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September 23, 2010 News 11 Comments

From Clinical Wisdom: “Re: KLAS. A friend told me that Eclipsys paid KLAS $300K per year. Can KLAS accept mega-bucks from vendors they evaluate without being influenced by their cash? Imagine Consumer Reports taking money from car companies. I think they owe those who buy their reports a full accounting of what they earn from vendors and what those vendors are promised.” We’ve been around and around the KLAS business model over the years. Providers don’t usually pay KLAS for the reports; they get them free in return for providing data, so they would not be surprised to find that vendors pay big bucks (i.e., it’s the HIMSS “ladies drink free” model). I asked Adam Gale in my 2007 interview if the company would be willing to have its survey and ranking process audited by an outside expert. He said yes, but that hasn’t gone anywhere as far as I know. He offered this comment when I asked if being paid by vendors is a conflict of interest:

I would say we have one of the world’s strangest business models, where internally, if you ask anyone at KLAS who our customer is, they’d tell you it’s the provider. That sometimes irks the vendors because they pay a reasonable amount of money to have access to the subscriber data. One vendor, as a mistake, sent us an e-mail intended to be internal that said, “Doesn’t KLAS understand who the customer is based on how much money we spend?” We hold that up and cheer. The vendor is not our key customer. The provider is. We frame every vendor question in terms of, “Will it help providers make a better decision?”

9-23-2010 9-32-57 PM

From Spell Czech: “Re: CareFusion Pyxis. Are they really struggling against Omnicell? I hadn’t heard that. Love the blog — been reading for a couple years now!” I’m sure Pyxis still holds most of the market, but it wasn’t long ago that they never lost customers. Both my current and previous hospital employers reconsidered whether Pyxis was worth keeping (clunky software, arrogance, bad support). In one case, we begrudgingly stuck with them because McKesson’s product wasn’t fully baked and Omnicell was struggling. In the other, we dumped Pyxis and never looked back. My conclusion is that, finally, Pyxis has some real competition from both of those now-acceptable alternatives and the market is reacting at least somewhat to that, even though those competitors share some of the same flaws (too many engineers making design decisions and worrying about moving parts instead of nurse-friendly software). I haven’t heard anything about Cerner’s entry into that business. Competition is good for everyone, especially the customer and patient.

From Mighty: “Re: ED denominator for Meaningful Use. CMS has finalized it, though I don’t see it mentioned in many places.” The CMS clarification says that only ED patients who are admitted as inpatients or who are treated as observation patients count toward the CPOE requirement and other parts of MU.  

9-23-2010 9-34-27 PM

From Computer Giant: “Re: UPMC. Can the EMRs not solve this problem?” That was tongue in cheek, in case you couldn’t tell. UPMC howls when a state report finds that flagship UPMC Presbyterian-Shadyside has a higher-than-expected mortality rate for CHF, septicemia, respiratory failure, and stroke. Their excuse is the standard: “our patients are sicker,” but when the state responded that everything was severity-adjusted, UPMC then commented that their younger patients throw off the stats. I’ve yet to see a hospital that took the news constructively that it’s underperforming. Be comforted: in their own minds, every hospital is above average.

From Peggy: “Re: Epic co-op. I love your site. I read it religiously! Our hospital is evaluating vendors to replace our clinical core and Epic is (of course) one of them. I’m interested in the consulting co-up you mentioned. Would you mind sharing more information?” I don’t have details, but I’m sure they will emerge publicly at some point.

From Slidell Computer: “Re: executive director of Physician Hospitals of America. She’s leaving. Rumors are circulating that changes will force physician-owned hospitals to sell out or close. Maybe she sees the writing on the wall.”

From Not Quite: “Re: GOP’s Pledge to America. It returns the country to the 2008 budget, ARRA stimulus money for EHR systems will end, and according to polls, the GOP will take over Congress. Shouldn’t all EHR purchases stop now since they won’t get their incentives?” I’ll stay out of the political debate since I distrust all politicians equally (except maybe Chuck Grassley and Ron Paul), but I would say that anyone buying an EHR solely because of Uncle Sam’s promised largesse should think twice even without the Pledge to America. CMS is like a devious cat owner waving a laser pointer around: they love to see providers jump around in reaction to ever-changing and mind-bendingly complex policies that address what initially seemed like simple, good ideas to make sure no payouts actually occur.

9-23-2010 9-36-14 PM

Wisailer, a reader attending Epic’s UGM, shared some of the interesting aspects from the meeting so far (his or her words, not mine):

  • According to Judy, one of Epic’s goals is "to improve health care for the world," based on their estimate that 30% of the US population is covered by an Epic EMR.
  • She says “do what Epic says" and your implementation will succeed.
  • Epic has spent 66,000 hours on Meaningful Use, which Carl Dvorak seemed to imply has slowed down their transition to Web-based applications.
  • The customer base is 224, up from 190 last year, and many of the sessions were oriented to new installations.
  • 200,000 physicians use Epic.
  • Vendor ally — boring. Lots of suites and pretty smiles. More consultants, fewer device and service providers.
  • Swag consisted of pre-washed, BPA-free water bottles with special refill funnels at water coolers.
  • The Haiku iPhone app will be extended to the Droid soon.
  • Canto, a new Epic iPad application, will be released in the near future. LOTS of buzz about this product.
  • Horse-drawn carriages are giving tours of the campus and bikes are available directly across from Epic Farms, thought by many to be the production source of Epic Kool-Aid.

The pic above of some of the Epic festivities, which looks like a more affluent, less crowded, and much colder (highs in the 60s this weekend) version of Woodstock, is from Dave Yost’s blog.

As Inga told me, we’ve been outed by Google. I set up HIStalkTV a few months back on a slow Sunday afternoon just to play around with posting HIT-related videos that I found amusing or useful. The site is suddenly popping up on search engines for some reason and readers are e-mailing us about it. It’s definitely beta and I haven’t really decided what to do with it if anything, but feel free to send me your thoughts. We even had one of our favorite PR people ask about sponsorship opportunities, which I appreciate even though I’ve given that zero thought.

9-23-2010 7-09-57 PM

I was motivated by Ed’s CIO Unplugged post about his use of MindManager for mind mapping, list making, etc. (maybe because he featured HIStalk prominently in the picture). I tried some of those programs years ago and lost interest, but figured I would look again since I really like the concept for creativity. I lost interest in MindManager again when I saw that it has become Visio-ized (tons of overly complex functionality added for corporations and priced accordingly — $349), so I found a simpler alternative that seems to work great: MindVisualizer ($79). I’m running the free trial and will probably buy it because it’s pretty darned slick. I used it today to make a few plans for the HIStalk reception at HIMSS and the tool didn’t get in the way of my thought process, which is the most important criterion.

This seems remarkably open minded considering the source: on the HIMSS blog, the senior director of federal affairs (Tom Leary) asks for comments on the federal government’s role in ensuring the safety of HIT products. Supposedly the only reason the FDA doesn’t regulate HIT today is because of some fancy, long-ago behind-the-scenes political footwork by various groups and vendors, so maybe HIMSS is considering taking an official position. Why not chime in?

9-23-2010 7-29-56 PM

A fun Medgadget post: the National Space Biomedical Research Institute has developed an astronaut EMR that combines a mobile monitoring device with software. The EMR is iRevive from 10Blade, which was designed for EMS users (you mean astronauts don’t enjoy the benefits of a certified EHR?)

Continuing my rant on badly written press releases, this HIE one speaks for itself. For the love of God, doctor and press release writer, take a breath! In addition to the hopelessly dense text, it starts off with (1) a mini-editorial; (2) a snooze-inducing history lesson; (3) a ton of quotes, apparently all so equally significant that none could be omitted to make it readable; and (4) in the VERY LAST paragraph, one long sentence that contains the only real news in all that fluff. There is a reason that companies pay experts to craft their communication instead of doing it themselves.

Precyse Solutions will unveil its new Automated Clinical Documentation software and Computer Assisted Coding software engine at AHIMA in Orlando next week.

Weird News Andy entitles this as “Half a woman is better than none.” Doctors in Canada take a drastic step to save a 31-year-old woman with untreatable bone cancer: they cut her body in half by removing her leg, lower spine, and part of her pelvis, then do a “pogo stick rebuild” in fusing her remaining leg back to her body. I wish I had her positive outlook: “I have no problem getting around. If I need to, I’ll crawl (up stairs) or scooch like a kid.” The most bizarre aspect of the story in my mind, however, was how the doctors described the size of the tumor: they said it was the size of a calzone.

9-23-2010 8-06-15 PM

Welcome and thanks to brand new HIStalk Platinum Sponsor T-System of Dallas, TX, which created and sells what is surely one of the most effective, well-accepted, and ingenious paper documentation solutions ever devised: the famous T-Sheets, on which over 30 million ED visits are documented each year. The company offers other versions for ED nurses, order sets, urgent care, and primary care, but I’m sure they would also want you to know about T SystemEV, the company’s emergency department information system (with modules for patient tracking, status board, nurses, physicians, and CPOE) that’s used by 240 hospitals. It offers comprehensive physician and nurse documentation, clinical content, a short learning curve (often just one shift, they say), status board, prescription writing, discharge instructions, CPOE, lab integration, real-time coding capture, and patient satisfaction and reporting tools. All are important for Meaningful Use, of course. Former McKesson MPT President Sunny Sunyal recently joined T-System as CEO, so I’d say he did his due diligence and liked the company’s performance and potential. Thanks to T-System for supporting HIStalk — Inga and I appreciate it.

All adult hospitals in Milwaukee County, WI will use My Health Direct for ED referrals to community health centers, courtesy of an agreement signed with the Wisconsin HIE. I interviewed Jay Mason, the chairman and CEO of My Health Direct, in June.

I was checking up to see what’s happening with long-time HIStalk bestie Scott Shreeve MD, formerly of Medsphere and now building Crossover Health, a member-based medical practice that will provide individualized urgent, primary care, and online health services from clinics in California (Newport Beach, Foothill Ranch, and Aliso Viejo). I didn’t think I’d be interested in the construction video above, but it’s pretty fascinating to see how that company and others are taking a very different approach to healthcare delivery for those who can pay for it themselves.

Some unusually juicy jobs on the HIStalk Sponsor Job Page: Sales Director, VP of Solutions Marketing, McKesson Consultants, Head of Quality Systems, Sales Director. On Healthcare IT Jobs, Senior Account Executive for VA, Sales Professional – North Carolina, Clinical Systems Analyst III, Epic Project Managers, Eclipsys Documentation Consultant.

9-23-2010 9-02-24 PM

Home care mobile solutions provider CellTrak Technologies announces the latest version of its smart phone system, which includes Android capability. It’s also sold in Canada by TELUS Health.

The US Army awards a research grant to InterSystems to look at its HealthShare platform to exchange data between Madigan Healthcare System (WA) and South Sound HIE.

Medical College of Wisconsin spinoff Imaging Biometrics gets an $800K NIH grant to develop its software that helps clinicians distinguish tumors from healthy tissue.

Odd: a woman’s iPhone is stolen while she is hospitalized and in labor.

E-mail me.

HERtalk by Inga

From Hamlet: “Re: KLAS, Epic, etc. KLAS found that nearly 70% of new 2009 hospital EMR purchases were for an Epic or Cerner integrated solution. Reading HIStalk, you would think Epic cleaned everyone’s clock.” They cleaned a lot of the clocks that counted, i.e. the big, influential hospitals with lots of beds and big dollar volume.

From A-Rod: “Re: on the move. Long-time healthcare CIO Bob Kaplan has been appointed EVP and CIO of Audax Health Solutions in Washington, DC. Bob has been CIO of WebMD, NCQA, IFMC, National Preferred Provider Network, and PHP Healthcare Corp.”  According to the Audax Web site, the company is an early-stage startup developing products that “change how patients and providers interact.”

From Sunshiney: “Eclipsys wins. Mercy Memorial Hospital System in Michigan is replacing McKesson with Eclipsys and Sidra Medical and Research Center in Qatar picks Eclipsys’ inpatient EHR.” Both verified.

Capario promotes sales and marketing VP Jim Riley to president. He replaces Andrew Lawson, who will be moving to another company within Martin Equity Partners, the entity that owns Capario. Riley was previously VP of sales and marketing for Payerpath, where he also worked under Jim Brady, Capario’s executive chairman.

Saint Barnabas Health Care System (NJ) picks EDIMS and its EDIS software for its six-hospital system.


Scribe Healthcare Technologies introduces Scribe Mobile, a new dictation app for the iPhone, iTouch, and iPad.

Yet another entity announces its ICD-10 conversion strategy. Global IT service provider HCL Technologies will use Health Language’s Language Engine solution as part of its end-to-end ICD-10 conversion solution.

Central Jersey HIE Project selects Advanced Data Systems, Greenway Medical, and MDTablet as its recommended EHR vendors. Well, at least that is what I think was said in the HIE’s very rambling press release.

holy redeemer

Holy Redeemer Health System (PA) will implement MobileMD and its 4D HIE technology to provide connectivity among the hospital, community physicians, and other area care providers.

This week on HIStalk Practice: InfoGard provides an update on when they’ll begin EHR certification and testing. A medical office janitor lands in jail after selling patient charts to a recycling company for $40. Theories on why medical office hiring is up despite declining revenues. A new study reveals the top EHR/PM companies in the ambulatory world.

san juan college

A sign of the times: San Juan College (NM) says it will shut down its medical transcription program at the end of the school year. School administrators admit that computers are increasingly taking the place of traditional medical transcription, so the school will instead focus on modernizing its coding and HIT degrees.

The local press highlights Rapid City Regional Hospital and its migration to Meditech. The hospital has implemented bedside medication verification and is now moving to physician documentation. The transition is not without its opponents, including one neurologist who is apparently not a big fan of EHRs:

They are good for insurance companies and good for controlling data, but it’s not necessarily good for patient care. The travesty is, so far the systems are bad. You’re not talking to the patients. You’re talking to the computers. If the doctor has to type, they’re not going to add very much information. Either you input data or you take care of patients, but you can’t do both well.

KLAS finds that the oncology market has been mostly ignored by enterprise software vendors, with best-of-breed vendors dominating the market. Enterprise vendors are more focused on the medical, rather than radiation oncology market, and often vendors are less interested in functionality and more focused on integration with other systems. Epic is named the closest enterprise system to delivering an oncology solution. Cerner, Eclipsys, GE, Meditech, and Siemens offer varying functionality as well.


E-mail Inga.


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Currently there are "11 comments" on this Article:

  1. Mighty, Are you sure that’s what CMS said in their recent clarification? Another reading is that patients admitted to observation status would be counted in addition to inpatient and ER treat and release patients. This was unclear in the original rule since they only specified place of service codes 21 and 23 (and observation patients are typically billed under POS 22)

    It would be a HUGE change if they decided to ‘only’ count admitted patients (either obs or inpatient) from the ER as you specified. I suggest some additional scrunity since other readers of the clarification (such as AHA) didn’t reach that conclusion.

    Here’s the offiicial clarification for reference. http://questions.cms.hhs.gov/app/answers/detail/a_id/10126/kw/observation

    Cheers, John

  2. ‘Not Quite’ wrote… “Re: GOP’s Pledge to America. It returns the country to the 2008 budget, ARRA stimulus money for EHR systems will end, and according to polls, the GOP will take over Congress. Shouldn’t all EHR purchases stop now since they won’t get their incentives?”

    While I share his skeptism, does “Cash for Clunker’s” bring back memories of this Admin’s “majority” rule? I believe it ran out of $$ the first go-around & when it re-surfaced, new stipulations were put in place on those families making more than $50k/yr were not eligible. Now transfer “Cash for Clunker’s” stimulus over to ARRA’s Meaningful Use.

    Personally, I don’t believe handing the “key’s” over to anyone 20-months later will make a difference on whether $$ running-out, or those “smaller” Provider’s being left-out of potential incentive’s because they simply don’t have the budgets to participate. For “other’s” (not to include ‘Not Quite’ contributor) to attempt to imply that handing the “key’s” over now to the other side of the aisle will deminish the likelihood of Provider’s receiving their hard-earned Incentive $$, is just not true. Due the math! How many millions of dollars are Provider’s investing to demonstrate MU, only to receive a “fraction” of that back thru the ‘incentive’?

  3. This potential renege on ARRA by the GOP PTA might remind us all that buying an EHR for the stimulus money is akin to having a baby for the tax deduction.

  4. Re: KLAS…
    If they were truly upfront, honest, fair, etc… they would publish a list of their top 20 revenue sources by payor. I doubt that wil ever happen, so as far as I am concerned their reports /results will always very be suspect.

  5. RE: Emergency Department CPOE

    The ED typically admits between 50-80 percent of the hospital total admissions, to say nothing of observation. Do CPOE in the ED, and you are pretty likely to get to the 30% which is phase 1.

    Where else can you safely implement partial CPOE and get to 30%? And once you get to the 100 percent requirement, who has systems that really work down in that hell? This makes the ED a pretty important place in meaningful use.

  6. Mr. HIStalk: I had the same reaction to MindManager as you.
    You may not care now that you have MindVisualizer (which I will also try), but B-Liner (B-Liner.com) is another that some people might like, especially if they ever used Warnier/Orr diagrams back in the day. I loved Warnier/Orrs and used them constantly, and this is essentially an automated version. Prices are the same.

  7. Re: Which Emergency Department patients should be included in the denominators of meaningful use measures

    In reference to the comment from John Davore, the AHA covered the issuance of new guidance from CMS on inclusion of ED patients in the denominators of meaningful use measures in a daily newsletter posted on September 22.

    In its guidance, CMS specifies two groups for inclusion in the denominator of meaningful use measures: patients admitted from the ED, and those provided observation services. CMS did not mention patients treated only in the ED in its guidance.

    Our story is at: http://www.ahanews.com/ahanews_app/index.jsp.

    The CMS guidance is at: http://questions.cms.hhs.gov/app/answers/detail/a_id/10126/kw/observation.

  8. Mind Manager – I too use Freemind (open source) as a tool not only to map thoughts and processes, but to also document relationships between locations, services, and capabilities within the network. I would agree it’s a little clunky, but it’s constantly being improved and the price is right!

  9. Regarding KLAS, Not sure if this is a fair comparison but let’s give it a whirl anyway….

    I just attended a state MGMA meeting and like so many other events, the customer for the assosciation or organization sponsoring the conference is the provider, office manager, etc. But the organizations use Vendors (of all types) as exhibitors who are charged often very high vendor exhibit fees to have a booth, etc. These fees actually subsidize or offset of the cost of the conference. And in some cases, I’m sure the organization makes a profit!
    I don’t know about you, but I see some similarities. I’m sure some HISTalk reader will dig deeper into the details than me and tell us why not.

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