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Monday Morning Update 1/17/11

January 16, 2011 News 17 Comments

HERtalk by Inga

From: Florence Bascom “Re: Selling for Epic. A rumor I have heard about their sales team is that their sales executives are not commissioned – which in itself would make it an extremely unique model compared to other HCSW orgs.” Mr. H mentioned his desire to talk to a former Epic sales rep (anonymously of course.) Comments like the above add to the intrigue.

From: Lu Wolf “Verizon vs. AT&T. David Letterman’s take on why fewer drop calls isn’t necessarily an improvement.” Very fun. Now that Verizon officially announces wireless service for iPhones as of February 10th, a predicted 26% of iPhone owners will likely switch from AT&T over the next year. I won’t be changing carriers, primarily because I live in a region where AT&T has much wider coverage. But seriously folks: why isn’t there an option that includes easy workflow, a fast network, and no dropped calls?

The SEC settles with Reza Saleh, a Perot Systems employee accused of insider trading when Perot announced its sale to Dell last year. Saleh, a longtime friend of Ross Perot, agreed to return all the money without admitting or denying any allegations. The SEC will also ask the court to impose financial penalties which could be as high as $25.8 million.

athena ymca

The local paper recognizes athenahealth’s $5,000 contribution to the Waldo County YMCA (MA). athenahealth donates a portion of its profits to organizations that enrich community health; what I find particularly cool is that athenahealth allows its employees to vote for which charitable organizations receive contributions.

Nearly one-third of malpractice claims are the result of mistakes that could have been caught by a surgical checklist, according to a new study out of the Netherlands. Researchers linked the reasons for 294 lawsuits with specific items on checklists and found matches in 29% of the cases. Could this be correct: checklists have been found to save lives and now money, yet only 25% of US hospitals use them?

Sage Healthcare will participate in  a series of workshops sponsored by the Florida Medical Association. The workshops, which include 18 sessions across nine cities, will offer guidance to doctors selecting and implementing EHR systems to meet Meaningful Use requirements.

sierra view

Sierra View District Hospital (CA) initiates its $13 million, four-year  Meditech EHR implementation. The hospital plans to go live on its first phase by November.

I’ve been very unsettled the last few days, after learning my zodiac symbol has changed. Could it be that I am not adventurous, energetic, enthusiastic, confident, quick witted, selfish, quick-tempered, impulsive, and  impatient, but instead, compassionate, romantic, imaginative, intuitive, selfless, secretive, weak-willed, and a compulsive workaholic? In other words, am I no longer a self-centered, life-of-the-party diva,  but instead just a nice person who works too much? Unsettling, indeed.

Coastal Connect HIE plans to go live with patient data exchange by mid-February. The alliance, which is sponsored by the Coastal Carolinas Health Alliance, includes 11 hospitals along the coast of North and South Carolina.

kevin e lofton

Catholic Health Initiatives (CO) CEO and president Kevin E. Lofton says his organization will invest $1.5 billion in EHRs and other IT systems between 2010 and 2015. Cerner systems are deployed in larger markets and Meditech in smaller facilities.

Clinical integration provider Valence Health hires Dan Iantorno as VP of information technology.

In his last post, Mr. H mentioned that he and Mrs. H were escaping for a much needed getaway. He checked in with me long enough to share this: “We’ve been here barely more than a day and we’re totally relaxed and pampered. I needed a break more than I realized.” He also added that he took my advice and is sampling the beer, which seems to compliment the gourmet grub and ease the pain of his overexposure to sunshine. Sounds perfect.

black ops

Thankfully WNA never seems to rest, sharing news of gamers who hacked into the server of a New Hampshire radiology practice. Seems the Scandinavian infiltrators were hunting for more band-width to play Call of Duty: Black Ops. Per WNA, “They never saw it coming.”


Baylor Health Care System announces its intent to register for stimulus funds and demonstrate meaningful use of EHR. Baylor CIO David Muntz says his organization has spent over $250 million implementing EHR over the least 10 years and that five of its hospitals have successfully standardized its “processes and technologies based on a certified electronic health record.”  My translation for that statement is that Baylor has fully implemented EHR (Allscripts Sunrise, I believe) in five (of 26) hospitals. The remaining facilities will continue rolling out EHR over the next two years.


E-mail Inga.

EPtalk by Dr. Jayne

I’m shamelessly pandering to Meaningful Use with EPtalk, since indeed I am an Eligible Provider. It doesn’t have the same catchy ring as HIStalk or HERtalk, though. Like many physicians, I take issue with the term “Provider” in general. If they needed a word or phrase to summarize those of us on the front lines, the least they could have done is make us “Patient Care Jedi.”

To those of you emailed your greetings and warm wishes, thank you! After several years as a HIStalk reader with the occasional comment or rumor sighting, being on the other side of the screen is a bit strange. I feel like I know you all personally. As a physician, I’m deluged with information from all kinds of sources, but other than FDA drug recall notices, HIStalk is the only one I allow to deliver to my inbox rather than routing into a folder for later. Clicking that link and finding my own writing is quite a thrill!

Several of you have asked for additional details about my background, specifically related to HIMSS, memberships, vendors, and conflicts. There seems to be a common theme about objectivity. Like my other HIStalk BFFs, being part of this team gives me the opportunity to speak candidly about the products on the market today. I have hospital privileges at multiple facilities, so my user experiences have been diverse. I’ve seen (and been forced to care for patients with) the good, the bad, the ugly, and the horrific.

In the interests of full disclosure: Like Mr. HIStalk and Inga, I’ll be attending HIMSS as a regular attendee. My “day job” employer pays for an individual HIMSS membership (as well as my specialty society, the local MGMA chapter, and the Southern Medical Association). A previous employer made me a Life Member of the AMA. Although I’m not currently on any national task forces or committees, that doesn’t mean I haven’t been in the past or might not be in the future. I do serve at the state/regional level in advocacy efforts. I’ve not been employed by any software or hardware vendor. I have never been convicted of a felony and my blood type is O positive.

Now that we have that out of the way… I saw an invite to an AMA continuing education seminar called “High-Reliability Safety: Applications to Healthcare” that’s being held on Wednesday the 19th. More info here.  They’ll be talking about embedding a “safety management system” in the healthcare environment. Unfortunately, I’ll be attending another tres exciting Meaningful Use Committee meeting at my institution, so if any readers happen to attend, email me with the interesting tidbits.

Multiple media outlets have been talking about the CDC report on EHRs in physician offices. National Coordinator for Health Information Technology David Blumenthal featured it under the extremely optimistic headline “EHR Adoption Set to Soar.” American Medical News was a little more restrained with “Physician EMR use passes 50% as incentives outweigh resistance.” Blumenthal goes on to celebrate the 41% of office docs and 81% of hospitals planning to apply for incentives, but goes on to note that many small practices “still need to learn about the opportunity they have.”

My thoughts on it: take it with a grain of salt. There are quite a few of my peers who are blissfully ignorant about this whole issue; maybe that’s not so bad. As for the study itself, the data was gathered via a physician self-reporting mail sample. Those of us that interview patients know what happens when patients self-report health behaviors – they either double it (exercise) or reduce it (alcohol) so that there’s no way of knowing what the patient is really doing. I think there might be a little bit of creative reporting by my peers here.

The survey looked at full vs. basic systems and although the headline “Physician EMR Use Passes 50%” sounds sexy, a closer look at the numbers reveals that 25% have a “basic” system and 10% have a “fully functional” system. The data doesn’t quite capture what portion of physicians have a system with bionic capabilities installed but are only using it to do the IT equivalent of crushing beer cans. (I recently visited a physician who was using her laptop as a base to stabilize an avalanche of journals, mail, and catalogs. She owns a gold-plated system. It was a shame.) If you dig deeper into the features that allowed a system to at least meet “basic” requirements, you could meet that with a word processor and some scanning software.

Bottom line: if a patient-care study had results like this, physicians would be extremely skeptical about its conclusions.


E-mail Dr. Jayne

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Currently there are "17 comments" on this Article:

  1. Dear Dr. Jayne,

    Wonderful perspective from the peanut gallery of EPs. Well rounded insight into the EMR/EHR Meaningful Use conundrum from the gang of HIStalk.

    Like you, long time chronic reader, occasional e-responder and just keep up your intuitive EP-spin on our collective adventures into the new healthcare “transition”, for lack of a more appropriate term.

  2. looks like a broken link on the note re:
    Nearly one-third of malpractice claims are the result of mistakes that could have been caught by a surgical checklist, according to a new study out of the Netherlands. I think it is referring to this article…

    de Vries EN, Eikens-Jansen MP, Hamersma AM, Smorenburg SM, Gouma DJ, Boermeester MA. Prevention of Surgical Malpractice Claims by a Surgical Safety Checklist. Ann Surg. 2011 Jan 4.

    Available at: http://journals.lww.com/annalsofsurgery/Abstract/publishahead/Prevention_of_Surgical_Malpractice_Claims_by_a.99302.aspx

    if you have a subscription.

    [from Inga] Link to press release fixed or here.

  3. RE:” what I find particularly cool is that athenahealth allows its employees to vote for which charitable organizations receive contributions.”
    Same for Epic.

    And when last I asked the question about sales people at Epic, I was told that to be a salesperson at Epic (I don’t believe they call them by that moniker) you have to first be a support person /installer for several years and work your way into sales. Of course there has always been a raging debate as to whether or not tech people can sell – but they seem to make it work. Or is the product just so darn good it sells itself??
    I do not know of a sales recruiter that have ever placed a ‘sales’ person at Epic. If they did they’d be advertising it from the highest mountain. Has Epic ever run a sales job add in HISTalk? Can’t remember seeing one.

  4. Dr Jayne says “I’m shamelessly pandering to Meaningful Use with EPtalk, since indeed I am an Eligible Provider. It doesn’t have the same catchy ring as HIStalk or HERtalk, though.”

    Maybe it’s not too late to call your column “DocTalk” or “JayneSayin” so you can be as cool as Mr. H and Inga!!

  5. >>> Blumenthal goes on to celebrate the 41% of office docs and 81% of hospitals planning to apply for incentives, but goes on to note that many small practices “still need to learn about the opportunity they have.”

    Just to be clear: the 41% of office docs are based on a survey on offices with 5 or more providers, leaving out small physician offices which make up 75% of offices in the USA, most of which don’t plan to apply for incentives. So the 41% number is a fabricated lie.

    It’s a shame that Blumenthal needs to quote misleading numbers to arrive at positive statements about the much-detested “meaningful use” mandates.

    URL: http://www.ahrq.gov/qual/mosurvey10/moreslttab2.htm

  6. Regarding EPIC Salespeople not getting “comp’d” for their sales efforts, I can’t speak from any personal insight. However, while a unique and disarming factor when approaching their potential executive cliientele (CFO, CMIO, CIO’s, etc) in being able to ‘claim’ their focus on marketing their EPIC offering is driven by improving patient care (via their enhanced integration platform) versus the industry “perceived” results-oriented (substantial) compensation from a multi-million dollar sale. The resulting “perception” being left that their “competitor’s” motives for closing the sale is driven by a 5-10% commission if successful… thereby, potentially willing to “say anything” to do so.

    Allow me to reiterate, I use the term “perception” and not claiming that EPIC salespeople directly (verbally) differentiate how they are compensated versus their competition.

    Therefore, should the “perception” be accurate that EPIC salespeople are not paid “commission’s” following a “sale”, then common sense tells us that they are being “compensated” by other means… whether thru a higher base pay, stock options, etc. Again, I cannot speak from personal experience or insight. My point is simple… last I checked we are still a “capitalistic” society and people; especially those in sales. are driven by results-oriented rewards for their efforts… and let’s face it, the sales cycle for such “system” sales may drag-out for 12-24 months and the actual deployment of such systems “may” result in phased pay-outs over the course of another 18-24 months depending on a vendor’s compensation policy. Therefore, let’s not be quick to believe that EPIC salespeople work their tails-off, sacrifice valued time from their families, enduring airport hass;les, etc. without a rewarding form of compensation in making it worth their while.

    It is not my purpose to disparage EPIC, or other Systems salespeople… instead, thru this lengthy dialogue, make sure there is no misinterpretation that EPIC rep’s are not generously compensated for their efforts, any less than their competitor’s.

    With that, let’s also keep in mind that their are reasons why EPIC has assumed the title as the #1 System’s provider… and deserve a round of applause for their marketing success… opening up a whole other round of discussions.

  7. ====”Bottom line: if a patient-care study had results like this, physicians would be extremely skeptical about its conclusions.”

    I think I am going to like you after all. So true Dr. Jayne, and is this study any different than the made up real truth in the HIT vendor and HIMSS sponsored studies being used to “educate” the Congress of the United States?

  8. It is true about Epic. They do not hire sales people, the also do not have a VP of Sales. Those who survive the boot camp and gain experience in implementations may eventually respond to field questions and team in RFP responses.

    Their “sales team” are their customers.

    Why ruin that?

  9. Epic’s sales people are still sales people, regardless of what background they come from before moving onto the sales team. They’re also adequately compensated, just like any sales person would be. If they’re not incentivized through compensation to complete sales, then they are the dumbest sales people on earth. To even begin to argue that Epic sales people are conceptually any different than other vendors’ is just absurd, and if hospitals are actually buying the Epic system based on this sort of stuff – call me, I’ve got a bridge in New York you might be interested in.

  10. So then…if I have several years of EHR sales experience, what are my chances of getting hired for that role at EPIC?

  11. For the ranters, ravers, and misinformed on here regarding Blumenthal and the CDC survey around EMR adoption:

    1. The survey on physician offices was done by the NAMCS survey at the CDC. It was not sponsored by HIMSS or some corporate entity.

    2. Survey is still the best source of aggregate source of physician EMR adoption in the U.S.

    3. Disregard the 50+% adoption number. It is meaningless. Not surprised that the basic news media outlets latched on to this number because of its cache. Then again if you rely upon the main new outlets with the exception of maybe McClatchy you are likely uniformed. You learn next to nothing about economic and scientific/healthcare news from the major new outlets.

    4. Here is who is included in the sampling frame for the CDC survey:

    “Methods—NAMCS includes a national probability sample survey of nonfederal office-based physicians. The target universe of NAMCS physicians is physicians classified as providing direct patient care in office-based practices, including additional clinicians in community health centers. Radiologists, anesthesiologists, and pathologists are excluded.”

    Pretty straight forward to be although I would like to see the actual demographics and seems pretty clear it refutes any intentional sampling bias that is not representative of U.S. physicians who practice patient care.


    5. There are some likely biases in the CDC survey but they use a fairly standard method to control for them including their followup efforts. Nothing that would likely amazing skew the results one way or the other.

    6. What everyone should be really focusing on is just how many physicians and hospitals who stated they will be going for meaningful use will actually not even submit and not succeed/drop out in each of the subsequent stages. That is what really matters from a policy perspective pot of view. If 81% of hospitals is the high-water mark, my bet is that number gets weeded out considerably even after Stage 2.

  12. Epic does not hire sales people. What part of that is confusing?

    You are limited by your paradigms. Epic thinks far superior than you mere mortals.

    Epic “sells” nothing.

  13. Reminder, Epic had a MARKETING SUCKS billboard. Their model is not the typical ken doll sales person. The “ssales” people are more project managers that come from seasoned analyst positions, and maintain anayst level knowledge. I have never heard of any comission type pay at Epic. Anonymous’s chances are zero.

  14. anonymous-I think the better question is, if you have several years of Epic “sales” experience, what is your chance of getting a job at another EMR vendor. I believe the answer would be zero. Project managers and analysts aren’t sales professional, nor will they be.

    I get offended by commens like certifiable’s-“ken doll sales person”.

  15. >>> Pretty straight forward to be although I would like to see the actual demographics and seems pretty clear it refutes any intentional sampling bias that is not representative of U.S. physicians who practice patient care.

    They give out the actual demographics:


    No small physician offices were included. Blumenthal should have realized that shortcoming/bias before using the data to try to advance “meaningful use.”

  16. Al – The demographic sampling frame you are pulling from from AHRQ’s Medical Office Survey on Patient Safety Culture.

    It states every clearly on the AHRQ website:

    “The survey was designed for medical offices with at least three providers (physicians, either M.D. or D.O.; physician assistants; nurse practitioners; and other providers licensed to diagnose medical problems, treat patients, and prescribe medications). Survey administration in solo practitioner or two-provider offices is not recommended because it would not be possible to maintain the confidential nature of individual responses. In small offices, rather than administering the survey, it can be used as a tool to initiate open dialog or discussion about patient safety and quality issues among providers and staff.”


    This is a completely different sampling frame from the NAMCS which is a survey done annually by the CDC.


    “The NAMCS utilizes a multistage probability design that involves probability samples of primary sampling units (PSUs), physician practices within PSUs, and patient visits within practices. The first-stage sample includes 112 PSUs. PSUs are geographic segments composed of counties, groups of counties, county equivalents (such as parishes or independent cities) or towns and townships (for some PSUs in New England) within the 50 States and the District of Columbia.

    The second stage consists of a probability sample of practicing physicians selected from the master files maintained by the American Medical Association and the American Osteopathic Association. Within each PSU, all eligible physicians were stratified by 15 groups: general and family practice, osteopathy, internal medicine, pediatrics, general surgery, obstetrics and gynecology, orthopedic surgery, cardiovascular diseases, dermatology, urology, psychiatry, neurology, ophthalmology, otolaryngology, and a residual category of all other specialties.

    The final stage is the selection of patient visits within the annual practices of sample physicians. This involves two steps. First, the total physician sample is divided into 52 random subsamples of approximately equal size, and each subsample is randomly assigned to 1 of the 52 weeks in the survey year. Second, a systematic random sample of visits is selected by the physician during the reporting week. The sampling rate varies for this final step from a 100 percent sample for very small practices, to a 20 percent sample for very large practices as determined in a presurvey interview.”

    The CDC survey on EMRs adoption includes practices under 5. This is some kind of gov’t conspiracy. They are completely different surveys performed by completely different federal gov’t agencies.

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