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April 14, 2011 News 12 Comments

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3-31-2011 7-47-10 PM Healthcare IT is one big reason that private practice docs are taking down their shingles and going to work for hospitals, according to experts interviewed by The New York Times. Unlike the Hillarycare era, there’s no turning back this time since reimbursement is encouraging that kind of vertical integration. The predicted result: less competition, leading to higher prices (although Kaiser is a mentioned as a disrupter in offering cited higher quality at lower cost). The experts seem pretty sure that quality will improve (like in Mayo or Kaiser, with salaried physicians), but not so sure costs won’t go even higher.

Reader Comments

3-31-2011 7-47-10 PM From Hypocrisy: “Re: Judy Faulkner. She was quoted as saying at an ONCHIT Policy Committee meeting, ‘What is showing up in blogs — I have seen and sometimes been told about this — is that we have to be careful of an apparent conflict of interest. That is if, in fact, the primary spokesperson for PCAST does have products that would benefit tremendously by this, do we get into — and I know we’re not supposed to judge — the uncomfortable position of an appearance of conflict of interests.’ She’s apparently talking about Microsoft’s Craig Mundie, discussed a lot on HIStalk as a PCAST committee member. Presumably she does not see a conflict of interest herself in serving on the committee.” I didn’t see the quote, but it’s interesting if accurate. Just to clarify for those who don’t follow the confusing cast of government players, Judy wasn’t actually on the PCAST committee that made recommendations to the President that pretty much had HealthVault or Google Health written all over them – the only for-profit company employees on it were Craig Mundie from Microsoft and Eric Schmidt from Google. Judy is on the HIT Policy Committee, which has for-profit members from Kindred Healthcare, WellPoint, Gastroenterology Associates (a private doctor), and Epic (Judy). I wouldn’t think she carries the level of influence over that group that some have said Craig Mundie had over the PCAST report.

3-31-2011 7-47-10 PM From Ludacris: “Re: rogue Meaningful Use. A vendor is e-mailing consultants offering a ‘private label’ EHR they can sell under their own name for a split of the revenue.” The company’s address appears to be a mail drop and the principals aren’t listed, although I found the CEO’s name elsewhere. The vendor’s Version 1.0 product is certified as a Complete EHR Ambulatory and the offer claims companies that want to private label it get their own name on the list of certified products. I suppose ONC didn’t address that issue – where the same product could be sold by multiple vendors under multiple names, each rightfully claiming to be offering a certified product. Certification was intended to reduce buyer risk, not buyer confusion, and some would argue that it has accomplished neither.

4-14-2011 10-03-17 PM

3-31-2011 7-47-10 PM From Dingin: “Re: Epic. You mentioned Oakwood and Singing River. Both were at a recent class in Verona, along with others you probably already knew about: Nebraska Medical Center, Providence Anchorage, Contra Costa, Norton, MUSC, Wake Forest Baptist, University of Cincinnati, and Driscoll Children’s.” I confirmed with MUSC that they’re going only with the ambulatory products, dropping McKesson Practice Partner since it doesn’t work well with MUSC’s TELUS Oacis Health Data Warehouse, but keeping Horizon Clinicals on the inpatient side.

4-14-2011 10-11-31 PM

3-31-2011 7-47-10 PM From Lorenzo: “Re: ICA. What’s going with them? Rumors of problems.” Not so, according to our Informatics Corporation of America contact. “We have just won Wyoming Medicaid HIE through our partnership with ACS, just selected as VOC with Central IL HIE, and we are hiring as fast as we can to keep up with recent wins of Middle TN eHealth Connect and KHIN. We’ve grown by 100% since the beginning of the year and we expect to grow by another 50% by year’s end in employees. Our funding is solid through our primary owners and we are working as hard as ever to meet customer demands. Go-lives of major clients are scheduled over many of our clients in the near future. Nothing could be further from the truth.”

3-31-2011 7-47-10 PM From HISwalk: “Re: magazine. Does anyone else think this slide show paints a ridiculously rosy picture of several vendors given their current situations?” I’m not a fan of online slideshows when a simple list would have been much easier to read, but this one’s OK (the information it contains was provided by Vince Ciotti’s firm, so I’d trust it more than if the usual sideline reporters undertook their own analysis). I would say the list contains some opinion, some analysis that’s not quite current, and focuses on revenue (which was the point) and not necessarily profit or market trends. I don’t link to other HIT sites or rags since I don’t use them as sources, but you can probably Google your way to it if you’re determined to check it out.

4-14-2011 10-12-35 PM

3-31-2011 7-47-10 PM From FACA: “Re: ONC Policy Committee. There’s a Webcast meeting on EHR usability and accessibility on April 21 at 9 a.m. It’s a public hearing, so questions are welcome.” The agenda is here. The presenter list is interesting. For some reason, the government, like others, capitalizes Epic (Epic does not spell it EPIC).

HIStalk Announcements and Requests

inga_small This week exclusively on HIStalk Practice: PracticeWise, a new  column by practice consultant Julie McGovern (who stirs up some discussion in her first post). Reefdiver weighs in on the value of certification in the EHR selection process (readers are opinionated on that topic, too.) KLAS  extends a free offer for HIStalk Practice provider readers. AMA tells CMS what physicians find most burdensome. Dermatologists ask patients for fashion advice. Americans want their physicians to use EMRs. So far, only six states have issued MU incentive checks. In honor of Leonardo da Vinci’s 558th birthday and because it makes me happy, please sign up for the e-mail updates while you are catching up on the latest HIT ambulatory news.

On the sponsor-only job board: Clinical Project Specialist, Software/Implementation Engineer, Healthcare Implementation Project Manager. On Healthcare IT Jobs: EHR/ePM Implementation Project Administrator, Coordinator Clinical Trials.gov, Project Manager – NextGen, Software Product Development Manager.

Acquisitions, Funding, Business, and Stock

4-14-2011 5-55-28 PM

inga_small Allscripts CEO Glen Tullman earned nearly $8.5 million between June 1, 2009 and December 31, 2010. That breaks down to $4.1 million for the 12 months ending May 31 and $4.5 million for last seven months of the year.

Streamline Health Solutions reports Q4 earnings: a net loss of $1.8 million compared to a profit of $1.6 million a year ago. Revenue fell from $6.3 million to $4.9 million.

4-14-2011 5-56-03 PM

inga_small In India, Michael Dell chats with local reporters on a number of topics, including healthcare IT:

We are #1 in healthcare IT globally. We acquired a company called InSite One, the leader in cloud-based archiving of medical images. We have taken that expertise all the way back to our product groups and created new offerings. IT in the healthcare industry is siloed. The CIO can’t make them work together. We have created vendor-neutral archives by speaking to medical equipment makers. We capture all the data and store locally or in our cloud archive.

3-31-2011 7-47-10 PM Add Medicomp Systems to the long list of EMR vendors that have been sued by Prompt Medical Systems over the years. PMS has no Web presence, so I assume its primary output is legal rather than technical. It appears to be the brainchild of Bernard Milstein MD, an ophthalmologist, UTMB professor, and founder of The Eye Clinic of Texas who patented the use of CPT codes in computer systems in 1994 (even though AMA holds the copyright to the CPT codes themselves). He appears to be backed financially in his litigation lottery by an investment banker and securities company founder. None of the previous cases made it to court from what I can tell, so I’m sure PMS is banking (no pun intended) on the EMR vendors paying them to go away rather than risk being tied up endlessly in an expensive legal action.


The US Military Health System selects Mediware’s blood transfusion management system for 68 military health sites worldwide. MHS will also deploy Mediware’s LifeTrak and InSight to track donor records and product inventories in 28 blood donor facilities.

4-14-2011 4-42-41 PM

Palomar Pomerado Health (CA) chooses GSI Health’s HIE solutions to connect PPH hospitals and affiliated physicians.

Cooper University Hospital (NJ) awards a contract to MedQuist for computer-assisted coding technology and outsourced coding services.

Girard Medical Center (KS) signs with Cerner.

Regional Medical Imaging (MI) chooses Merge Healthcare’s radiology information system, expecting to receive $600,000 from Meaningful Use incentives for its 13 radiologists. Merge says 90% of radiologists are eligible for MU money and it will pursue certification for its RIS to help them earn it.

Announcements and Implementations

4-14-2011 4-36-33 PM

Kaleida Health (NY) says it is actively adding EMR capabilities across it hospitals and clinics. Its $20 million Cerner implementation should be complete by the end of 2012.

Tift Regional Medical Center (GA) goes live with RTLS temperature monitoring and asset tracking from AeroScout.

inga_small athenahealth creates a “burn unit” to handle physician practices that have been burned by old EMR systems and are looking for new solutions. CEO Jonathan Bush says about 35% of his company’s new EMR clients are replacing old EMRs.

ODIN announces EasySpecimen, an RFID-based pathology specimen management system, licensing the technology from Mayo Clinic.

3-31-2011 7-47-10 PM England’s Department if Health announces completion a project to move all prisons to a single electronic medical records system, allowing them to transfer records when inmates are moved. The article takes jabs at NPfIT, saying the prison system has more detailed information than NPfIT’s Summary Care Record.

Government and Politics

3-31-2011 7-47-10 PM CMS’s healthcare fraud enforcer (a pediatrician and lawyer) says he’s going to crack down on criminals, many of them working out of South Florida, who are scamming Medicare and Medicaid for up a quarter trillion dollars per year. Much of his arsenal involves smarter payment software that can detect fraud more quickly, needed since the fraudsters are using electronic billing systems to commit their crimes. Says one expert, “The crooks know now that these computerized payment systems are their best friend. They will study carefully the art of billing correctly, they will produce electronic transactions that are perfect on their face, but it’s just a pack of lies.” An irony: Florida Governor Rick Scott was CEO of the company (Columbia HCA) that admitted to extensive Medicare fraud, costing the company $2 billion to settle.

ONC’s got some job openings for a program manager and three policy analysts.

Innovation and Research

CalPERS claims its integrated healthcare pilot saved $15.5 million between January and October 2010. Pilot participants include Blue Shield of California HMO, Catholic Healthcare West, and Hill Physicians Medical Group. The organizations’ combined efforts led to a 17% reduction in patient readmissions, a half-day reduction in the average LOS, and a 50% drop in stays of 20 days and longer.

West Wireless Health Institute awards its $10,000 developers’ challenge prize to a skin cancer detection app. The physician developer, who is a veteran and a melanoma survivor, created the iPhone app for his own self-examination.


inga_small CIOs say their organizations will qualify for Meaningful Use incentives, but not as early as they predicted a few months ago. In an August 2010 CHIME survey, 28% of responding CIOs predicted qualifying for funds by April 1 compared to 7.5% of CIOs participating in a survey last month. About 32% of the CIOs expect to qualify by September 30, 2011 and an additional 58% anticipate Stage 1 qualification by the end of the 2013 fiscal year. Only 26% of community hospital CIOs believe they will qualify for stimulus funds by September 30, 2011.

3-31-2011 7-47-10 PM Strange: a “stunning blonde” in her 20s, bidding over the Internet, buys more than $50,000 worth of items ranging from a stuffed owl to furniture at an auction in England. The auctioneer called her to arrangement payment, only to have the telephone answered by a doctor, not surprising since she’s a hospital inpatient committed under the Mental Health Act. Her credit checked out, but the hospital won’t let her pay, so the auctioneer says he’ll sue the hospital.

3-31-2011 7-47-10 PM Umass Memorial Healthcare pulls 10 employee kiosks out of service when they discover that anyone walking up to the kiosk could view pay stub information from the previous user. The IT people changed the software and removed bank account information, then put the kiosks back out.

4-14-2011 10-15-49 PM

3-31-2011 7-47-10 PM Associated Press gets punked: a couple of anti-corporate troublemakers float a phony press release with GE’s name on it, saying the corporation will donate its $3.2 billion tax refund to the US Treasury since the American public is upset at learning that GE paid no taxes on $14 billion in profit. AP ran the story without doing anything more than clicking on the link to the convincing-looking but phony Web site, only to pull their news item down less than an hour later.

4-14-2011 9-54-56 PM

A reader sent this in for Inga and her shoe-loving followers.

Sponsor Updates

  • Advanced Endoscopy & Surgical Center (NJ) contracts with Wolters Kluwer Health for its ProVation MD procedure documentation and coding software.
  • Design Clinicals and the AHA are hosting a Web demo April 21 entitled Electronic Medication Reconciliation: Achieving Stage 1 Meaningful Use and Full Compliance Joint Commission Standards with MedsTracker. 
  • Concerro creates a cute video that compares workforce management tools to paper-based systems, à la the Mac versus PC commercials.
  • eClinicalWorks announces that 2,000 practices have successfully upgraded to Version 9, eCW’s ONC-ATCB  certified MU version.
  • Access announces a new version of its e-Signature solution to help providers create paperless registration and bedsid consent processes.

EPtalk by Dr. Jayne

This week marks the 150th anniversary of the start of the American Civil War. What does that have to do with healthcare IT, you ask? Maybe more than you think.

I was listening to NPR when Adam Goodheart, author of 1861: The Civil War Awakening, was interviewed. Charleston, South Carolina (which I’d love to visit if the right invitation presents itself) was the scene. Miscalculations on both sides about who would flinch first ultimately pushed events past the point of no return.

Towards the end of the interview, Terry Gross asks, “Some states today want the right to basically be able to nullify federal legislation in their state and not obey it. For example, not to follow the new health care policy that Congress passed. Do you see that as like a contemporary expression of similar divisions dating back to the Civil War?”

This was just a tiny part of the interview, but it really struck me about how divisive things are in health care politics right now. I certainly don’t think we’re on the brink of Civil War, but we are a house divided.

Acceptance of recent federal legislation is love/hate. There’s confusion on whether Meaningful Use will be repealed, revamped, or replaced. For the first time, I recently heard physicians (who had previously stalled on implementing an ambulatory EHR because they weren’t sure the Meaningful Use final rule was ever going to be final) state that they were holding off on going paperless because they feel healthcare reform (and the accompanying MU legislation) will be repealed.

I think many people agree that this train has somewhat left the station. There’s no guarantee that it might not stop somewhere along the tracks, but it already has pretty good momentum. (Anyone seen the movie Unstoppable with Denzel Washington? Watched it recently — a good diversion from reading yet another stack of documents about forming an Accountable Care Organization.)

It will be interesting to see how quickly challenges (to not only federal, but various state legislation) make it to the United States Supreme Court. Given the current makeup of the Court, I wouldn’t lay odds on any outcomes just yet.

Most large healthcare organizations that depend on Medicare payments aren’t willing to take chances or play the game of wait and see. They need to implement certified systems now and demonstrate Meaningful Use so that they can not only receive incentive payments, but prevent the stick that will ultimately follow the carrot. Whether incentive legislation will be repealed or only partially implemented, we don’t know, but I’m pretty sure the Centers for Medicare and Medicaid Services won’t forget the idea of cutting reimbursements by using lack of technology as an excuse (at least not any time soon).

A lot of people are excited about the billions of dollars flowing into the health IT industry. I envision industry lobbying that will rival Big Pharma in intensity and scope if the effort to repeal recent legislation gains any serious traction. There are plenty of consultants waiting to deal with the things that happen when physicians and hospitals select and implement hastily, not to mention vendors that will be poised to sell replacement systems as the industry consolidates.

There you have it. If you’re ever confronted with an SAT-style question asking for a modern-day analogy to the Civil War, please feel to plagiarize, no citation needed. And if you can recommend a conference that will give me an excuse to visit South Carolina, let me know.


Mr. H, Inga, Dr. Jayne, Dr. Gregg.

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Currently there are "12 comments" on this Article:

  1. Dr. Jayne, you gotta visit Charleston, SC. It is beautiful! I saw the best fireworks show there 4th of July last year. Plus, Folly Beach is awesome; it’s a very nice beach, not to mention it’s the only beach in the area where you can drink booze!

    Bring those Ingatini’s!

  2. Re: Hypocrisy – As Mr. H points out, Craig Mundie is not simply “a PCAST committee member”, he is co-chair of the PCAST Health Information Technology Working Group and, according to the reports on HISTalk, he simply outsourced the creation of the report to Microsoft staff.

    Ms. Faulkner, on the other hand, is on the HIT Policy Committee specifically in her role as the sole “Representative of Information Technology Vendors”: http://www.gao.gov/press/health_it_committee2009apr03.pdf

  3. Kudos to Judy Faulkner for speaking out. She rightfully pointed out the existence of a conflict-of-interest, without mentioning any names. Craig Mundie should not be the spokesperson for the PCAST report. The appearance of a conflict-of-interest is corrosive to that effort and makes Microsoft look bad.

  4. Interestingly enough the tapes of that original infamous PCAST session are floating around now. They were NOT posted like other PCAST sessions and were not given out on request even though PCAST is documented to operate under FACA rules.

    On the tape you can actually hear Craig Munde asking a panel with two Microsoft Employees (Sean Nolan and Craig Feied) what they think the nation should do.

    They basically recite chapter 4 of the PCAST report (this is before the report was theoretically even written) and discuss the notion of requiring every American who receives any government subsidy for their healthcare to be forced to have their data made available on such a public search engine. Or, they’d have to pay the price of withholding it. You can hear the woman from the Center for Democracy in Technology ask if that meant you’d have to”pay for your privacy”.

    Craig Munde in the trusted role of CoChair, creates a panel with 2 employees of his, asks them what they think the nation should do, they recommend the nation buy Amalga, put up a Bing search engine and Healthvault and force everyone to use it. PCAST for healthcare is born.

    All this with the full support of Aneesh Chopra and Vivek from the Whitehouse who subsequently instruct the HITPolicy committee not to question PCAST, just to implement PCAST.

    Being a democrat doens’t mean you can’t take advantage of Chrony Capitalism.

    Kudos to Judy for having a conscience.

  5. per Dr Jayne ” They need to implement certified systems now and demonstrate Meaningful Use so that they can not only receive incentive payments, but prevent the stick that will ultimately follow the carrot”

    The stick you refer to is a really a twig. If a doc does $500,000 in medicare payments annually and the Medicare MB adjustment is say 1%, (remember they wanted to cut payments to docs by 23% up till a few months ago)…it adds up to 500k*.01*.33 = $1,800.! Some stick. So as I have said repeatedly on this blog and others…do it right, do it on your schedule, not the feds.

    By the way for those of you that still think that there will be Medicare MB increases down the road after listening to Obama’s budget cut speech, and of course the republican plan…I have a bridge I think you’ll like.

  6. Thanks Frankie P. I have advised my doctor clients not to spend thousands $ on EHR systems that will reduce their productivity.

    The penalty from Medicare is more than covered by the productivity maintenance from not having a cumbersome EHR and the savings on not having cash outlays and cash flow drains from maintenance contracts.

    The doctors have also found that if they need records in a hurry from another office, they/or staff call the office or hosptial and allow those employees to do the clicking and faxing.

  7. Have to say, I’m a little disappointed at how dismissive so many people are of an obvious conflict of interest. Judy Faulkner doesn’t represent all vendors, she represents Epic; in the 18 months or so that she’s sat on the committee, how much has her company directly benefited from the decisions made by that committee? Nobody can argue that it’s been proportionate to other vendors either; Epic went from upstart to industry leader in the 18 mos she’s sat on the committee. There are other people that represent for-profit entities, but none of them stand to directly gain from the policy decisions the way Epic does. There’s more disdain on here for GlenTullman shooting hoops with Obama than there is for Judy Faulkner using a federal committee to directly pad her bank account. My personal opinion is that David McCallie of Cerner and Marc Overhage of Siemens should also resign for similar COI reasons. I don’t think anyone can criticize the Microsoft-employed authors of the PCAST report and then turn around and defend Judy Faulkner for her role at ONC. You either have to be upset about both, or upset about neither.

  8. Re: Ice Cole – “Epic went from upstart to industry leader in the 18 mos she’s sat on the committee.” What alternate reality do you come from?

  9. To Fannie, with all due respect, you have raised “physician resistance” to a new level. There is sufficient evidence to show that a drop in productivity can be temporary when reasonable strategies are employed. Perhaps you could help them find less “cumbersome” systems to use. While I accept Frank Poggio’s ROI analysis, I would submit there is more at stake here than simply $$$. How may I ask do your phsycians manage preventive care and quality measurement? Patients prefer EMRs, and staff are inundated with paper. BTW, do your physicians use (gasp) ATM machines and smart phones? Or do they just let their staff take care of those lowly tasks?

  10. @PCAST

    Any links to where these tapes are floating? Can’t find anything of the sort, and I tried all sorts of searches….

  11. After the last week of seeing my sister-in-law’s inpatient care at a major respected acute facility be as “uncoordinated” (and dangerous) as possible, I simply am dumbfounded at the continued resistance to the need for EMRs.

    If you don’t think they are safe enough, advocate for better safety standards. But please don’t try and tell me that clicking and faxing are somehow a safe and responsible solution.

    They are merely the most profitable path for the least energetic providers.

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