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Monday Morning Update 8/5/13

August 3, 2013 News 2 Comments

8-3-2013 2-20-57 PM

From DCIntern: “Re: Stage 3 Meaningful Use. Expect ONC to recommend a delay during National Health IT Week.” Unverified.

From Fly on the Wall: “Re: [vendor name omitted]. Having glitches nationally and worldwide in its medication reconciliation programming, causing patient discharge medication lists to be in error. A safety letter was issued on August 1.” I’ve asked the company to confirm, but in fairness I’m leaving their name off until I hear back. A copy of the safety letter would be nice to have.

8-3-2013 3-24-47 PM

I needed updated copies of Microsoft Office and wasn’t too thrilled at the price or the limit of installing it on only one PC (it was three PCs in previous versions), so I was happy to have stumbled onto Office 365. The Premium version (Word, Excel, PowerPoint, Outlook, OneNote, Access, and Publisher, all in 2013 version) runs $99.99 year for up to five PCs or Macs and also five mobile devices. I don’t like renting software instead of owning but was about to bite the bullet when I strayed onto Office 365 University. Students, faculty, and staff of approved education institutions (like my hospital) can get a four-year, two-PC subscription that includes 20GB of SkyDrive storage for $79.99, which I did –$20 per year is just fine with me. Installation was slick, fast, and in the background. The new software versions work great, but I haven’t been able to figure out how to use the cloud features, especially with Outlook. It would be a really slick package if Microsoft offered an easy guide on how to use all the file-sharing features it touts. I admit that I didn’t spend much time trying to figure it out, but so far I’m using it just like the old CD version.

8-3-2013 1-08-53 PM

Three-fourths of poll respondents don’t see HIMSS as a major player in the debate about healthcare quality and cost. New poll to your right: do you follow the “Most Wired Hospital” type awards? The poll accepts comments once you’ve voted if you would care to elaborate.

Stock picking TV celebrity Jim Cramer, whose lips were perpetually planted on Glen Tullman’s posterior until Cramer finally advised dumping Allscripts shares way too late, is now enamored with Jonathan Bush and athenahealth. Cramer is entertaining, but watching him can be expensive if you take his stock advice. Bush says hospitals are in a decline and struggling ones are being bought up by sharp for-profit operators whose efficiency allows them to make a profit. Cramer says athenahealth “is solving a lot of the healthcare problems in this country.”

8-3-2013 8-38-47 PM

Financially struggling MaineHealth will shut down its nine-hospital tele-ICU program that loses $500K annually. One hospital says it pays $150K each year to participate, but, “While the service is fantastic for our patients, it’s not reimbursable … The consequence of this will be that some patients that may have stayed in the local community may have to travel further for care that we won’t be able to offer. MaineHealth signed a splashy deal with VISICU (now Philips) in 2005, with the health system’s president saying then, “The savings in lives and ultimately in dollars make it an important investment. It’s the kind of service that is possible only because we have forward-thinking clinical and administrative leadership.”

The previously insignificant number of physician practices that don’t accept Medicare is growing, according to a Wall Street Journal report that says 9,500 doctors opted out in 2012.

In England, a study of Internet searches for takeout food that originated from a hospital IP address finds that those searches quadrupled in one year.

An Iowa nursing home fires two employees for taking inappropriate photos of a resident and posting them on an unnamed social media site.

A former Health Management Associates hospital CFO files a whistleblower lawsuit claiming that the for-profit HMA and Tenet hospital chains paid kickbacks to two Georgia clinics in return for sending pregnant illegal aliens to their hospitals so they could bill Medicaid for emergency services. The clinics, which advertised, “We care about your health, not your immigration status,” were paid kickbacks disguised as translation service fees, according to the lawsuit. Illegals aren’t eligible for Medicaid, but emergency services, including childbirth, are covered.

Vince covers the HIS-tory of Siemens, Part 3 this week.


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

More news: HIStalk Practice, HIStalk Connect.


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August 3, 2013 News 2 Comments

News 8/2/13

August 1, 2013 News 12 Comments

Top News

8-1-2013 11-03-44 PM

Cerner announces plans to acquire a 237-acre abandoned mall near its Innovation campus in Kansas City. A new campus on the property will eventually house up to 15,000 new Cerner employees as the company grows over the years.

Reader Comments

From Jobu: “Re: access control. Have there been recent discussions about deploying fingerprint or iris scanner recognition systems vs. multiple passwords?” I’m sure there’s a case study out there somewhere from Caragidm or Imprivata or another user access systems vendor. Feel free to point the way if you’ve seen something.

8-1-2013 9-09-24 PM

From Bluebonnet: “Re: Oregon Health & Science University patient information stored on Google Drive or Gmail. Does this not point to an organization not meeting the needs of its users to promote patient care? Given that this organization has been pretty progressive, is it not troublesome?” That question rarely gets asked: what system deficiencies created the need to store information on consumer-grade services in the first place? OHSU plastic surgery residents were keeping a spreadsheet of their service’s patients on Google Docs, which contained minimal patient information. A similar practice was discovered in the urology and kidney transplant areas. Questions: (a) was the only problem that the hospital didn’t have a business associate agreement with Google? (b) does the hospital’s system not provide a snapshot of which patients each service is covering? (c) if not, then does the hospital not provide network storage for saving copies of files, or was the problem related to mobile devices? Give the residents credit for trying to do the right thing in making sure handoffs were done and using technology to do it. It’s a tough sell to argue that ubiquitous cloud storage is fine for almost everything except PHI.

From HIS Junkie: “Re: Siemens. Looks like the CFO will take over. Is the SMS ride about to end? Less R&D for Malvern? John Glaser in trouble? We all know they been losing their client base to Epic and others for the last three years. Will they come to the same conclusion as GE – healthcare IT can’t be a winner?” Siemens issues a surprise profit warning and uncharacteristically quickly fires its CEO, replacing him with the CFO (you just can’t beat the excitement of an engineering company run by a bean counter.) The new guy says the company tried to grown too fast and needs to get back to execution (not referring to that of his predecessor). The deposed CEO, who steered the company around its global bribery scandals, will get $20 million in severance and a $20 million pension for his six years in the job.

A reader asked whether outside healthcare IT experts could help veterans and what the 90-day agenda would look like. Proud veteran, healthcare IT guy, and HIStalk/HIStalk Connect contributor Lt. Dan provided this response:

I’d scrap iEHR and spend what’s left of the money creating a patient portal that would make the soldier the acting custodian of their own electronic medical record. After every clinic visit, ED visit, or hospitalization, the entire chart from that visit is pushed to the patient portal. It has lab results, physician notes, PT/ OT, all of it, an exact carbon copy of everything entered in the chart for every visit. The portal IS the medical record, and it houses all details of any injuries or illnesses treated.

The portal follows them through their military career and grows as they need services. If they’re transferring from Ft. Bragg, NC to Ft. Stewart, GA they process out of medical at Bragg where the Bragg doctor signs off on the chart and the portal is updated to show that the soldier is transferring to a new duty station, and that Ft. Stewart is now the primary care location.

When the soldier is ready to be discharged, they have their entire military record on the portal from all bases, including medical and dental. When they get back to the civilian world and meet their new civilian PCP, they can at worst print out the medical record for them, and at best leverage some type of HL7 interface to push a medical summary (CCD) to the provider with extractable allergies, prescriptions, problems, and medical history.

If the vet needs to submit a disability claim with the VA, they grant access to their portal so VA reps can review the records immediately, rather than waiting up to 90 days for DoD to find, print, and mail them a copy.

Vets already have a portal. It’s called My HealtheVet. It looks exactly like your typical portal. A dumbed-down, patient-centric version of a medical record. It’s fine, it’s just missing much of the information clinicians will want to see if they’re taking you on as a new patient after military service, or information that a VA rep would want to see if they’re processing a disability claim.

To help vets within 90 days, I’d get the entire medical record from the first day the soldier enters the military, feeding into that patient portal so that soldiers would have custodianship of their own medical record. Then I’d enhance that portal so that vets can easily authorize access to any or all of the content within it and could transmit a CCD from it.

I’d get a team of sergeants, corporals, and privates to execute the plan. It would be done in 89 days and there would be enough money left over in the budget to spend the last day drinking beer and barbecuing.

HIStalk Announcements and Requests

inga_small What you may have missed this week on HIStalk Practice: the number of physicians opting out of Medicare has tripled since 2009, according to CMS. CareCloud adds more than 150 new medical groups in the second quarter, with more than half also selecting CareCloud’s integrated EHR/PM. Dr. Gregg shares a story of a blogosphere encounter with another physician who took his office fully live on EMR in one day. Dr. Gregg offers additional insight on the doctor’s EMR platform in a subsequent post. Click over to HIStalk Practice and catch up on the latest ambulatory HIT news, sign up for e-mail updates, and check out the offerings of our sponsors. Thanks for reading.

Acquisitions, Funding, Business, and Stock

8-1-2013 11-07-25 PM

Ascension Health Ventures invests in Quantros, a portfolio company of Francisco Partners.

8-1-2013 11-10-49 PM

The Advisory Board Company reports Q1 results: revenue up 18 percent, adjusted EPS $0.31 vs. $0.31. The company also announces its purchase of referral technology vendor Medical Referral Source for $11.5 million.

8-1-2013 11-11-33 PM

MedAssets reports Q2 results: revenue up 4.7 percent, adjusted EPS $0.30 vs. $0.28.

McKesson re-elects all its board members at the company’s annual meeting despite dissent from activist shareholders who wanted the company to cut CEO John Hammergren’s pay and split his chairman and CEO roles.

A Bloomberg article says, without any facts to back it up, that Quality Systems has become a Siemens and McKesson takeover target because its share price has dropped and proxy fights have pushed the company to reevaluate its strategy.


8-1-2013 11-12-29 PM

Hallmark Health System (MA) selects athenahealth’s athenaClarity to proactively manage its patient population and engage in new reimbursement contracts.

The Hospital for Sick Children in Toronto selects MetaVision’s MVperfusion solution.


HIT Application Solutions names Betty Jo Bomentre, MD (Vitalize Consulting Solutions) CMIO.

8-1-2013 5-57-57 PM

Healthwise SVP Karen Baker joins the board of Center for Plain Language, a nonprofit that advocates for clear communication in government and business documents.

8-1-2013 9-56-07 PM

Health Care DataWorks names Kathleen Kimmel (MedeAnalytics) chief clinical officer.

Announcements and Implementations

Cerner opens an on-site health center for 2,800 employees and covered dependents of the California-based ViaSat, a communication products company. Providers will use Cerner’s EHR and patients will have access to the Cerner Patient Portal.

Brightree changes the name of its CareAnyware EMR software to Brightree Home Health and Hospice.

8-1-2013 11-14-37 PM

NorthCrest Medical Center (TN) implements Allscripts Sunrise Clinical Manager.

PinnacleHealth (PA) goes live on Soarian Financials.

University of Arkansas for Medical Sciences had the first of three Epic go-lives Thursday, bringing up ambulatory scheduling and registration, kiosks, referring physician portal, retail pharmacy, MyChart, and professional billing in all of its clinics. A third of the clinics also went live on EMR.

The Discovery Channel aired an episode of “Today in America” highlighting PeriGen’s PeriCALM and PeriBirth on Thursday. It’s pretty good, although host and former NFL quarterback Terry Bradshaw struggles painfully to pronounce the big words as he adopts the “Serious Terry” persona instead of his usual goofy on-screen presence.

The US Patient & Trademark Office awards EDCO Group a patent for its Solarity medical record scanning and indexing process that identifies a scanned document type by its recognizable content rather than by a printed bar code.

PatientOrderSets.com announces the integration of its order set tools with Cerner Millennium.


Government and Politics

VA Undersecretary of Health Robert Petzel, MD says that while one million veterans currently use some type of VA telehealth offering, he hopes to boost the number to more than four million.

Above is Farzad Mostashari, MD responding to questions at the Senate Finance Committee hearing on healthcare IT this week, courtesy of Brian Ahier.

8-1-2013 8-33-36 PM

ONC releases its user guide to EHR contract terms.

Innovation and Research

Researchers find that providers who use EHR clinical decision support predictive tools at the point of care are less likely to order antibiotics for respiratory tract infections.


8-1-2013 8-53-44 PM

The American Hospital Association says even EHR-experienced hospitals are struggling to implement electronic clinical quality measures, recommending: (a) slow the transition by reducing and then improving the measures; (b) make EHRs and eCQM tools more flexible; (c) improve EHR and eCQM standards to meet Meaningful Use expectations; (d) test eCQMs to make sure they are reliable and valid before rolling them out nationally; and (e) provide more tools and guidance for the transition.


8-1-2013 6-03-40 PM

inga_small A Capterra infographic lists the 20 most popular ambulatory EHRs based on number of customers, number of users, and social media presence. The accuracy of the information is suspect given that Epic is listed as having one to 50 employees rather than its actual 6,500. Potential buyers should note that “most popular” is not the same thing as “most likely to succeed” in a given practice, where the vendor’s prolific Tweeting and Facebook likes may provide little consolation.

Consumer advocates in Florida oppose a proposal that would boost allowed charges for providing copies of medical records to $1.00 per page rather than $1.00 per page for the first 25 pages and then $0.25 per page afterward. Lobbyists for release of information provider HealthPort technologies filed the request, surely seeing dollar signs at the prospect of nearly quadrupling revenue given the size of the average chart.

Dialysis patients of Boston Medical Center (MA) were exposed to hepatitis B earlier this year because nurses weren’t allowed to use the hospital’s EMR, the state health department has concluded. Contracted dialysis nurses from DaVita weren’t given access to the EMR that would have flagged an infected dialysis patient, leading them to improperly sterilize equipment and expose 13 patients to the disease. The state said the hospital should give EMR access to non-employed nurses who are delivering patient care.

Healthcare employers cut 6,843  jobs in July, the highest monthly total since November 2009. Hospital finances have been hurt by sequestration, Medicare payment cuts, and lower utilization as patients move to high-deductible insurance policies.

8-1-2013 11-22-12 PM

The CEO of WakeMed Health & Hospitals (NC) warns employees of possible cost-cutting and layoffs as the health system’s accumulated losses hit $15 million before the September fiscal year end. The hospital is spending $100 million implementing Epic and expects a $23 million reduction in payments next year.

The bond ratings agency for Johns Hopkins Health System gives it kudos for its system integration, including installing Epic system-wide.

In England, the BBC finds that Royal Berkshire Hospital has paid $25 million to 200 consultants over five years to help it bring up Cerner Millennium. The article says the total cost is $42 million so far, it’s still not working right, the annual cost is $10 million, and IT is now one of the biggest departments in the hospital.

Sponsor Updates

  • Joseph Eberle of CTG Health Solutions presents a case study on using data analytics to improve outcomes for chronic kidney disease patients at this week’s National Forum on Data & Analytics.
  • Impact Advisors’ Senior Advisor Janice Wurz co-authors an article with Henry Ford Health CTO John Hendricks on planning and designing strategic technologies for clinical BI.
  • Allscripts adds integration with Spaulding webECG, allowing the app to be launched from within Allscripts Enterprise EHR to support physician orders and provide access to ECG reports.
  • 3M Health Information Systems introduces Patient-focused Episodes software, which considers the costs and outcomes of longitudinal care.
  • Quest Diagnostics works with Greater Houston Healthconnect to make lab results available to providers.
  • Ingenious Med offers a white paper, “Transition from ICD-9 to ICD-10: Managing the Process.”
  • Andre L’Heureux and and Kevin Entricken of Wolters Kluwer participate in a roundtable on the genome approach to investing.
  • INHS recognizes 18 of its customers that were named Most Wired.
  • API Healthcare reports that it expanded its market reach to include behavioral health and rehabilitation centers in the second quarter.
  • Truven Health Analytics will add animated videos from Health Nuts Media to its Micromedex Patient Connect Suite.
  • Holon’s Scott McCall discusses the importance of good communication skills for HIE implementation team.
  • INHS client St. Elizabeth Hospital (WA) earns HIMSS Analytics’ Stage 7 recognition for EHR adoption.
  • Health Catalyst SVP Dale Sanders lists five indispensable information systems needed for ACO success.
  • RazorInsights will showcase its ONE Enterprise HIS solution during the Illinois Rural Health Association Educational Conference Aug. 22-23.
  • Five Medicity clients are serving as HIO ambassadors to a Chinese delegation gathering best practices for organizing, administering, and sustaining an HIO.

EPtalk by Dr. Jayne


The American Academy of Family Physicians has a new Web page covering the Medicaid-Medicare parity payments specified in the Affordable Care Act. Included is a checklist with the steps providers must follow to obtain the payments.

Clinical Decision Support update time: The US Preventive Services Taskforce publishes a draft recommendation for annual screening of high risk smokers by CT scan. Although it’s still a draft and insurers are not paying yet, it’s a good excuse to review the steps needed to configure new screening guidelines in your EHR.

I was intrigued by a blurb about Cisco’s “Video-enabled virtual patient observation” offering. Essentially it’s remote monitoring of patients who would normally require a “sitter” to ensure they don’t fall out of bed, remove IVs and other tubes, or otherwise cause self-harm. I wanted to find out more about it, but couldn’t without filling out a 17-field questionnaire including budget and timeline information. Based on my recent experiences from the patient perspective, I’d lobby that no technology can replace the presence of a family member at the bedside. For those who can’t have someone there 24×7 or for hospitals that have a shortage, it might be an interesting option.

Researchers at Temple University in Philadelphia are conducting a two-year study looking at virtual speech therapy. Patients will be pushed to spontaneously generate speech rather than practicing scripted conversations.

There have been several additions to the HealthIT.gov site recently, including a document on key terms used in EHR contracts. Based on some of the questions I receive from our affiliated providers, it should be required reading for anyone thinking about purchasing an EHR or going live on a hospital’s platform as part of an alignment strategy or Accountable Care Organization. It’s not a bad read on legal terms in general, especially for providers in the habit of signing documents without reading them.

Bianca Biller alerted me to the proposed cuts to the 2014 Medicare physician fee schedule. Highlights include the (now usual) 24.4 percent cut due to the SGR formula, implementation of value-based modifiers, changes to the Physician Quality Reporting System, and limitations on nearly 200 services where the physician fee schedule non-facility payment is more than the total payment for the same service in a facility setting.


It’s been a rough couple of weeks in the trenches, so I’m going to recharge my magic wand with a long weekend somewhere sunny. If I were a fairy godmother, this is what I would feel like about now. Here’s to sunscreen and fruity drinks.


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

More news: HIStalk Practice, HIStalk Connect.

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August 1, 2013 News 12 Comments

News 7/31/13

July 30, 2013 News 5 Comments

Top News

7-30-2013 8-31-15 PM

Community Health Systems will buy for-profit hospital competitor Health Management Associates for about $3.6 billion in cash and stock. With the assumption of debt, the merger is valued at $7.6 billion and includes 206 hospitals in 29 states. It will be interesting to see if HMA shareholders approve the deal since it only pays $10.50 per share compared to Monday’s closing stock price of $13.92.

Acquisitions, Funding, Business, and Stock

7-30-2013 7-22-55 PM

Specialty medical billing vendor Zotec Partners will acquire Atlanta-based ED billing firm Medical Management Professionals for $200 million from CBIZ. The combined companies will have 1,750 employees and $215 million in annual revenue.

7-30-2013 8-32-52 PM

Mediware CEO Kelly Mann says the company, which has acquired five home health software companies, will acquire one or two software vendors each year, focusing on home health and long-term care.


7-30-2013 5-50-19 PM

Excela Health (PA) contracts with SCI Solutions for its Schedule Maximizer, Order Facilitator, and Results Facilitator solutions.

The Arkansas Office of HIT selects Get Real Health as the patient portal development vendor for providers participating in the statewide HIE.


7-30-2013 3-58-42 PM

CareTech Solutions CEO Jim Giordano is named chairman of the St. John Providence Health System (MI) board of trustees.

7-30-2013 3-59-54 PM



John Lutz (Navigant Consulting) joins Huron Consulting Group as managing director of the company’s healthcare practice.

7-30-2013 6-11-48 PM

Justin Graham, MD (NorthBay Healthcare) is named chief innovation officer, healthcare of Hearst Business Media.

7-30-2013 6-16-15 PM

Dann Lemerand (The HCI Group) joins eVariant as vice president, solution engineering.

Clinical Architecture appoints Andrew Frangleton (UBM Medica) managing director of the company’s UK office.


Announcements and Implementations

Qsource and the Tennessee Office of eHealth Initiatives introduce Direct Technology for secure exchange of patient data.

7-30-2013 8-37-49 PM

Catholic Health Initiatives reports savings of nearly $1.5 million from reduced overtime and $3 million for reduced length of stay since its 2010 implementation of the Cerner Clairvia workforce and operations suite in 14 of its hospitals.

TECSYS announces the OR Inventory Manager perioperative supply change management system.

7-30-2013 8-35-56 PM

Napa State Hospital (CA) and two other psychiatric facilities give employees Ekahau RFID-powered name badges to signal for help and transmit their location in an emergency.

7-30-2013 7-10-17 PM

Baltimore-based Parallax Enterprises will begin beta testing its CHaRM OR safety checklist system starting in the fall.

Government and Politics

7-30-2013 5-56-58 PM

Through the end of June, 305,778 EPs and 4,024 hospitals collected more than $15.5 billion in EHR MU incentives.

inga_small In a Politico opinion piece, Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR) argue for the passage of legislation that would make Medicare claims data available through a free, searchable online database. The senators contend, “The publication of Medicare data will become healthcare’s new financial baseline; the measure of what America’s largest and most powerful buyer of healthcare gets for nearly $600 billion a year.” I understand that privacy issues remain a chief concern, but I have yet to hear a argument compelling enough to convince me that keeping this data largely sealed is preferable to open access and transparency for researchers and consumers.

7-30-2013 8-42-31 PM

A Time article recaps a Washington Post investigative article from earlier this month that describes the AMA group that tells the government how much Medicare should pay doctors. According to former CMS Administrator Tom Scully, “The idea that $100 billion in federal spending is based on fixed prices that go through an industry trade association in a process that is not open to the public is pretty wild.” The AMA criticized the article saying its recommendations are just optional guidelines, but left out the fact that the government accepts 90 percent of those recommendations without question.

Innovation and Research

7-30-2013 8-43-29 PM

A team from the Houston VA Medical Center creates EHR-based triggers to make sure that clinicians follow up on abnormal lab results that can indicate cancer (PSA, occult blood, iron-deficiency anemia, and bloody stools.) Positive predictive value ranged from 58 to 70 percent.

A heart surgeon in India who founded a chain of 21 medical centers offers coronary bypass surgery for $1,583 and hopes to drop the price to $800 within 10 years. The same procedure at Cleveland Clinic costs $106,000.


7-30-2013 8-44-22 PM

MMRGlobal announces Australian singer Guy Sebastian as the spokesperson for its “Don’t Worry Be Happy” advertising campaign for its personal health record.

The ratings agency for Catholic Health Services of Long Island downgrades its bonds, with a key ratings driver being, “Additional expense pressures in fiscal 2013 related to the implementation of an electronic medical record (EMR) has resulted in an operating loss of $18 million for the interim period.” The system filed a $144 million certificate of need in 2010 to implement Epic, which it estimated would add $40 million to its bottom line beyond HITECH payments, including a projection that its length of stay would drop 0.5 days for an annual savings of $28 million.

A jury awards a woman $1.44 million after a female Walgreens pharmacist shared her prescription records with the pharmacist’s husband, who was also the patient’s former boyfriend. Walgreens says the jury was wrong in finding it responsible for the actions of an employee who intentionally violated company policy and says it will appeal.

Weird News Andy calls this article “Potty Mouth.” A China-based research team grows teeth from stem cells extracted from urine. WNA says of this article about a venipuncture robot, “He vants to drink your blaad.”

Sponsor Updates

  • CommVault announces enhancements to its Edge software that give users the ability to securely share, search, and restore files across their mobile, desktop, and laptop devices.
  • NextGen reseller TSI Healthcare will integrate PatientPay with NextGen PM.
  • HealthTronics will integrate SampleMD’s eCoupon and eVoucher solutions from OPTIMIZERx Corp. within its UroChartEHR and meridianEMR platforms.
  • McKesson adds real-time analytics and mobile access to its Strategic Supply Sourcing supply chain solution.
  • ONC head Farzad Mostashari, MD and MGMA Healthcare Consulting Group’s Rosemarie Nelson will deliver keynote addresses at this week’s Aprima 2013 Annual User Conference in Dallas.
  • Greenway Medical will provide its PrimeSUITE customers access to PatientCo’s patient financial engagement  platform.
  • Greythorn Senior Account Executive Paul Tran writes about the importance of “soft skills” within a technology environment.
  • LiquidEHR partners with DrFirst to offer users integrated e-prescribing functionality.
  • Allscripts profiles Manitoba e-Health and its implementation of dbMotion’s eChart solution.
  • Infor Healthcare highlights the success of its supply chain management solutions at several organizations, including MLK Community Hospitals (CA), Huntington Hospital (CA), Prime Healthcare (CA), WellStar Health System (GA), University Health System (TX), and Greenville Health System (SC).
  • Talksoft Corporation integrates its portfolio of messaging services within the Healthpac Computer Systems billing platform.
  • Craneware introduces an update to its Supplies ChargeLink solution that includes an automated search function to identify HCPCS codes.
  • Ingenious Med releases a white paper that offers tips for transitioning to ICD-10.
  • A local publication features the use by Colquitt Regional Medical Center (GA) of Versus RTLS to improve patient care.



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

More news: HIStalk Practice, HIStalk Connect.

smoking doc

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July 30, 2013 News 5 Comments

Curbside Consult with Dr. Jayne 7/29/13

July 29, 2013 Dr. Jayne 1 Comment


Inga mentioned last week that MGMA had sent a letter to Health and Human Services Secretary Kathleen Sibelius. This was triggered by Medicare’s recent announcement that it does not intend to participate in end-to-end testing for ICD-10. In addition to MGMA, there are many more of us that agree that Medicare’s refusal to test with trading partners is problematic.

Medicare has a history of problems with claims backlogs whenever there are changes. My practice experienced this with previous transitions. Although our cash flow disruption was not as large as it could have been, it certainly wasn’t zero. Medicare has tested in the past for both 4010 and 5010 and the processes identified issues which could be resolved prior to the go-live date. CMS touted its testing week for HIPAA 5010 and it appeared to be very successful.

Medicare has said that practices should test with their commercial payers, but the problem there is the number of payers that take their direction from Medicare. If Medicare isn’t going to test, why should they spend resources testing with everyone in their networks?

The worst that can happen is claims are denied, which doesn’t hurt the insurance company and doesn’t hurt Medicare. It does hurt providers of all kinds, whether large or small, and the subsequent payment problems will ultimately have negative consequences for patients.

The MGMA letter calls out CMS for saying back in 2012 that there should be “industry wide best practices for the testing of ICD-10 and other standards.” CMS is requiring all state Medicaid payers to test with providers, but won’t participate itself. Providers are already nervous about ICD-10. This is going to add fuel to the fire.

It’s time for Medicare to eat its own dog food. What do you think? E-mail me.


E-mail Dr. Jayne.

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July 29, 2013 Dr. Jayne 1 Comment

Monday Morning Update 7/29/13

July 27, 2013 News 1 Comment

7-27-2013 1-20-56 PM

From Royal Jelly: “Re: Bobby Byrne interview. Edward Hospital was smart to plan around billing problems with Epic. Hospitals often underestimate the cash flow impact of a go-live.” Readers keep reminding me of the rumored near-meltdown of Wake Forest Baptist Medical Center (NC – above), which at least by urban legend managed to be live on Epic for three months without getting bills out. I don’t know how much of that is true, but there’s a lot of value in reminding hospitals that billing interruptions, no matter how justifiable, are crippling.

7-27-2013 6-56-40 AM

Results from my poll about VC-backed vendors were inconclusive, with a slight preference for them expressed by respondents working for both providers and vendors, but with vendor employees apparently appreciating them a bit more for their tendency toward innovation. New poll to your right: is HIMSS an important player in discussions about healthcare quality and costs?

Here’s how lazy reporting can be passed off as balanced and informed. An Alaska TV station’s headline says the state’s HIE “raises privacy concerns” and “has its share of controversy over privacy” makes it seem that a heated debated threatens to turn into civil unrest. The source of that broad-sounding, film-at-11 conclusion: the station prodded a guy from Alaska’s chapter of ACLU, who provided an uninformed and seemingly indifferent opinion that “if people’s medical records are going to be online, there needs to be really robust security.” News reports increasingly make up stories citing major concerns from unnamed or generalized sources, a sharp contrast from more responsible reporting days when such sloppy generalization about opinions and attitudes would have been rejected without specific facts to back them up.

7-27-2013 1-22-31 PM

From Cerner’s earnings call:

  • It was announced upfront that Neal Patterson would be available during the Q&A, but if so, he was quiet since he didn’t say a single word on the transcript.
  • Services revenue is growing faster than system revenue, which is a good thing as long as you’ve sold enough systems to drive continued services sales. It gives Cerner a way to grow despite competition and a mature market.
  • Global revenue was up 17 percent, which is another way to find new growth even though most US healthcare IT companies don’t do very well internationally.
  • The company brought 10 hospital sites live in 10 months for a newly sold client.
  • Cerner says it has a lot of opportunity and has “only one primary competitor.”
  • Population health was discussed a lot, particularly Cerner’s work with Advocate Health Care.
  • The company says government cutbacks, such as sequestration, increases demand for Cerner systems because they can reduce costs. Quibblers like me would rather hear that “use of systems” rather than the systems themselves reduce costs, but I’m not selling software.
  • When asked about the costs of moving employees to the new campus, CFO Marc Naughton said, “And many times, it’s the cost of the couple of cardboard boxes for them to put in their trunk to take over to the new building, not that we’re low-cost movers, but that is an approach that many of them take.”
  • Naughton says that hospitals are cutting spending on buying the latest and greatest MRI machines whose benefit is mostly marketing rather than medical, but are willing to spend money on IT to reduce costs.
  • I was amused that in talking up a sale it made to a prison system, the inmate population was referred to as “the incarcerated folks.” At least they weren’t referred to as “the mobility-restricted community.”

Caristix releases the HL7 Survival Guide., which addresses the HL7 interface lifecycle. It also includes free tools that include an HL7 listener and router.

7-27-2013 9-46-02 AM

Tim Tarnowski, associate VP/CIO of University of Kentucky HealthCare, will become VP/CIO at Indiana University Health.

The Leapfrog Group rolls out a downloadable Excel worksheet called the “Hidden Surcharge Calculator” that tells employers how much a given hospital’s medical error expense inflates their bill. It’s getting the AHA and other groups riled up over its methodology, which is probably exactly what it’s supposed to do.

7-27-2013 12-34-41 PM

Researchers in China are testing an “oral sensory system” that uses a wired false tooth to identify and record activities such as speaking, eating, and coughing. It may have medical potential, such as tracking dietary habits or detecting smoking. A similar project is Tooth Tattoo, in which a sensor is tattooed into tooth enamel.

7-27-2013 1-24-46 PM

In England, Aintree University Hospital NHS Foundation Trust says its document imaging-based electronic medical record costs $1.5 million less per year than the paper-based system it replaced. It says an innovative indexing solution makes it faster than paper and avoids dumping large PDF files into a folder that need to be individually opened and read. It also allows clinicians to work remotely.

7-27-2013 12-58-07 PM

White hat hacker and medical device security expert Barnaby Jack died Thursday in San Francisco, a week before he was to deliver a presentation, “Implantable Medical Devices: Hacking Humans” at the Black Hat security conference. He claimed he could kill a person from 30 feet away by interfering with their implanted heart device. He was 36.


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

More news: HIStalk Practice, HIStalk Connect.


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July 27, 2013 News 1 Comment

News 7/26/13

July 25, 2013 News 2 Comments

Top News

7-25-2013 11-14-10 AM

CIOs and CMIOs tell the HIT Standards Committee that Stage 2 MU needs to be delayed a year. They argue that EHR vendors will not deliver 2014 certified software updates in time for hospitals to implement, validate, and train on the changes and meet the July 1, 2014 deadline for starting the 90-day Stage 2 reporting period. The AHA and AMA also submitted recommendations to extend the MU timelines and make them more flexible.

HIStalk Announcements and Requests

inga_small Hot stuff this week from HIStalk Practice includes: comments on why EMR selection should not be based on features. MGMA urges HHS to conduct ICD-10 testing with external trading partners, including physician offices. Social media experts offer tips for physicians. Commentary on EHR vendor consolidation and provider dissatisfaction. EPs share their reasons for dropping out of the MU program. Legislation moves forward to to repeal the Medicare SGR payment formula and develop a payment program based on quality and efficiency. Nothing is more refreshing on a hot summer day than an ice cold beverage and a quick perusal of HIStalk Practice. Thanks for reading.

On the Jobs Board: Developer, Full Stack Android (Google Glass), Sales Director.

HIStalk Webinars

7-25-2013 5-48-30 PM

Encore Health Resources will present Full Speed Ahead: Creating Go-Live Success on Thursday, August 15 at 2:00 Eastern, presented by Judi Binderman, MD, chief medical officer.

In implementing a new EHR, organizations typically focus on getting the software ready … building workflows, creating interfaces, and performing data conversions. Just as critical as having the software reflect the organization’s needs is having the go-live activities mirror the organization’s culture, goals, and end user support needs. This webinar will give an in-depth discussion of those items frequently overlooked and under resourced in bringing an EHR live. Encore Health Resources will share our experiences and lessons learned in supporting 28 go-lives for 22 facilities and over 10,000 physicians.

C-level HIStalk readers have provided presenter feedback and the session will be moderated by HIStalk. Register here.

Acquisitions, Funding, Business, and Stock

Kareo acquires ECCO Health, a Las Vegas-based medical billing provider.

7-25-2013 6-06-21 PM

Compuware’s Q1 results: revenue up 0.6 percent, adjusted EPS $0.10 vs. $0.09. Revenue of its Covisint division was up 17 percent.

7-25-2013 6-07-38 PM

VMware’s Q2 numbers: revenue up 11 percent, EPS $0.57 vs. $0.44.

7-25-2013 6-08-26 PM

Cerner’s Q2 report: revenue up 11 percent, adjusted EPS $0.34 vs. $0.29, meeting earnings estimates but falling short on revenue.

7-25-2013 6-29-33 PM

McKesson’s Q1 results: revenue up 5 percent, EPS $1.83 vs. $1.58,  beating earnings expectations but falling short on revenue. Technology Solutions revenue was up 9 percent, with the company reporting growth in RelayHealth, McKesson Health Solutions, enterprise, medical imaging, and Paragon, which is tracking ahead of projections on getting Horizon customers to switch. Hospital Automation and International Technology have been moved to discontinued operations.

7-25-2013 10-30-07 PM

Vitera Healthcare completes its acquisition of SuccessEHS, which was announced June 17.

7-25-2013 10-30-48 PM

From the Quality Systems earnings call: the Hospital Systems business unit saw a 52 percent drop in revenue as it sustained a $2.6 million loss. The company said it caved in to the threatened proxy fight by dissident shareholder Clinton Group to avoid being “faced with what would be a two-month period of yet another proxy fight like we had last year.” The company says the proxy issue and rumors of a potential sale of the company hasn’t affected the sales pipeline.


7-25-2013 10-31-34 PM

Sunnybrook Health Sciences Centre in Toronto will implement iMDsoft’s MetaVision clinical information system in its ICUs.

Boston Medical Center selects MModal’s transcription services for its healthcare provider network.

The Denver Endoscopy Center selects ProVation Medical from Wolters Kluwer Health.

7-25-2013 10-33-56 PM

Santa Clara Valley Health & Hospital System (CA) will deploy Capsule Tech’s DataCaptor medical device integration software.

Congress Medical Associates (CA) selects SRS EHR for its 21 orthopedic providers and two locations.

The Physician Alliance (MI) expands its use of Wellcentive to include Wellcentive Advance for creating a quality improvement registry.


7-25-2013 6-12-07 PM

Caremerge hires Greg Silvey (PSS World Medical) as VP of business development.

7-25-2013 7-41-24 PM

Direct Consulting Associates names Andrew Tipton (Direct Recruiters, Inc.) project manager.

Announcements and Implementations

7-25-2013 10-34-38 PM

CPSI and Sunquest Information Systems join CommonWell Health Alliance.

7-25-2013 12-32-34 PM

The Regenstrief Institute and the International Health Terminology Standards Development Organisation will link their global healthcare terminologies LOINC and SNOMED.

Siemens Healthcare releases a series of nine videos recorded at the HIMSS conference in which experts address critical health IT issues using only three slides and three minutes. Above is our own CIO Unplugged and Texas Health Resources CIO Ed Marx talking about social media and the hospital CIO.

SCI Solutions announces the the integration of its Order Facilitator product with the Surescripts Clinical Interoperability network.

7-25-2013 7-17-17 PM

Healthcare Growth Partners releases its mid-year 2013 HIT Market and M&A review. It says that healthcare IT buyers will outnumber sellers this year, with competition keen for companies with strong recurring revenue, products that are beyond proof of concept, revenue of at least $5 million, software with strong ROI delivered as a service, and ideally with offerings that fit in risk-based models.

Users of pMD’s mobile charge capture solution increased their Medicare reimbursement by automatically scheduling follow-up visits for discharged patients that are reimbursed under two new CPT codes (99495 and 99496) that pay for transitional or follow-up care if the patient is contacted within two days, the company says. The company says its almost impossible to meet the requirements using a paper-based system because of the tight timelines. If your goal is amusement rather than reimbursement, check out the company’s FAQ page, which in answering a question about the types of reports provided, the answer is “completely, totally amazing ones.”

Innovation and Research

7-25-2013 7-36-00 PM

Qualcomm and Palomar Health (CA) launch Glassomics, the first medically-focused Google Glass incubator.

Above is the just-released TEDMED presentation by Harvard’s Isaac Kohane of the SMART Platform, which advocates the use of extensible, open source apps that sit on top of vendor EHR systems.

7-25-2013 9-19-23 PM

The commercialization arm of Wake Forest Baptist Medical Center (NC) signs a deal with Charlotte-based app vendor Novarus Healthcare to develop disease management apps.

Philips Healthcare announces plans to start an incubator in Israel, where it has a large development center and has made previous acquisitions.


7-25-2013 10-21-28 AM

inga_small St. Luke’s Medical Center in the Philippines introduces an online service that allows patients to book their preferred rooms in advance based on price and room amenities. I kind of like the $1,155 per night Presidential Suite, which includes a receiving room, guest room, PC and printer, eight-seat dining area, and three plasma TVs.

inga_small The mail processing company for  Clark Memorial Hospital (IN) blames a “processing error” for sending 1,093 billing statements to the wrong address.

7-25-2013 3-02-41 PM

inga_small Ezekiel Emanuel, MD, occasional White House advisor and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, calls the U.S. News & World Report “Best Hospitals” rankings and similar rankings “flawed to the point of being nearly useless.” In an opinion piece published in the Wall Street Journal, Emmanuel says the criteria used for rankings are “unrelated to quality, easily manipulated, and incentivize the wrong choices and behaviors.” Emanuel contends that if hospitals showed more transparency about quality, patients wouldn’t need rankings to select the best healthcare.

A Harvard Business Review article suggests that organizations are asking too much of their CIOs, saying the next generation of CIOs will need to balance four personas: infrastructure management, integrating systems, business intelligence, and innovation, possessing an integrative mind, focus and vision, and a trusting and trustworthy nature.

7-25-2013 6-40-31 PM

A Forbes analysis from last month of John Hammergren’s compensation titled “The World’s Most Outrageous Pension Deal?” says the McKesson CEO’s numbers are “utterly absurd”: a $159 million pension if he were to quit today, $131 million in one-year compensation,  a rumored $469 million if he’s fired by any new owners of the company, and $260 million due to his heirs if he dies or becomes disabled. The article says most companies other than McKesson cut back on very high CEO pension plans after SEC rules changed in 2007 requiring them to disclose those deals publicly. It also says the company gave Hammergren credit for years he didn’t work and pay he didn’t receive to come up with the big number, also waiving its early retirement penalty that applies to its other employees.

7-25-2013 7-54-29 PM

New analysis of CMS EHR attestation data for May by from Jamie Stockton of Wells Fargo Securities finds that Meditech, Cerner, and Epic hospitals lead the way in total numbers with over 400 attesting hospitals each, while Cerner, Epic, and HMS are the frontrunners in client percentages with 65 percent of their hospital customers successfully attesting. Trailing in customer percentages with 50 percent or less are McKesson (50 percent), Siemens (45 percent), and QuadraMed (25 percent.)

China’s public hospitals would collapse without the rampant bribery involving underpaid doctors and administrators, according to a Reuters review. New doctors earn $490 per month, the same as cab drivers, and without bribes would simply walk away from medicine. Patients are often expected to pay doctors extra in cash to ensure successful outcomes and to skip the line of waiting patients.

Sponsor Updates

  • e-MDs recognizes six of its clients selected by ONC as either as an Healthcare IT Champion or Meaningful Use Vanguard.
  • Black Book Rankings ranks Vitera the top ambulatory EHR in its user satisfaction survey. Other HIStalk sponsors earning high marks include Care360 Quest, Greenway, GE Healthcare, Kareo, Allscripts, McKesson, and eClinicalWorks.
  • First Databank releases the FDB High Risk Medication Module to help users identify medications designated as high risk by the FDA and with a Risk Evaluation and Mitigation Strategy (REMS) requirement.
  • Aspen Advisors Principal Dawn Mitchell discusses how to build a technology roadmap for emerging value-based care modules in a CHIME College live Webinar.
  • Jessica Clifton, product marketing manager for Billian’s HealthDATA, offers predictions of which healthcare skills will be in demand over the next decade.

EPtalk by Dr. Jayne


My “meeting of the week” award goes to our internal discussion on upcoming changes to the NCQA Patient-Centered Medical Home program, due to launch next spring. New proposed standards call for better integration between behavioral health and primary care. It seems like most of our time in primary care is spent in some flavor of behavioral health anyway – even when dealing with chronic conditions such as hypertension, diabetes, and hyperlipidemia, many of the best solutions are behaviorally driven rather than pharmaceutically derived.

This fifth version of the PCMH recognition program also aims to reduce duplicative testing, focus resources based on patient need, and emphasize outcomes. It sounds a lot like old-time family doctoring, when we aimed to treat what could be fixed as efficiently as possible and not waste resources when they wouldn’t change things.

Somehow I don’t think it’s going to be that easy, though. NCQA accepted comments (limited to 1,800 characters each) until a few days ago. The funniest comment was by my colleague who didn’t find out about the comment period until today, saying he was sorry he missed the opportunity to demonstrate the heightened abbreviation skills he’s mastered after a decade of using EHRs with character limits.

CMS will host a July 30 Webinar on one my favorite topics: Administrative Simplification. All medical students and residents should have to sit through a session like this so that they can see what they are really getting themselves into. If I had any idea how much I would have to learn about medical billing and other non-clinical arenas just to get by, I might have taken my sibling’s offer to pay for the LSAT exam a little more seriously.

Speaking of things that make physicians go “hmm…” the Washington Post runs a piece on doctors’ pet peeves. Items at the top of the list include patients talking on cell phones, late arrivals, no-shows, failure to share all information, lying, asking physicians to commit fraud, and “by-the-way” questions at the end of visits. I recently started moonlighting at a new emergency facility that is very busy and I’m trying to put a positive spin on the exhaustion. Maybe patients talking on the phone when you’re trying to interview them is a good thing – it’s a quick and easy indicator that you have time to run to the bathroom before you see them.

CMS releases the 2015 PQRS Payment Adjustment Fact Sheet, which my billing colleague dubbed “the penalty page.” Read and enjoy!


The MGMA Annual Conference is coming up in San Diego. Inga texted me the other day to see if I was ready to try to beat last year’s record for most parties attended by two bloggers in a single evening. Unfortunately, I’ll be sitting for the new Clinical Informatics board exam that week so I had to let her down gently. Hopefully I made up for it, though, by sharing the happiest bow tie I’ve seen this summer.



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

More news: HIStalk Practice, HIStalk Connect.


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July 25, 2013 News 2 Comments

News 7/24/13

July 23, 2013 News 1 Comment

Top News

A report finds that 81 percent of medical practice respondents who previously said they planned to eventually replace their EHR will actually do it within the next 12 months.

Reader Comments

7-23-2013 10-01-01 PM

inga_small From Boots: “Re: Quality Systems/NextGen. As a long-time client I don’t know what to make of the situation there. Sometimes the company’s actions make no sense. They seem to be managing to distractions and not to vision or mission. As to the rumors that NextGen is looking for a buyer, I’m not sure they will find one who will meet the shareholders’ often unrealistic expectations.” A couple of industry insiders tell me they believe NextGen is ripe for acquisition, given recent declines in net new software sales and uncertain positioning in the replacement market. A big vendor, such as Siemens, may be interested in them to gain market share. Alternatively a PE firm may pursue them with the intent to clean house, increase revenues, and eventually spin off.

From ShowMe: “Data breach lawsuit. It should be interesting to see what happens in the lawsuit against the federal government following the loss of a VA laptop. Am I the only one who thinks the government is showing a little chutzpah with its argument that the suit should be dismissed since there’s no proof of identity theft … yet?  The government should spend its energy encrypting devices and quit asking our veterans to find a smoking gun.” Details on the lawsuit and the motion for dismissal are here.

Acquisitions, Funding, Business, and Stock

7-23-2013 9-48-19 PM

CTG announces Q2 numbers: revenues up 0.4 percent from a year ago, EPS of $0.24 versus $0.25. The company notes that earnings growth in 2013 will be less than originally expected due to hospital clients dealing with “reimbursement reductions caused by the US federal budget sequestration.”

7-23-2013 9-49-14 PM

GE reports that its healthcare division logged a five percent increase in Q2 profit, though revenue was flat.

7-23-2013 9-51-05 PM

HealthStream reports Q2 results: revenue up 24 percent, EPS flat, but beating estimates by a penny. Shares hit an all-time high Tuesday with an 11.4 percent jump, up 60 percent since mid-April.

7-23-2013 9-52-04 PM

Lexmark reports good Q2 results, with revenue of its Perceptive Software business unit up 34 percent as the company transitions out of the inkjet printer business and into services.


7-23-2013 10-03-00 PM

Catholic Health Initiatives selects Conifer Health Solutions to provide population health management and data analytics tools.

Hospital Sisters Health System will deploy iSirona’s device connectivity solution in nine of its hospitals.

Whittier IPA (MA) contracts with Alere Accountable Care Solutions to build a community-wide HIE.


7-23-2013 5-59-21 PM

Culbert Healthcare Solutions hires Jaffer Traish (Zynx Health) as director of Epic consulting.

7-23-2013 3-29-31 PM

AHIMA appoints Meryl Bloomrosen VP of thought leadership, practice excellence, and public policy.

7-23-2013 6-56-08 PM

Encore Health Resources names Anne Dillon (Oracle) as client services executive for Southern California, New Mexico, and Arizona.

Announcements and Implementations

Surescripts expands its clinical messaging capabilities to users of Greenway, Inofile, SCI Solutions, and SOAPware.

The Colorado RHIO reports that with the addition of Exempla Healthcare, all of the state’s 100+ bed hospitals are connected to the HIE or are in the process of connecting.

7-23-2013 3-31-24 PM

Fairfield Memorial Hospital (SC) goes live on Cerner in September.

7-23-2013 3-36-05 PM

Atlantic General Hospital (MD) joins the Delaware HIN, becoming the first acute care hospital in the country to join an HIE located in another state.

Health Catalyst introduces Health Catalyst 2.0, which offers improved automation of metadata gathering from multiple IT systems and includes new content-driven applications for the enterprise data warehouse platform.

Government and Politics

7-23-2013 2-47-36 PM

inga_small ONC posts a progress report highlighting the steps taken since 2011 to implement the federal government’s strategic plan for using HIT to improve health and healthcare. We aren’t there yet, but in toto, the achievements to date are impressive.

In Australia, The Alfred Hospital reports that a university-created trauma decision support system reduced ED errors by 21 percent. It displays vital signs, captures the encounter on video, and incorporates 40 algorithms pertinent to the first 30 minute of a trauma case.


The NYC Economic Development Corp. names Kinsa the winner of its Innovate Health Tech NYC competition for its smartphone-connected thermometer that allows patients to track illness history, share details with physicians, and manage their illness.

Children’s Health Fund launches a telemedicine-enabled mobile clinic for underserved children in Miami on Thursday, July 25.


7-23-2013 6-33-31 PM 7-23-2013 7-44-47 PM

Travis from HIStalk Connect spotted a Nordic Consulting billboard at the Verona, WI exit for Epic. He sees this as the next advertising beachhead outside of the Madison airport security checkpoint and wonders if blimps and skywriting planes are being engaged for Epic’s UGM. The Epic campus photo on the right is from Steve Knurr of Vonlay, just in case you wondered how nice summer days are in Wisconsin.

Sisters of Charity of Leavenworth Health System sues hospital operator Prime Healthcare Services, to which it sold two Kansas hospitals earlier this year. SCLHS says Prime is using its billing software illegally and hasn’t handled patient billing as required by the sales agreement.

Healthcare costs not only bankrupt large numbers of US citizens, they appear to be on track to bringing entire cities to their financial knees. Detroit’s bankruptcy filing raises the possibility that Chicago could be next, with both cities struggling under the weight of underfunded retiree benefits. Chicago probably won’t get much help from the the state since Illinois has a $97 billion pension shortfall of its own. A large chunk of the underfunding is due to medical costs, with a recent study concluding that 61 major US cities have enough money to cover only six percent of their healthcare liabilities. Baltimore’s overly generous retiree healthcare obligations have caused the city to run up a debt of more than $10,000 per household.

Children’s Hospital Los Angeles (CA) will host the third annual Meaningful Use of Complex Medical Data Symposium on August 16-17. It connects clinical researchers and practicing physicians to big data computer experts with the goal of gaining medical insights from electronic information.

Weird News Andy says this doctor failed the “first do no harm” credo and wonders what the second one is. A Nebraska medical resident pleads not guilty to killing four people after being dismissed from the program.

I had some technical problems with Vince’s HIS-tory this past weekend that I didn’t have time to fix for the Monday Morning Update, so here is the belated Part 2 of Siemens.

Sponsor Updates

  • Consulting firm The HCI Group is named Northeast Florida’s fastest-growing company of 2013, with 1,301 percent average annual revenue growth since 2010.
  • NextGen will offer LDM Group’s healthcare messaging platform to its NextGen EHR clients.
  • The Orange County Register profiles Kareo and deems it a “most promising” company.
  • ADP AdvancedMD offers an on-demand Webinar outlining ways private physicians can save their practices.
  • Nuesoft Technologies changes the name of its Nuetopia product to NueMD Medical Billing Services and its Nuesoft Xpress offering to NueMD for Student Health.
  • Ping Identity joins the Cloud Security Alliance Security, Trust & Assurance Registry.
  • NextGen will integrate is Ambulatory EHR with Florida Blue and Availity to make patient-specific clinical information available at the point of care to both providers and payers concurrently.
  • Gartner places Informatica Corp. in the leaders quadrant in its 2013 Data Integration Magic Quadrant report.
  • Intelligent Medical Objects reports that 2,500 hospitals have licensed its interface terminology services, including new customers Catholic Health East (PA), Hospital Corporation of America (TN), Avera Health (SD) and Christus Health (TX).
  • Baystate Medical Center (MA) uses data derived from PeriGen’s PeriBirth EHR to calculate reductions in unnecessary inductions, C-sections, and NICU admissions.
  • First Databank will provide Geneix with its drug knowledge and clinical decision support solution.
  • SGS Life Science Services selects Merge eClinical OS for Phase I-IV studies.
  • Coeur d’Alene Pediatrics (ID) shares how its implementation of Vitera’s EHR, PM, and patient portal solutions led to $300,000 in MU incentive payments and resolved business challenges.
  • Medicity client Vermont Information Technology Leaders shares details of its successful HIE.
  • CoverMyMeds reports that its five millionth prior authorization request was received this week and that the site is now processing 25 percent of all prior authorizations submitted annually in the US.


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

More news: HIStalk Practice, HIStalk Connect.


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July 23, 2013 News 1 Comment

Monday Morning Update 7/22/13

July 21, 2013 News 4 Comments

7-21-2013 6-36-23 PM

Half of survey respondents say the ongoing DoD-VA EHR discussions haven’t changed their perception of those organizations, while a third day they’ve gone negative as a result. New poll to your right, as suggested by a reader: what’s your opinion of VC-backed companies? The answers are a little bit tricky to tease out the opinions of providers vs. vendors. As always, feel free to follow up your all-important vote by leaving a comment on the poll.

I have a lot of HIStalk Webinars scheduled and could use another person to serve as moderator. If you have healthcare IT Webinar presentation experience, have good speaking skills, and are available weekday afternoons Eastern time, tell me why I’d be stupid not to hire you.

7-21-2013 7-49-46 PM

Quality Systems hints in a comment buried in an SEC filing from last week that it may be considering selling itself. The filing describes the company’s acquiescence to dissident shareholder Clinton Group, whereby Quality Systems will bring on the three Clinton Group board nominees to avoid a threatened proxy fight. Clinton Group has successfully used the same threat with other companies.

7-21-2013 7-33-30 PM

Microsoft writes down $900 million after its Surface RT tablet flops and the company cuts the price of the 32 GB model from $499 to $349 hoping for potential buyers who have resisted only because of price.

7-21-2013 7-57-19 PM

Four college students in Uganda design a smartphone app that connects to a fingertip sensor to allow instant diagnosis of malaria without repeated needle sticks.

Vitera Healthcare Solutions names Jeremy Muench (McKesson) as SVP of client operations.

7-21-2013 8-38-28 PM

From athenahealth’s Q2 earnings call, following the announcement of poor results that sent the stock retreating:

  • Jonathan Bush proclaims that the company is “very much in the big show” with its Epocrates acquisition and enhancements to athenaClinicals.
  • The Ascension Health contract was highlighted.
  • Bush claimed that athenahealth is the only vendor that can financially guarantee its customers a smooth transition to ICD-10 and MU Stage 2.
  • The move to having recipients of information via athenaClinicals pay for its use rather than just licensing it to an organization is “a hard slog” and has extended the sales cycle and increased sales costs.
  • Both athenaCoordinator and athenaClinicals revenues are falling short.
  • Bush apologized for comments he had made previously about Epic, saying, “I made some unfavorable comments about Epic, which was a mistake. Epic is a fine company, one for which we have tremendous respect and we are proud to be working alongside of in terms of clinical integration. Soon, any Epic client should be able to connect with athenaNet with a very minor instruction and authentication process.”
  • $17 million of increased Q2 revenue came from Epocrates revenue and tenant rent from the Arsenal office complex the company purchased.
  • Sales and marketing expense jumped 50 percent in the quarter, while R&D cost was up 66 percent.
  • Bush said he thought Ascension went with athenahealth because it sees itself as a national clinical with doctors it doesn’t control.
  • Bush sees Epocrates as being enabled with secure provider-to-provider messaging and being given the capability to update non-athena systems with information. “If a doctor is on Epocrates and is chatting on and sharing patient information on athenaClinicals, even though the hospital they’re on maybe on Cerner or Epic, they would love to be able to order prescriptions and then say, ‘Now athena, you deal with updating my Cerner system because I don’t like logging into it or my Epic or my — pick your favorite A Flock of Seagulls system.’”
  • More athenaClinicals transactions are being automated, or as Bush says, “Now athenaClinicals with no fax server and no 1,000 people data entering clinical results in India is a very different profit profile than the one we have today.”
  • Demand for athenaClarity is so high outside of its Massachusetts origins that Bush says the company can’t keep up.

7-21-2013 8-27-11 PM

Mediware will announce Monday its acquisition of home infusion and specialty pharmacy systems vendor CPR+ of Westerville, OH.

The federal government, requesting dismissal of a data breach lawsuit involving a missing VA laptop, argues that no proof exists that anyone has seen the patient information it contained and no identify theft has occurred.

New Hampshire’s new $90 million Medicaid computer system, development of which was contracted to Xerox’s ACS, is causing payment problems due insufficient rules testing according to the CFO of Concord Hospital, which has a $5 million payment backlog. An orthopedics practice reimbursement specialist, noticing wild overpayments, asks for a billing manual and is told it is still being worked on. The HHS commissioner admits that payment of 40 percent of claims has been suspended pending further analysis.

7-21-2013 8-40-08 PM

ONC offers a 10-step plan for protecting PHI.

7-21-2013 8-29-34 PM

In England, East Kent Hospitals University NHS Foundation Trust blames its just-installed GE Healthcare radiology information system for delayed appointments and results.

7-21-2013 8-41-20 PM

The Mount Sinai Medical Center (NY) announces that it will use technology from Real Time Medical to implement teleradiology services in several imaging clinics. I’m curious (and annoyed) as to why the company’s name appears everywhere as Real Time (two words) except in its logo, where it’s one word.

Inga does her best Weird News Andy impression by sending me a link to this story. A British vacationer returning from Peru thought she was imagining the scratching sounds inside her head until doctors found maggots living inside a hole in her ear canal, hatched from eggs depositing there by a fly.


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

More news: HIStalk Practice, HIStalk Connect.


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July 21, 2013 News 4 Comments

News 7/19/13

July 18, 2013 News 3 Comments

Top News

7-18-2013 10-15-10 PM

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

Reader Comments

7-18-2013 7-39-15 PM

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

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

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

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

HIStalk Announcements and Requests

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

Acquisitions, Funding, Business, and Stock

7-18-2013 10-20-34 PM

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

7-18-2013 10-21-08 PM

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


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

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

7-18-2013 10-22-14 PM

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

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


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

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

7-18-2013 6-27-36 PM

CompuGroup Medical promotes Norbert Fischl to CEO of CGM USA.

7-18-2013 7-07-08 PM

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

7-18-2013 7-35-50 PM

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

7-18-2013 7-54-31 PM

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

7-18-2013 8-56-49 PM

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


Announcements and Implementations

7-18-2013 10-24-02 PM

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

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

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

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

Government and Politics

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

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

7-18-2013 8-00-54 PM

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

Innovation and Research

7-18-2013 7-19-14 PM

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


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

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

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

7-18-2013 10-07-24 PM

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


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

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

7-18-2013 9-48-52 PM

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

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

7-18-2013 8-29-37 PM

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

Sponsor Updates

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

EPtalk by Dr. Jayne


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

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

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


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


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

More news: HIStalk Practice, HIStalk Connect.


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July 18, 2013 News 3 Comments

News 7/17/13

July 16, 2013 News 9 Comments

Top News

7-16-2013 8-47-36 PM

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

Reader Comments

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

HIStalk Announcements and Requests

7-16-2013 6-45-28 PM

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

7-16-2013 7-29-37 PM

7-16-2013 7-43-36 PM

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

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

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

7-16-2013 8-06-31 PM

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

Acquisitions, Funding, Business, and Stock

7-16-2013 8-50-26 PM

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

Ping Identity closes a $44 million investment round.

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

7-16-2013 6-34-49 PM

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

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


7-16-2013 8-54-14 PM

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

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

7-16-2013 8-52-52 PM

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

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

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

The Scarborough Hospital (Ontario) selects SIS.

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

7-16-2013 8-57-23 PM

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


7-16-2013 5-26-59 PM

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

7-16-2013 6-05-08 PM

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

7-16-2013 7-20-05 PM

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

Announcements and Implementations

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

7-16-2013 12-54-25 PM

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

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

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

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

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

7-16-2013 7-27-42 PM

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

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

Government and Politics

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

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

Innovation and Research

7-16-2013 6-54-47 PM

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

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


7-16-2013 2-46-56 PM

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

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

7-16-2013 8-59-00 PM

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

7-16-2013 6-24-34 PM

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

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

7-16-2013 7-09-31 PM

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

7-16-2013 6-29-32 PM

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

Sponsor Updates

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


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

More news: HIStalk Practice, HIStalk Connect.


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July 16, 2013 News 9 Comments

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

July 15, 2013 Readers Write 3 Comments

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

7-15-2013 6-03-46 PM

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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July 15, 2013 Readers Write 3 Comments

Monday Morning Update 7/15/13

July 14, 2013 News 7 Comments

7-14-2013 7-04-39 AM

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

7-13-2013 6-38-03 AM

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

7-14-2013 7-06-53 AM

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

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

HIStalk Webinar Monday, July 29

7-14-2013 9-05-04 PM

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

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

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

7-14-2013 8-17-14 AM

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

7-13-2013 8-55-36 PM

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

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

7-14-2013 8-49-45 AM

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

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

7-14-2013 8-55-20 PM

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

7-14-2013 8-50-48 AM

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

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

7-14-2013 7-08-48 AM

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

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

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

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

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

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

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


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

More news: HIStalk Practice, HIStalk Connect.


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July 14, 2013 News 7 Comments

News 7/12/13

July 11, 2013 News 7 Comments

Top News

7-11-2013 8-30-30 PM

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

Reader Comments

7-11-2013 8-21-30 PM

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

7-11-2013 6-23-28 PM

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

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

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

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

HIStalk Announcements and Requests

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

7-11-2013 6-27-29 PM

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

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

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

7-11-2013 6-41-58 PM

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

Acquisitions, Funding, Business, and Stock

7-11-2013 8-18-42 PM

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

7-11-2013 8-17-32 PM

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


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

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

7-11-2013 8-11-55 PM

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

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


7-11-2013 5-25-40 PM

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

7-11-2013 12-13-59 PM

Bill Korn (Antenna Software) joins MTBC as CFO.

7-11-2013 2-54-14 PM

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

7-11-2013 5-29-27 PM

Systems Made Simple elects CFO Christopher Roberts to its board.

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

Announcements and Implementations

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

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

Government and Politics

7-11-2013 1-43-11 PM

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

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

Innovation and Research

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


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

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


7-11-2013 2-13-04 PM

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

7-11-2013 6-33-59 PM

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

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

7-11-2013 7-47-52 PM

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

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

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

7-11-2013 7-36-15 PM

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

7-11-2013 7-06-06 PM

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

Sponsor Updates

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

EPtalk by Dr. Jayne

7-11-2013 6-16-23 PM

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

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

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

7-11-2013 6-20-04 PM

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

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


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

More news: HIStalk Practice, HIStalk Connect.



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July 11, 2013 News 7 Comments

News 7/10/13

July 9, 2013 News 7 Comments

Top News

7-9-2013 7-27-41 PM

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

Reader Comments

7-9-2013 6-06-38 PM

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

7-9-2013 6-48-02 PM

7-9-2013 7-02-49 PM

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

7-9-2013 7-38-34 PM

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

7-9-2013 7-20-28 PM

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

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

7-9-2013 7-44-20 PM

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

HIStalk Announcements and Requests

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

Acquisitions, Funding, Business, and Stock

7-9-2013 10-27-15 PM

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

7-9-2013 10-41-18 PM

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

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


7-9-2013 10-30-36 PM

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

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

7-9-2013 10-29-13 PM

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

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

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


7-9-2013 6-14-32 PM

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

7-9-2013 6-15-32 PM

Arcadia Solutions appoints Chuck Garrity (Beacon Partners) RVP.

7-9-2013 7-51-21 PM

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

7-9-2013 10-09-53 PM

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

Announcements and Implementations

7-9-2013 10-34-16 PM

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

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

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

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

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

7-9-2013 10-33-12 PM

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

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

Government and Politics

7-9-2013 8-13-15 PM

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

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


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

7-9-2013 8-04-54 PM

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

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

7-9-2013 10-36-41 PM

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

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

Sponsor Updates

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


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

More news: HIStalk Practice, HIStalk Connect.


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July 9, 2013 News 7 Comments

Monday Morning Update 7/8/13

July 6, 2013 News No Comments

From Utopic: “Re: Notice of Privacy Practices. HIPAA 2013 regulations require that the NPP and breach notices be written in plain language. That didn’t happen in the original HIPAA notices and probably won’t happen in this version either. Communicating in plain language doesn’t seem to be an issue for any of your survey respondents. I have a three-page summary if anyone is interested.”

HIStalk Webinar July 17

7-6-2013 3-32-09 PM

The next HIStalk Webinar will be “Five Steps to an Enterprising Imaging Strategy” on Wednesday, July 17 from 1:00 to 1:45 p.m. Eastern, sponsored by Merge Healthcare and presented by Steve Tolle, senior VP of solutions management. The US performs 800 million studies annually and industry experts predict steady growth over the next three years. How do you plan to share this information across your organization and your referral network and to securely store it? Implementing an enterprise imaging strategy and archiving data in either the world’s largest VNA or the cloud is your ticket to true interoperability.

C-level HIStalk readers have provided presenter feedback and the session will be moderated by HIStalk. According to one of the CIO reviewers who reviewed the rehearsal session, “I have to be honest, I wasn’t sure if a presentation on enterprise imaging would grab me. The presenter did a great job in covering why an enterprise imaging solution is needed in today’s world and what it could do to alleviate issues in hospitals.” Register here.

7-6-2013 4-31-02 PM

The vast majority of respondents think McKesson’s customers should care that John Hammergren will get a pension of at least $159 million, although the comments are equally passionate for both sides. New poll to your right: now that implementation of the ACA employer mandate has been pushed back, should healthcare organizations proceed plans to buy software to meet ACA-driven needs?

7-6-2013 3-56-49 PM

Welcome to new HIStalk Platinum Sponsor CoverMyMeds. The Columbus, OH-based company has put the Prior Authorization process for prescriptions into modern decision support workflow. Over 100,000 providers use its service for free with health plans, PBMs, and drug companies footing the bill because CoverMyMeds makes them more efficient. Providers access the service through their EHR or from the company’s all-payer portal and get real-time determination. It’s not just about efficiency – when Prior Authorization takes too long, 30 percent of patients to just give up and abandon their prescriptions, causing all kinds of clinical and cost issues. The average doctor spends six hours per week filling out PA forms. If your company sells a pharmacy or EHR system, you can add the “Best Feature Ever” with APIs that can manage PAs either before they are submitted or after they are rejected. Thanks to CoverMyMeds for supporting HIStalk.

I found this YouTube video on how CoverMyMeds works.

7-6-2013 4-12-39 PM

Constantine Davides has updated his popular HCIT Consolidation Chart for HIStalk readers. It lists all of the healthcare IT acquisitions by company. Take a look if you (a) wonder why your vendor’s allegedly integrated products aren’t because they were simply bought and relabeled; or (b) you are creating a healthcare IT trivia contest and need hard questions like, “What was the name of the event notification software vendor that Philips acquired?” (answer: Emergin.)

7-6-2013 4-41-41 PM

NHS England publishes “Safer Hospitals, Safer Wards: Achieving an Integrated Digital Care Record” that describes its all-digital goal for 2018 and the $387 million in available grants for NHS Trusts. NHS says it will consider the use of the VA’s VistA, summarizing, “One of the significant products we have investigated is VistA and for reasons described in more detail below we are looking to adopt some of the ethos behind its creation and potentially part, or all, of the technical product, in combination with others to generate NHS VistA. NHS VistA as a concept will focus on bringing together the best of breed capability of Open Source solutions and will be driven by NHS organisations with the support of NHS England and others. The US Veterans Health Administration VistA system was created in the 1980s by clinicians and software engineers from the ground up. It has become renowned across the world as the first truly integrated, clinically owned system. It has been in operation long enough to be able to demonstrate real clinical outcome benefits.”

VistA expert Tom Munnecke’s “Open Letter to Chuck Hagel: DoD Still Doesn’t Know What the Hell They Are Doing” says “DoD is trying to get out of a hole by digging it deeper.” A snip:

Rather than lifting up the VA eligibility problem to a shiny new common information system, you are on the verge of dragging health IT into the same bureaucratic vortex that has already done so much damage in the past. AHLTA was declared “intolerable” in a Congressional hearing four years ago. Yet, not only is it still around (and absorbing $600m/yr operations and maintenance costs), but it is also serving as a template for the next generation of the IEHR – a top down, mega-centralized administrative system far removed from the clinical needs of health care professionals and patients. DoD continues to focus on the organization chart, not the patient, closely coupling their software designs to their bureaucratic stovepipes.  Indeed, it is rare for me to even find the word “patient” in any DoD health IT documents.

7-6-2013 7-13-51 PM

Christopher Assad, MD develops a prototype CPR app for Google Glass that walks laypeople through the process of performing CPR effectively following the beat of “Staying Alive,” which coincidentally sets a pace of 100 compressions per minute.  

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

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Outsourced UPMC transcriptionists hold a rally outside the health system’s headquarters in the US Steel building in Pittsburgh to protest the transfer of their jobs to Nuance. Their union wants them to receive severance pay, health insurance through Nuance, uncontested unemployment claims, and an apology from UPMC CEO Jeffrey Romoff. All were offered jobs by Nuance, but at $8 per hour instead of their previous $12-15.

ONC will hold a Webinar on its just-released patient safety plan on Wednesday, July 10 from 3:45 to 5:30 p.m. Eastern.

Vince covers the death the death last week of computer mouse designed Douglas Engelbart.


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

More news: HIStalk Practice, HIStalk Connect.


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July 6, 2013 News No Comments

News 7/5/13

July 4, 2013 News 8 Comments

Top News

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

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

Reader Comments

7-4-2013 9-40-51 PM

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

HIStalk Announcements and Requests

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

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

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


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

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

Government and Politics

7-4-2013 9-02-50 PM

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

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


7-4-2013 9-08-46 PM

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

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

7-4-2013 9-46-58 PM

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

7-4-2013 9-48-12 PM

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

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

7-4-2013 9-58-56 PM

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

EPtalk by Dr. Jayne

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

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

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


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


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

More news: HIStalk Practice, HIStalk Connect



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July 4, 2013 News 8 Comments

News 7/3/13

July 2, 2013 News 4 Comments
Top News

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

Reader Comments

7-1-2013 12-52-11 PM

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

7-2-2013 11-02-42 PM

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

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

7-2-2013 8-59-21 PM

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

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

Acquisitions, Funding, Business, and Stock

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

7-2-2013 11-06-31 PM

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

7-2-2013 10-54-17 PM

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

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

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

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

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

Government and Politics

7-2-2013 11-11-01 PM

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

Innovation and Research

7-2-2013 6-59-50 PM

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

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

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

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

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

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

7-2-2013 11-12-39 PM

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

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

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


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

More news: HIStalk Practice, HIStalk Connect


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July 2, 2013 News 4 Comments

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