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News 11/22/13

November 21, 2013 News 9 Comments

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11-22-2013 12-23-38 AM

HIMSS names Children’s Medical Center (TX) its 2013 Enterprise HIMSS Davies Award of Excellence winner.

From Ricky Roma: “To shag or not to shag… Please weigh in to help with our HIMSS 2014 booth decision, as our team is split along gender lines this year. Do we go with the high shag, ‘flooring equivalent of a peacock’s tail’; or the low shag, ‘it’s apparently easier to endure if you’re in heels’ booth carpet? What’s a sales leader to do?” I will solicit the collective knowledge of the HIStalk readership to answer this very important question.

HIStalk Announcements and Requests

inga_small A few HIStalk Practice highlights from the last week include: AMA continues to push for an ICD-10 delay. I share my recent experience with physician rating websites. The majority of physicians express dissatisfied with their ambulatory EHRs. A reader offers a music review from the NextGen UGM. A New Jersey practice manager shares details of her office’s EMR selection and implementation and discusses how the EMR has help improve the quality of care for patients. Thanks for reading.

Acquisitions, Funding, Business, and Stock

Catalyze.io, which offers a platform to accelerate the development of mobile health apps, secures a Series A financing round. The CEO of Catalyze.io is HIStalk Connect’s own Travis Good, MD.

Experian completes its acquisition of Passport Health.


Healthconnect HIE (TX) selects Surescripts services to make prescription and medication fill data available to hospitals.

11-21-2013 1-58-44 PM

Children’s Hospital of Wisconsin will implement Health Catalyst’s Late-Binding Data Warehouse and Analytics platform.

11-21-2013 2-00-16 PM

Inland Imaging (WA) will expand its use of MModal products to include MModal Fluency for Imaging and MModal Catalyst for Radiology.

11-21-2013 2-01-29 PM

Christiana Care Health (DE) selects grants management software from Huron Consulting Group.

11-21-2013 2-03-10 PM

Texas Health Resources will implement patient engagement technology from Emmi Solutions.


11-21-2013 2-05-07 PM

Huron Consulting Group names William T. Foley (Vanguard Health Systems) managing director of its healthcare practice focused on public healthcare systems and academic medical centers.

11-21-2013 9-34-48 PM

Randy Fusco (Microsoft Health & Life Sciences) joins Emdeon as SVP/CIO for revenue cycle services.


St. Luke’s Health System (ID) promotes CMIO Marc Chasin, MD to VP/CIO.

Announcements and Implementations

Clinovations launches the Clinovations Center for Population Health Management to help stakeholders design and implement infrastructures and operating models to support population management and value-based care delivery systems.

11-21-2013 6-58-02 AM

Children’s Hospital & Research Center Oakland (CA) completes the first phase of its $89 million Epic implementation.

Michigan Health Connect delivers diagnostic-quality images to its HIE member hospitals using the eHealth Connect Image Exchange platform from eHealth Technologies.

Visage Imaging implements its Visage 7 Enterprise Imaging Platform as part of vRad’s RG2 radiology operational management solution.

Roskilde Sygehus in Denmark goes live with iMDsoft’s MetaVision in its ICU, NICU, OR, and PACU.


The US Patent and Trademark Office issues SCI Solutions a patent for its method and systems used for secure online patient referral and ordering.


11-21-2013 12-51-41 PM

inga_small I’m thrilled to have found the perfect Christmas or Hanukah gift for all my favorite  clinicians (you know who you are, so just skip down to the next item if you don’t want to ruin the surprise.) Struck by Orca includes dozens of illustrations that depict artists’ visual interpretations of their favorite ICD-10 codes. I’m impressed that many of the illustrators are healthcare professionals and I thought the $20 price tag sounded reasonable. One of my favorites (because I’ve had this injury numerous times) is the above work by Sarah Bottjen, an Epic project manager.

Forbes profiles Cedars-Sinai Medical Center’s (CA) implementation of Voalte One technology combined with Epic.

Weird News Andy titles this article “Unconventional Therapy.” A Florida doctor uses whips and blindfolds to perform sadomasochistic acts in attempt to cure a female patient of depression. He wasn’t charged because the relationship was consensual, but he may lose license.

Sponsor Updates

  • Wolters Kluwer Health launches an enhanced web application within ProVation Order Sets.
  • Awarepoint is named the seventh fastest growing medical device company in North America in Deloitte’s 2013 Technology Fast 500.
  • RelayHealth Financial announces that all its financial connectivity solutions meet the current ICD-10 standards and that ICD-10 testing is available at no cost to its customers.
  • Troy Group and LRS install tamper-proof prescription printing capabilities at a North Carolina hospital.
  • Ping Identity introduces PingAccess, an identity gateway that combines web access management with mobile and API access management.
  • The Huntzinger Management Group reports that this year the company has increased its managed and advisory services and launched Huntzinger Staffing Solutions, a healthcare staffing company.
  • Perceptive Software’s Records Manager product is certified against Chapters 2 and 5 of the DoD 5015.2 standards for records management.
  • Intelligent Medical Objects highlights the integration of IMO’s Problem and Procedure solutions with Aprima EHR, which gives users on-demand access to over 180,000 medical terms from within the Aprima application.
  • MedDirect releases its upcoming conference schedule.
  • iHT2 interviews Wesley Valdes, DO, the medical director for telehealth services at  Intermountain Healthcare.
  • Vital Images will participate in the Image Sharing demonstration at next week’s RSNA meeting in Chicago.
  • UnitedHealth Group and Optum offer a free emotional support help line for people affected by recent tornados in the Midwest.
  • Liaison Healthcare wins four Gold, three Silver, and three Bronze awards at the Golden Bridge Awards ceremony. 
  • WisBusiness.com discusses the growth of HIT in Wisconsin with Nordic Consulting CEO Mark Bakken.
  • Bonnie Cassidy, Nuance’s senior director of HIM innovation, offers some key questions to consider when evaluating the efficacy of an ICD-10 coding program.
  • A Washington neurologist explains the benefits of the Virtual Lifetime Electronic Record, which uses technology and services from INHS.
  • The Business Application Research Center ranks QlikView first in collaboration and performance satisfaction among large international vendors offering BI software products.
  • HIMSS Analytics and The International Institute for Analytics launch DELTA Powered Analytics Assessment to allow healthcare provider organizations to evaluate and benchmark their analytical maturity relative to their peers.

EPtalk by Dr. Jayne


Readers who follow me on Twitter @JayneHIStalkMD may have seen me kvetching about problems with the HIMSS registration sit. I tried it multiple times on Firefox over a multi-hour period and even tried Internet Explorer. Previously it just said “something went wrong” but now it’s displaying a specific error. HIMSS did respond and offer to help me get squared away. If it’s not working in the next few days I might have to call. It’s expensive enough without missing the early bird registration and particularly so since my hospital no longer pays for anyone to attend.

Speaking of HIMSS, I was looking at last year’s “HIStalk Ladies Social Schedule” and it’s not too early to ensure your party makes it onto the Inga and Jayne must-see list. Email Inga inga@histalk.com or me drjayne@histalk.com and let us know why your event should make the cut. I’ll be arriving a little early to relax before the exhaustion of sessions, the exhibit hall, and of course HIStalkapalooza. I should probably take a few days off on the tail end of the meeting however my boss (probably assuming no one would actually pay his or her own way to HIMSS) scheduled a leadership retreat for Thursday and Friday so that’s not going to happen. Let’s hope it gets canceled or bumped.

I’m looking forward to HIMSS as a time to meet up with old friends and perhaps to explore some new opportunities. I’m starting to become a little leery of how our hospital is planning to tackle MU2 and various other initiatives. Several key members of our leadership have fallen victim to vulture-like consultants that have been circling. (Incidentally, did you know a group of vultures is called a committee? Makes perfect sense to me.) After dozens of hours of assessments the consultants have determined that our fairly conservative approach to Meaningful Use is overly strict and that we need to relax a little bit.

I know for a fact that I don’t look good in either black and white stripes or prison orange so some of the things they have suggested we do are downright frightening. They’re fairly cavalier in their interpretation of some of the rules and I’ve already made enemies by printing out specific CMS FAQ items and bringing them to meetings. I know the consultants think they’re impressing us by showing how much money we could be collecting (since we already ruled out a good chunk of providers as likely to not be able to attest) but it seems to be a shell game to me. Given the all-or-none nature of the Meaningful Use program it doesn’t seem like cooking the books even a little bit is a good idea.

They’re also pushing hard that we reorganize our employed medical group so we can start doing provider-based billing. I find it a fundamentally offensive approach to charge patients more a) just because you can, and b) just because everyone is doing it. We dabbled in this a couple of years ago with laboratory billing and the backlash from patients was overwhelming. It seems we are doomed to repeat the mistakes of the past.

Watching this happen is just one symptom of the growing dysfunction within the organization. It’s not easy to admit that you’re working at a place that is allowing its values to slip away in pursuit of profit (despite being a non-profit entity). I’m all for efficiency and streamlining, but there is a difference between that and cutting corners. We had a pretty significant layoff earlier this year and people genuinely fear for their jobs so what used to be a fairly transparent team-oriented workplace is rapidly becoming factious and paranoid. Many of the most talented analysts and team leads have already left with a fair amount of them going to work for either competing hospital systems or for vendors.

I’m not sure what I think about working for a vendor having been in non-profit health care for so long but sometimes it looks pretty good. On the other hand, I’ve seen how our CIO behaves towards some of our vendors and I wouldn’t want to be on the receiving end of that kind of treatment. I’m watching him pit two vendors against each other for a large rip-and-replace project and it reminds me of the movie “Gladiator.” It’s unpleasant yet I am still tugged by loyalty to an organization that I’ve been with a long time. Regardless, I’ll be dusting off my curriculum vitae (why can’t physicians just call it a resume?) and seeing what’s out there. What do you think about job hunting at HIMSS? Email me.


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

More news: HIStalk Practice, HIStalk Connect.

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November 21, 2013 News 9 Comments

News 11/20/13

November 19, 2013 News 2 Comments

Top News


A Johns Hopkins-led study published in JAMA concludes that the major factors driving healthcare costs up are consolidation of hospitals and practices that increase pricing power, high drug and medical device costs, and heavy IT investment with questionable value. It notes that costs are not visible to doctors or patients, which prevents healthcare from functioning as an efficient market.

Reader Comments

From Flash: “Re: AMIA. Perhaps the biggest news at AMIA so far is the non-news that CMS probably won’t delay Stage 2 MU. That’s essentially what the ONC’s Jodi Daniel said during a session Monday.” At this stage in the game, it would be more surprising if CMS did consider changes or delays.

Upcoming Webinars

DocuSign will present “Paperless Practices: Harnessing EHR Value by Improving Workflows with Electronic Data” on Tuesday, December 10 at 1:00 p.m. Eastern. “Audit Readiness: Three Simple Steps to Protect Patient Privacy”, presented by Iatric Systems, will be presented on Wednesday, December 11 at 2:00 Eastern. More information on both programs is on the Webinar page.

Acquisitions, Funding, Business, and Stock

CareFusion will acquire respiratory care and anesthesiology medicine manufacturer Vital Signs from GE Healthcare for $500 million.

11-19-2013 10-15-57 AM

Acupera, developers of population healthcare and coordination workflow management technology, secures $2 million in bridge financing.

MDS Medical, Greenway Medical’s top-producing channel partner, acquires the assets of EHRsolutions, Greenway’s second largest reseller.

Carl Icahn, who owns 4.7 million shares of Apple and a 16.9 percent stake in Nuance Communications, tells participants at an investment summit that he will not push Apple to buy Nuance.

Truven Health Analytics provided this comment related to its recently released 10-Q forms that a reader commented about in the Monday Morning Update:

Truven Health Analytics has performed well in 2012 and through the first three quarters  of 2013, with steady increases in revenue and robust margins for adjusted EBITDA.  Reported losses are due to accounting changes stemming from our divesture from Thomson Reuters and one-time costs associated with the migration of our data center from Thomson Reuters onto a standalone platform, neither of which affects ongoing operating performance.



The 25-bed Van Buren County Hospital (IA) selects McKesson Radiology and McKesson Study Share.

MModal adds new customers for its MModal Fluency for Imaging product including Coastal Radiology (NC), Coosa Valley Medical Center (AL), Greensboro Radiology (NC), Maricopa Integrated Health System (AZ), and Radiology Associates (OR).

Avera Health selects Craneware InSight Medical Necessity for 28 of their 33 hospital organizations.

11-19-2013 9-37-37 AM

King Khaled Eye Specialist Hospital in Saudi Arabia will implement InterSystems TrakCare. The hospital, by the way, is part of a compound that includes six five-story apartment buildings, 22 villas, a community center, tennis courts, playgrounds, a cinema, a supermarket, and a mosque.

Ophthalmology Associates (WI) selects SRS EHR for its six providers.

Avera Health (SD) chooses Craneware’s InSight Medical Necessity. 


11-19-2013 3-15-47 PM

The Georgia HIN names eHealth Services Group CEO Denise Hines executive director.

11-19-2013 3-19-47 PM

Recondo Technology appoints Lori Prestesater (McKesson Provider Technologies) chief growth officer.

11-19-2013 3-22-30 PM

Verisk Health promotes Nadine Hays from EVP of sales, marketing, and strategic partnerships to president, replacing Joel Portice who is leaving to pursue other interests.

Nuance extends the existing employment agreement with its CEO Paul Ricci through November 11, 2015 and agrees to pay him a base salary of $800,000 plus annual performance bonuses of up to $1.2 million.

MediTract, a provider of automated contract management solutions, names David F. “Buddy” Bacon (Meridian Surgical Partners) CEO.


Announcements and Implementations

eClinicalWorks will invest an additional $50 million over the next 12 months in addition to the $25 million it had already committed to enhance and expand population health solutions and patient engagement tools under its Health & Online Wellness business unit. Part of the funding will be used to hire an additional 100 software developers.

Southeaster Overread Services (NC) implements eRAD PACS with integrated speech recognition technology from MModal.

11-19-2013 10-47-26 AM

Parrish Medical Center (FL) expands its use of products from Strata Decision Technology with the implementation of  StrataJazz Decision Support.

11-19-2013 11-14-47 AM

Florida Governor Rick Scott joins iSirona employees to announce the company’s plan to create 300 new jobs over the next three years at its Panama City headquarters.

HIMSS Analytics and The International Institute for Analytics announce the launch of a service that will allow hospitals to assess the maturity of their analytics capabilities and benchmark against peers.

The Boston Globe names Meditech as one of the Top Places to Work in Massachusetts.

iMDsoft integrates the Electronic Whiteboard from  Intelligent Business Solutions into its MetaVision AIMS solution.


Government and Politics

House lawmakers introduce legislation that would create and expand physician reimbursement of telehealth services to active-duty service members, their dependents, retirees, and veterans.

Sen. Rob Portman (R-OH) proposes a bill that would extend MU incentive payments to behavioral health providers, including psychiatric hospitals, substance abuse facilities, and psychologists. The legislation would also address EHR-related adverse drug reporting to patient safety organizations, clarify that EHRs are not subject to the Food, Drug and Cosmetics Act, and limit electronic discovery in EHRs.

Medicare will cut reimbursements by as much as 1.25 percent to 1,451 hospitals next year as a result of their performance in CMS’s value-based purchasing program. An additional 1,231 hospitals will see payments increase by as much as 1.25 percent based on their performance across quality indicators.


The American Academy of Ophthalmology unveils the IRIS Registry, the nation’s first eye disease and condition patient database. The registry is designed to interface with any EMR system and will handle data on more than 18 million patients by 2016.

11-19-2013 8-22-44 PM

Three young programmers create HealthSherpa.com, which one-ups Healthcare.gov by allowing consumers to quickly get insurance prices by entering only their ZIP code. It took them only three days to develop and test the site. I tried it and had insurance prices and details in less than five seconds.

Weird News Andy finds this story to be strange but true. Researchers find that patients with a wide range of red blood cell sizes are more likely to have depression.


Sponsor Updates

  • Greenway Medical releases Intergy v9.00, which includes a dashboard to track the progress of a practice’s transition to ICD-10 or MU attestation.
  • The Drummond Group certifies Allscripts dbMotion 5.0  as an ONC-ACB 2014 compliant EHR Module.
  • Lifepoint Informatics announces the details of its March 13, 2014 user conference in Orlando.
  • National Decision Support Company, Montage Healthcare Solutions, and Nuance Communications collaborate to bring Imaging 3.0 tools to radiologists.
  • Medical Staffing Network (FL) completes their companywide implementation of API Healthcare’s solution suite.
  • Aspen Advisors raises $2,300 for Florida’s Health First health system during the company’s annual retreat in Ft. Lauderdale.
  • The Detroit Free Press names CareTech Solutions the top workplace in the large-company category based on employee satisfaction.
  • Surveys from Porter Research and Imprivata indicate that healthcare is beginning to trust cloud technology for the storage of PHI.
  • Emdeon discusses the challenges and opportunities of CPOE under Stage 2.
  • Sagacious Consultants launches Sagacious Connect to support hospitals extending their EMR software to independent practices and hospitals.
  • T-System’s Tonda Terrell offers seven considerations for payer contracting in the healthcare reform-era. The company’s Elizabeth Morgenroth also provides communication tips for a successful ICD-10 implementation and conversion.
  • Imprivata earns a spot on the Boston Globe’s Top Places to Work 2013 in the medium company category.


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

More news: HIStalk Practice, HIStalk Connect.

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November 19, 2013 News 2 Comments

Monday Morning Update 11/18/13

November 17, 2013 News 8 Comments

11-17-2013 11-13-49 AM

From Concerned: “Re: Truven Health Analytics. Its Q3 2013 SEC 10-Q says 2012 was an earnings disaster, and so far this year the company has lost $26 million and is increasing debt to pay bills.” I took a quick glance over the form, but I’m not an accountant and most of it glazed me over. Revenue took a big jump year over year and the net loss dropped as expenses were held fairly steady through the acquisition of the Thomson Reuters healthcare business in June 2012. As of September 30, the company appeared to be running a monthly loss of around $3 million and had $8 million in cash. The long document full of numbers is confusing because of the acquisition, but it appears that the company lost $8.4 million in the quarter vs. $20 million a year ago, so the situation may be improving. I found it depressing that Truven has 225 pending lawsuits against it filed by people who claim they were harmed by the drug Reglan and are suing the company because its patient education materials didn’t warn them of that possibility.

UPDATE: Truven provided this clarification: “Truven Health Analytics has performed well in 2012 and through the first three quarters  of 2013, with steady increases in revenue and robust margins for adjusted EBITDA.  Reported losses are due to accounting changes stemming from our divesture from Thomson Reuters and one-time costs associated with the migration of our data center from Thomson Reuters onto a standalone platform, neither of which affects ongoing operating performance.”

11-17-2013 11-14-48 AM

From FormerHHSIntern: “Re: HIE. Secondary consequences of poor Healthcare.gov rollout. Impending implosion over failed $600 million HHS/ONC Health Information Exchange grant program. At least one senior ONC leader will leave in next two weeks.” Unverified.

From Ken Dahl: “Re: paper vs. EMR for physician data entry. There’s a big difference on that score for inpatient vs. outpatient. For inpatient care, EHR is much better – for purposes of rounding, orders, med rec, and keeping track of care plans. Outpatient clinics are a bit more difficult because of the amount of charting required on EHR is overwhelming, and leads to a lot of MDs typing while talking which sets up an uncomfortable dynamic for the ‘therapeutic’ interaction. But there’s  always a tradeoff – either you chart with the patient or you chart at the end of the day and you lose an hour or two of time with your family that night. That is a reason MDs are becoming less interested in having a clinic practice.” General practice and some specialist physicians are, for the most part, vastly overtrained for seeing office patients. They are wasting most of their day looking at the same old problems that an extender could handle, playing EMR stenographer, and chatting with patients whose chronic disease requires no new diagnosis or treatment. Doctors (and healthcare in general) could learn from my dentist. Usually there’s just one dentist on duty, but a stable of hygienists and techs keeps several rooms full of patients undergoing everything from cleanings to denture repairs to crown and cavity work. He flits between rooms to oversee everything, speaks to every patient to hear any concerns, and shows up just in time to perform procedures on the fully prepped patients. He does not touch the practice’s fully electronic dental record and imaging system that I’ve ever seen, complete billing documentation, or handle referral or absent-from-work forms. We need to separate out the tasks that truly require a physician’s extensive education and experience and turf everything else off to cheaper and more readily available positions. One might argue, however, that physicians created the current state because they, until recently, were happy to collect big paychecks in return for underusing their skills.

11-16-2013 9-33-53 AM

From The PACS Designer: “Re: Apple’s curved screen iPad. As Apple continues to innovate in the PC space, they will be offering an edge to edge curved screen with the iPad 6 in 2014. Other rumored improvements are the replacement of the current screen material called Gorilla Glass with the indestructible sapphire material which is currently in the camera and fingerprint button.” The curved glass (image above from TechCrunch) would be mostly a cosmetic enhancement, but Apple is supposedly working on technology that will allow its mobile devices to detect the amount of pressure of a fingerprint touch and react accordingly. The current iPhone touch accuracy has been tested and found to be dramatically inferior to that of the Samsung Galaxy S3, so it’s time for the House That Two Steves Built to get on the ball.

11-16-2013 7-46-42 AM

Hospitals should stop fantasizing about big data and instead use the data they already have (and often ignore) to make improvements, the clear majority of poll respondents say. New poll to your right: do you use any mobile apps to monitor or improve your health? You can interpret what that means to you – apps for exercise, diet, medically related reminders, or health tracking.

11-17-2013 2-53-52 PM

Welcome to new HIStalk Platinum sponsor Connance. The Waltham, MA-based company was founded in 2007 to offer cloud-based predictive analytics and rule-driven workflow technologies that improve the financial performance of healthcare providers. Programs include self-pay maximization, commercial revenue optimization, performance benchmarking, charity and outreach, A/R valuation, revenue leakage detection, managed care contract enhancement, preventable readmission management, and consumer engagement. St. Joseph’s Hospital of Atlanta reported a 13:1 ROI, Florida Hospital saw a 20 percent increase in cash collections, and Children’s Hospital and Medical Center saw a 45 percent increase in charity dollars and a 40 percent decrease in bad debt expense (more case studies are here). I interviewed CEO Steve Levin in October 2013 and we covered some interesting topics: the changing nature of self-pay patients, the hit hospitals take on their patient satisfaction scores that are due to lack of financial service excellence, and ACA-triggered changes in charity classification. Some fun facts from its site: 40 percent of self-pay accounts generate 90 percent of the cash; 30 percent of accounts assigned to bad debt should be charity; and 20 percent of denials cost more to pursue than they will generate in cash. Thanks to Connance for supporting HIStalk.

11-16-2013 9-50-34 AM

Travis from HIStalk Connect and I will be reporting live from the HIMSS-produced mHealth Summit in the Washington, DC area on December 8-11. They’re offering a $75 registration discount to HIStalk readers (use code HISTalk). We’ll have a tiny HIStalk booth in the exhibit hall, staffed by my newest team member and the non-anonymous face of HIStalk, Lorre. I think she’s bringing some little giveaway items, hoping to distract from the fact that our booth will have all the charm of a rental storage unit because the furnishings were out of our price range (I may begrudgingly get her a chair to sit on, but I’m thinking about bringing one of those $10 folding camp chairs from the local Walmart). Lorre is getting a crash course in all things HIStalk without having met any actual readers or sponsors, so stop by and say hello so she doesn’t think I made it all up. You can email her to say hello if you like.

The AMIA 2013 Annual Symposium started Saturday in Washington, DC. I’ve never been to one (I’m not a member, although I once was, and I had a conflict this week) but I like the topics – it’s like a more academic and less commercial HIMSS conference from what I can tell. I decided to run tweets from the conference in the right column just in case you want to see what’s going on there.

11-17-2013 10-46-40 AM

AMIA announces at the leadership dinner of its conference the Stead Award for Thought Leadership, which will be awarded to recipients whose vision influences the use of informatics to improve healthcare. It honors Bill Stead, MD, associate vice chancellor for health affairs and chief strategy and information officer at Vanderbilt University Medical Center. Above are Stead with the members who recommended creation of the award: Nancy Lorenzi, PhD (VUMC); Bill Stead; Ed Hammond, PhD (Duke Center for Health Informatics); and Kevin Johnson, MD, MS (VUMC). The award’s colors will be Duke blue (where Stead was a student under Hammond), Vanderbilt gold, and AMIA crimson. I was amused that AMIA, like others regularly do, confused in the announcement its own journal’s name (JAMIA) with that of JAMA, saying that Bill was the first editor of the Journal of the American Medical Association, which if so means his informatics research has turned up the Fountain of Youth since JAMA’s first issue rolled off the presses in 1883.

ONC announces that it will develop interoperability standards that will allow EHRs to exchange information with state-run prescription drug abuse databases, updating pharmacy records in near real-time and helping prescribers identify potential abusers directly from order entry. An HHS task work group created the plan in 2011, final recommendations were issued in August 2012, and pilots were completed this year.

The Metro Atlanta Chamber names patient payments platform vendor Patientco its 2013 Healthcare IT Startup Company of the Year. I interviewed CEO Bird Blitch a month ago, including a question about Georgia healthcare IT companies.

11-17-2013 11-24-37 AM

Knowledge management solutions vendor Streamline Health announces a secondary stock offering to finance the acquisition of two small, unnamed software vendors. Company A offers patient scheduling and access solutions, has 29 clients, and will be acquired for $6.5 million in cash. Company B offers financial and operational analytics to its 35 clients and will be acquired for $13.75 million in cash and stock. I interviewed CEO Bob Watson in August 2013. I observed then that STRM shares had jumped from $1.50 in early 2012 to $7 at that time; they’re at $7.60 now.

Eleven Canada-based startup healthcare IT vendors will demonstrate their products in Philadelphia on Tuesday as part of a collaboration program between the city and a Canada-based health IT accelerator. On hand will be Caristix (HL7 integration), Hospitalis (clinical pathways and interventions), Infonaut (infection control surveillance), Memotext (patient adherence), Pulse InfoFrame (analytics), Sensory Technologies (homecare management), HandyMetrics (hand hygiene auditing), Impetus Healthcare (online communities), Interfaceware (HL7 integration), MetricAid (ED efficiency), and Phemi Health Systems (analytics).

11-16-2013 8-13-44 AM

The board of Cover Oregon, the state’s health insurance exchange, places its executive director on notice because of website problems that have resulted in zero enrollments for coverage that begins January 1. The board expressed displeasure with Oracle, which it says missed deadlines and provided marginally skilled employees. The exchange has asked the federal government to loan it seven people to help.

11-17-2013 11-34-00 AM

CMS Deputy CIO Henry Chao did his best to rally the troops this summer to get Healthcare.gov ready, but his patience for missed deadline excuses and demands for more money (especially from contractor CGI) was obviously wearing thin by mid-July. According to a July 12 email, “they [CGI] need about $38 million more to get them through Feb. 2014 … the $38 million does not include the approximate $40 million we have in the budget for this contract.”

11-16-2013 8-19-59 AM

Steve Larkin (maxIT Healthcare) joins ESD as regional VP.

11-16-2013 9-19-46 AM

Marc Winchester (Intuit Health) takes a sales and marketing role with supply chain systems vendor Aperek, previously known as Mediclick.

11-16-2013 7-54-35 PM

Robert Marcus, MD (NextGen) joins TrustHCS as a physician consultant.

11-16-2013 8-05-57 PM

Richard Tunnell (UMDNJ) is named CIO of University Hospital (NJ).

11-16-2013 8-17-15 AM

Fargo-ND-based Intelligent InSites employees wore tee shirts Friday to support United Way. The hats are from the company’s user group meeting held this summer, and since they invited me but I couldn’t attend, they’ve got one with my name on it.

If your HIS-torical memory includes names such as McAuto, SAINT, IBAX, and Amex, then you’ll enjoy Vince’s chapter this week in his continuing analysis of the confusing and sometimes incestuous McKesson HIT family tree.


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

More news: HIStalk Practice, HIStalk Connect.


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November 17, 2013 News 8 Comments

News 11/15/13

November 14, 2013 News 7 Comments

Top News

11-14-2013 11-32-20 PM

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

Reader Comments

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

HIStalk Announcements and Requests

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

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

Acquisitions, Funding, Business, and Stock

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

11-14-2013 10-45-11 AM

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


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

11-14-2013 11-36-12 PM

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

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


11-14-2013 4-04-26 PM

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

11-14-2013 10-47-47 PM

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

11-14-2013 10-52-53 PM

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

Announcements and Implementations

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

11-14-2013 11-26-55 AM

Virtual Radiology releases its free Radiology Patient Care benchmarking metrics.

Orion Health launches Rhapsody 5.5.

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

Government and Politics

11-14-2013 12-44-49 PM

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

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


11-14-2013 1-00-29 PM

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


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

11-14-2013 10-39-54 AM

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

NextGen UGM Update

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


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

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


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

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

Followed by:

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

And then:

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

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

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

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


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

More news: HIStalk Practice, HIStalk Connect.


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November 14, 2013 News 7 Comments

News 11/13/13

November 12, 2013 News 21 Comments

Top News

11-12-2013 5-49-15 PM

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

Reader Comments

11-12-2013 7-57-05 PM

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

Acquisitions, Funding, Business, and Stock

11-12-2013 3-22-35 PM

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

11-12-2013 3-26-09 PM

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

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

11-12-2013 7-45-41 PM

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


11-12-2013 1-42-31 PM

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

11-12-2013 1-40-41 PM

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

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

11-12-2013 1-38-41 PM

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

The Nevada HIE will deploy the Orion Health HIE.

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

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


11-12-2013 1-55-25 PM

PaySpan names Cheryl King (First Data) CFO.

11-12-2013 1-50-27 PM

Candace Smith (Medline Industries) joins Voalte as CNO.

11-12-2013 3-53-30 PM

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

11-12-2013 4-02-05 PM

Direct Recruiters, Inc. promotes Dan Charney to president.

11-12-2013 6-50-31 PM

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

Announcements and Implementations

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

11-12-2013 1-56-46 PM

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

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

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

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

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

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

Government and Politics

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

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

11-12-2013 6-23-55 PM

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

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

11-12-2013 8-07-25 PM

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

11-12-2013 8-08-44 PM

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

Innovation and Research

11-12-2013 8-09-30 PM

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


11-12-2013 4-34-12 PM

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

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

11-12-2013 6-31-54 PM

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

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

11-12-2013 8-02-34 PM

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

Sponsor Updates

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


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

More news: HIStalk Practice, HIStalk Connect.


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November 12, 2013 News 21 Comments

Monday Morning Update 11/11/13

November 9, 2013 News 10 Comments

11-9-2013 6-46-41 PM

From Dash Riprock: “Re: Allscripts. Cliff Meltzer leaving a year after being elevated to the tech savior is troubling. Customers give him credit for fixing the technology problems left behind by the previous executive team. Was it a difference of technical opinion or something else?” Allscripts seems to be betting its future on the hope that the recently acquired dbMotion and Jardogs will allow it to jump on the fashionable population health bandwagon to avoid the competitors that are beating it soundly in hospital and practice new sales, with hosting and add-on services generating recurring revenue from existing customers of products that are rarely mentioned these days (the stable of practice systems, Sunrise Financial Manager, the former Premise, Allscripts ED, e-prescribing, etc.) providing revenue to give the battleship time to turn. Putting Jim Hewitt from Jardogs in charge of development might reinforce that perception. Paul Black came from Cerner and that sounds exactly like Cerner’s strategy, other than Cerner was already highly successful with better management, the broad and deep Millennium product line was more credible, it developed rather than acquired its core systems, it knows how to meet the expectations of both Wall Street and clients simultaneously, and Cerner’s DNA doesn’t include the comically mismanaged Misys, Eclipsys, and late-stage Glen Tullman Allscripts. The Allscripts pitch seems to be entirely focused on population health and whatever of its pieces and parts can be cobbled together to claim a solution for it, and given the frothy enthusiasm in population health technology, why not? To the company’s credit, Wall Street seems to be buying it for now, probably because it’s trusting Paul Black to figure it all out. He’s been in charge since December 2012 and MDRX shares are up around 20 percent since then, although their performance lags the Nasdaq index, which was up up 30 percent in the same period.

From The PACS Designer: “Re: Apple’s LTE hub. As our IT environment fills up with more iPads, it becomes practical to ensure connectivity options are available no matter where you may be daily. With the Apple LTE communications function, everyone present can connect to the Internet and cloud services as long as at least one laptop is running the Apple iOS with the LTE mobile hotspot option. There is some disadvantage in that as more iPads join the group, the LTE network will have a slower response time for Internet queries.”

11-9-2013 3-52-56 PM

Buy Cerner shares if you want to invest in healthcare IT, poll respondents say. Looking back one year, your $10,000 investment would now be worth $22,488 (athenahealth), $14,811 (Cerner), $11,818 (Allscripts), $8,106 (Merge Healthcare), and $13,688 (Quality Systems). New poll to your right: how well do hospitals and practices use the data they already have to make improvements? Dr. Jayne pointed out that hospitals that don’t seem to have much interest in doing anything with the piles of data they’re already collecting are inexplicably salivating over big data. There’s no need for big data envy until you’ve wrung out every possible improvement from the “little” data you already have, which few hospitals and practices have done.

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

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11-9-2013 5-06-24 PM

Jeffrey Allport (JLA Insights) is named VP/CIO of Valley Presbyterian Hospital (CA).

11-9-2013 5-12-17 PM

The House Oversight and Government Reform Committee subpoenas US CTO Todd Park to testify at its November 13 hearing about Healthcare.gov, saying that he is the only administration witness “unwilling to appear voluntarily.” The White House responded that the subpoena was not necessary since Park offered to appear in December after he finishes work on the struggling site. The White House says it will “respond as appropriate.”

Epic and service provider NNIT win a big EHR deal for all of eastern Denmark, beating out Cerner and IBM/Systematic. According to a press release translated from Danish, “We have chosen Epic and NNIT’s offer as the economically most viable. All three bids included good, professional suggestions for the healthcare platform but in the end we chose the offer that scored the highest on the parameters we had defined for the bid in advance. Now we look forward to seeing the positive effect for our professional users and not least the patients.” The project for Regions Zealand and Hovedstaden, which will involve 40,000 users, is valued at $180 million. The Denmark-based Systematic was probably the pre-decision favorite. NNIT, oddly enough, is owned by drug manufacturer Novo Nordisk and, not so oddly, is also headquartered in Denmark.

11-9-2013 6-47-39 PM

From the Allscripts earnings call Friday:

  • CEO Paul Black blamed missed revenue numbers on the transition to subscription pricing. Not to be cynical, but surely this is the longest streak of quarterly reports in which a company blames its own voluntarily chosen strategy for causing disappointing results.
  • Most of the discussion revolved around population health and 40 percent of the Q3 bookings came from it.
  • The company talked up its electronic referral network and homecare solutions.
  • Black said 90 percent of Sunrise clients will commit to the 6.1 upgrade by the end of the year.
  • Both system sales revenue and professional services revenue were down, causing non-GAAP revenue to drop by 7 percent year over year.
  • Black confirmed that SVP Jim Hewitt, former Jardogs CEO and CIO of Springfield Clinic, will replace Cliff Meltzer as the head of development, although didn’t really answer the directly asked question of why the replacement was necessary.
  • Ambulatory solutions were hardly discussed except in the context of forming a network to connect all Allscripts users.

11-9-2013 6-00-46 PM

According to a tweet by former National Coordinator Farzad Mostashari, MD, the HIMSS EHR Association “can’t just say, ‘we don’t want FDA regulation.’ Have to work hard to make the (ONC) alternative work.”

11-9-2013 7-01-00 PM

The PR company that manges ONC’s “Health IT Buzz Blog” wins a PR society award for their efforts. You might be surprised (but probably not) by how many company blogs are ghostwritten or edited by freelance writers and PR flacks, aimed at promoting rather than informing. HHS/ONC awarded Ketchum a $25.8 million public relations contract in 2010  because of its track record in gaining public acceptance for unpopular projects, placing provider EHR adoption and patient privacy concerns in that category. The government has a history with Ketchum: the GAO said that a 2004-2005 series of Ketchum-produced prepackaged “news” reports sent to local TV stations to run as their own, complete with actors pretending to be journalists reporting from Washington, were actually “covert propaganda” that failed to disclose that the government paid for them.

ONC names the winners of its recent patient empowerment codeathon. In the Blue Button category: Edge Interns (patient health evaluations), Light Hearts (discharge CHF workflow), and Patient Watch (wearable device data tracking). In the financial category, WTF! Denied (redesign EOB and surely the most interesting name among the participants), MintMD (patient cost presentation), and Archimedes (ranks personalized insurance plans from California’s insurance exchange).

11-9-2013 7-02-21 PM

The CEO of University Hospital (GA) says hospitals will probably have to join in regional alliances to survive because of EHR costs and the Patient Protection and Affordable Care Act. CEO Jim Davis, whose hospital spent $50 million on Epic and is facing another $30 million in upgrades, is considering signing a shared services contract with Novant Health, saying he can’t compete with that organization’s 20-hospital economy of scale. “When Novant, which has 20 hospitals, does an upgrade on their Epic system, which takes a lot of work, they spread that cost over 20 hospitals.  When I do that same upgrade, I spread it over one. If I can be the 21st hospital that (cost) gets spread over, then everybody’s costs goes down.” He’s worried about PPACA because Georgia opted out of Medicaid expansion and even those who buy insurance will probably buy the cheapest plans with high deductibles and lower provider reimbursement.

Weird News Andy isn’t impressed with the excuse of a Florida doctor caught on surveillance video stealing a framed bird picture from Naples Community Hospital by slipping it under his white coat after hours: the doctor claims he was just borrowing it.  

The city of Washington, DC seeks guardianship of its most frequent 911 caller, with its Department of Behavioral Health filing a court petition claiming that the 58-year-old woman (who was named in the report and in the newspaper story) has psychiatric disorders and insufficient mental capacity to make medical decisions for herself. The woman started calling 911 for fainting spells in 1997 and hasn’t stopped, racking up 226 calls and 117 ambulance transfers in the past year alone.

11-9-2013 8-09-43 PM

Monday is Veterans Day in the US, set aside to honor everyone (living and dead) who has served in the military. If you served, thank you. If you didn’t, thank them. Use hashtag #HonoringVets on Monday.

A reader asked me to re-run my 2007 list of EMR rollout rules. Here you go.

Mr. HIStalk’s Universal Rules for Big EMR Rollouts (From 2007)

1. Your hospital will pledge to make major process changes, vowing to “do it right” unlike all those rube hospitals that preceded you, but the executive-driven urgency to recoup the massive costs means the noble goals will change to just bringing the damn thing up fast, hopefully without killing patients in the process.

2. The project and/or system must be anointed with an incredibly dopey and user-embarrassing name, preferably chosen from user submissions and with the offer of crappy vendor paraphernalia or lame IT junk as a prize, and also preferably made up of a far-fetched phrase whose contrived acronym spells out a medically related word or female name. Instead of inspiring the expected collegial chumminess among users, it will serve as a bitter reminder of the innocent, naive days between RFP and go-live before it got ugly.

3. Doctors won’t use it like you think, if at all, because hospitals are one of few organizations left that doctors can say ‘no’ to.

4. You’ll spend a fortune on mobile devices and carts that will sit parked in a corral due to the short life of their $100 battery and a dysfunctional but not yet fully depreciated wireless network, the keystone arches to the entire project.

5. All the executives who promised undying support to firmly hold the tiller through the inevitable choppy waters and who overrode all the clinician preferences in a frenzy of inflated self esteem will vanish without a trace at the first sign of trouble, like when scarce nurses or pharmacists threaten to leave or when the extent of the vendor’s exaggeration first sees the harsh light of day in some analyst’s cubicle.

6. It will take three times as long and twice the cost of your worst-case estimate.

7. You’ll pay a vendor millions for a software package consisting of standardized business rules, then argue bitterly that all of them need to be rewritten because your hospital is extra-special and has figured out the secrets that have eluded the vendor’s 100 similar customers. The end result, if the vendor capitulates, will be a system that looks exactly like the one you kicked out to buy theirs.

8. You’ll loudly demand that the vendor ship regular software upgrades to fix all the bug issues you submit, but then you’ll refused to apply them because you’re scared of screwing something up with the skeleton maintenance staff you can afford, given that millions were spent on systems with nothing left for additional IT support staff or training.

9. All those metrics you planned to collect to show how quickly the EMR would pay for itself instead show the situation unchanged or getting worse, so factors beyond your control will be blamed (like a ridiculously long implementation time that changed all the assumptions and external conditions) and ROI will not be brought up again in polite company.

10. No matter how unimpressive the final result toward patient care or cost, the EMR will be lauded far and wide as wonderful since the vitality of the HIT industry (vendors, CIOs, consultants, magazines, HIMSS, bloggers) requires an unwavering belief that IT spending alone will directly influence quality, even when nothing else changes.

Vince continues his fascinating HIS-tory of McKesson, this time covering its acquisition of IBAX. He’s looking as always for fun stories, photos, and memories from folks who were there and his contact information is on the last slide.


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

More news: HIStalk Practice, HIStalk Connect.


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November 9, 2013 News 10 Comments

News 11/8/13

November 7, 2013 News 6 Comments

Top News

11-7-2013 6-41-31 PM

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

Reader Comments

11-7-2013 11-16-30 AM

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

HIStalk Announcements and Requests

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

11-7-2013 6-45-21 PM

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

Acquisitions, Funding, Business, and Stock

11-7-2013 6-47-10 PM

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

11-7-2013 5-25-15 PM

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


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

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

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

11-7-2013 6-50-27 PM

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


11-7-2013 9-06-31 AM

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

11-7-2013 9-20-24 AM

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

11-7-2013 3-27-19 PM

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

11-7-2013 4-32-58 PM

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

Announcements and Implementations

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

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

11-7-2013 6-56-20 PM

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

Government and Politics

11-7-2013 5-41-36 PM

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

11-7-2013 1-49-39 PM

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

11-7-2013 5-45-29 PM

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

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

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


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

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

11-7-2013 6-33-54 PM

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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


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

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

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

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

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

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

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

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

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


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

More news: HIStalk Practice, HIStalk Connect.


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November 7, 2013 News 6 Comments

News 11/6/13

November 5, 2013 News 7 Comments

Top News

11-5-2013 9-31-24 PM

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

Reader Comments

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

HIStalk Announcements and Requests

11-5-2013 7-10-32 PM

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

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

Acquisitions, Funding, Business, and Stock

11-5-2013 6-39-11 AM

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

11-5-2013 10-59-44 PM

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

11-5-2013 11-00-22 PM

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

11-5-2013 11-01-13 PM

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

11-5-2013 11-02-04 PM

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


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

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

11-5-2013 9-51-52 AM

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


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

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

11-5-2013 9-13-06 AM

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

11-5-2013 8-05-52 PM

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

11-5-2013 8-10-34 PM

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

Announcements and Implementations

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

11-5-2013 10-01-30 AM

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

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

11-5-2013 6-31-26 PM

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

Government and Politics

11-5-2013 8-29-01 PM

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

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

Innovation and Research

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

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


11-5-2013 10-21-28 PM

ECRI Institute releases its 2014 Top 10 Health Technology Hazards:

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


11-5-2013 12-58-33 PM

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

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

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

11-5-2013 11-08-44 PM

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

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

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

11-5-2013 11-13-25 PM

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

11-3-2013 8-08-41 AM

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

Sponsor Updates

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


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

More news: HIStalk Practice, HIStalk Connect.


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November 5, 2013 News 7 Comments

Monday Morning Update 11/4/13

November 2, 2013 News 20 Comments

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

11-2-2013 11-36-18 AM

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

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

11-2-2013 11-29-12 AM

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

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

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

11-2-2013 5-38-19 AM

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

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

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

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

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

11-2-2013 6-19-01 AM

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

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

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

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

11-2-2013 12-31-36 PM

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

11-2-2013 12-32-37 PM

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

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

11-2-2013 8-26-02 AM

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

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

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

11-2-2013 11-47-08 AM

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

11-2-2013 10-42-27 AM

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

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

Sponsor Updates

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


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

More news: HIStalk Practice, HIStalk Connect.



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November 2, 2013 News 20 Comments

News 11/1/13

October 31, 2013 News 7 Comments

Top News

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

Reader Comments

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

10-30-2013 6-36-08 PM

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

HIStalk Announcements and Requests

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

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

Acquisitions, Funding, Business, and Stock

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

10-31-2013 4-48-54 PM

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

10-30-2013 12-09-43 PM

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

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


10-31-2013 4-50-54 PM

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

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

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

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

10-31-2013 2-53-31 PM

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

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

Announcements and Implementations

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

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

10-31-2013 4-58-38 PM

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

10-31-2013 5-00-27 PM

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

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

10-31-2013 1-44-10 PM

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

Government and Politics

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

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

Innovation and Research

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

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


10-31-2013 2-30-09 PM

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


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

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

10-31-2013 5-08-12 PM

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

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

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

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

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

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

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

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

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

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


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

More news: HIStalk Practice, HIStalk Connect.

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October 31, 2013 News 7 Comments

News 10/30/13

October 29, 2013 News 9 Comments

Top News

10-29-2013 8-10-09 PM

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

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

Acquisitions, Funding, Business, and Stock

10-29-2013 11-57-10 AM

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

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

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


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

10-29-2013 6-24-14 PM

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

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

10-29-2013 6-25-44 PM

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

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

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

10-29-2013 3-40-13 PM

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

10-29-2013 6-28-30 PM

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

10-29-2013 6-29-28 PM

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

New York Methodist Hospital selects workforce management solutions from Kronos.


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

10-29-2013 11-48-15 AM

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

10-29-2013 6-30-55 PM

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

10-29-2013 4-22-43 PM

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

10-29-2013 4-52-42 PM

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

Announcements and Implementations

10-29-2013 6-32-44 PM

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

10-29-2013 6-33-57 PM

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

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

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

10-29-2013 6-35-22 PM

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

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

10-29-2013 6-40-13 PM

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

Government and Politics

10-29-2013 6-51-55 PM

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


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


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

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

10-29-2013 8-07-51 PM

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

Sponsor Updates

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


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

More News: HIStalk Practice, HIStalk Connect.

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October 29, 2013 News 9 Comments

Monday Morning Update 10/28/13

October 26, 2013 News 10 Comments

10-26-2013 4-13-54 PM

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

10-26-2013 2-16-06 PM

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

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

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

10-26-2013 12-57-42 PM

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

HIStalk Webinars

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

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

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

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

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

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

10-26-2013 1-54-41 PM

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

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

10-26-2013 2-29-54 PM

10-26-2013 2-30-41 PM

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

10-26-2013 2-33-47 PM

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

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

10-26-2013 3-57-36 PM

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

10-26-2013 3-36-49 PM

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

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


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

More news: HIStalk Practice, HIStalk Connect.


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October 26, 2013 News 10 Comments

News 10/25/13

October 24, 2013 News 11 Comments

Top News

10-24-2013 7-17-26 PM

Cerner reports Q3 numbers: revenue up 8 percent, adjusted EPS $0.35 vs. $0.30, falling short on revenue expectations. From the conference call:

  • Domestic revenue was up 8 percent, while global revenue increased only 1 percent.
  • The company sold its sixth French client and its first one in Brazil.
  • Cerner says that by the end of the decade, the EMR will provide just one feed into a population health management system, and the company is already selling solutions and services to customers who don’t use a Cerner EMR.
  • Cerner and Epic are distancing themselves further from their competitors, and Cerner says it is gaining momentum against Epic.
  • Cerner says its clients have acquired hospitals at six times the rate of Epic’s, giving the company more potential users.
  • Cerner has been approved by Apple as the only non-carrier company allowed to sell the iPhone, and it will offer an unlocked, no-plan iPhone for CareAware Connect, which can replace pagers and other communications devices.
  • Cerner says its work with Intermountain Healthcare will disrupt the industry and accelerate clinical computing by a decade, reducing healthcare costs by up to 20 percent. Projects include using Intermountain’s Care Process Models as an EMR-agnostic “clinical navigation system” and blending content with the EMR to provide activity-based costing as a resource management system.
  • EVP Jeff Townsend compared Epic to Kodak for its suggestion that Meaningful Use be delayed for five years, suggesting that both Epic and Kodak spent too much time selling profitable old technology and trying to delay the inevitably changing future.
  • An analyst noted that “Intermountain has a history of chewing up and spitting out vendors” and asked how Cerner can keep them happy. Townsend said Cerner will do an accelerated Millennium implementation so they can get to the “fun stuff” more quickly.
  • Cerner says it was chosen over Epic at Intermountain because of population health and the ability to influence cost, saying, “This is not a project. This is a decade, if not a two-decade-type relationship.”

Reader Comments

From Digital Bean Counter: “Re: million dollar question. Why hasn’t the government asked any of us health informaticists about fixing the Healthcare.gov website?” It’s not an informatics problem, so that would be pointless. Nobody in healthcare (nor in government contracting, apparently) has the experience needed to plan for the kind of scale Healthcare.gov needs and there’s nothing there at all related to informatics. It requires people who have built monster-sized e-commerce sites, the kind who live in the Silicon Valley instead of the beltway. It’s a shame that the site has turned into a political football – nobody seemed to mind when the VA, DoD, and HHS were burning through millions to billions of dollars in poorly planned and poorly managed IT projects and the website is only marginally related to Obamacare. Nobody can say anything about any topic these days without someone screaming about a perceived political agenda, and politics isn’t the same as the government, which is comfortingly inefficient and wasteful no matter which party is involved. I think I remember a stat that 50 percent of US government software projects are utter failures and a complete waste of taxpayer money and almost all of the rest don’t deliver the expected value.

From Alexis Nexis: “Re: expense reports gone wild. There’s no understanding of what someone on the road experiences:  a hotel room and bed, no ability to cook some eggs in the morning, no ability to pack a sandwich for lunch, doing laundry just on the weekend, etc. Not to mention the additional six to 25 non-billable hours of travel (above the commute between hotel and office) typically incurred every week by road warriors. I can assure you that there’s no road warrior getting rich off his meal expenses. I am quite surprised that snacks and coffee are being included. IRS guidelines view meal expenses as breakfast, lunch, and dinner. Shame on the commentator for not having negotiated a contract accordingly. And shame upon those contract administrators who insist upon receipts for when IRS guidelines don’t require them. To have to save my receipt for the toll on the highway or for my $7 of breakfast in the morning is ludicrous. It burdens everyone with additional unnecessary overhead. I routinely put into my contracts the IRS per diem rate for the locale. Perhaps we should wonder about what it is that makes healthcare in the United States the most expensive in the world without our getting the best return what we spend. I would suggest that it’s not the relatively incidental amounts being referred to. By the way, where could I sign up for that $200 an hour rate?” This is one of those “don’t sweat the small stuff” issues. Line item living expenses are annoying because you get into that pointless mental debate over whether a consultant who buys a $4 coffee on the way to the hospital every morning must be screwing you in other ways as well, and yet sometimes that same employer doesn’t give the consultant a clear picture of what work needs to be done or doesn’t have the required internal people lined up. At $200 per hour, that $4 coffee represents just over one minute of billable time, and I’ve seen consultants trying to find things to do for hours each day because they were just shown a cubicle and abandoned because nobody had the time to manage them.

From Bignurse: “Re: Yann Beaullan-Thong of Vindicet. You interviewed him a few weeks ago. The 2013 McKnight Technology Award in the Transitions category was awarded to a Vindicet client for implementing its patient management system. The organization says the system cut admission time to its skilled nursing settings to less than 1 hour.” Yann’s HIStalk interview from December 2012 is here. The company offers referral management and discharge managing systems.

From Boy Oneder: “Re: Epic’s Healthy Planet. It’s population health management and is robust – wellness, chronic disease registries, population outreach, high risk care management, and risk stratification algorithms.” I heard the term “Healthy Planet” and asked Boy Oneder what it was all about. Boy Oneder also says that Epic had documented clinical workflows in the Netherlands years ago in preparation for sales like the two that just happened to two large Amsterdam hospitals. I don’t think Epic is joking when it talks about world domination.

From Player: “Re: Epic hospital. You should interview a CFO, anonymously or otherwise, about how they looked at the cost justification for implementing Epic.” That would be fun. Volunteers?

10-24-2013 10-57-39 PM

From Boy Lee: “Re: innovative companies. You profiled some of them years ago.” I ran a series I called Innovator’s Showcase in 2011, which took a ton of work. I invited startups to apply to be profiled on HIStalk, but they had to have an original product, real customers, real revenue (although not too much of it), an a short time in business. I had three folks review their brief applications and we chose seven for the Innovator’s Showcase. We thought these had the best chance of success. None have failed as far as I can tell. They were:

Aventura (clinician computing experience)
Health Care DataWorks (analytics)
OptimizeHIT (which was connected to ImplementHIT in some way that confuses me to this day, which offers EHR training)
Caristix (HL7 and interfacing software)
Logical Progression (acquired by Bottomline Technologies – offered mobile documentation)
Trans World Health Services (benchmarking and analytics)
Health Nuts Media (learning games and educational material)

From DrLyle: “Re: your comments about physician-focused startups with no clue how to make solutions for doctors. I loved your answer. I just wanted to make sure the key word is ‘most’ and not ‘all.’ Some of us are actually making some good stuff that truly uses HIT to automate and delegate care, saving time for docs and improving quality for patients.” I was amused at the number of folks whose brains blocked all but the words they get emotional about, firing them up to argue about what they perceived as an anti-innovation rant. I very specifically mentioned only companies that don’t care about patients or providers and that are clueless, arrogant, insulting, and badly planned. If I were CEO of one of those I’d keep quiet, and if I was one of the better startups, I’d be happy that my unworthy competitors had been called out publicly. I’ve been the hospital IT guy who heard these pitches and I’m fairly certain most of my peers think similarly – don’t come knocking until you’ve done your homework. Hospitals may seem like local businesses that need help, but they are massive enterprises. Getting your fledgling product in the door means someone internal is going to have to go to bat for you, meaning their job is on the line if you can’t deliver. Do you have documentation, an implementation plan, around-the-clock support, and sound technology that isn’t dependent on your one Romanian programmer not finding a better contract?

I should mention that part of my rant came about is because I resent any company (big or small) that barges into healthcare without showing respect for patients and the people who have been involved in taking care of those patients all along. Healthcare is a vendor’s Vietnam, as Misys or Sage or any number of other half-hearted former dabblers can explain. They saw themselves swooping in from other industries with massive firepower and a hearts-and-mind campaign that would ensure a quick and painless surrender by the peaceful, primitive locals. A handful of years later, their thoroughly defeated and demoralized salespeople and executives were climbing over each other’s backs desperate to squeeze onto that last available helicopter ride to safety.

10-24-2013 9-02-13 PM

From Lazlo Hollyfeld: “Re: Healthcare.gov. At least the CD version is slated for a ‘16 release.” The Onion is brilliant as usual in its satire about Healthcare.gov.

HIStalk Announcements and Requests

inga_small Some goodies you may have missed this week on HIStalk Practice include: Practice Fusion defends its practice of emailing patients to request physician reviews. Parents want to email their pediatricians and they want it to be free. The Rothman Institute will implement White Plume ePASS. Female doctors provide better quality care than their male counterparts. A physician is charged with breaking and entering after she broke into an office, set up a temporary practice, and began seeing patients. Hayes Management Consulting VP Rob Drewniak outlines a process to prevent breaches with HIPAA compliance. Dr. Gregg offers a Top 10 and a Bottom 10 List on HIT adoption. Linda Fischer, EMR manager for Boulder Community Hospital Physician Clinics, discusses her Greenway Medical EMR implementation, including details on the selection process, EHR data migration, obtaining physician buy-in, and quality care initiatives. In lieu of sending Halloween candy, please treat me to your email address to subscribe to the latest HIStalk Practice updates. Thanks for reading.

Here are a couple of on-the-spot interviews Bonny and Catherine of Aventura conducted at ACEP13 in Seattle last week. They just turned on the video recorder and let the folks say whatever they wanted about IT.

From an ED physician:

Technology is struggling to match what physicians and other clinicians actually want to have happen. When people say all the time, “Is this a great system?” then yes, it’s a great system, but not in this particular setting. There’s many, many, many times a mismatch between what the clinicians want to have done and what the technology can do. There’s innocence on both sides. That’s what my experience has been with this technology. This innocence of mismatch, where the technical people are extremely good at what they do, the hospital people and clinicians are very good at what they do, but this matching of the two is really not working nearly as well as everybody thinks it is. As an example of why there’s this disconnect between documentation and clinicians is my assessment of a patient begins way before anybody thinks it does. It begins when I hear that patient screaming out of the corner of my eye as he’s brought in. I’m not documenting then. I’m not even seeing the patient yet, but that’s when my assessment begins. When I walk into the room, the smells and everything, that’s all part of my assessment, but many times that does not get documented.

From a resident:

I’m a fourth-year EM resident. Our workflow is that we will typically sign up for patients at the doctor’s station and go and see the patient, which takes about five to 10 minutes. Then come back, put our orders in, see other patients, and then we’ll frequently come back and either document or dictate in between patients. Aventura seems like a good application. Friendly, very fast. Sounds like it would be helpful.

Acquisitions, Funding, Business, and Stock

10-24-2013 7-18-05 PM

Microsoft turns in Q1 numbers: revenue up 16 percent, EPS $0.62 vs. $0.53, beating expectations.

10-24-2013 11-01-16 PM

McKesson files Q2 numbers: revenue up 10.7 percent, adjusted EPS $2.08 vs. $1.79, beating expectations on both. Technology Solutions revenue was up 7.7 percent although software revenue was down 9 percent. The company also announced that it will acquire a majority stake in Germany-based drug wholesaler Celesio for $8.3 billion “to form a global leader in healthcare services.” John Hammergren, asked about whether the company will keep the technology business, waffled by saying results are good and there are no plans to change the mix, but MCK isn’t married to any particular strategy and has a responsibility to revisit that decision constantly.

10-24-2013 11-01-56 PM

Covisint reports its first quarterly results after its recent IPO: revenue up 19 percent, adjusted EPS –$0.08 vs. –$0.15.

10-24-2013 11-02-46 PM

Hospital health information management provider IOD Incorporated acquires ApeniMED, a Minneapolis-based company offering healthcare interoperability solutions.

10-24-2013 11-07-48 PM

Accelera Innovations secures a $200 million equity investment agreement from Lambert Private Equity. I’ve never mentioned Accelera even once on HIStalk and I admit I’ve never heard of them. Their website looks like something kid with FrontPage might have created in 2002, playing annoying music (unless you’re an “Arrested Development” fan, in which case you’ll enjoy Europe’s “The Final Countdown” because it will remind you of a G.O.B. magic trick ) following someone loudly and pedantically reciting a company pitch. Frankly, I’m struggling to believe the accuracy of the story that someone invested $200 million in this operation.

10-24-2013 7-18-58 PM

Quality Systems reports Q2 results: revenue down four percent to $118 million, EPS $0.22 vs. $0.31, missing analyst estimates on both. CEO and President Steven T. Plochocki says the results are indicative that the reorganization plan put in place during fiscal 2013 is beginning to gain traction. He also notes that revenue, bookings, and system sales were up from the first quarter.

10-24-2013 4-58-37 PM

The Wellness Network acquires hospital patient education software company Logicare.

10-24-2013 7-36-43 AM

Cureatr, which offers secure messaging solutions for providers, secures $5.7 million in Series A financing.

Miami Children’s Hospital signs a deal to allow HealthFusion to offer South Florida pediatricians an MCH-specific version of the company’s iPad-based MediTouch EHR that will connect to the hospital’s systems.


10-24-2013 10-36-56 AM

Trinitas Regional Medical Center (NJ) selects EDCO Health Information Solutions to implement Solarity technology and indexing services for medical records scanned at patient discharge.

Elmwood at the Springs Healthcare Center (OH) selects VersaSuite for EHR/PM for its long term acute care facilities.

Rush Health (IL) endorses athenahealth’s EHR and PM services for its 300 affiliated private physician members.

The State of California Office of Health Information Integrity selects iBlueButton from Humetrix for its HIE pilot.

The Berlin Visiting Nurse Association (CT) will replace McKesson Homecare with Brightree’s home health platform.

Children’s Hospital of Philadelphia signs a five-year contract with OnPoint Medical Diagnostics for its MRI Quality Assurance software.

VA Midwest Health Care Network chooses Visage 7 Enterprise Imaging Platform enterprise viewer for regional diagnostic interpretation and image access throughout its 11 hospitals. The organization also chooses Medicalis for enterprise workflow and Acuo for its vendor-neutral archive.


10-24-2013 10-24-23 PM

Athenahealth names Amy Abernethy, MD, PhD (Duke University Medical Center) to its board.

Vermont IT Leaders elects Paul Harrington (Vermont Medical Society) chair of its board.

Announcements and Implementations

Care at Home (CA) deploys AtHoc’s Home Care Alerts emergency mobile solutions.

Spectrum Health (MI) automates the exchange of patient information via CCD between its HealthMEDX post-acute care EMR and its Cerner and Epic platforms.

HIMSS names Texas Health Resources a winner of the 2013 Enterprise HIMSS Davies Award of Excellence for its use of HIT. CIO Ed Marx is a regular contributor to HIStalk.

10-24-2013 11-39-02 AM

Boston Children’s Hospital launches Wired Informatics to provide enterprise-grade NLP solutions for hospitals and other healthcare entities and introduces its flagship product Invenio, which extracts and leverages knowledge contained in clinical notes.

10-24-2013 4-57-34 PM

Partners Healthcare’s Center for Connected Health launches Wellocracy, a clinically-based source of self-help technologies for consumers, including health and fitness trackers and mobile apps.

Government and Politics

10-24-2013 12-49-20 PM

Finally some good news from the government: every dollar invested to investigate and prosecute healthcare fraud returns at least $20, based on data collected from 2008 to 2012.

A bipartisan group of House lawmakers introduces the Sensible Oversight for Technology  which Advances Regulatory Efficiency (SOFTWARE) Act  that would clarify regulations for mobile medical apps, EHRs, and other HIT technologies. The legislation builds on the FDA’s final guidance on mobile healthcare apps.

Healthcare.gov contactors tell a Congressional panel that it’s not entirely their fault the site doesn’t work as well as hoped – the government should have supervised them better and tested more thoroughly before setting the go-live date. An SVP of Canada-based CGI stuck with the story that user volume was greater than expected and said it was CMS’s job to do end-to-end testing, not the company’s. Andy Slavitt of Optum, which owns contractor QSSI, said the government decided late in the game to require users to create an account before viewing insurance plans and the company’s function for that didn’t work well in the site’s first few days. Rep. Anna Eschoo (D-CA), who represents the Silicon Valley, said blaming user volume is a “lame excuse” that “really sticks in my craw,” adding that Amazon doesn’t crash the week before Christmas.

10-24-2013 11-16-37 PM

John Halamka’s conclusion about Healthcare.gov: “… Nine women cannot create a baby in a month. There is a minimum gestation period for IT projects and our policymakers should learn from the lessons of the Health Insurance Exchange and re-calibrate the timelines shown in the graphic above [the CMS reform timeline] so that everyone is successful.” Or as one of my hospital programmers always told me years ago when pressed to make a delivery date, “You can take the cake out of the oven any time you want, but don’t blame me when you don’t like it.” 

10-24-2013 11-17-57 PM

The VA’s Office of the Inspector General finds that three ED patients died at the Memphis VA after receiving substandard care, one because the doctor violated policy by hand-writing an order for a drug to which the patient was allergic, a situation that CPOE would undoubtedly have warned about.

Innovation and Research

10-24-2013 11-19-02 PM

The Merck | Heritage Provider Network Innovation Challenge offers $240,000 in total prizes for creating tools that help people with heart disease or diabetes follow their care plans. Submissions are due November 10, 2013.

A peHUB article called “Disrupting healthcare – on whose terms?” says that companies with no healthcare background who jump into healthcare IT investments have a big performance disadvantage. It concludes, “These data clearly show a massive advantage for firms with healthcare expertise when making healthcare investments. And why shouldn’t they? Don’t we assume, for instance, that energy investors do better at energy investments vs. those firms without any energy focus or experience? Healthcare is at least as complex and regulated an ecosystem as energy and yet it repeatedly experiences cycles of outsiders driving up investor frenzy.”


Verizon Enterprise Solutions releases Converged Health Management, a remote patient-monitoring platform that allows patients to use biometric devices to capture vital signs and automatically transmit details to their providers.


10-24-2013 12-09-56 PM

Providers rely on telephone calls, letters, and face-to-face conversations more than any other method to communicate with patients, despite the increased use of newer technologies such as text messaging, social networking sites, portals, and emails.

10-24-2013 11-20-46 PM

HIMSS announces keynote speakers for the mHealth Summit in December: FDA Commissioner Margaret Hamburg, Qualcom CEO Paul Jacobs, Denmark’s Minister of Health, and Nobel Peace Prize Winner Muhammed Yunus. I’ll be reporting from the conference, as will Travis from HIStalk Connect. HIStalk will have a microscopic, sparsely furnished booth in the exhibit hall because they were nice enough to give us one, which will be capably manned (or womanned) by the fabulous Lorre.  She may have nobody to talk to since I’m not certain the mHealth Summit draws a lot HIStalk readers, but if you’re going, find our micro-booth (#1305, right beside a slightly larger booth and company called AT&T) and say hello. 

10-24-2013 8-33-51 PM

More on the summary of KLAS’s report on McKesson Paragon, which concluded that the product isn’t ready for big hospitals in important areas (like clinical functionality and an integrated ambulatory system) and has experienced a pretty big drop in KLAS scores since 2010, but customers seem satisfied to wait for the three-year roadmap to bring it up to their expectations. The graphic above shows that 32 large hospitals bought Horizon replacements in 2012, with 10 each choosing Cerner and Epic and 11 choosing Paragon, with cost being a big driver for the Paragon wins. Among smaller Horizon hospitals, Epic was the big winner, probably through acquisition if I had to guess since I doubt those hospitals could afford Epic otherwise except though an affiliate agreement. Allscripts, Meditech, and Siemens didn’t get a single Horizon replacement deal, with the most startling fact in that statement being the inability of Meditech to execute in what should be a receptive market.

10-24-2013 10-30-03 PM

Brian Stowe, the former Epic project manager charged with taking sexually explicit photos of passed out women (of whom six of the eight were his Epic co-workers,) pleads guilty to taking photos and video of a 17-year-old girl asleep in his bed and will be sentenced  in January to a minimum of 15 years in prison. He still faces 62 felony counts.

10-24-2013 8-59-19 PM

A thief breaks into the offices of AHMC Healthcare (CA), making off with two unencrypted laptops on which was stored the information of 729,000 patients. The hospital has expressed a sudden interest in encryption, which the near-certain $1.5 million fine might have covered. Apparently hospitals are unable to muster the technical expertise and financial motivation to encrypt computers until after they’ve been inevitably burned and fined, so it costs them even more. Police arrested a vagrant for the theft on Wednesday, but the laptops are still missing.

10-23-2013 10-28-08 AM

inga_small After reading Tweets and news stories about all the folks who have been able to find more affordable healthcare coverage options on the Healthcare.gov website, I decided to once again attempt the application process. Unfortunately I did not get farther than the second screen, which contained a lot of gibberish. I guess I’ll give Jeff Zients, Verizon, and all the newly recruited techies a bit more time to fix things.
Weird News Andy says he is singing “La Cucaracha” to himself as he enjoys this story: cockroach farming is booming in China as the country finds them both delectable as a culinary treat and miraculous as a a basis for drug development, with hospitals using them to treat burns and a pharmaceutical manufacturer claiming its cockroach syrup cures ulcers and TB.

Sponsor Updates

  • NVoq announces the general availability of its SayIt 8.2 release.
  • Strata Decision Technology hosts 400 attendees in Chicago this week at its annual summit.
  • Wolters Kluwer Health introduces Lippincott’s CoursePoint, a digital course solution for nursing education.
  • DocuTAP will integrate Wolters Kluwer Health’s Health Language applications into its EMR solutions for the urgent care environment.
  • Intelligent InSites will hold its InSites Build 2013 conference October 29-30 in Fargo, ND.
  • Greythorn will offer an October 29 webinar on Radiant implementation and optimization.

EPtalk by Dr. Jayne

Let’s face it, consultants are a fact of life in our industry. Most of us are trying to do more than we possibly can with the staff we have in place. We’re trying to cope with an ever-changing regulatory landscape. We’re feeling the squeeze between immovable deadlines and vendors who aren’t delivering required code as early as we want them to. Sometimes we can’t hire new FTEs quick enough or we may not have anyone with the skill sets needed to help us stay compliant. And so, we turn to consultants.

A reader mentioned last week that his or her company was not in favor of paying meal and incidental expenses for consultants and asserted that the consultant’s employer should pay those expenses since it is already charging a hefty per-hour fee. The comment sparked several replies, so I decided to reach out to some of my friends who are consultants to see what they think. I’ve been on both sides of the story as I’ve hired consultants and been one, but I’ll hold on my thoughts for now.

Most of the consultants I talked to this week feel that their clients have a skewed view of what consultants actually are paid. Even though a consulting firm or vendor may charge $200 or $300 an hour, it’s unlikely that the individual field consultants are taking home even a third of that. Although many senior consultants do quite well, many junior consultants spend up to 50 weeks a year away from home. Divide the pay by the hours away from home and family and the paycheck starts to look even less great.

Companies have to cover for the time that their consultants are engaged in non-billable activities such as training, staff development, continuing education, and maintaining competency with EHR vendor software. Increasingly clients are refusing to pay for consultant travel time (or imposing ridiculous travel caps that don’t even cover flying time) and that has to be covered as well. One consultant I’ve used repeatedly tells the story of going to a small town in a remote western state, where he had to take four flights (to stay under the client’s air fare cap) and then drive four hours to get there. The total travel day was close to 18 hours and then of course he had to get home. The client had a three-hour round trip travel cap. I’m pretty sure the client knows they’re a four-hour drive from the nearest airport.

One of my favorite niche firms works with a single EHR vendor and maintains a very small group of consultants. All of them are nurses and the CEO is a nurse as well. Most of them continue to maintain their licensure and attend CNE so they can stay current with clinical topics. It makes them extremely effective and I’m happy to pay a higher per-hour fee for them because I know I’m getting the quality input I need for projects that need both nursing or other clinical expertise and a high degree of vendor-specific knowledge. I’m also happy to pay more for a small firm that I know runs lean and has little administrative bloat because I know they pay their workers well.

Unfortunately, the health system I work for has what can only be described as Enron-style accounting and they are constantly late in paying the consulting invoices even when all supporting documentation is provided in a neat and timely package. I wish the accountants understood the value of these consultants – they are super busy and don’t need my business to stay afloat and I’m afraid eventually they’ll stop working for me because it is simply too much of a bother.

Due to the size and scope of some of our projects, I’ve had engagements with the 800-pound gorillas of the consulting world as well. Although there have been a handful of consultants that have tried to take advantage of expense policies, the majority have been fair in what they submit for reimbursement. For those who have been a little too cavalier with their spending, it’s been fairly easy to address it with management. I haven’t yet run across anyone operating like the George Clooney character in “Up in the Air” where he pushes his expense reports to maximize his airline mileage. If you’ve ever been a road warrior and haven’t seen the movie, I’d recommend it.

The best defense against ridiculous expense reports is negotiating a good contract with the consulting firm. Know what you are willing to pay for, but be fair. Know what typical hotel rates are in your area and make sure you are allowing your consultants to stay somewhere that you would consider staying yourself. I’ve heard horror stories (and seen pictures) of “client recommended” hotels that I can’t imagine a hospital administrator would expect his own family to accept. If you have a corporate discount, make sure consultants have the codes, and if there is a limit to the number of rooms that can be booked at the corporate rate, that they book well in advance.

As far as meal allowances, they seem fair for the companies I’ve worked with. I don’t begrudge my consultants the coffee and snacks they submit because they’re working their tails off for me. Some of them can deliver in a week what my IT department takes a month to deliver, so the expense is well worth it. One of our IT buildings is away from the main hospital campus and there aren’t any close restaurants. I always have lunch delivered for the consultants so they don’t have to waste time trying to find food and worry about their logistics. But when I negotiate engagements, that is taken into account and their maximum daily meal reimbursement is adjusted accordingly. If you don’t want to pay for alcohol because you’re a faith-based organization, write it into the contract or hire a consulting firm that doesn’t allow alcohol to be submitted.

As I’ve mentioned before, I did a fair amount of consulting while I was building my CMIO skills and still do a couple of jobs a year with the full permission of my hospital. Ethics and professionalism are what keep consultants from abusing the system. Having been in those shoes, if I find someone milking it, I’m going to send them packing. On the flip side, I’ve been abused by clients and it’s never pleasant. At one site where I was engaged for a couple of months, my “handler” would routinely book my schedule with 10-hour days containing back-to-back meetings that didn’t allow for restroom breaks, let alone lunch breaks. I would hit the local supermarket before going on site and stock up on granola bars, fruit, and drinks. The same client didn’t even have cups or utensils in the break room, so I had to travel with my own mess kit if I brought restaurant leftovers.

Another client scheduled a business dinner after a full work day. The agenda was for me to meet with providers and address their concerns regarding an upcoming implementation. It was at a fairly expensive celebrity chef restaurant and I was looking forward to it. However when the bill arrived, the client asked for separate checks and made me pay for my own. Needless to say that blew my expense account for the day (actually three days’ worth) and I had to cover it out of pocket. Had I been on my own that evening, I probably would have had a turkey sandwich and a handful of grapes. Maybe some chips if I was feeling wild and crazy. Most of would agree these examples are pretty extreme, but unfortunately I’m not the only one who has had those experiences.

If you’re looking to cut down on consulting expenses, look at whether you really need consultants on site. Those who work projects remotely don’t submit meal or travel expenses and often they are more productive when your staff isn’t interrupting them or trying to pick their brains on unrelated projects. One consultant friend keeps me laughing with stories of his prowess at slaying scope creep since his client’s analysts are hell-bent on involving him in work that has nothing to do with his engagement just because they know he has the skills. He could probably deliver his analytics build faster if he was working from his bachelor pad than sitting in your cube farm among squeaky chairs, gossipy employees, and those who bring colds and flu to the office.

That’s another thing – nice clients have a plan for when consultants get sick or have family emergencies. They are understanding. They don’t make you feel bad when your daughter breaks her arm and you have to accompany her to the operating room (true story from a former grad school roommate.) They may even offer to have a physician evaluate you and make sure you aren’t near death alone in your hotel room after you get food poisoning at a dinner they catered. I’ve written prescriptions (with appropriate examination and documentation, of course) to treat minor illnesses and helped consultants get care after sports injuries. Just because they’re consultants doesn’t mean they’re invincible.

If clients really have a problem with consultant expenses because they object to having to pass them on to patients, I recommend they look at their own policies as well as consulting policies. One hospital where I’m on staff provides a 64-ounce mug to each new employee, who can then fill it with free beverages throughout the work day. Although it was instituted as a staff perk, I can’t help but wonder what the patients think as they see staff slurping their way through the day from mugs that are less than clean. You can bet that’s being passed onto the patient bill, as are the employee health care expenses from obesity and diabetes since I rarely see people filling up with diet pop, that’s for sure. Then there’s the lost productivity for the trips to refill.

While we’re at it to cut costs and save healthcare, let’s cut out frivolous marketing, overkill signage, and anything having to do with “centers of excellence.” I bet we could lower some hospital bills right there. But let’s not take it out on consultants who are working hard on our behalf.

What do you think about consultants and their expenses? Email me.


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

More news: HIStalk Practice, HIStalk Connect.


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October 24, 2013 News 11 Comments

News 10/23/13

October 22, 2013 News 1 Comment

Top News

The HIT Policy Committee may miss its end of year target date to deliver MU Stage 3 recommendations and begin work on Stage 4, according to the committee’s vice chair Paul Tang, MD. Eleven ONC committees and workgroups, including the Policy Committee, canceled meetings during the shutdown; Tang says his committee is shifting its schedule of deliverables out a month.

Reader Comments

10-23-2013 6-17-35 AM

From Friend of Bob: “Re: BOB EDIS. Physicians’ voices were heard again at ACEP. A record breaking number of ED physicians attended ACEP13, over 7,000 reported. Wellsoft noted that at this year’s Scientific Assembly most attendees had a deep knowledge of BOB EDIS functionality and integration capabilities. This echoes the KLAS Specialty Report EDIS 2013: Revealing the Physicians Voice issued earlier this year.”


Acquisitions, Funding, Business, and Stock

10-23-2013 6-13-48 AM

DMH International, parent company of Touch Medical Solutions, signs a definitive letter of intent to acquire 100 percent of Virtual Physician’s Network, a provider of an online scheduling platform for surgeons.

VMware reports Q3 numbers: revenue up 14 percent, adjusted EPS $0.84 vs. $0.70, beating analyst estimates of $0.82 and in line with revenue expectations.

CTG reports Q3 numbers: revenue down five percent, EPS $0.23 vs. $0.23. The company says its healthcare business declined from last year because “a number of hospital clients are holding off on system investments” due to sequestration-related reimbursement concerns.

Lexmark reports Q3 numbers: revenue down three percent, EPS $0.95 vs. $0.94. Revenue for Lexmark’s Perceptive Software segment grew 38 percent.


10-23-2013 6-25-15 AM

Rochester General Health System (NY) will replace its existing enterprise content management system with Perceptive Software’s Content and Perceptive Capture solutions across its hospitals, ambulatory care centers, and physician offices.

10-23-2013 6-28-08 AM

St. Joseph Hospital (CA) will implement secure texting and on-call scheduling solutions from Amcom Software.

10-23-2013 6-29-06 AM

FirstHealth of the Carolinas (NC) selects MModal’s front- and back-end speech recognition, transcription, coding, and clinical analytics for its EHR systems.

10-23-2013 6-30-09 AM

Boston Children’s Hospital (MA) selects Strata Decision Technology’s StrataJazz for decision support and cost accounting.

10-23-2013 6-32-00 AM

Johns Hopkins Medicine (MD) will integrate Vital Images’ Universal Viewer into Epic.


10-23-2013 6-32-57 AM

Availity names Stephanie Kovalick (GE Healthcare) VP of portfolio operations.

Navicure appoints Sheridan B. Johnson chief compliance and security officer.

10-23-2013 6-34-30 AM

Population health analytics provider Rise Health names Michael Previti (Merge Healthcare) EVP of sales.

Announcements and Implementations

Meditech and Vitera Healthcare Solutions connect to the Surescripts network to provide their users with Direct secure messaging capabilities integrated with their EHRs.

10-23-2013 6-35-24 AM

Confluence Health-Central Washington Hospital & Clinics implements Merge Hemo from Merge Healthcare to automate their cath lab processes.

10-23-2013 6-36-48 AM

Summit Health (PA) deploys Nuance’s Clintegrity 360 Computer Assisted Coding and Clinical Document Improvement solutions for ICD-10 readiness.

Center Point Counseling (WI) installs ForwardHealth Group’s PopulationManager technology.


10-22-2013 10-38-31 AM

Most providers express optimism about McKesson Paragon’s ability to deliver in large hospital settings despite current functionality gaps, according to a KLAS report. In 2012, Paragon secured 11 of the 32 larger hospitals migrating from Horizon; 131 large Horizon hospitals have not yet selected a replacement platform.

10-22-2013 11-31-12 AM

Individuals are far more likely to die or suffer complications at hospitals receiving the lowest Healthgrades rating according to the report, Healthgrades American Hospital Quality Outcomes 2014: Report to the Nation.

The Physicians Foundation issues over $3 million in grants to medical society foundations and healthcare organizations to assist almost 10,000 physicians select and implement EHRs.

An Arizona woman says she is the victim of identity theft four months after a University of Arizona Medical Center-South employee posted a workplace photo on Facebook that inadvertently included a computer screen with the woman’s personal information. The photo was removed after 30 minutes when a manager noticed the violation. The hospital’s privacy officer was notified of the incident, as was the patient. The woman recently notified the police after someone used her personal information to apply for food stamps. She also retained a lawyer, saying the incident has “been a nightmare,” that she is afraid to be home, and her life is at stake. Not to diminish the seriousness of the violation, but I can probably think of one or two things more nightmarish and life threatening than a breach of my PHI.

Sponsor Updates

  • RazorInsights’ ONE Ambulatory EHR achieves ONC certification and secures 2011 compliance as a Complete EHR.
  • EDCO Health Information Solutions will present a session on point of care medical records scanning at next week’s AHIMA Product World meeting in Atlanta.
  • T-System names six winners of its fourth annual T-System Client Excellence Awards, which recognize emergency care facilities and physician groups that effectively use T-System solutions to improve clinical, financial, and operational outcomes.
  • Emdeon will add full-color printing capabilities for printed communications to its Payment Network during the first quarter of 2014.
  • Clinicians at Georgetown Hospital System share how their use of Aventura has saved them time and increased productivity and job satisfaction.
  • A local paper profiles Jones & Sciortino Orthopedics (MO) and its use of eClinicalWorks to achieve Meaningful Use.
  • Clinicians with Mercy and HealthEast Care System (MN) share how the use of Humedica’s clinical analytics platform from Optum have provided their organizations with health insights to improve treatment outcomes, care coordination, and quality.
  • Information analysis firm IHS ranks Perceptive Software’s Acuo VNA the world’s market share leader among independent software vendors with 42.3 percent of total studies managed.
  • Chilmark Research recognizes Medicity as a top-tier HIE vendor in its 2013 evaluation of the HIE market.
  • HIStalk sponsors earning a spot on Capterra’s Top EHR Software list include: eClinicalWorks, McKesson, Allscripts, e-MDs, NextGen, NueMD, Vitera, and ADP AdvancedMD.
  • Beacon Partners hosts a webinar on the steps healthcare organizations should take to form a patient-centered medical home.
  • Quantros demonstrates the QPrecision release of its safety event management solution at next week’s ASHRM Annual Conference in Austin, TX.
  • VitalWare embeds Atigeo’s xPatterns Clinical Auto-Coding into its CDiDocuMint application.
  • CommVault introduces a content-based retention solution that enables enterprises to reduce storage requirements by keeping only data that is important to the business.
  • MModal releases the Fluency Flex Mobile app for iPhones, allowing doctors to record clinical notes during patient encounters for integration within EHRs.



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

More news: HIStalk Practice, HIStalk Connect.

smoking doc

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October 22, 2013 News 1 Comment

Monday Morning Update 10/21/13

October 20, 2013 News 15 Comments

10-20-2013 6-28-06 AM

From Across the Pond: “Re: Epic. Two large academic hospitals in Amsterdam, AMC and VUmc in The Netherlands, signed a contract with Epic last week.” Academic Medical Center has 7,000 employees, 2,300 medical students, 120 medical informatics students, and an annual volume of 26,000 admissions and 350,000 outpatient visits . VUmc, which cooperates closely with AMC, is affiliated with the other big university in Amsterdam. Wikipedia says The Netherlands has eight university medical centers and 10 large non-university hospitals.

10-19-2013 2-36-03 PM

From Jane Jetson: “Re: Weight Watchers. I received an email this morning owning to the fact that they had technical problems. Perhaps I should forward to Kathleen Sebelius so that Healthcare.gov could borrow the wording.” The problem with the government is that nobody is ever individually responsible for anything; the incompetence is collective. It would be unheard of to acknowledge that something isn’t working except for political gain, or to accept responsibility for anything but success. All of the professional bureaucrats are busy trying to hang onto jobs that must be pretty sweet given their ducking and covering to keep them.

From Kittanning: “Re: startups. Why don’t you cover more startups? That’s where the innovation will come from.” I cover startups that have interesting consumer-facing technology, but rarely those who are targeting hospitals. Reason: most of them think their great technology idea will offset the founders’ lack of knowledge (and lack of interest) about how hospitals and doctors work and who just want to cash in quickly rather than helping patients or providers. Newbies can’t come in guns blazing telling everyone in healthcare that they’ve figured it all out as a 30-year-old programmer turned self-proclaimed CEO, insulting those who have more years in healthcare than they’ve had breathing, and nobody in a position of enterprise IT responsibility is going to be impressed by swaggering overconfidence from unpolished newcomers who think they’re the next Steve Jobs just because they are as abrasive as he was. I’ve seen very few great startup ideas that have the potential to turn into anything more than a spare bedroom business, and of those, only a tiny percentage are being run by people on whom you’d make even a small bet as a customer or investor. Creating enterprise technology innovation, unlike writing cute iPhone apps, requires a lot more than a Foosball table and cases of Red Bull. I’ve seen company pitches, most of them naive and unskillfully prepared, and the commonalities are: (a) lack of money and of a realistic plan for profitability that will allow ever bringing their product to scale; (b) a low barrier to entry that virtually guarantees that any degree of success can quickly be replicated by competitors; (c) lack of realization that it takes a lot of skill, money, and time to connect your great idea to hospitals even willing to undertake a pilot, much less buy the product, and the lack of appreciation of just how long the hospital sales cycle is and how imitative their purchases are; (d) having no one on the team who has ever sold technology to hospitals or partnered with similar firms; and (e) lack of understanding that people bet on the jockey, not on the horse, and impressive developers usually don’t make impressive CEOs regardless of their level of hubris. Great ideas are  a dime a dozen; the hard work is the long, expensive slog trying to get traction with them, and if you are new to healthcare selling a product whose target customer is hospitals, it’s a near-certainty that you’re going to justifiably fail, with your only hope that a better company will buy yours before it splats to the ground. That’s not anti-innovation at work – it’s the reality that healthcare attracts a lot of flaky, poorly thought out startups that don’t deserve to succeed. Come back when you hit $1 million in annual revenue.

10-19-2013 3-46-16 PM

From The PACS Designer: “Re: Omate watch. Another watch, funded through Kickstarter, is now available for purchase starting at $249. The Omate TrueSmart Watch can be used as a phone with its Bluetooth capability while still being fully functional without the phone. This no-hands phone style of watch will surely be used in healthcare settings.”

From Expense Reports Gone Wild: “Re: consultants. I continue to get bothered by the number of submissions on the bills of consultants for coffee, snacks, lunch, dinner, beverages, protein bars, etc. Why is it that we as a customer are expected pay for all this sustenance? Is the $200+ hour not enough? I am fine with paying for folks to get from home to the location, but why has there been this tradition of paying for other than travel? I think it is time to begin to object to these costs. If we are going to be part of saving health care we can’t continue to exacerbate the issue with rampant unnecessary spending. I have heard all the arguments around inconvenience of travel and this to make up for that but then let the employer of that person eat the cost. The per diem fee doesn’t fly either — when I go to work, I have to pay for my food, just because work means getting on a plane doesn’t excuse one from that obligation. Convince me I am misguided.” I agree, but taking the counterpoint as a consultant might, I could make the same argument for buying $500K hospital CIOs cars, club memberships, travel of a questionably patient-valuable nature, and bonuses for doing the job they were already paid to do. I think the conclusion is that everybody gets to pass the literal buck down to the patient bill, and only recently did big hospitals worry about their inability to create enough charges to pass through the excessive costs.

10-19-2013 2-27-00 PM

The problems with Healthcare.gov are either due to (a) screwed-up government software bidding and contractor oversight , or (b) not unexpected for a rollout of that scope, say most poll respondents. New poll to your right: is the influence of private equity firms on healthcare IT positive or negative? Your answer doesn’t provide any context, so after you’ve voted, click the Comments link to explain.

10-19-2013 2-40-16 PM

Welcome to new HIStalk Platinum Sponsor Sentry Data Systems, which offers hospital pharmacy procurement, revenue cycle, and compliance solutions. Sentinel RCM manages financials, inventory, charge master, auditing, and order flow, allowing them to track drugs from the point of purchase all the way to billing. Sentrex helps hospitals manage their 340B contract pharmacy relationships to maintain compliance by using a proprietary rules-based engine to apply hospital policies and procedures, supporting both 340B and Own Use programs. These products run on the Datanex infrastructure platform that processes millions of transactions each day. Hospitals running a 340B drug program need specialized technology to avoid running afoul of a maze of regulatory and auditing challenges and Sentry is the company to call. Thanks to Sentry Data Systems for supporting HIStalk.

I cruised YouTube for more on Sentry Data Systems and found this pharmacy director testimonial.

10-19-2013 3-48-35 PM 

AtHoc is a brand new HIStalk Gold Sponsor. Over 200 hospitals rely on AtHoc for critical communication and personnel safety, turning their IP network into a closed-loop, multi-modal notification and communication system. Examples: protecting home health nurses with a smartphone duress/panic button, communicating with clinicians during IT downtime, and automating shift availability and filling processes. Above is a video on Kaiser Permanente’s use of AtHoc for staffing. Thanks to AtHoc for supporting HIStalk.

10-19-2013 3-04-35 PM

Athenahealth turned in unimpressive numbers that fell short of expectations Thursday, some but not all of them related to its Epocrates acquisition, but that didn’t stop shares from going on a tear after the announcement. ATHN hit an all-time high Friday and closed up 24 percent on the day at $130.83, valuing the company at almost $5 billion. Investors apparently ignored the financial results and instead were encouraged by a growing client base and an extended contract with PSS World that will put more salespeople on the ground pushing athenahealth offerings. Above is the one-year chart of ATHN (blue) vs. the Nasdaq (red). Jonathan Bush holds $40 million worth. From the earnings call, which is always informative whether you care about ATHN or not because Bush is willing to say what others won’t:

  • One large client, an ambulance company that was never named at that company’s request (but had to be Rural/Metro), went bankrupt even before going to pilot with athenahealth and “new leadership fired us.”
  • Like everybody else, athenahealth talks about population health a lot.
  • The company will roll out athenaKnowledge in 2014, which will provide financial and clinical decision support to physicians.
  • AthenaClinicals  can automatically make a note in the chart when patient prescriptions are filled, although so far that works in only about 23 percent of orders.
  • AthenaClinicals users who also use athenaCoordinator can exchange patient information via athenaNet with no additional interfaces or exchanges.
  • When asked whether athenahealth would gain or lose hospital business through consolidation, Bush replied, “I don’t know, dude. I assume we’ll win. I mean — the for-profit sector is where most of these mergers are going on that you’re talking about, and it’s a very rational sector. Most of the headwind we face in the enterprise world is with institutions who don’t view their bottom line as all that important. And their reputation as the bringer of great new physicians into the world and their reputation as the provider of procedures that no one else can provide, trump their abilities, their interest in asset efficiency. Now as we’ve said in past calls, we believe that asset efficiency is going to rise in appeal to even the most theoretical of academic medical centers as the pressure builds.”
  • According to Bush, “At some point, the idea of information being liquid across people who don’t own each other is a major trump card when you think of this tragic lemming march of acquisitions, doctors and hospitals marrying up in marriages of convenience, nothing wrong with doctors and hospitals marrying up in marriages of love, but this wave of kind of moony, large-scale marriages of convenience just to get information integrated when there is another way, to me, it’s sort of a profound megatrend to watch.”
  • When asked about hospitals using athenahealth products to control physician behavior, Bush said, “Well, I’ll tell you every proposal to a new enterprise today include a Google Map of all of the doctors that have admitting privileges at their institutions that are already on athenaNet. And those Google Maps are getting more and more dotty, lots and lots of little dots around their blue H. And the fact that now we don’t say we can direct, but we say, ‘Listen, hospital, do you want to — speaking of manifestos, do you want to get compliance via force or do you want to get compliance via love?’ … be the most high-quality, easy-to-do business with receiver of patient referrals. Be big and successful and survive this drought that’s coming by being the best, and that means being the most integrated, the most available … we don’t even need the tipping point for that, right? We could just show up and say, hey, you’re going to do a go-to-market strategy with your subsidized EMR the way poor Long Island Jewish did with Allscripts banging away, giving it away at red lights, trying to get the windshield wiper guys to give it away. Here, you got thousands of doctors paying for it, wanting it, and all you’ve got to do is light up your logo inside of the order screen.
  • On selling athenaClinicals to customers who already have an EMR, “I know the last time I looked, it was 40 percent of our clinical sales today were people throwing one out … you have a huge wave of folks who looked, went out and jammed the EMR thing because Obama told them to, and then they got to Meaningful Use day and they got nothing … Used properly, they’ll get you Meaningful Use. But doctors are not supposed to be using them properly. All they’re supposed to be doing is seeing patients … Nobody wants to go back to their Board of Directors or their Board of Doctor Owners and say, ‘Yes, so sorry but I convinced you spend thousands and at times, millions of dollars on something that I really want to throw out now.’ But it is what it is. It’s a cash-on-cash no brainer. You just have to go through the embarrassment.”

John Lynn did an ICD-10 Hangout on EMR & EHR Videos.

GE reports Q3 numbers: revenue down 1.5 percent, adjusted EPS $0.31 vs. $0.33, but train and plane sales along with aggressive cost-cutting helped the company exceed Wall Street’s expectations, sending shares to a five-year high. GE Healthcare’s sales were flat, but earnings rose 7 percent.

A series of Wisconsin Democratic Party focus group meetings identifies the two favored candidates for governor, one of whom is Judy Faulkner of Epic. The strengths the groups favored were a wealthy, politically outsider woman not from Dane or Milwaukee Counties with name recognition who hates everything about Republican Governor Scott Walker.  I don’t think I’d take the results too seriously since they seemed to favor celebrity status over political qualifications – the group’s other choice was just-retired Green Bay Packer and “Dancing with the Stars” winner Donald Driver.

10-19-2013 4-49-35 PM

Eric Topol, MD isn’t impressed with MD Anderson’s use if IBM’s Watson to undertake a “moon shot” aimed at eliminating cancer. He tweeted, “This ‘Ending Cancer stuff, while a laudable goal, is sending a wrong message to public.” He didn’t explain, but I assume he meant that cancer isn’t one disease and the likelihood of eliminating it, with or without Watson, is nearly nil. Prevention is more important than treatment, I conclude, but if MD Anderson thinks Watson can help eliminate cancer (or help it market itself to cancer patients, which bring it nearly $4 billion per year in revenue for treating cancer rather than preventing it), then it’s worth a shot, moon-worthy or otherwise, even if it does encourage minimally intellectual Americans to think that anything less than a cure is a failure.

10-20-2013 6-55-09 AM

Val Jones, MD (aka blogger Dr. Val) says that despite her previous support of digital data in medicine, EMRs are doing more harm than good. Her reason: data entry is “an enormous time-suck for physicians” that harms thoughtful interaction with patients that would allow a correct diagnosis and sensible treatment plan. She doesn’t like correcting offshore transcription, hospitals with large IT departments (“40 young tech support engineers were furiously working to keep the EMR from crashing on a daily basis”), and EMR-required data fields (she called out Allscripts, whose system requires the doctor to indicate for every discharge prescription whether the medication comes in a tablet or capsule, which the system knows full well but which has to be entered again to allow the inpatient EMR to accept the information). I think she might have aimed her wrath more precisely at the one hospital at which she apparently had a bad experience since what she describes is certainly not universal, but certainly some hospitals are exactly as she describes.

Peace River Center, a Florida non-profit psychiatric agency, is awarded a $30,000 United Way of Central Florida grant to implement technology that will allow its home case workers and clinicians to remotely connect to its EMR.

In Canada, Victoria County Memorial Hospital loses its telephone service and Internet connectivity when a construction vehicle severs cables, causing the hospital to cancel walk-in diagnostic and lab services.

Twitter’s just-announced November IPO may be tarnished by “Twitter quitters,” those who try the service but abandon it because they can’t figure it out or don’t find value in it. A new poll shows that 36 percent of those who sign up for Twitter don’t use it and 7 percent close their accounts, much worse numbers than for Facebook. According to an active Facebook user who stopped using Twitter, "I didn’t really get the point of it at all. Most of them were people I wasn’t interested in hearing what they had to say anyway.” Twitter is big, but then again so were Second Life and Myspace.

Madison, WI-based 11-employee Wellbe raises $1.4 million in funding. The company’s Patient Guidance System, which it describes as a GPS for health, sends patients emails and information before and after their surgeries.

10-20-2013 8-02-13 AM

HHS gave UK-based government contractor Serco, under investigation there for contract fraud, an $87 million contract extension to its existing $114 million CMS contract to handle paper insurance applications just five days before the launch of Healthcare.gov, leading to speculation that the government knew Healthcare.gov was going to fail and paid Serco to handle the inevitable flood of paper-based insurance applications. However, CMS suggests that the Congressional Budget Office had estimated that 20 million people would apply, with 6 million of those doing so on paper, and the 2,000 people Serco hired were necessary to process the paper applications. HHS gave Serco a $1.2 billion contract in July to manage paper insurance applications for 34 state insurance exchanges in its first-ever US healthcare project. The parent company has annual revenue of around $8 billion. Serco took over NHS’s largest hospital pathology laboratories in 2009 in a privatization joint venture worth $1.3 billion over 10 years and was involved in a series of admitted serious patient errors, including losing samples, incorrect computer flagging resulting in administration of inappropriate blood, a software problem that calculated kidney function incorrectly, and a section of blood chemistry equipment that had to be shut down for four days after a computer virus infection. The 1,000-employee JV, called GSTS Pathology, couldn’t control its costs, had to borrow money from the hospitals to continue its operations, and announced that it would need to pull out of certain markets. GSTS Pathology continues to bid on new UK business, hoping to capture 30 percent of the pathology market.

10-20-2013 7-21-58 AM

California Attorney General Kamala D. Harris issues “Medical Identity Theft – Recommendations for the Age of Electronic Medical Records.” It cites a recent report stating that nearly half of medical identify theft isn’t really that at all – it occurs when someone with insurance loans their card to someone who doesn’t have insurance. EHR-specific recommendations include:

  • Implement role-based access controls.
  • Embed a copy of a patient’s photo (but not a government-issued ID) into the EMR.
  • Give patients clear instructions on how to get a copy of their information.
  • Give patients a copy of Clinical Care Summary documents asking them to verify the information but warning them keep it confidential.
  • Set up the EMR to flag suspicious issues (known a “red flags”), such as a patient refusing to show an ID (other than in the ED); presenting an ID whose photo doesn’t match their appearance; presenting an ID with a name or address that doesn’t match the EMR information; giving a Social Security number, address, or telephone number that is already assigned to another patient;  receiving returned, undeliverable mail from the patient’s address; receiving previous denial of payment for situations such as a second appendix removal; bills returned as undeliverable while new charges continue under that same address; patient interview information is inconsistent with the EMR information; observing that a patient is not aware of the information in their record; and finding information in the EMR that conflicts with other information or with the patient’s presentation.
  • Develop a process for instantly reporting any of the red flags above to a team that will review all available records and place affected accounts on hold, looking for problems such as erroneous data entry or inappropriate medical records merge.
  • Document findings and policies in the EHR where it can be seen.
  • Create a database of identities that have been used fraudulently.
  • Add a message to the patient portal encouraging patients to review their records regularly, also giving them instructions on how to report discrepancies.
  • Audit EHRs for unauthorized access.
  • Build demand for provider detection software, which the report says is offered by only a handful of unnamed vendors whose applications are too expensive for all but the largest health systems.
  • Correct records as needed, either annotating them or moving them to a specific “medical identify theft” location and then starting a new record.
  • Use the Continuity of Care Document to electronically notify business associates and other providers that the record has been corrected.
  • Follow HIE rules for correcting information.
  • Encourage development of technical standards that would allow Health Information Organizations to exchange red flag information, such as modifying the MPI to indicate the addition of a red flag by a member.
  • ONC should include red flag recommendations in Meaningful Use Stage 3.

Weird News Andy titles this story GIGO, wondering, “Who, if anybody, tested this thing?” (answer: government contractors). Not only is Healthcare.gov failing to allow most would-be users to get into the system, it’s also sending erroneous data to insurance companies from those who do. Duplicate enrollments, spouses listed as children, and missing data have been reported.

WNA also files these reports from his Weird Newsroom. Doctors are unable to determine why a Tennessee man has been crying blood for seven years, an unnerving trait that has cost him every job he has held. A Denver woman whose arm was unnecessarily removed after an incorrect cancer diagnosis tries out a robotic arm, but her rare underlying condition remains – any bruise she gets turns to bone, which is gradually transforming her into a human statue who knows she will be fully immobile soon.

A hospital sues one of its patients who refuses to leave because she likes her bed there. The patient was discharged after a four-day stay for pneumonia, but intentionally had her state-provided hospital bed removed from her home so that she could argue that her discharge was unsafe. The hospital says the patient is abusive to staff and fellow patients, complains if her room is at any temperature other than 83 degrees, and repeatedly calls the police department, public health department, and the attorney general to complain about her stay. The hospital wants a temporary injunction to send her packing.

Vince continues his fascinating HIS-tory of McKesson, specifically HBO, with information he received directly from Walter Huff himself. It’s fascinating to read how many early HIT pioneers were hospital CFOs who did programming or other computer work for their hospitals, and how many vendor systems came out of those hospitals.


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

More news: HIStalk Practice, HIStalk Connect.


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October 20, 2013 News 15 Comments

News 10/18/13

October 17, 2013 News 2 Comments

Top News

10-17-2013 8-40-26 PM

HHS Secretary Kathleen Sebelius is reported to have no intention of quitting after Republican criticism of the Healthcare.gov online insurance exchange debacle. Sebelius has acknowledged the problems, but says fixes are being put in place and those who were unable to sign up should try again. Success rates for those attempting to enroll were less than 20 percent the week of its rollout on October 1 and under 13 percent the second week, although one researcher says fewer than 1 percent of those who tried to register were successful. Another report finds that the cost for the system ballooned from the original estimate of $94 million to $292 million, with those payments going to the US federal government division of Canada-based CGI. Other estimates peg the total cost of Healthcare.gov to be more than $500 million.

Reader Comments

10-17-2013 1-09-42 PM

inga_small From Dr. Travis: “Re: Color me pink. Breast cancer awareness month has jumped the shark this year.” Travis tells me he likes the innuendo of this poster’s message, which I believe was from the Twisted Taco restaurant in the Atlanta area. Thanks for the reminder to support breast cancer research, get screened regularly, and/or encourage your loved ones to be screened.

From Reader One: “Re: from a vendor-specific forum today. ‘We inadvertently assigned 5,000 accounts to a bad debt agency. Is there a way to mass cancel?’ Now that’s what I call exciting.”

HIStalk Announcements and Requests

10-17-2013 5-46-56 PM

Welcome to new HIStalk Platinum Sponsor Boston Software Systems. The company offers an error-free workflow automation platform that allows its healthcare customers and business partners to streamline their business processes and improve productivity. Boston WorkStation lets IT departments efficiently solve problems and eliminate performance gaps in existing IT systems – integrating third-party registrations, performing eligibility checks, integrating lab results, posting payments and collections notes, performing mass updates, creating backup databases, running and distributing reports, and managing dictionaries and tables. Existing systems can be enhanced by creating new business rules and workflows and providing real-time access to external applications. IT departments love Swiss Army knife-type solutions that be used to enhance systems without vendor involvement or ongoing labor requirements, such as the hospital that’s saving 125 hours per month using Boston WorkStation to automatically create a pre-registration account at the time of scheduling or another that saves $500K by automating their materials management system to load inventory purchases and manage price updates. The company also offers Cognauto, the next-generation automation platform. The company’s products are used by over 2,500 hospital customers running many IT systems. Thanks to Boston Software Systems for supporting HIStalk and for issuing a very cool press release announcing that fact.

10-17-2013 6-59-48 PM

10-17-2013 6-55-21 PM 
Thanks to Bonny and Catherine from Aventura, self-proclaimed “HIStalk minions” who volunteered to report from the American College of Emergency Physicians Scientific Assembly (ACEP13) in Seattle this week. They conducted some ED doc interviews about IT that I’ll have up later, but here are some of Bonny’s observations:

  • The topic of scribes performing EMR data entry split the group, with some ED physicians expressing satisfaction in offloading tasks to what is often a pre-med student, but others feel guilty about making scribes do what some would say is their work.
  • The best-of breed EDIS vendors were there (Picis, T-System, MEDHOST) as were the big enterprise vendors with EDIS, with Epic notably being MIA.
  • Education and discharge instructions vendors (Discharge 1-2-3, Elsevier ExitCare, Krames) were exhibiting.
  • Bonny says MEDHOST stole the show with a patient throughput solution that pushes preemptive communication about patients from the ED or OR, such as when a patient is likely to be admitted but whose emergency care is still underway. It also offers real-time and forecasted financial operational metrics for executives.
  • ACEP rented out the Space Needle, the Chihuly Museum, and the Experience Music Project for attendee events.
  • In the all-important vendor swag category, Bonny lauds Interactive Health Massage Chairs, whose booth was across from Aventura’s such that Bonny and Catherine could perform their own first-hand research as well as watch attendees shed their stress and exit happy. Check out the photo above – who wouldn’t want to have a chair massage while covered lightly with a blanket right on the show floor?

inga_small Highlights from HIStalk Practice this week include: a local paper profiles two physicians with opposing views on EMRs. CMS pushes a PQRS reporting deadline back three days. A vendor speaks out against shortened exhibit hours at MGMA. Most medical practices are concerned that ACA insurance exchanges will lead to increased collection burdens and lower reimbursements. Epocrates adds a provider directory to help members identify clinicians for consults and referrals. Emdeon will pay its departing CEO $2.4 million over the next two years. Thanks for reading.

Acquisitions, Funding, Business, and Stock

10-17-2013 6-14-23 PM

Athenahealth announces Q3 results: revenue up 43 percent, adjusted EPS $0.29 vs. $0.30, missing analyst estimates on both.

IVantage Health Analytics acquires Professional Data Services, a provider of managed care analytics and benchmarking solutions for hospitals.

10-17-2013 9-02-48 AM

StartUp Health admits 14 new companies to its three-year development program for health technology startups. Lt. Dan profiles the companies on HIStalk Connect.

10-17-2013 7-14-52 PM

Medical practice technology vendor Waiting Room Solutions changes its name to WRS Health.


Medical Services of America (SC) chooses Allscripts Homecare for its 70 home care service locations.

Elmcroft Senior Living (MO) will install Cerner CareTracker at its 85 assisted living facilities.

The 30-bed Aspire Hospital (TX) will implement clinical and financial applications from Healthcare Management Systems and physician documentation from Patient Logic.

The VA and DoD award Systems Made Simple a re-compete of the iEHR system contract for systems integration and engineering support.

10-17-2013 8-44-20 PM

Saint Luke’s Health System selects PeriGen’s PeriCALM fetal surveillance system for seven birthing hospitals in northwest Missouri and northeast Kansas.

The VA awards Harris Corporation a $60 million, four-year contract to design, install, and support the wireless infrastructure at 112 VA medical centers.

Riverside Medical Group (VA) selects athenaCollector for billing and practice management for its 300+ physicians.

The Texas Health Services Authority chooses EHNAC to develop a state accreditation program for private and public HIEs operating in Texas.

Texas Health Physicians Group selects StrataJazz from Strata Decision Technology as its integrated financial platform.

10-17-2013 8-45-28 PM

St. Luke’s Health System (ID) will implement Epic at a cost of $200 million and will offer Epic ambulatory to independent practices through an affiliate program.  St. Luke’s, defending itself against antitrust claims for its purchase of Salzer Medical Group, says Epic is a superior system that will allow providers to share information with patients and with each other more easily.


10-17-2013 4-29-12 PM

Northwest Community Healthcare (IL) names Glen Malan (Cadence Health) VP/CIO.

OpenTempo names Jim Crook (IDX) chairman of the board, Walt Marti (GE Healthcare) chief administrative officer, and John Jordan (dbMotion) VP of sales and marketing.

Announcements and Implementations

Quantros releases IRIS 2.4, a configurable dashboard to view overall hospital performance and display trends, distribution, and variations in performance.

Government and Politics

inga_small A California state appellate court rules that providers do not necessarily have liability to patients when medical records are stolen or misappropriated unless they are accessed by a third party. The ruling stems from a 2011 incident in which a UCLA Health physician’s laptop containing medical records on 16,000 patients was stolen from his home. The provider could have been liable for up to $16 million as part of the  class action lawsuit, even though there was never any indication the data had been accessed. The suit was dismissed. Rebecca Fayed, associate general counsel and privacy officer at The Advisory Board Company, tells me the ruling only applies to California, which has its own statute governing the disclosure of medical information and allows affected individuals to sue for damages for certain violations. She adds:

Although the ruling would not apply nationwide at the federal level, other states with similar state laws may look to this case for reasoning and may analogize to it even if it has no precedential value in any state other than California.

10-17-2013 1-51-48 PM

inga_small The ONC Tweeters seem happy to be back at the keyboard after a 16-day furlough.

Innovation and Research

10-17-2013 7-10-10 PM 

Children’s Hospital of Philadelphia (CHOP) offers Harvest, an NIH grant-funded open source software toolkit that allows biomedical researchers to explore large data sets, such as those from EHRs and genomic databases. Researchers from CHOP’s Center for Biomedical Informatics are testing Harvest against several data collections, including the Longitudinal Pediatric Data Resource that tracks data from children with conditions detected in newborn screenings.


Deloitte introduces PopulationMiner, a data analytics solution that draws clinical, financial, and operational data from Intermountain Healthcare’s warehouse to support patient-outcome analysis.

ArborMetrix integrates surgical video analysis capabilities into its reporting and analytics platform, enabling healthcare organizations to improve performance benchmarking of surgeons.

Ninety percent of surveyed nursing home physicians say their use of drug references on mobile devices prevented at least one adverse drug event the month before the survey.


Virtualization software and dictation with speech recognition applications are emerging as top areas for growth potential in hospitals, according to a HIMSS Analytics report on the US hospital IT market. The demand for ambulatory EMRs and ambulatory PACS also appears to be growing.

10-17-2013 7-47-45 PM

Joint Commission issues a sentinel alert warning for objects left inside surgery patients, which it says has caused 16 deaths in the past eight years. Most of the recommended actions involve processes and communication, but consideration of “assistive technology” such as RFID-tagged counting systems are also recommended.

10-17-2013 8-47-11 PM

In Canada, information on 2,000 patients of Parkwood Hospital is exposed when an unencrypted laptop is stolen from the car of a McKesson Automation employee.

10-17-2013 7-28-08 PM

Weird News Andy notes that California’s insurance exchange, Covered California, pulled down its online provider directory just eight days after go-live when the California Medical Association noted that obstetricians were labeled as ophthalmologists and doctors were incorrectly identified as speaking foreign languages. CMA also observed that some doctors were listed as exchange providers who didn’t actually sign up since insurance companies were permitted to add their in-network doctors to the list without their permission unless the doctor specifically opted out.

Staff and patients of Unit 5, the children’s cancer floor of the University of Minnesota Amplatz Children’s Hospital, create a video titled “Brave.”

Sponsor Updates

10-17-2013 12-27-57 PM

  • SRSsoft hosts about 300 customers at its User Summit this week in Greenwich, CT.
  • Sunquest and the Association for Pathology Informatics will offer an October 24 webinar on the topic of IT-driven virtual autopsies.
  • Clinovations celebrates its five-year anniversary and highlights a few of its awards and honors.
  • E-MDs integrates PatientPay’s online bill pay solutions within its PM software. The company will also integrate Phreesia’s point-of-care check-in solution into its EHR .
  • St. Elizabeth Hospital’s (WA) use of e-form solutions from Access and hosted services from Inland Northwest Health Services helped the hospital meet HIMSS Stage 7 paperless requirements while eliminating the need for dedicated on-site hardware.
  • Greythorn conducts a market survey for HIT professionals to analyze compensation, benefits, job satisfaction, hiring trends, and industry participation. Greythorn will donate $1 to the Boys and Girls Clubs of Bellevue and Chicago for every submission by November 20.
  • Ed Bayliss, executive director for ChartMaxx, participates in a panel discussion on data exchange across the continuum of care at the eHealth Initiative 2013 Data Exchange Summit October 30-31 in Washington, DC.
  • Humedica publishes a case study detailing how Mayo Clinic Health System prepared for value contracting using Humedica MinedShare.
  • ZeOmega will embed Health Language technology from Wolters Kluwer Health into its Jiva care management platform.
  • The Drummond Group certifies SRS EHR as a 2014 Complete EHR.

EPtalk by Dr. Jayne


You can tell that fall has arrived when every coffee vendor (including the one in the hospital lobby) is pushing pumpkin spice latte. Unfortunately, it is also the time I start sweating the fact that I need to come up with an extremely creative Halloween costume and come up with it stat. One of my favorite former bosses throws a massive party and the price of admission is a great costume. I enjoy Halloween immensely and have a closet full of costume options, but this party is peopled with brilliant individuals from academia, healthcare, and health IT so throwing on the Princess Leia braids simply will not do.

Maybe I’ll print a bunch of completely random attributes (some of which relate to me and some that do not) and go as my LinkedIn profile. I always laugh when people endorse me for knowledge of vendors I have never even heard of. I know several of the attendees are faithful HIStalk readers. Maybe I can convince my date to adopt a couples costume and we can go as Inga and Mr. H. Of course I could always go as Dr. Jayne, but that might be a little obvious. I guarantee at least one attendee will be wearing a bowtie and a Farzad-worthy grin.

The lobby of our medical school has a wall with pictures of our staff who have won various Nobel prizes. I could always dress as one of them and see if anyone picks up on it. Getting someone to identify that choice might be a little dependent on how far after the start of the cocktail hour I arrive, though, so not entirely a safe bet. I’m leaning towards possibly a World War I nurse just to have an excuse to purchase an awesome vintage cape. In medicine (and nursing) we used to dress more formally and I miss that. I understand that the current culture of scrubs is all about comfort and practicality, but I can’t help but think that if we dressed more seriously our patients (and administrators) might take us more seriously.

I took a course recently that covered communication and corporate culture. We did several exercises looking at how appearance plays a role in group dynamics. Watching several videos, we scored the characters based on believability, authority, seniority, and a host of other factors. Regardless of the scenario, those characters who dressed in traditional business attire scored higher than those who dressed casually. Besides dress, there are a lot of other factors at play with power dynamics, including the position of the participants (same height vs. seated/standing), tone, demeanor, etc.

I had the opportunity to rotate through a hospital in the UK during the late 1990s and was struck by the formality of the nursing staff. They still wore traditional dress whites (with caps) and nursing trainees wore blue. Physicians wore the long white coat and neckties. There were very few female physicians who I interacted with during my rotation, so I can’t particularly remember what they wore.

I trained at an academic medical center with an extremely traditional surgery department. Surgeons were never to wear scrubs outside the operating room. Trainees were not allowed to consume food or drink in the hallways – not even a sip of coffee – and white coats were to be fully buttoned at all times. Conversely, the OB/GYN house staff wore scrubs and sneakers 24×7, which created more than a few resentments. I wonder though if the patients or other hospital staff really perceived the departments differently? Was it a factor of dress code or of other factors that the dress code exemplified, such as discipline, order, and precision?

Scrubs and casual dress have become a way of life for most hospitals and medical offices. My hospital requires care teams to wear certain colors of scrubs depending on employee roles. Nurses wear navy, respiratory therapy wears light blue, patient care technicians wear khaki, etc. This seems to better help patients understand who is caring for them and what to expect. Unfortunately, physicians run the gamut between coat and tie and whatever scrubs they put on at the last hospital they rounded at. Some are so casual it’s hard to take them seriously. In response to a number of male physicians going sockless in loafers, one local facility created a rule requiring that “hosiery be worn at all times.” I’d like to have been a fly on the wall at the medical staff meeting where that was discussed: readmission rates, surgical site infections, ventilator-associated pneumonia, and bare ankles.

In the ambulatory care setting, the proliferation of scrub styles is mind boggling. We see a lot of “hip” medical assistants and patient care techs in low rider scrubs with flare bottoms that drag the ground to the point where they fray. I hope they never have to run to a code or crouch down to provide CPR, and if they do, that they have their waistband firmly in hand. One pediatrician I know has hand painted lab coats for every holiday and season. She’s the only physician on staff who wears a blue coat, so it really stands out. I smile every time I see her in the elevator, but I’m not sure what some of the patients and visitors think.

Generally I think the offices where staff dresses in a more uniform manner appear more organized and professional, but again maybe the dress code is a side product of management rather than a causative factor. Many of our offices provide staff with practice-logo polo shirts to be worn with khaki pants. This can be useful to reinforce an office brand as well as to help patients identify staff members, especially in busy offices with many ancillary services. That might be a great costume idea – maybe I’ll borrow a polo and masquerade as a staffer for a competitor practice.

I didn’t set out to write a fashion review, but perhaps Inga has been a greater influence on my writing than I previously thought. I could write an entire column on sassy patent leather hospital clogs, but we’ll save that for another night. I’m off to the internet for costume ideas. Got a great one? Email me.


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

More news: HIStalk Practice, HIStalk Connect.


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October 17, 2013 News 2 Comments

News 10/16/13

October 15, 2013 News 3 Comments

Top News

10-15-2013 10-09-26 PM

Cerner shares hit a 52-week high Tuesday following announcement of a partnership with Wolters Kluwer Health to develop a physician documentation system using Provation Clinic Note content with Cerner Millennium. CERN shares are up 52 percent in the past year, with the company’s market cap now at $19 billion. 

Reader Comments

10-15-2013 9-13-05 AM

inga_small From Veteran: “Re: insurance marketplace. I take it all back. This really is a disaster. A New York Times article this weekend chronicled a whole series of issues going back months, not the least of which was HHS’s decision to project manage this themselves when they (and everyone else) knew they had neither the expertise nor the experience. Hope this doesn’t set health reform back years.” Veteran (and a few others) were critical of my comment that the opening day of the insurance marketplace was a “failure” because I was unable to access the system. According to the Times, insiders were aware of the system flaws long before the launch, but because of political concerns, continued with the original timeline. By one estimate the project is now about 70 percent of the way toward operating properly, but the time frame for completion could be anywhere from two weeks to a couple of months. Apparently I am just one of a few thousand people who have opted to wait a few weeks before making additional attempts to enroll.

From CA/DC Fellow: “Re: failed health insurance exchange site. Will US CTO Todd Park take the fall?” Healthcare.gov is a high-profile political embarrassment. In politics and government, someone has to be lynched publicly to appease the press. Todd was sent out to try unsuccessfully to talk around the situation, which I think puts him at risk. Sebelius would toss him overboard in a second to save her image. Nobody ever blames the contractors since it was someone’s job to manage them.

HIStalk Announcements and Requests

Listening: Nada Surf, a nearly perfectly listenable alternative rock band that’s been around for 20 years. I’m playing them constantly.

Acquisitions, Funding, Business, and Stock

10-15-2013 10-57-32 AM

A report predicts that HIT funding will double over last year thanks to the implementation of the ACA and HITECH. Venture capitalists invested $737 million in 51 deals during the third quarter, compared to $623 million in 168 deals a year ago.

CareCloud CEO Albert Santalo tells the Boston Business Journal that his company may launch an IPO next year.

10-15-2013 10-12-17 PM

A business publication says transcription vendor MModal, saddled with heavy debt and slow sales, may need to seek restructuring if its current turnaround efforts fail.


Australia’s NSW Heath will implement iMDsoft’s MetaVision throughout the state’s adult, pediatric, and neonatal ICU beds.

Adventist Health System selects the Explorys suite of analytic and population health management solutions.

TeamHealth (TN) chooses Shareable Ink’s Anesthesia Cloud and ShareMU solutions for selected sites nationally.

Virginia Hospital Center Physician Group selects eClinicalWorks EHR for its 100 employed physicians.


10-15-2013 3-12-46 PM

Henry Schein appoints Steve Klis (CareFusion) president of global practice solutions.

10-15-2013 9-27-43 AM

CareCloud names R. Scott Lentz (Aprima Medical, Picis) CFO.

10-15-2013 8-36-53 PM

AtHoc names John Tempesco (Informatics Corporation of America) as senior director of healthcare operations and marketing.

Vocera Communications hires Paul Johnson (Intuit) as EVP of sales and services.

Announcements and Implementations

10-15-2013 10-14-04 PM

Heritage Valley Health System (PA) activates Allscripts Sunrise for its Beaver and Sewickley campuses.

10-15-2013 1-40-27 PM

Medfusion rebrands its recently reacquired Inuit Health patient portal technology back to its original name and adds Vern Davenport (formerly of MModal) and Buck Goldstein (UNC Chapel Hill) to its board.

10-15-2013 10-15-26 PM

For-profit surgical hospital operator Victory Healthcare (TX) implements Omnicell’s G4 Unity medication management system.

Optum and Dignity Health introduce Optum360, a new company that will address the back office functions of healthcare systems.

Unified emergency notification systems Vendor AtHoc announces the launch of its healthcare vertical with the launch of AtHoc Home Care Alerts, which offer home care service organizations with mobile duress and emergency alerting, field reporting, and personnel tracking.

Jordan Shlain, MD and Todd Johnson of automated patient follow-up solution vendor HealthLoop will present at the UHC Conference Innovation State on Friday.

10-15-2013 10-17-02 PM

Lewistown Hospital (PA) implements Summit Downtime Reporting System for business continuity.

Lucca Consulting Group and ICD-10 Coach announce a partnership to help small hospitals and practices implement ICD-10.  

Government and Politics

The VA names Health eTime the winner of its medical appointment scheduling competition and a $1.8 million prize. The open source app allows veterans to schedule visits across VA locations and gives VA providers the ability to share appointments with the personal digital calendars of veterans.

A Pittsburgh Tribune-Review investigation finds that the VA is one of the largest violators of health privacy laws. From 2010 to May 31, 2013, VA workers or contractors committed 14,215 privacy violations at 167 facilities that victimized at least 101,018 veterans and 551 VA employees. Violations included postings of anatomy on social media sites and identities stolen to create fraudulent credit cards.

Innovation and Research

CEOs of hospitals with high levels of advanced technologic capabilities earn an average of $135,862 more than hospitals with low levels of technology, according to a study published in JAMA Internal Medicine. Hospitals with high performance on patient satisfaction also compensated their CEOs more, but no association was found between CEO pay and processes of care, patient outcomes, or community benefit. Based on the findings, researchers suggest that hospital boards place more emphasis on quality when setting compensation.

Two graduate students in Israel develop a computerized system for diagnosing Parkinson’s disease consistently. The patient performs specific movements in front of a 3-D depth camera, whose data is the analyzed by computer to determine a diagnosis with 94 percent accuracy.


10-15-2013 11-22-36 AM

Encore earns top scores in a KLAS report on go-live support vendors. Santa Rosa Consulting was recognized for having the most engagements overall, followed by Encore and ESD.

The Carolina eHealth Alliance (SC) reports that the four hospital systems participating in its electronic exchange network saved more than $1 million over a 12-month period by reducing unnecessary admissions and redundant procedures.

Clinithink posts an animated video depicting the role of clinical NLP in transforming healthcare.

An article in Medical Marketing & Media says that mobile devices are yesterday’s news for marketing drugs to physicians, concluding that “EHRs will become the dominant context for physicians” in promoting drugs at the time of e-prescribing. However, it warns that overly aggressive drug promotion could lead to regulation. A drug company spokesperson predicts  consolidation of the EHR industry, saying “a relative few will own the space and will own the access” for drug companies to promote their products as part of physician workflow. Drug companies are doing away with traditional field reps for product promotion.

10-15-2013 10-19-55 PM

The local newspaper writes up Novant Health (NC), which earned HIMSS Stage 7 EMRAM last week for its $600 million Epic implementation, which Novant says it finished three years ahead of schedule and under budget.

Sponsor Updates
  • Caradigm will add predictive clinical analytics capabilities from MEDai to its Care Management platform.
  • Sunquest announces a new partnership with the Boys & Girls Clubs of Tucson.
  • Cynthia Davis, RN, FACHE of CIC Advisory will speak Thursday at the 2013 Annual Healthcare IT Symposium in Las Vegas sponsored by the Shriners Hospital for Children. Her topic will be “Paddling Upstream: From Data Collection to Better Patient Care.”
  • Epic will allow direct use of the QlikView Business Directory platform within Hyperspace and will support content sharing between joint Epic and QlikView customers.
  • NTT DATA’s Optimum Suite achieves 2014 Edition Complete EHR Inpatient certification.
  • The SSI Group announces that both its clearinghouse services and RCM solutions are ICD-10 ready and that it is currently testing with provider and payer communities.
  • An Imprivata survey finds that the adoption of server-hosted virtual desktops in the EMEA healthcare industry could increase 74 percent within 24 months.
  • Trinity Health (MI) shares how it generated $3.1 million in profits and an eight to one ROI in five years using Medseek Predict for marketing campaigns.
  • VitalWare partners with DCBA to create CDiDocuMint, a clinical documentation improvement tool that uses a query and tracking methodology.
  • The Washington Business Journal recognizes Clinovations as the 10th fastest-growing company in the district.
  • Utah Business Magazine honors Health Catalyst Chairman David Burton, MD for his lifetime achievement as a healthcare hero.
  • Weill Cornell Medical College CIO Curtis L. Cole shares how he helped Intelligent Medical Objects develop its flagship product.
  • UltraLinq Healthcare Solutions partners with Mobisante to integrate UltraLinq’s image management platform with MobiUS point-of-care imaging devices, enabling providers to deliver remote diagnosis and second opinions.
  • LDM Group’s pharma messaging technology is featured in an article on engaging physicians through EHR messaging.


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

More news: HIStalk Practice, HIStalk Connect.


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October 15, 2013 News 3 Comments

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