News 7/14/10

From CernerDoesItToAnutherExec: “Re: Trace Devanny. He’s leaving Friday. He was shipped by Neal to France early this year, which is like getting dead fish in the Sopranos. Unlike the last 5-7 execs, it looks like Trace left on his own.” Too bad I don’t usually post news on Monday since that’s when this came and I’d have had a scoop. As I said on February 12 when Cerner announced his transoceanic relocation, “It seems curious that Cerner would allow its president to live and work overseas when only a tiny bit of its business comes from there, so I’m guessing there is more to that story.” It was nice timing to release not-so-positive company news on the day of Meaningful Use’s rowdy debutante ball (and not only just ahead of the earnings announcement, but “to pursue other opportunities” that apparently start just three days from now – hmmm). They’ve already removed him from the Web site. Neal will now hold all the Cerner titles – president, CEO, and chairman of the board. His Pie is secure.

From Jacob Black: “Re: Daniel Barchi interview. I guess Epic has a very closed system like Apple, but the similarities stop there. I think one of the problems with HIT today is that there are too many Microsofts raking in the implementation fees and we desperately need an Apple to shake things up. I think we’ll see one arrive in the next 24 months, and when it does, it will be a game-changer.”

From Dr. Boogie: “Re: Gibson General Hospital, Indiana. Medicare fraud.” The fired hospital CFO goes whistleblower.

From Ms. MarCom: “Re: Meaningful Use. All I can say is WOW. You have totally blown away any publishing competition this morning, both from a posting standpoint and from a speed of analysis standpoint. WOW! Great job!” I replied back to Ms. M that I would treasure her nice words, especially if I got fired for spending a couple of hours digging through the MU rule instead of working for the hospital whose clock I was on at the time. I don’t know if my employer would buy the industry service argument that I had rationalized. Our only plan for the day was that Inga would sit in on the Webinar, so it was impromptu.

From Ivo Nelson: “Re: consulting company life cycle. I’m going to take offense to your comments regarding your life cycle for consulting firm buy-outs. What you failed to mention was that some of us build our businesses on delivering for clients. That delivery creates trust that leads to more business. It takes years, if not decades to build the level of trust needed to be in the ‘inner circle’ of the CIOs. Most of them aren’t stupid and don’t just buy the current consulting fad; rather, they hire firms they trust and respect knowing these decisions can be career-limiting if it leads to a bad implementation. The reality of our business goes well beyond the spin. In my world, there’s an intermediate step that few of the hundreds of consulting firms that start up in this space ever achieve — that is widespread respect and trust that only happens through the grind of delivering on projects year end and year out. Trust doesn’t happen through spin.” Ivo knows I was being tongue-in-cheek. He’s right that a consulting company doesn’t grow enough to be an acquisition target unless they do things very, very well, like he did with Healthlink and is doing again with Encore Health Resources. My ribbing was aimed more at the companies (usually hardware vendors) that buy them thinking it looks like easy, high-margin money compared to moving iron.

And now, the obligatory Meaningful Use news and reaction.

Notice that during the press release (video above) that Kathleen Sebelius started off by botching the name of CMS, calling it the Centers for Medicaid and Medicare Services (backwards). That makes about as much sense as making its acronym CMS instead of CMMS, but I can’t swear I’d say it right either if facing a ton of cameras.

Inga has collected some thoughts and comparisons about the proposed vs. final Meaningful Use rule. She’s Meaningfully Used up, so help her out by adding a comment to that post with anything she missed.

Everybody with skin in the Meaningful Use game will be cranking out press releases extolling their love or hatred for what’s been passed. Thos who love it so far: Allscripts, AARP, UnitedHealth Group, Medsphere, AHIP. Those who hate it: American Hospital Association. I’m sure PR people are proofing a lot more press releases yet to come. In fact, CHIME issued a press release that said they are “actively reviewing the changes” and will publish its summary “once CHIME has thoroughly reviewed the 864-page rule.” I shall alert the media. Oh, wait, they already did.

Don Berwick’s first day on the job involved participating in the Meaningful Use press briefing. He reminded everybody about President Obama’s goal to for every American to have electronic medical records by 2014, which was probably a mistake since, like a lot of other ambitious administration goals, it’s clearly not going to happen just because of some stirring oratory. Inga speculates that the President rushed Berwick’s confirmation through so DB could look authoritative on his first day and use the opportunity to meet and greet. To me, he comes across as likeable and sincere.

Announced: the House Ways and Means Subcommittee will review the guidelines next Tuesday.

Check out Page 34: “We expect to update the meaningful use criteria on a biennial basis, with the Stage 2 criteria by the end of 2011 and the Stage 3 criteria by the end of 2013.”

My reaction to the rule: it’s a nicely done compromise. The really contentious areas were scaled back, and even in areas that weren’t, thoughtful rationale was provided. Breaking out the requirements into the mandatory vs. elective requirements was a great idea. CMS was smart to start tough in the proposed rules and then ease up after taking public comments into account. Some folks will still think the bar is set too high, but nobody’s putting a gun to anyone’s head to take the thousands to millions of otherwise free taxpayer dollars. If you don’t like the gift horse, don’t ride it.

What’s the biggest surprise in the final Meaningful Use guidelines? That doctors don’t have to actually enter any orders to meet the CPOE requirement. Anybody allowed to write orders can do it for them. That should goose the medical scribe job market. I think CMS got a little too user-friendly with that change since the next most important number other than overall percentage of orders entered via CPOE is the number that are entered directly by the physician instead of entered on their behalf as verbal or written orders by nurses (which opens the door right back up to transcription errors – the whole “readback” thing is lame). Also, anybody who implements clinical decision support thinking that the nurse will sift through the on-screen warnings and pass the important ones to the doctor knows how poorly that works.

I loaded the government’s PDF to Scribd as soon as a reader sent me the link this morning (thanks!) I see that file has received 2,177 reads so far. I don’t think HIStalk will set a one-day reader record, but it’s had 6,000 visitors so far (early Tuesday evening Eastern time). Needless to say, MU interest was high.

I e-mailed John Glaser to get his thoughts since he was instrumental in putting MU together. He thinks the best part was that they listened to industry concerns about flexibility and setting the bar too high. I told him he should get a completion bonus of the billions, of which he humbly suggested 1%. He also offered this piece:

The Big Day

On Tuesday (7/13/10) the final Meaningful Use regulation was released as was the final Standards and Certification Criteria regulation.

Arriving at the release of these regulations took time and an impressive amount of work. The regulations appeared 17 months after the passage of ARRA and 14 months after the first meetings of the Policy Committee and Standards Committee. Hundreds of hours were spent by volunteers of the Policy and Standards committees and their workgroups. Thousands of comments were written by organizations and individuals and read by dozens of federal staff. Some very large number of blog comments, articles and white papers were prepared by consultants, academics, vendors, practitioners and others. And an incalculable number of hours were devoted by staff at ONC, CMS, OMB and other federal agencies and departments.

All of this resulted in over 1,000 pages of regulations. Regulations that will bring tens of billions of dollars into healthcare and promise to significantly improve the care of patients. Healthcare in this country was forever changed on Tuesday. Those of us who work in the industry have not seen a day as momentous as this and may not see one again.

There are many individuals whose efforts brought us to this point. David Blumenthal. Farzad Mostashari. Tony Trenkle. Paul Tang. Jon Perlin. John Halamka. But I wanted to single out one person – Janet Marchibroda.

Janet was the founding CEO of the eHealth Initiative (eHI). For many years the eHealth Initiative has brought together a diverse group of stakeholders to develop strategies, author example policies, compile lessons learned and provide education to further a vision – significant improvements in care through the adoption and effective use of interoperable electronic health records. Years before there was an ARRA, eHI and Janet were relentless in their pursuit of this vision and they were remarkably effective in bringing their ideas to Congress, the Executive Branch, state governments and the industry. While not the only voice in the early days of this undertaking they were an exceptionally effective voice. You could clearly argue that Janet and eHI are one of the primary reasons that HITECH was included in the ARRA legislation in the first place.

Congratulations Janet. This day must be very sweet.

I hear that Eric Rose, medical director of McKesson Physician Practice Solutions, has signed on with Microsoft’s Health Solutions Group to work on global health technology offerings. 

A reader tells me that a Vermont hospital’s practice EMR has been down for two days so far after its vendor tried to apply an upgrade, apparently mistakenly loading the 64-bit version instead of the 32-bit. They had to go to backup, and everybody could have predicted what happened next: the backup was no good. I guess downtime doesn’t get you Meaningful Use credit.

St. Joseph Health System (CA) chooses periop and anesthesia systems from Picis for its 13 facilities. A couple of readers have sent over positive rumor reports about Picis lately, so without my speculating about the details, I expect to hear news shortly.

Listening: The Doors, because I was watching the mediocre, Johnny Depp-narrated When You’re Strange on Netflix and got stoked about them all over again (actually, it was pretty good other than Johnny). May favorite Doors tunes: Crystal Ship; Yes, the River Knows; Not to Touch the Earth; The Unknown Soldier; and When the Music’s Over. Mr. Mojo Risin’ has been dead for nearly 40 years, but his digital detritus remains vibrant and essential. We should all be so lucky.

Consumer Reports says it can’t recommend the iPhone 4 because of its notorious antenna problems, saying Apple should fix its own phone instead of telling owners to buy themselves a case (or use duct tape like CR recommends) to prevent touching the antenna and thereby drop signal strength. The iPhone scored at the top of its ratings otherwise.

If you clicked the e-mail link to read this post, you’ll notice a single sponsor ad at the very bottom, right before the comments. That was the brainchild of a couple of readers who felt guilty that they don’t always look over the ads in the left column, but who said they’d pay significant to attention to a single strategically placed one. All sponsor ads get an equal chance – it’s a random display for each page view. Thanks for the idea and for supporting HIStalk’s sponsors.

Speaking of sponsors, thanks to new HIStalk Gold Sponsor My Health Direct. You’ll recall that I interviewed CEO and Chairman Jay Mason a few weeks back. The best way to describe the company’s offering is as “OpenTable for Healthcare”, a SaaS application that connects patients (usually ED ones) with provider appointments in the community. The system searches open provider appointments and manages the mix of low-paying reimbursement those providers are willing to accept. It also increases compliance with follow-up visits since patients leave the ED with a firm appointment. Thanks to My Health Direct for supporting HIStalk and its readers. And in case it looks suspicious, I promise there was no discussion about sponsorship when we did the interview. I often interview somebody who is then overwhelmed by the “hey, I saw your picture on HIStalk” feedback they get afterward from the very cool HIStalk readership, so they send the marketing people my way.

Weird News Andy loves his UK stories, of which this one is big: NHS will restructure and take hospitals out of the system, eliminating all 10 strategic health authorities and the 152 primary care trusts in favor of local control answering to an independent NHS board. Their private income was previously capped. From the video: “Our guiding principle will be no decision about me, without me.” Sounds like the opposite of what we’re doing here. I wonder if Don Berwick admires them more or less now?

Interoperability vendor Holon announces GA of its Medication Management Solution, which accepts electronic or scanned orders and routes them via a workflow scheduler.

Healthcare claims processor and cost management vendor MultiPlan will be acquired by private equity investors in a deal valued at $3.1 billion. You just know you’ll see more of this as investors lick their chops at the profitable administrative overhead sure to be introduced by healthcare reform (irony intentional). Surely nobody thinks insurance companies and their lobbyists will voluntarily find another line of work.

Iowa HITREC chooses Greenway’s PrimeSuite EHR.

Dentrix Enterprise Dental Practice Management earns certification as an electronic dental record solution for the Indian Health Service.

Kronos introduces its new Rich Internet Applications. I had to look that up – it means Web apps that work like desktop apps by using browser plug-ins or virtual machines. Gmail is an example.

It’s not exactly poverty-vowing nuns running hospitals: Wayne Smith, CEO of publicly traded hospital operator Community Health Systems, took home $17.8 million in compensation last year.

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