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News 7/19/13

July 18, 2013 News 3 Comments

Top News

7-18-2013 10-15-10 PM

Athenahealth reports Q2 results: revenue up 44 percent, non-GAAP EPS -$.08 vs. $0.24, beating revenue estimates but missing consensus earnings expectations of $0.22. The company says it stands by previous FY13 guidance.

Reader Comments

7-18-2013 7-39-15 PM

From Keen Observer:“Re: Senate Finance Committee on Health IT hearing Wednesday. Here are my notes.” Thanks. Video is here and the transcript of Farzad’s testimony is here. I’m including your notes below.

Farzad and Patrick Conway from CMS fielded a lot of questions about the Meaningful Use program’s benefits and the adoption rate, especially among rural providers. Farzad’s bow tie also took a number of shots, including one from Sen. Pat Roberts advising him not to wear it in Dodge City, KS. Both Senators Baucus and Roberts urged Farzad to get out into rural America and see what the conditions are like before assuming that all rural hospitals and providers should be held accountable to the same IT standards as their urban counterparts.

They asked Farzad about his thoughts on a delay to Stage 2 and he said he didn’t think it would be beneficial to slow the momentum. Senator Thune asked about what Stage 3 will look like and if there will be more stages beyond that. Both witnesses ignored the second part of that question. They also talked a lot about interoperability and evolving standards. Some asked if the bar was too low for interoperability. Senator Enzi really hammered Dr. Conway about the physician drop out rate that was reported for docs who achieved Stage 1 MU.

Next week the Finance Committee will hold another hearing with with Janet Marchibroda from the Bipartisan Policy Center, John Glaser from Siemens Healthcare, Marty Fattig from Nemaha County Hospital which is a critical access hospital and Colin Banas from Virginia Commonwealth University Medical Center.

HIStalk Announcements and Requests

inga_small This week on HIStalk Practice: CareCloud introduces an update to its Charts EHR that I believe includes Medicomp Quippe functionality. TransforMED selects 90 primary care practices for a three-year patient-centered medical neighborhood pilot project. CMS highlights key 2014 deadlines for the EHR incentive and other eHealth programs. Physicians in larger states, ER specialists, and pathologist historically experience higher levels of PQRS success. Dr. Gregg shares a scary tale of EMR demos, UXs, and UIs. Join the fun, take a read, and check out the offerings of a few HIStalk Practice sponsors. Thanks for reading.

Acquisitions, Funding, Business, and Stock

7-18-2013 10-20-34 PM

Quality Systems reaches an agreement with Clifton Group, an investor that had called for the replacement of the company’s board. Quality Systems will add three Clifton Group nominees to its board.

7-18-2013 10-21-08 PM

UnitedHealth Group reports Q2 results: revenue up 12 percent, EPS $1.40 vs. $1.27, falling short on revenue expectations but beating handily on earnings. The company’s Optum segment turned in revenue of $8.8 billion with earnings from operations of $536 million, which contributed significantly to the bottom line. The insurer’s quarterly profit was $1.44 billion.


Care New England Health System selects Infor Healthcare’s business process automation solutions.

Jefferson Radiology (CT) contracts with McKesson Business Performance Services for revenue cycle management.

7-18-2013 10-22-14 PM

St. Joseph’s Hospital Health Center (NY) selects ProVation Care Plans from Wolters Kluwer Health.

Pilgrim Hospital (UK) chooses MetaVision from iMDsoft for its ICU.


7-18-2013 6-28-30 PM 7-18-2013 6-29-06 PM

Extension names Brian McAlpine (Emergin) VP of product management and marketing and Johnathan Salyer (Capsule) director of strategic accounts.

7-18-2013 6-27-36 PM

CompuGroup Medical promotes Norbert Fischl to CEO of CGM USA.

7-18-2013 7-07-08 PM

HealthAlliance (MA) names Chris Walden, RN, BSN (Flagler Hospital) as CIO.

7-18-2013 7-35-50 PM

Former Florida Governor Jeb Bush joins the board of Alpharetta, GA-based healthcare staffing company Jackson Healthcare LLC.

7-18-2013 7-54-31 PM

Cleveland-based analytics vendor Socrates Analytics names Jim Evans (McKesson) as CEO.

7-18-2013 8-56-49 PM

Industry long-timer Jim Klein, who worked for CompuCare, QuadraMed, InterSystems, Advisory Board, and Gartner, died of prostate cancer Wednesday, July 17 at his home in Great Falls, VA. He was 65.


Announcements and Implementations

7-18-2013 10-24-02 PM

ProHealth Care (WI) implements Omnicell’s G4 Unity medication management platform.

The Ottawa Hospital launches Wolters Kluwer Health’s UpToDate Anywhere.

Southeast Hospital (MO) implements Access e-forms barcoding to manage registration packets, order sets, and home health documents.

Navicure reports that it increased revenues 27 percent in the second quarter and added 316 medical practices.

Government and Politics

CMS releases information suggesting that EHR use is helping providers manage patient care and provide more information securely. CMS notes that since 2011, providers have used EHRs to send more than 190 million prescriptions electronically, send 4.6 million patients an electronic copy of their health information, forward more than 13 million patient reminders, check drug and medication interactions over 40 million times, and share more than 4.3 million care summaries with other providers.

inga_small During a Senate Finance Committee hearing, ONC head Farzad Mostashari, MD says that pausing the MU program to evaluate whether the bar has been set too low would “stall the progress that has been hard fought (and) take momentum away from progress.”  Incidentally, even senators aren’t immune to Mostashari’s dapper bowties: Sen. Orrin Hatch apparently took a moment to call Mostashari’s cravat “a beauty.”

7-18-2013 8-00-54 PM

Sen. Bill Nelson (D-FL) introduces a bill that would impose specific deadlines for the Department of Defense and the VA to exchange electronic health information. The Service Members’ Electronic Health Records Act would require the DoD and VA to use standardized forms within six months of enactment; to exchange real-time information and use a common UI within a year; and to offer service members with electronic copies of their information by June 30, 2015. According to the Senator, “For 15 years, we have tried to fix this problem. In the past five years, the departments have spent around $1 billion, but we are not there yet.”

Innovation and Research

7-18-2013 7-19-14 PM

Seamless Medical Systems is awarded a $50,000 grant from the Venture Acceleration Fund of Los Alamos National Security, LLC. The company will use the money to further develop its SNAP Practice patient engagement platform.


Connexin Software will use Health Language applications from Wolters Kluwer Health to normalize data into standard terminologies within its pediatric EHR solutions.

Tech writers are stalking executives of Apple, hoping to see visual evidence of the wearable body sensors or related devices that the company is rumored to be studying.

Children’s Hospital Foundation (DC) passes on Microsoft SharePoint for its Intranet because of complexity and staffing requirements, instead choosing Igloo.

7-18-2013 10-07-24 PM

Tech Crunch profiles ElationEMR, a San Francisco-based startup founded by a Stanford economics professor who says she and her brother “had no prior experience building anything of the sort. And my brother happened to have a knack for design and I kind of had a bit of a knack for engineering and learning quickly to pull things together.” The EMR costs $149 per month, which includes support, e-prescribing, lab interfaces, training, and a patient portal. An ElationEMR user can see all the practices that have seen their patient. Signup for a test account is free.


inga_small A majority of surveyed EHR consultants expects the majority of EHR vendors to involved in merger, acquisition, or closure within five years, most often due to delaying usability problems in favor of meeting MU requirements. Do we blame the fallout on opportunistic vendors taking advantage of a hot market, or the government and MU for managing their development priorities? Probably a bit of both. The study concludes that well-funded smaller vendors serving niche sectors may do better than some larger vendors who have failed to resolve “fundamental flaws caused by being all things to all physicians.”

The National Football League says it’s on track to roll out an iPad-based sideline concussion assessment tool next season. The results will be printed and placed in a paper chart, but eight teams will be piloting a program to send the information directly to the patient’s electronic medical record.  The league’s 2011 collective bargaining agreement called for deploying a full EMR this year that would allow medical records to follow a traded player. Safeguards are being put in place to prevent viewing of the records by competing teams, the league itself, and teams for which the player is trying out but is not yet signed. The NFL signed a 10-year agreement with eClinicalWorks in November 2012 to provide its EMR.

7-18-2013 9-48-52 PM

Milwaukee Health Services, a Federally Qualified Health Center,  says Atlanta-based Business Computer Applications is endangering 40,000 people by remotely locking the organization out of its own data servers in a billing dispute. Milwaukee Health Services has done business with BCA for 24 years, but says it paid the vendor $3 million to develop an EMR called Pearl EMR that still doesn’t work and isn’t HIPAA compliant. The hospital moved to GE Centricity, claiming BCA promised to give it a copy of its database, but later reneged. It’s suing under the Computer Fraud and Abuse Act. BCA claims to be the largest minority-owned software company in the world and claims it developed the first EMR in the US outside of the Department of Defense. It still sells Pearl EMR, which is certified by CCHIT as a Complete EHR for ambulatory.

Weird News Andy says if you have to be shot, there’s no better place. A patient is superficially wounded by a bullet shot through the window of her room in Crozer-Chester Medical Center (PA).

7-18-2013 8-29-37 PM

WNA says this woman doesn’t have a leg to stand on. A Utah woman who says she has wanted to be disabled since she was four years old seeks a doctor who will cut her perfectly healthy sciatic and femoral nerves to paralyze her legs. She suffers from Body Integrity Disorder, which causes her to believe her legs aren’t her own. The woman has tried to paralyze herself by intentionally causing accidents and now hopes that aggressive skiing might do the trick since she can’t afford to pay a doctor to cripple her.

Sponsor Updates

  • Allscripts will offer its ambulatory clients LDM Group’s ScriptGuide patient education solutions.
  • Sandlot Solutions offers an August 14 Webinar, “Real-time, Clinical & Claims Data at the Point of Care: Reshaping the Way You Deliver Healthcare.”
  • Aprima reports that over 1,000 Allscripts MyWay customers have switched to Aprima PRM since October, when Allscripts announced that it would not provide MU or ICD-10 enhancements to MyWay.
  • The TrustHCS Academy graduates its class of coding students.
  • Ecfirst validates Imprivata Cortext as HIPAA compliant and will perform ongoing audits.
  • GetWellNetwork will add patient-education content from ASCO’s Cancer.net patient Website.
  • An API Healthcare-sponsored study finds that hospital and health system executives are prioritizing workforce management-related issues to achieve long term fiscal sustainability.
  • A Beacon Partners-CHIME survey of  healthcare CIOs examines Meaningful Use progress and challenges.
  • Ingenious Med announces impower Mobile 2.0.
  • HealthMEDX forms a physician medical advisory board.
  • Carl Fleming, principal advisor with Impact Advisors, discusses the evolution of tablets and how they are helping physicians.
  • Wellcentive introduces a Network Maturity Model to evaluate the maturity of healthcare organizations.
  • Clinical Architecture is recognized as a 2013 Indiana Company to Watch award.
  • Sandlot Solutions Director Rosalind Bell discusses information as healthcare’s ultimate business partner.
  • Intellect Resources publishes an infographic depicting the use of social media in healthcare.
  • ICSA Labs’ Jack Walsh discusses the vulnerability of Android devices.
  • Chicago Crain’s Business profiles Care Team Connect Founder and CEO Ben Albert.
  • Ping Identity CEO Andre Durand discusses the setting of reachable goals in a New York Times interview.

EPtalk by Dr. Jayne


ONC releases a new “ONC Certified HIT Certification and Design Mark” along with a nine-page guide on how it is (and is not) to be used. I’d show it to you, but that in itself would be a violation of the terms of use, so you’ll just have to check it out for yourself. I did provide a hint above. I’m less worried about the Pantone graphics people coming after me than a hit squad from ONC.

A reader sent me this slide show from a Medscape physician lifestyle report. I’m sad to see that both my primary and secondary specialties are in the top three for burnout. Check out Slide 8, which lists physicians’ favorite pastimes. Non-medical writing ranks at the bottom, but I’d personally put it at the top. Some weeks it seems like being part of the HIStalk crew is the only thing keeping me sane.

From Checklist Diva: “Re: checklists. I was reading your post about checklists and it warmed my heart. Personally, I love checklists. I write things on my lists just so I can cross them off, items like ‘eat lunch.’” I put a block on my calendar every day not only to remind myself to eat lunch, but also in the hopes that someone will show a little humanity and not schedule a lunch meeting. It works a good part of the time, probably because I put humorous titles on the appointments to make it look like I have important meetings. My admin occasionally gets into the spirit and changes the locations or adds ridiculous attachments that make me laugh. He provides support to several of us and I’m pretty sure I’m his favorite because I have a sense of humor.


Speaking of humor, I might not have much left after next week. It’s our regularly scheduled “All Provider” meeting, which usually turns into a freeform complaint session because the (very young) president of the medical group has a hard time moderating his more senior peers. Some of the physicians get pretty far out of control and the audience gets completely restless with audible sighs, vigorous paper shuffling, slamming chairs around, and the occasional demonstrative hand gesture. For years EHR has been the designated punching bag, but we seem to have been elbowed aside by Accountable Care as the villain of the day. Some meetings though I feel like we should be dressed for roller derby instead of the board room.


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

More news: HIStalk Practice, HIStalk Connect.


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July 18, 2013 News 3 Comments

HIStalk Interviews Andrew Farquharson, Managing Director, VentureHealth

July 17, 2013 Interviews 4 Comments

Andrew Farquharson is managing director and co-founder of VentureHealth.

7-17-2013 8-06-39 PM 

Tell me about yourself and VentureHealth.

I’m a venture capital investor and entrepreneur focused on healthcare investing and company building. I began my career in life science when I graduated with a BA from UC Berkeley, and went right into the research side of Genentech. After Genentech, I went to Harvard Business School and founded my first company there. I returned invested capital back to investors. I didn’t make a killing, but learned a lot.

After that, a friend and I took over a company called Operon that makes synthetic DNA and built it up into the world’s number one provider of DNA. At Operon, I ended up running the entire demand side of the business: sales, marketing, customer support. My friend Nathan Hamilton ran operations, R&D, and reinvented the way they make DNA. We ended up selling that company for a $150 million in June 2000 without taking any venture money.

After that, I became an angel. As an angel, I realized that one of the challenges is getting access to the very best deals; getting access to venture-quality deals. I joined a small venture fund and then I met my current partner Mir Imran. Mir is one of these rock star innovators in the biomedical space. He’s founded about 24 companies and has returned billions to investors. He invented the implantable defibrillator, among many other things, which has generated over $200 billion in revenues. Not bad. Mir is one of these guys where 80 percent of the things that he does return money for investors. He’s very good at what he does.

VentureHealth was not an idea that came out of nowhere. When we were raising our second venture firm, a number of folks wanted to co-invest with us because of our previous successes. Mir had lots of success. There are many healthcare professionals who would like to get involved in healthcare startups, but don’t know how to do it. Those are the folks who initially began reaching out to us.

Our initial response was really kind of uncertain. Investing is very risky, and we didn’t want to encourage people to partake in investments they didn’t understand. But as we kept chatting with high net worth individuals, we realized that there’s a large pool of financially sophisticated folks who want access to venture capital deal quality deals in healthcare, but who don’t know how to do it and don’t have a time to figure it out. We help them get access to venture quality deals in ways that were consistent with SEC guidelines.

Then the JOBS act came along. The future is going to become very interesting. The future is going to allow groups like ours to expand our investor base and publicly disclose when we’re raising capital. We can’t do that yet. The SEC is being thoughtful and measured in how it goes about regulating the JOBS Act. 

For right now, everything we’re doing is within the confines of the current law and the current regulations, which is why we’re doing what we’re doing with accredited investors we personally vet who really understand the risk. But if and when the SEC begins to actually implement the JOBS Act, we’re watching that carefully and we plan to respond appropriately once the doors are wider open.


Could you provide a quick summary of the JOBS Act and what it means for angels, accredited investors, and the general public?

The JOBS act will allow potentially hundreds or thousands of investors to invest, a true crowd of individuals who have much less money to write much smaller checks and get involved in a venture capital deal or any kind of startup deal.

But we’re not there yet. The SEC is still ironing out the details. It’s something that the SEC wants to move slowly towards that because they really want to make sure folks who invest know about what companies are doing and they understand the risks of investing capital. The SEC particularly wants to protect individuals against fraud, which we agree with.

For VentureHealth, we see the JOBS Act having an immediate impact on high net worth individuals as soon as  the next 12 or 18 months. We’re going to be thoughtful about how we begin to open up to a true crowd.


Right now, VentureHealth is only focused on accredited investors?

Exactly. Healthcare equity crowd-funding is very new. There are companies mushrooming up trying to make equity crowd-funding platforms real. One of the most successful that’s focused on the consumer space is called CircleUp. If you’re an entrepreneur raising money yourself, you should probably have a look at CircleUp’s model just to understand what they’re doing. They’re venture backed. They’re doing deals every month. Like us, they’re focused on accredited investors for now, but are trying to open up to the general public when it becomes legal.


You’re not taking any cash from the startup.

That’s right. The VentureHealth portal takes no cash from startups. That approach may be attractive for entrepreneurs, but does not necessarily make sense from an investor’s perspective.

This can be counterintuitive until you think through the incentives. We’re compensated along with the investors like any venture firm. In the case of VentureHealth, the individual investors make the decisions. The money flows from them. They’re the ones who own the equity through a fund structure. If the company returns cash to investors, we participate as members of the general partner. 

In contrast, if you’re a broker-dealer, you make money every time cash flows into a startup, so your incentive is to drive as many transactions as you can regardless of quality. Whereas for us, the incentive is to only take deals if we’re going to ultimately make money for investors. We’re aligning with the investors to try to find companies that are going to have successful outcomes as opposed to just driving a whole bunch of deals.


What separates VentureHealth from AngelList?

AngelList is a successful, creative approach to crowd-funding at high volume. AngelList has allowed lots of startups to put their wares up on the website and allowed lots of individual investors to look at those deals. It enables connection between the investors and startups. AngelList does not have a model, as far as I know, where it makes money by charging the startups or the investors.

I think they’re providing a really valuable service to everyone. As an angel myself, I appreciate what they do. I think they’re a great company and they’re well off. But what we do is very different. We curate our deals and only select investment opportunities that meet our criteria. As our exits this year reflect, our approach seems relatively robust. We curate our deals and will post far fewer than AngelList.

Conversely, AngelList does not try to protect investors from bad deals, just like Kickstarter doesn’t either. It’s really up to the investor. Investor beware, which is the case with many robust marketplaces. In the case of healthcare investing, however, investors often don’t have the clinical, regulatory, and business perspectives to bring an opportunity into the proper focus. 

I think that there’s a lot of value in their model, but the model does require a lot of understanding on the part of the investors. That does not always translate well into healthcare.

Our model is simple. We do our best to protect our investors, unlike AngelList and Kickstarter and most of the other equity crowd-funding platforms. Another way of saying this is we try to find the most attractive opportunities run by the best entrepreneurs. Our assumption is that, over time, this will prove successful for everyone.


What stops you from taking all of the best deals for yourself?

We manage about $72 million right now, which is really small money in the big picture of things. Our fund is not going to be able to fund all healthcare innovation. Far from it. We sit back a little bit and think about what’s happening in healthcare.

A lot of life sciences venture funds have been failing. The supply of venture capital dollars for life sciences innovation is, shall we say, challenged and at the same time there’s a strong demand from accredited investors who are not traditional angels and don’t know how to source or invest in these deals.


You’ve mentioned life sciences explicitly a few times. Is VentureHealth only focused on life sciences such as pharmaceutical and biotech or are you also looking at software, hardware, services, wellness, PRM, and medical devices?

For us it all begins with clinical outcomes. If we can see a way to really dramatically impact clinical outcomes, then we begin to get excited. That said, our history has been medical devices, and we have recently been moving assertively into biopharmaceuticals.


How big is the team curating deals?

The answer is a little complicated. There are three of us who are co-founders of the portal — Mir Imran, Talat, and me. We all had a lot of experience making and curating deals. But there are another 30-plus people inside InCube Labs — who are great friends of ours  — who actively work in forming companies and doing research. In a sense, we get a free ride from a much larger group of people, primarily PhDs. They’re from pharmacology, engineering, protein science, material science, implantable sensors, Wi-Fi technology, and even guys in social media and web development.

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July 17, 2013 Interviews 4 Comments

News 7/17/13

July 16, 2013 News 9 Comments

Top News

7-16-2013 8-47-36 PM

A Massachusetts eHealth Collaborative-sponsored study finds that EHR adoption by doctors in three communities generated no statistically significant per-member, per-month cost savings, although EHR usage appeared to be associated with less-rapid cost increases. Participating communities were chosen as having the highest likelihood of EHR success by MAeHC, which also paid most of their system and implementation costs. The most commonly used systems were from Allscripts, GE Healthcare, eClinicalWorks, and NextGen. Insurance cost information from 2005-2009 was used.

Reader Comments

From Jessica: “Re: speakers. I love HIStalk and am an avid reader. Can you recommend speakers that you’ve seen and liked?” I haven’t heard many lately, so I will defer to readers. Who stood out?

HIStalk Announcements and Requests

7-16-2013 6-45-28 PM

HIStalk’s seven millionth visit was logged Tuesday morning. Thanks for contributing to that number.

7-16-2013 7-29-37 PM

7-16-2013 7-43-36 PM

Welcome to new HIStalk Platinum Sponsor CareWire. The Excelsior, MN-based company’s mobile solution improves outcomes and loyalty by engaging patients in timely communication that is tailored, thoughtful, and relevant. It sends mobile messages that are encounter-specific, personalized, and perfectly timed: patient instructions, arrival information, and links to services or provider-specific content. The result for providers is a reduction in the cost of no-shows, fewer manual interventions, and improved outcomes and reduced risk. According to the executive director of an outpatient surgery center, “CareWire is like air traffic control for my patients.” The SaaS-based solution requires minimal interfacing – just send it a daily flat file and it’s happy. CareWire’s proprietary rules engine identifies the patients and their mobile numbers, determines the appropriate messages to send, and allows authorized users to send their own messages directly to patients. Templates are provided for appointments, procedures, and case-based episodes that span visits and procedures. Thanks to CareWire for supporting HIStalk.

7-16-2013 7-54-16 PM 7-16-2013 7-58-45 PM

I’m really enjoying Pepperland, a fun novel about music, anarchy, computers and sexual freedom in the 1970s. The Amazon reviews include a quick one I wrote that compares its detail, in-jokes, and pop culture to something Stephen King would have written without his bloated excess and often ridiculous supernatural themes. The author is the amazing Barry Wightman, writer, musician, voiceover guy, and VP of marketing for Forward Health Group. I hardly ever read fiction because it usually annoys me and I have a microscopic attention span, but Pepperland is a blast.

7-16-2013 8-06-31 PM

I usually notice when a company is proud enough of sponsoring HIStalk that they say so on their Web page. The iHT2 folks do and I appreciate it. I keep thinking I’ll attend one of their Summits since readers have told me good things about them.

Acquisitions, Funding, Business, and Stock

7-16-2013 8-50-26 PM

Healthcare analytics provider ArborMetrix closes $7 million in Series B financing.

Ping Identity closes a $44 million investment round.

Caremerge, a developer of communication and care coordination apps for seniors, raises $2.1 million in Series A funding.

7-16-2013 6-34-49 PM

Reed Elsevier Group will move  Elsevier/MEDai to its LexisNexis Risk Solutions business unit, where it will join the acquired EDIWatch as a fraud and abuse solution.

NPR profiles Cerner in an EHR series it’s running, pointing out its HITECH-fueled employment boom in which 3,000 employees were hired in the past two years.


7-16-2013 8-54-14 PM

Winthrop-University Hospital (NY) chooses PeriGen’s PeriCALM Plus charting and fetal monitoring system.

Celebration Orthopaedic & Sports Medicine Institute (FL) selects simplifyMD’s EHR/PM system for its 10 providers.

7-16-2013 8-52-52 PM

Pacific Alliance Medical Center (CA) will implement Summit Healthcare’s Express Connect interface engine.

Wishard-Eskenazi Health (IN) selects eClinicalWorks PM for 385 providers across eight locations.

Harris Corporation will use Symedical Server from Clinical Architecture to enhance terminology management, interoperability, and data normalization in its HIE and clinical integration solutions.

The Scarborough Hospital (Ontario) selects SIS.

Canada’s Fortius Sport & Health will implement EMR and PHR technologies from Telus.

7-16-2013 8-57-23 PM

Georgia Regents Health System (GA) signs a 15-year, $300 million contract with Philips Healthcare for consulting services, medical technologies, and operational performance, planning, and maintenance services.


7-16-2013 5-26-59 PM

Anthelio appoints Asif Ahmad (McKesson Specialty Health, Duke University Health System) CEO, replacing co-founder Rick Kneipper, who will remain as chief strategy and innovation officer and chair of the company’s healthcare innovation council.

7-16-2013 6-05-08 PM

Bruce Brandes (AirStrip) joins Valence Health as EVP for growth and innovation. David Kirshner (Boston Children’s Hospital) also joins the company as VP of corporate and business development.

7-16-2013 7-20-05 PM

PathCentral, which offers a online information exchange and digital consultation forum for pathologists, names David Frishberg, MD chief medical advisor. He will continue in his pathology roles with Cedars-Sinai Medical Center.

Announcements and Implementations

Michigan Health Connect becomes the state’s first HIE to transfer infectious disease lab reports from hospitals to the state health department.

7-16-2013 12-54-25 PM

HIMSS introduces the HIMSS Health IT Value Suite, a knowledge repository that classifies, quantifies, and articulates the clinical, financial, and business impact of HIT investments. In reading the press release and details on the HIMSS Website, it appears that HIMSS is positioning it as an industry resource as opposed to a product or service available for purchase.

MModal rebrands its Philippines-based medical transcription provider MxSecure to MModal Global Services.

Southern Health NHS Foundation Trust deploys SEIM and content security technology from Trustwave.

Open Door Center for Change (WI) installs Forward Health Group’s PopulationManager.

NCH Healthcare System (FL) completes its implementation of Cerner this week.

7-16-2013 7-27-42 PM

Deep Domain releases Version 3.0 of its EHR reporting software. It charges $78 per provider per month for a reports subscription.

AHIMA and CHIME announce plans to join forces in conducting HIM/HIT research, presenting sponsored Webinars, co-presenting sessions at CHIME’s Fall CIO Forum, and working together on advocacy issues.

Government and Politics

Only 18 of the 32 first-year Pioneer ACOs reduced Medicare costs in their first year, though all improved their quality measures. Seven of those that did not produce savings say they will switch to the Medicare Shared Savings Program, while two others will leave the program entirely. While the Pioneer program rewards providers for shared savings, the majority of a provider’s patients are likely still covered by traditional fee-for-service contracts.

National Coordinator Farzad Mostashari, MD, interviewed by NPR: “Paper works just fine if you want to deliver healthcare the way you sell shoes. If you want to wait in your office for the door to open and say, jingle, jingle, and you say, can I help you, and pull a chart and deliver care, and then when you close that chart, that information is dead, paper works just fine. If you want to coordinate care with other providers, if you want to share information with the patient and engage them as partners in their own care, paper doesn’t work just fine.”

Innovation and Research

7-16-2013 6-54-47 PM

A video by Vonlay’s Steve Knurr, Google Glass Explorer, records cycle racing using the device. He plans to help develop a heads-up cycling display that will include bike telemetry, biometrics, and race information.

It’s not all Google Glass in the computing eyewear field. Italy-based GlassUp, running its launch campaign on Indiegogo, will offer a camera-free and more stylish alternative that will cost only $399 ($299 as a Indiegogo donation, or $1,500 for 10 pairs right off the first production run.) They will also offer a prescription version for those who already wear glasses.


7-16-2013 2-46-56 PM

A Wolters Kluwer Health survey finds that changing reimbursement, financial challenges, and finding time to spend with patients are the top challenges facing doctors.

The healthcare business intelligence market lacks a clearly perceived leader, according to a KLAS report. Large BI vendors such as IBM, SAP, Microsoft, and Oracle command the largest mindshare, but the lack of sufficient healthcare focus leaves most providers with unmet needs.

7-16-2013 8-59-00 PM

US News & World Report releases its annual hospital rankings. Johns Hopkins (above) reclaimed the top spot, followed by Mass General, Mayo Clinic, Cleveland Clinic, UCLA Medical Center, Northwestern, New York-Presbyterian, UCSF, Brigham and Women’s, UPMC, HUP, Duke, Cedars-Sinai, NYU, Barnes-Jewish, IU Health, Thomas Jefferson, and University Hospitals Case Medical Center.

7-16-2013 6-24-34 PM

The top administrator of a Georgia cancer treatment center files a whistleblower lawsuit claiming its health system owner overcharged the government by upcoding claims. It also charges that Columbus Regional Healthcare System essentially pre-paid a referral kickback by intentionally overpaying for a local cancer center it bought for $10.5 million; that its medical director modified the medical record to justify higher charges because he was upset at a potential income loss caused by regulatory changes; and an insurance company executive who sat on the hospital’s board threatened to withdraw his financial donations to the hospital if the medical director were to leave in a contract dispute.

A Wall Street Journal article covers hospitals that use big data, specifically The Advisory Board Company’s Crimson platform, to encourage higher-quality, lower-cost physician behavior by showing doctors how they compare to their peers. 

7-16-2013 7-09-31 PM

A labor publication editorial written by a union-represented RN complains that EMRs “are getting in the way of the fundamental work nurses do.” She says that the union understands benefits of EMRs, but doesn’t want nurses “to become lost in the land of acronyms, drop-down menus, non-existing options, and endless grey pages in which endless boxes must be clicked.” She concludes that her employer needs to replace McKesson Paragon with a system that “fulfills both the legal compliance needs and the needs of the patients who are hospitalized for competent, attentive, and effective nursing care” The author has previously argued that nurses should work for independent agencies rather than directly for hospitals.

7-16-2013 6-29-32 PM

The Judy Maple Foundation will hold a charity golf tournament on July 27 in East Springfield, OH hoping to raise money for the Charity Hospice of Wintersville to replace outdated computers for use with its EMR.

Sponsor Updates

  • Aventura is named as one of 10 Denver startups with cool offices, complete with pinball machines, a gym, and healthy food. 
  • Beacon Partners hosts a July 26 Webinar on optimizing clinical systems.
  • IHE USA and ICSA Labs certify eight HIT products under its pilot certification program to test security and interoperability in the IHE Patient Care Device or IHE IT infrastructure domains.
  • InstaMed announces the availability of its InstaMed Network, which allows providers to accept electronic payer and patient payments.
  • Levi, Ray & Shoup finalizes its purchase of Capella Technologies.
  • Kareo outlines five ways it can help users prevent denials.
  • Emdeon will integrate the Simplicity Settlement Services by ECHO into the Emdeon Payment Network. The company also introduces Virtual Card Services, an electronic payment option to reduce payment distribution costs and payment processes.
  • KLAS Research adds MModal Fluency Direct to its customer rankings.
  • BayCare Health System CIO Tim Thompson shares his organization’s experience implementing Medicity’s HIE platform.
  • The Nashville Business Journal profiles Shareable Ink CEO Laurie McGraw.


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

More news: HIStalk Practice, HIStalk Connect.


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July 16, 2013 News 9 Comments

Readers Write: The Enterprise Content Management Adoption Model

July 15, 2013 Readers Write 4 Comments

The Enterprise Content Management Adoption Model
By Eric Merchant

7-15-2013 6-21-31 PM

There have been numerous publications recently about the amount of unstructured content that exists (80 percent of all content) in a non-discrete format outside of the electronic medical record. This unstructured content exists as digital photos, scanned documents, clinical images, and faxes and e-mails.

The challenge of capturing this information as close to the source as possible — managing it effectively and ultimately delivering it to the necessary physician, nurse, or other provider in a timely manner at the point of need — is a continuous uphill battle. There are varying degrees of being able to manage unstructured content and make it available to decision makers in a meaningful way to improve patient care, drive operational efficiencies, and improve financial performance in the healthcare market.

In developing a content strategy, the challenge is greater than simply buying a software suite and thinking your problems are over. As content grows in volume and complexity, the strategic plan needs to be flexible to be able to grow and adapt accordingly.

To do this, a reference is needed to determine where we were, where we are now and where we want to be. I began creating an Enterprise Content Management (ECM) adoption model as an internal point of reference, but also as a strategic guide for the industry. In practice, it would function similarly to the seven stages of the EMR adoption created by HIMSS Analytics.

ECM Adoption Model

Stage 10

Vendor Neutral Archive (VNA) Integration: Ability to seamlessly integrate with VNA.

Stage 9

Federated Search: Ability to search content across the enterprise.

Stage 8

Information Exchange: Ability to share/publish content with external entities, social media, etc.

Stage 7

Analytics: Meaningful use of content.

Stage 6

Image Lifecycle Management (ILM): Ability to purge and archive.

Stage 5

Capture, Manage and Render Digital Content: Ability to capture photos, videos, audio, etc.

Stage 4

Intelligent Capture: Ability to use OCR and other techniques to extract/use data.

Stage 3

Integration: Ability to render content inside ERP, EMR, etc.

Stage 2

Workflow: Ability to use automated workflow to streamline processes.

Stage 1

Capture and Render Documents: Ability to scan/upload and retrieve documents.

Stage 0

All Paper: No document management system (DMS).

This adoption model can serve the healthcare industry well by allowing us to keep focused on the outcomes we want to achieve and the systems that would provide them. The adoption model also intertwines patient care initiatives (capture content and deliver within the EMR), operational efficiencies we need to achieve (federated search and analytics) and outcomes that will directly benefit healthcare organizations’ financial performance (intelligent capture, VNA and Image Lifecycle management).

In addition, this strategy also delivers on the commitment to support Meaningful Use and IHE data-sharing initiatives with the ability to share and publish unstructured content to information exchanges.

EMR systems have received the bulk of the attention the past few years due to the value they bring and the public policy and reimbursement implications of getting them successfully implemented. However, as the healthcare market becomes more electronically mature, we cannot lose focus on the larger picture and the bigger challenge and ultimately the patient. This picture is incomplete without bringing together both the unstructured content created outside the EMR and the discrete information within the EMR.

To do this, the ECM adoption model, in conjunction with the EMR adoption model, must both be used as a roadmap to reach that goal. ECM vendors must take the same approach that EMR vendors have taken and work hand in hand with healthcare organizations to provide the solutions to achieve Stage 10 of the ECM adoption model and ultimately move closer to a complete patient record, which subsequently creates better health outcomes delivered efficiently and in a financially solvent manner.

Eric Merchant is director of application services, health information technology, for NorthShore University HealthSystem of Skokie, IL.

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July 15, 2013 Readers Write 4 Comments

Readers Write: Requirements Versus User Experience: The MU Design Impact on Today’s EHR Applications

July 15, 2013 Readers Write 3 Comments

Requirements Versus User Experience: The MU Design Impact on Today’s EHR Applications
By Tom Giannulli, MD, MS

7-15-2013 6-03-46 PM

Since the first electronic health record (EHR) applications, the federal government has been looking for ways to leverage EHR technology to improve the quality and cost of healthcare delivery. A decade ago, President George W. Bush declared that every American should have an electronic health record within 10 years. While we’ve come a long way, almost half of all medical providers are currently searching for an EHR, installing one now, or looking to switch out the one they have in place.

This is an eye-opening situation given the investment of billions of dollars in EHR technology by healthcare providers, technology suppliers, and the government via incentive programs. Why is this? One contributing factor is that the government incentive programs have excessively focused on features over user experience and outcomes.

When the current EHR incentive programs emerged in 2009, EHR suppliers with existing products were faced with the challenge of meeting Meaningful Use (MU) requirements. It’s not easy to retrofit new functional requirements into an existing product, and it’s commonly understood many suppliers had to focus on achieving functionality requirements however possible given the potential impact of government incentives. The time-bound goal was simply to get X feature programmed in Y weeks so that version update or hot fix could be applied to meet customer certification timelines.

Function ruled over form, often resulting in degraded user experience and sub-optimized workflows. In hindsight, it may have been better to have fewer incentive program requirements with broader definitions and simpler tests to validate compliance.

For example, assume a general requirement for physicians to be able to share standardized clinical documents with basic tests of compliance. With this more general goal, technology suppliers would have greater freedom around how to solve the requirement resulting in a greater range of solutions—some of which likely would have superior usability. The market would then reward the company that best met both the requirement and the associated usability and user satisfaction.

The overall goals of MU are sound; it’s simply that in practice the extent and specificity of the requirements often overemphasize feature content and prescribed usage at the expense of user experience and the innovation that comes with flexibility. A doctor on HIStalk a few weeks ago highlighted this reality:

“When you’re used to using very clean designs—a MacBook, an iPhone, Twitter, Facebook—and you sit down on an EMR (electronic medical record system), it’s like stepping back in time 15 or 20 years.”

I had the opportunity to build an EHR after MU Stage 1 had been established. This allowed us to take a more comprehensive approach in terms of meeting our overall design goals, including usability, as well as MU requirements. We wanted to make it possible for the physician to use the application to chart patient visits and the required data and reporting were generated as an by-product of normal use.

Now, we are facing changes for MU Stage 2, integrating those into an existing product, tying them to user needs in a way that makes sense. We have developed a process that uses a lot of user feedback and testing and we try to iterate quickly with releases at least monthly.

But the fact is that the specificity of MU and the rigorous testing don’t provide for the best user experience. Ironically, these really specific requirements—a number of which dictate the user experience to a large degree—are supposed to be creating improved usability when in fact they are detracting from user-friendless and improved workflow.

I believe that without MU, many EHR features would be similar, but there would be notable differences resulting from the focus on user feedback versus government direction. As a physician and an EHR designer, I would still want to track health maintenance and have tools to manage people’s care. The big change would be the ability to focus on some market-driven elements that we haven’t been able to spend as much time on because they aren’t MU requirements.

We would be spending more time looking at how we could use the practice data to highlight workflow problems or areas where the practice isn’t using best practices. By leveraging our large pool of operational and clinical data, we could generate more recommendations for practice optimization and patient care. These are very high level concepts that we are exploring, but are at a lower priority given the resources required to implement MU2 in a way that is well integrated and results in a positive user experience.

In a perfect world, current MU2 requirements would be replaced with just few high-impact goals related to interoperation and communication. Current MU2 requirements have added little new incremental value while creating a significant burden for vendors and end users. This situation is even more challenging in that the requirements are becoming more specific and dictate user interaction in some cases. The structure is in place to capture discrete data, measure quality, and communicate standardized data.

At this point, I believe the market should drive the process of advancing features and expand-on the valued features outlined by the MU requirements.

Tom Giannulli, MD, MS is chief medical information officer at Kareo.

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July 15, 2013 Readers Write 3 Comments

Morning Headlines 7/15/13

July 14, 2013 Headlines No Comments

Practice Fusion raising $60M, sources say

Ambulatory EHR freeware vendor Practice Fusion is rumored to be within days of announcing $60 million in new funding from an undisclosed New York-based investment firm.

Sutter’s New Electronic System Causes Serious Disruptions to Safe Patient Care at E. Bay Hospitals

Nurses with the California Nurses Association working at Alta Bates Summit Medical Center (CA) have gone on strike, citing patient safety concerns with the hospital’s newly implemented Epic system. Alta Bates, a Sutter Health facility, becomes the third health system to fall victim to an EHR-related nursing strike in the past few months after Affinity’s nurses hit the pavement in June over what they called a "hurried" Cerner implementation and Martin General Hospital (CA) nurses went on strike in May to delay a upcoming McKesson implementation. Sutter Health is reportedly spending $1 billion on a system-wide Epic implementation.

Athenahealth soars on Ascension deal

Athenahealth stock rose 20 percent Friday after the company announced a deal with Ascension Health Network worth as much as $42 million. Athena will implement its practice management solution to more than 4,000 Ascension providers.

Do Clinical Trials Work?

An op-ed in the New York Times questions the validity of clinical trials for new medications.The use of Avastin to slow the development of aggressive brain tumors is discussed. Researchers have not been able to link Avastin to improved survival rates through clinical trials despite growing anecdotal evidence that suggests a relationship does exist.

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July 14, 2013 Headlines No Comments

Monday Morning Update 7/15/13

July 14, 2013 News 7 Comments

7-14-2013 7-04-39 AM

From Flyswatter: “Re: Practice Fusion. Running out of money, expanding, or both?” Free, ad-supported EMR vendor (are you a vendor if your product doesn’t cost anything?) Practice Fusion is rumored to be raising another $60 million after a $34 million round held less than a year ago.

7-13-2013 6-38-03 AM

Three-quarters of respondents say healthcare organizations should continue with their plans to buy software in preparation for Affordable Care Act-related changes even though the future of the ACA is uncertain. New poll to your right: how has the DoD/VA discussion about a shared EHR changed your perception of those organizations?

7-14-2013 7-06-53 AM

I mentioned last week that it would be fun to hear from folks who have been reading HIStalk since the beginning 10 years ago. Some replies:

  • ”I know I’ve been reading your stuff since the beginning for sure. I think a friend of mine referred the site to me, but I can’t remember who and/or exactly when… all I know is that now you can’t get rid of me.”
  • “I count you as one of my celebrity acquaintances.” [this tongue-in-cheek comment came from someone who knows me]
  • “I found HIStalk while searching for a primary source of unbiased information about the healthcare IT world. I found HIStalk to be one of the few outlets at the time willing to publish all things healthcare IT (good, bad and the ugly) and provide value to sponsors and readers alike. It’s been wonderful watching HIStalk grow with the healthcare IT industry. Congratulations!”
  • “In 2003 I worked for Eclipsys, and one of our sales reps asked if I read HIStalk. He said it was the best blog about the industry he had ever read, and that if I wanted to be in the know and feel hip at the same time, I should check it out.  And so I did. And stayed. Congratulations!”

HIStalk Webinar Monday, July 29

7-14-2013 9-05-04 PM

Jonathan Teich MD, PhD of Elsevier will present “Clinical Decision Support: The Promise, Pitfalls, and Practicalities” on Monday, July 29 from 2:00 to 2:45 p.m. Eastern. He will provide practical insights into the key success factors for selection, design, management and rollout of CDS interventions and will describe 10 types of CDS and how to apply them. My CIO reviewers who provided feedback on the rehearsal gave this Webinar rave reviews, with one of them saying he was so engrossed by the CDS examples that he wished it had lasted 30-45 minutes longer (when’s the last time you heard that about a Webinar?) I thought it was really well done myself. You can register here.

Also upcoming: “Five Steps to an Enterprise Imaging Strategy,” presented by Merge Healthcare, on Wednesday, July 24 from 3:00 to 3:45 p.m. Eastern.

These Webinars meet HIStalk’s standards for quality, clarity, and attendee value. They have been critiqued by experts and are moderated by folks who work with me.

7-14-2013 8-17-14 AM

Six people lose their jobs for inappropriately viewing electronic patient records at Cedars-Sinai Medical Center, possibly those of Kim Kardashian. Four employees of community physician practices were found to have been using the login credentials of their physician employer and were dismissed, along with a medical assistant and an unpaid student research assistant. The journalistically rigorous TMZ decided that a phony quote and Photoshopped picture were the perfect way to illustrate its uncredited rumor, which was repeated by traditionally privacy-indifferent press anxious to jump on the celebrity gossip bandwagon without appearing to be pandering to intellectual lightweights.

7-13-2013 8-55-36 PM

Another nurse union uses an EMR implementation to publicly criticize a health system. The California Nurses Association cites 100 reports from RNs claiming Sutter Health’s $1 billion implementation endangers patients of Alta Bates Summit Medical Center. The nurses say the system requires too much nursing time, delays care, and isn’t clinician friendly. The union wasn’t nearly as concerned about patient safety eight weeks ago when it ordered its nurses to walk off the job for seven days in those same Sutter East Bay facilities to protest a reduction in their health benefits.

Intermountain Healthcare says it has developed an EHR module that allows state death certificates to be completed automatically.

7-14-2013 8-49-45 AM

A Silicon Valley business newspaper profiles former professional quarterback Steve Young, now a private equity deal-maker for HGGC (formerly Huntsman Gay Global Capitalist). The article says he was involved in that private equity firm’s investment in Sunquest, which it later sold to Roper Industries.  

A dozen employees from the Raleigh, NC offices of Allscripts volunteered to help clean up tornado damage in Moore, OK and presented the local hospital with a check for $50,000. Allscripts covered all of their expenses and paid their full salaries.

7-14-2013 8-55-20 PM

Ivo Nelson’s Next Wave Health advisory and investment firm will announce Monday that former Steward Health Care CIO Drexel DeFord has joined the company as a principal advisor.

7-14-2013 8-50-48 AM

Shares of athenahealth jumped 20 percent on Friday after the company filed SEC documents disclosing a June 30 deal with Ascension Health Network’s physician segment, which will deploy the company’s system to its 4,000 providers and affiliates. Athenahealth’s market cap is now $4 billion, with Jonathan Bush holding shares worth $33 million. A $10,000 investment in ATHN shares on this day three years ago would be worth $48,000 today.

Also earning a spot on the Nasdaq’s top percentage gainers for Friday were WebMD (up 25 percent on its sales outlook) and Quality Systems (up 12 percent on an analyst’s upgrade).

7-14-2013 7-08-48 AM

Showing his HIStalk colors at the top of Mt. Bachelor in Oregon is Dean Sitting, PhD, professor of biomedical informatics at UT Health Science Center in Houston.

Maybe it’s just me: every time I get an e-mail survey from HIMSS, I dutifully start completing it, but then bail out in annoyance just a few questions in. Every HIMSS survey is way too long, has endless answer choices but often not the one I need, and uses a stiff and authoritarian tone that makes me feel like I’m dealing with IRS instead of an organization to which I voluntarily pay dues out of my own pocket.

Blue Cross Blue Shield of North Carolina is called out for sending out live patient data to software developer DST Systems for testing its systems. Cigna went on record saying it would never do that, while Aetna said it shares data in similar situations.

Brown University researchers create software that can analyze the cries of an infant, hoping that the 80 auditory parameters can detect developmental problems.

An interesting New York Times opinion piece questions whether clinical drug trials work, wondering if disease and response is so individualized that mass testing creates more frustration than usable knowledge. It says drug companies are just playing the lottery in testing drugs they don’t expect to be effective, hoping for a statistical miracle. It also says that nearly every study is biased from the outset because drug companies pay for them, turning them into a “straw-man comparator” of drug vs. placebo instead of a real quest for finding the best treatments. The healthcare IT connection: genomics, which could effectively match patients with drugs likely to benefit them.

Vince starts his history of Siemens in this week’s HIS-tory. He is trying to find the lost history of the IBM SHAS (Shared Hospital Accounting System), so if you know more than what’s on Vince’s slides, he would enjoy hearing from you. Vince loves this stuff and his enthusiasm and fun memories come through loud and clear in his HIS-tories.

Sponsor Updates
  • Intelligent InSites will host a July 25 Webinar, “The Hospitality Environment” – Improving the Patient Experience with Innovative Technology.”
  • O’Reilly’s Strata Rx Conference, “Data Makes a Difference,” offers HIStalk readers a 20 percent discount on registration through August 15. It will be in Boston September 25-27 and feature speakers from athenahealth, Valence Health, HHS, and Humedica.


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

More news: HIStalk Practice, HIStalk Connect.


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July 14, 2013 News 7 Comments

News 7/12/13

July 11, 2013 News 7 Comments

Top News

7-11-2013 8-30-30 PM

DoD and VA officials tell the House Armed Services and Veteran Affairs Committees that they will focus on creating a system that will display standardized information from both organizations instead of pursuing an integrated health record now estimated to cost $28 billion. DoD also announces that it will tender bids for replacement of its AHLTA, CliniComp Essentris, SAIC CHCS, and TMDS systems. Video of the hearing is here, although a lot of it involves the famous claims backlog. The DoD people are grilled at around 45:00 as to why they are ignoring the President’s mandate for an integrated record and are instead off shopping commercial software for themselves. The answer is not nearly as direct as the question, although in an interesting moment, DoD Undersecretary Frank Kendall disputes a quote about his department’s intentions and criticizes the source as “entirely incorrect,” only to be told that the quote came from the Secretary of Defense.

Reader Comments

7-11-2013 8-21-30 PM

From Lance Boyles: “Re: HCA. Just consolidated its IT staffing vendor list to just Zycron, Robert Half Technology, and Insight Global. TEKsystems, shockingly, did not make the cut even with its long-term, high-value corporate relationship.” Unverified.

7-11-2013 6-23-28 PM

From Punditry: “Re: Senate Finance Committee. Has called Farzad Mostashari, MD from ONC and Patrick Conway, MD from Center for Clinical Standards and Quality to testify at a July 17 hearing called Health Information Technology: A Building Block to Quality Care.”

From Fresh: “Re: CIOs fired during or after an Epic install. I was curious on your take.” CIOs do indeed get fired during or after their installs of Epic … and Cerner, Allscripts, Meditech, and every other system out there. My take:

  • You hear about the Epic ones because, by definition, they are the highest-profile hospitals and CIOs, and the high cost of their implementation projects increases the risk of being made a sacrificial lamb when things don’t go smoothly.
  • Epic takes quite a bit of time to install because it’s usually replacing most major systems, and with CIO turnover being what it is, there’s a good chance that some CIOs will leave in those years purely by chance.
  • Some hospitals want an Epic-experienced CIO knowing the many millions of dollars that are at risk and — either at their own initiative or because Epic identifies potential problems — decide to make a change.
  • I would hope that hospitals don’t put the CIO in charge of the project since that’s a big mistake, but I would also hope that the CIO and IT department don’t let the Epic train roll over them by being anything but ecstatic over a project that has already been embraced with possibly irrational exuberance by operational leadership.
  • When you read about high-profile Epic failures, I would bet you any amount of money that the risks were spelled out well in advance in the extremely detailed (and blunt) executive status reports that Epic provides regularly, which means the facility probably either ignored its recommendations or wasn’t functional enough to fix the noted problems. If those chips fall on the CIO, hilarity will not ensue.

From Deep Thoughts: “Re: EHR usability. It’s one piece of a complex puzzle. I’ve worked with EHRs that are loved by physicians, but lack basic capabilities, like allergy checking if a medication name is spelled wrong. Per this quote about the stethoscope from 1834, there is resistance to change, and the key is channeling it into systemic improvements.” The 1834 stethoscope quote: “It will never come into general use, not withstanding its value; it is extremely doubtful because its beneficial application requires too much time and gives a good bit of trouble both to the patient and the physician because its character is foreign and opposed to all of our habits and associations.”

HIStalk Announcements and Requests

inga_small Recent highlights from HIStalk Practice include: a reader wonders how EMR requirements differ between small and large practices. The American Academy of Ophthalmology will implement an eye disease patient database. A third of physician executives think healthcare costs rise when hospitals buy physician practices. CMS proposes paying providers for non-face-to-face care of patients with multiple chronic conditions if the provider uses a certified EHR. ONC’s Farzad Mostashari, MD predicts an uptick in full EHR adoption in 2014 just before providers risk penalties for not meeting MU standards. Federal financial incentive programs have spurred e-prescribing adoption. Brad Boyd of Culbert Healthcare Solutions offers recommendations to avoid impacting cash flows when prepping for ICD-10. Reading HIStalk Practice may not be a cure for the summertime blues, but it is a cool way to catch up on the latest ambulatory HIT news. Thanks for reading. 

7-11-2013 6-27-29 PM

Earn HIStalk Karma Points by: (a) signing up for spam-free e-mail updates; (b) searching or navigating your way to finding the offerings of HIStalk sponsors in the Resource Center; (c) finding a consulting firm painlessly by blasting your quickly-entered RFI to the companies of your choosing – including all of them as an option – via the Consulting RFI Blaster;  (d) connecting with us on Facebook, Twitter, and LinkedIn, including the HIStalk Fan Club that reader Dann set up in 2008 (happy five years, Dann!) that now has 3,200 members; and (e) sharing my amazement at the impressive roster of industry-leading companies that support HIStalk by perusing and occasionally clicking their ad to your right and telling them in person that you saw them on HIStalk. Thank you for reading, with extra gratitude to that handful of readers who were there with me when I started writing HIStalk in June 2003.

Actually, there may be more than a handful of 10-year readers out there, so if you’re one and would like to tell me how you found HIStalk in 2003 and why you’ve kept reading, that would be fun.

On the Jobs Board: Health Analytics Data Analyst, Senior Healthcare Policy Analyst, Marketing Specialist, Systems Administrator.

7-11-2013 6-41-58 PM

HIStalk Connect’s Dr. Travis and Kyle were at the Converge conference in Philadelphia this week, with Kyle on the right sporting Google Glass and Travis jealously wishing his plain old optical glasses were half as cool. A report from Travis is here.

Acquisitions, Funding, Business, and Stock

7-11-2013 8-18-42 PM

Allscripts announces that it expects Q2 bookings and contract backlog to increase 3 percent and 13 percent, respectively. That includes the just-announced $400 million services extension by North-Shore-LIJ Health System, which provided important validation that the company can meet the needs of a large health system.

7-11-2013 8-17-32 PM

In the same SEC filing, Allscripts announces that EVP of Sales Steve Shute, who joined the company in July 2011, will resign effective August 8, 2013 and will receive as severance his expected one-year compensation of $880,000.


Kindred Healthcare (KY) selects dbMotion create a single patient record.

Medical Center Hospital (TX) chooses Convergent Revenue Cycle Management.

7-11-2013 8-11-55 PM

Gundersen Health System (WI) will implement iSirona’s device connectivity solution.

The Specialty IPA of Kansas retains Wellcentive to facilitate clinical integration, manage P4P programs, and support its integrated network of primary care physicians.


7-11-2013 5-25-40 PM

Health Catalyst names Scott Holbrook (Medicity/KLAS) as a strategic advisor.

7-11-2013 12-13-59 PM

Bill Korn (Antenna Software) joins MTBC as CFO.

7-11-2013 2-54-14 PM

Scripps Health names Steven Steinhubl, MD director of its Digital Medicine program, tasked with leading the scientific evaluation of mobile health devices through the Scripps Translational Science Institute.

7-11-2013 5-29-27 PM

Systems Made Simple elects CFO Christopher Roberts to its board.

Acusis appoints Robert Parsons (Cerner) VP of strategic business solutions.

Announcements and Implementations

Nuance announces that 750 developers have joined its healthcare developer community.

The health IT program at the University of Texas at Austin and Jericho Systems will participate in an ONC-approved national pilot to explore advanced patient control over shared medical records and how patients can better control the release of their PHI when requested electronically from their providers.

Government and Politics

7-11-2013 1-43-11 PM

ONC issues an ONC Certified HIT mark for EHR technology that has 2014 edition certification requirements.

The HIT Policy Committee’s Information Exchange Workgroup issues preliminary recommendations on patient record queries and provider directions for Stage 3 MU.

Innovation and Research

Healthbox partners with BlueCross BlueShield of Tennessee to launch a new health IT accelerator in Nashville, joining its locations in Chicago, Boston, and London. The first class will start in September at the Nashville Entrepreneur Center.


Pixie Scientific develops a diaper that works with a smartphone app to detect possible UTIs, kidney dysfunction, and dehydration, transmitting its findings to a physician. The developers say the diaper also has potential as a consumer product and would likely cost about 30 percent more than regular diapers.

inga_small In contrast to the simple genius of this diaper, I was reminded yesterday just how far behind healthcare is. My new insurance carrier offers online access to an electronic image of the insurance card. I thought it was semi-brilliant of me to take a photo of the online image with my iPhone instead of printing it. It was easy to hand the pharmacy tech my phone so she could enter the numbers into their system. The doctor’s office, however, requires the actual card so they can scan it into their system. I would have been pleased two years ago to have my card scanned for a computer system instead of photocopied for a paper chart. Today I am annoyed because the doctor’s office was unable to think outside the box  and accept my electronic copy.


7-11-2013 2-13-04 PM

A HIMSS Analytics survey finds that network/architecture support and security are the jobs that most often require industry certification.

7-11-2013 6-33-59 PM

Indiana University School of Medicine and Regenstrief Institute endow a chair to honor informatics pioneer and LOINC inventor Clem McDonald, MD (left in the photo above). The first Clem McDonald Professor of Biomedical Informatics is Titus Schleyer, DMD, PhD, MBA, director of the Regenstrief Institute (right in the photo above).

HHS fines insurer WellPoint $1.7 million for exposing the medical information of 600,000 people in 2009-2010 due to Internet server security issues.

7-11-2013 7-47-52 PM

Texas Health Harris Methodist Hospital Fort Worth notifies several hundred thousand former patients that their medical information from the 1980s has been exposed when several microfiche pages are found in a park. The hospital says its disposal contractor, Shred-it, didn’t.

Friends of industry long-timer Milton Antonakos, who died along with his family in a plane crash in Alaska earlier this week, are welcome at a remembrance get-together at the Columbia, SC offices of Allscripts on Friday, July 12 (today) at 3 p.m. Inga will provide the RSVP information and location details if you e-mail her.

Citizens of a small town in Canada whose only doctor will be away on his honeymoon for six weeks are offered telemedicine services in the interim by the province to mixed reaction. According to one resident, “I did the doctor camera thing. Basically I diagnosed myself and he gave me a prescription. It was pretty impersonal.”

7-11-2013 7-36-15 PM

PCWorld, the only remaining print edition consumer computer magazine, publishes its last paper issue to focus on its online and digital editions.

7-11-2013 7-06-06 PM

Healthcare isn’t behind in technology, we’re just on the leading edge of security. The Kremlin, panicked by the release of electronic secrets by WikiLeaks and Edward Snowden, issues an RFP for electric typewriters of the specific German model above. Retro-secure fax machines and pagers can’t be far behind.

Sponsor Updates

  • Covisint expands its partnership program to enable organizations to resell, refer, or white-label Covisint Identity Services.
  • Beacon Partners will provide consulting expertise to help organizations using Information Builders’ BI and analytics solution.
  • Marshfield Clinic Information Services subscribes to the Capsite Database to assist with health technology procurement and purchasing.
  • CIC Advisory launches a blog entitled, “Think.Learn.Care.” or TLC, which profiles hospital leaders who are effectively using technology to improve the efficiency and effectiveness of patient care.
  • Emmi Solutions selects Truven Health Analytics as its preferred partner provider of patient discharge instructions.
  • Quest Diagnostics provides access to de-identified hepatitis C test results from its Health Trends national clinical laboratory database to the CDC for public health analysis.
  • T-System publishes an infographic depicting the MU history of its EV product.
  • University of Florida Health and Florida Hospital securely exchange PHI with the Florida HIE Patient Look-Up Service developed by Harris Corporation.
  • O’Reilly Strata RX Conference posts the schedule for its September 25-27 conference.
  • Surgical Information Systems discusses the role of IT in quality reporting. 
  • Billian’s HealthDATA Jennifer Dennard takes on Google and inaccurate hospital data. 
  • TeleTracking Technologies looks at patient care satisfaction and its impact on an organization. 
  • SpeechCheck’s Ken Schafer discusses the importance of accurately recording narrative data within the EHR.
  • Advanced Medical Imaging (CO) discusses how it increased point-of-care patient collections by 315 percent within a year of implementing ZirMed’s Patient Estimation solution.
  • Verisk Health announces details of its annual conference September 18-20 in Orlando.
  • Optum’s CMO Miles Snowden, MD discusses how to navigate the journey from providing care to managing health.
  • HMC HealthWorks will integrate the Healthwise Care Management solution into ProGuide, the HMC care management platform.

EPtalk by Dr. Jayne

7-11-2013 6-16-23 PM

Alberta Children’s Hospital has deployed a robot named MEDi to aid children receiving flu shots. Those who engaged with the robot reported less pain and distress than those who didn’t. The study involved 57 children with moderate to severe fear of needles. In addition to distracting patients, the robot also provides instructions for relaxation and deep breathing.

Nearly a third of “Pioneer” ACOs may opt out, with some joining the Medicare Shared Shavings Program instead. Some have been threatening to do so since a dispute over measures in March. Although CMS did make some changes, it may not have been enough. Pioneer ACOs have until next Monday to notify CMS of their plans to leave that model and until July 31 to apply for the Shared Savings Program.

Health Affairs looks at the reasons poor patients prefer hospitals over office-based care. Researchers from the University of Pennsylvania documented patterns where patients using less preventive care were more likely to become acutely ill and/or require hospital care, costing over $30 billion each year. Reasons cited by patients included hospitals being less costly and more convenient with better quality care. That’s a sad commentary on our clinic and safety net ambulatory systems.

7-11-2013 6-20-04 PM

Congratulations to HIStalk contributor Ed Marx, who reached the summit of Mt. Elbrus in Russia earlier this week.

Thanks to everyone who sent good wishes for my laboratory orders go-live this week. It went fairly well and the phone lines were pretty quiet. We rarely receive compliments, but sometimes not hearing complaints is enough to know we did the job right. It’s been a tiring week, nevertheless, so I’m keeping tonight’s piece short and going to bed early.


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

More news: HIStalk Practice, HIStalk Connect.



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July 11, 2013 News 7 Comments

Readers Write: Asking the Right Questions: How to Find the Right Technology Development Partner

July 10, 2013 Readers Write No Comments

Asking the Right Questions: How to Find the Right Technology Development Partner
By Lee Farabaugh

7-10-2013 5-54-37 PM

We’ve all heard the stories. A hospital implements technology only to discover that it is so complex and confusing that it takes clinicians twice as long to get their work done as it did before, frustrating providers and patients. The hospital tries to work through the issues to no avail, and the organization ultimately abandons the software in pursuit of something else.

Money, time, and resources are wasted, and the organization is still no closer to effectively leveraging technology to improve patient care or streamline efficiencies. On the other hand, there are technology implementations that go smoothly, with providers fully embracing an application and using it appropriately.

What differentiates the good from the bad? User experience design, centered on end user input. Positive outcomes (increased user adoption, for example) occur when end users are actively involved in technology design, development and implementation.

To determine whether your technology partner incorporates user experience into its approach, there are some key questions you should ask. Getting answers to these questions can help you avoid disastrous technology roll-outs and ensure potential applications are a good fit for your organization.

Does your technology partner take a provider-centric approach by involving clinicians as key members of the development team?

These clinicians should be providers who have been actively involved in practicing medicine, so they are aware of the issues clinicians face in their day-to-day work. Getting direct input from providers who will use the system ensures that any potential roadblocks are addressed and resolved. Even if the technology you are considering is more patient-focused, clinicians should still be part of the development team. When people with medical expertise are involved in designing a patient-focused product, they can share the clinical perspective on what is possible and preferable for the technology.

How much of your technology partner’s research and development budget is devoted to garnering information about user experience?

This question can reveal the value your technology partner places on end user input. In other words, are they putting their money where their mouth is and dedicating resources to obtaining and leveraging user feedback?

Have you ever had a usability assessment on your application portfolio?

This puts hard data around your technology partner’s usability claims. By reviewing a usability assessment, you can clearly see whether providers or patients are actually using the software your partner developed on a long-term basis.

Does your technology partner have an end user group to provide ongoing feedback?

This type of forum can be a valuable source for transparent feedback about a solution. Not every software developer has the resources to sustain a user group for each of its clients, but those companies that do communicate their commitment to their customers and end user satisfaction. If your technology partner does have a user group, you may want to ask if you can attend a meeting. Although this may not be possible—some companies prefer to limit the number of attendees at a meeting—it would allow you to gain helpful information directly from other users.

Does your technology partner provide you with easy and intuitive training and support?

While some applications may be “plug and play,” most will require a certain level of training. Getting a sense of how user-friendly the training is can help provide insight around your technology partner’s commitment to user experience design across all of its materials. User-centered training may involve short videos, web-based modules or super-user mentoring. Ideally, you want to avoid day-long didactic training sessions that provide limited value and take providers away from patient care.

User experience design is the linchpin for technology adoption. Technology companies that don’t place value on user experience in the design and development process could offer products that aren’t fully usable and don’t meet the needs of your organization. As such, asking deliberate questions about your partner’s view on the value of user experience is time well spent.

Lee Farabaugh is the chief experience officer at PointClear Solutions.

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July 10, 2013 Readers Write No Comments

Morning Headlines 7/10/13

July 9, 2013 Headlines 2 Comments

Stinger Medical Merges with Enovate

Stringer Medical, which manufactures mobile workstations, has merged with its primary competitor Evnovate, resulting in the largest mobile workstation producer in the country.

Health Information Technology in the United States 2013

Since 2010, EHR adoption has tripled in the US, with 42 percent of hospitals and 38 percent of eligible providers successfully attesting to Stage 1 Meaningful Use .

CMS mulls payment policy changes on chronic care, telehealth

CMS is considering paying paying primary care physicians for chronic care management services without requiring an in-person patient visit, suggesting that telehealth services may finally become reimbursable.

OFT probe could ratchet up pressure on health IT providers

In England, the Office of Fair Trading is investigating health IT vendors that intentionally limit interoperability to gain strategic advantage.

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July 9, 2013 Headlines 2 Comments

News 7/10/13

July 9, 2013 News 7 Comments

Top News

7-9-2013 7-27-41 PM

Mobile clinical workstation manufacturer Stinger Medical merges with competitor Enovate, forming the country’s largest mobile workstation provider that will operate under the name Enovate Medical. Stinger’s CEO and CFO will continue those roles with the new company, as will Enovate’s COO.

Reader Comments

7-9-2013 6-06-38 PM

From HIT Veteran: “Re: death of Milton Antonakos. The industry has lost a sales superstar. Milton was always a top performer because you couldn’t outwork him. He was a bundle of energy, had great life balance, and was always encouraging others. Tragic and a reminder to live every day fully.” Milton Antonakos of CareAnywhere, previously with Allscripts/Misys for 23 years, was killed in the crash of an air taxi in Soldotna, AK on Monday along with his wife and three children. Also killed were Chris McManus, MD, a radiologist with Greenville Health System, his wife and two children, and the plane’s pilot. Condolences to family and friends.

7-9-2013 6-48-02 PM

7-9-2013 7-02-49 PM

From QSII Watcher: “Re: Quality Systems, parent of NextGen. Looks like another proxy battle ahead. The Clinton Group, an activist investor, has filed an alternative board slate that includes former President Scott Decker. He’s the second former exec to try to join the board – Pat Cline was added in the last (failed) proxy battle by the second-largest shareholder Ahmed Hussein. Doesn’t look like Hussein is officially part of this proxy battle, but the SEC filing alludes to conversations with him. You can bet he’ll vote his shares in their favor. Also on the board slate is Peter Neupert, formerly of Microsoft and now at David Brailer’s Health Evolution Partners.” The  proxy statement says the performance of Quality Systems lags its peers in earnings and total return, with share price flat since 2008 while the S&P 500 rose nearly 60 percent. It cites equity analysts in saying that management has no clear strategic plan, keeps chasing distractions, is losing sales, and has questionable potential in the small hospital segment. Above is the five-year share price of QSII (blue), the Nasdaq composite (red), Cerner (green), and Allscripts (brown).  

7-9-2013 7-38-34 PM

From Ricardo: “Re: pet health portal. Yesterday I received an e-mail from dog’s vet introducing me to their new Pet Health Portal, where I can log in to see my pet’s health record, request appointments, search their pet health library, view vaccination history, etc. I actually laughed out loud considering I’ve received no indication whatsoever of a patient portal offering from my primary care physician. Thought you might appreciate that.” I do indeed appreciate that information, having been equally impressed by similar systems, often rolled out by veterinary chains like Banfield. Vets also offer Pet Mail to answer questions. Next time someone says they’ve been treated like a dog, congratulate them.

7-9-2013 7-20-28 PM

From Keith: “Re: JAMA opinion piece from Dartmouth, of all places. The educational and cognitive purpose of the evolved medical chart has been devalued by EHR.” The editorial by Robert S. Foote, MD of Dartmouth-Hitchcock’s nuclear stress laboratory says, “Discussions of EMRs have tended to be dominated by descriptions of their potential benefits, while less attention has been paid to their potential hazards, among which are breaches of privacy, incompatibility of different systems, introduction of computer-based errors, and loss of productivity owing to cumbersome procedures that EMRs sometimes require. I think it behooves us as well to consider the impact of these systems on a very basic element of clinical practice, namely, how clinicians think.” Among his comments:

  • Epic has “68 tabs, many of which lead to numerous subtabs and links” and lists every field generically (like “code report”) even when they don’t apply to the particular patient
  • Notes written by all providers, including non-physicians, are jumbled together and often copied and pasted, interrupting the thought process.
  • The system tries to force standardization through the use of checkboxes, but often omits important information as a result, saying that he has never seen a checkbox saying, “my daughter died of the chemotherapy you are proposing for me.”
  • The medical record is not data or a repository to hold data, but rather information that has been transformed by caregiver knowledge.
  • The medical record is a battleground over the future of healthcare, because “as it becomes more difficult to write like a clinician, sooner or later it will become more difficult to think like one.”

7-9-2013 7-44-20 PM

From ColonelPeter: “Re: QlikView. Our organization just chose to purchase a BI technology called QlikView after seeing a demonstration of its integration with Epic at HIMSS. The pre-sales guy was a former Epic veteran who said that they were still working through logistics of a partnership with Epic.  Seems if Epic wants to dispel the belief that they’re difficult to work with, they should be trying to fast track a partnership with these guys. We’ve only had the software two weeks and already have gotten a ton of value from just playing with it.” I’ve mentioned QlikView several times and have played around with their free download. You can try their surgery scorecard live demo.

HIStalk Announcements and Requests

The upcoming HIStalk Webinar, “Five Steps to an Enterprising Imaging Strategy,” sponsored by Merge Healthcare, has been rescheduled for Wednesday, July 24 at 3:00 – 3:45 p.m. Eastern.

Acquisitions, Funding, Business, and Stock

7-9-2013 10-27-15 PM

Predixion Software raises $20 million in a Series C financing round led by Accenture and GE Ventures.

7-9-2013 10-41-18 PM

Coppersmith Capital Management, LLC, which owns 7 percent of the shares of Alere, launches a proxy fight in nominating its own slate of three directors for consideration at the August 7 Alere shareholder meeting. Its letter to shareholders urges the company to sell its Health Management division, which connects diagnostic devices to health management services.

The Italian subsidiary of Germany’s CompuGroup Medical will acquire a majority stake in Studiofarma Srl, which sells pharmacy software in Italy and has 7,000 customers.


7-9-2013 10-30-36 PM

WellStar Health System (GA) selects Besler Consulting to assist with the identification and recovery of Medicare Transfer DRG underpayments.

CareBridge Palliative Care Services(OH) will implement Authentidata Holding Corp.’s Electronic House Call and Interactive Voice Response telehealth solutions for remote patient care.

7-9-2013 10-29-13 PM

Alameda Health System (CA) engages MedAssets for A/R services.

The Children’s Care Alliance (PA) will create a health information exchange for underserved children based on HIE technology from Alere Accountable Care Solutions.

North Shore-LIJ Health System extends its managed services agreement with Allscripts through 2020.


7-9-2013 6-14-32 PM

Truven Health Analytics names Roy Martin (WELM Ventures) COO of its hospital, clinician, employer/health plan, and life sciences customer channels.

7-9-2013 6-15-32 PM

Arcadia Solutions appoints Chuck Garrity (Beacon Partners) RVP.

7-9-2013 7-51-21 PM

Dartmouth-Hitchcock (NH) names Terry Carroll chief innovation officer. He was previously SVP of transformation and chief information officer at Fairview Health services (MN) and has held CIO roles at Detroit Medical Center (MI) and Baystate Health Systems (MA). 

7-9-2013 10-09-53 PM

Christopher Olivia, who was paid $6 million in his last year as president and CEO of money-losing West Penn Allegheny Health System (PA) before Highmark bought it in 2011, is named president of Continuum Health Alliance, a physician management company whose offerings include IT services.

Announcements and Implementations

7-9-2013 10-34-16 PM

Doctors May-Grant Associates (PA) and Lancaster General Health’s Women’s & Babies Hospital (PA) successfully exchange CCDs between the practice’s Greenway Medical platform and the hospital’s Epic system.

Greenway Medical will add PatientPay’s online patient payment solution to its PrimeSUITE EHR/PM platform.

Resolute Anesthesia and Pain Solutions begins a nationwide expansion of Shareable Ink’s Anesthesia Cloud for iPad following an initial deployment at the Boca Raton Outpatient Surgery and Laser Center (FL).

Miami Children’s Hospital implements the AnyPresence solution to enhance development of mobile patient engagement apps.

Northern Ireland launches its national patient record system based on Orion Health’s portal and integration technology.

7-9-2013 10-33-12 PM

The Brooklyn Hospital Center implements the MedAptus Professional Charge Capture solution for the coding of inpatient and outpatient encounters.

HIMSS will announce its HIMSS Health IT Value Suite in a July 16 event streamed live from Washington, DC. It sounds like a pitch for the ROI of products and services offered by its vendor members.

Government and Politics

7-9-2013 8-13-15 PM

CNSI, whose $200 million Medicaid claims system contract with the State of Louisiana was cancelled over alleged bidding irregularities, claims the state will lose $100 million by keeping its old system instead. A state DHH spokersperson responded, “CNSI really is not in any position to be commenting on costs that may be incurred by the state, especially in light of its own actions.” DHH Secretary Bruce Greenstein, a former CNSI executive, resigned after the probe was announced.

In England, the Office of Fair Trading launches an investigation to determine if hospitals become overly dependent on healthcare IV vendors when outsourcing and whether certain vendors try to stifle competition by limiting their interoperability with competitors. Experts suggest that Cerner, McKesson, and Epic will earn lower margins if they don’t open up their systems to third-party products given NHS England’s interest in best-of-breed systems.


Gartner ranks Dell as the leading provider of healthcare IT services globally based on 2012 revenues.

7-9-2013 8-04-54 PM

The annual healthcare IT report from Robert Wood Johnson Foundation finds that 44 percent of hospitals had a basic EHR in 2012, up 17 percentage points from 2011, with the number tripling going back to 2010 when HITECH started paying. Only 42 percent of hospitals met Meaningful Use Stage 1, however, with that number expected to drop for Stage 2, and only 27 percent participated in an HIE. The report also concluded that practices weren’t far behind hospitals in adoption percentages, but small practices continue to lag.

Fitch Ratings upgrades the bonds of Beebe Medical Center (DE) to “stable” despite weaker 2012 operating results partly caused by its write-down of the “not sufficiently robust” McKesson system that was replaced by Cerner at a cost of $37 million.

7-9-2013 10-36-41 PM

Vermont’s largest employer is now Fletcher Allen Health Care, with 7,100 employees.

Weird News Andy says the nurses were right again. The Syracuse newspaper uncovers an HHS report describing a series of errors that almost resulted in St. Joseph’s Hospital Health Center harvesting organs from a patient who was not brain dead. The doctor ignored nurses who argued that the overdose patient was responding to touch and breathing on her own. The patient survived her hospitalization, but committed suicide two years later.

Sponsor Updates

  • Covisint offers a Direct Toolkit that explains how Direct messaging relates to HIEs and why providers should adopt it.
  • Aspen Advisors announces the addition of 19 healthcare clients and 18 employees during the first six months of 2013.
  • Perceptive Software releases Document Filters 11, which allows software companies and services providers to embed their solutions with technology to unlock unstructured files and extract data.
  • Vitera hosts a July 24 Webinar highlighting steps to prepare for ICD-10 success.
  • The Healthcare Network Accreditation Program awards Capario full EHNAC accreditation.
  • Staffing Industry Analysts names Intellect Resources the fastest growing staffing firm in the US for 2013 based on its 125.5 percent growth rate.
  • Twelve CareTech Solutions customers win honors for their hospital websites.
  • Imprivata introduces a suite of proximity and fingerprint readers integrated with Imprivata OneSign to provide an end-to-end identity and access management solution.
  • The SSI Group aligns with ABT Medical to provide release of information services to SSI’s RAC solution.
  • Orion Health moves forward with expansion plans for its Christchurch, NZ development center.
  • Bottomline Technologies will honor Joshua Krantz, an employee who died from injuries received in an assault, at a July 15 memorial service when an award in his name will be announced. 
  • The FDA lists iMDsoft’s myAnesthesia app as a Class 1 medical device.
  • TrustHCS launches the TrustHCS Academy to train and place coding professionals in advance of ICD-10.
  • Impact Advisors leads an online CHIME focus group July 16 discussing optimization services.
  • Ingenious Med employees provide financial and onsite support to the Zambia Medical Mission, which provides medical assistance to underprivileged Zambians.


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

More news: HIStalk Practice, HIStalk Connect.


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July 9, 2013 News 7 Comments

News 7/5/13

July 4, 2013 News 8 Comments

Top News

A Dow Jones article says Intuit not only found its healthcare portal business to be a poor fit in its financial product lineup, the company had to write down $46 million in May after Allscripts bought Jardogs, which offered a patient engagement platform that will likely eliminate the dependence by Allscripts on the Intuit Health patient portal. The customer comments I heard at ACE 2010 (the Allscripts user group meeting) weren’t complimentary about Intuit’s portal, which it had just bought with its acquisition of Medfusion. It will be interesting to see if Allscripts will make a play for Intuit Health since it has already acquired Jardogs as an alternative.

Those with memory deficits might want to study yet another example of how outsider companies throw down big money to buy their way into the healthcare market because it looks easy, then slink off licking their wounds shortly afterward as they dump customers off to any bidder willing to take over the smoking wreckage of what used to be a decent company and product. That might be a fun exercise: leave a comment about which big company screwed up the most in its unsuccessful foray into healthcare. I always vote for Misys, which I’ve always suspected was created solely to amuse the industry with an exaggerated parody of incompetence.

Reader Comments

7-4-2013 9-40-51 PM

From RustBeltFan: “Re: HIPAA Omnibus Rule Advisory Panel responses. Scary answers! Maybe you’d be doing all of us a favor by developing a HIPAA Omnibus Rule 101 series for HIStalk!” Most of the CIO/CMIO respondents said their organizations were generally oblivious to the new rule, which kicks in September 23, 2013. If you are an expert on the topic, consider presenting an HIStalk Webinar to enlighten readers. This would be purely educational, with no commercial bias or sponsorship, and I’ll provide the platform and promotion to let you reach an appreciative audience (and it’s not bad for resume expansion and industry exposure besides.) Contact me if you’d like to present on this or any other educational topic.

HIStalk Announcements and Requests

Happy Independence Day. I’m not a fan of calling it the “Fourth of July” since that’s devoid of creativity and as dull as calling Christmas the “Twenty-Fifth of December” or New Year’s Day the “First of January.” About the only good thing about calling it the Fourth of July is that politicians weren’t tempted to make it a Monday holiday and thus destroy its historical significance simply to give Federal workers (and eventually the rest of us) a long weekend. At any rate, my flag is flying outside and I hope yours is, too. I worked a regular day today at the hospital and now I’m writing HIStalk, so I’ll celebrate by watching a few minutes of “A Capital Fourth,” which I’ve actually seen in person on the National Mall once. It was fun but dangerously hot, and while I’m glad I did it once, I have no plans to do it again other than on TV.

Other than HIStalkapalooza, what HIStalk activities, if any, would you like to see at the HIMSS conference in February? Let me know. I’m planning it now before I get swamped again starting in October.

On the Jobs Board: Senior Healthcare Policy Analyst, Epic Project Director, Android Developer – Healthcare + Google Glass, Staff Software Engineer .NET.


7-4-2013 7-48-02 PM 7-4-2013 7-49-11 PM 7-4-2013 7-49-52 PM 7-4-2013 7-50-29 PM

Scott MacLean, deputy CIO and director of operations at Partners HealthCare, starts his one-year term as chair of the HIMSS board. Carol Steltenkamp, MD (CMIO, University of Kentucky Healthcare), is named vice chair; Paul Kleeberg, MD (CMIO, Stratis Health) becomes chair elect; and Pete Shelkin (Shelkin Consulting) is named vice-chair elect.

7-4-2013 7-53-33 PM 7-4-2013 7-54-38 PM 7-4-2013 7-55-12 PM 7-4-2013 7-55-55 PM

New HIMSS board members starting their three-year terms this month are Beverly Bell, RN (VP, Health Care Dataworks); Beth Halley, RN (principal advisor, MITRE Corporation); Rick Schooler (VP/CIO, Orlando Health); and Michael Zaroukian, MD, PhD (VP/CMIO, Sparrow Health System).

Government and Politics

7-4-2013 9-02-50 PM

The Wall Street Journal apologizes for not having been critical enough of the Affordable Care Act, which it calls “a fiasco for the ages” and a “rolling train wreck.” It speculates that the Treasury Department pushed for delayed implementation (possibly illegally since Congress didn’t approve a delay) of the employer mandate because its own software isn’t ready to handle the changes. Apparently only the WSJ missed the obvious point that employers could bypass new healthcare expenses by either (a) cutting their headcount to drop below the 50-employee minimum; or (b) turning full-time positions into part-time positions. Their conclusion: the whole ACA could go right down the toilet because it was sloppily written, is impossible to execute, and will hurt employment. 

Speaking of the ACA, here are some interesting thoughts from a well-connected reader who knows what he’s talking about: with the announced delay in the ACA employer mandate and the uncertainty about the individual mandate, will hospitals ever really see the influx of newly insured patients they have expected? And if they have any doubt about that (which they should), will they curtail big software investments now?


7-4-2013 9-08-46 PM

US Army Sgt. Kyle Patterson and his wife Ashley thank The Aroostook Medical Center (ME) for using an iPad and Skype to create a video connection that allowed him to participate in the March 29 birth of his daughter from his post in Afghanistan. According to Ashley, “Kyle was just over the moon. He told me before the birth that he was not going to cry, but he did. He sure did.” The family presented TAMC with a flag that Sgt. Patterson flew in their honor at Bagram Airfield. The hospital flew that flag on July 4 to honor all members and veterans of the military.

A New York Times article entitled “American Way of Birth, Costliest in the World” says we spend $50 billion per year on four million births, a lot more than other developed countries that provide comparable access to services and technology. It describes a pregnant woman whose insurance doesn’t cover maternity costs trying to figure out how much money she would need, only to be told by the local hospital that it would be between $4,000 and $45,000. Her response: “How could you not know this? You’re a hospital … I feel like I’m in a used-car lot.” 

7-4-2013 9-46-58 PM

Maine Medical Center says it has fixed its problems with Epic, with Epic itself issuing a rare statement in saying MMC’s problems weren’t related to software defects. The hospital admits that the computer issues caused budget problems, but says those aren’t related to the buyout offers it will send out to 400 employees this week.   

7-4-2013 9-48-12 PM

The bonds of North Mississippi Health Services (MS) are downgraded because of financial losses largely due to $11 million in one-time expenses in implementing Allscripts at its Tupelo campus. Fitch Ratings says the implementation required more staffing and budget than expected and also increased length of stay.

In England, the head of the defunct NPfIT is called out, along with two other executives, for spending more than $100,000 for a consultant to help them look good in a single meeting with the Public Accounts Committee. A Member of Parliament describes their performance at the hearing as “woeful,” and suggests, “Perhaps they should ask for their money back.”

7-4-2013 9-58-56 PM

Weird News Andy succinctly titles this photo, “The ‘M’ stands for … “

EPtalk by Dr. Jayne

A Minnesota study demonstrates improved blood pressure readings using telemonitoring technology. Patients also kept their blood pressures controlled six months after the intervention ended. Pharmacists provided consultation and education over the phone once readings were received.

We know that exercise helps many of us deal with stress. Princeton researchers show that exercise creates new brain cells while also creating calm in other parts of the brain. The study involved mice running on wheels, which is a lot like being employed in the health information technology realm, especially during the summer. So many people assume summer is a “slow” time but I’ve found it to be stressful with many co-workers on vacation and the same amount of work to be done. Don’t forget to get your exercise and be glad you don’t have to be immersed in ice-cold water to be stressed (like the mice were.)

Thank you to everyone who sent comments (both posted and e-mailed) regarding my “tale of the ED” Curbside Consult. I’m happy to report that my sweet grandmother was discharged home to continue living independently. Her medications were adjusted, she’ll have some home therapy, and we’re off tomorrow to see if she’s a candidate for an injection of the pinched nerve that seems to be the root of the problem. I’m pleased to report that the care she received on the med/surg unit was both high touch and high tech, which renews my hope that we don’t have to sacrifice one for the other.


Thank you also to HIStalk contributor Ed Marx, who was the first to wish me a Happy Birthday this morning even though he is in the midst of climbing Mount Elbrus. His team is scheduled to summit on the 10th, so please join me in wishing them a safe journey. For our US readers, enjoy the Independence Day holiday. If you’re working in the trenches, double thanks to you.


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

More news: HIStalk Practice, HIStalk Connect



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July 4, 2013 News 8 Comments

Morning Headlines 7/3/13

July 2, 2013 Headlines 6 Comments

Health IT Patient Safety Action and Surveillance Plan

ONC releases its much-anticipated patient safety and surveillance plan that tackles a number of issues, such as how patient safety problems will be reported and tracked. EHR certification bodies will be required to confirm functionality and usability not only through testing, but through field observation. The Joint Commission has also been contracted to help identify and address safety issues.

Intuit Announces Next Phase of Structural Moves; Organizational Foundation Now in Place

Intuit will sell its Intuit Health Group, reporting that it had initially evaluated healthcare as a growth opportunity, but that it had come to realize that its health group would be better off with an organization that has a stronger focus on the healthcare industry.

Judge orders Affinity to bargain with union

A judge in Ohio has sided with a nurses’ union at Affinity Medical Center after they filed a unfair labor charge over a rushed Cerner implementation. Nurses claimed that the go-live date was too aggressive and a lack of training compromised patient safety. The judge ruled that Affinity leadership violated labor laws a number of times, first by refusing to negotiate with the nurses’ union, but other less-than-honorable examples cited by the judge included managers reducing the number of nurses in the ICU as retaliation and managers scrutinizing the charts of nurses who were outspoken union supporters in an effort to initiate disciplinary actions.

Washington Hospital "goes live" with $86 million electronic medical records system

In Freemont, CA, 339-bed Washington Hospital goes live on Epic across all inpatient and outpatient departments.

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July 2, 2013 Headlines 6 Comments

News 7/3/13

July 2, 2013 News 4 Comments
Top News

7-2-2013 6-10-06 PM
ONC releases its patient safety and surveillance plan based on public comments the draft received this past December. In summary:
  • ONC wants EHRs to be equipped with a “report a problem” type button that would collect information about the issue and send it to Patient Safety Organizations using AHRQ’s Common Formats.
  • Certification bodies will be required to “conduct surveillance” to ascertain that the capabilities of a given certified EHR are the same in the field as they were observed in certification testing.
  • Certification body surveillance will also monitor EHR vendor responsiveness to user complaints.
  • ONC will monitor FDA’s MAUDE medical device problem reporting database to find reported events that are related to health IT.
  • Meaningful Use and certification standards will be expanded to cover more patient safety-related objectives.
  • ONC will create tools that will allow provider EHR users to assess patient safety in their organizations.
  • ONC awards the Joint Commission a sole source contract to assist the ONC in detecting and proactively addressing health IT-related safety issues across a variety of care settings. The Joint Commission will develop an IT incident classification system, provide de-identified reports on related sentinel events, conduct at least five event investigations each in hospitals and practices, develop provider tools to help providers understand IT-related sentinel events, and publish a research paper that analyzes IT-related sentinel events.

Reader Comments

7-1-2013 12-52-11 PM

From Evangelist: “Re: Epic. Killing it in large practices.”More than half of all EMR-using practices that have 40 or more doctors use Epic, according to SK&A. Allscripts and eClinicalWorks each serve a substantial percentage of the smaller offices and the top 20 vendors support almost three-quarters of all practices using an EMR. Where people get in trouble is trying to infer from this limited information who’s buying what, which is more a question of practice ownership rather than practice size as hospitals keep buying out doctors and sticking Epic and Cerner in there.From Pointy Head: “Re: McKesson. Killing the MED3OOO Unity project and sunsetting InteGreat in favor of Practice Partner. There have been layoffs.” Unverified. McKesson acquired MED3OOO in October 2012 and claimed major go-forward love for InteGreat, so that’s quite a change in stated direction if so.

7-2-2013 11-02-42 PM

From Iknowa: “Re: Inova. Will collaborate with ValleyHealth, which has hospitals in Virginia and West Virginia, in several strategic areas, including IT. Inova brought its final two hospitals live on Epic over this past weekend, with all five now live on both financials and clinicals.”

From Patient Portal Believer: “Re: portals. Mr. H, you are spot on about the need for a strong patient portal strategy. EMR vendors that don’t currently have a tested and feature-rich patient portal should go out and acquire a portal vendor while there are still a few companies available. The portal is too important to MU2 and beyond to ‘partner’ with a portal vendor and it’s too late in the game to still be developing your homegrown solution. Yet, there’s still a handful of sophisticated inpatient EMR vendors without a portal answer. Hard to believe.“

7-2-2013 8-59-21 PM

From HITEsq: “Re: IRS conservative targeting scandal. RHIOs seeking non-profit tax exemptions were sent to the IRS group that reviewed Tea Party applications.” A New York Times article from last week says the IRS targeted not only conservative groups, but any groups whose use of non-profit application keywords suggested political activities. Among the keywords the IRS used to trigger further scrutiny was “regional health information organizations.”

From West Coast Angel: “Re: RECs. Over half of the 63 ONC grant-funded Regional Extension Centers are developing new service lines in privacy and security, patient engagement, practice optimization, and new service delivery models like ACOs. First round will go live in September.”

Acquisitions, Funding, Business, and Stock

7-1-2013 3-05-33 PM
EyeNetra, which offers inexpensive eye-testing technology using smartphones, raises$2 million in equity funding.Allscripts closes $650 million in new financing, which with previously announced credit lines gives it a net of $400 million in liquidity.

7-2-2013 11-06-31 PM

inga_small As reported here this past weekend on HIStalk from an Indoor Privy rumor, Intuit announces plans to divest its health group, including the patient portal business it acquired from Medfusion in 2010 for $91 million. Intuit says it thought the health group could make money, but it needs to be owned by someone who understands healthcare better. It would not be surprising to see one of Intuit’s resellers — such as Allscripts, GE, or Greenway — make a play for the business.A union investment group urges McKesson’s shareholders to vote out Chairman and CEO John Hammergren and two other directors because of Hammergren’s compensation, also demanding that the company split the chairman and CEO roles he holds.

7-2-2013 10-54-17 PM

The Boston newspaper says a real estate deal involving athenahealth as a corporation and Jonathan Bush as a personal investor, along with a developer, will turn several real estate parcels in the Arsenal on the Charles area near athenahealth’s headquarters into apartments, restaurants, and boutiques that will cater to young technology professionals.  According to Bush, “We have work but we couldn’t get live and play into the Arsenal on the Charles. Nobody in this generation wants to schlep for an hour and a half on the Mass. Pike to a little patch of land. This is a generation of people who are just coming out of their dorm rooms. That’s who we’re hiring. These are people who want to work and live near a restaurant that grows its own food, a bar that makes its own beer.”

Women’s Healthcare Associates (LA) selects Vitera PM/EHR.
7-2-2013 2-32-56 PM
Memorial Hospital (MS) will implement ProVation Order Sets from Wolters Kluwer Health.
7-2-2013 6-41-18 PM
Liberty Hospital (MO) contracts with Allscripts for IT management services and will transfer its 30 IT employees to Allscripts.
Medical Services of America selects Patientco as its RCM solution.

7-2-2013 11-08-27 PM
GetWellNetwork names David D. Bennett (Krames StayWell) EVP/COO.
7-2-2013 9-45-36 AM
Kathleen A. Frawley, AHIMA board chair and president, died last week at the age of 63, according to an AHIMA notice. She was also a professor and chair of the HIT program at DeVry University’s North Brunswick, NJ campus. Angela Kennedy will take over as AHIMA board president/chair.

Announcements and Implementations
Washington Hospital (CA) launchesits $86 million Epic system.Core Health releases results of its healthcare integration compensation survey.

7-2-2013 7-22-54 PM 7-2-2013 7-23-35 PM

Flagler Hospital (FL) went live this past weekend on Allscripts SCM, ED, lab, radiology, HIM, registration, scheduling, billing, pharmacy, medication administration, and CPOE. According to HIStalk friend CIO Bill Rieger, “So far so good. Mandatory compliance for physician training has led to some great conversations. The Breakaway Group training simulator program has worked and benefited us Day 1 more than we thought it would. MAKE Solutions workflow testing team work really saved us a lot of Day 1 pain as well. Kudos to the Allscripts team for excellent support and response.” CMIO Michael Sanders, MD dressed for the occasion in a brand new Kevlar vest and garish go-live socks, while the command center crew kept on top of the trouble tickets.

Government and Politics

7-2-2013 11-11-01 PM

The Treasury Department announces that the Affordable Care Act mandate that businesses with more than 50 employees must provide health insurance will be delayed for a year to 2015.

Innovation and Research

7-2-2013 6-59-50 PM

The Hoosier Healthcare Innovation Challenge will present three developer challenges in Indianapolis on July 12: reduce infant mortality by delivering educational information, eliminate duplicate messages caused by multiple Continuity of Care Documents, and perform medication reconciliation across inpatient and outpatient encounters. Teams can receive cash and an in-kind services worth up to $25,000.

The US Patent and Trademark Office awards LDM Group a patent for a method of providing targeted information to a patient through a physician’s server as a prescription is written.

CORHIO reportsthat approximately 44 percent of Colorado’s 5.2 million residents are represented on the statewide HIE.Tea party activists in Ohio will use a little-known IRS provision that allows citizens to challenge the non-profit status and executive salaries of hospitals, saying that citizens should question why hospitals with large cash reserves need more federal money to deliver indigent care. One of the group’s leaders calls out Cleveland Clinic’s $9 billion in assets and CEO Toby Cosgrove’s $2.5 million annual salary, saying, “This guy’s making $2 million a year, pleading poverty to help poor people. It just seems a little disingenuous to us in the tea party who volunteer for nothing. We’re curious to see their definition of poverty.”

An unnamed South Carolina hospital’s humorous employee training video demonstrates the frustration patients feel when asked mandatory Meaningful Use questions. “I live in the US of A. My primary language is American.”

Walgreens will pay $1.38 million to a woman who sued the drug chain for filling a prescription incorrectly written by her doctor. The doctor realized that she had specified 100 mg of promethazine, quadruple the intended amount, and called the pharmacy to cancel it. The pharmacist did so, but a computer problem allowed the prescription to be filled anyway. The patient claimed side effects caused her to be fired.

One of the 850 employees laid off last month by St. Vincent Health (IN) was CMIO Alan Snell, MD. The health system also gave a pink slip to its chief medical officer.

7-2-2013 11-12-39 PM

Ohio State University’s Wexner Medical Center paid almost $1 million in legal fees and fines in a frantic effort to avoid having its clinical lab shut down by the federal government. That effort, aided by appeals by the state’s lawmakers to HHS, was successful. The hospital’s laboratory information system incorrectly flagged a proficiency test to be sent out to an external lab and a medical technology student didn’t catch the mistake.

Weird News Andy is fascinated that dogs are being trained to detect hyperglycemia in children by their smell, allowing them to paw the child as a signal to take corrective action. He also concludes that “you can’t legislate intelligence” after reading the story of a woman who mixed up Super Glue and cold sore cream with predictably gripping results and another in which six armed police officers take down the suspected “Surgical Mask Bandit” in a Wells Fargo bank, only to find that he’s a chemo patient making a withdrawal.

Sponsor Updates 
  • Vocera demonstrates how its badges work with the Stanley Hugs infant  protection solution.
  • Infor integrates NextGate EMPI and identity management solutions with its Cloverleaf integration and information exchange suite.
  • ZirMed announces that its first claims acceptance rate is averaging 98 percent or higher.
  • Sunquest launches a new website.
  • SIS posts a blog entry called “Careers in Nursing Informatics: Applying Your Knowledge.”
  • The ONC Beacon-EHR Vendor Affinity Group names SuccessEHR National Director of Government Affairs Adele Allison the group’s co-chair, along with Chuck Tryon of MyHealth Access Network.
  • Truven Health Analytics releases the Truven Health Unify ACO solution to help Medicare shared savings program participants manage their ACOs.
  • Forrester Research names CommVault a leader in The Forrester Wave: Enterprise Backup Software, Q2 2013.
  • Jonathan Handler, MD, MModal’s CMIO, shares his thoughts on population health data and why doctors struggle with it.
  • T-System creates a video on its RevCycle+ RCM solution.
  • St. Cloud Orthopedics (MN) discuss how the practice earned $342,000 in Medicare incentives payments following its implementation of SRS EHR.
  • A Windows 8.1 version of AirStrip ONE Cardiology will be released as part of the company’s strategic partnership in Microsoft’s AppsForSurface program.


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

More news: HIStalk Practice, HIStalk Connect


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July 2, 2013 News 4 Comments

News 6/28/13

June 27, 2013 News 2 Comments

Top News

6-27-2013 7-27-32 PM

ONC releases its report to Congress on healthcare IT and HIE adoption through April 30, 2013, basically a predictably uncritical annual report of its activities. I chose this graphic randomly, then immediately noticed the common mistake of saying “Advanced Directives” instead of “Advance Directives” (you specify them in advance, but they aren’t necessarily advanced.)

Reader Comments

inga_small From Chris ToeBall: “Tenet-Vanguard deal. The merger could be good news for a lot of vendors, starting with Tenet’s Conifer Health Solutions.” Tenet President and CEO Trevor Fetter says in a conference call that Conifer will provide RCM services to Vanguard’s 21 hospitals, which could provide a 28 percent boost to revenues. Less clear is the impact on athenahealth, which provides services for Vanguard’s ambulatory clinics, and McKesson, which serves Tenet’s clinics.

HIStalk Announcements and Requests

inga_small HIStalk Practice highlights from the last week include: Humana takes the top spot in athenahealth’s 2013 PayerView Report, while Medicaid continues to underperform. Financial management issues are the most challenging difficulties currently facing group practice executives. Consumer Reports publishes an excellent overview of the PCMH model. The AMA votes to lobby CMS for a two-year grace period to avoid complying with the ICD-10 transition – which seems like wasted energy to me, given the ONC’s promise to hold firm on the current October 2014 deadline. CMS concludes that the adoption of EHRs in community practices doesn’t necessarily impact costs. Dr. Gregg amuses with a fairy tale in the kingdom of happy healthcare. Maybe HIStalk Practice isn’t exactly summer beach reading, but there is still lots of good stuff to check out. Thanks for reading.

On the Jobs Board: Data Analyst Meaningful Use, Healthcare Software Project Manager, Resolute PB Team Lead.

Acquisitions, Funding, Business, and Stock

Craneware warns that its revenues and earnings will be below market forecasts, saying it will likely not close one of its large sales opportunities despite increased levels of sales activity.

6-27-2013 9-43-02 PM

PokitDok, a startup that offers a platform for healthcare providers to advertise directly to consumers, raises $4 million in funding.


Erlanger Health System expands its relationship with MModal to include MModal Fluency Flex for creating reports and documenting patient records.

6-27-2013 9-52-15 PM

Slidell Memorial Hospital (LA) will implement Medhost’s EDIS and ED PASS for self-service patient check-in.

Piedmont Orthopaedic Associates (SC) selects SRS EHR.

6-27-2013 9-53-00 PM

South Georgia Medical Center will implement RelayHealth’s HIE platform.

ProMedica’s Lenawee Physician Hospital Organization (MI) selects Wellcentive’s population health management and data analytics solutions.

6-27-2013 9-54-52 PM

North Shore-LIJ Health System chooses InterSystems HealthShare for connectivity of all its systems in a $25 million deal. Competitor Allscripts dbMotion, now owned by NS-LIJ’s incumbent EHR vendor, wasn’t mentioned.

6-27-2013 9-34-49 PM

The Miami VA chooses GetWellNetwork for in-room entertainment, Internet access, and patient education under a $2.4 million contract.


6-27-2013 6-29-10 PM

CareTech Solutions appoints Brian Connolly (Oakwood Healthcare) chairman of the board, replacing Peter Karmanos.

6-27-2013 6-31-36 PM

Chris Bauleke (RelayHealth) joins Healthland as CEO. Former CEO Angie Franks (above) continues as president.

6-27-2013 6-33-01 PM 6-27-2013 6-34-34 PM

PatientPoint hires John McAuley (Allscripts) as COO and Eldon Richards (UnitedHealth Group) as VP of engineering and technology services.

6-27-2013 6-35-36 PM

Nordic Consulting promotes Vivek Swaminathan to chief consulting officer.

6-27-2013 6-37-08 PM

Jacobus Consulting names Noel Allender (Beacon Partners) managing director of its Epic practice.

6-27-2013 6-38-25 PM

RemitDATA names Michael Kallish (MPV – above) SVP of business development and Jim Harter (e-Rewards) CTO.

6-27-2013 9-38-06 PM

Imprivata President and CEO Omar Hussain is named as an Ernst & Young Entrepreneur of the Year in New England.

Huron Consulting hires Tracey Mayberry (CSC) and Kevin Smith (MedeAnalytics) as managing directors in its Huron Healthcare practice.

Announcements and Implementations

Cerner achieves HDI Support Center Certification.

Quest Diagnostics makes its Care360 Solution Suite available through AT&T Healthcare Community Online.

6-27-2013 8-21-06 PM

The local TV station profiles Cedar Rapids, IA-based healthcare website developer Geonetric, pointing out that none of its 70 employees have managers, food is available and free, and flex time and sabbaticals are standard. According to the HR director, “We want you to enjoy life and experience life, and do great work for us. And it’s awesome.” It says the company will hire another 130 people and move into a new building. Its website declares it to be the “coolest healthcare Web company. In the history of ever.” According to its site, employees get free ice cream when a new client is signed,  dress is casual, Grillin’ Friday is BYOM (bring your own meat), and there’s a knitting circle.

6-27-2013 8-06-11 PM

AMIA’s review course for the clinical informatics subspecialty certification that starts in October is scheduled for July 15 availability. Live courses started in April.

Caristix introduces Caristix 2.0, the latest version of its HL7 interface lifecycle management platform.

Allscripts announces that Sunrise Acute Care 6.1 and Sunrise Ambulatory Care 6.1 have been certified as Complete EHRs under ONC 2014 Edition criteria.

Penn State Hershey Children’s Hospital uses Amcom Messenger for calling Code Blue.

Cerner announces its support for Blue Button +.

6-27-2013 7-54-43 PM

Sprint announces the availability of the TigerText HIPAA-compliant secure messaging solution and a less-expensive offering powered by TeleMessage branded as Sprint Enterprise Messenger – Secure.

Government and Politics

Industry officials testifying before the Senate Committee on Finance offer opinions on how to improve healthcare quality. Concerns raised include:

  • CMS should consider reducing the 1,000+ quality measures currently used for reporting and payment programs and develop measures that are more outcome- and patient-oriented.
  • Many traditional EHRs, especially those used by small physician practices, are not well designed, which limits a provider’s ability to produce meaningful data for quality reporting.
  • Provider payments need to be better aligned with outcomes and quality reporting.
  • The government should go beyond the EHR incentive program and work towards the development of a framework for care coordination and long-term care outcome measurements.

CMS redesigns its Physician Compare Website to include details on physician or practice specialties, EHR use, board certification, and hospital affiliation.

Practice Fusion launches a medical imaging API that will allow its practice users to connect to imaging centers, allowing physicians to receive results electronically for Meaningful Use and giving imaging centers potential new business. Use is free for the practice, but not for the imaging center.


6-27-2013 9-01-45 PM

Arizona-based surgeon Gil Ortega, MD performs the world’s first orthopedic trauma surgery while wearing Google Glass, which he says will be useful for teaching students who will have a clear view of the sterile field, recording the surgery, and requesting information via the device.

6-27-2013 9-18-59 PM

A study finds that the survival rate for non-hospital heart attack patients doubled when paramedics performing CPR were coached using Real CPR Help software that is standard on  ZOLL Medical’s defibrillators.


A study published in JAMA finds that treating the costliest Medicare patients in doctors’ offices instead of ERs may not save as much money as previously hoped, only about 10 percent.

Porter Research looks at ICD-10 readiness among physician practices and finds that most are concerned with disruptions in cash flows when the new code set goes into effect. Of practices that have not yet started preparing for the transition, more than a third believe they have adequate time to prepare. The rest either don’t know where to begin or lack time, staff, or training resources.

Healthcare attorney David Harlow, who writes HealthBlawg, launches a crowdfunding project called Hacking HIPAA. It will a create a new Common Notice of Privacy Practices that will give patients an explanation of potentially beneficial electronic transfer of their data (e-mail, cloud, video, text messaging) and obtain their consent for its use before the new Omnibus HIPAA Rule “will make cloud hosting of healthcare projects untenable very soon.” He’s hoping to raise $10,000. That’s Fred Trotter in the video.

6-27-2013 8-52-49 PM

Who proofed this announcement? It’s apparently how they role.

6-27-2013 8-57-23 PM

Kaiser Health News test drives the health insurance exchange enrollment software that will be rolled out in Minnesota, Maryland, and DC for the scheduled October 1 launch.

Weird News Andy hopes the patient remembers his native language. A 69-year-old man being treated for stroke at Robert Wood Johnson University Hospital is sent unconscious on a charter flight back to his native Poland when he’s found to be uninsured and living in the US illegally.

Sponsor Updates

6-27-2013 7-35-20 PM

  • Visage Imaging releases a case study about the use of the Visage 7 Enterprise Imaging Platform by teleradiology provider Rays.
  • UltraLinq Healthcare will incorporate cardiology decision support tools from DiACardio into its cloud-based image management and reporting system.
  • Karen Marhefka, MHA, RHIA of Encore Health Resources will present a primer on value-driven healthcare at the Texas AHIMA convention today (Friday, June 27) at 1:30 p.m. Central time.
  • Quantros announces the patent pending status of its Smart Classification technology for classifying incident reports in real-time.
  • The Center for Economic Growth recognizes etransmedia Technology with a technology innovation award.
  • Cornerstone Advisors announces its #1 KLAS mid-term ranking in the Planning and Assessment category and its projected 100 percent growth this year.
  • Nuance Communications names 11 hospitals as 2013 winners of the Million Dollar Club, having saved at least $1 million by using Dragon for medical transcription and clinical documentation.
  • Xerox VP Ed Gala asks JetBlue co-founder Ann Rhoades and hospital IT executives what airlines and hospitals have in common.
  • Greenway Medical will integrate the inpatient EHR of Health Management Systems its PrimeSUITE solution.
  • Nuesoft Technologies celebrates its 20th anniversary.
  • Kareo integrates its PM application with Demandforce, an Intuit company, to help practices build their online reputations and proactively engage with patients for preventive or recurring care.
  • Sandlot Solutions CEO Joe Casper discusses improving care with HIE and data analytics.
  • Verisk Health recaps its recent Webinar featuring Granite Healthcare Network’s (NH) use of data analytics to provide cost-effective care.
  • Versus offers a replay of the AHA-hosted Webinar on improving safety measures with RTLS featuring Western Maryland Health Systems. Versus also offers a case study that details how the organization reduced elopements and improved response times with RTLS technology.
  • AT&T partners with Project HOPE to improve women and children’s healthcare in Asia and Africa.
  • Northern Ireland’s health minister writes about the transformation of the country’s healthcare system using technology from Orion Health.

EPtalk by Dr. Jayne

The National Uniform Claim Committee announces that CMS has finally approved the new 1500 claim form. It allows identification of whether ICD-9 or ICD-10 is being used and expands the number of diagnosis codes which can be reported. The deadline for transition to the new form seems to be fluid. Providers should contact their clearinghouses to determine when they will begin accepting the form and should work with their vendors to ensure practice management systems can generate the new form.

HIMSS calls for proposals for pre-conference symposia. New this year, they’re looking for abstracts for full-day preconference programs. The deadline is July 22 and those selected will be notified in August.


Medical Economics identifies “10 regulatory irritants fueling physician dissatisfaction” according to a Physicians Foundation study. The list includes:

  1. Meaningless work
  2. Box checking
  3. Data is replacing information
  4. Quality
  5. Site of Service
  6. Fraud
  7. Sustainable growth rate (SGR)
  8. PCORI and IPAB
  9. Costs
  10. The government is coming between me and my patients

Bloomberg discusses the top US states where physicians have gone digital. I was surprised to see Washington, DC at the bottom along with Louisiana, New Jersey, and Connecticut. Wisconsin is at the top, followed by Minnesota, North Dakota, and Massachusetts.

Note to marketing folks: always test your mail merge skills before sending out blast e-mails (and especially snail mail). This week I’ve been on the receiving end of two charity letters asking me to send my pledge (which wasn’t a pledge but an outright donation) and now an e-mail addressed to “Dennis.” First impressions are everything, folks.


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

More news: HIStalk Practice, HIStalk Connect.


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June 27, 2013 News 2 Comments

Readers Write: Health Data Analytics Provides Greater Value Over Big Data

June 26, 2013 Readers Write 9 Comments

Health Data Analytics Provides Greater Value Over Big Data
By Joe Crandall

6-26-2013 6-39-39 PM

Like you, I’m tired. I am tired of the latest buzzword in healthcare circles: “Big Data.”

The problem I see as a healthcare professional is that most experts are not offering solid, realistic ideas about how to leverage data at the decision-maker level. Most articles and experts are talking about using data to fundamentally change healthcare (genomics, population health, etc.) How many times have you heard that a new something was going to change healthcare forever? These experts are doing a disservice to the large majority of hospitals and health systems out there. I suggest you forget the term “Big Data” and begin to think about Health Data Analytics (HDA).

The truth is that most hospitals have been using health data analytics to some degree for a long time. Because of external and internal drivers, healthcare organizations are now being pushed to do more with less. That means leveraging their data and tools more efficiently. This isn’t about predictive analytics . It is about giving the clinical decision maker the information they need when they need it so they can make better decisions to drive better outcomes.

Six things to think about in regards to HDA:

  1. Ignore the hype. Don’t fall for the sales pitches and doom and gloom if you haven’t bought a business intelligence (BI) tool yet. About 90 percent of the hospitals out there are in the same boat as you. The hospitals giving the “Big Data” talks have been on that path for decades and have spent millions of dollars. Not surprisingly, they are only starting to leverage the data for research. You don’t need “Big Data” — you need analytics.
  2. Be realistic. Let me say that again: be realistic. You are not going to go from a data-averse culture to a data-driven culture overnight. You aren’t going to be able to convince everyone this is the right project to invest in. Buying the best in KLAS BI vendor is not going to magically transform your organization. If you do decide to buy a BI tool, be realistic when setting expectations with a BI vendor. The implementation won’t be as easy as they say and the people won’t flock to the platform as quickly as they say. In fact, it is like every other platform IT has installed. Focus on the people rather than the technology for lasting success.
  3. Conduct an in-depth assessment. Before you start a HDA program, take an honest assessment of your current state of health data readiness. A readiness assessment saves money in the long run by clearly identifying any gaps in skills, tools, or process. Answer some basic questions first. Does our organization have a culture of sharing data? Do we have a good data governance program in place? Do we have data integrity issues? Do our people know how to use the information we can provide? Knowing where you are starting and your end goal is an important part of any project. A great assessment will help you plan to reach your goals with clearly laid out courses of action.
  4. Start small. HDA projects need to start small with scalable and sustainable processes that will allow the program to expand intelligently. While in the military, we used the “crawl, walk, run” methodology and it applies to implementing a HDA program at your facility. Do not start running with “Let’s change the discharge process” as your first HDA project. A better and more focused choice could be to crawl with “On the labor and delivery floor, how do we discharge patients before 11 am?” Start small with big results. Then grow.
  5. Grow intelligently. Once that first project is a success, look into expanding under the guidance of a strong executive sponsor and a competent governance structure. Keep in mind that you don’t need to duplicate the first project throughout your facility – you need the ability to replicate it. Duplication implies a direct copy, while replication allows variances for each situation that might be encountered while implementing the new way of doing business. Once people start to see the benefit of a data-driven culture, requests for projects will pour in and the organization will need a plan to intelligently address all requests and aggressively pursue the best ones.
  6. Focus on your people. Most importantly is the focus on the people. Each person within your organization has a decision-making maturity that may or may not be able to leverage the HDA program effectively. This is why certain programs are successful under the leadership of one person but flounder once that leader moves on. It is why someone can look at raw data and see patterns in the business and make decisions that drive action. It is why a project can be successfully run by staff while being led by an inept leader. It is the maturity of each individual that will determine the success of the HDA program, not the tools or platform.

The requirement of leveraging data to gain a competitive edge is upon us. Healthcare organizations are being asked to improve outcomes as the main driver for improving the bottom line. A data-driven culture will transform an organization from volume based to value based, but it will take time and the right people. Focus on one project initially, guided by a strong executive sponsor utilizing a process that is scalable and sustainable.

If you do this, before you know it, your organization will be utilizing health data analytics to make more intelligent decisions that will ultimately improve outcomes. You will have created a data-driven culture.

Joe Crandall is director of client engagement solutions for
Greencastle Associates Consulting.

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June 26, 2013 Readers Write 9 Comments

News 6/26/13

June 25, 2013 News 8 Comments

Top News

6-25-2013 6-58-04 PM

McKesson Chairman and CEO John Hammergren is due a $159 million lump sum pension payout when he retires, the company discloses in its annual proxy filing. Experts believe it’s the largest pension in corporate history, also noting that the amount doubled in the past six years. I mentioned the hoops the company’s board went through to boost his pay without being obvious to shareholders back in January 2009, when he would have received only $85 million. Above is the six-year share price (blue) vs. the standard market indices. You can decide whether he’s worth it and if healthcare can afford it.

HIStalk Announcements and Requests

6-25-2013 7-04-47 PM

Welcome to new HIStalk Gold Sponsor Seamless Medical Systems, which offers the SNAP Practice cloud-based patient engagement platform. It includes an iPad-based patient registration app and health education and literacy tools. SNAP Express includes primary care forms, digital signature capture, and forms tools, while the enterprise version also includes a bidirectional interface to the PM/EMR along with marketing tools. The iPad-based system engages patients in the waiting room as they complete forms electronically, read health and wellness information, and take notes about their visit and e-mail them afterward. Download it to your iPad for a free trial. Thanks to Seamless Medical Systems for supporting HIStalk.

I found this SNAP Practice overview on YouTube.

Acquisitions, Funding, Business, and Stock

6-25-2013 8-43-31 PM

Next Wave Health makes a minority investment in HealthPost, which offers a provider search and booking platform.

Tenet Healthcare will acquire Vanguard Health System for $4.3 billion, which includes the assumption of Vanguard’s $2.5 billion in debt. The transaction will make the combined company the second-largest for-profit US hospital chain with $15 billion in revenue, 79 hospitals, and 157 outpatient centers. Obviously they aren’t worried that healthcare costs are going down any time soon.


Baptist Memorial Health Care will integrate Micromedex clinical referential and patient education resources into Epic.

Kerckhoff Klinik in Germany choses iMDsoft’s MetaVision for its 267-bed facility.

The North Dakota HIN selects Orion Health HIE for its statewide exchange.

6-25-2013 8-51-07 PM

Washington Regional Medical Center (AR) selects patient portal and HIE solutions from InteliChart.

ProMedica (OH) will add dbMotion’s interoperability platform.

Bon Secours Health System (MD) will implement HIE technology from Aetna’s Healthagen subsidiary.

Athens Bone and Joint Orthopedic Clinic (GA) selects simplifyMD.

Novant Health chooses CSI Healthcare IT to fill training positions for its October Epic go-live.


6-25-2013 5-56-46 PM

Care Team Connect names Richard Popiel, MD (Cambia) to its board.

6-25-2013 1-52-39 PM

Shaun Shakib (Caradigm) joins Clinical Architecture as chief informatics architect.

6-25-2013 6-41-27 PM

Brett Davis (Oracle) is named general manager of Deloitte Health Informatics, a newly launched informatics business.  

The Premier healthcare alliance names Leigh Anderson (Global Healthcare Exchange) COO of informatics and technology services.

Announcements and Implementations

The Yale Center for Clinical Investigation deploys an interface between Yale’s Epic EMR and the OnCore Clinical Research solution.

6-25-2013 7-13-37 AM

Fulton County Hospital (MO) goes live on Healthland’s financials and clinicals.

Deloitte and Intermountain Healthcare launch OutcomesMiner, an analytics tool that leverages EMR data for comparative research.

RFID Journal profiles Texas Health Harris Methodist Hospital Alliance and its use of RTLS, including software from Intelligent InSites. They interviewed Winjie Tang Miao, the hospital’s president.  I did too, in December 2012.

SCI Solutions releases v36 of its Schedule Maximizer patient and resource scheduling system.

Government and Politics

The VA reports that it has processed 97 percent of its two-year-old veterans’ disability benefits claims and is now working on one-year-old claims.


6-25-2013 9-00-06 PM

Hawaii Health System revises its estimate for converting its 14 public hospitals to Siemens, which now stands at $100 million compare to $58 million five years ago and $75 million at the end of last year. The health system say consultants underestimated the time required to maintain the system and the infrastructure in its facilities is in bad shape.

The Massachusetts eHealth Institute will award grants of up to $75,000 each to 32 collaborative projects to help 80 healthcare organizations connect to the Massachusetts statewide HIE.

Massachusetts economic development officials tentatively agree to extend $9.5 million in state tax credits to athenahealth in exchange for athena’s pledge to add 1,900 workers by 2022. Athenahealth also announces it will bring 500 new jobs to Atlanta and invest $10.8 million in a new office complex.

Weird News Andy isn’t sure what the business model of Figure 1 (the narrator of the video above pronounces it “figger one”) since it offers free photo sharing for clinicians, but WNA hopes they have plenty of photo screeners. The company says it has figured (figgered?) out a way to limit use to licensed physicians. A terse comment about the video says it all: “Looks like a quick way to get fired. Or sued.”

WNA also likes this story, which he titles “Busted!” A Chinese woman lying on her stomach playing a smartphone game for several hours experiences chest pain, which the hospital diagnoses as a ruptured breast implant.

Sponsor Updates

  • First Databank launches a five-part blog series on prescription drug abuse.
  • Merge announces the eClinical OS Marketplace, which allows users to electronically request and receive services from within clinical study workflows.
  • CCHIT certifies that Health Care Software’s INTERACTANT v6.9 software is compliant with the ONC 2011 Edition criteria as an EHR module.
  • Levi, Ray & Shoup earns HP’s Silver Partner in Excellence Award.
  • Allscripts outlines its population health management strategy during a gathering of industry and financial analysts at the Center for Connected Medicine.
  • Novant Health chooses CSI Healthcare IT to fill training positions for its October go-live with Epic.
  • Beacon Partners publishes an article that highlights four healthcare system executives and their perspectives on integrating strategic initiatives.
  • Elsevier launches EduCode Doc Briefs, an ICD-10 education series for physicians and other practitioners.
  • Kareo reports that one-third of the 4,000 providers signed up for its EHR have moved from another EHR system.
  • Clinovations staff volunteered at the Spring Kick event with DC United, which brought soccer to 400 underprivileged youth from 12 DC neighborhoods.
  • CareTech Solutions will offer its help desk clients Courion’s PasswordCourier password management and AccountCourier user provisioning solutions.
  • Verisk Health will give away three $30 Starbucks gift cards to random participants of its online survey on the shared-risk care delivery model.
  • EClinicalWorks has signed up 1,000 providers for its RCM during the first six months of 2013 and is projected to reach $100 million in revenues by 2015.
  • SQL Server Pro highlights the new version of Predixion Software’s collaborative predictive analytics platform.
  • Conway Medical Center (SC) shares how its implementation of Rev-Cycle+ from T-System helped the organization increase collections 41 percent over five and a half years.


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

More news: HIStalk Practice, HIStalk Connect.



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June 25, 2013 News 8 Comments

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