strengthens patients’ right to access lab test reports

HHS announces changes to both HIPAA and the Clinical Laboratory Improvement Amendments of 1988 that will result in patients being able to access their laboratory results directly from the lab, rather than from the doctor that ordered the tests.

Can Healthcare IT (HIT) Deliver Value? (Part II)

David Levin, CMIO of Cleveland Clinic, discusses the ROI of health IT projects and concludes that health IT project planning tends to focus on building ideal workflows rather than realizing cost reductions or outcomes improvements. He says “if you don’t know where you expect to achieve value and you don’t have a specific plan to get there, you probably won’t.”

Health information for more than 40,000 Unity members missing

Researchers at University of Wisconsin lose an unencrypted hard drive containing the personal information of 40,000 Unity health insurance customers. The researchers had the hard drive because they were working with Unity on a benefits analysis project.

Exploring the Value of Health IT on HIMSS14 Exhibition Floor

HIMSS releases new details on the HIMSS14 Exhibit hall. New exhibits include: a startup showcase hall for first-time HIMSS exhibitors, an Intelligent Medical Home model demonstrating home monitoring solutions and real-time data exchange between the medical home and a mock hospital unit, and a revamped interoperability demonstration.

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February 3, 2014 Headlines 3 Comments

Morning Headlines 1/31/14

January 30, 2014 Headlines No Comments

DoD Healthcare Management Systems Modernization (DHMSM): Draft Request for Proposal

The DoD publishes an open solicitation for a new EHR that will replace all of its existing legacy systems. The usability testing scenario’s outlined within the proposal describe a medic calling up evidence-based guidelines and documenting care while providing emergency treatment to a wounded marine in the field. Subsequent scenarios describe field surgeons using the system to coordinate care delivery once the Marine arrives back at the forward operating base, then medications being administered by nurses during an air medevac to a larger hospital in the US, and finally the transfer of care from the DoD to a VA rehabilitation facility. The last scenario requires vendors demonstrate the exchange of medication lists and narrative care summaries between DoD/VA facilities.

Thousands of providers rank healthcare software and services in annual Best in KLAS report

athenaHealth dethrones Epic from the top spot on the Best in KLAS 2013: Software and Service report. Epic had held the number one position for the past eight years.

eHealth Exchange Survey Reveals Dramatic Increases in Participation and Online Transactions

The eHealth Exchange, a non-profit, public-private HIE collaborative, reports that its membership has grown to include 800 hospitals, 6,000 mid-to-large medical groups, 800 dialysis centers, and 850 retail pharmacies.

Hospital’s new IT system ‘has increased waiting times and led to lost patient data’

In England, staff at Croydon University Hospital are blaming their recent Cerner go-live for increased waiting times and lost patient information. The university’s director of quality maintains that the implementation of Cerner went well in technical terms, but members of the board were not convinced and are insisting that "patient care has definitely suffered."

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January 30, 2014 Headlines No Comments

News 1/31/14

January 30, 2014 News 6 Comments

Top News

1-30-2014 8-32-06 PM

The Department of Defense opens bidding to replace all of its EHR systems, saying the new system will use off-the shelf technologies running on ONC-approved standards. The VA solicited bids Tuesday for the next step in its replacement of VistA. Evidence is scant that the two groups plan to work together to implement a single EHR systems as mandated by the President and Congress, with their only obvious common ground being a willingness to separately enrich the usual government contractors with massive taxpayer dollars.

Reader Comments

From Silversand: “Re: MU Stage 2 CQM measures. In meeting with our vendor, we were told they can’t submit them electronically yet because the standards changed in December and their software hasn’t been updated. I can’t find anything on a standards change. Is this true? Are other vendors running into the same issue? I would love to know what your readers think.” So would I (cue readers to chime in.)

From Ockham: “Re: vendor market share. KLAS estimates by bed size, i.e. ‘Meditech has 18 percent of hospitals over 200 beds.’ This is meaningless. It should be expressed as the number of beds in all hospitals using a system, which would be easy to calculate using information from HIMSS Analytics. Having a lot of beds means having a lot of clinician users, which pushes product development. Epic blasted into a leadership position is because having 400 hospitals that are large and larger trumps having 2,000 hospitals that are small (Meditech).” That’s true, as long as your product is suitable for large hospitals and you have the competence to sell it to them. Epic’s timing was perfect because soon those big, Epic-using hospitals will have bought all the smaller ones and replaced their incumbent systems, putting Epic in hospitals that couldn’t have afforded or supported it on their own. It’s like the political system – you’ll see all kinds of parties on the ballot, but only two of them get a significant number of votes.

HIStalk Announcements and Requests

inga_small A few HIStalk Practice highlights from the last week include: physicians prefer smartphones to tablets to perform most professional tasks. Practice Fusion offers free Google Chromebooks to new users. CMS reminds EPs of pending deadline to attest to MU for the 2013 Medicare EHR incentive program. In part three of our series, HIT vendor execs share details about technologies on their company’s roadmap for the next 12-18 months. Thanks for reading.

1-30-2014 6-59-18 PM

Welcome to new HIStalk Platinum Sponsor Optimum Healthcare IT. The Jacksonville Beach, FL-based full-service consulting firm provides expert consultants at competitive rates. Services include EHR deployment (all major vendors); integration services (interface development and integration engines); staff augmentation (program directors, project managers, application builders and testers, clinical experts, analysts, security experts, trainers); security and identity management; and regulatory guidance (Meaningful Use, ICD-10.) The company provides small-business flexibility with large-business stability, but without the high cost. Thanks to Optimum Healthcare IT for supporting HIStalk.

Upcoming Webinars

February 5 (Wednesday) 1:00 p.m. ET. Healthcare Transformation: What’s Good About US Healthcare? Sponsored by Health Catalyst. Presenter: John Haughom, MD, senior advisor, Health Catalyst. Dr. Haughom will provide a deeper look at the forces that have defined and shaped the current state of U.S. healthcare. Paradoxically, some of these same forces are also driving the inevitable need for change.

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.

February 13 (Thursday), 12 noon ET. Advancement in Clinician Efficiency Through Aware Computing. Sponsored by Aventura. In an age of information overload, a computing system that is aware of the user’s needs becomes increasingly critical. Instant-on roaming for virtual and mobile applications powered by awareness provides practical ways to unleash value from current HIT investments, advancing efforts to demonstrate meaningful use of EHRs and improve clinical efficiencies. The presenters will review implementation of Aventura’s solution at Orange Coast Memorial Medical Center.

Acquisitions, Funding, Business, and Stock

1-30-2014 5-46-59 PM

GNS Healthcare, a provider of big data analytics products and services, completes a $10 million Series B financing round led by Cambia Health Solutions.

1-30-2014 5-49-51 PM

VMware reports Q4 results: revenue up 20 percent, adjusted EPS $1.01 vs. $0.81., beating earnings estimates.

1-30-2014 5-50-35 PM

CommVault releases Q3 results: revenue up 20 percent, adjusted EPS $0.54 vs. $0.39, beating estimates on both.

1-30-2014 5-51-15 PM

Quest Diagnostics announces Q4 results: revenue down one percent, adjusted EPS $1.03 vs. $1.01, beating estimates on both.

1-30-2014 6-57-56 PM

McKesson announces Q3 results: revenue up 10 percent, adjusted EPS $1.45 vs. $1.44, beating revenue expectations but missing expected earnings of $1.84. CEO John Hammergren said the results of Technology Solutions was disappointing (revenue up 6 percent, margins 8.55 percent) because the company had to  “take action in response to the anticipated timeline for Meaningful Use 3 and to size our organization in Horizon Clinicals appropriately” and took a $42 million restructuring charge to reduce headcount.

1-30-2014 9-07-20 PM

CPSI anounces Q4 results: revenue up 7 percent, EPS $0.90 vs. $0.83.


1-30-2014 5-52-06 PM

Texas Children’s Hospital selects OpenTempo’s scheduling and workforce management solution.

1-30-2014 5-53-53 PM

Valley Health (VA) selects Capsule Tech to integrate medical devices in operating rooms with Epic EMR.

1-30-2014 6-52-22 PM

Greater Regional Medical Center (IA) implements PeriGen’s PeriCALM fetal surveillance system.


1-30-2014 5-57-54 PM 1-30-2014 5-58-50 PM

Cumberland Consulting Group promotes Greg Varner and Mike Penich from principals to partners.

1-30-2014 5-59-52 PM

Community Health Network (IN) names Ron Thieme, PhD (AIT Laboratories) chief knowledge and information officer.

1-30-2014 6-00-48 PM 1-30-2014 6-01-34 PM

Population health management vendor Welltok hires Michelle Snyder (Epocrates) as chief marketing officer and Vance Allen (Pearson eCollege) as CTO.

1-30-2014 6-03-05 PM 1-30-2014 8-03-22 PM

Charles Denham, MD, accused by the Department of Justice of accepting $11.6 million in kickbacks from CareFusion to promote its skin disinfectant product at the National Quality Forum, resigns from the board of The Leapfrog Group. The DOJ has assessed a $41 million fine against CareFusion; Denham says the allegations are false. There’s a healthcare IT connection: when Dennis Quaid started limelighting  for patient safety after his newborn twins were overdosed with heparin at Cedars-Sinai (he had breezy good intentions, but minimal knowledge even for an actor), HIMSS put him on stage at the 2009 conference and inexplicably donated to his foundation. Dennis apparently found another shiny object and merged his foundation a year later with Texas Medical Institute of Technology, which was founded and run by Chuck Denham (who didn’t live in Texas, but instead in a $14 million oceanfront estate in Laguna Beach, CA.) Denham claimed that TMIT’s “national research test bed” involved 60 percent of US hospitals, although few people seemed to have heard of it. the other healthcare IT connection is that CareFusion sells Pyxis drug dispensing machines and Alaris smart IV pumps, just in case your hospital feels the urge to buy something from a company willing to bribe its way to the bedside.

1-30-2014 7-46-27 PM

Microsoft’s board is rumored to be preparing to name Satya Nadella, VP of the company’s cloud and enterprise group, as CEO as soon as Friday. The board is also discussing the possibility of replacing Bill Gates as their chairman with an unnamed candidate. Nadella would be the company’s third CEO following Gates and Steve Ballmer.


Announcements and Implementations

More than 800 hospitals and 6,000 medical groups are participating in the eHealth Exchange, a group of government and non-government organizations that agree to support interoperability standards to exchange information.

1-30-2014 6-05-42 PM

Scott & White Memorial Hospital (TX) goes live on Epic.

1-30-2014 9-03-23 PM

Greater Baltimore Medical Center (MD) goes live with the PatientRoute Systems patient flow solution.


1-30-2014 6-08-25 PM

Members of the governing board for the UK’s Croydon University Hospital raise concerns that the hospital’s new Cerner system has led to increased waiting times and has lost patient information. Despite Cerner’s assurances that the system issues have not harmed patients, at least one board member expressed doubts:

You say that no harm has occurred, but while we’ve had no direct incident so far, patient care has definitely suffered. You talk about increased waiting times and there’s a risk that harm may occur because of the difficulty in getting in touch with clinicians who actually know what is going on with the patient. I’m very concerned from a quality point of view that our main provider has a serious problem with its information systems.

1-30-2014 6-09-11 PM

CCHIT announces that it will no longer offer ONC testing and certification and will change its business model to become a certification consulting firm. CCHIT recommends that its customers work with ICSA Labs for future testing and certification services.

Federal prosecutors charge former Allscripts director of internal audit Steven M. Dombrowski with insider trading, alleging that in 2012 he used a secret account in his wife’s name short MDRX shares ahead of a poor financial report, netting him $286,000.

1-30-2014 8-51-35 PM

The Wall Street Journal describes the analytics challenges of Memorial Hospital of Gulfport (MS), which can’t get much useful information from its separate inpatient and outpatient EHRs now, but hopes things will improve after a Cerner go-live in March followed by implementation of Health Catalyst analytics afterward. The hospital selected Allscripts EHR/PM in 2009.

In Israel, the health ministry launches a medical data sharing project for health fund clinics and hospitals.

1-30-2014 9-39-59 PM

Recently released documents from the antitrust lawsuit against St. Luke’s Medical Center (ID) reveal that its merger with Saltzer Medical Group could have raised pricing for outpatient visits by 60 percent and increased insurance rates by about 30 percent. Last week a federal judge ordered St. Luke’s to divest itself of Saltzer, saying the acquisition would give the health system an unfair bargaining position with insurance companies.

1-30-2014 6-12-56 PM

Epic is unseated for the first time since 2008 as the top overall vendor the 2013 “Best of KLAS” awards, with athenahealth leading the pack. Winners (with links to HIStalk sponsors) include

Athenahealth athenaCollector (practice management 1-10 physicians)
Athenahealth athenaCollector (practice management 11-75 physicians)
Athenahealth athenaCommunicator (patient portal)
CareTech Solutions (IT outsourcing, extensive)
CareTech Solutions (IT outsourcing, partial)
Cerner (application hosting)
Cerner CommunityWorks (community HIS)
Cornerstone Advisors (planning and assessment)
Cymetrix (extended business office)
Dolbey Fusion Speech (speech recognition)
Epic Care Everywhere (HIE)
Epic EpicCare (acute care EMR)
Epic EpicCare Ambulatory (ambulatory EMR 11-75 physicians)
Epic EpicCare Ambulatory (ambulatory EMR >75 physicians)
Epic OpTime (surgery management)
Epic Radiant (radiology)
Epic Resolute (patient accounting)
Epic Resolute/Prelude/Cadence (practice management >75 physicians)
Epic Willow (pharmacy)
Impact Advisors (clinical implementation principal)
J2 Interactive (technical services)
McKesson ERP Solutions (financial/ERP)
Merge Healthcare Cardio (cardiology)
Precyse (transcription services)
PwC (revenue cycle transformation)
QlikTech QlikView (analytics)
Quest Diagnostics ChartMaxx (document management)
Rays (teleradiology services)
Sagacious Consultants (clinical implementation supportive)
Sectra PACS (PACS)
Siemens Novius Lab (laboratory)
SRSsoft EHR (ambulatory EMR 1-10 physicians)
Thornberry NDoc (homecare)
Unibased USA RMS (enterprise scheduling)
Wellsoft EDIS (emergency department)
ZirMed (claims and clearinghouse)

Weird News Andy says this doctors has it. A New Zealand doctor spearfishing with friends is attacked by a shark, fights it off with a knife, stitches his leg wound on the beach, and heads to a bar for a beer. He goes to the hospital for more stitches only after bar employees notice him bleeding onto the floor.

1-30-2014 7-33-22 PM

WNA uses his less-cynical alter ego “Wonderful News Andy” in this story of medical dedication. A neurosurgeon working at an Alabama hospital is called to a cross-town hospital to perform emergency brain trauma surgery. His route is blocked by snow-related traffic, and as his cell phone signal fades, the second hospital’s neuro intensive care unit nurse hears him say, “I’m walking.” Which he did, covering six miles in a trek of several hours and then heading straight to the OR with the patient, who had a successful outcome.

Sponsor Updates

  • HIStalk sponsors winning KLAS Category Leaders 2013 awards include Siemens (Soarian Clinicals), GE Healthcare (Centricity Perioperative Anesthesia), Merge Healthcare (cardiology hemodynamics), Elsevier (CPMRC), Wolters Kluwer (Sentri7, MediRegs Comply/Track), PatientKeeper (Physician Portal), 3M (360 Compass, Codefinder), Allscripts (EPSi), Phillips (IntelliSpace Portal), lifeIMAGE (image exchange), GetWellNetwork (interactive patient system), iSirona (DeviceConX), MedAptus (Pro Charge Capture), Passport (IntelliSource), TeleTracking (Capacity Management Suite), McKesson (EnterpriseRX Outpatient), Xerox (Midas+ Solutions, financial ERP implementation services), Fujifilm (Synapse RIS), Craneware (Bill Analyzer, Chargemaster Toolkit), Imprivata (One-Sign), API Healthcare (Staffing and Scheduling, Time and Attendance), VMware (vSphere), Emdeon (eligibility services), Encore (go-live support services), and Aspen Advisors (ICD-10 consulting).
  • McGraw-Hill Professional partners with RelayHealth to make the AccessMedicine online medical platform available to providers.
  • AirWatch adds a professional certification level to its Enterprise Mobility Certification Program.
  • Besler Consulting publishes a white paper focused on Medicare Transfer DRG underpayments.
  • AT&T sponsors a series of articles that explore how hospitals and health systems are addressing the care continuum in their strategic and operational plans.
  • ReadyDock founder and president David Engelhardt discusses when and how to clean and disinfect mobile devices in a blog post.
  • Extension Healthcare founder and CEO Todd Plesko explains the future of secure messaging app in a blog post.
  • Passport Health posts a white paper discussing the benefits of front-end patient financial patient triage.
  • A Virtelligence case study profiles Allina Hospitals and Clinics (MN), which implemented Epic with support from the company’s consultants.
  • SimplifyMD publishes proof statements highlighting various successes and stats as of the end of 2013.
  • QPID offers a case study highlighting Massachusetts General Hospital, which saw improvements in clinician productivity, higher throughput in the GI suite, and improved outcomes by avoidance of adverse events following the implementation of QPID’s automated record review.
  • Predixion will provide academic institutions with the free use of Predixion analytics software for students and teachers of data science.
  • NVoq highlights what’s new in its version V8.3.
  • Culbert Healthcare Solutions discusses the optimization of Epic work queues in a company post.
  • LifeIMAGE offers a series of customer testimonials highlighting their use of lifeIMAGE technology for image sharing.

EPtalk by Dr. Jayne

Mr. H published a rumor earlier this week about CCHIT leaving the EHR certification business. As many HIStalk rumors are, it was confirmed a few days later. CCHIT cites the complexity of testing and changing federal requirements as contributing factors. They plan to move into the consulting business.

This seems to be the big news of the week, which isn’t surprising considering we’re in the run-up to HIMSS. Major vendors aren’t going to be announcing much of anything, and instead will be saving any upcoming news for release at the big show.

I guess I’m also not surprised to see CCHIT exiting the testing business. Keeping track of the constantly changing testing criteria can’t be easy. I can barely keep track of the provider-based Meaningful Use requirements and the ongoing parade of CMS Frequently Asked Questions that cause ongoing re-interpretation of how we need to comply. If you haven’t seen the testing criteria, I’d recommend taking a look – they make some of the most complex projects I work on look like a cakewalk by comparison.

I know some of the people who participated on our ambulatory vendor’s certification testing team. The process sounds like it’s about the same level of fun as going through med school, trying to make sure you know everything, and then being an intern and having the worst call night ever – sleepless, stressed out, and having to deal with endless minutiae. I would imagine that being on the other side and having to deal with an ongoing parade of vendor teams who are similarly at their wits’ end may not be the most satisfying or stress-free job.

I’m not sure about the direction they’re taking. It seems like the consulting world is already saturated with Meaningful Use advisors, stakeholders, and other thought leaders. They plan to have a “series of summits and events to support that work,” but I’m not sure who will attend. Most of us in the trenches don’t have the budget to attend conferences and meetings we attended in the past and want to keep attending, let alone add other meetings to the docket.

The first CCHIT Summit will be held on Wednesday during the HIMSS conference. It will feature several former National Coordinators reviewing health IT during the last decade. It will be followed by an audience participation session to discuss what role health IT should play in the next decade. If they keep the CCHIT Summit events as part of existing conferences, they will definitely increase their chances for meaningful participation.

Along with the change in mission, CCHIT has restructured its board of trustees and will be replacing the CCHIT commissioners with stakeholder advisory groups. CCHIT was a leader in EHR certification and it will be sad to see them go, but I’d bet they’re not the only one that exits the business. At this point, there are fewer EHRs certified for MU2 than there were for MU1, and as more vendors abandon the Meaningful Use arms race, there won’t be as many products going through the process.

What do you think about CCHIT leaving the certification business? Leave a comment or email me.


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

More news: HIStalk Practice, HIStalk Connect.


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January 30, 2014 News 6 Comments

HIStalk Interviews Dean Sittig, PhD, Professor, UTHealth

January 30, 2014 Interviews 1 Comment

Dean F. Sittig, PhD is professor of biomedical informatics at The University of Texas Health Science Center at Houston and a co-author of the SAFER (Safety Assurance Factors for EHR Resilience) Guides that were developed for the Office of the National Coordinator.

1-29-2014 6-27-22 PM

Describe the SAFER Guides and their purpose.

Following the IOM report in 2012 on patient safety and health IT, ONC promised that they would create some guidance to help organizations improve the safety and utility of their EHRs. The SAFER Guides were their attempt to do that. They contracted with us to develop them.


What do the Guides contain and  how would you recommend that a hospital or health system use them?

There are some complex organizational structures, but mostly the Guides have about 10 to 25 recommended practices that are very general. Something like, “You need to back up your mission-critical hardware and software.” The Guides also have examples to help people understand what that means, so for a backup, that ought to be an encrypted, offsite backup taken on a daily basis.

There is also a rationale to help people understand why they would do that particular practice. There are a lot of references to link people to different aspects of the scientific literature from where those ideas came from. If the items on the list were either from the HIPAA guidelines or the Meaningful Use guidelines, we link those to give people a renewed emphasis on why they need to do certain aspects.

As to the answer to how an organization would use them, we think that in a large organization, you would convene a multidisciplinary team with someone from IT, some clinical people, some nursing, some of the ancillary services, maybe medical records people. Try to bring all those stakeholders together. Some people know the answers to certain questions and know the nuances of those. In smaller organizations, you’d probably have to contact your EHR vendor or your IT consultant that’s helping you to get the answers to these questions.


It looks like some of the items could be incorporated into an RFP.

While we were doing this, we started out going to a lot of different healthcare provider organizations and talking to them about what they were doing and trying to understand what things were working and weren’t. Some of them, we realized that the EHR vendor really has to do these things. 

When we say something like, “The patient’s name should be on every screen and maybe it should have a picture of the patient,” the EHR vendor has to make that capability available. Then the organization has to implement that capability. You’re right; some of these things are very particular and only the vendors can do them.


How do you think the average hospital would do? Are these stretch goals, or would a hospital that’s competent in IT do fine?

Of the leading organizations — I think about the Scottsdale Institute members, for example, IHC, Mayo Clinic, and Partners in Boston, those kind of places –  I would expect they’re doing between 50 and 75 percent of the recommended practices. Of the 25 percent that they’re not doing, probably half of them they’ve consciously decided not to do them for one reason or another.

Some of these things are still a little bit controversial in terms of whether they’re really a good thing to do or whether an organization can really do them. For example, not allowing a user to open more than one chart for a patient on the same computer terminal. Most people would agree that that’s a good safety measure and would reduce wrong patient orders. But most clinicians would say, “I can’t survive if I can’t look at two charts at once.” 

Then it becomes a push-pull at the organizational level of whether the organization’s administration is going to make that kind of a proclamation to make that happen. If you look at a company like Epic, for example, they limit you to only opening five charts on one screen, but that’s a user-configurable parameter. You could say only one chart is allowed to be open on one screen.


A parallel would be hiring an external auditor to do a hospital IT audit. They evaluate their checklist of things that are important. You don’t have to do all of them, but since the report goes to your management, you would at least justify why you don’t. Would a rational use of the SAFER Guides be not necessarily checking every box, but at least recognizing that you should have a good reason for not checking them knowing they affect patient safety?

That’s a good way to say it. You need an explanation. If I were a CEO reading over the results and you were the IT person that came to me, I would want an explanation for why you think you should open more than one chart on it. You can say that the clinicians disagreed and we’ve decided to limit it to two. We could talk about that and decide whether that was reasonable or not. 

Intelligent people who are safety conscious could agree to disagree on certain of these items. But it’s something you definitely need to think about and understand why you’re doing it.


The beauty of an external IT audit report is the accountability. It seems as though like the audience that would be most interested, from an exposure from a patient care or legal liability standpoint, would be a hospital’s CEO.

I agree completely. We are really hoping that that’s the way they’re used. Either insurance companies will pick these up and ask organizations whether it’s doing this, or someone like the Joint Commission might take these up. 

We’re hoping that this is something that starts a conversation between what I’ll call the clinician, the EHR vendors, and leadership within your organization. That conversation is the key to improving the safety.


The IOM’s To Err is Human brought a lot of activity with regard to medical errors. The IOM’s EHR patient safety report was the genesis of the SAFER Guides. Will that make the idea easier to sell?

I would think that reasonable people would agree with these recommendations. The problem is that these recommendations generally are going to cost some extra money and some extra time.

Right now, with everyone thinking about Meaningful Use Stage 2 and ICD-10 coming up, I’m sorry to say that I think patient safety has been pushed to number three on the list. That is going to be the biggest struggle with these Guides and trying to get patient safety moved up to a high level of awareness within an organization.


Meaningful Use gets you a check, ICD-10 makes sure you keep getting checks, and patient safety doesn’t get you anything except possibly a lawsuit avoided. Is ONC going to market this like they do their other programs?

We’re hoping they’re going to do that. If they can keep their focus on this, I think that will happen. But like you said, this is really a cost avoidance thing. The organizations that seem to do the best in terms of meeting most of the recommended practices are those organizations that have had the biggest accidents. It’s like you don’t get religion until you need the religion.

In some of the organizations here in the Texas Medical Center after Hurricane Ike, they really got some newfound impetus to make sure they had better backup systems in place. They were ready for bad weather. It was Hurricane Alison that was like around year 2000 where we realized we couldn’t have our data centers in the basements any more in Texas Medical Center when they all flooded. It turned out the first floor of our buildings flooded, too. Now all of the hospitals in Texas Medical Center have their data centers at least on the third floor. 

It was interesting to me that when they had Hurricane Sandy in New York City that New York City still hadn’t learned that lesson about putting data centers and power generators and backup systems in the basement. Because when there’s a really big flood, the basements flood. It seems like we should be able to learn those things from other organizations. You shouldn’t have to experience them yourself. But for some reason, people always think that it couldn’t happen here. Like, do they think that New Orleans was a one-off, Houston was a one-off, and now you think New York City was a one-off? The important points are that these things can happen to anyone, anywhere.


What kind of resources would be required to complete the series and come up with a conclusion for an individual hospital?

It depends what you start with. We’ve had some pushback when we mentioned that you ought to have all your hardware systems backed up and you ought to have duplicate hardware. Sometimes that means two servers running in parallel and another one sitting off to the side, so when one of those that are running in parallel breaks, you have one to replace it. Some people say, “We can’t afford to have three of them on site all at one time.” We hear them say, “Our vendor promises 24-hour delivery.” A lot of it are those kinds of expenses and there are a lot of examples in the contingency planning about warm site backups, for example.

That’s just a matter of how much money you want to spend to get the kind of response and get the kind of availability that you think you need. You can always spend way too much money on any aspect of your process. You’ve certainly got to balance the amount of money you spend with the safety that you need. That’s a hard question to answer. 

The other way to answer it is, there are some other guides that would recommend that, for example, when you’re doing physician order entry that you ought to have all of your orders go through the physician order entry system. This idea of trying to get 30 or 60 percent of your orders through the order entry system — we think that sort of partial implementation of CPOE is a real danger because then you have some orders on paper and some on the computer system. 

That’s not really a cost in terms of money. That’s a cost in terms of the political capital of the leadership of the organization, of how much pressure they can put on the physicians — those final holdout physicians who aren’t using it. How much pressure can you put on them to incentivize them to use the system? There’s cost, both financial cost as well as a political cost.


If a hospital downloads the Guides, how much effort does it take for them to get far enough into the process to know where they stand?

In our preliminary evaluations, if you have either a very knowledgeable person or a group of knowledgeable people together, you can go through a Guide in under 30 minutes. There are nine Guides, so we’re talking four or five hours. If you took a half day, you could go through and get a pretty good feel for where you stood on these different items.


The obvious question without an obvious answer is that the government is paying incentives to get people use electronic health records. Now the government has issued a set of guidelines that says, “This is how you keep them safe,” and yet those factors are not tied to any incentive. Who’s supposed to run with this?

We’re not really sure right now what’s going to happen with them. Like I said, I’m placing my bets on insurance companies. The payers are the ones that can really enforce this. 

In one sense, the federal government is a payer. You could imagine CMS incorporating some of these recommendations in their Conditions of Participation and then making the Joint Commission responsible for looking at them. You could imagine public health departments saying something like this, or insurance companies saying, “We’re not going to approve this, or maybe we’ll incentivize you to use the SAFER Guides and give you a little more money if you have completed the SAFER Guides.”

We’re in the midst of negotiating with a lot of different organizations to try to get them to see who will step up and say, “This is a good idea. The people  we are working with ought to explain to us why they are or aren’t doing these kinds of things that are in the Guides”.


Are there other phases planned?

We have work planned, but we don’t have funding to do the work. Most of the criticisms we get fall into two categories. One is that there’s too much stuff on the Guides and they need to be shorter. The other criticism is, you left something out. When they say that we’ve left something out, they say, “We really need a Gguide for clinical documentation that would help people to understand how much copy-and-paste is allowable in a document.”

There’s also a lot of people who have been talking about a Guide for how to do  the patient engagement aspects of it — how should you configure your personal health record and what policies and procedures should go around the patient portal and their access to information. We certainly know there are at least two more Guides that would be very well received and are needed, but right now there’s no funding to develop them.


Do you have any final thoughts?

I would strongly encourage organizations to take a look at these Guides. They can really help an organization understand where they are and understand what the issues are.

A lot of people think that they’re unique and that things that they hear about don’t apply to them. When they see these Guides, they’ll realize that a lot of people are going through and struggling with these same issues. The leading organizations have pretty well come together and decided that backups are a good idea, for example, or physician order entry is a good idea. An organization would learn a lot by going through the Guides and seeing where they stand.

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January 30, 2014 Interviews 1 Comment

News 1/29/14

January 28, 2014 News 3 Comments

Top News

1-28-2014 6-24-30 PM

The VA opens procurement for VistA Evolution workgroup coordinators, the next step in replacing VistA Web with a single VA-DoD EHR viewer that supports mandated interoperability requirements. The solicitation was posted on January 27, leaving just nine days for interested companies to assemble and submit proposals by the February 6 due date.

Reader Comments

1-28-2014 1-19-03 PM

From Green Stamp: “Re: Dave Henriksen. Left Carestream Health, as you mentioned last week, and has moved on to NexTech Systems as president and CEO.” Dave’s LinkedIn profile confirms his new position with the PM/EHR vendor.

1-29-2014 3-05-40 AM

1-29-2014 2-46-58 AM

From Believe Me: “Re: CCHIT. Exiting the ONC certification business.” Unverified, but reported by more than one reader. CCHIT hasn’t responded yet. UPDATE: Verified, from an update on CCHIT’s site. CCHIT says ONC 2014 Edition certification requires a lot of testing and its federally-driven business is unpredictable, so it won’t accept any new applications for certification and recommends using ICSA Labs instead. CCHIT will change its business model to become a certification consulting firm and will partner with HIMSS to “provide both counsel and thought leadership to the health care provider and HIT vendor communities” that will include summits starting at the HIMSS conference, apparently still operating as a non-profit.  The most recent Form 990 I could find was from 2011, at which time it was paying Chairman Karen Bell $409K, Executive Director Alisa Ray $250K,  and five other employees over $100K. It would seem to me that given CCHIT’s genesis, mission, and name, it should just go away rather than trying to morph itself into the already overcrowded thought leadership business. It probably would if HIMSS wasn’t riding in on a white horse to save it, not surprising given that HIMSS formed CCHIT (along with partners AHIMA and NAHIT) in 2004.

1-28-2014 5-55-21 PM

From Hit Newbie: “Re: CMS. The MU attestation portal is having issues to Healthcare.gov. It’s laughable that there is still no API or portal designed for the volume. CMS says it won’t allow appeals for late attestations due to website downtime.”

From Bill Pare: “Re: HIMSS travel site. I notice that the login page is not encrypted. I find that ironic.” HIMSS uses a travel portal from nuTravel. I checked the company’s documentation and it says the registration page is encrypted with 128-bit SSL, but the HIMSS travel registration page is not encrypted.

HIStalk Announcements and Requests

1-28-2014 4-38-58 PM

HIStalkapalooza registration has closed with quite a few more requests than we have capacity. Imprivata will email invitations Tuesday, February 4.

Listening: new Dum Dum Girls, lo-fi jangly indie pop.

1-28-2014 5-39-46 PM

Welcome to new HIStalk Gold Sponsor Treehouse Resources. The company connects qualified Epic consultants with clients interested in hiring them at market-leading rates with hassle-free paperwork. The free, five-minute signup for consultants allows them to privately review opportunities that meet their career and life balance goals, even optionally becoming a W-2 hourly employee of Treehouse. Treehouse checks references and approves the consultants, then clients review the consultant profiles, arrange interviews, and let Treehouse manage the invoicing and billing. The company’s model (which is kind of like Angie’s List or Match.com) focuses on efficiency and doesn’t require recruiters or salespeople, meaning consultants make more money and clients pay some of the lowest rates in the country. At the moment, 487 consultants (of 1,100 who requested to participate)  and 88 clients have signed up. You most likely know the principals behind Treehouse, Glenn Galloway and Mike Tressler, both previously with Healthia Consulting and longtime friends of HIStalk. Thanks to Treehouse for supporting HIStalk.

Upcoming Webinars

February 5 (Wednesday) 1:00 p.m. ET. Healthcare Transformation: What’s Good About US Healthcare? Sponsored by Health Catalyst. Presenter: John Haughom, MD, senior advisor, Health Catalyst. Dr. Haughom will provide a deeper look at the forces that have defined and shaped the current state of U.S. healthcare. Paradoxically, some of these same forces are also driving the inevitable need for change.

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.

February 13 (Thursday), 12 noon ET. Advancement in Clinician Efficiency Through Aware Computing. Sponsored by Aventura. In an age of information overload, a computing system that is aware of the user’s needs becomes increasingly critical. Instant-on roaming for virtual and mobile applications powered by awareness provides practical ways to unleash value from current HIT investments, advancing efforts to demonstrate meaningful use of EHRs and improve clinical efficiencies. The presenters will review implementation of Aventura’s solution at Orange Coast Memorial Medical Center.

Acquisitions, Funding, Business, and Stock

1-28-2014 8-26-12 PM

Secure messaging provider TigerText raises $21 million in a Series B round. Its secure, industry-agnostic solutions sends encrypted messages that self-destruct after a preset time.

1-28-2014 4-42-11 PM

Perceptive Software reports adjusted revenue growth of 70 percent in Q4.

1-28-2014 4-43-20 PM

Patient engagement provider Relatient closes its first round of funding led by former AIM Healthcare Services president Jim Sohr. The company sends health-related messages including reminders for appointments, outreach, collections, and surveys.

1-28-2014 4-43-59 PM

Covisint reports Q3 financials: revenue up one percent, adjusted EPS -$0.10 vs. -$0.09.

1-28-2014 4-44-39 PM

Informatica reports Q4 results: revenue up 18 percent, adjusted EPS of $0.49 vs. $0.41, beating analyst estimates on both.

Apple reports Q1 numbers: revenue up 5.7 percent, EPS $14.50 vs. $13.81, beating expectations but releasing disappointing current-quarter guidance. Shares dropped 8 percent Tuesday on the news. Sales of the Mac and iPad beat expectations, but iPhone sales fell short and iPod sales were down more than 50 percent year over year. Analysts variously blamed smartphone sales, lack of new products, slow growth in China, and the inability of the iPhone 5c to create a strong low-cost entry in the smartphone market.


Kaiser Permanente Announces Data Warehouse Project

1-28-2014 4-45-15 PM

1-28-2014 4-46-05 PM 1-28-2014 4-46-33 PM

Health Catalyst closes $41 million in Series C funding led by Sequoia Capital and announces plans to invest $50 million in product development over the next 24 months. Investors also include customers Kaiser Permanente and Partners HealthCare.

I spoke to CEO Dan Burton and President Brent Dover before the announcement.

Burton says Kaiser will roll out Health Catalyst’s data warehouse platform for all 38 of its hospitals. “While we have worked with other large health systems – earlier in the year we signed with Partners in Boston and Providence – but Kaiser is almost in a class by itself in terms of size and scale. The nature of the first project is system-wide, a terrific test of the scalability of our platform.”

Burton says Kaiser will initially use Health Catalyst for two projects. “They have a specific need for system-wide access to a subset of data around transplant patients,” he explained. Dover added that Kaiser is working on a specific project for diabetic patients in Colorado. “Kaiser is reaching out to diabetic patients. They were going after patients using spreadsheets and complex SQL extracts. They told us Health Catalyst builds a cohort in 180 seconds when it used to take 180 days. This allows them to proactively go after patients for population health management.”

Eleven of Health Catalyst’s customers, including Kaiser, are Epic clients. I asked Burton why Kaiser chose a third-party tool over Epic’s Cogito data warehouse and reporting platform. “In our experience, it’s an apples to oranges comparison,” he said. “Cogito offers basic functionality from a data storage perspective that could meet rudimentary needs. We’re offering a data warehouse as a platform for transformation from an advanced clinical apps perspective.” Dover added, “When I worked at Medicity, customers always asked for analytics tools. No client really knows what they want to analyze – it’s a never-ending list. The market demands an incredibly flexible platform. We have 17 case studies and none of them have anything to do with each other – it’s what each of them needed to improve quality and cost.”

I asked Burton about the $50 million in product development to create 200 advanced clinical applications. “A couple of our longstanding customers, Texas Children’s and Stanford, worked on specific areas to identify inefficiency and variation of care in heart failure and asthma patients, showing where the variation existed, what needed to change, and tracking progress, even tracking the return on investment of the improvement. At a CEO level, said they need to target 20 applications per year over the next five years to measurably and meaningfully bend the cost curve to allow them to not only survive, but thrive and lead. That opened our eyes that what our clients are seeking is a roadmap. We decided to become a company that offers hundreds of analytic applications so we can be a long-term partner to help these health systems transform themselves.”


Vermont IT Leaders will incorporate Orion Health’s Rhapsody Integration Engine into its statewide HIE that runs on Medicity.

VHA selects Xerox to automate its healthcare claims pricing process.

Allina Health (MN) chooses Strata Decision Technology’s StrataJazz for cost accounting.


1-28-2014 9-37-23 AM

VMware names Chris Wolf (Gartner) CTO for the Americas.

1-28-2014 3-20-49 PM

Culbert Healthcare Solutions promotes Gibran Cotton to director of GE and Allscripts consulting.

1-28-2014 6-59-09 PM

Halifax Health (FL) promotes Tom Stafford to CIO.

1-28-2014 5-38-08 PM

Brian Ahier was interviewed last week in studio on WFED, Federal News Radio, where he talked about health IT and ONC’s recent annual meeting. He also gave a nice plug for HIStalk as the best place to keep up with healthcare IT news.

Divurgent hires Jeff Powell (AT&T) as client services VP and Anthony Jones, Shaun Sangwin (Vascular and Interventional Physician Partners), and Justin Stefano (MedSys Group) as regional client services directors.

Announcements and Implementations

1-28-2014 6-48-07 PM

Walter Reed National Military Medical Center (MD) implements AtHoc Interactive Warning System for mass notification and interactive hospital communications.

Long-term care provider Levering Management (OH) deploys the COMS Interactive Daylight IQ product suite covering disease management, care guides, and nursing assessments.

1-28-2014 11-43-27 AM

HIMSS announces that the ONC’s Karen DeSalvo, MD will offer opening remarks at 8:30 am, Thursday, February 27, the closing day of the HIMSS conference.Too bad the mass exodus of attendees will begin Wednesday afternoon.

1-28-2014 6-51-04 PM

OhioHealth O’Bleness Hospital goes live on McKesson Paragon.

Memorial Hospital (MS) goes live on Cerner March 15 and will later implement analytics software from Health Catalyst.

1-28-2014 6-00-09 PM

1-29-2014 4-08-03 AM

Hearst Corporation announces the creation of Hearst Health, a new brand that encompasses its healthcare information businesses that include First Databank, Zynx Health, MCG, Homecare Homebase, and Map of Medicine. It also involves a new startup fund, Hearst Health Ventures, and Hearst Health Innovation Lab, which will prototype internal and external health IT projects. The innovation lab will be run by Chief Innovation Officer Justin Graham, MD, MS, previously CMIO of NorthBay Healthcare (CA), who joined the company in July 2013.

1-28-2014 6-06-18 PM

Mobile Heartbeat announces Mobile Heartbeat CURE, a smartphone-based location and communications application for clinical teams.

1-28-2014 7-19-13 PM

Mobile charge capture vendor pMD will announce Wednesday a partnership in athenahealth’s More Disruption Please program in which its product will be integrated with athenahealth’s billing and practice management systems.


1-27-2014 2-07-13 PM

A Commonwealth Fund study finds that practice EHR adoption rose considerably from 2009 to 2012, but solo physician practices lag in use of functions such as electronic data exchange with other providers. Practices associated with IDNs had the highest rate of technology adoption.

Black Book names its #1 HIE vendors in several categories: Covisint (payer/insurer based); ICA (core HIE); Cerner (inpatient EHR); Allscripts dbMotion (ambulatory based); and Infor (complex technology services).

1-28-2014 7-32-35 PM

Microsoft will rename its SkyDrive could storage to OneDrive after losing a trademark battle with British broadcaster BSkyB.

1-28-2014 8-13-07 PM

Concierge medicine provider PlushCare launches an Indiegogo campaign to create its service and to provide children with immunity to measles. It’s a confusing combination, but donors who are California residents get email, telephone, and video visits, and as a bonus, recognition for immunizing a child. The company says two Stanford MDs will diagnose and treat simple illnesses or injuries the same day. The tech guy is Ryan McQuaid, former product head for AT&T ForHealth.

1-28-2014 7-45-43 PM

Something’s fishy here: a Canadian company called Kallo Inc. claims to have sold the Republic of Guinea $200 million US worth of healthcare software that includes systems for hospital, telehealth, and pharmacy. The fishy part is that the company’s shares trade OTC for $0.15, valuing the entire company at $46 million, with shares having dropped almost 30 percent on the news of the big sale.

Weird News Andy is breathless over these stories. Researchers find that use of mouthwash raises blood pressure and increases the risk of heart attack, although the study involved only 19 patients and the increase in diastolic blood pressure was small. Another group of researchers finds that dogs can be trained to smell cancer in the same way they can sniff explosives or human scents, leading to the possibility of creating instruments that can detect the same odors to sense cancer.

Sponsor Updates

  • Madison Memorial Hospital (ID) reports an annual benefit of $327,658 following the implementation of Craneware’s Chargemaster Toolkit and Pharmacy ChargeLink.
  • Wolters Kluwer Health and Laerdal Medical introduce vSim for Nursing, an online learning solution that simulates curriculum-driven patient scenarios.
  • 3M Health Information Systems releases an enhanced version of its Code Translation Tool to convert ICD-9-based custom problem lists into ICD-10 coded problem lists for import back into a provider’s existing EMR.
  • Forbes names Kareo to its annual list of “America’s 100 Most Promising Companies.”
  • Sandlot Solutions will offer the White Pine Systems SPINN patient engagement platform to its HIE and ACO clients.
  • InstaMed reports it enables payers to achieve the highest levels of electronic payment adoption with its fully integrated Claims Settlement Complete.
  • Physicians’ Choice (CA) discusses in a case study how it uses Capario to process more than 24,000 claims a month.
  • In a case study, Bozeman Deaconess Hospital (MT) shares how Quantros Safety Event Manager improved patient safety and satisfaction.
  • Nuance Healthcare reveals details of its Conversations Healthcare 2014 conference April 6-9 in Phoenix.
  • Alan Lundberg, Informatica’s principal marketing manager for emerging products, blogs about the value of business intelligence in business operations.
  • SCI Solutions launches Provider Network Manager, a technology platform and service for health systems to create better managed affiliations with independent and employed providers.
  • Bethesda Magazine spotlights GetWellNetwork founder and CEO Michael O’Neil, who discusses the creation of his company.
  • Novation awards Paragon Development Systems (PDS) a VAR agreement for hardware and IT services.
  • BlueTree Network co-founder Reggie Luedtke shares four healthcare trends to be excited about in a Forbes article.
  • CCHIT certifies that Healthwise Patient Education EMR Module version 10.0 is compliant with the ONC 2014 Edition criteria as a Modular EHR.


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

More news: HIStalk Practice, HIStalk Connect.


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January 28, 2014 News 3 Comments

HIStalk Interviews Alan Rosenstein, MD, Disruptive Physician Behavior Consultant

January 27, 2014 Interviews 1 Comment

Alan Rosenstein MD, MBA is an educator and consultant in disruptive physician behavior. He welcomes contact by email.

1-27-2014 10-15-03 AM 

Tell me about yourself and what you do.

I’m a physician. I also have an MBA. I still do a clinical practice in internal medicine a couple of days a week. I do a lot of consulting work around care management.

One of my other positions is being medical director for a company called Physician Wellness Services, which is in Minneapolis, although most of my career has been involved on getting physicians around best practice care.


You’ve done a lot of work with disruptive physician behavior. How is that defined or evidenced?

I got into this as vice president and medical director for the VHA West Coast. We would always look at how we could help the medical directors focus on the issues that they think are important. The usual span of issues are quality of care, cost of care, and physician relationships with the hospital. 

I started noting that they were putting down disruptive behavior as one of their key issues. This really got exacerbated during the nursing shortage. That’s when I started the original survey on what is disruptive behavior? Are you witnessing it? Who’s doing it? Where is it occurring? That led to all the research about how significant an issue it is and then what we can do about it.

We describe disruptive behavior as any inappropriate behavior that can negatively impact patient care. That’s the simplest definition.


When you look at other professions, are physicians more likely to be disruptive, or it just more easily perceived because of the work environment they practice in?

It’s a combination of both. There are certain personality traits that lead people to go to medical school. It’s very competitive. They’re very ego-centric. During the medical school process, you’re taught very autocratic, independent, autonomous types of behavior. Physicians give orders. There is that personality that’s built in. 

Healthcare is a very hierarchical system. Physicians are on top of the totem pole. They’ve usually had their free way in giving orders and not taking any responsibility for their actions, although their actions are really aimed at best patient care. 

That in combination with the fact it’s a really stressful environment. In fact, if you look at where disruptive behaviors occur most frequently, it’s in either stressful areas — such as surgery, the emergency room, or OB — or in very stressful situations where the patient is having a negative outcome or the severity is increasing and they’re taking a turn for the worse and the physician needs to get involved. Sometimes they don’t do that in the most cordial manner.


In my experience , physicians who staff perceive as problematic and prone to explosive tempers are often respectful to their patients and even have great bedside manner.

I’m not sure they have great bedside manner with the patients. I think their intent is 100 percent, “I want to do the best for you, and in a crisis situation, I’m the one who knows best and I really need to take control.” That’s all appropriate, but many of these physicians are not good. 

in our research and others, we’ve shown that three to five percent of physicians — and nurses, actually — are truly disruptive. This can have a significant impact on the organization. But what we also found is that 40 to 45 percent of them are ineffective communicators. If you go back to that medical school, you’re trained in technology, you’re trained in knowledge competency, but you’re not trained in personal skill development. 

Now with healthcare being so complex, there’s many physicians in on a case, many other providers who are not physicians. The physician needs to better communicate and coordinate with them and also to present it effectively to the patient. 

I’m not sure that they have the best bedside manner, but they certainly are doing it with the intent of, “I need to take control.”


Is that behavior rewarded more readily for certain specialties, like cardiothoracic surgeons versus pediatricians?

Why do people act disruptively? First of all, many people act disruptively and they don’t even know they’re doing it because they don’t understand the downstream effect. A lot of the research has shown there’s a significant downstream effect where patient care is actually compromised.

They’re acting disruptively because they need to take control. They feel like they need to give the orders and get the best patient outcome. They’re doing it to try to provide best patient care, but they don’t realize what they’re doing or how it’s impacting, or most importantly, the long-term impact of what they’ve done. 

Eventually it gets to the point where you antagonize a person so much … in the short term, they’ll hopefully do what you’re asking them to do, but moving further down after the crisis, they don’t want to communicate with you any more. These communication gaps lead to problems with the patient outcomes of care.


Does medical training encourage or at least support disruptive behavior? Do you see that changing as newer generations of practitioners emerge who have been trained more as a team member rather than a single player?

Yes, absolutely. What we’re finding right now in medical schools is that they’re beginning to realize how important personal skills, communication skills, and teamwork skills are. 

Three things are happening. One is the MCAT, which is the Medical College Admission Test. They’re now posing more questions on the humanities, not just math and science. Two, as far as the people who are majoring, they used to major in chemistry or biology, now they’re looking for people who major in sociology and philosophy. Three, and most importantly, a lot of the more progressive medical schools are beginning to teach communication, collaboration, and personal skills during the freshman year of medical school to get away from this autocratic or independent behavior.


For physicians trained under that different model that no longer applies, it must be difficult when hospitals are acquiring practices, exercising more control in ACO-type arrangements, and mandating use of EHR systems that impose standardized care guidelines and require doctors to document themselves in ways that don’t benefit them. Does that feeling of loss of control elicit disruptive behavior?

Absolutely. One of the things that I talk about is why do people behave the way they do. I talk about the internal things. Age — those different values and attitudes based on your age and your generation. There are gender differences between men and women in how they view stress and how they handle stress. There are differences from culture and ethnicity, power, issues related to gender, issues related to dominance. Then there’s all the stuff from your life, upbringing, what you’ve been exposed to.

Those are the internal factors. Those can be addressed, maybe by sensitivity training or communication skills training. 

The external events — one of them you hit on — is from healthcare reform and initiatives and the electronic medical record. There’s now more and more pressure on providers, not just physicians, to be able to demonstrate and document good value care based on what other people think, not necessarily what they think. More adherence to guidelines telling you what you can and you cannot do. Taking people away from the bedside, spending more and more time on fulfilling all the requirements of the documentation. That gets everybody very frustrated because they just want to practice good care. 

One of the key concerns right now is the significant amount of stress, burnout, and frustration that’s hitting our physician workforce as well as others. A lot of them are trying to change jobs, get out of the profession, or retire early. That’s a real issue right now, because we are — if not currently, tomorrow — going to have a workforce shortage. 

One of the things that organizations need to do as they acquire physician practices and as they get them to adhere and be compliant with their protocols, their electronic medical record — they have to work with them to help them bring them up as a precious resource and not tell them, “This is what you have to do or else.”


What tips would you have for CIOs and CMIOs on the most constructive way to deal with physicians, especially those who have a reputation of being disruptive or resistant?

On the global level, physicians needs to understand why you’re asking them to do certain things. You need to raise the business case of why reducing variation and improving efficiency is going to get you the best patient outcome. That’s what you really want in the end, whether it’s a quality issue, whether it’s a cost issue, or whether it’s a satisfaction issue. Our goal is to make the patients get the best value out of a healthcare interaction and no one, no matter where they’re coming from, is going to say that’s not an appropriate goal. So you need to set the business case.

The second thing is you need to talk about what protocols and what enhancements you have, either technological or care management, and explain to them why we’re doing this — the idea that you reduce variation, we’re trying to do best-practice care, this will give you the best practice outcome. 

The most important thing is they want us to sit down and talk to them and listen. One of the frustrations from physicians is, “I have a concern, I have a problem, I have an issue, but no one is taking the time to talk to me about what my individual concerns are.” 

One of the key steps is that you need to sit down and talk to the physicians and find out what their resistance is based on what their barriers are. If you can potentially address some of those barriers, that’s something that the organization really needs to do. 

The last piece is that besides the business case and the support, you want to provide ongoing training. When you implement or you go live, make sure that you have these work groups that are readily available to help the physician get through what they really need to get through.


Pushback against systems like CPOE seems to have lessened. Are people learning how to deal more constructively with physicians or are physicians just resigned that they have to do it?

A combination of both. People are being resigned. Remember, for physicians, it’s not just the inpatient record, it’s also the office record. With Meaningful Use and with billing, you need to get into the electronic, so there is a business reason for them. I think the technology is there.

Certainly with the newer physicians who were brought up on technology, this is not an issue. It’s mostly the physicians who have been in practice for 20 to 30 years. They’re very used to their ways of doing things and don’t understand why they need to change. With the growing need that everybody is going to have to be up and running on electronic medical records, the physicians are recognizing that this is something they really need to participate in. 

The organizations do realize this, and as they implement these new medical records, they are very concerned about getting them on board and doing the appropriate training.


Do you have any final thoughts?

Part of it is the electronic medical record and part of it is the way the physicians behave. Physicians are a precious resource. I really do believe that all they really want to do is to do their job. Everything seems to get in the way, and some of those things are right.

Reducing variation, improving efficiency and productivity, and maximizing best patient outcomes is an absolute right thing to do. But I think organizations need to recognize that physicians are frustrated, they’re angry, they’re burned out, and they’re stressed. They need to spend more time in working with the physicians to prevent the inappropriate and truly disruptive behaviors, which can have a profound, negative impact on the organization.

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January 27, 2014 Interviews 1 Comment

Morning Headlines 1/27/14

January 26, 2014 Headlines No Comments

Athenahealth Seaholm deal faces tough questions at City Council

Several Austin (TX) City Council members are questioning the decision to offer athenahealth incentives to open a new office in its busy downtown business district. The council members hold the opinion that the city is capable of attracting new jobs and filling office space in the business district without offering perks.

Dynamic modeling of patient and physician eye gaze to understand the effects of electronic health records on doctor–patient communication and attention

The International Journal of Medical Informatics publishes a study that correlates EHR use with a drop in doctor-patient eye contact when compared to practices that use paper charts.

UK ministers cap government IT contracts at £100m

In England, new rules published Friday limit government IT contracts to $165 million unless there is an "exceptional reason", eliminates automatic contract renewals, caps hosting contracts at two-years, and requires that software be implemented by a company other than the software or hardware vendor.

BIDMC Aims To Engage Patients and Families in Effort to Eliminate Preventable Harm in Intensive Care Units

Researchers from Beth Israel Deaconess Medical Center receive a $5.3 million grant from the Gordon and Betty Moore Foundation of California to develop an IT system that will help monitor for, and reduce, preventable harm in ICU patients.

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January 26, 2014 Headlines No Comments

Monday Morning Update 1/27/14

January 26, 2014 News 10 Comments

1-25-2014 7-29-00 AM

From Brute Forceps: “Re: Leidos Health. President Steve Comber is stepping down.” Unverified, but BF included a purported email from Steve to his team announcing his departure. “Our Executive Leadership, along with the Board of Directors, have made a decision to further invest in health by adding a recognized & proven industry leader at the forefront of our health business. As such, in the very near term a search will be underway for a health expert / leader who will be chartered with the responsibility of taking our health business to the next level.”

From Cabana: “Re: [company name omitted.] They are blocking access to your site after you wrote something uncomplimentary about them.” It’s my crowning achievement when a company blocks access to HIStalk. Given previous examples involving clueless, egotistical executives intent on guiding their enterprises right into the ground, I can say with confidence that employees reading factual information on HIStalk should be the least of their worries.

1-26-2014 7-03-37 AM

From Scooper: “Re: Martin Hospital. You scooped the main media on their EHR crash.” I just happened to have a reader with a friend who was admitted at the time and he passed the information along to me. CIO Ed Collins was nice to provide a response. The contact said it was chaos in the hospital, with confused employees assigning random numbers to patients, runners delivering paper copies of everything, medication errors occurring, and unhappy family members threatening to sue everything that moved (all unverified, of course.) The hospital says the problem was hardware, not Epic, and claims (as hospitals always do) that patient care wasn’t impacted. Of course patient care was impacted – the $80 million system that runs everything went down hard. It would be interesting for Joint Commission or state regulators to show up during one of these hospital outages anywhere in the country to provide an impartial view of how well the downtime process works. All that aside, downtime happens and the key is preparing for it, just like Interstate Highway construction and lane-closing accidents. It’s not a reason to drive a horse and buggy.

1-26-2014 7-06-58 AM

From Keith: “Re: UCSF death in the stairwell case. Four caught snooping.” San Francisco General Hospital announced for the first time Friday that a routine audit of the electronic records of high-profile patients turned up four employees who looked at records of the patient who was found dead in a hospital stairwell in October 17 days after she disappeared from her inpatient bed. Two of the employees have been fired and two were suspended. The hospital announced changes Friday as mandated by CMS after the incident, in which the hospital performed an incomplete search, alarms and cameras were found to be out of order, an incorrect description of the patient was issued to searchers (the hospital said to look for a black woman in a hospital gown, but the patient was white and wearing her own clothes), and the sheriff’s department failed to follow up on a report of a body lying in the hospital’s stairwell.

1-25-2014 7-32-23 AM

From The PACS Designer: “Re: Windows upgrades. The decision to upgrade from Windows XP, which will go off support in April, will be a challenge for most of us. Do we go to Windows 7, 8.1 or wait for Windows 9? Most likely Windows 7 will not be that choice due to its limited future with Windows 9 coming. Windows 8.1 with its rumored Upgrade 1 will be a likely choice since it will be easier to make the move to Windows 9 when its ready for release.” Windows 8 has been an amazing success with one group – the companies that sell add-ons to hide the absurdly annoying tile-driven Metro user interface. It’s probably fine if your computing needs are so basic that you can use a touch screen, but if that’s the case, you might as well just use a tablet, preferably one not running anything from Microsoft.

1-25-2014 6-36-53 AM

No clear trend exists for vendor layoffs, respondents said. New poll to your right: how often do you check your work email after hours and on weekends?

Upcoming Webinars

February 5 (Wednesday) 1:00 p.m. ET. Healthcare Transformation: What’s Good About US Healthcare? Sponsored by Health Catalyst. Presenter: John Haughom, MD, senior advisor, Health Catalyst. Dr. Haughom will provide a deeper look at the forces that have defined and shaped the current state of U.S. healthcare. Paradoxically, some of these same forces are also driving the inevitable need for change.

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.

February 13 (Thursday), 12 noon ET. Advancement in Clinician Efficiency Through Aware Computing. Sponsored by Aventura. In an age of information overload, a computing system that is aware of the user’s needs becomes increasingly critical. Instant-on roaming for virtual and mobile applications powered by awareness provides practical ways to unleash value from current HIT investments, advancing efforts to demonstrate meaningful use of EHRs and improve clinical efficiencies. The presenters will review implementation of Aventura’s solution at Orange Coast Memorial Medical Center.

HIStalkapalooza last chance: registration to request an invitation ends Wednesday. We’re planning to email invitees the following Tuesday, February 4. Thanks to Imprivata for sponsoring the event – it’s going to be a big deal.

1-25-2014 7-34-47 AM

Welcome to new HIStalk Platinum Sponsor Greencastle. The Malvern, PA-based company was founded in 1997 by two former US Army Rangers who brought to the consulting world the military concepts of sense of purpose, discipline, teamwork, and systematic methods. They make it a point to hire junior military officers (among others) and help them apply their skills to the corporate world. Greencastle consultants are ready to take responsibility for large-scale clinical and business initiatives to help healthcare organizations maximize the value of change. Services include clinical systems implementation, application consulting, project management, and system selection. The company did a CHIME focus group presentation on building a business case for analytics and offers white papers. Thanks to founders Celwyn Evans and Jacob Kretzing for their military service and to Greencastle for supporting HIStalk.

Listening: Failure, deeply lush, ambitious, influential, and prophetically named 1990s alt-rock (Pink Floyd meets Radiohead) that nobody’s heard of despite their stunning 1996 concept album masterpiece “Fantastic Planet,” which they played great live. They broke up in 1997, but are reuniting this year. 

South Nassau Communities Hospital (NY) adds dbMotion and FollowMyHealth to its Allscripts portfolio, joining Sunrise.

Beth Israel Deaconess Medical Center (MA) receives a $5.3 million private grant to develop IT-driven ICU tools that include a patient-specific clinician checklist dashboard and a patient-family communications display. BIDMC joins Johns Hopkins Medicine, UCSF, and Brigham and Women’s as part of the Libretto ICU Consortium of the Gordon and Betty Moore Foundation.

A federal judge orders St. Luke’s Health System (ID) to divest itself of the Saltzer Medical physician group it bought last winter, saying the hospital’s ownership of 80 percent of the primary care doctors in Nampa, ID would give the health system an unfair bargaining position with insurance companies even though the intent of the acquisition was motivated only by improved patient outcomes. St. Luke’s had defended the acquisition in responding to a lawsuit brought by competitors and the Federal Trade Commission, arguing that the merger would support new risk-based care models and that its $200 million Epic system will be better than anyone else’s when implemented.

1-26-2014 7-24-19 AM

NHS Hack Day was held this past weekend in Cardiff, Wales, bringing together people with healthcare-related problems and developers ready to build rapid software prototypes to solve them.

A eye movement study of 100 primary care patient visits finds that EHR-using doctors spend a third of their time looking at the computer monitor, making it hard for patients to get their attention and reducing the physician’s ability to listen and think. The study also found that patients look almost constantly at the EHR screen instead of their doctor even though they have no idea what anything on it means. The author suggests that vendors design EHR displays that both physicians and patients can use.

1-26-2014 7-16-50 AM

Several members of Austin’s city council question the city’s plan to offer athenahealth incentives to move one of its operations there when demand for Austin commercial space is already high. Said one of the council members, “While it’s great that the company is looking to hire locally, we don’t have 336 software people that are unemployed right now. That’s not a target area and it could be an onus on companies that we already here.”

1-25-2014 10-52-28 AM

In England, ministers vote to limit government IT contracts to $165 million other than for an “exceptional reasons,” also barring vendors that provide hardware and software from implementing their products themselves. Contracts will also be limited to a two-year term with no automatic extensions. According to Cabinet Office Minister Francis Maude, “Big IT and big failure have stalked government for too long. We are creating a more competitive and open market for technology that opens up opportunity for big and small firms.” Maude drove the government’s “digital by default” effort to centralize government websites and use technology to make its services more efficient.

The board of Cookeville Regional Medical Center (TN) approves a five-year, $1.5 million expenditure for RelayHealth’s patient portal.

1-25-2014 10-34-40 AM

Puget Sound Blood Center (WA) issues an emergency appeal for blood donations after a regional telecommunications outage forces it to cancel blood drives and donor collection.

1-25-2014 10-24-53 AM

A man cleaning the vacated office of an Ohio family practice physician finds an old computer containing the electronic records of 15,000 patients. The doctor had told the man to keep anything he wanted and send everything else to the trash. The doctor says the PC was left behind by mistake and he wants it back, adding that it is password protected, but the local newspaper found the desktop icon above that opens a Word document containing the names and passwords of all the practice’s employees.

1-25-2014 8-43-12 AM 1-25-2014 8-47-08 AM 1-25-2014 8-48-01 AM

Weird News Andy titles this story “Jailhouse Rock” and adds a guitar pun in proclaiming the protagonist to be “high strung.” A 54-year-old male patient  claims to be Pink Floyd’s David Gilmour and Rush’s Alex Lifeson during several hospital stays, telling the hospitals that his agent would take care of his bill. Obviously not only did hospital staff not ask for ID, they don’t know either band very well because the man’s resemblance to either guitarist (above) is slight.


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

More news: HIStalk Practice, HIStalk Connect.


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January 26, 2014 News 10 Comments

Morning Headlines 1/24/14

January 24, 2014 Headlines No Comments

Quality Systems, Inc. Reports Fiscal 2014 Third Quarter Results

Quality Systems Inc., parent company of NextGen, release their Q3 results: total revenue decreased five percent compared to the same period last year. Adjusted EPS was $0.11 vs $0.26, a 62 percent decline. Still, shares rose eight percent on the results by the end of trading.

Best-of-breed oncology vendors hold their own

KLAS finds that McKesson is leading the medical oncology market, while Cerner and Epic continue to improve. Best of breed vendors are still leading the radiation oncology market.

US and UK working to strengthen use of health IT for better patient care

HHS Secretary Kathleen Sebelius and U.K. Secretary of State for Health Jeremy Hunt sign a bi-lateral agreement between the nations committing to: share medical data, share and co-develop quality indicators, promote the adoption of EHRs, and foster innovation in health IT.

Healthcare Information Technology and Healthcare Information Services: 2013 Year-End Review

Healthcare Growth Partners publishes its annual review of the healthcare IT market, and its current and predicted future financial drivers.

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January 24, 2014 Headlines No Comments

News 1/24/14

January 23, 2014 News 3 Comments

Top News 

1-23-2014 8-33-43 PM

At ONC’s annual meeting on Thursday, HHS Secretary Kathleen Sebelius UK Secretary for Health Jeremy Hunt sign a collaboration agreement between the US and UK that calls for sharing quality indicators, exchanging data and interoperability ideas, maximizing healthcare IT usage, and encouraging health IT innovation.

Reader Comments

1-23-2014 5-33-01 PM

From Freedom Rock: “Re: Martin Health System, Stuart, FL. A friend who is there says their $80 million Epic system is down throughout three hospitals and many other facilities and physician offices. They’re calling in off-duty nurses and clerks to go back to paper.” I asked CIO Ed Collins, feeling guilty as I did so knowing as an IT person how annoying it is to field questions about downtime when you could be fixing it instead, but he was gracious to provide a response Thursday afternoon:

“Martin Health System had a hardware failure that has resulted in our network being down. The failure occurred the evening of Jan. 22 and we are continuing to work on rectifying the situation. Epic is among the systems being impacted by this hardware failure, however, it was not the genesis of the problem. We are continuing operations as scheduled, while strictly monitoring any potential patient safety concerns or issues that would require appropriate care determinations to be made. Our patient care teams are following downtime procedures and protocols to ensure patient safety and proper documentation is provided.”

1-23-2014 6-37-04 PM

From Macke: “Re: Dave Henriksen. The former SVP/GM at McKesson who left to become president of healthcare information solutions at Carestream Health in July 2013 has left Carestream.” Verified. A Carestream spokesperson says Henriksen has left the company for an unspecified opportunity.

HIStalk Announcements and Requests

inga_small Some of this week’s highlights from HIStalk Practice include: EMRs helped improve the identification and follow-up of infants born infected with hepatitis C. Connecticut IPA Medical Professional Services selects athenahealth’s Population Health Management platform. Provider engagement and administrative issues present the biggest challenges to practices adopting and implementing EHRs. The biggest complaint patients have about their physician: waiting in their office. CMS seeks EP participation in the 2013 PQRS-Medicare EHR Incentive Pilot. Twelve HIT vendors discuss emerging technologies expected to have the biggest impact on physician practices over the next 12-18 months in the second of a three-part series. Dr. Gregg ponders if HIT has jumped the shark. Thanks for reading.

I like it when companies issues press releases announcing their HIStalk sponsorship, so thanks to Coastal Healthcare Consulting for doing just that.

On the Jobs Board: Principle Clinical Healthcare Consultant, Marketing Manager, Sales Engineer – Boston or Raleigh.

Upcoming Webinars

February 5 (Wednesday) 1:00 p.m. ET. Healthcare Transformation: What’s Good About US Healthcare? Sponsored by Health Catalyst. Presenter: John Haughom, MD, senior advisor, Health Catalyst. Dr. Haughom will provide a deeper look at the forces that have defined and shaped the current state of U.S. healthcare. Paradoxically, some of these same forces are also driving the inevitable need for change.

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.

Acquisitions, Funding, Business, and Stock


VMware will buy mobile technology management vendor AirWatch for $1.54 billion. VMware gains secure mobile device credibility to its story for enterprises, including hospitals, that are shifting from fat client desktops to virtualized and mobile devices.

1-23-2014 3-40-06 PM

Quality Systems reports Q3 results: revenues down five percent; adjusted EPS of $0.11 vs. $0.29, missing estimates on both due to previously announced problems with its hospital software division. Shares rose 8.4 percent Thursday after the announcement before the market opened.

1-23-2014 10-04-45 PM

Microsoft announces Q2 results: revenue up 14 percent, EPS $0.78 vs. $0.76, beating estimates of both.

1-23-2014 3-40-43 PM

Proteus Digital Health, a developer of patient-care and self-health management technologies, closes $31.6 million in debt financing expansion. The company had previously raised around $160 million in funding. Proteus sells miniature medication tracking sensors (smart pills) that are activated by gastric contents, sending the information to skin patches that then forward the information via mobile device to a central service and allowing clinicians and family members to track oral medication intake.

1-23-2014 3-42-05 PM

Telehealth services and software provider MDLive raises $23.6 million.  It offers around-the-clock consumer access to doctors. An individual plan costs $15 per month and includes one-day physician response to emails; phone or video visits cost $20. The company’s previously announced partnerships include Cigna and Sentara Healthcare (VA). One of its financial backers is former Apple CEO John Sculley, best known for firing Steve Jobs from Apple.


1-23-2014 1-01-15 PM

Parkview Health (IN/OH) will implement business analytics and denials management solutions from Streamline Health.

The District of Columbia Primary Care Association joins The Guideline Advantage quality improvement program, which uses population health management tools from Forward Health Group.

OSF Healthcare (IL) chooses Strata Decision Technology’s StrataJazz for budget and management reporting.


1-23-2014 1-33-33 PM

EDCO Health Information Solutions promotes Lynne Jones to president.

1-23-2014 6-53-23 AM

The Pennsylvania eHealth Partnership Authority HIE names the state’s HIT coordinator Alexandra Goss executive director.

1-23-2014 1-35-08 PM

HIMSS names Emanuel Furst (Improvement Technologies) the recipient of the 2013 ACCE-HIMSS Excellence in Clinical Engineering and Information Technology Synergies Award.

Announcements and Implementations

Philips Healthcare launches a Healthcare Informatics Solutions and Services business group to be led by Jeroen Tas, who previously served as CIO for Philips. It will offer hospitals clinical programs, analytics, and cloud-based platforms. The company also reorganized its North America Healthcare sales organization.

Mississippi Gov. Phil Bryant announces the launch of the Mississippi Diabetes Telehealth Initiative to improve disease management and health outcomes for diabetic patients. The program, which is a joint effort between the University of Mississippi Medical Center, GE Health, North Sunflower Medical Center, and C Spire, will use telehealth technology to connect UMC providers with diabetic patients in the Mississippi Delta.

1-23-2014 9-52-01 PM

Santa Clara Valley Medical Center (CA) goes live with RTLS asset management from Intelligent InSites.

Government and Politics

In his annual budget address, New York Gov. Andre Cuomo proposes a $95 million plan to digitize patient records using $65 million in state funds and $30 million from the federal government’s Medicaid program.

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New National Coordinator Karen DeSalvo kicked off ONC’s annual meeting Thursday morning, mostly providing some background about herself and talking yet again about Hurricane Katrina like it was yesterday instead of eight years ago. HIMSS marketed the heck out of that disaster as a call to arm for electronic medical records (as sold by the vendors who provide most of its income, and when that didn’t help sales much, along came HITECH) and now KD has ridden it into the National Coordinator chair as her primary credential even though I haven’t seen any proven Louisiana outcomes that resulted. Her EHR experience isn’t clear, but she has a great public health background. I liked that she characterizes HITECH money as the involuntary taxpayer gift that it was, referring to it as “major investments by the American people.” She seems nice enough and her speech was friendly if not particularly powerful, although her uptalking made her sound less authoritative and is sure to drive mellifluous members of Congress who are used to polished oratory crazy. Nitpicking aside, I like her so far.

1-23-2014 8-25-41 PM

In England, Secretary of State for Health Jeremy Hunt urges hospitals to treat patients like people and for clinicians to work together as teams, suggesting that British doctors to behave like US hospitalists in taking responsibility for the patient’s entire stay from plan to handoff, including putting their names up on the wall of the patient’s room as being responsible. He also urges adoption of information-sharing technology, studying whether medical specialties are too specialized, and reducing patient transfers. I don’t know much about him or his politics, but I like him.


A Microsoft research project uses Kinect to help stroke victims recover.

1-23-2014 6-56-34 PM

An irrationally exuberant and painfully breezy INC Magazine article declares mHealth to be “the trillion dollar cure” and “the miracle cure for the rising cost of health care in America” in which “smart startups are already cashing in” and that mHealth is “up for grabs, providing an extraordinary opportunity for medically minded entrepreneurs.” It quotes HIStalk Connect’s Travis Good (“a physician and influential blogger on health care technology”) and Palomar Health Chief Innovation Officer Orlando Portale, both of whom contributed just about the only thoughtful content amidst the hype. Like mHealth itself, the article is all over the place with a hodgepodge of apps ranging from weight loss to vital signs monitoring. It isn’t convincing in the slightest that most of them are either effective or destined for financial success, much less the cure for healthcare’s quality and cost problems, but business magazines like to make everything sound like a sure thing.  

1-23-2014 9-58-33 PM

Speaking of mHealth, you know it has jumped the shark when former basketball player Shaquille O’Neal gets involved. Shaq says he’s working with Qualcomm on wireless and health technologies (I hope that won’t interfere with the making of Kazaam 2 or the next “Shaq Fu” album). Cynicism  aside, Shaq actually has meaningful comments, not surprising since he’s a smart guy (he earned an Ed.D doctoral degree in 2012):

I have been using a FitBit, a connected activity monitor, to manage my fitness levels and am finding motivation in the real-time data I can collect on my movement—or lack thereof! Not only can mobile health technologies be engaging, social and easy-to incorporate into your everyday lifestyle, but using them for health monitoring will actually save between $1.96 billion and $5.83 billion in health-care costs worldwide by 2014. The latest technologies can’t solve all of our problems, though. Throughout my career I have found that when individuals come together for a common goal, whether it’s to win an NBA championship or reduce the number of people with chronic disease globally, greater results are achieved. We are on the verge of a new wave of breakthroughs in medical and wireless technologies, legislation and more, but unless we all come together to collaborate across public and private sectors and across educational systems and research institutions we will not see significant change and improvement.That’s why I am joining forces with the World Economic Forum, who are encouraging a global shift towards healthy living and supporting healthy, active lifestyles at individual, community and societal levels.

1-23-2014 8-08-28 PM

A Wall Street Journal report says IBM’s Curam eligibility software is responsible for problems with health insurance exchanges in Maryland and Minnesota.


1-23-2014 1-43-56 PM

Cerner and Epic are making inroads in the medical oncology market, but product immaturity is leaving providers with a lack of functionality, according to a KLAS report. Radiation oncology is still a best-of-breed market with Elekta and Varian as the main competitors.

1-23-2014 5-44-54 PM

A HIMSS heads up: I didn’t realize that the Peabody Hotel in Orlando, across from the street from the convention center and the favored gathering place for well-heeled HIMSS attendees (meaning I’ve never stayed there, although we did hold the first HIStalkapalooza there in 2008), was sold in October for $717 million. It’s now the Hyatt Regency Orlando and is being marketed to mouse ears-wearing tourists. The famous ducks are gone, and given the prohibitive expense of shipping them back to the only surviving Peabody in Memphis, they may well have ended up as a l’orange.

A study finds that the use of EHRs improves the follow-up in identifying and treating babies born to mothers with hepatitis C. Identification of at-risk patients increased from 53 percent to 71 percent, while appropriate follow-up jumped from 8 percent to 50 percent.

1-23-2014 7-22-39 PM

Healthcare Growth Partners releases its 2013 Year-End Review report, which is as insightful, rich in detail, and downright eloquent about healthcare in general as it is healthcare IT investments. I would say it’s a must-read for anyone interested in the business side of healthcare delivery. An excerpt:

HGP remains very bullish on the health IT sector. Creating an environment of connected networks and transparency is core to addressing the structural flaws of the U.S. healthcare system, and IT is critical to enable the reform initiatives underway and any reform initiatives that may follow. The need is high, the runway is long, and the consequences are significant – as long as we get out of the way of ourselves, health IT stands to completely redefine not only the delivery of healthcare but also the management and sustainability of health.

inga_small The dearth of HIT fashion-related news is finally over, thanks to B-Shoe, a start-up company that is testing a walking shoe that helps prevent falls. Designed for seniors or the physically challenged, the shoe incorporates pressure sensors and an algorithm that detects imbalance, plus a motion device that rolls the shoe slightly until the wearer regains his balance. Perhaps there will be a stiletto version by the time I’m in need.

Weird News Andy makes a Roman numeral pun in calling this story “The 4th Doctor.” A company called IV Doctor makes house calls in New York to deliver a $200 hangover-curing IV solution, even providing a sales video. Those who attended the HIMSS conference in Las Vegas will recall my mentioning a similar service in that city.

1-23-2014 8-53-42 PM

WNA also turned up this story. A Nashville opera singer says a nurse-midwife’s episiotomy incision ended her mezzo-soprano career when it caused her to experience incontinence and excessive flatulence. She’s suing the federal government for $2.5 million since the treatment was provided by the Army, in which her husband was serving at the time.

Sponsor Updates

  • Solstices Medical will use Infor Cloverleaf to integrate its DOCK-to-DOC platform with clinical, financial, and supply chain systems, including Infor Lawson Enterprise Financial Management and Chain Management for Healthcare.
  • Vonlay adds 4,000 square feet in office space to its existing Madison, WI headquarters.
  • CCHIT awards Iatric Systems Meaningful Use Manager ONC HIT 2014 certification for all 29 clinical quality measures.
  • Kareo integrates its PM application with the Nexus EHR.
  • Connance CEO and Co-Founder Steve Levin and Gwinnet Hospital System (GA) VP Cathy Dougherty author an HFM Magazine article, “A New Imperative for Patient Relationship Management.”

EPtalk by Dr. Jayne

A recent post on the Harvard Business Review blog discusses research indicating that smartphone use after 9 p.m. can make workers less productive the following day. Their work concludes that phone use causes sleep disturbances that impact work performance. Their two studies will be published later this year and I’m looking forward to seeing the details.

In the first study, they used a survey approach where each participant’s survey response data was analyzed individually over a two-week period. It had a relatively low number of participants (fewer than 100) but showed that increased phone use impacted sleep, creating work issues the next day. The second study had twice the number of participants with more diverse occupations. In addition to daily surveys, they measured use of phones, laptops, tablets, and televisions. The data indicated that smartphones had a greater impact than other devices.

As a physician, I enjoy being able to remotely access my patients’ charts, handle refill requests, process lab results, and take phone messages without being tethered to the office or to a PC. For me, however, using my phone to handle these tasks is a choice. Since my physician income is based on an “eat what you kill” model, I understand the value of my time and can make an informed decision to work outside the office or not.

Our ambulatory EHR has a great mobile product. Logging in and accessing a patient chart takes just a couple of seconds. This has made cross-covering after-hours call for colleagues much easier. I provide better care because I know more about the patients. I don’t have study data, but it would seem to be safer (not to mention more convenient) for the patient if I can address the issue based on the information in the chart rather than sending patients to urgent care. It also makes documenting those phone calls a snap.

Putting on my CMIO hat, however, I worry about the prevalence of working outside the office. Despite various office policies and customs encouraging staff to stay off email after hours, we’re having increasing challenges with staffers who continue to work long after the work day is over. Many of our employees are able to use flex time to accommodate family issues and expect to see some after-hours access in that circumstance. We’ve had some significant weather events with multiple school cancellations this winter, so quite a few parents have been working at home.

Barring flex time arrangements, however, I don’t expect to see people online at 8 or 9 at night unless it’s a scheduled maintenance event, and in that case, it would be happening after 11 p.m. Why is this behavior growing, then? Our health system has been through a couple of rounds of downsizing in the last couple of years and I wonder what impact that has had on people working after hours. Are employees trying to work longer and harder to distinguish themselves from their teammates in the event of another reduction in force? Are they young motivated analysts trying to get ahead? Are they just workaholics? I’d be interested to hear if readers in the trenches are seeing the same trends and what they’re doing to address them.

I beat Weird News Andy to the punch on this one. A Wisconsin medical examiner agrees to a plea deal after being accused of stealing body parts. According to the Wausau Daily Herald, she is accused of taking a piece of cadaver spine and human tissue “to train her dog.” Next time I’d suggest a Milk Bone or possibly a package of Snausages.


Earlier this week in Curbside Consult, I mentioned that I’m going to need roller skates to maneuver through everything we need to accomplish in 2014. Thanks to @SmyrnaGirl who found me the perfect pair. I bet Inga will be jealous.


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

More news: HIStalk Practice, HIStalk Connect.


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January 23, 2014 News 3 Comments

Morning Headlines 1/23/14

January 23, 2014 Headlines No Comments

Results of Health IT Research Review Positive Overall, but Some Topics Need More Focus

An ONC EHR literature review finds that the number of EHR-related studies is increasing about 25 percent each year, most of them focused on clinical decision support and CPOE. Other important EHR functions, such as e-prescribing and interoperability, were the subject of fewer studies.

VMware to buy mobile security firm AirWatch for $1.54 billion

VMware announces plans to acquire mobile security company AirWatch for $1.54 billion, allowing VMware to offer PC-level security solutions for smartphones and tablets used by employees.

Government health data sharing may break EU law

In England, a plan to collect health information on all citizens, store it in a centralized database, and share it with care providers across the nation may hit a roadblock as the European Union drafts a data protection law that requires citizens to opt in for data sharing.

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Morning Headlines 1/22/14

January 21, 2014 Headlines No Comments

GE to Acquire API Healthcare

GE announces that it will acquire workforce management software vendor API Healthcare for an undisclosed sum. API Healthcare’s administrative solutions are used by more than 1,600 hospitals and staffing agencies in the U.S. The company’s time and attendance solution has been rated by Best in KLAS for the last 10 years.

Three EMRs lead the pack in the midsize-practice space

Epic continues to lead performance scores in the midsize physician practice market, with athenahealth and Greenway rounding out the top three.

Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices: United States, 2001–2013

In 2013, 78 percent of office-based physicians used some form of EHR, but only 13 percent reported using systems that comply with Stage 2 Meaningful Use. In total, only 69 percent of respondents report that they intend to participate in MU.

‘Defect’ on VA benefits site shares vets’ personal details online

The VA’s online eBenefits program is suspected of exposing thousands of veterans personal information after an upgrade-related defect causes other veteran’s data to be erroneously presented to users when they logged into the system. Exposed data reportedly including past and current medical conditions, bank routing numbers, and social security numbers. The VA has shut the eBenefits system down pending an investigation, and will provide credit monitoring for affected users.

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News 1/22/14

January 21, 2014 News 6 Comments

Top News

1-21-2014 4-15-52 PM

GE will acquire API Healthcare, a provider of healthcare workforce management software and analytics solutions.

Reader Comments

From Brian: “Re: Advisory Panel ‘2014 will be the year of …’ patient relationship management. Spanning not only the clinical realm, but the financial realm as well. Every touch, clinical and financial, influences the patient’s attitude towards the health system, impacting satisfaction and their willingness to return for elective services or recommend to friends and family.”

1-21-2014 5-31-25 PM

From Keith: “Re: HHS. This issue needs Meaningful Use guidelines.” OIG finds that HHS paid $172 million in claims for 474,000 vacuum erection systems (penis pumps) from 2006 through 2011, spending twice as much per unit as the VA paid or what online retailers charge.

1-21-2014 5-38-21 PM

From Across the Pond: “Re: interesting article from Isala Hospital, Netherlands. It’s in Dutch, but explains the positive outcomes (reduced hospital mortality and others) realized from introducing an extra pre-procedure safety check beyond the usual time-outs before open heart surgery. Results are remarkable: 95 percent vs. 55 percent of professionals now feel the treatment is a team effort and the post-surgical hospital mortality rate was reduced from 15 percent to 1.7 percent. Doctors plan to share the results with US colleagues.”

1-21-2014 8-30-06 PM

From MDCIO: “Re: Windows XP computers after its retirement on April 8. Can you be HIPAA compliant and qualify for Meaningful Use if your system is not receiving security updates?” At minimum, you could interpret that running an obsolete OS for which no security updates are available means you aren’t protecting PHI to the best of your ability. I’m interested to hear from readers, especially CIOs whose hospitals are still running some XP PCs. Hard and fast rules aside, I wouldn’t want to be deposed to provide post-breach “why were you still using XP” justification to OIG or a plaintiff’s attorney. According to HHS:

The Security Rule was written to allow flexibility for covered entities to implement security measures that best fit their organizational needs. The Security Rule does not specify minimum requirements for personal computer operating systems, but it does mandate requirements for information systems that contain electronic protected health information (e-PHI). Therefore, as part of the information system, the security capabilities of the operating system may be used to comply with technical safeguards standards and implementation specifications such as audit controls, unique user identification, integrity, person or entity authentication, or transmission security. Additionally, any known security vulnerabilities of an operating system should be considered in the covered entity’s risk analysis (e.g., does an operating system include known vulnerabilities for which a security patch is unavailable, e.g., because the operating system is no longer supported by its manufacturer).

1-21-2014 6-53-26 PM

From NurseJane: “Re: Prognosis HIS. Did you know it was acquired? We are concerned as we are going through a MU audit and we are on their system. They laid off over half the company last year and replaced the CEO. I would appreciate you finding out more and reporting on it.” CEO Jim Holtzman provided a quick response to our inquiry:

In 2013, Prognosis completed a transaction in which it was acquired by two of its original founders who have since rejoined the company, with the common goal of enhancing its ability to provide the best software and services to our customers in their dedication to provide excellent healthcare services to their patient base.

As a bit of history, In 2012 I joined Prognosis as CFO. At that time, I rapidly joined with our team in a process of improving Prognosis’s financial position, while also taking on a venture/PE fundraising effort that had started shortly before I joined the company. Through 2012 and into May of 2013, our management team worked to enhance our financial position, part of which included a restructuring and initial reduction in force. On May 15, 2013, I took the role of CEO and continued our mission of managing through our challenges. At that time, we implemented one more, final reduction and began the process of completely revising how we approach our business processes to better and more efficiently serve our customers. Over the remainder of the year, we radically improved our support processes, closed new business and continued to guide our company through some difficult waters.

Then, three weeks ago on December 30, 2013, Prognosis closed an investment transaction with AO Capital Partners, LLC, a private equity firm and financial investor. As part of their investment, AO Capital Partners acquired Prognosis through an asset acquisition and made an initial cash investment in the company in the form of working capital.

It is important to note that AO Capital is led by two of Prognosis original founders, Dirk Cameron and Isaac Shi.  Previously, Mr. Shi was the Chief Architect of our software when it was originally designed and built back in 2006. We are extremely excited to have both Mr. Cameron and Mr. Shi back in the Prognosis fold and as members of our leadership team. We are already actively exploring new pathways of product development that include innovative new features and functionality, as well as innovative methods of delivery. We also continue to focus on enhanced customer support and professional service models to better support our customers. We look forward to sharing the fruits of this new partnership with our customers and prospects in the very near future. The simple fact of this transaction is that our customers will feel essentially no difference aside from our efforts, with new development and support resources to further enhance our processes that we have worked on so hard this last year.

We continue to work toward completion of our MU2, 2014 software certification which will be completed in multiple waves. The first of those waves was completed in December and we crushed the certification process, completing our certification, in one day of testing, of more modules than we had originally scheduled. I am confident that we will perform as flawlessly in the remaining waves as we did in wave one. We are now modularly 2014 certified following wave one and continue along the pathway of full EHR certification by end of the first quarter of 2014.  Our customers are going to feel nothing more than continued improvements. 

The only minor change that we will be making beyond the comments above is a tweak to our name, which will now be Prognosis Innovation Healthcare, reflecting our commitment to innovative software that serves the healthcare community.

As always, I welcome calls and questions and will be happy to answer any questions about our company and our products and services.

HIStalk Announcements and Requests

inga_small I was looking over the HIMSS conference schedule today and was intrigued by the new Startup Showcase, which features 40 startup and early stage HIT companies. It looks like the showcase will be in the exhibit hall and participating vendors will have a chance to demo their offerings. Could be fun.

1-21-2014 8-33-47 PM

inga_small Another fun option might be the HIMSS14 Wellness Challenge. Participants wearing a Misfit Shine activity tracker can compete in different daily challenges such as steps taken, calories burned, and distance walked. I always feel like I walk 10 miles a day, so maybe I should sign up.

Reminder: sign up by January 29 if you want to be considered for a HIStalkapalooza invitation. Not everyone who signs up will be invited, but on the other hand, everyone who is invited will have signed up (this sounds like one of those logic problems from the SAT, but it’s really not hard.) We will email invitations to the folks we can accept on February 4 or thereabouts. We have hundreds more requests than we have spots, so not everybody will get an invitation, unfortunately.

1-21-2014 5-58-03 PM

Welcome to new HIStalk Platinum Sponsor MEDHOST. The company offers solutions for ED (MEDHOST EDIS); patient flow (MEDHOST PatientFLow HD); perioperative (MEDHOST Advanced Perioperative Information Management System); patient portal (MEDHOST YourCareCommunity); public health reporting (MEDHOST YourCareLink); clinicals, patient access, revenue cycle, and financials (Enterprise Solutions); BI (MEDHOST Business Intelligence); hosting and managed services (MEDHOST Direct); and services for outsourcing, consulting, and optimization. The 30-year-old Franklin, TN-based company, formerly known as HealthTech and serving more than 1,000 hospital customers of all sizes, unified its corporate identify and product line under the MEDHOST name last month. It pledges to deliver unparalleled value and easy-to-use technology for managing care and the business of healthcare. Customer case studies are here. Thanks to MEDHOST for supporting HIStalk.

I found a YouTube video describing MEDHOST Direct hosting at Valley Regional Hospital (NH).

Upcoming Webinars 

February 5 (Wednesday) 1:00 p.m. ET. Healthcare Transformation: What’s Good About US Healthcare? Sponsored by Health Catalyst. Presenter: John Haughom, MD, senior advisor, Health Catalyst. Dr. Haughom will provide a deeper look at the forces that have defined and shaped the current state of U.S. healthcare. Paradoxically, some of these same forces are also driving the inevitable need for change.

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.

Acquisitions, Funding, Business, and Stock

1-21-2014 4-16-32 PM

Kareo secures $29.5 million in growth capital.

1-21-2014 4-17-35 PM

UnitedHealth Group’s Optum health services business grew revenue 35 percent in the fourth quarter.

1-21-2014 4-18-26 PM

Etransmedia Technology acquires Medigistics, a Columbus-OH based provider of RCM and AR management services for the healthcare industry.


1-21-2014 10-41-02 AM

RegionalCare Hospital Partners (TN) will deploy AirStrip ONE OB and AirStrip ONE Cardiology across its eight-hospital system.

Medical Professional Services selects athenahealth’s population health Management platform for its 450-provider IPA.

1-21-2014 10-42-26 AM

Healthstat will implement eClinicalWorks EHR across more than 350 sites.

1-21-2014 10-44-51 AM

Nexus Health Systems (TX) selects Summit Healthcare Express Connect interface technology.

1-21-2014 10-45-52 AM

Scotland County Hospital (MO) chooses Access electronic patient signature and e-forms solutions to complement its Meditech 6.x EHR implementation.

Summit Healthcare selects Secure Exchange Solutions as its Health Information Service Provider for secure healthcare information exchange.


1-21-2014 10-47-04 AM

VisionWare names Paul Roscoe (The Advisory Board) CEO and board member.

1-21-2014 4-25-27 PM

Medhost names Lionel Tehini (Acuitec) president of the company’s professional services division.

1-21-2014 8-09-03 PM

Telemedicine software vendor REACH Health names Steve McGraw (SAI Global) as president and CEO, replacing the retiring Richard Otto.

AtHoc appoints Karen Garavatti (Ericsson) head of human resources.

Salar appoints new members to its clinical documentation advisory board, including Neri Cohen, MD (Greater Baltimore Medical Center), Brian Houston, MD (Johns Hopkins Medicine), Don Levick, MD (Lehigh Valley Health Network), Eric Radler, MD (Lifespan), and Jenson Wong, MD (San Francisco General Hospital.)

Announcements and Implementations

1-21-2014 8-36-01 PM 1-21-2014 8-36-49 PM

Michigan Health Connect and Great Lakes HIE will merge their operations later this year to create one of the country’s largest HIEs.

AirWatch opens a Miami office.

1-21-2014 4-28-28 PM

University Hospital Southampton NHS Foundation Trust in the UK expands the rollout of its personal health record, which is based on Get Real Health’s InstantPHR patient engagement platform.

1-21-2014 5-19-16 PM

France-based IT services vendor Atos launches an enterprise content management system for healthcare based on EMC Documentum.

1-21-2014 8-37-43 PM

Aventura will integrate its instant-on awareness computing technology for clinicians with virtualization offerings from Varrow.

Government and Politics

1-21-2014 10-24-31 AM

About 69 percent of physicians intend to participate in the MU program, according to CDC survey conducted in mid-2013. At that time, 13 percent of them were using an EHR capable of supporting 14 of the 17 Stage 2 Core Set objectives. Half of office-based physicians were using at least a basic EHR, up from 11 percent in 2006.

An IT security expert says that Healthcare.gov is not secure, claiming that he can extract thousands of database records directly from the site without even hacking it. He listed 20 security issues weeks ago and says  they haven’t been fixed. HHS says it doesn’t believe him and the site is fine.

1-21-2014 8-17-54 PM

The VA says that the medical and financial information of more than 5,000 users of the VA/DoD eBenefits military benefits site may have been exposed to other users last week due to a programming error.


1-21-2014 11-34-04 AM

“123456” tops Splashtop’s list of the of most commonly stolen passwords for 2013, beating out longtime favorite, “password.”

1-21-2014 7-31-44 PM

A new KLAS report says Epic, athenahealth, and Greenway lead the 11-75 physician practice segment. Allscripts, McKesson, and Vitera have the highest percentage of unhappy customers who will stick to the EMR they bought even though they wouldn’t buy it again.

A study finds that the leading online source of medical information for both providers and patients is Wikipedia.

Tim Moseley and Ron Hedges of the IT department of Memorial Hospital of Gulfport (MS) are presented a certificate of appreciation and Seven Seals Award for setting up a Skype session that allowed Air National Guard Staff Sergeant Drew Bynum, deployed overseas, to see his newborn daughter. Major Jeff Wyatt of the 255th Air Control Squadron told the men, both of whom are veterans themselves, “It’s hard enough being over there and doing your job in trying circumstances, but you’re never totally over there. There’s always a part of you that is back here with your family and friends. It takes people like you, supporting us, to enable us to do our job overseas.”

Weird News Andy provides a quote for this story: “There is not one blade of grass, there is no color in this world that is not intended to make us rejoice.” A 70-year-old man who was born color blind can suddenly see colors after experiencing a fall. Doctors can’t explain it since color blindness is a retinal cone defect, but postulate that it’s the man’s perception of colors that has changed.

Sponsor Updates

1-21-2014 5-55-46 PM

  • More than 150 Surgical Information Systems employees participated in the company’s first community service day in metro Atlanta.
  • NextGen Healthcare reports that its Ambulatory EHR version 5.8 meets the latest ICD-10 standards, adding that it will offer customers ICD-10 educational and testing tools.
  • Harry Greenspun, MD, senior advisor for healthcare transformation and technology for the Deloitte Center for Health Solutions, discusses the four dimensions for effective mobile health in a blog posting.
  • Quest Diagnostics certifies CompuGroup Medical’s LabDAQ LIS as a Gold Quality Solution under Quest’s Health IT Quality Solutions program.
  • Wolters Kluwer Health collaborates with the Academy of Medical-Surgical Nurses to review the core procedures in the Lippincott Procedures software application.
  • RelayHealth’s RelayClearance, RelayAssurance, RelayAnalytics, and RelayPayer Connectivity Services achieve a Level 2 appraisal rating under CMMI Institutes’ Capability Maturity Model Integration.
  • Beacon Partners hosted an analytics roundtable on establishing an analytics-driven healthcare culture.
  • EDCO Health Information Solutions sponsored a presentation by HIMSS VP John H. Daniels on the HIMSS Analytics EMR Adoption model at a New Jersey Hospital Association meeting last week.
  • Surgical Information Systems and QlikTech renew their agreement to expand the use of QlikView with SIS Analytics.
  • Adventist Health (CA) shares how it reduced its revenue cycle by two days after implementing The SSI Group’s RCM solution.
  • A Nuance Communications study finds that 71 percent of physicians would be more responsive to clinical documentation improvement clarifications if they were delivered in real time within their EHR workflow.


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

More news: HIStalk Practice, HIStalk Connect.


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January 21, 2014 News 6 Comments

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