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News 12/11/13

December 10, 2013 News 6 Comments

Top News

12-10-2013 5-23-25 PM

Practice Fusion closes a $15 million Series D round led by Qualcomm Ventures, bringing the company’s total funding raised to date to $149 million.

Reader Comments

12-10-2013 5-53-48 AM

From Lorre: “Re: mHealth. So many people were coming up to me asking if I was Inga that I finally had to make this sign. I am going to get a well-made one for HIMSS. At one point today I showed someone my shoes and he said, ‘Yeah, you’re not her.’” Lorre was holding court at our little HIStalk booth at this week’s mHealth conference. I’m going to recommend that she not only get a better sign for HIMSS but step up her shoe attire, just to confound suspicious readers.

From Helen: “Re: mHealth Summit. I met Lorre – she rocks!” Lorre enjoyed meeting those (few) readers who attended the conference this week. I’m not sure it was relevant enough for a return next year, but we’ll see.

From ASMD: “Re: floppy disks. New York Times or Dilbert?” An article points out that government is not the most sophisticated technology user, noting that The Federal Register often receives submissions from federal departments via 3.5” floppy disks.

Acquisitions, Funding, Business, and Stock

12-10-2013 5-26-09 PM

HealthLoop, which offers an automated patient follow-up solution, raises $10 million in Series A funding led by Canvas Venture Fund. The company’s CEO is Todd Johnson, the former CEO and president of Salar.

IMS Health, a big data firm that aggregates and sells large databases of de-identified healthcare data, acquires Pygargus, a Swedish health analytics firm. Bloomberg, by the way, reports that IMS Health is considering an IPO in 2014 and  may seek a company valuation of at least $8 billion.


The Indiana HIE selects AT&T’s healthcare Community Online information exchange platform for clinical messaging and medical record sharing.

12-10-2013 1-49-05 PM

Crystal Run Healthcare (NY) selects the Health Catalyst data warehousing and analytics platform.

12-10-2013 1-48-17 PM

UF Health Shands (FL) contracts with Besler Consulting for its Transfer DRG recovery services.


12-10-2013 1-50-04 PM   12-10-2013 1-53-47 PM

HMS Holdings names Joel Portice (Verisk Health) divisional president of government solutions and corporate strategy and Douglas M. Williams (Aveta) divisional president of commercial solutions.

12-10-2013 1-54-45 PM

Teleheatlh solution provider AMC Health appoints Lisa J. Roberts (Viterion Corporation) SVP of its government market division.

12-10-2013 11-54-26 AM

Juan Diaz (Association Capital Resources) joins The HCI Group as SVP/general counsel.

12-10-2013 4-37-04 PM

Bobbie Byrne, MD is named SVP/CIO of Edward-Elmhurst Healthcare, created by the merger of her former CIO employer Edward Hospital and Elmhurst Memorial Healthcare. She will also have responsibility for the facilities and construction departments at Edward as well as the two locations of the Edward Cancer Centers.  

Next Wave CONNECT names Doug Cusick (HP/IBM), Robert Cothron (Singing River Health System), Becky Heflin (IBM), John McDowell (Oslo’s), and Sherry Reynolds (HHS) to its community management team.

Announcements and Implementations

12-10-2013 8-21-45 AM

St. Mary’s Health Care System (GA) makes the Epic MyHealth portal available for hospital patients.

Billings Clinic (MT) implements Omnicell automated dispensing cabinets integrated with Cerner Millennium EHR via the CareAware iBus.

Mercy Medical Center (MD) deploys BridgeHead Software’s Healthcare Data Management for the protection of its Epic system data.

PA eHealth, eVantage Health, and Caradigm will complete the pilot for their HIE project in early 2014.

The Mount Sinai Health System (NY) will use $5 million in funding from the NYC Economic Development Corporation to establish the Mount Sinai Institute of Technology. The Institute will initially focus on digital health technologies, biologically integrated technologies, and prescription technologies.

Government and Politics

The FDA, ONC, and FACC will release a report early next year outlining strategies and recommendations on an HIT framework that promotes innovation, protects patient safety, and avoids regulatory duplication.

Do as I say, not as I do: the OIG finds that the HHS Office of Civil Rights failed to comply with certain federal cybersecurity requirements for the IT systems used to store HIPAA-compliance investigation data. The OCR says all deficiencies have now been corrected.


Almost 76 percent of the largest not-for-profit senior living organizations are implementing EHR technology and 83 percent are implementing point-of-care systems.

12-10-2013 12-25-49 PM

KLAS finds that despite vendor claims of the importance of technology differentiation, providers find that technology platforms do not accurately predict EMR capabilities or clinical success.

12-10-2013 12-45-36 PM

Also from KLAS: StatRad, Rays, and TRS earn top scores for overall customer satisfaction in a report on teleradiology in the ED.

12-10-2013 12-33-20 PM

Thanks to Brian Ahier for forwarding an updated graphic that clarifies the newly proposed timeline changes for MU. Brian notes, “I think the important point here is that although there will very likely be more changes to come, healthcare organizations and providers should not count on any delay or changes but prepare for plans to proceed under this current current regulatory framework.”

Further thoughts on the MU Stage 2 extension: the Stage 2 timeline is unchanged, as Brian’s graphic depicts. Just because Stage 3 has been pushed back a year doesn’t mean that ONC is ignoring concerns about Stage 2 as CHIME and other groups seem to assume by their ballistic reaction to the Stage 3 announcement. ONC’s decision-making process has been thoughtful, participative going back to when Farzad was named National Coordinator. ONC announced the Stage 3 decision Friday and mentioned this week that it will offer a public comment period for the regulatory strategy being worked on with HHS and FDA when that report comes out in in early 2014. Those events show show that nothing has changed just because Farzad has moved on – ONC is listening and won’t blindside anyone with salvos of dictatorial imperatives. The pundits are also missing another important point – decoupling product certification from MU gives vendors more predictable certification updates and the change to give input. Vendors can deliver what the market wants (usability and patient safety features, for example) instead of chasing certification checkboxes.

A Massachusetts man spends about $10 and 20 minutes to make a prosthetic hand for his 12-year-old son on a 3D printer using plans he found on the Internet. The estimated cost for a traditional prosthetic hand is $20-$30,000.

Sponsor Updates

  • API Healthcare reports that more than 250 hospitals and other healthcare providers have chosen its ShiftSelect to automate staffing and scheduling processes.
  • HMS will integrate Medi-Span Controlled Substances Drug File from Wolters Kluwer Health into its Prescriber Eligibility solution.
  • Visiongain includes AT&T and Airstrip on its list of Top 20 Mobile Health Companies for 2014.
  • Anthelio Healthcare Solutions and Encore Health Resources align to promote economies of scale and expand available services.
  • Certify will participate in next month’s IHE NA Connectathon 2014 in Chicago.
  • Caristix posts a white paper on managing predictable outcomes and margins with  HL7 integrations.
  • Iatric Systems hosts a December 12 webinar on integrating EHRs with Welch Allyn vitals.
  • Billian’s HealthData shares its list of the five most popular health market reports for 2013.
  • Twenty-nine percent of patients participating in the 2013 Connance Consumer Impact Study rate their most recent hospital billing experience with top satisfactions scores, though 19 percent express full dissatisfaction.
  • PeriGen hosts a December 11 webinar featuring the company’s chief clinical officer Thomas Garite, MD and a discussion on problems with Category II fetal heart rate problems.
  • KLAS gives 3M Health Information Systems the highest overall performance score among vendors for the 360 Encompass System, 3M’s inpatient CAC technology.


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

More news: HIStalk Practice, HIStalk Connect.

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December 10, 2013 News 6 Comments

Monday Morning Update 12/9/13

December 7, 2013 News 8 Comments

12-7-2013 7-45-29 AM

From Beyond the Legalese: “Re: revised Stage 2 timelines announced late Friday. What exactly does this delay mean? If we are a hospital that must attest to Stage 2 by end of fiscal year 2014, does this mean we now have until end of fiscal year 2015 for our first MU2 attestation year?” My impression is that the Stage 2 start date hasn’t changed, only the end date, so it’s not really a “delay” as much as it is an “extension” to make Stage 2 a three-year program. In that regard, I’m not sure the extension is cause for universal celebration since the 2014 dates remain unchanged for Stage 1 and Stage 2 – it’s really only Stage 3 that has been delayed. Feel free to leave a comment. CMS and ONC “announced” the change in a potentially obscure blog post late on a Friday without making supporting material available to clarify, but I expect they will provide more details. CHIME is already complaining that the 2014 start dates haven’t changed as it and other organizations wanted (nobody feels guilty about looking the taxpayer gift horse in the mouth, apparently.)  

From The PACS Designer: “Re: smartphone overview. With the holiday season upon us, TPD thought it would be useful to post features of the smartphones currently available from various sources. As smartphones get more integrated into everything we do daily, it’s important to match the intended use with the right smartphone features, whether it be iOS or an Android system.”

12-6-2013 3-46-17 PM

Respondents are split on whether the FDA should regulate clinical software to any degree. New poll to your right: have you made a personal medical decision based on published hospital quality data in the past one year? I’ll admit that having worked almost my entire adult life in hospitals, I’ve never looked at the published quality data of local hospitals, including my own (although I’ve also never been hospitalized, so I had little motivation.)

I’ll be writing from the mHealth Summit this week. Drop by the microscopic HIStalk booth (#1305) and say hello if you are so inclined. The event has more than doubled in attendance since the last time I attended in 2010 and I’m hoping that the conference logistics have improved after HIMSS took it over from the National Institutes of Health.

12-6-2013 4-39-53 PM

Welcome to new HIStalk Platinum Sponsor Juniper Networks. A secure, reliable network is mandatory for EMRs, HIEs, telemedicine, PACS, high definition video, remote patient monitoring, real-time wireless location, and mobile clinicians. Juniper’s Healthcare Network Solution provides clinician access from any mobile device, secure access to patient records, a single user policy for all network points, and reductions in cost and risk via a unified wired and wireless infrastructure. Juniper’s WLAN solution provides the highest levels of reliability, scalability, management, and security to meet the needs of a mobile healthcare workforce. See “Top 10 Reasons Healthcare Prefers Juniper Wireless.” A case study quote from Juniper customer Lurie Children’s Hospital (IL): “We need to broker the complex relationship between stability and speed. We want to be able to put new applications on the network and adjust the network to meet the need. But on the other hand, we want to retain a stable network. We need a network that has very predictable behavior.” Juniper powers 60 percent of the world’s Internet transactions. Thanks to Juniper Networks for supporting HIStalk.

I found this new Juniper Networks video on YouTube.

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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Medicaid fraud is too common to be newsworthy, but not when foreign diplomats are involved. Among the 49 people charged with defrauding Medicaid of $1.5 million are dozens of Russian diplomats and their wives, who federal prosecutors say misstated their income to get Medicaid to pay their medical bills and then used the money for luxury vacations and helicopter rides. The government, of course, didn’t blame itself for happily paying the bills of non-citizens.

12-6-2013 7-59-11 PM

Nashville-based healthcare IT consulting firm eMids raises $13 million in funding.  

12-7-2013 6-52-41 AM

Emory University Hospital (GA) uses IBM InfoSphere Streams real-time analytics and data acquisition software from Excel Medical Electronics to analyze ICU patient data in real time. If you want to play around with stream computing, there’s a free download of InfoSphere Streams.

12-7-2013 7-50-25 AM

Huntsville Hospital Health System (AL) chooses Caradigm Health Information Exchange to connect its affiliates. Caradigm signed a partnership deal earlier this year to market Orion Health’s HIE product.

A former Epic employee files a class action lawsuit against the company, claiming he and hundreds of other Epic quality assurance employees should have been paid overtime wages over several years. Epic disagrees, saying federal law is clear in classifying QA people as salaried rather than hourly.

12-7-2013 7-05-04 AM

Keith Seaman (Department of Veterans Affairs) joins VMware as chief technology executive for healthcare.

Saint Francis Health System (OK) chooses Epic.

Norton Healthcare (KY) reports that it has earned $12 million in HITECH payments in the third year of its $200 million, five-year Epic implementation.

Houston Methodist Hospital reports that a laptop containing the information of 1,300 transplant patient was stolen last week, but as is rarely the case when these announcements are made, the laptop was encrypted.

12-7-2013 7-40-39 AM

A 22-year-old woman sues a doctor, Northwestern Memorial Hospital, and the Feinberg School of Medicine (where the doctor is a pain management fellow) after he posts pictures of the woman drunk in the ED on Facebook and Instagram. The doctor also posted a Facebook invitation to join him for cocktails near the ED while waiting for the woman to recover from alcohol poisoning. He wasn’t actually her doctor – he came to the ED at the request of a mutual friend – and the hospital now claims he inappropriately accessed the patient’s medical records.

Illinois chiropractors consider going off the insurance grid and making patients pay cash due to high patient deductibles, medical coding issues, and the cost of software. According to one chiropractor, “The Affordable Care Act will make deductibles so high that people will soon be paying out-of-pocket for chiropractic medicine anyway. So why not go cash-only? This way, I can get rid of the headache of dealing with insurance companies, bring costs down for my patients, and get back to spending more time helping people.”

Ed Marx got a lot of responses to his “Identity and Leadership” CIO Unplugged post last week and has decided to delve deeper into the topic in the specific areas of titles and physical appearance. Watch for his next post.

The last 100 directory assistance operators in Connecticut will lose their jobs in February due to smart phones, which caused 411 calls to drop by 70 percent in the last three years.

12-7-2013 6-41-08 AM

Congratulations to those physicians (Dr. Jayne among them) who received notice Friday that they passed the exam to become board certified in clinical informatics.


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

More news: HIStalk Practice, HIStalk Connect.


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December 7, 2013 News 8 Comments

News 12/6/13

December 5, 2013 News 8 Comments

Top News

12-5-2013 8-03-31 PM

Healthcare Informatics owner Vendome Group acquires The Institute for Health Technology Transformation (IHT2), which offers executive health IT conferences, webinars, and research reports.

Reader Comments

12-5-2013 8-52-52 PM

From Quilmes Boy: “Re: Medseek. Underwent another round of layoffs this morning. My role was one of them.” Medseek CEO Peter Kuhn provided this response to our inquiries: “Over the past 12 months, Medseek has developed a significant offshore development operation, adding almost 150 personnel in India to accelerate product development and enable us to respond quickly to changing market dynamics and evolving customer requirements. In addition, weeks ago we funded the acquisition of Madison, WI-based Symphony Care, a leading population health and care management solution provider. Today, the company initiated a planned restructure to take full advantage of these recent investments. Medseek has retained all key personnel to deliver on customer commitments and deliver on near and long-term strategic goals.”

HIStalk Announcements and Requests

inga_small Some recent goodies from HIStalk Practice include: McKesson may close its Seattle office. Physician EMR adoption in the US is up but still lags behind many countries. Texting while doctoring could negatively impact patient care and safety. CMS finalizes the 2014 Medicare Physician Fee Schedule, which includes a 24 percent pay cut if the SGR formula is not amended. Patent data from EHRs provide reliable measures of the process of care and the patient-centeredness of a primary care practice. A gastroenterologist finds pleasure in his move to a low-tech office. Lab ordering rates among primary care physicians decline with providers have a real-time display of cost information within their EMRs. Dr. Gregg takes a trip back to the future. Thanks for reading.

On the Jobs Page: Program Manager – Healthcare Resellers.

Upcoming Webinars

December 17

How to Drive ROI in Your Healthcare Improvement Projects,” presented by Bobbi Brown and Leslie Hough Falk, RN, MBA, PMP of Health Catalyst. Sponsored by Health Catalyst. Tuesday, December 17 at 1:00 Eastern. At a time when average hospital’s margins are stagnating, executives should be asking tough questions about the ROI of "indispensable" technologies. Will new technologies prove their worth or drive them further into the red? How do you measure and track ROI?

December 10


Paperless Practices: Harnessing EHR Value by Improving Workflows with Electronic Data,” presented by Jay Ward of Kryptiq, Mike Kelly of DocuSign, and Sam Clark of  Asheville Head, Neck, & Ear Surgeons, P.A. Sponsored by DocuSign. Thursday, December 10 at 1:00 Eastern. During this Webinar, panelists will discuss how industry and market trends have aligned to rationalize the adoption of e-signature in healthcare. They will also review primary, practical considerations such as legality, security, and mobility. Finally, panelists will highlight case studies and relevant examples of organizations that have successfully jumped onto the “path to paperless”.

December 11

Audit Readiness: Three Simple Steps to Protect Patient Privacy,” presented by Mark Combs of WVU Healthcare System and Rob Rhodes of Iatric Systems. Sponsored by Iatric Systems. Wednesday, December 11 at 2:00 Eastern. Join us for this insightful Webinar to learn what you can do to keep your healthcare organization safe from unauthorized access to patient data.

December 12

Looking Behind the Curtain: Value Based Care’s Impact on the Revenue Cycle ,” presented by Karen Marhefka, MHA, RHIA of Encore Health Resources. Sponsored by Encore Health Resources. Thursday, December 12 at 1:00 Eastern. This webinar provides a basic understanding of value-based health care, or accountable care, explain why value-based reimbursement may not impact the core revenue cycle components immediately, discuss the key focal points for change needed to maintain profitability in a value-based reimbursement model, review why organizations will be pressured to consolidate revenue cycle systems, list the type of tools that are being introduced or are changing with the move to value-based reimbursement and name the major changes that will be required from organizations to move to value-based care and reimbursement.

December 17

The Power of Doctor Happiness: Why The Ideal Patient Experience Needs to Start with the Ideal Provider Experience,” presented by Lyle Berkowitz, MD, FACP, FHIMS (DrLyle). Sponsored by HIStalk. Thursday, December 17 at 2:00 Eastern. Hear from a "Doctor Happiness Guru" who describes how to think innovatively about using healthcare IT in ways which can automate and delegate care, resulting in time savings to doctors as well as improved quality and efficiency for patients.

Acquisitions, Funding, Business, and Stock

12-5-2013 5-49-33 PM

ClearDATA Networks closes a $14 million Series B funding round.

Accelera Innovations will pay $4.5 million in cash for Behavioral Health Care Associates, a billing and PM provider.

12-5-2013 6-48-07 PM

The College of American Pathologists (CAP) confirmed with Inga that it will shut down its CAP Consulting business over the next few months, concluding that, “The Board decided to exit the CAP Consulting business, our division located in our Lake Cook Road office that provides terminology and clinical information consulting services. CAP Consulting has made steady progress against its business objectives over the past several years; the services it provides are incredibly important and valuable. But with current fiscal constraints, the CAP is not able to continue to invest at the level needed to sustain and grow the business.” Employees were told on November 21. CAP hopes to place those affected in open positions, but also recognizes that the vendors it works with may have an interest in hiring them. CAP will continue to support existing products such as Electronic Cancer Checklists and Electronic Forms and Reporting Module.

12-5-2013 9-50-01 PM

Carl Icahn raises his stake in Nuance to nearly 19 percent of the company’s shares. NUAN shares rose around 6 percent in the past week.


St. Luke’s Hospital (TX) will add Craneware’s Pharmacy ChargeLink.

San Diego Orthopaedic Associates Medical Group (CA) selects SRS EHR.

12-5-2013 5-54-24 PM

Marin General Hospital (CA) engages MedAssets to support the optimization of clinical support resources through cost and operational management improvements.

Baptist Health South Florida will implement the Medseek Empower enterprise patient portal and integrate it with its existing Siemens and NextGen EMRs.

12-5-2013 7-25-07 PM

Banner Health selects Wolters Kluwer Health’s Health Language solutions to navigate the ICD-10 conversion process.

University Physicians of Brooklyn-Anesthesia (NY) will implement OpenTempo’s staff scheduling and case management solutions.


12-5-2013 3-59-33 PM

Experian names Jennifer Schulz (Visa) group president of its vertical markets group, which includes the company’s healthcare business. Its healthcare-related acquisitions include SearchAmerica (December 2008), Medical Present Value (June 2011), and Passport Health Communications (November 2013).

12-5-2013 8-24-11 PM

The National Association of Professional Women names Trudy Easton, RN, senior clinical consultant with McKesson, as its Professional Woman of the Year.

MedSynergies hires Doug Hansen (Accelion Health) as CFO.

Announcements and Implementations

12-5-2013 9-52-27 PM

Homecare and medical staffing company Interim HealthCare implements Procura Home Care Software across 47 locations.

Pediatric genetic testing laboratory Claritas Genomics will implement Cerner’s Millennium Helix solution, join Cerner’s Reference Lab Network, and collaborate with Cerner to develop a laboratory solution for molecular diagnostics. Cerner Capital has also invested in Claritas, closing the company’s Series A round.

Impact Advisors completes a feasibility analysis for Sutter Health (CA) that consider the possibility of Sutter sharing its EHR platform with a community hospital.

Healthix and the Brooklyn HIE (NY) complete their merger and will combine their separate technology platforms over the next year. The organization will retain the Healthix name.

PerfectServe introduces Clinical Event Push, which automatically informs physicians of important clinical events as they occur.

Coastal Healthcare Consulting announces Fusion, a solution to help healthcare organizations achieve peak performance from their EMR investment.

12-5-2013 9-21-07 PM

Mediware releases the MediLinks WTS workload solution for respiratory therapist staffing. 

Government and Politics

ONC’s HIT Policy Committee votes to urge HHS to abandon a proposed requirement for providers to give patients reports showing who looked at their EHR data. Though patient advocacy groups support the requirement, opponents claim the option would be technically impractical and administratively burdensome.

CMS reports that 85 percent of eligible hospitals have received a MU incentive payments through the end of October and 60 percent of Medicare EPs are meaningful users. Agency representatives also note that 89 percent of EHs have attested to Stage 1 MU using a primary vendor that had any 2014 edition product, while 70 percent of EPs used a primary vendor that had any 2014 edition product.

12-5-2013 1-35-14 PM

Rep. Scott Peters (D-CA) introduces the Health Savings Through Technology Act, which would create a commission to investigate how digital health technologies could help reduce healthcare costs and how they could be integrated into federal healthcare programs.

Innovation and Research

Researchers find that physicians who receive email notifications of lab results for tests pending at the time of patient discharge are significantly more likely to be aware of abnormal test results. Authors of the AHRQ-supported study suggest that widespread use of such automated systems could improve patient safety.

When it comes to HIE adoption, physicians are more influenced by other physicians with whom they interact and have common patients than by geographical proximity or other factors, according to a study published in the Journal of the American Medical Informatics Association,


12-5-2013 9-50-31 AM

inga_small Microsoft researchers develop a smart bra prototype embedded with sensors that flash smartphone warnings when the wearer’s mood suggests they might be about to eat too much. Enterprising hackers would be well advised to seek fast food chains willing to underwrite lingerie infiltration activities to redirect consumers’ dietary choices.

12-5-2013 7-01-41 PM

A study of 19 healthcare systems using the Philips eICU ICU telemedicine system finds that mortality and length of stay were reduced, adding that patients were 26 percent more likely to survive their ICU stay and were discharged from the hospital 15 percent faster. The study also identified the most important criteria in delivering patient care and cost benefits from an tele-ICU program:

12-5-2013 7-00-32 PM

I spoke to principal author Craig M. Lilly, MD, professor of medicine, anesthesiology, and surgery at the University of Massachusetts Medical School and director of the eICU program at UMass Memorial Medical Center (MA), who told us, “All of the things we found made sense." The most important factors affecting patient outcome and cost were:

  • Having a remote or local intensivist review the patient and care plan within an hour of ICU admission
  • Reviewing the results of the program regularly
  • Responding faster to patient alerts and alarms
  • Following ICU best practices
  • Conducting interdisciplinary rounds
  • Running an effective ICU committee

Lilly clarified that the organizations studied were hospitals which had not outsourced their intensivists to a for-profit company.

I asked about previous vendor-supported studies that claimed benefits from tele-ICU programs that independent studies rarely validate. He emphasized that no commercial ties existed in this study. "Any meta-analysis that’s done going forward will definitely show improvement whether you include or whether you exclude the studies that were done by the commercial manufacturers."

Several health systems have shut down their tele-ICU programs due to cost and questionable benefit, most recently MaineHealth, and I asked Lilly about that. He said, "The MaineHealth outcome is really interesting. They had withdrawn it from about 35 community hospital intensive care beds and those folks actually signed up with another vendor. Even though MaineHealth wasn’t going to support it or subsidize it — and they were providing a pretty darned good subsidy, I can tell you, to have it in these community hospitals, which I think is when it became financially unviable and that was one of the reasons they wanted to cut it down — these other community hospitals absolutely saw the value in it for their patients and also for their financial outcomes.They signed up with another vendor and paid a lot more money to do so."

In summarizing his study, Lilly told me, "It didn’t matter whether you had in-house intensivists or didn’t and a lot of these places did. They still got better when they added this layer on. Even though they had somebody in house, that person couldn’t be everywhere they needed to be when they needed to be there. Because while they were dealing with the emergency in Bed 1, the patient in the the ICU three floors above them in Bed 7 was really getting sick and they didn’t know about it. This technology allowed hospitals with good intensivists and great bedside nursing to get the right expertise when they needed it, where it needed to be there because they were able to get on the alerts and alarms in less than three minutes and they couldn’t before."


Allscripts India opens a new and expanded office in Vadodara to house 275 existing employees and to accommodate up to 400. Allscripts has 2,000 employees in India, up from 850 in 2010.

A psychiatrist warns peers about blanket authorizations that patients sign to get their insurance companies to pay for their care, with an example of a subsidiary of Quest Diagnostics requesting the complete paper file on one of his patients. He found that the company mines prescription data and sells it to life insurance companies to consider when deciding whether to issue policies. Psychiatric News, which ran the story, said, “Steven Daviss, MD, chair of the APA Committee on Electronic Health Records, told Psychiatric News that health information exchanges (HIEs), which connect different sources of patient health care data for the use of practitioners caring for patients, can also be an unexpected source of sensitive information. In Maryland, for example, the HIE contains information on hospital treatments, laboratory and radiology data, diagnoses, and medications. ‘This is valuable information that improves the continuity of care, but states have different policies regarding access to these data beyond treatment purposes,’ he said. ‘Most states have mechanisms that allow one to opt out of the HIE and to see who has accessed your information.’”

12-5-2013 10-02-58 PM

Boston Children’s Hospital (MA) reports a substantial drop in medical errors with the introduction of more standardized communication during patient handoffs, including a structured handoff tool within the EMR that self-populates standard patient information.

Vendors, beware: lawsuit-happy MMRGlobal is awarded its tenth healthcare IT patent entitled “Method and System for Providing Online Records,” which covers prescription and appointment reminders as well as e-prescribing.

12-5-2013 7-43-28 PM

A New York Times opinion piece by Pulitzer-winning writer Tina Rosenberg says hospital quality data is inconsistently reported and hard to understand. She says, “But at times it seems as if hospitals aren’t trying very hard. They like to report process measures on which they score well. But with 440,000 deaths from hospital error per year, their record is poor on key safety outcomes. This somewhat dampens their enthusiasm for public reporting. And what hospitals want matters a lot.”

12-5-2013 7-52-42 PM

A study finds that hospitals have a median of two employees assigned to manage population health, with mid-level managers being the most likely to be involved. It concludes that hospital population health approaches are inconsistent and poorly integrated.

In Europe, big drug companies are enlisting patient groups to lobby against legislation that would require them to publish all results of clinical trials, not just favorable ones, so that independent researchers could validate their conclusions. The two drug company trade associations want patient advocates to protest the release of such data by expressing concerns that it would be misinterpreted by non-experts. According to a trade group SVP, “EMA’s proposed policies on clinical trial information raise numerous concerns for patients. We believe it is important to engage with all stakeholders in the clinical trial ecosystem, including the patients who volunteer to participate in clinical trials, about the issue. If enacted, the proposals could risk patient privacy, lead to fewer clinical trials, and result in fewer new medicines to meet patient needs and improve health.”

Adoption of core medication MU elements reduces adverse drug event rates with cost savings that recoup 22 percent of IT costs, according to a study published in the American Journal of Managed Care.

12-5-2013 6-40-22 PM

An op-ed piece in New England Journal of Medicine reviews the OpenNotes initiative that calls for patients to have access to the notes made about them by their clinicians, citing previous studies showing that most patients read the notes and reported improved understanding, medication adherence, and feeling of control, with the vast majority of both patients and clinicians urging that the program continue. However, the article finds that while electronic medical records created the opportunity, they also complicate it:

Early adopters are learning that implementation means more than simply mailing notes or visit summaries or having patients log on to a portal. For starters, the knowledge that patients (and often their families) will have access to records affects the intent and sometimes the content of clinical documentation. Writing accurately about a suspicion of cancer, for instance, can be difficult for clinicians who don’t want to worry patients unnecessarily, and addressing character disorders or cognitive dysfunction in ways that are useful to patients, consulting providers, and others who use the records requires carefully considered words. These challenges are compounded by today’s electronic records, in which the story weaving together social, familial, cultural, and medical contributors to the patient’s health and illness often disappears, obscured by templates. A boon to billers, quality assessors, and researchers, such records can become formulaic and susceptible to data-entry errors. Moreover, they’re often filled with copied-and-pasted information that buries the essential narrative under voluminous repetitive text.

You may think you possess an unnatural ability to speak Siamese Thai when watching this video from Bumrungrad International Hospital in Thailand that describes its planned January go-live with inpatient nursing documentation using Medicomp’s Quippe.

12-5-2013 7-34-04 PM

Weird News Andy racked his brain to come up with “From Doobies to Boobies” as his working title for this article, which describes the potential for marijuana smoking to cause gynecomastia in men (i.e., moobs). WNA also likes the story of Ben Taub Hospital’s ED director (above), who is charged with breaking into the home of another female physician and using red lipstick to write “whore” and “homewrecker” on her bathroom mirror, presumably for reasons not involving emergent care.

Sponsor Updates

  • Clinical insights platform vendor QPID is named a finalist for a publisher’s innovation award, as chosen by a panel of hospital CIOs and other executives.
  • Greythorn conducts a market survey for HIT professionals to analyze compensation, benefits, job satisfaction, hiring trends, and industry participation. Greythorn will donate $1 to the Boys and Girls Clubs of Bellevue and Chicago for every submission.
  • MedcomSoft partners with Liaison Healthcare to connect its Record EHR platform to more than 120 labs and imaging centers integrated within the Liaison EMR-Link Lab Hub.
  • Aprima Medical integrates DMEhub into its EHR, allowing physicians to write orders for durable medical equipment directly from their Aprima EHR.
  • First Databank begins publishing the National Average Drug Acquisition Cost pricing file from CMS.
  • Aspen Advisors spotlights Baystate Health’s (MA) EHR optimization efforts following Aspen’s review and analysis of the organization’s EHR options.
  • API Healthcare highlights the top 10 interview questions to ask nurses.
  • The Indiana HIE details its work with Predixion Software to develop predictive analytics healthcare solutions at this week’s National Readmission Summit.
  • Truven Health Analytics extends its contract to use Post-n-Track’s cloud-based web services platform for the exchange of eligibility data.
  • AT&T launches EverThere, a wearable device that connects to a 24/7 call center if it detects that the wearer has fallen.
  • Impact Advisors principal Laura Kreofsky discusses the sharing of patient data between hospitals.
  • Quantros launches Quantros Member Center, a customer portal that provides immediate access to support cases, training videos, release notes, and user groups.

EPtalk by Dr. Jayne

From The Grey Goose: “Re: RSNA. Booth traffic felt like it was up. The temps were much warmer than last year (except they dip to the 20s later this week) so that probably helped improve the moods. All the big anchor exhibitors continue to improve their booths – more flash, more high tech, better organized space – so people wouldn’t get log-jammed in the middle. Lots of focus on moving data to HIPAA-compliant clouds and being able to access it securely on any device, anywhere. Folks not looking at that seem to be in the minority now which is a big shift from a year or two ago. People want to be more efficient to drive down costs in the land of Obamacare.” Thanks for sharing your experience. It’s great to have roving reporters fill us in on the meetings we’re not able to fit onto our busy dance cards.


From Converse All-Star: “Re: your Thanksgiving column. Mentioning readers sending photos of shoes brought to mind a pair of shoes that my lovely wife possesses. As you might expect, she saves them for special occasions and they also occupy a place of honor in our closet at home.” I’ll let our readers guess what state they represent. The coordinating scarf definitely puts these over the top! Is this the beginning of a 50-state themed challenge? Or better yet, perhaps we could convince The Walking Gallery’s Regina Holliday to branch out into shoes?

Dr. Jayne’s HIMSS Registration Update


More fun and games on the HIMSS website this week. After the HIMSS14 registration site couldn’t figure out how to charge my membership, I decided to go to the HIMSS main website to try to update my membership first so I wouldn’t have to do that step on the conference page. No luck – this critical error message was all I received. The site also refuses to recognize my MD and I can’t figure out how to update that part of my demographics (although it does refer to me as “Dr.” so it’s even more confusing).

I tried it again a couple of days later. I didn’t get the critical error, but when I tried to renew my membership, it adjusted the expiration date by a month since I’m renewing before mine expires, making it effectively only good for 11 months. At that point I was just glad my housing reservation was successful. I gave up for the night.


I decided to go back to the conference website and try it again that way. I am still receiving an alert that it can’t find the pricing for a membership renewal, but at least it has my expiration date in the wrong year. For those of you who are not familiar with the concept of positive pessimism, that’s an example: following up a negative statement with another negative statement to take the edge off the current problem. You’ll learn more about it if you are actually able to register for HIMSS and stay until Thursday to hear Erik Weihenmayer speak. He’s one of the best motivational speakers I’ve heard.


I tried to do it again without the membership renewal (thinking I’d try to do it on the main HIMSS site in January) and got this great new alert. Unfortunately it doesn’t tell me what to do with “please note” rather than “error” or “warning.” Perhaps we could use this as a testing scenario for next year’s Clinical Informatics board exam. Is anyone else having these issues? Or is it as I suspect and half the attendees are either vendors or media so they have a different registration process entirely and no one has complained yet?

I finally broke down and called because I didn’t want to miss the Early Bird discount. I was directed into a phone queue that didn’t have an option that applied to my scenario. Unfortunately the best advice the live agent could give was, “log out and log in again” and we all know how much end users love to hear that. I explained that I had been trying to register using multiple browsers on multiple different devices over many days, so I didn’t think logging out would help.

I asked if they could manually register me. She had to ask a supervisor. Ultimately the blame was placed on the data file that HIMSS sent with the incorrect expiration date, although they said they had no access to the file to try to verify the correct dates. After roughly half an hour of back and forth, they were able to shadow me in their system and bypass the problematic steps, so I suppose now I’m good to go. Inga and I are well into planning our social schedules, so please keep those event invitations coming.


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

More news: HIStalk Practice, HIStalk Connect.


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December 5, 2013 News 8 Comments

News 12/4/13

December 3, 2013 News 4 Comments

Top News

12-3-2013 6-04-00 PM

Hearst Corporation will acquire 85 percent of Homecare Homebase, the #1 KLAS-ranked software provider for the homecare and hospice market. Hearst’s other healthcare IT companies include First Databank, Map of Medicine, MCG, and Zynx Health.

Reader Comments

From N2InformaticsRN: “Re: CAP Consulting. The College of American Pathologists is dissolving CAP Consulting, its informatics consulting practice. This is the group that was doing exceptional work in terminology and standards with a deep understanding of the information needs and challenges faced by providers across the health care delivery and laboratory spectrum. More recently they developed an effective framework to assess and tackle health information management.  The team has unique skill sets and helped us ensure ontological correctness by developing a terminology roadmap. It will be interesting to see who picks these folks up or whether they form a consulting group on their own.” Unverified. We have a call scheduled for Wednesday with CAP Consulting to learn more.

HIStalk Announcements and Requests

12-3-2013 6-53-05 PM

Welcome to new HIStalk Platinum Sponsor Physician Technology Partners. The physician-owned and led consulting company offers provider-to-provider services that make Epic-using physicians more productive. Its physician champions hold ASAP and EpicCare Ambulatory certifications. PTP’s six-phase approach to building to optimize for quicker ROI includes strategic planning, implementation, build and validation, training, go-live support, and optimization. They’ve done it for customers that include Ohio State, UCSF, Sutter, Exempla, Texas Children’s, Providence, University of Miami, and a bunch more names you would know. PTP’s expertise also includes making Dragon speech recognition work optimally in an Epic environment. Thanks to Physician Technology Partners for supporting HIStalk.

I have an interesting challenge with HIStalkapalooza. Jonathan Bush has a conflict and, for the first time since the inaugural HIStalkapalooza in 2008, we may need to find someone else to present the HISsies awards (travesty, I know.) I need someone who has commanding stage presence, a wicked sense of humor, and a cynical view of healthcare IT (extra points for being able to swig large-format bottles of high-gravity beer while uttering a non-stop stream of one-liners during the otherwise august proceedings.) Let me know if you’ve seen anyone who can approximate JB’s on-stage magic since otherwise Inga’s going to have to get up there and she will be terrified.


Acquisitions, Funding, Business, and Stock

12-3-2013 6-06-47 PM

Post-acute care software provider Brightree acquires MedAct LLC, a developer of home medical equipment and DME software solutions.

12-3-2013 6-07-45 PM

Entrada, a developer of workflow products that are integrated with EHRs from athenahealth, Allscripts, Greenway, and NextGen, raises $1.12 million in new equity.

12-3-2013 6-16-06 PM

Shareable Ink closes $10.7 million in Series C financing and names former Allscripts CEO Glen Tullman to its board.

12-3-2013 6-16-57 PM

Lexmark will consolidate four acquired businesses — Pacsgear, Saperion, Twistage, and Acuo Technologies — under its Perceptive Software subsidiary.


12-3-2013 9-21-02 PM

AnMed Health (SC) will implement technology from Iatric Systems to integrate multiple hospital and departmental systems.

The Metropolitan Chicago Healthcare Council selects HIE technology from Sandlot Solutions.

Children’s National Medical Center (DC) will deploy Streamline Health’s OpportunityAnyWare business analytics software suite.



12-3-2013 7-47-10 PM

Kristina Greene (Proxicom) joins Lucca Consulting Group as RVP.

12-3-2013 8-14-35 AM

Acusis names Richard Simonetti (Horiba Medical) VP of strategic business solutions.

12-3-2013 8-35-54 AM

Kareo hires Amyra Rand (HireRight) as VP of sales.

12-3-2013 8-34-56 AM

Perigen appoints Chip Long (Merge Healthcare) SVP of growth and development.

12-3-2013 6-11-55 PM 12-3-2013 6-12-47 PM

RCM service provider MedData appoints Paul Holland (QuadraMed) VP of sales and Carl Naso (Aleris International) corporate controller.

12-3-2013 6-14-43 PM

Stephen Bernard (Accretive Health) joins Connance as VP of professional services.

12-3-2013 12-51-06 PM    12-3-2013 12-50-27 PM

Valence Health names Nathan Gunn, MD (Verisk Health) VP of population health and Dan Blake (AirStrip Technologies) SVP of software product development.

KLAS names six members to its first-ever imaging advisory board: Mark Christensen (Intermountain Healthcare), Karen McGraner (Exempla St. Joseph Hospital Denver), Eugene V. Pomerantsev (Massachusetts General Hospital), Peter S. Rahko (University of Wisconsin Hospital), Pablo Ros (University Hospitals HS Cleveland), and Brian Wetzel (Our Lady of Lourdes Memorial Hospital Binghamton.)

Announcements and Implementations

Pro-Laudo, a teleradiology practice in Brazil, implements eRAD PACS with integrated reporting and speech recognition.

12-3-2013 8-53-08 AM

PeaceHealth Medical Group in Longview, WA goes live on Epic.

Hospitals and skilled nursing facilities in California’s Santa Clara county will deploy CareInSync’s Carebook platform to coordinate care transitions.

12-3-2013 9-24-47 PM

Cheyenne Regional Medical Center (WY) converts patient information and data from seven legacy systems into a single platform integrated with Epic using Hyland Software’s OnBase ECM solution.

More than 50 Adventist Health/Central Valley Network (CA) facilities go live this week on Cerner.

12-3-2013 6-19-51 PM

Martin Health System (FL) deploys the RightPatient iris biometrics patient identification system from M2SYS Healthcare Solutions.

Providence Health & Services (WA) opens a clinic without a waiting room in its first go-live of RTLS from Versus Technology.

UCLA Health System (CA) opens the Lockheed Marking UCLA TeleHealth Suite and Lockheed Martin Outpatient Recovery Suites for Wounded Warriors of Operation Mend, which were made possible by a $4 million gift from Lockheed Martin.

GE Healthcare launches Centricity 360, an online clinical collaboration tool that provides real-time sharing of data.

3M Health Information Systems releases 3M ChartScriptMD Software for Radiology, a reporting application that allows radiologists to create, sign, and distribute complete reports and communicate diagnostic findings from a single, integrated system.

12-3-2013 7-33-20 PM

Congratulations to Tampa General Hospital (FL), which VP/CMIO Richard Paula tells me has earned HIMSS EMRAM Level 7 with its $90 million Epic system.

Innovation and Research

Researchers from NORC at the University of Chicago will study how Cerner employees respond to cost transparency tools from Change Healthcare. The RWJF-funded study will assess the impact of price, quality, and engagement approaches on consumer choice of healthcare.

Researchers at the University of Pittsburgh create a publicly searchable digital database of infectious diseases cases dating back 125 years.



12-3-2013 9-47-33 AM

The Leapfrog Group publishes its annual list of top hospitals based on quality of care.

Carolinas HealthCare System launches analytics capabilities that integrate data for evidenced-based health management, individualized patient care, and predictive modeling. The health system’s in-house analytics group built the data analytics models and are using de-identified clinical and financial information from 10.5 million patient encounters. I interviewed SVP/CIO Craig RIchardville in September.

Happtique certifies 19 health and medical apps, which requires them to meet privacy, security, and operability standards and pass clinical content testing.

WEDI, EHNAC, and DirectTrust partner to promote and accelerate the adoption of a national accreditation program for information “trusted agent” service providers.

12-3-2013 1-46-45 PM

inga_small The New York Times highlights the insanity of US hospital charges, including pricing that is often arbitrary; wide variations in pricing for the same service across different facilities and regions; and, heavily inflated prices for routine supplies and services. For example, the average cost of treating a cut finger in an ER ranges from $790 in New England to $1,377 in the Pacific. Also noted: the hefty incomes of many executives in non-profit health systems, including 28 Sutter Medical Center officials who each make more than $1 million a year.

12-3-2013 1-31-36 PM

inga_small A tone-deaf boy in Denver suffers a concussion playing lacrosse, recovers, and develops the ability to play 13 instruments. His physician theorizes that the musical talent was “latent in his brain and somehow was uncovered by his brain rewiring after the injury.” Sort of gives new meaning to the term, “one-hit wonder.”

Crain’s Chicago Business points out that despite the hoopla around the 34 hospitals MetroChicago HIE has announced as members, it has failed so far to sign at least three of the biggest ones: Northwestern, University of Chicago Medicine, and NorthShore.

Weird News Andy finds himself thankful for piercings after reading this story, which describes a joystick-like device implanted as tongue piercing that allows paralyzed people drive their wheelchairs by flicking their tongues.

WNA may have a new competitor, as a reader provided this toothsome morsel of prose. A Swedish prisoner escapes two days before his scheduled release to have a tooth fixed, having been denied service by the prison dentist. He has the tooth removed and then returns to his cell. The prison gives him an oral warning and extends his stay by 24 hours to make up his time.


Sponsor Updates

  • Administrators from Nemours Children’s Hospital (FL) explain how Rauland-Borg Corporation, Versus Technology, and GetWellWork integrated their technologies to inform patients about their doctor or nurse as they walk into a patient room.
  • Mike Silverstein and Kasey Fahey of Direct Recruiters, Inc. interviewed 21 healthcare IT executives about trends and predictions.
  • Capsule Tech joins the Continua Health Alliance.
  • Greenway Medical Technologies will integrate data analytic tools from Inovalon into its PrimeSUITE EHR platform.
  • AirWatch develops app reputation scanning technology for its platform in support of corporate-owned and BYOD deployments.
  • Vital Images showcases clinical enhancements to its VitreaAdvanced software at this week’s RSNA meeting.
  • MedAssets shares a video case study highlighting how it helped the Texas Purchasing Coalition achieve $60 million in cost reductions and increase efficiencies.
  • Culbert Healthcare Solutions hosts a December 13 webinar on the ICD-10 impact of revenue cycle operations and clinical workflows.
  • Quantros offers a December 11 webinar on quality reporting requirements for inpatient psychiatric facilities.
  • Nuance adds speech recognition accuracy and workflow enhancements to the PowerScribe 360 platform.
  • Beacon Partners publishes a white paper outlining best practices when connecting affiliated physicians to the health system.
  • Merge Healthcare releases iConnect Network, an imaging network for the secure electronic exchange of imaging information.
  • FUJIFILM Medical Systems introduces Synapse VNA technology and demonstrates Synapse RIS EHR solution at this week’s RSNA meeting.


RSNA Impressions

12-3-2013 7-12-28 PM
Deborah Kohn checks in with a high-level reaction to RSNA.

Based on my observations of RSNA 2013’s multitude of imaging informatics products, radiology (and other image-generating “ology” or department) PACS continue to be “deconstructed”.

For example, the “A” in PACS (for Archiving) remains the focus of many Vendor Neutral Archive (VNA) system products. No noteworthy independent (of PACS vendors) VNA products are being introduced this year, and most of the PACS vendor VNA products are trying to catch up to the independents by highlighting new functionality. This year’s newer focus centers on enterprise viewers, which consolidate provider organizations’ large number of disparate clinical system viewers, such as those of the multi-modality PACS (DICOM), Enterprise Content Management (non-DICOM), and even EHR system viewers.

Also moving to the enterprise level are the image share / image exchange capabilities, which include the taking-along of key clinical content down/uploaded from/into the EHR. An impressive Johns Hopkins Medicine work-in-progress at IHE’s Image Sharing Demonstration included Face Time/Skype-like (yet HIPAA secure) video conferencing for consultations and/or second opinions. The remote providers collaborated on diagnostic-quality views of DICOM images with side-by-side, structured EHR data and unstructured text reports – all in one view at the click of a button.

In summary, traditional PACS functionality continues to be siphoned off into other, more robust and often enterprise components, leaving traditional PACS as the important workflow engines for the modalities.


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

More news: HIStalk Practice, HIStalk Connect.


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December 3, 2013 News 4 Comments

Monday Morning Update 12/2/13

November 30, 2013 News No Comments

11-30-2013 6-37-29 PM

From The PACS Designer: “Re: Splunk for data. Splunk has an app library for developers of data solutions and uses Hadoop and XML to easily craft viewing platforms for various data solutions. By using basic Simple XML concepts you can experiment and find a data viewing solution for critiquing by your user groups.”

11-30-2013 11-53-52 AM

Two-thirds of respondents say they’re OK with entertaining new job possibilities at the HIMSS conferences. New poll to your right: should the FDA regulate clinical software in any way? Vote and then use the poll’s comment link to elaborate.

Listening: Feeder, somewhat obscure (in the US anyway) radio-friendly British rockers who’ve been around for 20 years.

News is slow as it always is over Thanksgiving weekend. I hope your holiday (for those celebrating) was memorable in positive ways. It’s barely more than three weeks until Christmas, believe it or not.

11-30-2013 6-29-26 PM

I’ll be writing daily from the mHealth Summit in the Washington, DC area next week. If you’re going, drop by the our first-ever HIStalk booth (#1305) and say hello. Ours will be the nearly bare one because it’s really expensive to furnish a booth. My impression from the last time I attended was that not many hospital folks attend, but the event has grown to 5,000 attendees since HIMSS bought it and may have outgrown its governmental and public health roots.

11-30-2013 6-35-27 PM

In Canada, Children’s Hospital of Eastern Ontario announces that it will implement Epic in its hospital and 80 clinics. The budget was reported at $7.7 million, which is surely incorrect except possibly for the clinics only.

11-30-2013 7-59-53 PM

MetroChicago HIE will be announced this week and launched early next year, reports say, with 34 area hospitals (listed here) participating initially. The HIE was originally planned in 2009 and announced in April 2011 but stalled when hospitals balked at paying to participate.

Palomar Health (CA) releases a mobile app built with Extension Healthcare that locates patients and lets caregivers communicate.

Speaking  of Palomar Health, here’s a video from the November 5 SoCal HIMSS CIO Forum featuring Chief Innovation Officer Orlando Portale speaking about hospital innovation. He says that only 5 percent of hospitals are innovative; the rest are followers.

11-30-2013 7-53-25 PM

University of Washington Medicine (WA) says that information on 90,000 patients was accessed in October 2013 when an employee opened a email attachment that contained malware.

Weird News Andy extends his Thanksgiving best wishes with a story about what he calls “a chip that makes you lose weight.” It’s genetic rather than potato, nacho, or chocolate — an arm-implanted computer chip releases a hormone that sends an “I’m not hungry” message when the implantee has eaten enough.

Vince continues to put a personal face on the confusing string of McKesson acquisitions in this week’s HIS-tory, which covers CyCare.


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

More news: HIStalk Practice, HIStalk Connect.


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November 30, 2013 News No Comments

News 11/27/13

November 26, 2013 News 2 Comments

Top News

11-26-2013 7-24-25 PM

Nuance Communications reports Q4 results: revenue up less than 1 percent, adjusted EPS $0.30 vs. $0.51. Unenthusiastic company guidance sent shares plummeting 18 percent Tuesday; they’ve sunk 41 percent in the past year. Above is the one-year price graph of NUAN (blue) vs. the Nasdaq (red).

Reader Comments

11-26-2013 3-42-24 PM

From BR549: “Re: Health Care DataWorks. Laid off 35 percent of its workforce last Wednesday.” HCD CEO Jason Buskirk provided this response to our inquiries: “We do not share specific statistics, but the percentage that you quote is incorrect. Based on feedback from our clients, we are realigning the organization to be laser focused on our software, KnowledgeEdge. HCD will continue to hire the best and brightest technical talent in the industry.” Buskirk was announced as CEO on September 18, replacing founder Herb Smaltz, who had held the CEO position since 2008 but remains on the company’s board.

11-26-2013 12-51-59 PM

inga_small From TomT: “Re: holiday wishes. It’s that time of year when we should take a moment to give thanks for for all 141,000 new ICD-10 codes coming our way. I hope you and the rest of the HIStalk gang avoid any of these turkey-related injuries and have a wonderful Thanksgiving.” Yet another reason to buy the frozen Butterball. Many thanks to TomT and all the other readers who have sent us holiday greetings!

HIStalk Announcements and Requests

11-26-2013 3-13-32 PM

Welcome to new HIStalk Platinum Sponsor Medfusion. The Cary, NC-based company enhances the patient-provider relationship by providing new ways for them to communicate, improving patient engagement and allowing providers to meet MU Stage 2 requirements. The former Intuit Health’s patient portal allows providers to spend more time on patients through the efficiencies gained from online messaging, appointment scheduling, bill payment, payment plans, refill management, and results sharing. Medfusion’s portal also integrates with popular EHRs and provides patients with mobile access. See for yourself – you can test drive the patient portal instantly with no signup required just like I did. I interviewed founder Steve Malik, who bought the company back from Intuit in August 2013. Thanks to Medfusion for supporting HIStalk.

11-26-2013 4-07-10 PM

I’ll have details about our HIMSS activities (including HIStalkapalooza) after New Year’s, but here’s something fun: we’ll be having an HIStalk sponsor networking reception Sunday evening, February 23 from 6:30 until 8:30 (an easy walk from the HIMSS opening reception, which runs from 5:00 to 7:00). Sponsor executives always enjoy the chance to lay aside their competitive armor in renewing old acquaintances and making new ones in a relaxed setting, so this should be a fun evening in which business will be inevitably conducted as well. Lorre will be hosting and I’ll provide great food and drinks. Watch for your invitation.

Acquisitions, Funding, Business, and Stock

11-26-2013 9-21-29 AM

Patient engagement and education provider PatientPoint completes the acquisition of publishing assets from American Hospitals Publishing Group International, a developer of customized patient guides and communication tools.

11-26-2013 10-51-41 AM

Genophen, a developer of a health management platform and clinical support tool, raises $2 million in a third round of funding.

11-26-2013 4-10-12 PM

Streamline Health Solutions prices its secondary stock offering of 3 million shares at $6.50 per share for net proceeds of $17.1 million.

11-26-2013 6-11-00 PM

Cumberland Consulting Group acquires life sciences implementation firm Mindlance Life Sciences

11-26-2013 7-01-17 PM

PM/EMR vendor CureMD acquires medical billing company AviaraMD.


11-26-2013 9-22-31 AM

AtlantiCare (NJ) selects MedCurrent’s OrderRight Radiology Decision Support system, which will be integrated with AtlantiCare’s existing Cerner PowerChart platform.

Madera Community Hospital (CA) will implement Passive Incident Management software from RGP Healthcare.

UK Healthcare (KY) will implement medical image sharing services from lifeIMAGE.

Allina Health (MN) expands its use of MedAssets Contract and Episode Management solutions into outpatient settings.

Bone marrow donor center DKMS chooses registry software from Remedy Informatics.


11-26-2013 9-33-17 AM

Brigham and Women’s Health Care (MA) names Cedric J. Priebe, MD (Care New England Health System) CIO.

11-26-2013 11-16-35 AM

Michael Dal Bello, managing director of Emdeon’s parent company Blackstone Group, resigns from Emdeon’s board.

11-26-2013 12-50-23 PM

The Pennsylvania eHealth Partnership Authority appoints Michael Fiaschetti (Highmark) to its board.

11-26-2013 6-03-02 PM

Outpatient specialty care software vendor Net Health hires Mary Mieure (Greenway) as VP of training and implementation.

Announcements and Implementations

The Kansas HIN and the Lewis and Clark Information Exchange agree to connect their HIEs, allowing the networks to keep $1 million in federal funding.

Huntsman Cancer Institute (UT) deploys the NLP-based I2E software platform from Linguamatics to extract discrete data from unstructured texts in clinical notes.

ProHealth Care (WI) becomes the first healthcare system to use Epic’s Cogito data warehouse tool, which combines patient data from Epic with information from other EMRs and data sources.

Government and Politics

11-26-2013 3-08-55 PM

Several industry organizations ask the House Ways & Means and Senate Finance Committees to ensure that MU Stage 3 includes interoperability requirements for EHRs and remote patient monitoring systems.

Vermont Governor Peter Shumlin reprimands Health Access Commissioner Mark Larson for lying to state representative earlier this month when Larson was asked directly if the state’s insurance exchange had experienced any security breaches. Larson failed to disclose an October incident in which a user pulled up the personal information of someone else due to a reassigned username.

Seven Democratic senators call on the President to name a CEO of the Healthcare.gov website who would report directly to the White House instead of to HHS.

Innovation and Research

Researchers find that rural ED physicians are less likely to make medication administration errors when using telehealth technology to consult with specialists.


11-26-2013 3-10-31 PM

The AHA urges CMS to ensure Medicare contractors and state Medicaid agencies  begin end-to-end testing on ICD-10 by January in order to prepare for the October 1, 2014 deadline.

11-26-2013 8-04-17 PM

Epic will build two laboratory installations of its EpicCare EHR at Oregon Health & Science University for medical informatics and research purposes. On the research side, the University will have access to Epic’s source code. 

Weird News Andy notes breaking news from Good Shepherd Medical Center (TX), where a male suspect is being held in the Tuesday morning stabbing death of a female nurse in the hospital’s ambulatory surgery center. Another employee and three visitors were also injured.

An Idaho state senator video chatting with her son on her iPhone on Face Time has a stroke, which her son notices from seeing her confusion and facial drooping . He rushes her to the hospital in time for speedy treatment and she’ll make a full recovery. She says, “I’ll always be a dedicated fan of the iPhone,” while her son adds, “If you have adults that live away, you need an iPhone for ‘em. I’m serious, that’s huge. … Seeing their face, you can actually see if something’s amiss.”

USA Today talks up the promise of analyzing large healthcare databases to its audience of hotel guests and airport travelers,  although the article wanders around with a few unrelated facts and no real conclusion other than “it’s coming.” It did contain one interesting factoid: a study found that diabetic hospital readmissions weren’t dominated by older patients who had forgotten to inject their insulin, but rather young female diabetics who had intentionally skipped their dose trying to lose weight.

Sponsor Updates

  • Nuance Communications announces the general availability of Dragon Medical 360 l Network Edition 2.0, which allows clinicians to document using multiple devices and provides an accuracy level of 98 percent or higher out of the box.
  • E-MDs Solutions Series 8.0 achieves Complete EHR 2014 certification for Stage 1 and 2.
  • MModal integrates radiology report measurements from PACSGEAR’s ModLink with MModal Fluency for Imaging Reporting.
  • Merge Healthcare will showcase iConnect Access Version 5.0, its universal viewing and imagine sharing solution, at next week’s RSNA meeting in Chicago.
  • Iatric Systems announces that Meaningful Use Manager with Clinical Quality Measures Version 3.0 has earned ONC 2014 certification as an EHR Module.


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

More news: HIStalk Practice, HIStalk Connect.


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November 26, 2013 News 2 Comments

Monday Morning Update 11/25/13

November 23, 2013 News 13 Comments

From HIT Newbie: “Re: Jonathan Bush of athenahealth. Here’s his recent interview at Duke’s Fuqua Distinguished Speaker Series. Great stuff.” It’s very interesting even for non-athena fans and less manic (but still as full of quotable sound bites) as his shorter-form interviews. It’s hard to stop watching once you start.

From The PACS Designer: “Re: Android’s coming up fast. The latest information available on shipping volumes for mobile platforms shows the Android platform beating everyone else easily. While the healthcare space is benefiting from the huge volume of available Apple apps, it won’t be long before Android development expertise grabs the opportunity to offer solutions for big data applications which are sorely needed by researchers and practitioners.”

11-23-2013 9-01-21 AM

Our field involves technology and health, but only about half of respondents use apps to monitor or improve their own health. New poll to your right, inspired by Dr. Jayne: if you’re going to the HIMSS conference, will you be open to the possibility of finding a new job?

Healthcare IT news is always slow in November and December unless some company decides to do a year-ending acquisition, so don’t think a shorter HIStalk post means you’re missing anything. It’s not a magazine with an incentive to pad out the issue with non-newsworthy junk. As I always say, 90 percent of my job is deciding what “news” to ignore. I hate reading stories with attention-getting headlines and cleverly written prose that turn out to be a complete waste of time.

11-23-2013 6-54-31 PM

Sunquest forms The HIT Group, soliciting member companies that agree with its position that the FDA should regulate healthcare IT, with particular emphasis on patient safety and software development practices. I wouldn’t expect many companies to join except those who, like Sunquest, are already regulated by the FDA, but it would be a bold move for vendors to encourage regulation and use their influence to make it reasonable rather than waiting for the FDA to spring a potentially vendor-unfriendly surprise. As a patient, it’s hard to argue against external oversight of systems that are becoming more influential in how care is delivered. I’m not quite sure why the announcement letter capitalizes words and phrases that don’t require it, such as “patient,” “health information technology,” “government,” and “patient safety.”

The New York Times finds that Healthcare.gov was doomed from the start by an unbroken string of bad decisions: the White House’s infatuation with creating a dazzling site, its inflexibility on an October 1 go-live that required ill-advised shortcuts, White House meddling that caused weeks of delay in answering simple software engineering questions such as whether the user should be required to enter their Social Security number, CMS’s decision to use the NoSQL database despite warnings from contractor CGI that not many people know how to program against it, CMS deciding to act as its own systems integrator instead of hiring an experienced company, and putting a CMS official in charge without giving him the authority to make decisions without first contacting the White House. The gist of the article is that White House arrogance combined with CMS incompetence created a disaster that everybody saw coming but nobody could stop.

Encore Health Resources will present an HIStalk Webinar, “Looking Behind the Curtain: Value Based Care’s Impact on the Revenue Cycle” on Thursday, December 12 at 1:00 Eastern.

11-23-2013 6-57-50 PM

Health Canada apologizes to 40,000 medical marijuana users when it mails an information update with a privacy-torching return address of the Marijuana Medical Access Program.

Block Island Medical Center, a two-doctor practice in Rhode Island, reports frustration with its conversion to an unnamed EMR in its quest to collect HITECH incentives. The executive director says “it takes hours to enter records” and one of its doctors reports, “What used to take minutes to write in is now taking hours. The other night I was here until midnight.” A board member says the EMR is “totalitarian,” while the board president said they should have had an implementation person or guide.

The western Montana region of Providence Health & Services lays off employees to offset the cost of new positions required to support Epic.

11-23-2013 6-59-44 PM

Virginia-based gastroenterologist Michael P. Jones, MD (who, interestingly enough, also holds a degree in dentistry) writes a Los Angeles Times opinion piece on EMRs, saying it takes doctors more time to document procedures than to actually perform them and that the main role of EMRs is to create “a bill of sale” to get insurance companies to pay for services. He’s not a fan of the healthcare system in general, either:

My job is to listen and observe, to figure out who really does have something bad going on and who may simply be feeling the effects of life’s wear and tear. There’s a huge difference between that and the healthcare industry, which is more about industry than health or care. Third-party payors don’t really care what happens in an exam room. The visit that you, as a patient, have been anxiously waiting for could just as easily be shoes or oranges or pork bellies to these folks. It’s just a commodity. It’s just data. And now the industry wants it documented in a format that works for billers and statisticians but not so much for doctors: the electronic medical record.

Sponsor Updates
  • Prominence Advisors is named as a “National Best and Brightest Companies to Work For” for 2013.
  • Infor announces enhancements for its MediSuite system for hospitals in Canada, including workflow enhancements, the addition of care models, and improved physician integration.


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

More news: HIStalk Practice, HIStalk Connect.


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November 23, 2013 News 13 Comments

News 11/22/13

November 21, 2013 News 9 Comments

Top News

11-22-2013 12-23-38 AM

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

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

HIStalk Announcements and Requests

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

Acquisitions, Funding, Business, and Stock

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

Experian completes its acquisition of Passport Health.


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

11-21-2013 1-58-44 PM

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

11-21-2013 2-00-16 PM

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

11-21-2013 2-01-29 PM

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

11-21-2013 2-03-10 PM

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


11-21-2013 2-05-07 PM

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

11-21-2013 9-34-48 PM

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


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

Announcements and Implementations

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

11-21-2013 6-58-02 AM

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

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

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

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


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


11-21-2013 12-51-41 PM

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne


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

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

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

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

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

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

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


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

More news: HIStalk Practice, HIStalk Connect.

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November 21, 2013 News 9 Comments

News 11/20/13

November 19, 2013 News 2 Comments

Top News


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

Reader Comments

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

Upcoming Webinars

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

Acquisitions, Funding, Business, and Stock

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

11-19-2013 10-15-57 AM

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

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

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

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

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



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

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

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

11-19-2013 9-37-37 AM

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

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

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


11-19-2013 3-15-47 PM

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

11-19-2013 3-19-47 PM

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

11-19-2013 3-22-30 PM

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

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

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


Announcements and Implementations

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

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

11-19-2013 10-47-26 AM

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

11-19-2013 11-14-47 AM

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

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

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

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


Government and Politics

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

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

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


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

11-19-2013 8-22-44 PM

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

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


Sponsor Updates

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


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

More news: HIStalk Practice, HIStalk Connect.

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November 19, 2013 News 2 Comments

Monday Morning Update 11/18/13

November 17, 2013 News 8 Comments

11-17-2013 11-13-49 AM

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

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

11-17-2013 11-14-48 AM

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

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

11-16-2013 9-33-53 AM

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

11-16-2013 7-46-42 AM

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

11-17-2013 2-53-52 PM

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

11-16-2013 9-50-34 AM

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

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

11-17-2013 10-46-40 AM

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

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

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

11-17-2013 11-24-37 AM

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

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

11-16-2013 8-13-44 AM

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

11-17-2013 11-34-00 AM

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

11-16-2013 8-19-59 AM

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

11-16-2013 9-19-46 AM

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

11-16-2013 7-54-35 PM

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

11-16-2013 8-05-57 PM

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

11-16-2013 8-17-15 AM

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

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


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

More news: HIStalk Practice, HIStalk Connect.


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November 17, 2013 News 8 Comments

News 11/15/13

November 14, 2013 News 7 Comments

Top News

11-14-2013 11-32-20 PM

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

Reader Comments

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

HIStalk Announcements and Requests

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

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

Acquisitions, Funding, Business, and Stock

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

11-14-2013 10-45-11 AM

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


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

11-14-2013 11-36-12 PM

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

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


11-14-2013 4-04-26 PM

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

11-14-2013 10-47-47 PM

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

11-14-2013 10-52-53 PM

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

Announcements and Implementations

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

11-14-2013 11-26-55 AM

Virtual Radiology releases its free Radiology Patient Care benchmarking metrics.

Orion Health launches Rhapsody 5.5.

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

Government and Politics

11-14-2013 12-44-49 PM

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

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


11-14-2013 1-00-29 PM

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


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

11-14-2013 10-39-54 AM

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

NextGen UGM Update

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


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

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


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

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

Followed by:

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

And then:

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

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

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

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


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

More news: HIStalk Practice, HIStalk Connect.


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November 14, 2013 News 7 Comments

News 11/13/13

November 12, 2013 News 21 Comments

Top News

11-12-2013 5-49-15 PM

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

Reader Comments

11-12-2013 7-57-05 PM

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

Acquisitions, Funding, Business, and Stock

11-12-2013 3-22-35 PM

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

11-12-2013 3-26-09 PM

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

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

11-12-2013 7-45-41 PM

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


11-12-2013 1-42-31 PM

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

11-12-2013 1-40-41 PM

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

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

11-12-2013 1-38-41 PM

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

The Nevada HIE will deploy the Orion Health HIE.

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

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


11-12-2013 1-55-25 PM

PaySpan names Cheryl King (First Data) CFO.

11-12-2013 1-50-27 PM

Candace Smith (Medline Industries) joins Voalte as CNO.

11-12-2013 3-53-30 PM

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

11-12-2013 4-02-05 PM

Direct Recruiters, Inc. promotes Dan Charney to president.

11-12-2013 6-50-31 PM

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

Announcements and Implementations

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

11-12-2013 1-56-46 PM

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

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

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

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

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

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

Government and Politics

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

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

11-12-2013 6-23-55 PM

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

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

11-12-2013 8-07-25 PM

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

11-12-2013 8-08-44 PM

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

Innovation and Research

11-12-2013 8-09-30 PM

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


11-12-2013 4-34-12 PM

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

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

11-12-2013 6-31-54 PM

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

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

11-12-2013 8-02-34 PM

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

Sponsor Updates

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


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

More news: HIStalk Practice, HIStalk Connect.


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November 12, 2013 News 21 Comments

Monday Morning Update 11/11/13

November 9, 2013 News 10 Comments

11-9-2013 6-46-41 PM

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

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

11-9-2013 3-52-56 PM

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

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

11-9-2013 4-18-54 PM
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11-9-2013 5-06-24 PM

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

11-9-2013 5-12-17 PM

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

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

11-9-2013 6-47-39 PM

From the Allscripts earnings call Friday:

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

11-9-2013 6-00-46 PM

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

11-9-2013 7-01-00 PM

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

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

11-9-2013 7-02-21 PM

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

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

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

11-9-2013 8-09-43 PM

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

More news: HIStalk Practice, HIStalk Connect.


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November 9, 2013 News 10 Comments

News 11/8/13

November 7, 2013 News 6 Comments

Top News

11-7-2013 6-41-31 PM

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

Reader Comments

11-7-2013 11-16-30 AM

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

HIStalk Announcements and Requests

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

11-7-2013 6-45-21 PM

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

Acquisitions, Funding, Business, and Stock

11-7-2013 6-47-10 PM

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

11-7-2013 5-25-15 PM

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


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

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

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

11-7-2013 6-50-27 PM

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


11-7-2013 9-06-31 AM

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

11-7-2013 9-20-24 AM

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

11-7-2013 3-27-19 PM

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

11-7-2013 4-32-58 PM

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

Announcements and Implementations

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

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

11-7-2013 6-56-20 PM

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

Government and Politics

11-7-2013 5-41-36 PM

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

11-7-2013 1-49-39 PM

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

11-7-2013 5-45-29 PM

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

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

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


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

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

11-7-2013 6-33-54 PM

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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


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

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

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

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

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

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

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

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

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


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

More news: HIStalk Practice, HIStalk Connect.


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November 7, 2013 News 6 Comments

News 11/6/13

November 5, 2013 News 7 Comments

Top News

11-5-2013 9-31-24 PM

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

Reader Comments

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

HIStalk Announcements and Requests

11-5-2013 7-10-32 PM

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

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

Acquisitions, Funding, Business, and Stock

11-5-2013 6-39-11 AM

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

11-5-2013 10-59-44 PM

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

11-5-2013 11-00-22 PM

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

11-5-2013 11-01-13 PM

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

11-5-2013 11-02-04 PM

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


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

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

11-5-2013 9-51-52 AM

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


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

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

11-5-2013 9-13-06 AM

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

11-5-2013 8-05-52 PM

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

11-5-2013 8-10-34 PM

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

Announcements and Implementations

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

11-5-2013 10-01-30 AM

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

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

11-5-2013 6-31-26 PM

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

Government and Politics

11-5-2013 8-29-01 PM

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

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

Innovation and Research

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

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


11-5-2013 10-21-28 PM

ECRI Institute releases its 2014 Top 10 Health Technology Hazards:

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


11-5-2013 12-58-33 PM

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

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

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

11-5-2013 11-08-44 PM

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

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

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

11-5-2013 11-13-25 PM

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

11-3-2013 8-08-41 AM

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

Sponsor Updates

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


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

More news: HIStalk Practice, HIStalk Connect.


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November 5, 2013 News 7 Comments

Monday Morning Update 11/4/13

November 2, 2013 News 20 Comments

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

11-2-2013 11-36-18 AM

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

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

11-2-2013 11-29-12 AM

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

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

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

11-2-2013 5-38-19 AM

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

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

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

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

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

11-2-2013 6-19-01 AM

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

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

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

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

11-2-2013 12-31-36 PM

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

11-2-2013 12-32-37 PM

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

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

11-2-2013 8-26-02 AM

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

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

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

11-2-2013 11-47-08 AM

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

11-2-2013 10-42-27 AM

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

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

Sponsor Updates

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


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

More news: HIStalk Practice, HIStalk Connect.



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November 2, 2013 News 20 Comments

News 11/1/13

October 31, 2013 News 7 Comments

Top News

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

Reader Comments

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

10-30-2013 6-36-08 PM

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

HIStalk Announcements and Requests

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

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

Acquisitions, Funding, Business, and Stock

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

10-31-2013 4-48-54 PM

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

10-30-2013 12-09-43 PM

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

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


10-31-2013 4-50-54 PM

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

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

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

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

10-31-2013 2-53-31 PM

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

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

Announcements and Implementations

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

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

10-31-2013 4-58-38 PM

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

10-31-2013 5-00-27 PM

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

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

10-31-2013 1-44-10 PM

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

Government and Politics

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

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

Innovation and Research

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

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


10-31-2013 2-30-09 PM

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


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

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

10-31-2013 5-08-12 PM

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

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

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

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

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

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

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

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

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

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


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

More news: HIStalk Practice, HIStalk Connect.

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October 31, 2013 News 7 Comments

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  • Matthew Holt, pedant: What would MrHIStalk say about a PR agency putting out a sloppy press release that repeated information twice and droppe...
  • Lazlo Hollyfeld: I'm sure health IT veterans will have a very cynic approach to yet another large IT company entering the healthcare prov...
  • Luis: I hope that the MASS really work, a lot of people is using it, but I think that a good advance in medicine will be the o...
  • Deja vu, but...: FLPoggio, I had the same initial reaction you had. And it may still play out that way in this case. We've seen and hea...

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