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Monday Morning Update 1/27/14

January 26, 2014 News 10 Comments

1-25-2014 7-29-00 AM

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

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

1-26-2014 7-03-37 AM

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

1-26-2014 7-06-58 AM

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

1-25-2014 7-32-23 AM

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

1-25-2014 6-36-53 AM

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

Upcoming Webinars

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

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

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

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

1-25-2014 7-34-47 AM

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

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

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

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

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

1-26-2014 7-24-19 AM

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

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

1-26-2014 7-16-50 AM

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

1-25-2014 10-52-28 AM

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

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

1-25-2014 10-34-40 AM

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

1-25-2014 10-24-53 AM

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

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

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


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

More news: HIStalk Practice, HIStalk Connect.


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January 26, 2014 News 10 Comments

News 1/24/14

January 23, 2014 News 3 Comments

Top News 

1-23-2014 8-33-43 PM

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

Reader Comments

1-23-2014 5-33-01 PM

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

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

1-23-2014 6-37-04 PM

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

HIStalk Announcements and Requests

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

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

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

Upcoming Webinars

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

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

Acquisitions, Funding, Business, and Stock


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

1-23-2014 3-40-06 PM

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

1-23-2014 10-04-45 PM

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

1-23-2014 3-40-43 PM

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

1-23-2014 3-42-05 PM

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


1-23-2014 1-01-15 PM

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

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

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


1-23-2014 1-33-33 PM

EDCO Health Information Solutions promotes Lynne Jones to president.

1-23-2014 6-53-23 AM

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

1-23-2014 1-35-08 PM

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

Announcements and Implementations

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

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

1-23-2014 9-52-01 PM

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

Government and Politics

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

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

1-23-2014 8-25-41 PM

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


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

1-23-2014 6-56-34 PM

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

1-23-2014 9-58-33 PM

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

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

1-23-2014 8-08-28 PM

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


1-23-2014 1-43-56 PM

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

1-23-2014 5-44-54 PM

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

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

1-23-2014 7-22-39 PM

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

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

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

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

1-23-2014 8-53-42 PM

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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


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


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

More news: HIStalk Practice, HIStalk Connect.


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January 23, 2014 News 3 Comments

News 1/22/14

January 21, 2014 News 6 Comments

Top News

1-21-2014 4-15-52 PM

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

Reader Comments

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

1-21-2014 5-31-25 PM

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

1-21-2014 5-38-21 PM

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

1-21-2014 8-30-06 PM

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

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

1-21-2014 6-53-26 PM

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

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

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

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

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

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

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

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

HIStalk Announcements and Requests

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

1-21-2014 8-33-47 PM

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

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

1-21-2014 5-58-03 PM

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

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

Upcoming Webinars 

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

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

Acquisitions, Funding, Business, and Stock

1-21-2014 4-16-32 PM

Kareo secures $29.5 million in growth capital.

1-21-2014 4-17-35 PM

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

1-21-2014 4-18-26 PM

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


1-21-2014 10-41-02 AM

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

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

1-21-2014 10-42-26 AM

Healthstat will implement eClinicalWorks EHR across more than 350 sites.

1-21-2014 10-44-51 AM

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

1-21-2014 10-45-52 AM

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

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


1-21-2014 10-47-04 AM

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

1-21-2014 4-25-27 PM

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

1-21-2014 8-09-03 PM

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

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

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

Announcements and Implementations

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

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

AirWatch opens a Miami office.

1-21-2014 4-28-28 PM

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

1-21-2014 5-19-16 PM

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

1-21-2014 8-37-43 PM

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

Government and Politics

1-21-2014 10-24-31 AM

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

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

1-21-2014 8-17-54 PM

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


1-21-2014 11-34-04 AM

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

1-21-2014 7-31-44 PM

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

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

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

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

Sponsor Updates

1-21-2014 5-55-46 PM

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


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

More news: HIStalk Practice, HIStalk Connect.


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January 21, 2014 News 6 Comments

Monday Morning Update 1/20/14

January 19, 2014 News 6 Comments

From Big Kahuna: “Re: Advisory Panel question about ‘2014 will be the year of …’ Patient Access! Of the 10 hospital CEOs we heard speak at last week’s J.P. Morgan conference in San Francisco, eight mentioned patient access as a chief concern or initiative.”

1-18-2014 2-14-01 PM

“Jeopardy” winner or not, readers aren’t impressed with the healthcare potential of IBM’s Watson. New poll to your right, as requested by a reader: are HIT vendors laying off more people than 1-2 years ago? You can click the poll’s Comments link after voting to explain.

1-18-2014 2-26-46 PM

Lorre is finishing up work on HIStalkU, a new site that will showcase our completed, recorded HIStalk webinars to give them more long-tail visibility. We included the capability to include outside webinars, white papers, and videos as well, so if you are interested, contact Lorre. We have plans for adding more purely educational content such as lectures and slide sets (thus the name.)

1-18-2014 3-33-19 PM

Welcome to new HIStalk Platinum Sponsor Arcadia Healthcare Solutions of Burlington, MA. The 12-year-old, 200-employee company has worked with 7,500 providers, 150 PCMH practices, and five pioneer ACOs to improve healthcare quality and reduce cost via EHR outsourcing and consulting, vendor-agnostic data integration and population analytics, provider retention, and practice transformation and coaching. The company can improve key ambulatory network measures 15-30 percent in six months by bringing together EHR and claims data and helping providers use it. Some of its EHR optimization accomplishments include reducing log-in time by 50 percent, improving system performance by 27 percent, and increasing physician satisfaction by 20 percent. Arcadia provides expert advisors rather than, as it says, “high-priced management consultants who leave nothing behind but PowerPoint.” You probably know some of Arcadia’s industry long-timer leaders: Sean Carroll (Nuance); Sam Adams (Lawson, Picis); and Chris Couch (Health Dialog). Thanks to Arcadia Healthcare Solutions for supporting HIStalk.

1-19-2014 8-45-35 AM

Cerner launches what will be the largest corporate campus in Missouri at an eventual 4.1 million square feet. Cerner says its $4.3 billion complex will house up to 1,500 new employees within three years.

1-19-2014 10-37-06 AM

Meanwhile in England, the interim CEO of Royal Berkshire Hospital says its $47 million Cerner Millennium system is still not working right, adding, “It was particularly bad the year before, but it’s still not good enough. We’re in the process of moving with a new strategy with what the information system should be in future.”

1-19-2014 10-38-13 AM

The local newspaper covers a site visit to St. Rita’s Medical Center (OH) by a nine-member delegation from an Epic prospect hospital in the Netherlands.

1-19-2014 10-39-16 AM

DreamIt Health Baltimore launches and adds Kaiser Permanente to its list of strategic partners that includes Johns Hopkins and Northrop Grumman. Startups chosen for the four-month boot camp, many of which don’t even have websites that I could find, are:

  • Aegle. Wearable biometrics.
  • Avhana. EHR clinical decision support.
  • Cognuse. Game-based stroke rehab.
  • EMOCHA. Medication data capture.
  • Protenus. Patient consent management.
  • Respi. Smartphone-based spirometry.
  • Patient Feed. Inpatient collaboration.
  • Phobious. Augmented reality treatment of behavioral health issues.
  • The Smartphone Physical. Smartphone diagnostic tools.

1-18-2014 4-06-55 PM

Beverly Bell (Health Care DataWorks) is named VP of consulting at Siemens Healthcare. 

1-19-2014 9-09-14 AM

Connie McGee (AirSrip) joins Pershing Yoakley & Associates as a principal.

1-19-2014 10-00-22 AM

Actor Dennis Quaid is back on the patient safety bandwagon again years after after his high-profile legal crusade against medication errors went on hiatus. Quaid, whose newborn twins were given 10,000 unit/ml of the blood-thinning drug heparin as an IV flush rather than 10 units/ml at Cedars-Sinai in 2008 without permanent harm, is urging Californians to support the Pack Patient Safety Act that would require doctors to look up their patients in the state’s CURES prescription dispensing database before prescribing narcotics. The proposed act, which will appear on the November ballot if it gets enough signatures, would also adjust California’s $250,000 medical malpractice cap for inflation to $1.1 million, require physicians to be randomly tested for drugs and alcohol, and would require doctors to report their peers if they witness substance abuse or medical negligence. Bob Pack’s two children were killed in 2003 when a doctor-shopping drug addict ran over them, after which he found that multiple Kaiser Permanente doctors were prescribing narcotics for the woman without realizing it. Pack, the founder of NetZero, developed the CURES system that few doctors use ( including those of Kaiser) and that doctors say is user-unfriendly. Quaid sued everybody in sight after the medication error involving his twins (including the drug’s manufacturer and distributor, who had nothing to do with the nurse’s mistake) and shamed Cedars into spending $100 million for medication barcoding. HIMSS put him on as a conference keynoter in 2009. He merged his patient safety foundation with another group the next year and hasn’t had much to say about patient safety since.

1-19-2014 9-26-13 AM

NextGen, like Greenway and Allscripts before it, will integrate analytics from Inovalon (which changed its name from MedAssurant last year.)

A Wall Street Journal blog entry mentions an Amazon patent for “anticipatory shipping,” where the company it will use its customer information to reduce the delays between ordering and shipping that “may dissuade customers from buying items from online merchants.” Nobody seems to interpret the possibilities as I do in reading between the lines: the company could ship items “on approval” for opt-in customers with return postage paid, allowing the company to put appealing merchandize into the hands of qualified customers with the confidence that many will keep it. Amazon would be putting a lot of trust in the information it owns, but imagine the possibilities of customers voluntarily buying items they didn’t order, just like making impulse purchases in a store’s checkout lane. Amazon has blurred the line between bricks-and-mortar stores and online purchases with its Prime program, fast shipping, digital downloads, superb product recommendations and reviews, and the possibility of drone-delivered packages. I can see this as its next step in world domination. Imagine the mess if hospitals and practices used their patient data to automatically schedule tests or issue prescriptions and you’ll see why Amazon is a lot smarter.

1-19-2014 10-41-17 AM

GE Healthcare announces 2013 financial results, with sales down slightly but profits up 4.4 percent.

1-19-2014 10-24-32 AM

The local paper says the formerly high-flying transplant program at University of Arizona Medical Center has been temporarily shut down after a dispute with the program’s chief surgeon, who was fired in September 2013 when the hospital accused him of falsifying the electronic records of unsuccessful surgeries. The surgeon claims he was let go after criticizing the dean of the university’s medical school.  

1-19-2014 10-43-10 AM

Girish Navani, CEO of eClinicalWorks, is interviewed by the New York Times on his management style. Some highlights: (a) he doesn’t believe in titles because they create “title warfare”; (b) he doesn’t fire people, he just tells them to take three months to find something else they want to do or be prepared to change how they work; (c) the company hires straight out of college, saying, “We don’t hire free agents, we draft players.” I like this idea:

There’s a big, oval table outside my office, with eight chairs around it, and I spend a lot of time working there. It gives an opportunity to anybody to come up to me, ask questions, discuss an idea and brainstorm on a big whiteboard. Some people will join a conversation just because they want to learn. You never ask the question, “Why are you sitting at this table?”

1-18-2014 4-12-44 PM

Weird News Andy says she’s on pins and needles. New England Journal of Medicine reports the case of a woman with resistant knee pain who was found by doctors performing X-rays to have knees filled with hundreds of acupuncture needles, apparently left there intentionally for ongoing benefit by her acupuncturist.

Vince’s HIS-tory of McKesson Paragon is bittersweet because it’s the last episode in his series that has been running on HIStalk for years. Industry long-timers have enjoyed some fond (and not-so-fond) memories of companies, products, and people in the past, while newer folks have developed new appreciation for the origins of the industry in which they work.


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

More news: HIStalk Practice, HIStalk Connect.


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January 19, 2014 News 6 Comments

News 1/17/14

January 16, 2014 News 7 Comments

Top News

1-16-2014 7-51-54 PM

Streamline Health will acquire St. Louis-based patient scheduling and surgery systems vendor Unibased Systems Architecture.

Reader Comments

From Salient Point: “Re: vendor layoffs. I’ve never had so many colleagues (most of them older), including high-performing salespeople, being let go. Seems like more than the usual Q4 pruning. Are you seeing this?” I will defer to readers. It does seems as though companies are cutting back, maybe because the HITECH boom is pretty much over unless you are Epic, Cerner, or a consulting company.  The EMR dance partners have largely been chosen, other than the likely ambulatory rip-and-replace caused by unmet expectations and acquisitions.

From Eclipsys Gal: “Re: Chad Eckes, chief strategy officer at Cancer Treatment Centers of America. Replacing Sheila Sanders as CIO at Wake Forest Baptist University Medial Center (NC).” Unverified. Sanders resigned after four years at WFBUMC in May 2013 following a disastrous Epic rollout, although the hospital said her departure was unrelated.

HIStalk Announcements and Requests

A few highlights from HIStalk Practice over the last week include: CareCloud reports the addition of 520 new clients in 2013, including the 20-provider Urology Austin (TX). The PCMH model leads to lower cost, better access to care, higher patient satisfaction, and fewer avoidable or unnecessary services. Practice Fusion achieves 2014 Complete EHR certification in time to beat its December 31 “guarantee” deadline. More than half of providers say they have not yet estimated the impact of ICD-10 on their cash flow. Doximity claims it has more physician members (250,000) than the AMA. SureScripts adds almost two dozen vendors to its clinical network for secure HIE. A dozen HIT vendors share opinions on the biggest challenges facing physicians and physicians practices in 2014 in part one of a three-part series. Thanks for reading.

1-16-2014 4-26-31 PM

Welcome to new HIStalk Platinum Sponsor MBA HealthGroup of South Burlington, VT. The company’s consulting services include Epic, Allscripts, ICD-10, EHR optimization, Meaningful Use, and RCM. They’ve trained and supported more than 5,000 physicians on Allscripts EHR, trained 3,000 users on Epic 2012, and provided RCM services to 400 physicians in 38 states. Fletcher Allen CIO Chuck Podesta mentioned using the company’s Epic 2012 upgrade services when I interviewed him earlier this week (the case study is here.) I noticed a new company blog post on the benefits and pitfalls of personalizing Epic that contains good nuts-and-bolts advice. Thanks to MBA HealthGroup for supporting HIStalk.

Listening: The Neighbourhood, a new California-based five-piece that skillfully blends alternative music with R&B. The singer is 22, which must be the coolest thing ever.

HIStalkapalooza and HIMSS

1-16-2014 3-16-49 PM

HIStalkapalooza registration will continue for several days. Everybody who wants an invitation has to register individually (that includes Inga and me, so don’t expect sympathy after the fact if you didn’t bother). We would love to invite everyone, but that’s not possible given that we had more than 750 requests in the first few hours, so watch your inbox for invitations on February 4 or so and follow #HIStalkapalooza14 on Twitter. Imprivata is doing an amazing job to make it the best event possible, as you’ll see if you score an invitation. It’s hard to comprehend that this will be the seventh version, going all the way back to Orlando in 2008 when it was 200 or so people in a Peabody Hotel conference room. I was thrilled because I was secretly hoping for 100 but expecting 25.

HIStalk sponsors: let Lorre know if you’ll be attending our sponsor-only networking reception on Sunday evening, February 23 at the HIMSS conference. It’s going to be pretty cool and a nice way to finish to the pre-conference weekend. Contact Inga if you haven’t sent your information for our HIMSS guide.

Acquisitions, Funding, Business, and Stock

1-16-2014 3-38-29 PM

The price of Allscripts shares climbed nine percent Wednesday following the company’s prediction of five to eight percent adjusted revenue growth per year from 2014 to 2016. Analysts were expecting five percent growth in 2014. Above is the one-year chart with MDRX in blue and the Nasdaq in red, with shares rising 60 percent.

1-16-2014 3-40-14 PM

Valence Health reports revenue growth of 35 percent for 2013 and a 65 percent increase in bookings.

1-16-2014 3-41-01 PM

Craneware says its first half earnings are expected to be up five percent over last year.

1-16-2014 6-11-24 PM

Mercom Capital Group issues its healthcare mergers and acquisitions report for 2013, reporting $2.2 billion and 571 deals in 2013 vs. $1.2 billion and 163 deals in 2012. The top five VC-funded companies for the year were Evolent Health ($100 million), Practice Fusion ($85 million), Fitbit ($73 million), MedSynergies ($65 million), and Proteus Digital Health ($45 million). Above are the largest M&A transactions of the year. The full report costs $599.


Center for Diagnostic Imaging (MN) extends its use of Merge Healthcare solutions to include the iConnect Network interoperability platform.

Long-term care provider Grace Healthcare (TN) selects the Daylight IQ disease management system from COMS Interactive.

1-16-2014 3-55-06 PM

NorthBay Healthcare (CA) selects Health Catalyst’s Late-Binding Data Warehouse and Analytics platform.

1-16-2014 3-56-44 PM

WakeMed Health & Hospitals (NC) will implement population health and final risk management solutions from Evolent Health.

Kaiser Permanente (CA) renews a multi-year agreement with MedAssets for strategic sourcing and spend analytics solutions and to serve as Kaiser’s exclusive GPO for its nationwide facilities.


1-16-2014 4-21-50 PM

ISalus Healthcare hires Jason McDonald (Kareo) as chief sales officer.

1-16-2014 4-22-51 PM

HIMSS names its former board chair Willa Fields (San Diego State University) the winner of the 2013 HIMSS Nursing Informatics Leadership Award.

1-16-2014 4-23-41 PM

Rick Roycroft (MedAssets) joins Huron Consulting Group as managing director of the company’s healthcare practice.

Cureatr names Vik Shah (Medidata Solutions) as EVP of client services and operations.

Announcements and Implementations

Johns Hopkins HealthCare (MD) and BlueRush Media Group will co-develop an online portal that provides information for employers and their employees who are undergoing or have gone through cancer treatment.

1-16-2014 8-30-37 PM

The City of New Orleans EMS integrates its EMS Service Bridge electronic patient care reporting system from ImageTrend with the Greater New Orleans HIE.

In Canada, Cerner completes deployments of its ambulatory EMR  at three Ontario ambulatory clinics, supported by Canada Health Infoway.

1-16-2014 4-55-49 PM

Compass Oncology (OR) pilots My Care Plus, a patient portal designed specifically for cancer patients by McKesson Specialty Health.

1-16-2014 8-33-42 PM

The VA deploys Health Level’s critical case management platform for all its VA National Teleradiology Program medical centers.

The Ministry of Health of the Kingdom of Saudi Arabia launches nationwide open access to Wolters Kluwer Health’s UpToDate for the country’s 80,000 physicians and nurses.

1-16-2014 4-53-06 PM

Lincoln Hospital (WA) and Community Wellness (WA) use the INHS TeleHealth system to offer diabetes and pre-diabetes education to rural communities in northern Idaho and eastern Washington.

Government and Politics

1-16-2014 5-00-05 PM

1-16-2014 5-03-31 PM 1-16-2014 5-04-40 PM 1-16-2014 5-06-52 PM

ONC releases the Safety Assurance Factors for EHR Resilience (SAFER) Guides, which include checklists and recommended practices to help providers assess and optimize the safety and safe use of EHRs. The set of nine guides are High Priority Practice, Organizational Responsibilities, Contingency Planning, System Configuration, System Interfaces, Patient Identification, CPOE with Decision Support, Test Results Report and Follow-Up, and Clinician Communication. Each starts with a checklist of recommended practices for optimizing EHR safety. The guides were developed by Joan Ash, PhD (OHSU), Hardeep Singh, MD (Houston VA, Baylor), and Dean Sitting, PhD (UT Health Science Center). This is some really good work.

ONC announces the beginning of a 30-day period for organizations to submit requests for ONC-Approved Accreditor status, which is valid for up to three years. This the organization that accredits EHR certification organizations, with ANSI as the incumbent since the role was first defined in 2011.

CMS and ONC select McKesson and Meditech as its first designated “Test EHRs.” In order to meet the transition of care objective in Stage 2, EPs, EHs, and CAHs must successfully exchange an electronic summary of care document with a CMS-designated test EHR or with an EHR technology different that the provider’s EHR technology.

1-16-2014 8-39-31 PM

Several North Carolina doctors file a class action lawsuit against the state for delayed Medicaid payments, claiming that the the state’s Department of Health and Human Services and its contractors — CSC, Maximus Consulting, and SLI Gobal Solutions — were negligent in their rollout of the state’s $484 million NCTracks payment system.

Brian Ahier provided this audio of Karen DeSalvo’s introduction of herself to the HIT Policy Committee earlier this week. She sounds kind of fun, but for some reason her voice goes up in tone at the end of some sentences like she’s asking a question when she isn’t.


1-16-2014 3-43-21 PM

A HIMSS Analytics report predicts accelerated growth for patient portals, clinical data warehousing and data mining, and radiology barcoding applications. The number of patient portal vendors rose from 28 in 2009 to 62 today.

CTG will add 300 jobs in its home city of Buffalo, NY in a medical informatics partnership with University of Buffalo’s Center for Computational Research in a genomics and big data initiative. The company helped create UB’s Institute for Healthcare Informatics in 2010 and contributed funds for Roswell Park Cancer Institute’s Center for Personalized Medicine.

1-16-2014 3-12-00 PM

A California highway patrol officer stops a California software developer for speeding, also citing her for wearing Google Glass. He considered the device to be covered under the same laws that prohibit playing video in the driver’s field of vision.

Texas and the city of Austin offer athenahealth $5.7 million in incentives to open an R&D center that would create 607 jobs with a capital investment of $13 million. The company is also considering locations in California, Massachusetts, and Georgia, the latter two of which have previously provided athenahealth with similar incentives.  

1-16-2014 9-21-33 PM

BIDMC CIO John Halamka says he has written two books, one a reflection on his blog writings and other a fictional thriller. He’ll be signing the former at HIMSS. He really is a Renaissance man now that he’s turned into a gentleman farmer (I’m hooked on his “Building Unity Farm” series.) I just can’t understand how he finds the time to get so involved in so much, maybe because I’m lazy.

The governor of Guam signs a bill approving a $25 million loan to Guam Memorial Hospital to help it repay its previous bailout loan and to pay the support fees of NTT Data, which threatened to cut the hospital off from software support.

1-16-2014 7-35-53 PM

Michael Gilbert, MD, a family medicine physician with St. Joseph Health (CA), writes a good ONC post for practices called “How to Use a Patient Portal.” As an Allscripts Enterprise user, he says the company pushed him to use Jardogs FollowMyHealth after they bought that company, resulting in a 40 percent drop in registrants from their previous portal (presumably Intuit Health). Current problems include the large number of pending registrations that never become active (which throws off the MU Stage 2 denominator), the requirement for users to install the Microsoft Silverlight graphics browser plugin (which hangs up my browser regularly, so I can understand that), and  the need for providers to motivate patients to participate. Interestingly, the practice bought a software development company and will build its own portal and HIE (!!!), but in the meantime seems fairly happy with the Allscripts product:

[providers] participate in secure online clinical communication, schedule appointments, refill medications, and answer routine questions with and for patients. The new portal automatically uploads all results within minutes of being verified by the provider and patients can directly schedule into providers schedules, ask for medication renewals and pay bills. The portal also offers a computer, iPad and iPhone application with all of the above functionality to patients. We have over 30,000 patients registered, and have achieved 10 percent penetration of all registered patients across both medical groups. Some providers have almost half of their patients registered. Our physicians encourage their patients to message them via the portal.

Weird News Andy appropriately finds this story sad. An ambulance takes 18 minutes to arrive at the scene of a shooting in a mall parking deck, unable to enter the facility because of the low ceilings. The crew had to roll the gurney up the ramp to get to the male victim, who had refused to hand over his keys to four carjacking assailants, who then shot him as his wife sat beside him in the car. He died.

An Iowa state prison psychiatric hospital employee is fired for downloading patient photos from the hospital’s computer, Photoshopping them, and emailing them to co-workers, who often responded with additional requests (some of those folks were also fired, apparently.) One of his works involved patient faces superimposed on a “Star Wars” poster whose title he changed to “Tard Wars.” He was also found to have used work PCs to visit adult site including “Heavy Hotties.” The man said his job mostly involved playing cards or Wii with patients, which enabled him to “Photoshop at the same time I am changing lives. It’s called multi-tasking.”

Sponsor Updates

  • The coreANALYTICS health system performance improvement system from Encore Health Resources earn ONC 2014 certification as an EHR module. Catholic Health Initiatives is using it.
  • Allscripts announces that its KLAS scores are on the rise, with Allscripts Enterprise EHR up 11 percent for the 12-month period ending December 2013 and Sunrise Clinical Manager up four percent.
  • Coastal Healthcare Consulting introduces Convergence, a patient identity management solution that uses NextGate’s Enterprise MPI.
  • NextGen will map its EHR directly to the IRIS eye disease registry.
  • Josh Byrd, Patientco’s director of marketing, shares his perspective on why the patient experience matters.
  • Joseph Petro, SVP of healthcare R&D for Nuance, explains how clinical language understanding is critical for helping providers drive productivity while remaining focused on patient care. 
  • TriZetto’s Provider Solutions Business unit introduces the Top Codes Report, which allows providers to chart their most frequently billed procedure and diagnosis code pairs in preparation for ICD-10.

EPtalk by Dr. Jayne


ONC releases SAFER Guides to aid providers in safe use of health information technology. The Safety Assurance Factors for EHR Resilience Guides contain best practices for EHR use and include checklists for practice assessment. ONC Chief Medical Officer Jacob Reider discusses the nine guides on his “Health IT Buzz” blog.

There was a lot of discussion in the physicians’ lounge this morning regarding the suggestion that medical school could be reduced to three years. Certainly the idea of saving a year’s worth of tuition and living expenses might be attractive to those who already know what residency they want to pursue. Several of the programs currently in place reduce electives and require summer classes in order to meet required educational standards.

My medical school’s fourth year curriculum was all elective, and in hindsight, I’m glad I had it. Being at an urban academic medical center allowed me to see things I wouldn’t have been exposed to in residency and also allowed me to practice my clinical skills with less focus on competing against my peers. Coupling reduced medical school experiences with resident work hour limits could create a rocky start for some physicians entering practice.

The other hot topic in the lounge has been the recent New York Times article on scribes. After reading the article, several of my colleagues now think scribes are the be-all, end-all answer to their EHR problems. I enjoy moonlighting at a local emergency department that uses scribes, but physicians need to understand the limitations of the scribe model. Although they’re very popular for episodic care (emergency, urgent care) there are challenges in office-based medicine. One of the major issues is that using a scribe doesn’t relieve the physician of the need to learn the EHR. He or she will need to be able to access the system to view data and to handle after-hours patient contacts such as hospital admissions, phone calls, cross-coverage, etc.

Scribes hired from third-party agencies are expensive – up to $28 per hour in my market. It’s hard for physicians to cover that expense in primary care. The alternative chosen by many physicians is to train a medical assistant to scribe. That approach can be effective as long as the medical assistant is relieved of their other daily responsibilities. It is extremely difficult to try to play both roles in a busy primary care practice. The article says physicians using scribes can see up to four extra patients per day. That’s not been the experience of physicians in our community, who are lucky to see one or two extra patients per day. Scribes may not be as helpful with telephone messages, provider-to-provider communication, and other administrative burdens that impact physicians.

Physicians also need to spend time reviewing the scribe’s notes for accuracy. At my site, there is a pool of scribes and we may work with three or four during a single shift. Although the overall quality of their work is acceptable, the work of some is much stronger than others. Their work requires careful review, especially when they are new. Scribe training programs may be only a few weeks long. If you get lucky and have one who is a pre-med student or a nursing student, it can be a lot of fun since you can do some teaching along the way and they are generally very motivated to do a good job in the hopes they will be able to ask for a recommendation. If you get unlucky and have a scribe who has been up late the night before cramming for exams, it can be a challenge.

Speaking of challenges, today HIMSS invited me to attend a focus group. How could I resist their opening line: “Are you a CIO with a bed size of 150-400 or an IT Director/Manager with a bed size above 300 and not a practicing physician?” Why do they keep demographic files on members if they aren’t going to use them? Between that and the overall lack of HIMSS social invites, I’m starting to wonder whether this meeting is going to be more work than play. I’m confident, however, that with Inga’s vast social network, things will turn around. What are your HIMSS social plans? Email me.


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

More news: HIStalk Practice, HIStalk Connect.


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January 16, 2014 News 7 Comments

News 1/15/14

January 14, 2014 News 11 Comments

Top News

1-14-2014 7-43-05 PM

Healthcare billionaire Patrick Soon-Shiong launches health IT company NantHealth at the JPMorgan Healthcare Conference, which will offer the “intelligent Clinical Operating System” (iCOS) that will integrate information from molecular science, computer science, and big data to deliver solutions for population health management, cancer care coordination, transition management, and wellness. The company also announced a partnership with the Clinton Foundation to implement iCOS in two areas of the country. The company says iCOS is running in the country’s largest oncology group that covers 150 practices, 22 EMRs, and real-time data feeds moving 50GB per day; its Cancer Decision Support Engine is used by over 50 percent of oncology practices; and its EMR is running in 12,700 facilities in 13 countries. It talks about DeviceConX device connectivity, which is the iSirona’s product it gained when it acquired the company effective January 1, 2014.  Most of the other offerings are also previous NantHealth acqusitions, including the GlowCaps medication reminder system, home monitoring devices from Boston Life Labs, and Ziosoft medical imaging. Soon-Shiong spent $800 million on 60 companies and research projects that make up iCOS, which he says can be purchased right now. I’m never quite sure whether to take Soon-Shiong seriously, but having $7 billion gives him at least some instant credibility.

Reader Comments

1-14-2014 5-00-38 PM

From Holly S: “Re: Jonathan Bush’s leave. He’s going on an extended vacation from February to April. He’ll be spending time with friends and family, both travelling and hunkering down. His agenda is to play and experience some things he’s always wanted to do. He has never been so energized about the business, its ability to effect change in health care, the marketplace’s receptivity to change. He’s all-in on what’s ahead.” Thanks to athena for providing this update in respond to a reader’s inquiry. JB told me he hates to miss “the boat show” (the HIMSS conference) and especially his MC duties at HIStalkapalooza, but as he also confided, “I am honored to have been your MC these past few years and hope dearly that whoever replaces me in 2014 will be a bomb so that you will have me back in 2015.”

HIStalk Announcements and Requests

1-14-2014 4-59-23 PM

Thanks to Greenway Medical for sending this note in response to recent rumors of employee layoffs:

We’d prefer to not comment on rumors. We have, in fact, been working through a very thorough review of our organization since completing the merger of Greenway Medical Technologies and Vitera Healthcare Solutions, which includes Vitera’s SuccessEHS. That process includes aligning our resources to most effectively serve our customers, which we’re accomplishing by delivering our innovative7 industry-leading solutions, delivering data liquidity through our powerful interoperability engine, and leading our customers through what will be an awesome change from production medicine to outcomes-based medicine through our clinically driven revenue cycle management solutions. Our mission at Greenway remains the same.  We believe healthcare will continue to electronify, the consumer will become more engaged and demand change, and we will improve population health by delivering smarter solutions.  We’re privileged to serve such a large provider base, clinical professionals who provide care to millions and millions of patients. 

Voting for the HISsies awards is underway, as follows:

  • I pleaded for nominations on HIStalk over several days and, as happens every year, didn’t get many nominations even though anyone can nominate. If you don’t like the choices on the ballot, blame those few hardy readers who actually submitted nomination since everyone who has complained so far didn’t.
  • The most-nominated entries made it onto the final ballot, which was emailed directly to the addresses in the HIStalk update list (which prevents ballot box stuffing since the voting is tied to the email address.)
  • So far, 765 of the 10,000 email recipients have voted.
  • The results will be revealed at HIStalkapalooza and on HIStalk.

On the Jobs Page: NextGen Activation Consultant, Epic Activation Consultant, Epic Certified Builder.

Listening: new (released today, in fact) from Sharon Jones & the Dap-Kings, brilliant and amazing 1960s-style revivalist pop soul with lots of horns recorded on good old analog. Treatments for Sharon’s pancreatic cancer (diagnosed June 2013) left her bald but unbowed in the video.

1-14-2014 5-42-48 PM

Welcome to new HIStalk Gold Sponsor Accreon. The company is a leader in system optimization, information integration, and software solution development. They worked on Canada’s clinical information highway and have built tools for US-based vendors for population health management, remote patient monitoring, and workflow optimization. Services for providers include strategic planning, project management, implementation, integration, analytics strategy and optimization, and HIE architecture and sustainability. They can also help vendors with near-shore solutions, software development, integration, and analytics projects and they also do work for payors, pharma, and government. Eric Demers is the Boston-based president of Accuron USA and not only is an industry long-timer who you may know, he even has a MHSA degree, which always clearly signifies that “I’m a healthcare person” since just about everybody else gets a general MBA instead. Thanks to Accreon for supporting HIStalk.

Upcoming Webinars

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.

Webinar questions? Contact Lorre.


1-14-2014 4-37-23 PM

I’ll post a separate HIStalk article Wednesday afternoon with the link to the registration page, so watch for the email update. There’s no need to rush – we’ll leave the registration page up for several days and then invitations will go out February 4. Above is a bit of a hint about the sponsor and location. Meanwhile, I’ll say just once more that I think the primary sponsor has one co-sponsor slot open, so email me if you want more information.

Acquisitions, Funding, Business, and Stock

1-14-2014 6-04-48 PM

WellDoc, provider of a Type 2 diabetes mobile device management program, raises $20 million from Merck Global Health Innovation Fund and Windham Venture Partners.

1-14-2014 6-24-15 PM

Surgical Information Systems acquires ambulatory surgery EMR and management software vendor AmkaiSolutions.

1-14-2014 6-10-53 PM

Online employee health shopping systems vendor HealthSparq acquires ClarusHealth Solutions, which offers a provider search function for consumers. HealthSparq’s president is Scott Decker, formerly of NextGen and Healthvision.

1-14-2014 7-00-46 PM

Transcription and speech recognition vendor MModal, acquired by a JPMorgan private equity arm in a leveraged buyout worth $1.1 billion in August 2012, hires a restructuring firm, according to sources cited by The Wall Street Journal. Sales are dropping and  the company is paying high interest charges on its debt of $750 million, which has tripled since the acquisition.

Post-acute care software provider Brightree acquires Strategic AR, a provider of private-pay billing and collection services.


1-14-2014 6-29-53 PM

Rush Health (IL) contracts with Caradigm for healthcare analytics and population health software to support its private HIE. Rush Health’s CEO says the HIE is the largest investment the organization has ever made, adding, “We want to use this infrastructure to connect and exchange real-time information so we can do a better job coordinating care.” Rush Health will also offer to cover the first-year of EHR expenses the 10 percent of its doctors who are still using paper, moving them to Epic, eClinicalWorks, or athenahealth.

1-14-2014 8-41-02 PM

Contra Costa County Health Services (CA) engages Vonlay to support its Epic 2012 upgrade.

The 22-hospital St. Vincent Health (IN) will pilot Acupera’s population health analytics and clinical workflow management platform in one of its physician offices.

1-14-2014 6-32-14 PM

Catholic Health Partners (OH) will implement Epic’s MyChart Bedside at all of its hospitals following a successful pilot at its St. Rita’s Medical Center (OH) location. Patients and family members access their health information, labs, caregiver team member information, and educational materials on a hospital-issued tablet.

Geisinger Health System (PA) selects Besler Consulting to identify Transfer DRG underpayments.

CMS awards Optum/QSSI a contract to serve as a senior advisor on the HealthCare.gov website following its interim engagement as general contractor after the site’s October 1 meltdown. The company’s press release, oddly enough, includes testimonials from HHS Secretary Kathleen Sebelius and CMS Administrator Marilyn Tavenner.


1-14-2014 5-17-16 PM

CHIME names HIStalk’s own “CIO Unplugged” Ed Marx (Texas Health Resources) as its 2013 John E. Gall Jr. CIO of the year.

1-14-2014 5-18-47 PM 1-14-2014 5-19-39 PM

Arcadia Healthcare Solutions names Sam Adams (Accretive Health – above left) SVP of sales,  Jonathan Rider (Jetstream Consulting) SVP of technology and engineering, and Sandi Molettieri (UTC Aerospace Systems – above right) director of HR.

1-14-2014 5-23-05 PM

NavigatorMD appoints Alexander Poston, Jr. (Entrada) CIO.

1-14-2014 5-25-27 PM

Artemis Health Group names John Doulis, MD (MedCare) president and CEO, replacing Phillip Suiter, who resigned.

1-14-2014 5-36-28 PM

Andrew Baker (Intuit Health) joins Culbert Healthcare Solutions as VP of business development.

1-14-2014 5-38-38 PM

Mike “The PACSMan” Cannavo (McKesson) returns to his PACS consulting business.

Kim Bahrami joins government contractor Acentia as VP of business development over the company’s expansion into DoD and VA healthcare.

CMS appoints Acting CIO Dave Nelson as the agency’s permanent CIO.

Announcements and Implementations

CECity and athenahealth will offer a health data exchange integration and reporting service to automate information flow from athenaClinicals to national clinical registries using CECity’s clinical quality data gateway.

1-14-2014 12-10-33 PM

Dubai’s Mediclinic City Hospital and Mediclinic Welcare Hospital will install Oneview Healthcare’s patient engagement software.

Varian Medical Systems will expand its existing Salt Lake City facilities in anticipation of creating 1,000 full-time jobs over the next 15 years.

1-14-2014 9-41-47 PM

Heart Imaging Technologies provides Merge Healthcare access to its portfolio of healthcare information patents, including zero footprint technologies to provide access to diagnostic-quality images in a standard web browser. The agreement also settles litigation initiated by Heart IT against Merge for patent infringement related to internet-based image viewing.

MedHOK, which just closed $77.5 million in funding, will increase its 100-person staff by about 35 percent over the next year. 

Government and Politics

1-14-2014 1-55-54 PM

CMS announces it will consider on a case-by-case basis requests made under the Freedom of Information Act for information to find out much Medicare pays individual physicians.

VA CIO Stephen Warren says that for 2014 his agency will be focusing on improving its system baseline practices and procedures, configuration management, patch management, and elevated privilege review.

1-14-2014 1-46-25 PM

A GAO report criticizes CMS, the VA, and six other agencies for their inconsistent implementation, policies, and procedures for responding to data breaches involving personally identifiable information.

Innovation and Research

A report finds that ACOs are competent in offering e-prescribing, a single database containing medical and prescribing information, and formulary options that encourage the use of generic drugs, but lack tools that notify physicians when prescriptions are filled, prevent duplicate drug therapy, measure quality, and demonstrate the value of appropriate medication use.


1-14-2014 8-20-28 AM

Alere Connect receives FDA 510(k) market clearance for its Alere HomeLink platform, which also earned CE Mark certification which will allow it to be marketed in Europe.


Cerner Middle East expands its office in Riyadh (Saudi Arabia) in support the company’s growth plans.

1-14-2014 1-23-01 PM

Products from EBSCO, Elsevier, Wolters Kluwer, Truven Health Analytics, Isabel, and Logical Images earn the highest rankings in a KLAS report on clinical decision support resources, including tools for disease reference, drug reference, nursing reference, and diagnostic decision support.

An ICD-10 readiness survey by Navicure and Porter Research reveals that 74 percent of physician practices have not yet started implementing their ICD-10 transition plan, though most don’t anticipate any disruptions from their EHR, PM, or clearinghouse vendors. A couple of alarming stats: 27 percent of survey practices are unsure how or where to start preparing for the transition, while 22 percent claim they don’t have the staff or resources to begin preparing.

The former CEO of two-hospital, 350-bed Cape Cod Healthcare (MA) who resigned abruptly in 2010 remained the organization’s highest-paid employee for the next two years, earning over $1 million in each year, and was still being paid in 2013. The hospital’s board chair said, “A lot of executives have post-employment benefits,” while a business ethics expert says it’s no wonder that US healthcare is so expensive. The CEO is also a physician and was disciplined by the state medical board after he left the hospital for inappropriately writing prescriptions for family members.

Weird News Andy notes, “Hipsters, beware” about this story in which a man in China stretches and yawns so hard that he collapses his own lung. WNA provides his targeted warning because the at-risk group is “tall, slim young men.”

WNA also likes a story that he titles “Clean Booze,” in which a man steals 12 bottles of hand sanitizer from a hospital by hiding it in his arm sling and then goes back twice more for additional bottles. He told the police who finally nabbed him that he makes a cocktail by mixing the alcohol-containing cleaner with orange juice.

Sponsor Updates

  • HealthMEDX announces that it will be the first long-term and post-acute care EMR vendor to participate in the Interoperability Showcase at HIMSS14.
  • McKesson’s MED3OOO division expands its Dayton, OH office space from 10,000 to 12,000 square feet and will increase its local employee head count from 110 to 122.
  • Allscripts will incorporate the Adheris DirectStart medication adherence communication program into its EHR.
  • Gartner positions InterSystems as a Challenger in its Magic Quadrant for Operational Database Management Systems.
  • Clinovations consultant Matt Lambert, MD publishes a book that includes his reflections on healthcare and the push for change in the midst of healthcare reform.
  • Wolters Kluwer Health expands use of Lippincott’s Nursing Procedures and Skills to include hospital-based clinicians and renames the product Lippincott Procedures.
  • Doctors Community Hospital (MD) shares how its use of GetWellNetwork improved patient education and entertainment while generating revenue.
  • The Rochester Business Journal names eHealth Technologies to its Rochester Top 100 list based on dollar and percentage revenue increases over the past three years.
  • Loran Cook, product evangelist for Billian’s HealthDATA, considers the future of partnerships, payers, and a loophole in the ACA.
  • Rock Health names Health Catalyst CEO Dan Burton to its list of Top 50 Digital Health Entrepreneurs.
  • RelayHealth releases the second generation of RelayAnalytics Pulse for comparative analytics.
  • Emdeon achieves CAQH CORE Phase III Certification, which certifies the company accurately and efficiently exchanges healthcare electronic funds transfer and electronic remittance advise information.
  • ICSA Labs certifies InteHealth’s patient and physician portals with 2014 Edition Modular EHR Inpatient and Ambulatory ONC HIT Certification.
  • Cornerstone Advisors founder and president Keith Ryan advises Bartlett Regional Hospital’s (AK) planning committee on its EHR options. 


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

More news: HIStalk Practice, HIStalk Connect.


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January 14, 2014 News 11 Comments

Monday Morning Update 1/13/14

January 11, 2014 News 1 Comment

1-11-2014 2-49-45 PM

From Yogic Flyer: “Re: Merge. How could a sales rep hide being paid for non-existent contracts unless there are absolutely zero controls in place in that company?” Merge announced last week that a former sales rep created phony contracts worth $15 million to meet his or her sales quota, earning the rep more than $250,000 in sales commissions. The rep worked in the eClinical OS business, which sells clinical trials software to drug companies. It’s hard to believe that some level of collusion (individual or corporate) wasn’t required for a sales rep to just make up contracts that were used not only to pay commissions, but also to be rolled into the corporate orders backlog of a publicly traded company. It’s also interesting that customers weren’t billed for the amounts specified in the contracts, so Merge’s internal processes must be majorly disjointed. MRGE shares dropped more than 10 percent on the news, decreasing the company’s market capitalization to just over $200 million. The share price is down nearly 70 percent from February 2013. Chicago-based vendors Merge and Allscripts seemed likely at one time to cause a worldwide shortage of feet to shoot themselves in.

From It’s a Sledgehammer: “Re: Allscripts. [sales exec name omitted], another former IBMer hired by Glen Tullman, has been terminated. Paul Black’s master plan of putting the Cerner band together takes one more step.” Unverified.

1-11-2014 2-47-59 PM

From Willing Participant: “Re: HIStalkapalooza. I enjoyed last year’s event and read that invitations will be sent next Wednesday. Do I need to do anything to be eligible?” The registration page will go live Wednesday, January 15 (CGI isn’t building it, so hopefully we won’t have problems.) Sign up  then if you want to come. We will email invitations on around February 1 to those we can accommodate since we always have a lot more demand than supply. The most important thing to remember is that you have to register if you want to attend. Every year I get emails from people ranging from pleading to angry who didn’t register and who apparently expected the Official HIStalk Psychic to divine their attendance intentions and send them an unsolicited invitation. It doesn’t matter if you are a swaggering CEO, a sponsor executive, or a self-identified industry celebrity – you have to register (just like I do) to be considered for an invitation. Please don’t embarrass both of us by claiming I didn’t mention it on HIStalk since I clearly do multiple times, and once the spots are assigned, it’s too late. I can say this so far having had several conversations with the sponsor: HIStalkapalooza (#HIStalkapalooza14 on Twitter) is going to be amazing.

Upcoming Webinars

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.

Webinar questions? Contact Lorre.

1-11-2014 8-15-37 AM

Respondents think ICD-10 will challenge hospital CIOs more than other high-profile issues in 2014. New poll to your right: how much impact will IBM’s Watson computer have on healthcare?

1-11-2014 3-48-30 PM

1-11-2014 4-27-21 PM

Speaking of Watson, IBM announces plans to spend $1 billion to improve Watson’s slow sales progress, with most of the money earmarked to bring in more salespeople and consultants and to create an app store program. The smothering hype after Watson’s “Jeopardy” performance obviously set unreasonable expectations, so there’s a little bit of desperation as it slides in the Trough of Disillusionment. At least it’s being used: Elsevier will employ the technology to enhance the online search capabilities of its medical journals and textbooks, allowing users to search by natural language questions rather than a list of keywords.

1-11-2014 9-21-29 AM

Welcome to new HIStalk and HIStalk Connect Platinum sponsor Voalte (that’s pronounced “volt,” in case you were wondering.) The Sarasota, FL-based company provides caregiver-connecting mobile technology that includes Voalte One (all-in-one smartphone communication including VoIP calling, alarm notification, and text messaging), Voalte Me (secure texting that can be used securely on personal smartphones), and Voalte Connect (mobile device management, powered by AirWatch). Available case studies include Cedars-Sinai, Texas Children’s, and Sarasota Memorial. I interviewed Trey Lauderdale, president of the company, in September and we talked a lot about pagers, medical device alarms, and BYOD. Thanks to Voalte for supporting HIStalk.

Here’s a demo of Voalte One that I found on YouTube.

Stuff you can do to support HIStalk: (a) sign up for email updates, thereby entering an exclusive club of 11,194 well-informed and slightly offbeat healthcare IT experts; (b) connect with us on Facebook, Twitter, and LinkedIn so that Inga, Dr. Jayne, Lorre, and I can pretend we are socially active despite the reality of spending most of our time alone in front of a computer; (c) join the HIStalk Fan Club that reader Dann started in 2008, which now has 3,349 members who are all above average and cute besides; (d) send me news and rumors so I don’t miss something important; and (e) peruse a few ads of sponsors and their listings in the Resource Center, confident that despite your differences with their role as vendors and yours as a prospect, you all show your innate coolness by reading HIStalk for sophomoric humor and scandalous rumors.

Listening: Ozma, serving up Pasadena-based power pop since 1995 and best known as being Weezer’s tour mates (not to mention sounding a good deal like them). They are better than you might expect.

1-11-2014 2-43-08 PM

Quality Systems announces that it will review certain assets in its NextGen Hospital Solutions division and record a charge against those assets in Q3. The announcement mentions the division’s poor performance and implementation backlog. The company also announces that its Q3 results will fall short of expectations due to poor Hospital Solutions Division results, a reduction in capitalized software development expense, and higher expense amortization related to new versions of NextGen Ambulatory. The hospital division is made up of the acquired Opus Healthcare Solutions and The Poseidon Group.

1-11-2014 8-50-37 AM

The White House fires Canada-based CGI Federal from the Healthcare.gov project, handing Accenture a one-year, $90 million, no-bid contract. The outcome of that should be interesting.

I’m getting a little bit annoyed by carefully cloaked Twitter bragging disguised as humility, i.e. “Thanks to all my great co-presenters at XXX conference” or “I’m honored that XXX Magazine has chosen to run my article.” We get it, you are wonderful and way better than the rest of us. 

1-11-2014 4-07-12 PM

Andrew Ury, MD, who founded Practice Partner and sold it to McKesson in 2007, raises $1.9 million in funding for his new venture, ActX. The Seattle startup is working on technology to incorporate patient genomic information into medical practice.

1-11-2014 10-04-46 AM

Five University of California medical centers test the use of game-based clinician education sent to their smartphones in small sections over a three-month period. It’s delivered by Harvard-based Qstream, whose primary offering supports sales rep coaching. 

Harvard Business Review finds that the impact of potentially disruptive retail clinics has been disappointing, with slow growth, little expansion to underserved areas, and an unclear impact on healthcare spending. Reasons: (a) poor people would rather go to the ED for free than pay even low retail clinic prices; (b) the clinics are usually staffed by nurse practitioners , whose reimbursement is less than that of physicians; and (c) Medicaid doesn’t want to pay for services delivered by retail clinics. In other words, hospitals are so unwilling or unable to make ED abusers pay that the market can introduce no acceptable alternative. It’s tough to compete with “free.”

1-11-2014 10-28-16 AM

ONC is looking for someone to lead its EHR certification team.

In Australia, an anesthesiologist says he’s being harassed by his hospital employer after complaining that a study of blood transfusion patients failed to de-identify them properly, allowing him to easily determine their names via an Internet search.

Bill Gurley, a partner in Benchmark Capital (Uber, Zillow, OpenTable, and Yelp) is looking for  “orthogonal/disruptive” approaches that don’t “partner closely with current players.”

Phoebe Putney Memorial Hospital (GA) fires two employees over two PHI-containing laptops that were stolen from one of its clinics in November, hinting that the terminated employees violated the hospital’s policies.

1-11-2014 10-48-13 AM

@Farzad_MD tweeted this table from an Annals of Internal Medicine “study of studies” article showing good historical outcomes for healthcare IT, leading me to accept his broadly issued challenge of, “I bet the next negative study of some bad health IT implementation gets more ink.” I pondered this and concluded that negative articles are more popular because:

  • With the money and effort involved with implementing systems, it shouldn’t be newsworthy that they work and provide ROI and patient value. It should instead be newsworthy when they don’t.
  • It’s still hard to convincingly prove that healthcare IT saves money or improves outcomes, and experience is still inconsistent because of not only lack of standardization, but even the lack of consensus that standardization is a good thing.
  • Successful implementations often don’t have any conveniently easy lessons to learn since they often involved big organizational commitment and slow, steady progress. The closest thing to a magic bullet is not what to do, but what to avoid doing, and the negative articles call out those potential potholes.
  • Technology is incorrectly viewed by technologists as the solution rather than a way to enhance the effectiveness or ineffectiveness of a given organization. Amazon doesn’t make you smarter – it just makes it easier to buy the kind of books you already read.
  • The industry is small and there’s always animosity toward a given vendor or provider organization based on personal or organizational history.
  • People feel superior when someone else fails in ways they are convinced they themselves would never be guilty of doing.
  • Organizational HIT success often is accompanied by selective user discontent, so it’s common for a physician to write emotional editorials against the intrusion of technology (as well as government, health systems, and insurers) into the practice of medicine while their employer can demonstrate positive improvements from that very same technology. The “organizational good” story gets buried if it’s written at all, while the “public good” story gets even less exposure.
  • Most of the people writing don’t have any direct experience with healthcare IT or reading peer-reviewed journals and find it easier to make names for themselves with sensationalistic or negative headlines pulled from questionably newsworthy source stories. 
  • Organizations with successful HIT outcomes don’t get any benefit from telling the world about their experiences, while those that fail are usually mad at someone they blame instead of themselves and are happy to talk about it.

HIMSS exhibitors, take note of “Confessions of a Former Booth Babe,” written by a “brand representative” assigned to the huge CES in Las Vegas. Her summary: (a) at $25-$50 per hour, it pays better and was at least less demeaning than being a shot girl or go-go-dancer; (b) it’s the hiring company and not the attendees that sets the level of lewdness; and (c) you know what you’re being hired to do if the application requires full-body photos rather than sales experience. Another expresses discomfort with photo-seeking male attendees who are far right on the horndog-pervert continuum: “You kind of wonder where your picture’s going to end up. I had someone ask to take a picture just of my feet. One guy asked to take a picture of me while I was wearing nude fishnets. Then, after he took the photo, he wanted to talk to me about his pantyhose fetish.”

Weird News Andy titles this story “Right Bullet, Wrong Gun.” A couple finds via DNA testing that their daughter, born by artificial insemination in 1992, was fathered by a fertility clinic employee rather than the husband who provided sperm. Testing suggests that the part-time employee may have swapped out his own sperm sample for that of hundreds of prospective fathers. The couple is urging former clinic patients to have the DNA of their children tested.

1-11-2014 3-54-51 PM

WNA says he can’t put his finger on what’s wrong with this story, which he names “Proctally Perfect in Every Way.” Researchers develop an artificial robotic butt for teaching medical students to perform prostate exams. It warns them not only if they press too hard, but also if they don’t make enough eye contact beforehand. I can think of far more lucrative consumer applications.

Vince is wrapping up his HIS-tory series after a several year run on HIStalk, which leaves me disappointed since I enjoy the heck out of them. His next-to-last one tries to untangle the remaining hairball of McKesson’s acquisitions that turned into 200 products.


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

More news: HIStalk Practice, HIStalk Connect.


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January 11, 2014 News 1 Comment

News 1/10/14

January 9, 2014 News 3 Comments

Top News

1-9-2014 10-34-30 PM

inga thumb Merge Healthcare discovers in an internal review that a former sales employee falsified the existence or amount of certain customer contracts. Merge had not invoiced any of the customers or recognized revenues, meaning previously reported results are not affected. However, the company reduced its non-GAAP subscription backlog totals over 25 percent from prior statements. The sales rep, who had been paid about $250,000 in commissions on the invalid contracts, has admitted to falsifying the orders and has offered to pay restitution. Merge has referred the matter to the US Attorney’s Office. While the rep’s actions are reprehensible, I am sure that plenty of sales veterans (me included) in HIT and other industries are aware of other instances of  “creative accounting” in order to hit quotas.

Reader Comments

1-9-2014 10-35-38 PM

From Politico: “Re: Greenway. Major layoffs this week.” Unverified, but reported by several readers, one of whom gave a number of 80 affected employees.

From Nasty Parts: “Re: Carrollton is cratered. Rumor is 150 people downsized at Greenway’s former HQ, including the VP of HR. This comes on top of an exodus of sales executives, including two VP. Approximately 10 of the top reps have left, many because they did not want to sign the feared Vista non-compete. Also, word is that the HQ of SuccessEHS, another Vista acquisition, was also cleaned out today.” Unverified, but Nasty Parts has been right several times in the past. We didn’t receive a response to our inquiry.

From Xflo-Bee: “Re: Cerner. I’m hearing a lot of buzz on the wire about Cerner being the focus of a big lawsuit over a state reporting SNAFU. Can anyone verify?”

From Bob A. Booey: “Re: MU attestation. We’re having an awful time trying to attest for 2013 MU on the CMS website. Here is the response from CMS. ‘We have been notified that the Registration and Attestation Application is experiencing technical difficulties. This is currently being investigated. At this time, we do not have an estimated time for resolution. Please try again later. We apologize for any inconvenience this may cause.’”

1-9-2014 10-15-33 PM

From MT Hammer: “Emdat. A new banner on Emdat’s website points to another Nuance acquisition.”

HIStalk Announcements and Requests

inga thumb Here’s some HIStalk Practice highlights from the first week of 2014: doctors who Google patients. CMS wants to ban abusive prescribers from government programs. Free app Figure1 allows physicians to share de-identified photos of medical conditions. Patients from practices affiliated with University Hospital (GA) embrace the health system’s Epic portal. Montana requires insurers to reimburse telehealth visits at the same rate as in-person visits. Brightree and athenahealth will share patient referral data. Dr. Gregg provides insight on why some physicians choose to remain independent. While you are stopping by, sign up for the email updates so you don’t miss a post. Thanks for reading.

inga thumb We sent our sponsors an email earlier this week about our activities at the HIMSS conference, so if you should have seen this and didn’t, email me

1-9-2014 12-56-29 PM

inga thumb Speaking of HIMSS, I ran across this infographic depicting the importance of social media during HIMSS14. Mr. H, Dr. Jayne, and I will be providing occasional updates on Twitter, but you’ll also want to make sure you are following Lorre (@Lorre_HIStalk). She’ll be manning our HIStalk booth (#1995) and passing along our impressions of the exhibit hall’s best and worst booths, as well as tips for finding the coolest swag, free cocktails, and good coffee.

Last chance: HISsies nominations will close shortly, so nominate your choice for Best Vendor, Best CIO, etc. ASAP.

HIStalkapalooza details and registration will be available next Wednesday, January 15. We’re getting a bunch of emails every day asking about it, so please save us some time by hanging in there until next week. Our primary sponsor still has spots for two more co-sponsors who will be recognized in a variety of ways, so email me if your company is interested.

1-9-2014 9-34-01 PM

Welcome to new HIStalk Gold Sponsor Wide River Consulting. The Lincoln, NE-based company offers healthcare IT consulting services with an emphasis on serving hospitals in rural and underserved communities. Wide River has helped 50 Critical Access and Rural Hospitals that were struggling to keep up under the weight of ICD-10, MU, EHR upgrades, and PQRS reporting, often with vendors that find it challenging to send people to their locations. The company offers a wide range of technical and engineering services through a partnership with Sterling. Executive Director Todd Searls tells me that with the REC grants ending, PPCPs and CAHs need a low-cost way to keep forging ahead with Meaningful Use and Wide River can help. The company’s ICD-10 services are a big hit as well. CAHs can get a one-year subscription to Wide River’s Meaningful Use Help Desk for $175 per month and providers can sign up for $60 per month, gaining access to experts who can help with MU-related questions ranging from patient portals to exclusions. The company’s goal is to help teach small and rural hospitals to succeed with the resources they have, even helping them form mini-HIT co-ops. Thanks to Wide River Consulting for supporting HIStalk.

Upcoming Webinars

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.

Acquisitions, Funding, Business, and Stock

Shareholders of Health Management Associates approve the previously announced $3.9 billion sale of the hospital chain to Community Health Associates.

Endo Health Solutions will sell its HealthTronics business to Altaris Capital Partners for total consideration of up to $130 million, including $85 million in cash upfront. HealthTronics is a provider of urological products and services, including the UroChart EHR and meridianEMR systems.

1-9-2014 10-42-01 PM

Lumiata, formerly known as MEDgle and the developer of a predictive analytics platform for healthcare, closes a $4 million Series A round led by Khosla Ventures.


1-9-2014 10-47-00 AM

Dameron Hospital Association (CA) selects Allscripts Sunrise clinical products suite.

1-9-2014 12-22-08 PM

Presbyterian Senior Living (PA) will implement AOD Software’s long-term care EHR across its 23 locations.


1-9-2014 11-23-59 AM

VMware promotes Ben Fathi from SVP to CTO.

1-9-2014 11-23-15 AM

Telehealth solution provider AMC Health names John Larus (Clinipace) SVP of solutions development for the clinical trials division.

1-9-2014 11-21-57 AM

RCM provider Encoda names Michael Kallish (RemitDATA) CEO, replacing co-founder William Cox, who will assume the role of president and CTO.

1-9-2014 11-53-23 AM

Impact Advisors appoints Steven Schlossberg, MD (Yale School of Medicine) VP/CMO.

1-9-2014 12-15-42 PM

Surescripts announces that CEO Harry Totonis will step down effective March 2014 and that it has hired an executive search firm to find his successor.

AHIMA members elect Angela Kennedy (Louisiana Tech University) as president/chair of the board of directors, a role she has held since June following the death of Kathleen A. Frawley. Members also elected Cassi Birnbaum (Peak Health Solutions) president/chair elect; Jennifer McManis (Crowley Fleck Attorneys) speaker of the house; and Zenethia Clemmons (HHS OCR), Virginia Evans (Emory Healthcare), and Colleen Goethals (Midwest Medical Records Association) directors.

Southcoast Health System (MA) hires Greg Robinson (AltaMed Health Services) as executive director of enterprise informatics.

Announcements and Implementations

ICUcare and IEEE will collaborate to develop a universal industry standard/specification and a free web-based middleware API to help healthcare providers map data from medical devices to EHRs and other health information systems.

1-9-2014 12-04-06 PM

Advocate Eureka Hospital (IL) implements electronic patient and e-forms technology from Access.


1-9-2014 11-05-23 AM

The Institute of Medicine proposes a standard framework to help providers identify and quantify the costs and benefits of EHR implementations.

Non-profit hospitals paid their CEOs a mean compensation of $594,781 in 2009, according to a JAMA Internal Medicine-published report. Hospitals with high levels of advanced technologic capabilities compensated their CEOs $135,862 more than hospitals with low levels of technology.

A Reuters article says that drug companies, with newly limited access to doctors per PPACA requirements, are moving their sales efforts to EHRs. It mentions Practice Fusion, which sells EHR pop-up ads, and EHRs that email refill and vaccine reminders that don’t clearly state if the message is sponsored by a drug company.

Weird News Andy says the appropriate ICD-10 code is “X59.9 or X12 or combination thereof.” At least 50 people are scalded from emulating TV weather people who tossed boiling water into cold Midwestern air to watch it freeze.

Sponsor Updates

  • AirWatch wins three 2014 Compass Intelligence Awards in the enterprise mobility category, while AT&T was named the best service provider in the health and wellness category, as well as a winner in multiple non-healthcare related categories.
  • Lexmark’s Perceptive Software launches Perceptive Media Connector, which enables the cloud-based capture, management, and access of video content with the Perceptive Content client interface.
  • Ping Identity opens registration for Cloud Identity Summit 2014, scheduled for July 19-22 in Monterey, CA.
  • KLAS extends a high early-performance score to Health Catalyst for its healthcare-specific analytics platform.
  • ChartWise Medical Systems and TrustHCS partner to offer ChartWise’s CDI software with TrustHCS’s coding services and ICD-10 education.
  • Ellis Medicine (NY) cut overtime costs by $721,000 during the first six months after deploying API Healthcare’s workforce management technology.

EPtalk by Dr. Jayne


After several extremely slow news weeks, I’m glad to see things are starting to heat up. I’ve heard a lot of buzz about the Consumer Electronics Show, which is taking place this week in Las Vegas. Several readers have sent me blurbs about wearable tech. I’m not nearly as much of a fashionista as Inga, but I do like to keep an eye on the trends, especially when they’re related to health IT.

The first product I looked at was the wearable ambulatory blood pressure monitor from iHealth. It’s both USB- and Bluetooth-enabled and allows for blood pressure readings at intervals of 15-120 minutes. Most home blood pressure monitoring units are bulky and patients are not as compliant as they might be. It is compatible with both iOS and Android and can store up to 200 measurements. It reminds me a bit of a futuristic version of the shoulder holsters worn by 1980s television cops, but with a touch of neoprene.


The company also has a wireless ambulatory ECG device that looks pretty cool. Instead of having multiple sticky leads attached to the patient, it has a single unit that is worn under clothing. In keeping with the throwback 80s vibe, it reminds me of the handset of a vintage rotary phone, although it doesn’t appear to come in avocado green or harvest gold. Bluetooth connectivity to iOS allows for real-time transmission of readings. Both it and the blood pressure monitor are still awaiting FDA clearance and pricing isn’t yet available, so put your credit cards away.

Another reader sent me an article about the need to design tech wearables for women. I was excited to read about Ringly, which is creating jewelry and accessories that receive notifications from the wearer’s mobile phone. Being alerted by jewelry would be much nicer than the incessant phone checking I see. After recently working in an office where the front desk staff notified the back office of patient readiness using an extremely loud intercom (“patient for Dr. Jayne!”) I wonder if we could tie it to the EHR patient tracker. Ringly’s goal is to create jewelry that looks like jewelry rather than gadgets and also to allow users to leverage its app to prioritize the alerts they receive.

Don’t get me wrong, gadgets can be cool. I wear a Garmin when I run that screams, “Hey, I’m a GPS! No way you’re mistaking me for a watch!” I’m not crazy about how it looks, but its function makes it tolerable. On the flip side, there’s Everpurse, which can charge a cell phone on the go and looks nice as well. Although they’re sold out of virtually everything except the persimmon leather clutch, I might have to keep an eye on the site for new offerings.

Looking back at some of the promotions from the Consumer Electronics Show, Intel has launched its Make it Wearable contest to help identify the next generation of accessories. Maybe someone will develop a white lab coat with a sensor to track the level of dirt on the cuffs or the time since it was last laundered. I can think of a couple of physicians who would benefit from that functionality.

How about a patient hospital gown that alerts you when your backside is flapping in the breeze or one that self-adjusts to prevent unintended exposure? The video clip on the Intel website showed a dress that appeared to be zipping itself, so it might just be in the realm of possibility. Maybe next year Inga and I should include the Consumer Electronics Show in our meeting and convention plans. Have a connection that can help us register? Email me.


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

More news: HIStalk Practice, HIStalk Connect.


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January 9, 2014 News 3 Comments

News 1/8/14

January 7, 2014 News 1 Comment

Top News

1-8-2014 6-34-26 AM

Two healthcare-focused private equity firms will invest $77.5 million to take minority positions in MedHOK, which offers care, quality, and compliance software.

HIStalk Announcements and Requests

1-8-2014 5-29-05 AM

Welcome to new HIStalk Gold Sponsor Coastal Healthcare Consulting. The Mountlake Terrace, WA-based company has completed 850 engagements and won numerous KLAS clinical implementation awards since its founding in 1995. Most of its consultants have been with the company for at least 10 years. Offerings include Catalyst (SWAT team project crisis response), Convergence (reducing denied claims), Fusion (linking technology to clinical processes), and Wave (application support, workflow analysis, system build, and activation). Product expertise includes Allscripts, Cerner, Epic, GE Healthcare, and Meditech. Industry long-timer Amy Noel, RN is CEO of the company. Thanks to Coastal Healthcare Consulting for supporting HIStalk.

Upcoming Webinars

January 9 (Thursday), 2:00 p.m. Beyond the Summits. Sponsored by HIStalk. Presenters: Ed Marx, SVP/CIO, Texas Health Resources, and Elizabeth Ransom, MD, FACS, EVP/clinical leader North Zone, Texas Health Resources. Everyday healthcare executives share leadership and teamwork principles they learned from climbing some of the world’s highest peaks over the last four years.

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.

Acquisitions, Funding, Business, and Stock

1-7-2014 11-51-07 AM

Press Ganey acquires On The Spot Systems, developer of a real-time data capture system for patient feedback, and launches Point of Care, a solution that allows providers to capture patient feedback via tablets and mobile devices.


Mount Sinai Health System (NY) selects MU Assistant from SA Ignite to automate its MU attestation process.

The Guam Regional Medical City hospital will deploy Allscripts Sunrise EHR and Financial Manager platforms when it opens in late 2014.

The Department of Defense awards Carestream Health a  one-year, $70.2 million contract for medical imaging technology.


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McKesson Specialty Health and the US Oncology Network appoint Jeffrey Kao (Coventry Health Care) CIO/SVP of information and technology services.

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T-System promotes Mark Horner from VP of client services to SVP/GM of RevCycle+ and  expands CFO Steve Armond’s duties to include leading the company’s documentation solutions.

1-7-2014 8-07-10 AM

Jacob Nguyen (Craneware) joins VitalWare as EVP of business development and operations.

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Vocera names Rhonda Collins (Fresenius Kabi, USA) chief nursing officer and promotes Steve Jackson from COO of its ExperiaHealth division to chief strategy officer.

1-8-2014 7-34-58 AM

David Cerino (Zynx Health) is named CEO of WiserCare.

Announcements and Implementations

1-8-2014 7-02-06 AM

Fairfield Medical Center (OH) goes live this month with a fingerprint ID system from CrossChx.

Harrison Medical Center (WA), which affiliated with Franciscan Health System last year, will switch to Epic this summer.

Riverside Medical Center (IL) implements the DebMed electronic hand hygiene compliance monitoring system.

Wesley Medical Center (KS), Cypress Surgery Center (KS), and Surgery Center of Kansas go live on Anesthesia Touch from Plexus Information Systems.

inga thumb McKesson announces the general availability of its Paragon Ambulatory Care Practice Management solution, which is an extension of its single database HIS for inpatient facilities and designed for hospital-owned practices. I understand the PM module was developed internally, as opposed to a bolt-on of one of McKesson’s acquired products, and that an EHR module is also in the works. Sounds like McKesson is positioning itself to compete with Epic and Cerner in the IDN market.

Government and Politics

The Office for Civil Rights proposes an amendment to the HIPAA privacy rule to allow certain entities to disclose the identities of individuals with mental health “prohibitor” status to the gun background check system. The change would apply to individuals who have been involuntarily committed to a mental institution; found incompetent to stand trial or not guilty by reason of insanity; or otherwise deemed by a lawful authority to be in danger of themselves.

CMS reports that more than 30,000 hospitals, physicians, and medical equipment providers are using its online esMD documentation system instead of mail or faxes for auditor medical record requests and prior authorizations requests for power mobility devices.

1-8-2014 6-01-46 AM

A new OIG report says CMS and its contractors haven’t done enough to address Medicare fraud related to EHRs. It recommends that CMS provide guidance to its contractors on detecting fraud and suggests they review provider EHR audit logs. The report identifies inappropriate EHR copy-pasting and creating of false documentation to support higher charges as key fraud issues. CMS responded by saying it will develop copy-paste guidance and identify best practices for its contractors to detect fraud associated with EHRs.

Innovation and Research

South Dakota philanthropist T. Denny Sanford donates $125 million to Sanford Health (SD) to support the incorporation of genomics into the health system’s primary care programs, including added genetic testing information to the EHR to allow clinicians to personalize drug therapies. Sanford has donated $1 billion to the health system that bears his name.


1-7-2014 9-42-35 AM

QlikTech’s QlikView earns the top spot among business intelligence products in a KLAS report on the healthcare analytics market.


inga thumb According to a JAMA-published study, not too many physicians are joining Mr. H’s smoking doc for smoke breaks. Only about two percent of physicians admit to smoking, compared to 16 percent of the general population and 25 percent of licensed practical nurses.

1-7-2014 8-31-06 PM

A local paper profiles Whidbey General Hospital (WA), which experienced critical cash flow issues during its transition to Meditech. The hospital claims its billing process was abnormally slow after the system went live in May and caused A/R levels to climb and cash on hand to decline. The hospital, which expects to spend $7.5 million on its Meditech installation, is recovering. The paper incorrectly blames the ACA rather than than HITECH for requiring the use of EMR to avoid financial penalties.

A federal judge dismisses a patient’s lawsuit that charged a healthcare provider violated HIPAA laws when an employee’s laptop was stolen. The judge ruled that only HHS can enforce HIPAA and individuals do not have the right to bring lawsuits for its enforcement.

1-7-2014 8-50-30 PM

The Pittsburgh paper profiles hospital pharmacy automation vendor Aesynt, the former McKesson Automation / Automated Healthcare that was sold to Francisco Partners in November. It says the company has developed new hospital drug management software being tested by UPMC and Intermountain. President and CEO Kraig McEwen says the company has introduced more products in the past 12 months than in the past five years. He also says the company is looking for acquisitions  that will help it expand its offerings for reducing hospital drug costs.  

IBM’s “Jeopardy”-winning Watson computer is falling far short on the company’s revenue targets. Healthcare is its most promising market, but a $15 million M.D Anderson cancer genomics project is “in a ditch” according to the IBM executive in charge. A Watson oncology regimen project at Memorial-Sloan Kettering could go live later this year. IBM’s business plan calls for Watson to contribute $1 billion in annual revenue by 2018, but it has only generated $100 million in its three-year existence. The main problem is the effort required for engineers to program Watson for each business case so that it can learn from available information.

1-8-2014 6-53-33 AM

Massachusetts will launch the second phase of the Mass HIway HIE Wednesday at Beth Israel Deaconess Medical Center. The HIE  has received $55 million in federal funding.

E-Health Ontario, the provincial agency tasked with creating EHRs for all Ontarians, will share $2.3 million in performance bonuses across its 704 staff members. The payout follows a court settlement that restored payouts that were cancelled in 2011 as part of a controversial wage freeze.

John Lynn of EMR and HIPAA is producing an April 7-8 Las Vegas conference covering healthcare IT marketing and PR.

James Parks, former COO/CIO of Box Butte General Hospital (NE), is indicted on seven counts of child pornography after the hospital reports finding explicit content on his computer.

The governor of Minnesota blames IBM for problems with its state-run health insurance exchange that launched October 1. Minnesota Governor Mark Dayton sent a highly critical letter to CEO Ginny Rometty last month that blamed the company for a laundry list of items:

Your product has not delivered promised functionality and has seriously hindered Minnesotans’ abilities to purchase health insurance or apply for public health care programs through MNsure…. your product has significant defects, which have seriously harmed Minnesota consumers.

Sponsor Updates

  • CCHIT certifies that the Arcadia Analytics Meaningful Use Calculation Engine v1.0 is compliant with the ONC 2014 Edition criteria as an EHR module.
  • PeriGen recognizes Barbara LaBranche, senior director of clinical informatics design and usability, for being named an EHR Game Changer.
  • Muhammad Chebli, interoperability product manager for NextGen Healthcare, discusses the importance of interoperability in achieving MU2 objectives, particularly summary of care.
  • Liaison Technologies reveals its top predictions for 2014, including the dramatic growth of data integration complexity and the normalization of mass customization.
  • Nuance Communications demonstrates wearable devices with Dragon Mobile Assistant and Swype keyboard for smartwatches at this week’s CES 2014 in Las Vegas.
  • Prominence Advisors is named one of the 50 top Chicago employers of Generation Y employees (those aged under 33).
  • Visage Imaging releases a demo video shot at RSNA of its Visage 7 Enterprise Imaging Platform.


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

More news: HIStalk Practice, HIStalk Connect.



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January 7, 2014 News 1 Comment

Monday Morning Update 1/6/14

January 4, 2014 News No Comments

From The PACS Designer: “Re: Google Apps starter. With the continued growth of mobile devices, Google has exploited this trend with a mobile app landing platform for the iPad, iPhone, Android Tablet, and Android Phone. Now and in the future it will be easier to get apps to play on no matter which mobile device you may have in your possession as Google expands this landing platform with even more mobile solutions.” Google is everywhere these days, but I’m finding their apps less capable and more annoying. They tie everything into your Gmail account even when you don’t want them to, and the initially intriguing minimalist design of all Gmail-related apps is now just as annoying and clunky as a 1980s Invision screen (example: Gmail doesn’t support using the Delete key to delete an email, instead going the proprietary/obscure route by using the E key instead.)

1-4-2014 8-19-56 AM

Poll respondents find Medicare’s fraud-sniffing efforts to be unimpressive. New poll to your right: what will be the biggest challenge for hospital CIOs in 2014? The length of the list suggests the challenges inherent in that job.

Upcoming Webinars (Times are Eastern) 

1-4-2014 2-32-14 PM
January 7 (Tuesday), 1:00 p.m. Clinical Analytics for Population Health Management. Sponsored by HIStalk. Presenter: Cora Sharma, principal analyst, Chilmark Research. As providers move from fee-for-service to value-based payment models, they must not only comply with ever-proliferating quality metrics, but also transition from a cost-plus business model to one of cost containment. 

January 9 (Thursday), 2:00 p.m. Beyond the Summits. Sponsored by HIStalk. Presenters: Ed Marx, SVP/CIO, Texas Health Resources, and Elizabeth Ransom, MD, FACS, EVP/clinical leader North Zone, Texas Health Resources. Everyday healthcare executives share leadership and teamwork principles they learned from climbing some of the world’s highest peaks over the last four years. 

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.

HIStalk-sponsored webinars are non-commercial presentations of broad interest. I appreciate our pro bono presenters, who get a sizeable audience and recognition without the frustrations involved with presenting at a conference. Contact me if you’d like to present.

1-4-2014 9-21-20 AM 1-4-2014 2-33-19 PM

Welcome to new HIStalk Gold Sponsor The Loop Company. The Williston-VT-based research advisory firm helps companies launch new offerings, enter new markets, win more business, and create customer loyalty. They design programs to help companies understand how the market perceives them and can help improve sales, marketing, product development, and operations. It’s a new venture from old HIStalk friend and industry long-timer Gino Johnson, who created the excellent CapSite healthcare IT research and advisory firm that HIMSS acquired and rolled into HIMSS Analytics in October 2012. Thanks to The Loop Company for supporting HIStalk.

HISsies nominations continue, so please submit yours now. It will only take a couple of minutes and you can skip categories you aren’t interested in.  I’m enjoying reading the early nominations for worst vendor, Lifetime Achievement Award, and the always-popular “industry figure with whom you’d most like to have a few beers.” Long-time readers may remember years ago when Jonathan Bush won that category (as he often does) and agreed to let me auction off an evening with him as a charity fundraiser.

Listening: Blue Coupe, made up of hard-rocking 1970s legends Dennis Dunaway (the shamefully underappreciated bass player and principle songwriter for Alice Cooper when it was a real band) and the Bouchard brothers Joe and Albert (key members of Blue Oyster Cult), thus the band’s name as a nod to the respective histories of its members. The band started out playing Alice Cooper covers, but earned Grammy attention for new material in 2011/2012.

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

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In Australia, the ambulance service of New South Wales requires a government bailout after its aborted EMR and billing system project left it with $7.5 million in invoices it couldn’t send out.

North Carolina, which just passed a law requiring hospitals treating Medicaid patients to participate in the state HIE, sends out nearly 50,000 new Medicaid cards to the wrong people.

1-4-2014 10-57-35 AM

Intelligent InSites names investor and executive board chair Doug Burgum as interim president and CEO, replacing Margaret Laub, who has left the company. Burgum founded accounting software vendor Great Plains and sold to Microsoft in 2000 for $1.1 billion.

Weird News Andy likes the story that he titles “Print a Liver – 2014,” to which he adds a “Silence of the Lambs” pop reference in wondering if they can also print a nice Chianti (although I seem to remember that the book instead said “big Amarone” before Hollywood dumbed down it down for less oenophilic  moviegoers.) A California biotech firm says it will successfully use 3D printing to create a human liver (or more precisely, a working model of a human liver suitable for drug company research) by the end of this year.

“Taking from Peter to Pay Paul” is WNA’s assessment of a survey of doctors in England, in which a third of them want to charge each ED patient $16 to to discourage usage for minor complaints. The patient counterpoint would be that appointments are hard to get and practices are closed nights and weekends. We have similar challenges here, obviously: the ED is always open and free if you can’t or won’t pay, while urgent care isn’t always open and they expect money upfront.

1-4-2014 1-17-29 PM

Strange: a medical student examining a standardized patient (an actor playing the role of a patient) pretending to have an abdominal aortic aneurysm detects the actual condition, alerting the instructing physician to urge the man to see a cardiologist. He does and is found to require stent replacement surgery. According to the patient’s wife, “Jim’s life was saved by a UVA medical student, no doubt about it.”

Vince covers the $14.5 billion acquisition of HBOC by McKesson in this week’s HIS-tory. I think he’s planning to wrap up his HIS-tory series after the next couple of installments. I will miss them since I have enjoyed every one.


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

More news: HIStalk Practice, HIStalk Connect.


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January 4, 2014 News No Comments

News 1/3/14

January 2, 2014 News 3 Comments

Top News

1-2-2014 7-58-42 PM

President Obama announces that he will nominate Leon Rodriguez, director of the Office for Civil Rights of HHS that enforces HIPAA, for Director of Citizenship and Immigration Services in the Department of Homeland Security.

Reader Comments

1-2-2014 7-45-24 PM
Photo: Brian Snyder/Reuters

From DZA MD: “Re: Baystate Medical Center. Cerner PowerChart crippled with record inpatient census and Nor’easter in full effect. Unable to process timely discharges before brunt of storm arrives.” Unverified. As I write this Thursday evening, Massachusetts is about to get nailed by a winter storm that will bring up to 30 inches of snow in places with wind chill as low as 20 degrees below zero and even colder Friday night.

From Dirk Benedict: “Re NextGen lawsuit. Mountainview Medical Center in Montana sues NextGen, saying it didn’t install its $441,000 EHR system as promised.” The six-bed hospital contends that NextGen was to install a system “which would permit MVMC to demonstrate ‘meaningful use’ of such electronic health records through all stages of applicable federal regulations” and was to complete implementation by October 1, 2013. According to NextGen’s website, NextGen Inpatient Clinicals EHR 2.6 is 2014 Edition certified as a modular EHR, so it’s difficult to determine what the exact issue(s) might be. NextGen provided us with this statement:

We cannot comment on the pending litigation, other than to say that we firmly believe the allegations made by Mountainview Medical Center are without merit and we will defend against them vigorously. We confidently stand behind the quality and performance of our products and offerings.

1-2-2014 6-06-14 PM

From Intractable Vermonting: “Re: Vermont health insurance exchange. The cost overruns have been tremendous and the politicians responsible pass it off as ‘changing project scope costs money.’ 99 percent of all IT leaders in the US would be fired if they managed a project in this fashion. Also, security is the last thing that is built into the technology before it goes live and I am sure there were shortcuts taken with all these exchanges. The hackers know that most sites require Social Security number to register.” The Vermont Health Connect insurance exchange website is the most expensive IT project ever undertaken in the state, running up a tab of $172 million, of which the federal government contributed $48.7 million. One big contractor was the ever-present CGI, which managed to turn its $42 million contract into $84 million worth of billables while missing key deadlines that kept the site from being ready on October 1. CGI was smart: the state says the delays cost $26 million, but CGI’s contract says it can be penalized a maximum of $5 million.

HIStalk Announcements and Requests

1-2-2014 5-48-35 PM

It’s time for the HISsies nominations. What’s your choice for “Stupidest Vendor Action Taken,” “Most Overused Buzzword,” “Industry Figure With Whom You’d Most Like to Have a Few Beers,” and “HIStalk Healthcare IT Industry Figure of the Year?” Enter your nominations, from which the most-nominated choices will go on the final ballot in a week or so. That means no complaining if your choice isn’t on the ballot and you didn’t nominate them.

1-2-2014 6-15-48 PM

HIStalkapalooza registration will open up the week of January 13. Read HIStalk religiously for the link to the signup notice in the next couple of weeks. We fill up really fast every year. Above is a photographic hint of the venue for those wondering. The primary sponsor has a couple of co-sponsors whose support will allow the event to be even bigger and better. If your company is interested in getting exposure as a HIStalkapalooza co-sponsor, let me know and I’ll connect you since they are willing to take on two more.

1-2-2014 6-39-01 PM 1-2-2014 6-48-11 PM

Welcome to new HIStalk Platinum Sponsor healthfinch (they tell me it’s supposed to be all lower case). The company offers RefillWizard, which improves doctor efficiency as a “Team-Based Decision Support System” that improves patient safety while reducing refill turnaround time by up to 95 percent. They begin by preparing a customized savings document like the one above and making recommendations to optimize the refill process. They have found that 62 percent of refills can be selectively and safely delegated to clinical staff, reducing the staff time to 34 seconds (some PCPs spend 1-2 hours per day just managing refills.) RefillWizard, which just won the Allscripts Open App Challenge, works either with paper protocols or integrated with the EMR. HIStalk readers probably know DrLyle (Lyle Berkowitz, MD), the company’s chairman and chief medical officer. Thanks to healthfinch for supporting HIStalk.

I found this healthfinch RefillWizard overview on Vimeo.

Upcoming Webinars (Times are Eastern) 

January 7 (Tuesday), 1:00 p.m. Clinical Analytics for Population Health Management. Sponsored by HIStalk. Presenter: Core Sharma, principal analyst, Chilmark Research. As providers move from fee-for-service to value-based payment models, they must not only comply with ever-proliferating quality metrics, but also transition from a cost-plus business model to one of cost containment. 

January 9 (Thursday), 2:00 p.m. Beyond the Summits. Sponsored by HIStalk. Presenters: Ed Marx, SVP/CIO, Texas Health Resources, and Elizabeth Ransom, MD, FACS, EVP/clinical leader North Zone, Texas Health Resources. Everyday healthcare executives share leadership and teamwork principles they learned from climbing some of the world’s highest peaks over the last four years. 

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify and extract waste from their systems

Acquisitions, Funding, Business, and Stock

Healthcare Data Solutions acquires StratCenter, a provider of healthcare provider data.

1-2-2014 9-09-48 PM

Stryker Corporation will acquire surgical sponge counting technology vendor Patient Safety Technologies, Inc. for $2.20 per share. The company’s market cap is $85 million.


1-2-2014 11-52-35 AM

In the UK, King’s Mill Hospital signs a five-year, $5.9 million EHR contract with Specialist Computer Centres and McKesson.

Medical billing company Medorizon Partners selects InstaMed’s patient payment plan technology.

The Defense Logistics Agency awards TeraRecon a maximum $30 million fixed-price contract for the procurement of radiology systems and services.

Central Georgia Health System will implement Infor’s healthcare business automation applications.


1-2-2014 11-54-08 AM

CareTech Solutions hires Daniel Lincoln (Palace Sports & Entertainment) as corporate controller.

1-2-2014 11-55-09 AM

CMS announces the retirement of COO Michelle Snyder, who supervised development of HealthCare.gov. The agency says Snyder had originally planned to retire in 2012 but stayed on at the request of CMS chief Marilyn Tavenner.

1-2-2014 3-47-05 PM 1-2-2014 3-49-03 PM

CareView Communications, which offers patient flow and safety solutions, promotes Steven G. Johnson from president to CEO, taking over for Samuel A. Greco, who is retiring for health reasons. Careview also names Sandra K. McRee (McRree Consulting) COO and appoints Jason T. Thompson to the board, replacing his father, Tommy G. Thompson.    

1-2-2014 7-26-42 PM

Direct Consulting Associates promotes Frank Myeroff to president.

Announcements and Implementations

Baptist Memorial Health Care (TN) goes live on Epic this week at four minor medical centers and at its Baptist Medical Group clinics. Four Memphis-area hospitals are scheduled for a March 11 go-live.

Government and Politics

1-2-2014 8-13-46 PM

A new North Carolina law requires hospitals with EHRs to connect to the state’s HIE and submit data on services paid for with Medicaid funds.

The Department of Defense issues an RFP to keep AHLTA and CHCS running through the end of 2018 after plans for a joint DoD-VA EMR were scrapped last year when costs were estimated at $28 billion. The value of the new contract is estimated at $250 million to $1 billion. DoD is looking at a commercial replacement for contractor-developed AHLTA, whose estimated cost to taxpayers was up to $5 billion.

Innovation and Research

1-2-2014 8-06-17 PM

A study of 295 smartphone apps that claim to prevent, detect, or manage cancer finds no published studies that prove their usefulness, effectiveness, or safety.


The FDA extends the Kinsa Smart Thermometer the first-ever 510(k) clearance for a smartphone-connected thermometer.

The US Patent and Trademark Office issues CommVault Systems a patent for efficient data management improvements, such as docking limited-feature data management modules to a full-featured data management system.


Riverside Health System (VA) announces that a now-terminated LPN inappropriately accessed the records of 919 patients over a four-year period.

Cerner completes the purchase of the 237-acre tract for its planned $4.3 billion office development in south Kansas City.

1-2-2014 12-09-10 PM

Ward County (TX) officials will give Ward Memorial Hospital an additional $200,000 to cover a budget shortfall that is partially blamed on their recent EHR implementation (Healthland Centriq, I believe.) 

A new study contradicts the Affordable Care Act assumption that putting uninsured Americans on Medicaid will reduce ED visits, instead finding that ED visits in Oregon increased by 40 percent as the newly insured sought ED for issues that could have been handled in physician offices. The primary author, an MIT economist, concludes that, “As I tell my economics students, when something is free, people use more of it.”

The Department of Justice joins the whistleblower lawsuit of two Charlotte, NC contract ED physicians who claim for-profit hospital chain Health Management Associates offered them kickbacks to order unnecessary tests and increase admissions. The doctors say HMA’s Pro-Med software was programmed to automatically order batteries of tests on ED patients based on their complaints before they were seen by a physician. They say HMA required EDs to admit 50 percent of Medicare patients whether they needed it or not, quoting a 2009 email from an HMA executive to ED managers that said, “Big declines in over 65 admissions – you know what to do!”

A Huffington Post reprinted piece by writer and medical resident Brian Secemsky, MD doesn’t have much good to say about the EMR used by the underserved clinic where he works:

After several months of receiving emails full of buzzwords such as improved care coordination and effective closed-loop med administration from the powers that be, I couldn’t help but drink the Kool-Aid and join the anticipated excitement of integrating an innovative source of technology into an over-booked and often overwhelming practice. Where my mind was brimming with images of easy-to-use tabs, high-yield keywords and a system where clinic documentation could effectively reflect patient encounters using minimal time and effort, I was instead bombarded with yet another early ’90s-style template full of odd-sized buttons and novel concepts that were the far from intuitive. The spiked punch quickly wore off the minute I first fumbled through this bulky piece of technology, and I was back to spending hours each night typing away, well after seeing the last of my patients.

1-2-2014 6-34-23 PM

Weird News Andy likes this unlikely innovation and even suggests the above graphic for advertising. A car mechanic in Argentina falls asleep after watching a YouTube video about a machine that extracts corks from wine bottles, then wakes up inspired to invent a device that uses an inflated plastic bag rather than forceps to extract babies stuck in the birth canal. Against all odds, WHO has endorsed his invention and a US device maker has licensed it.

1-2-2014 8-51-31 PM

A bizarre article concludes that the government is planning to execute US citizens. It concludes that ICD-9 code E978 (legal execution) is part of a secret plan to create an “International One World Government,” claiming that, “Even more disturbing, is finding out American citizens have been subject to the ICP Medial code for many years. Thus, giving the United Nations our private information through coding.” The article proposes a solution even more dramatic than ICD-10 foot-dragging: the US should pull out of the United Nations.

Sponsor Updates

  • Sunquest releases new versions of Sunquest Laboratory and Sunquest Molecular.
  • The Boston Globe profiles Sumit Nagpa, CEO of Alere Accountable Care Solutions.
  • Jason Fortin, senior advisor for Impact Advisors, discusses the impact of Meaningful Use in 2013.
  • EDCO Health Information Solutions posts a Point of Care Scanning Process video.

EPtalk by Dr. Jayne

I received a lot of feedback about this week’s Curbside Consult. I’ll be posting more responses to the original reader email in the next Curbside Consult, but wanted to share some quick responses in the interim.

One reader asked for more detail about how we’ve tied the physician bonuses to EHR use. I can’t claim credit for the approach since we copied it from another organization, but it has worked well. It only applies to employed physicians using the group’s EHR platform. We have a couple of practices that we have acquired that are on other systems and are not yet converted, so they are exempt for now.

Physician bonus amounts are determined by three factors: patient satisfaction, clinical quality scorecard results, and productivity. A sliding scale is used for each element. For example you might receive 100 percent of your patient satisfaction and productivity bonuses but only 80 percent of your quality bonus.

The EHR plays into that in two ways. Since we’ve been fully adopted on EHR for many years, all of our quality reporting is now derived from EHR data (no more manual chart reviews). If providers are not documenting in the EHR, their scores will be low. We initially did a hybrid approach with both manual chart review and EHR reporting while physicians were adopting, but that has been phased out. Our staffing for compliance reviews has dropped significantly. They used to take three full work days per physician and now they take two to three hours per physician.

The major way that EHR applies to the bonus, however, is simple. All visits must be documented in the EHR and must meet our minimum data standards. These aren’t a lot different than the paper chart. The visit has to be complete within 24 hours of the patient visit and has to include certain critical data elements that essentially align with CMS coding requirements. For example, documentation has to have a chief complaint, history of present illness, review of systems, review of pertinent patient history, physical exam, and an assessment and plan.

We expected this to be present in the paper world and now it’s actually easier since the data is shared across the multispecialty group rather than living in separate paper charts by location. Providers can review histories with one click rather than having to dig for histories that may have been mentioned in various progress notes. Our physicians were not particularly good at keeping the paper problem list and past / family / social history face sheets up to date on paper.

For some practices that were challenging implementations, we actually had to physically visit the practice and make sure they didn’t have shadow charts. One site didn’t have charts, but had “jackets” for each patient. We didn’t just fail them outright but gave them three months to remediate, then audited them again. Over the last few years that the EHR requirements have been attached to the bonus structure, we’ve been fair about doing pre-audits so people know where they stand, then allowing enough time for them to remediate before their final audit.

The reader also asked about the “standards” that I mentioned our physicians have to meet to stay employed. Some are pretty simple – no OSHA or CLIA violations, favorable scores on coding and compliance audits, and getting along with their partners and staff. Some are more rigorous. We have high standards for clinical quality, and physicians are graded on blood pressure control, appropriate use of drugs for coronary artery disease, cholesterol control, influenza vaccination, cancer screening (colorectal, breast, prostate), diabetes management, and a couple of others. Physicians who can’t keep their scores in the desired range are remediated (as are their office staff – many of the metrics can be improved by leveraging staff and using standing orders including vaccination and screenings).

Finally, physicians are expected to be productive – specifically, to be above the 75th percentile based on MGMA data. That’s a lot to ask, but the group makes it clear when physicians join and it’s actually spelled out in the contract. Our compensation parallels this – our physicians consistently earn salaries in the top 20 percent based on MGMA data. If they choose to work less than full time, the productivity expectations are scaled accordingly. Our retention rate has been very good. Most of the providers who leave within five years of joining have a family reason. For example, they may only work with us for a year or two while they wait for their spouse to receive a residency or fellowship appointment that requires relocation.

In addition to their bonuses, our providers also received a hefty chunk of their Meaningful Use payments as a cash bonus. This differs from most organizations I’ve talked to that tend to keep the MU payments at the corporate level. I think the way we shared them is especially surprising given the fact that our providers don’t pay anything for EHR software, training, or maintenance. The only EHR-related charge that the practices incur is for hardware, which averages $8,000 – $10,000 per provider every three to four years.

Another reader asked how we handle the EHR records with a physician who chooses to leave the organization (or is let go) yet wants to keep his or her patients and office location. It’s actually pretty easy. We have a subsidized EHR offering (under the Stark exception) so we already have local private physicians on our EHR database with independent practice data. We simply copy the charts of active patients (those seen by the provider within the last three years) into a new practice in the EHR. Only clinical data is copied, no financial data and no accounts receivable.

If the provider is on staff at one of our hospitals, he or she may be eligible for a subsidy. Otherwise they pay fair market rate and we host it similar to a SaaS model offering. Although the providers can still share data with the employed practice, they have to do it through our private HIE rather than sharing a direct chart within the multispecialty practice. Providers are charged $0.50 per chart for the copy. That’s a holdover from our old contract when we had paper charts and they paid that much for the paper charts. I have no idea where that number came from — it’s been in place for at least 15 years.

If they choose not to stay on our platform, we have a third-party consultant perform an extract based on the new vendor’s specifications. It’s the same very skilled consultant we use when we acquire practices and bring the data into our system. Once the drive goes into the Pelican case and enters the physical transport protocol, though, it’s out of our hands.

I’ve seen two physicians treated poorly by their new vendors. One took several months to move the extracted data onto the new EHR. Another simply turned the data into PDFs and parked it in the new EHR’s scanning system, which is pretty sad considering the level of discrete data we can provide. Providers can also buy a system directly from our vendor and we’ll do the extract in that situation as well.

I’ve shared a lot of fairly specific information this week, so I hope it doesn’t come back at me. Stay tuned for the next Curbside Consult. I’ll be sharing my thoughts on infrastructure and interoperability as well as what happens when you try to drive a Ferrari in a corn field.


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

More news: HIStalk Practice, HIStalk Connect.


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January 2, 2014 News 3 Comments

Monday Morning Update 12/30/13

December 29, 2013 News 6 Comments

12-29-2013 9-01-12 AM

From Informatics Doc: “Re: PCORI. Announces who they will fund to build clinical data research networks and patient-powered research networks, which has a fairly ambitious national goal. MU-compliant EHRs will be a key component to several networks.” The Patient-Centered Outcomes Research Institute, a non-profit created as part of PPACA/Obamacare,  approves $93.5 million to fund 29 clinical research data networks that will form PCORnet, a national network that will study clinical outcomes. Of the 29 participating organizations, 11 are hospitals, plans, and health networks that will provide real-time patient encounter information, while the other 18 are patient-operated, condition-focused groups. Quite a bit of technology is involved, including interoperability and data collection from EHRs such as Cerner and Epic, data standardization, patient-facing applications, and population health management tools. Harvard Pilgrim Health Care Institute won a $9 million contract in September to run the program, naming as directors Richard Platt, MD, MS from Harvard Medical School along with Robert Califf, MD from Duke University Medical Center. I think it’s a great idea, although the politics and special interests involved in translational research make it hard to predict whether it will be successful in turning new medical data into health-improving and cost-saving principles. 

12-29-2013 2-11-27 PM

From The PACS Designer: “Re: iPhone 5S. With the gifting completed for the holiday, TPD thought it would be useful to post instructions for the HIStalkers who may have received the iPhone 5S. Since it can be daunting getting started with the 5S,  providing detailed instructions will get you going sooner.”
12-29-2013 7-20-01 AM

Barely more than half of poll respondents think Karen DeSalvo was a good choice to be Farzad’s replacement as National Coordinator, although none of those who voted added a comment to explain their position. The suck-up organizations (which is pretty much all of them) can’t say enough good things about her even though most of their flattery is either superficial or irrelevant, so to you naysayers, what don’t you like about her? Leave a comment on this post if you like. New poll to your right: how would you grade Medicare’s fraud prevention efforts?

12-29-2013 8-16-29 AM

The Associated Press Oregon names Cover Oregon’s botched insurance exchange website as the state’s top news story for 2013, summarizing:

Once considered a national health care leader, Oregon produced the worst rollout in the nation of the new national health insurance program. While the crippled federal website eventually got up and walked, Oregon’s remained comatose, unable to enroll a single person online. The state had to resort to hiring 400 people to process paper applications. Officials lay much of the blame on the primary information technology contractor, Oracle Corp., and withheld some $20 million in payments. But state officials’ own actions played a role, too. In the face of disaster, they insisted on doing things The Oregon Way, clinging to a grandiose vision of creating a grand health IT system that would not only enroll new people in the national health insurance program, but also provide other vital services. In the midst of the finger-pointing, executive director Rocky King went on indefinite medical leave, and chief information officer Carolyn Lawson resigned.

12-29-2013 10-31-27 AM 

Massachusetts, whose healthcare programs inspired Obamacare, has paid $11 million of a $69 million contract for creating its health insurance exchange website, which has enrolled only 2,800 people due to technical problems. The state says the system, built by Healthcare.gov lead contractor CGI, is slow, displays random error messages, and times out. It requires applicants to submit their information online, then wait for a mailed letter before signing up for insurance. Both Massachusetts and Vermont have halted payments to CGI for their insurance exchange sites, saying the company isn’t meeting its obligations.

12-29-2013 9-30-52 AM

Canada-based CGI, whose Healthcare.gov contract is worth around $300 million of that site’s $700 million cost so far, has a market cap of $10.6 billion. It’s one-year share price chart is above, with GIB in blue and the Dow in red. Vanity Fair’s profile of CGI is unflattering, citing previous unhappy customers and creative acquisition-related accounting practices (the company is made up of 70 acquired entities.) Industry long-timers will remember its 2004 acquisition of American Management Systems (AMS), from which quite a few hospitals bought medical records scanning and workflow applications. Including my hospital at the time, which earned AMS/CGI strong consideration for my “worst vendor” list. The article summarizes:

The story of how the Obama administration and the Centers for Medicare and Medicaid Services (CMS), the agencies tasked with implementing the Affordable Care Act got it so wrong is still unfolding. Much of the blame has to fall on an insular White House that didn’t want to hear about problems, and another chunk has to land on CMS, which instead of hiring a systems integrator, whose job it would have been to ensure that all the processes feeding into healthcare.gov worked together, kept that role for itself. As anyone who has worked with the federal government on such projects knows, it is utterly inept when it comes to technology.

Palomar Health’s Glassomics incubator for Google Glass releases a demo video of potential medical applications, including real-time integration with patient monitors and the EHR.

12-29-2013 2-13-01 PM

Hawaii Governor Neil Abercrombie releases $21.7 million in state capital funds for healthcare projects, of which Hawaii Health will receive $14.3 million for EHR-related projects.

Venture Beat predicts the hot tech buzzwords for 2014: “growth hacker” (data-driven marketing people); “nth screen” (sharing across devices); “design thinking” (human-focused innovation); “ephemeral sharing” (Snapchat-like shared data that disappears); and “hyperdata” (cooler than the now-unhip term “big data,” but meaning about the same thing).

In England, NHS and Department of Health create The Walk, an exercise app that combines a pedometer with a mystery story that unfolds as more steps are accumulated toward 500 miles of walking. It was developed by the creators of Zombies, Run!, which similarly combines a mystery story with running.

Hope Phones collects unwanted cell phones, allowing individuals and companies to outfit global health workers with the erased and furbished devices. Donation couldn’t be simpler: just print a postage-paid label from their site and put your phone in the mail. It’s part of Medic Mobile, a San Franciso-based public charity that uses mobile technology to improve health.

A Hero’s Welcome to Health IT, a government-funded program, will introduce military veterans to careers in health IT at the HIMSS conference. It offers mentoring and entry-level certification.

12-29-2013 2-46-21 PM

ONC’s annual meeting will be held January 23-24 at the Washington Hilton in DC, with 1,200 attendees expected.  It will probably be the first public appearance of new National Coordinator Karen DeSalvo, MD, who will start at ONC on January 13. 

The txt4health mobile personalized messaging program for diabetes management launched by three ONC-designated Beacon Communities reached a good many participants in Michigan, Ohio, and Louisiana, but more than half of them dropped out of the 14-week program, many of them apparently just ignored the messages, and only 3 percent of active participants tracked their weight. The article generously concludes that “this type of approach may not be appropriate for all.”

12-29-2013 1-55-14 PM

The board chair of a children’s hospital in Greece is arrested for demanding a $34,000 bribe from an advertising company that had been awarded a $262,000 contract to develop an anti-obesity campaign for children. He was also fired from his full-time position with the National Bank of Greece. The bribe was paid by an informant wearing a wire, which recorded the man’s stated rationale: “What kind of an idiot would I be to have made a 190,000-euro deal and not kept a cent for myself?”

12-29-2013 2-02-55 PM

Strange: parents of a newborn sue a Pittsburgh rabbi, claiming he severed their son’s penis while circumsizing him. Surgeons reattached it during an eight-hour microsurgery that involved six blood transfusions, two months in the hospital, and leech therapy. According to the rabbi’s website, “A doctor’s medical circumcision, usually performed in the hospital on the second or third day after birth, does not fulfill the requirements of a Bris Milah and is not considered valid according to Jewish law.”

Sponsor Updates

12-29-2013 9-09-57 AM

The annual holiday fundraiser held by Surgical Information Systems raised $15,000 from employees to support Cookies for Kids Cancer, Donor’s Choose, Toys for Tots, USO Wishbook, and The Weekes House.

12-29-2013 9-13-09 AM

Employees of ESD donated toys for Lucas County Family Services, which supports abused and neglected children.

The Lab Executive War College and CHUG (Centricity Healthcare User Group) donate hundreds of extra conference backpacks annually to Coffee Creek Backpacks project, run by Frog Pond Church in Wilsonville OR, which provides women newly released from the local correctional institute with essentials to help them return to society.


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

More news: HIStalk Practice, HIStalk Connect.


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December 29, 2013 News 6 Comments

News 12/27/13

December 26, 2013 News 11 Comments

Top News

12-26-2013 7-01-06 AM

CMS adopts final rules that extend the Stark exception sunset date from December 31, 2013 to December 31, 2021. The amendment allows healthcare entities to continue subsidizing physician purchases of EHRs and includes additional rule modifications, including:

  • The exclusion of lab companies from donating EHR items and services
  • The elimination of the e-prescribing capability requirement
  • Updates to the interoperable provision
  • Clarification of the requirement prohibiting any action that limits or restricts the use, compatibility, or interoperability of donated items or services.

HIStalk Announcements and Requests

inga thumb   Mr. H whisked away Mrs. H for a little holiday this week, but he should be back this weekend. We’re about to be in the midst of the pre-HIMSS fury so I am glad he took time for R&R with Mrs. H before the craziness begins.

inga thumb  News was slow on HIStalk Practice this week but you’ll want to check out the letter Dr. Gregg sent to Digital Santa before St. Nick jumped on his sled.  Thanks for reading.

Acquisitions, Funding, Business, and Stock

The HIMSS Foundation and the National eHealth Collaborative merge their organizations and announce plans to create the HIMSS Center for Patient- and Family-Centered Care and to integrate NeHC’s educational and HIE programs with existing HIMSS resources.

PM and RCM service provider Medical Transcription Billing files a registration statement for a proposed IPO.

12-26-2013 12-51-39 PM

The Singapore government invests $500,000 in Ring.MD, a telehealth startup focused on improving access to high-quality physicians in Asia. The company was founded by Justin Fulcher, a 21-year-old entrepreneur who has been coding since he was seven and started his first business as a preteen.


12-26-2013 2-40-26 PM

Big Bend Hospice (FL) selects Allscripts Homecare software.

12-26-2013 2-42-49 PM

CareTech Solutions will provide consulting services to Medicine Bow Technologies (WY), which is developing a disaster recovery plan for services impacting Invinson for Memorial Hospital.



12-26-2013 2-46-03 PM

Cerner names former Indiana governor/current Purdue University president Mitch Daniels to its board of directors.

12-26-2013 12-42-09 PM

Family Health West (CO) hires Pam Foyster (Quality Health Network) as clinical informatics director.



Announcements and Implementations

Jamaica’s minister of health says his country will being implementation of an $50 million EMR system for hospitals and primary care clinics during the first quarter of 2014.

12-26-2013 2-47-16 PM

Maine Medical Center will increase its Epic EMR investment from $145 million to $200 million and dedicate about two-thirds of the funds for additional employee training. Health system officials admit they originally underestimated the resources required for training and may have made a mistake by starting the implementation at its 6,000-employee Maine Medical Center, rather than a smaller pilot facility. Earlier this year the hospital’s CEO said the Epic rollout and incorrect billing issues contributed to a $13.4 million loss in the first half of its 2013 fiscal year.

12-26-2013 2-48-59 PM

Weems Memorial Hospital (FL) goes live on its $450,000 EMR from CSS.

Sagacious Consultants launches Sagacious Analytics to help hospitals improve reporting and make better use of EMR data for performance measurement.

Vermont Information Technology Leaders makes radiology and transcribed reports from Fletcher Allen Health Care available to providers via the state’s Medicity-powered HIE.


Government and Politics

CMS announces the formation of 123 new accountable care organizations, bringing the total number of established ACOs to more than 360.


Innovation and Research

A new influenza forecasting method developed by Columbia University’s Mailman School of Public Health is proving almost twice as reliable as traditional approaches that rely on historical data. The system combines real-time estimates from Google Flu trends and CDC surveillance programs.




12-26-2013 2-55-33 PM

Apple secures a patent for an embedded heart rate monitor for smartphones.



A USA Today article looks at how the adoption of HIT and preventative care are improving healthcare and lowering costs. David Blumenthal, MD highlights areas requiring more work, including moving from fee-for-service payment models to risk-sharing or team-pay systems; improving care coordination through the use of IT; educating consumers on how to choose better care based on quality and lower costs; and, increasing the use of standards to lower administrative costs.

Mount Sinai Hospital (NY) reports a 40 percent decline in its sepsis mortality rate since implementing an early warning system within its EMR. The system triggers an alert whenever staff enter vital signs that match the criteria for early sepsis.

12-26-2013 10-25-15 AM

Over two-thirds of HIT professionals participating in a HIMSS compensation survey report receiving a salary increase in 2013; the average reported salary was $110,269.  Almost half of the 1,126 survey participants also received bonuses with the median bonus equal to three to four percent of annual salaries.


Sponsor Updates

  • NextGen posts its January webinar schedule.
  • Optum opens an on-demand health and wellness clinic in  Overland Park, KS.
  • Imprivata hosts its second user conference HealthCon 2014 May 4-6 in Boston.
  • Forbes profiles Ping Identity founder and CEO Andre Durand.
  • As the industry shifts to P4P and ACOs, API Healthcare VP of nursing Karlene Kerfoot predicts a shift in healthcare jobs from hospitals to home care agencies, outpatient surgery centers, and urgent care clinics.
  • Info-Tech Research Group names Informatica a Champion in its Data Integration Tools Vendor Landscape.
  • EDCO posts a video highlighting its point of care scanning process for clinical staff.

EP by Dr. Jayne

It’s a very slow week here since a good portion of our department took vacation days around the Christmas holiday. I’ve enjoyed the relative quiet and am glad to see that people are staying off of email. CMS shared some holiday cheer by emailing providers to remind them that if they didn’t e-prescribe in 2012 or 2013 they will receive their penalty in 2014. I don’t know why they insist on calling it a “payment adjustment” rather than a penalty. Penalties related to Meaningful Use will begin on January 1, 2015 so if you’re going to avoid them you need a solid strategy now.

I’m keeping my eye out for exciting opportunities in the New Year and was interested to see a couple of CMIO postings pop up at organizations that haven’t had a CMIO previously. Although it may be exciting to be the first CMIO and to be able to define the role, I don’t envy anyone taking a job at an organization that is just now figuring out they need one. A couple of the job descriptions were nebulous to the point where I’m wondering if the hospital even understands what they are looking for.

Medical Economics recently did a piece on the survival of the doctor-patient relationship. Physicians cite administrative burdens as the highest threat (41.9 percent) followed by EHR at 25.8 percent. I’m glad the article makes the point that some of the tasks could be assigned to other office staff members. I still struggle with physicians who insist on doing work that could be done by support staff including printing lab requisitions, tracking down test results, processing refill requests, and dealing with insurance paperwork.

The article addresses the EHR challenge more specifically – citing anecdotal stories of physicians who spend 10 minutes of a 15 minute appointment typing. I’m continually surprised by the number of my peers who refuse to learn to type. If you’re going to use free-text rather than structured documentation, typing skills are essential. I remind our physicians that if they mastered biochemistry and tying surgical knots they can learn to touch type but they still resist. I’ve even tried a games-based approach to try to harness their competitive natures, but haven’t had a lot of success.

Another physician states he spends “eight to 10 minutes per chart entering information not directly related to patient care, mainly tied to quality metrics.” Based on conversations with some of our providers I’d have to challenge that statement. We have a large employed provider base and it’s always a shock when someone thinks that a particular clinical quality element is “not my problem” especially in the ACO environment. We’re fortunate to have an EHR where the quality metrics are baked into the documentation – there’s not a lot of extra work to do. I know many sites don’t have this advantage but for us there’s no excuse.

I recently went a couple of rounds with a surgeon who said the patient’s morbid obesity was “not my problem.” I countered that if he plans to do any procedures on her, it certainly is his problem because of the risk of complications directly related to the obesity, not to mention the need to find out if there is diabetes related to the obesity because that alone can complicate wound healing. The same thing applies to our orthopedic surgeons who don’t want to check blood pressures. Fortunately our organization has made measurement of vital signs part of the required elements for physicians to receive bonus payments, so it makes it easier for me to push back at them.

I know there are a lot of EHRs out there where the documentation isn’t so simple and having used a couple of them I’d encourage physicians to look for alternate strategies to make it easier. I did a stint as a locum tenens where the physicians dictate using voice recognition and then staff post-loads the discrete data elements that the system doesn’t recognize. It worked well and the physicians had a high level of satisfaction. Essentially the extra two patients a day they could see by using voice recognition allowed them to pay for the extra staff needed to load the data. It was revenue neutral but the physicians felt better not clicking as much as they used to.

I think the key to managing quality indicators is having a plan on when they are going to be addressed. I see a lot of physicians struggling to try to address every indicator at every visit and it’s just not necessary. My EHR allows me to filter and only see those items that are due in the next three months, six months, etc. so that helps somewhat. Our group also has policies about when the indicators are to be addressed. For example, patients in for an annual preventive visit should have all preventive services due during the next 18 months addressed. This covers them for the next year and a little bit extra should their return appointment be delayed.

The article also cites the amount of time needed to have a conversation with the patient about screening services as a barrier. We provide extensive training to our medical assistants (no nurses in our world) on how to address preventive services with patients during the intake and rooming process so that the patient knows it will be a topic of discussion. The staff can provide educational materials for the patient to read before the physician enters the room, which can make some of those conversations easier and faster. Additionally, providers are not expected to address all preventive services on acute visits. We rely on our automated outreach mechanisms to catch those patients who don’t come in for preventive visits or who have lapses in care. This has been a major physician satisfier because the acute visits remain fairly quick and they don’t have to spend time worrying about patients falling through the cracks.

Having policies on when to address what kinds of services doesn’t have anything to do with the EHR – we actually had these policies in place in the paper world – but they’ve made a great deal of difference. We also provide training for support staff on completing pre-authorizations and pre-certifications so that work can be handed off even in a small office that doesn’t have dedicated referral staff. Looking at the operational workflow and staff training has helped physician satisfaction and hopefully will be one of the things bolstering the patient-physician relationship in our organization. Does your organization have any secret recipes for success? Email me.


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

More news: HIStalk Practice, HIStalk Connect.

smoking doc

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December 26, 2013 News 11 Comments

Monday Morning Update 12/23/13

December 20, 2013 News No Comments

12-20-2013 2-24-22 PM

From Kris Crinkle: “Re: Epic. The bells rang for a new contract signing. Southcoast Health System (MA). Replacing Meditech Magic, eClinicalWorks, athenahealth, and Cerner homecare. I’m an avid reader and love the format, especially Dr. Jayne.”

From JG: “Re: musical stocking stuffers, best of 2013. The Growlers, Dean Wareham, The Men. Thank you for everything you do!” I listened to all three bands and liked all three.

12-20-2013 1-23-27 PM

From The PACS Designer: “Re: all-digital solutions. A truly remarkable event took place at this year’s RSNA. Philips Healthcare introduced the world’s first all-digital diagnostic treatment solution in the form of a CT/PET Scanner. This event should be of great interest to Doctor Dalai as he’s been contemplating the purchase of such a system for quite some time.”

12-20-2013 10-09-07 AM

The vast majority of poll respondents think it’s time to retire the word “mHealth.” New poll to your right: is Karen DeSalvo a good choice for National Coordinator? Feel free to click the poll’s Comments after you’ve voted to explain why you think she is or isn’t.
12-20-2013 10-24-43 AM
Welcome to new HIStalk Platinum Sponsor DataMotion. The Morristown, NJ-based company offers easy-to-use solutions for email encryption, secure file transfer, and Direct-based secure messaging, allowing customers to cut costs and meet compliance and Meaningful Use requirements. DataMotion Direct makes secure messaging via Direct easy to implement and use, and the DataMotion Direct Developers Program provides vendors a quick, capital-free way to implement Direct messaging in their applications (EHRs, HIE, patient portal, interface engine) and to meet MU Stage 2 secure data exchange requirements. Give SecureMail a free trial, request access to their Sandbox,  or view the recorded Webinar, “HIPAA, Business Associate Agreements, and What You Need to Know.” Thanks to DataMotion for supporting HIStalk.
Here’s a DataMotion introductory video I found on YouTube.Here’s the complete list (not just AMIA members like the list I ran earlier) of the new diplomates in the Clinical Informatics subspecialty area.
Athenahealth will move its Bay Area office from a 20,000 square foot space in San Mateo to a 60,000 square-foot building in San Francisco.
Archbold Memorial Hospital (GA), San Francisco General Hospital and Trauma Center (CA), Virginia Hospital Center, and Western Connecticut Health Network select Perioperative Management from Surgical Information Systems.
An internal Marine memo reveals current inefficiencies in the transfer of medical records from the Navy to the VA. Currently the Navy prints service treatment records and mails them to the VA. At the same time the VA is in the process of scanning all paper files, which are saved electronically as PDFs. Depending on a the service member’s length of service and documented medical conditions, a single record can run thousand of pages.
Pharmacy benefit manager Prime Therapeutics contracts with CoverMyMeds.com for electronic prior authorization services.

A ProPublica investigation uses the federal government’s own Medicare databases to find evidence of rampant Medicare drug plan fraud, with organized groups either stealing the identity of doctors or bribing them to write prescriptions. Medicare’s process is so poorly managed that they rarely catch anyone. Example: Medicare paid $3.8 million in one year to fill the prescriptions of a psychiatrist, most of them for drugs unrelated to his specialty, when someone stole his identity. Pharmacies and insurers say they’re reporting suspicious behavior to Medicare but are being ignored. The series of articles concludes that newspaper reporters can easily detect fraud from Medicare’s databases, but the agency itself isn’t doing it.

Fraud rings use an ever-evolving variety of schemes to plunder the program. In one of the most popular, elderly, broke, disgraced or foreign-trained doctors are recruited for jobs at small clinics. Their provider IDs are used to write thousands of Medicare prescriptions for patients whose identities also may have been bought or stolen. Once dispensed, the drugs are then resold, sometimes with new labels, to pharmacies or drug wholesalers. In other schemes, investigators say, pharmacies are active participants, billing Medicare multiple times for prescriptions they never fill. Doctors can readily disavow the prescriptions as forged, investigators say. And because the schemes don’t always involve painkillers, a law enforcement focus, they can escape notice.


Weird News Andy delivers this story, which he titles “Yes C-Section, No C-Baby.” Doctors in Brazil perform an emergency C-section delivery after failing to hear the baby’s heartbeat, only to find that their patient wasn’t pregnant. The woman showed up with proof of her prenatal care and a protruding abdomen, but she was having a false pregnancy, her second of the year. The hospital suggested she seek mental care instead.


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

More news: HIStalk Practice, HIStalk Connect.


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December 20, 2013 News No Comments

News 12/20/13

December 19, 2013 News 7 Comments

Top News

HHS names Karen DeSalvo, MD, MPH, MsC National Coordinator for Health Information Technology. DeSalvo, health commissioner for the City of New Orleans, will start on January 13, succeeding Farzad Mostashari, MD, MsC. According to an internal email from HHS Secretary Kathleen Sebelius, “Throughout her career, Dr. DeSalvo has advocated increasing the use of health information technology (HIT) to improve access to care, the quality of care, and overall population health outcomes –including efforts post-Katrina to redesign of the health system with HIT as a foundational element.”

Reader Comments

12-19-2013 5-44-16 PM

From MC Scanner: “Re: Apple commercial. The video for ‘Misunderstood’ that will air on TV next week brought tears to my eyes. It’s amazingly powerful – even better than their ‘1984’ ad.” Maybe I’m just being a Scrooge, but it seemed to me like a lame, Microsoft-style attempt to make people believe that their lives are incomplete unless they experience it using consumer technology. This commercial features a kid who chooses not to participate in family holiday activities with everybody else, instead messing around with his phone and recording everything for the big reveal when he shows the edited video to the family on the big screen TV. The message appears apt for the self-obsessed Facebookers of the world who can’t turn their smartphones off long enough to participate in the world instead of documenting it in Kodak moments for public display. I was creeped out when the family stopped doing everything warm and loving about the holidays and instead stared at themselves on TV, suddenly overcome with affection for the kid who couldn’t relate to them otherwise (probably because he never stops staring into his phone). Here’s my alternative, non-Apple approved holiday message: put down your electronic pacifiers, spend time with people you love, forget the always-beckoning fantasy world of your phone for just one day, and live like a human instead of an online avatar.

From Unnamed: “Re: [company name removed]. Laying off US employees right before Christmas, moving jobs to India, cutting budgets by 25 percent, and disregarding outstanding financial commitments. Sounds like a HISsies ‘Stupidest Vendor Move’ category.” We had some financial problems with that company, too.

From Jack: “Re: Orion Health’s list of best healthcare reporters and blogs. I saw this and figured either your actual name was on here (gasp) or whomever wrote this doesn’t actually read HIStalk. But how in the world do you get left out of that list?” HIStalk gets left off quite a few of the “best HIT sites” lists for several reasons: (a) it competes with the interests of whoever created the list; (b) it’s based on an Internet metric like Alexa or Klout scores; (c) they can’t figure out whether to consider HIStalk a blog or something else; or (d) they think other sites are better, which is perfectly fine and maybe they’re right. I never look at those lists and I often haven’t heard of the sites they proclaim as the busiest or best, but all I know is that Orion Health sponsors HIStalk, which seems to indicate they think it’s OK even though it’s not on their “Five Healthcare IT Reporters You Need to Follow” or “Health IT Thought Leaders” list.

HIStalk Announcements and Requests

inga_small From HIStalk Practice in the last week: a few moonlighting suggestions for physicians. CMS offers informal reviews for EPs and group practices who will be subject to the 2014 eRx payment adjustment. CMS confirms that providers who assign their reimbursement and billing to a CAH under Method II are now eligible to participate in the MU program as EPs. A solo physician does a commendable job addressing a data breach. Salaried GPs in the UK face declines in compensation. My favorite gift, regardless of the holiday, is having new readers, so please take a moment and stop by. Thanks for reading.

Listening: The Honorary Title, a Brooklyn-based indie rock band that flamed out in 2009 without a lot of success. I’ve been obsessed with Nada Surf lately and they sound a good bit like them.

12-19-2013 6-15-33 PM 12-19-2013 6-21-15 PM

Welcome to new HIStalk Gold Sponsor (and HIStalk Connect Platinum Sponsor) CareSync. The Florida-based company offers a family health record and the mobile-based Visit Manager that provides access to a family’s medical records, organizes questions for providers, and stores to-do lists and notes, all to get family members organized before, during, and after their medical appointments. Information can be selectively shared with providers and family and friends who are helping with health needs. It allows tracking of health goals, prescriptions, emergency contacts, and providers. The company’s team of medical records specialists will even help assemble and organize the health information. It is reasonably priced and could make a nice Christmas gift for a family member. You probably know some of the industry long-timers who are involved – Travis Bond (Bond Technologies) and Amy Gleason, RN (Allscripts), to name two. Thanks to CareSync for supporting HIStalk.

I found this CareSync video on YouTube that explains it much better than I just did.


Mercy Health Physicians (OH) will implement PatientPoint’s patient engagement solutions.

Queen Elizabeth Hospital King’s Lynn (UK) selects iMDsoft’s MetaVision for its ICU.

Children’s Medical Center (TX) engages PCCI to build predictive analytical models to identify children at-risk for asthma crises and to develop an information exchange between pediatric and social services providers.


12-19-2013 12-42-34 PM

ClearDATA names Scott Whyte (Dignity Health) SVP for growth and innovation.

12-19-2013 8-39-01 AM

Ryan Donovan (Visa) joins Practice Fusion as VP of corporate communications.

12-19-2013 8-45-05 AM

CareInSync hires Cheryl Cruver (The Advisory Board Company) as SVP of provider solutions.

12-19-2013 9-13-32 PM

Rainu Kaushal, MD, who holds a number of roles including informatics at Weill Cornell Medical College and New York-Presbyterian Hospital, is named chair of the college’s Department of Healthcare Policy and Research.

Announcements and Implementations

Arch Health Partners, a medical foundation affiliated with Palomar Health (CA), deploys Phytel’s population health management platform.

Kansas HIE and the Lewis and Clark Information Exchange connect their networks.

University of Colorado Health migrates 17,000 mailboxes from three disparate healthcare organizations on multiple legacy email platforms into one single consolidated Microsoft Office 365 environment. The consolidation is expected to save the organization $13.9 million over 11 years.

Landesklinikum Amstetten (Austria), AZ Sint Lucas (Belgium), Hospital La Pitie-Salpetriere and Centre Hospitalier Regional De Metz-Thionville (France), and Medway Maritime Hospital (UK) go live with the iMDsoft MetaVision platform.

Wesley Medical Center, Cypress Surgery Center, and Surgery Center of Kansas go live on Anesthesia Touch from Plexus Information Systems.

Lehigh Valley Health Network (PA) implements Salar’s TeamNotes, which sits on top of GE Centricity EMR to facilitate ICD-10 compliant documentation.

Government and Politics

A report by the Senate Commerce Committee highlights minimally regulated data brokers that buy and sell patient data, including disease-specific patient lists and in one case, lists of rape and domestic violence victims.

The VA’s ongoing cybersecurity problems are the subject of a Federal News Radio series, which points out the material weaknesses listed in its financial statements. Among them: failing to revoke network access of terminated employees, failing to keep unauthorized software off the network, and improperly securing Web-based applications. An unnamed government official says the VA CIO’s office has developed a siege mentality against Congressional inquiries, concluding,

“I find it disingenuous in how they are responding to this and the degree of contempt they have in how they are approaching this. They feel it’s a witch hunt. There is a marked lack of respect for the committee by the IT leadership. How they are managing the process is indicative of the lack of respect for Congress and particularly the Veterans Affairs Committee. They think it’s a game so they will evade, obfuscate and they will basically come back with just the bare minimum so as not to be out of compliance.”

12-19-2013 10-20-31 PM

The Oregon government official in charge of the state’s trouble-prone health insurance exchange website resigns. The state had bragged that its marketplace would be one of the most advanced when it opened October 1, but it still can’t handle electronic applications and required hiring 400 workers to process paper forms. Carolyn Lawson, CIO of the Oregon Health Authority and Department of Human Services, stepped down Thursday for “personal reasons.”

12-19-2013 9-29-02 PM 12-19-2013 9-30-58 PM

Representatives Doris Matsui (D-CA) and Bill Johnson (R-OH) introduce the Telehealth Modernization Act of 2013, which would create a federal definition of telehealth based on an earlier California definition with the hopes of standardizing inconsistent state-level policies. It addresses patient-provider relationships, informed care,  provider documentation, sending documentation to other providers, and prescribing requirements.


Scripps Health launches a pilot of the Sotera Wireless ViSi Mobile vital signs wrist monitor, which measures ECG, heart rate, pulse,  oxygenation, and temperature.

MMRGlobal is awarded another patent, this time for just about everything a person can do to access health information on a mobile device.


The healthcare industry is making slow progress on preparing for ICD-10, according to a WEDI readiness survey. About 20 percent of vendors claim they are halfway or less complete with product development, while about half of providers have yet not completed an impact assessment. Meanwhile, about one-third of health plans have not initiated internal testing; two-thirds have not started external testing.

12-19-2013 5-12-32 PM

The Orlando newspaper profiles Automated Clinical Guidelines, which offers some kind of clinical pathway guidance product whose company-provided description is obfuscated by a writhing nest of unintelligible HIT-related cliches that marketing people dream about when you naively ask what a particular product does and 20 minutes you still have no idea:

ACG has developed an innovative healthcare ecosystem that is patient-centered, operates in real-time, is language-independent, and serves up evidence-based medicine for application on a worldwide basis. The ACG expert system represents a breakthrough in processing structured clinical information utilizing automated clinical guidelines. ACG software is a patented, smart, internet-based, and platform independent solution to the medical crisis in a demographically aging world faced with a severe shortage of physicians. ACG is NOT an EMR or an EHR product and in fact operates in a product space that is totally EMR/EHR independent. ACG revenue streams come from annual renewable institutional contracts, physician patient visits on a per click basis, and by medical products advertising. The ACG ecosystem is an elegant design that requires little or no training and guides the user by use of Symbolic and Boolean logic clinically correlated algorithms, as opposed to current attempts to use database centered templates and report writers.

12-19-2013 5-36-03 PM

The Houston newspaper writes up Decisio, which formats information from patient monitors into an electronic triage system. Says CEO Bryan Haardt, who was COO of Prognosis Health Information Systems until June 2013, “Today’s thermostats have more intelligence than most medical monitors.”

12-19-2013 7-36-34 PM

Cottage Health System (CA) discloses that the information of 32,500 patients was exposed when a vendor inadvertently opened up one of its servers to the Internet. As is nearly always the case, the problem was discovered by someone who found the information while Googling names. Surely there must be a monitoring service that can ping a supposedly secure server from outside the firewall and raise an alert if it gets in.

AMIA runs a list of its members who passed the first clinical informatics subspecialist exam in October.

12-19-2013 10-38-05 AM

inga_small A 66-year-old man files a lawsuit against Advocate Condell Medical Center (IL), claiming that hospital security guards threatened him, beat him, and bit him as he attempted to discharge himself from the ER. The main waited six hours for treatment of his TIA before trying to depart for another hospital, at which time he says seven security guards verbally and physically attacked him. Following the altercation, he claims he was injected with narcotics, strapped to a gurney, and kept in the hospital for six days.

12-19-2013 6-08-37 PM

Weird News Andy offers a list of items “for all the HIStalk techies in your life” from this article, cynically saying of an anesthesiologist robot, “What could go wrong?”

WNA will be sorry he didn’t see this first. A Chicago ED doc says he deals with sex-related accidents twice per week, enough to make him the star of a stupid new reality show (was that redundant?) called “Sex Sent Me to the ER.” Some of the cases he’ll cover involve people who fell on penetrating foreign objects (right), broken penises, and a 440-pound male virgin so focused on his first sexual experience that he pushed his girlfriend’s head through a wall. It looks stupid, sensationalistic, and poorly made, which of course means it will be an instant hit.

Sponsor Updates

12-19-2013 5-18-19 PM

  • Visage Imaging lists the top five trends it observed about enterprise imaging at RSNA 2013.
  • QPID releases some funny, holiday-themed training videos for its customers (1, 2, 3).
  • The MarketsandMarkets research firm ranks Perceptive Software’s Acuo VNA platform the world market share leader among all independent and PACS-affiliated VNA solution providers.
  • ICSA Labs awards CliniComp’s Essentris v213.01 software 2014 Edition Inpatient Modular EHR ONC Health IT Certification.
  • Deloitte includes Kareo on its Technology Fast 500 list of fastest growing technology, media, telecommunications, life sciences, and clean technology companies in North America based on its 797 percent growth over the last five years.
  • Gartner positions Informatica as a leader in its 2013 Magic Quadrant for Data Masking Technology report.
  • University College London (UCL) and Elsevier will establish the UCL Big Data Institute to explore innovative ways to serve the needs of researchers by providing analytical data for scientific content.
  • The Drummond Group certifies Alere Analytics Clinical Quality Measures Services version 2.1 and Public Health Electronic Laboratory Reporting and Communication Portal version 3.2 for ONC-ACB MU as Modular Inpatient and Modular Ambulatory solutions respectively.
  • T-System offers free T-Sheets flu documentation templates to hospitals and healthcare providers.
  • Greenway Medical Technologies wins the 2013 Intel Innovation Award for its PrimeMOBILE app for Windows 8.
  • Besler Consulting releases a review of the Hospital Outpatient Prospective Payment System 2014 final rule.
  • Experian integrates its identity proofing and risk-based authentication platform Precise ID for health care portals with Epic’s MyChart patient portal.
  • Impact Advisors principal Laura Kreofsky discusses HIT in 2014.
  • E-MDs Cloud Solutions v. Cirrus achieves ONC-ACB certification for MU Stage 1 and 2 and is compliant as a Complete EHR 2014.
  • Huntzinger Staffing Solutions expands its offerings to include Cerner staffing and sourcing services.
  • Carolyn Brzezicki, senior clinical specialist for Healthwise, challenges readers to behave as if they have Type 2 diabetes for one day.
  • Billian’s HealthDATA hosts a January 16 #HITchicks Tweet Chat.
  • HIStalk sponsors winning Fierce Innovation Awards include Health Catalyst for Best Problem Solver and Data Analytics; Patientco for RCM; QPID for Best Cost-Saver and Clinical Information Management; and CoverMyMeds in the HIE category and an overall award in Best in Show: Best New Product/Service.
  • Australia’s Adelaide Research and Innovation names Wolters Kluwer Health an Innovation Champion based on its ongoing partnership with Joanna Briggs Institute to bring evidence-based practice resources to healthcare institutions globally.

EPtalk by Dr. Jayne

I keep my eye on Twitter for interesting health IT items. A mention of “24 Outstanding Statistics on How Social Media has Impacted Health Care” caught my eye, mostly because of the use of the number 24. Usually articles will feature a top 10, top 20, maybe a top 25 but I thought going with 24 was an interesting choice. The statistics are drawn from some interesting sources from advertising and media firms to Mashable.

The first two numbers weren’t surprising: 40 percent of consumers say social media impacts how they deal with their health, 18-24 year olds are more likely than 45-54 year olds to use social media, and so on. The third did surprise me: 90 percent of those 18-24 said they’d trust medical information shared by others on their social media networks. This little tidbit doesn’t give me a lot of hope for humanity since my “official” practice persona is Facebook friends with a number of our patients in that age bracket. Let’s just say that most of the posts from that demographic are not exactly systematic literature reviews.

I wonder if they also buy into links for “one simple way to lose belly fat” or “avoid this one food to lose weight?” Behind the closed door of the exam room, I’ve heard a lot of things that 18-24 year olds say about health issues and can confidently attest that most of them have been bogus. Typically those conversations have been in the realm of reproductive health, which probably adds to the mystery of some of their statements, but I’m not sure I’d trust most of the advice these teens have been given by their peers.

Back when the Internet was all we had, I used to counsel patients that the Internet is like the world’s largest bathroom wall. There are a lot of things written on it and some of them are certainly true, but it’s hard to figure out which. The number and volume of sites, apps, and sources available now makes keeping track of the truth even more challenging.

Only 31 percent of healthcare organizations have written guidelines for social media, which I think is low, especially if the respondents were organizations of any size. A good friend of mine is a plaintiff’s attorney and regularly licks his chops at the prospect of litigating cases where medical advice was inappropriately given via social media or where patient-specific information was inadvertently released. Another statistic later in the piece states that 26 percent of hospitals participate in social media, so perhaps the relatively low rate of those online makes the guidelines percentage look a little better.

I liked the statistic that 54 percent of patients are “very comfortable” with their providers using online communities to aid in treatment. It’s validating for me personally since I was once yelled at by a hospital VP after being quoted in a newspaper interview about using the Internet to search for information while seeing patients. He told me it was “unseemly” to admit that you didn’t know everything the patient needed you to know and would undermine confidence. I’ve always found patients appreciated the fact that I admit I don’t know everything and am willing to make sure I have the correct approach before I apply it to their situation.

Although 41 percent of people claim social media would impact their choice of a physician or hospital, I’d like to see the numbers if we asked which was more influential: social media or insurance coverage. I’m pretty sure reimbursement trumps reputation and quality much more often than most of us would like. Among resources used to health information, Wikipedia was at 31 percent. Since I personally use Wikipedia to validate information fairly often, that felt low to me.

I was heartened to learn that 60 percent of people trust physicians’ social media posts over any other group. In real-life clinical practice, it felt like I was often competing against Aunt Betsy or the neighbor up the street, so six out of 10 isn’t bad. Given this number in light of the statistic about the 18-24 year olds being so trusting of items seen on social media, I should probably start posting “safe sex” advice on my professional Facebook page. I’m sure my grandmother would be scandalized, but I can say I’m doing it in the name of science.

The final statistic mentioned is that Facebook is the most popular for hospitals that have an online presence. I must admit, my professional self no longer follows my hospital’s Facebook presence because I simply couldn’t take it any more. Rather than being a good source of health information and patient advocacy, it had become little more than a marketing vehicle. If I read one more congratulatory back-pat for earning some bogus “Top Whatever Hospital Center of Excellence Patient Choice Satisfaction” award, I was going to need anti-nausea medication.

What would Mark Twain think of the information age and its lies, damned lies, and statistics? Email me.


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

More news: HIStalk Practice, HIStalk Connect.


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December 19, 2013 News 7 Comments

News 12/18/13

December 17, 2013 News 6 Comments

Top News

The 2014 defense authorization bill, which has been endorsed by both the House and Senate, requires the DoD and VA to develop by the end of January “a detailed plan for the oversight and execution of the interoperable electronic health records with an integrated display of data, or a single electronic health record.” If the agencies miss the deadline they risk losing their ability to spend more than 25 percent of the estimated $344 million in funding needed for the project and will be required to notify military and veterans committees before dispensing any project funds in excess of $5 million. The system deployment deadline is end of 2016.

Reader Comments

12-17-2013 1-11-40 PM

inga From Lion: “Re: LinkedIn. OK, I’m curious. What is the deal with your profile picture?” There’s no faster way to peg yourself as a HIStalk Newbie than by asking Mr. H why a healthcare-related website features a smoking doctor or why I have hot shoes on my LinkedIn profile. I shared with Lion that I used to have the Inga avatar on my profile, but the LinkedIn police took it down, saying only photos were acceptable. I feel like such a renegade every time I see the sexy shoe photo on LinkedIn, though I’m now thinking it’s time to feature a new pair. Stay tuned.  

12-17-2013 6-32-42 PM

From Leaving T-System: “Re: big changes at T-System last Friday. Sunny Sanyal will leave the company in January, now looking for new CEO. Mikael Ohman, COO will be working on special projects only. Jim Mullen, SVP Sales is leaving to join Allscripts. Mark Horner is now SVP & GM over RevCycle+, already updated his LinkedIn page.” Varian Medical Systems has already announced that Sunny Sanyal will be taking over as SVP and president of its Imaging Components businesses as of February 7, 2014.  We appreciate T-System’s response to our inquiries:

It is with mixed emotions that we can confirm those changes are accurate. Sunny made the decision based on a personal need to work closer to his family and spend more time with his wife and three children. Sunny was very well-liked and respected at T-System and we will truly miss him. Sunny will remain as the CEO of T-System until the end of January. On a positive note, we have some additional, exciting changes that we would like to share with HIStalk readers. John Trzeciak, a long-standing board member and principal at Francisco Partners, will help with the transition and step in as the interim CEO of T-System while we search for a replacement. John has an extensive background in leading healthcare organizations and helping companies manage leadership transitions, and is already engaged in the T-System business through his role on the board. We are excited to announce that Tom Dunn has been named as Executive VP of sales and marketing. Tom had tremendous success as the sales and marketing VP at QuadraMed, helping the company achieve double-digit growth. We anticipate that he will drive further alignment of our new revenue cycle and documentation solutions. Jim is leaving to pursue new opportunities and we’re grateful for his contributions. Additionally, Mark Horner was promoted to senior VP and GM of our revenue cycle solutions while Steve Armond, T-System CFO, was promoted with additional responsibilities that include operations for client services and performance solutions.

12-17-2013 9-41-01 PM

From Dr. L: “Re: technology tip. I appreciated your review of the Asus MeMo Pad and the tip to find it on sale at Office Depot! I checked immediately and snagged the last one at my local store. I’m in a similar situation with an aging device, and it’s helpful to follow someone you trust to wade through the plentiful options. I was considering one of the new iPad Minis, but I agree the Asus delivers a lot of value and doesn’t feel like I’m skimping. You’d have a lot of grateful followers if you included a regular Personal Technology section on your blog. I recall a comment several years ago about your strategy to use your iPod Touch on WiFi instead of an iPhone, and I adopted that idea, too. Many thanks to you and your team for all you do each week. You’re the highlight of my day!” I appreciate those nice words and I’m still loving the Asus, especially for $120 (try playing this movie on it to appreciate the HD display.) I don’t buy a whole lot of technology, but I usually get excited about it when I do, because I’m a nerd, obviously, and a bargain hunter besides. It would be fun to have readers weigh in on their latest purchases and the deals they’ve found.

HIStalk Announcements and Requests

12-17-2013 6-48-04 PM

Welcome to new HIStalk Platinum Sponsor Lincor. The 10-year-old Nashville-based company’s patient engagement technology portfolio includes PatientLINC (touch-screen, in-room access to clinical information for caregivers and  patient tools, communication services, and entertainment such as on-demand video and games); ClinicalLINC (secure bedside EMR access via wall-mounted terminals);  MediaLINC (in-room patient access to educational materials and entertainment); and MobileLINC (patient access to medical information, educational materials, and entertainment on their mobile devices). All of these increase patient satisfaction and improve outcomes, helping hospitals meet Medicare-funded requirements for patient satisfaction, readmissions, and Meaningful Use. The company’s systems are used by 120 hospitals and 25,000 beds all over the world, and the world headquarters have been moved from Cork, Ireland to Nashville. Just this week the company announced another funding round, this time of $3 million, to expand in the US and EMEA. Thanks to Lincor for supporting HIStalk.

My YouTube cruise turned up this new and well-done video overview of Lincor’s LINC technology.

Acquisitions, Funding, Business, and Stock

12-17-2013 6-33-29 AM

HealthTech Holdings, which includes the HMS, Patient Logic, and Medhost brands, changes its name to Medhost and names Craig Herrod president. He previously served as president and CEO of the Medhost division.

Juniper Networks will acquire WANDL, a provider of software solutions for multi-layer networks, for $60 million. 


At Home Healthcare (TX) selects Procura Homecare software as its home and community care platform.

The Louisiana Senior Care Coalition chooses eClinicalWorks Care Coordination Medical Record as its population health management solution for advancing ACO objectives.

12-17-2013 6-22-19 PM

The VA St. Louis Health Care System will implement LiveData PeriOp Manager and integrate it with its existing VistA EHR.

Hospital Sisters Health System (IL) chooses Passport to provide RCM solutions and services to its 14 hospitals and network of affiliated facilities.

Intermountain Healthcare (UT) selects Elsevier ClinicalKey to provide electronic medical reference and knowledge-based information to its clinicians and medical libraries.


12-17-2013 10-48-26 AM

Medfusion names Vern Davenport (MModal) president and an equity partner.

12-17-2013 9-28-06 AM

Jack Redding (Mount Sinai Medical Center) joins Halfpenny Technologies as SVP of sales and marketing.

Oncologist Susan Desmond-Hellman, MD, MPH (UCSF) is named CEO of the Bill & Melinda Gates Foundation. One of her key policy recommendations to the National Academy of Sciences was creation of a knowledge network that would allow sharing patient data across research and clinical practice to tailor treatments to individual patients.

T-System appoints Tom Dunn (QuadraMed) EVP of sales and marketing.

12-17-2013 5-50-58 PM

inga Kathleen Sebelius announces the appointment of former Microsoft executive Kurt DelBene as senior advisor to lead and manage the Healthcare.gov project. DelBene was president of the Microsoft Office division, leading me to wonder if he’ll be typing many of his own memos in Word and if the memos will ever include the term “EHR.” Wouldn’t it be great if he were able to lobby his former employer to fix that annoying EHR/HER auto-correct issue?

Announcements and Implementations

HIMSS and HHS are recruiting for an “Innovator in Residence” to serve a two-year term to develop and implement a nationwide patient data matching strategy.

12-17-2013 6-18-02 PM

Susquehanna Health (PA) implements Summit Provider Exchange technology to provide bidirectional integration between its hospitals and physician practices running NextGen EMR.

Bay Area Medical Center (WI), which recently signed a letter of intent to partner with Aurora Health Care (WI), begins implementation of Epic, the platform already in place at Aurora.

The Illinois HIE and Missouri Health Connection will share clinical patient data.

12-17-2013 12-10-00 PM

Essentia Health-Virginia (MN) goes live on Epic.

Polk County Human Services (WI) adopts Forward Health Group’s PopulationManager to track and analyze the progress of patients with substance abuse disorders.

Palomar Health (CA) goes live with AirStrip ONE for remote EKG access, co-developed by the organizations based on Palomar’s MIAA (Medical Information Anytime Anywhere) platform that AirStrip acquired in mid-2012.

12-17-2013 7-50-09 PM

Oncology EMR vendor Altos Solutions and outcomes and analytics vendor COTA announce a partnership to sell value-based cancer care systems in the US.

In the UK, the Department of Health opens bidding to choose a new outsourcing provider for its Oracle HR management system, planning to replace McKesson after 13 years. The contract is valued at up to $730 million over six years.

12-17-2013 8-21-36 PM

UPMC’s Children’s Hospital (PA) will make its physicians available for second opinions to members of MDLIVE, which offers secure online access to physicians.

In England, NHS’s clinical research group uses QlikView to review clinical data quality and find unusual patterns.

Government and Politics

12-17-2013 6-19-56 PM

Medicare publishes a list of the 97 best and 85 worst hospitals for hip and knee replacements based on post-surgery complications and readmissions.

inga Congressmen Erik Paulsen (R-MN) and Jim Matheson (D-UT) propose legislation that would mandate the use of clinical decision support software by physicians receiving Medicare and Medicaid reimbursement when they order diagnostic imaging tests. The goal is to provide doctors with immediate feedback and recommendations for the appropriate tests to order. Sounds like a great idea that would likely create a few administrative nightmares.

Big pharma wants an independent investigation of the FDA’s computer security after a database containing clinical trial results and drug marketing plans submitted by drug companies was hacked last month. The drug companies are afraid their confidential information could end up in the hands of a competitor. FDA says the attacked system didn’t contain such information.


12-17-2013 9-05-13 PM

ReferralMD Founder and CEO Jonathan Govette, like others, says that EMRs will become unbundled the same way that a myriad of Craigslist features turned into much better individual platforms started by others. Above is how he sees that happening (click the image to enlarge). Tip from @ForwardHealthGP.

HIMSS will hold an mHealth Summit Middle East in Abu Dhabi in May 2014.

12-17-2013 9-54-13 PM

StartUp Health and AARP release a report on digital health in consumers over 50. Like much of what’s packaged as mHealth, it’s mostly aimed at investors rather than consumers.

Saint Francis Hospital (NY) says its Meditech implementation forced it into bankruptcy with $50 million in debt, but adds that it was the hospital’s own poor financial implementation and not Meditech that cost it “tens of millions of dollars” of uncollectible revenue. The hospital will sell itself once it exits bankruptcy.

A group of New York City parents files suit against the city and the Department of Education, claiming that disruptive 6- and 7-year-olds are being sent by ambulance to area EDs in violation of the Americans with Disabilities Act solely because the schools can’t handle them. According to one mom, “It has caused a financial and emotional strain for me and my entire family. I feel that they sent my son to the emergency room as an excuse to not do their job. If my child acts up at home I cannot send my son to the hospital emergency room.”

12-17-2013 10-39-45 PM

A California newspaper profiles 20-employee, Sebastopol-based E-Health Records, which develops EHRs primarily for use in developing nations. It runs on Android-powered tablets over Amazon cloud services.  

inga A former HHS investigator shares tips for preparing and responding to a fraud and breach investigation. The investigator says one of the biggest mistakes an organization can make during an on-site visit is to make the investigator wait. I’m guessing he’s never had to be on hold forever while trying to follow up on a Medicare claim. Now that’s waiting.

12-17-2013 7-46-39 PM

Weird News Andy summarizes this story as, “Makes it easy to put on socks.” Doctors in China reattach a man’s severed hand to his ankle for a month while he regains strength for hand surgery. I’m not entirely buying it – the story sounds suspicious and the picture looks a bit Photoshoppy.

WNA also notes this non-weird story, which describes November’s US hospital admissions as the lowest in a decade, with the survey sample of 98 hospitals reporting that admissions were down more than four percent.

Sponsor Updates

  • LRS releases the Mobile Connector for VPSX software, which allows users to print documents from any mobile device to any VPSX-defined output destination.
  • Athenahealth will integrate Merge Healthcare’s iConnect Network into its athenaClinicals EHR to allow users to receive and view exam results and diagnostic-quality images.
  • Wolters Kluwer Heath integrates its Health Language Provider Friendly Terminology with Epic EHR for mid-size to large practices and for hospitals.
  • Greenway Medical adds Digital Assent, a provider of patient satisfaction survey solutions, to its online Marketplace of value-added partners.
  • McKesson Episode Management releases 22 new episodes based on the PROMETHEUS Payment Evidence Informed Case Rate definitions, making it the first automated bundled payment solution to support the latest PROMETHEUS model.
  • InstaMed has grown to 1,000 providers and has processed over $30 billion in healthcare payments in 2013.
  • Razornsights employees celebrate the company’s Founder’s Day by building shoebox gifts in support of Operation Christmas Child.
  • Minnesota’s Office of the Commission of Health certifies Sandlot Solutions a health data intermediary, authorizing the company to provide HIE services in the state.
  • Maryland hires Optum/QSSI to provide project management and operational support for the Maryland Health Connection website.
  • A Nashville paper spotlights Lincor Solutions and the launch of its patient engagement technology for hospitals and health systems.
  • Health Catalyst board member and former Intermountain CIO Larry Grandia wins the 2013 Utah Governor’s Medal in Science and Technology.
  • Fujifilm demonstrated its Synapse products and the showed the MU Stage 2 capabilities of its Synapse RIS at RSNA
  • T-System authors a case study featuring its facility coding customer Memorial University Medical Center (GA), which boosted its ED revenues 20 percent through its coding initiative. 


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

More news: HIStalk Practice, HIStalk Connect.


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December 17, 2013 News 6 Comments

Monday Morning Update 12/16/13

December 14, 2013 News 11 Comments

12-14-2013 3-20-22 PM

From Epic Fail: “Re: Epic. During the Q&A portion of a talk by Bernard Tyson (Kaiser CEO) at Epic today, an Epic employee stood up in front of a full Epicenter and asked Mr. Tyson if he thought that Kaiser would consider selling insurance in the future.” I will generously assume that the interrogator was one of Epic’s youthful, perfect-SAT savants who performed a quick scenario analysis and was shrewdly suggesting to Mr. Tyson that Kaiser’s business model might need to adopt to ever-changing healthcare requirements by focusing on other aspects of the corporate portfolio beyond its extensive insurance offerings. Either that or it was the typical Epic 24-year-old philosophy graduate who knows nothing about healthcare, but who has gained unwarranted conversational confidence from telling hospital people how to run their businesses using knowledge obtained from reading software manuals.

12-14-2013 8-48-04 AM

From Sharing is Caring: “Re: Kaiser. I just got this and it is very interesting… revolutionary, in fact. We can now share patient information between any Kaiser and all of the major hospitals in the SF Bay Area that use Epic-Sutter, Stanford, UCSF, and Alta Bates.” Shared Epic information includes just about everything from the patient, encounters, and results, omitting only flowsheets, images, smart forms, and scanned documents.

12-14-2013 9-39-51 AM

From The PACS Designer: “Re: RSNA highlights. The 2013 RSNA featured an interesting shift in how radiologists can interact with patients. Aunt Minnie listed five areas that drew the attention from attendees. TPD was pleased to see informatics among the list of the top five categories presented in the list for radiologists to consider for adoption.” According to the writeup:

In the past, big iron scanner introductions drew the lion’s share of attention at McCormick Place. One of the defining characteristics of the “new normal” for the RSNA meeting, however, may be the continued prominence of imaging informatics software in the exhibit halls and the scientific program. Indeed, market interest in these technologies seemed to provide a rare sign of hope amidst the overall malaise that still seems to be plaguing much of radiology.

That radiology maturation seemed inevitable – it happened in lab, where the intelligence moved from the instruments to the software managing the information the instruments created. Imaging costs, radiation exposure, remote viewing, patient image sharing, and radiology efficiency are all key issues that smart software (rather than the latest and greatest scanner) can improve.

12-14-2013 7-48-50 AM

Even hospital people like HIStalk readers don’t pay attention to published hospital quality data when making medical decisions for themselves. New poll to your right: is the term “mHealth” obsolete or unnecessary? I think it’s not only meaningless (as is “digital health”) but also unnecessarily divisive as companies and people wall themselves off behind that label instead of jumping into the mainstream of just “health.” That’s not a criticism of the companies waving the mHealth banner – we’re having the same identity crisis in “healthcare IT” as well as it becomes clear that our horizons should be “health” and not just “healthcare” and we try to figure out how population health management and wellness fit among our stodgy billing and order entry episode-based applications. Somewhere among all of that self-imposed digital segregation are consumers-slash-patients wondering why we have to make everything so provincial, fragmented, and complicated.

My latest grammar pet peeve examples, provided without explanation since they are hopefully obvious: (a) I went away for a couple days; (b) So I read a new book; (c) I eat breakfast everyday in the backyard. I’m also still frustrated constantly by lame articles with supercharged headlines that make them sound useful and insightful when they clearly aren’t, leaving me to feel as though I wasted my time with the journalistic equivalent of trying to make a meal of air-filled Cheetos and instead ended up still hungry and with embarrassing orange gunk on my lips (I’m often led to those worthless articles by Twitterers and Facebookers who seem to love being the first to link to awful healthcare IT articles.)

12-14-2013 9-18-37 AM

Welcome to new HIStalk Platinum Sponsor Proximare Health. The 10-year-old Savannah, GA-based company improves the referral process, with 3,000 users processing 25,000 referrals per month through its clinical rules-powered IRIS (Internet Referral Information System). The result: referrals are made to the most appropriate service, the appropriateness is validated from the Web-based system, eligibility and authorization are verified, patients are prioritized by condition, clinical documentation is managed, and results are shared among a patient’s providers. IRIS was built with the help of clinicians from nearly every specialty at Cook County in Chicago, who were trying to solve access challenges by making sure referrals were clinically appropriate, with the referral process managed by (and supported by) clinicians instead of a non-clinical utilization management department. Cook County’s results: (a) referral processing time was reduced from three months to 5.5 days; (b) 22 percent of the referrals were rejected as inappropriate; (c) referral volume increase sevenfold with fewer employees needed to manage it. Check out the short  videos covering order entry, rules engine, scheduling, document and results sharing, patient messaging, appointment preparation, interoperability, and business intelligence. Thanks to Proximare Health for supporting HIStalk.

Proximare had lots of its own YouTube videos, but I found one created by Portland IPA on how it uses the IRIS referral management system.

12-14-2013 8-32-16 AM

My first-generation iPad is getting long in the tooth to the point it can’t run newer versions of apps. I don’t use it enough to justify spending $499 on an iPad Air or even $299 for an iPad mini, so I did my research and instead bought an Asus MeMo Pad HD 7 for $119 from Office Depot on Friday. It’s amazing how much technology you get these days for so little money and in a thin, 10-ounce package: a high-definition display, super fast performance with 1 GB of DDR3 memory, front and rear cameras, dual speakers that sound really good, 10-hour battery life, highly responsive touch, 16 GB of storage, and a Micro SD card reader slot for cheap storage expansion. A seven-inch screen is plenty big when you have an HD display — even tiny text is crisp and playing a YouTube HD movie will just about take your breath away (I’ll use it to watch movies on planes, I’m sure.) Picking up my old iPad now is like hefting a yellowed, weighty encyclopedia volume from 1970. The MeMo Pad feels every bit as satisfying and well designed as my iPhone and Android is just as easy to use as iOS. Thank you, Google, for developing an economical and powerful alternative to the OS wares of Apple and Microsoft.

12-14-2013 8-06-25 AM

Cerner announces a $217 million share repurchase program. As a review, those programs involve companies using their cash to buy their own shares (which they often consider undervalued) on the open market. Or at least that they’ve announced plans to do so – companies don’t always follow through. Those purchases take shares off the market, which increases earnings per share even though overall earnings haven’t changed. They also increase executive bonuses tied to earnings per share at the expense of reduced cash that might have been spent on R&D or acquisitions. In other words, share repurchase programs don’t mean a thing despite the feel-good message that “we love our stock so much that we’re buying it ourselves.” Above is the five-year performance of CERN vs. the Nasdaq.

12-14-2013 8-10-17 AM

Jamie Stockton of Wells Fargo Securities provides the above slice-and-dice of hospital Meaningful Use attestations through 10/31/13. Meditech leads by far in total and net number of attestations, while Epic, Cerner, and McKesson have the highest percentages of clients successfully attesting. Trailing the pack in client percentages are Healthland, Siemens, and Allscripts.

12-14-2013 3-26-42 PM

Duke University Health System goes live with Strata Decision Technology’s StrataJazz for capital and long-range financial planning. 

12-14-2013 3-16-40 PM

A former IT director of The Advisory Board Company pleads guilty to defrauding his employer of $100,000 by approving the payment of invoices to a sham company he created for that purpose.

12-14-2013 3-28-52 PM

Barron’s says athenahealth’s stock drop late last week was due to concerns raised at the company’s investor meeting: (a) CEO Jonathan Bush announced that he will take a two-month leave next year; (b) the company guided next year’s earnings expectations down; (c) the company’s use of flattering but unusual financial measures that have given it a “thin-air valuation” of $5 billion; (d) athenahealth’s statement at the investor meeting that it will double its market opportunity by selling inpatient clinical software to hospitals and by doing so will “undermine the foundations” of Cerner and Epic; (e) the company has little choice for selling to hospitals because they are acquiring its practice-based customers and replacing athenahealth’s products. Athenahealth’s hospital plans apparently involve pre-certification and referrals.

Weird News Andy titles this story as “Now that’s what I call a gestation period,” although he notes that “the train never left the gestation.” Doctors find that an 82-year-old woman with stomach pain has a 40-year-old fetus inside her.

Here’s Vince’s Christmas edition of HIS-tory.


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

More news, HIStalk Practice, HIStalk Connect.


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December 14, 2013 News 11 Comments

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