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May 5, 2011 News 10 Comments

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5-5-2011 9-46-18 PM

Q1 numbers for Allscripts: revenue up 82% , EPS $0.06 vs. $0.12, but beating expectations by $0.01 excluding non-recurring items. The company announces a $200 million share buy-back.

5-5-2011 7-26-32 PM

Alembic Foundation announces the availability of Aurion 4.0, its first release of the open source HIE software based upon CONNECT from the Federal Health Architecture.

Reader Comments

image From RC: “Re: Inova Health System. They’ve announced that they will be going with Epic. They were previously with IDX since before the GE acquisition.” Unverified since I couldn’t find any mention on the Web, but I believe it for two reasons: (a) an official-looking press release was included, and (b) I had little doubt after interviewing CIO Geoff Brown a few weeks ago, even though he didn’t come right out and say anything. Actually, I did just now find a tiny mention in an undated message from the peds chair at Inova Fairfax: “The Joint Commission (TJC) now requires all inpatient chart entries to be dated, timed and signed, with either a provider code or legible name present. This is evolutionary. The Electronic Medical Record will automatically contain this, and many of its other benefits will be transformative in nature. Inova is now going with the EPIC system.”

5-5-2011 8-04-28 PM 
5-5-2011 9-19-34 AM

image From Fixer Upper: “Re: Judy Faulkner. Is she selling her house? This must be it – it’s the same architecture and artwork as the Verona campus.” I see the resemblance, but from what little I could find by sleuthing, the $3.9 million, 8,000 square foot home on 173 acres (top) in Oregon, WI is being sold by an owner that isn’t Judy. The same sleuthing suggests that the house in the bottom picture, worth about 10% of the the Epic-looking one, is hers, which would strike me as being more in character. But that’s just casual Internet detective work. Maybe someone who works there knows, not that it’s all that important anyway.
image From Maven: “Re: not news, not rumor … just venting. As an HIT industry insider, I get so discouraged when I am a patient. I just registered for a minor procedure at a major teaching hospital that’s a beacon for HIT adoption. I was handed a two-inch, three-ring binder and was told by the clerk to take it with me when my name was called. Only nurses entered information into the computer, while the MDs and CRNAs did their documentation in the binder. I saw no evidence of innovation over what I implemented in 2002. I bet their EMR is mostly a document imaging system. I’ve seen progress behind the scenes at most hospitals, but bedside technology lags far behind.” I’ve worked in big places and IT is usually advanced in some areas, but a disaster of paper and poorly interfaced, outdated legacy systems in most. I’ll stick with my assessment that the big hospitals buy gazillion-dollar systems overseen by huge IT shops and highly compensated magazine-cover CIOs, but it’s often the tiniest ones that deliver the most impressive results from the systems they can afford. The main reasons: (a) fewer prima donna doctors and executives; (b) a more focused environment, both culturally and geographically; (c) better connection to their local community and patients; (d) more urgency to make IT projects succeed since they don’t have the bloated budgets to take a mulligan and buy them all over again a few years later when fads change. All of that offsets the lack of cash and the preponderance of community-based physicians whose EMR participation can’t be mandated.

image From Jen: “Re: ex-Epic employees. I’m within the ‘exile period"’ of a year and am curious about my realistic job options. Recruiters lose interest when I explain I can’t staff for a few more months. Any tips on where I should put my considerable skills to use? Perhaps readers who have been in a similar position can offer advice.” Comments welcome. I’ve heard of employers taking on Epic-certified folks even with their mandatory time out, figuring they can let them do general project work until they are allowed to leave the penalty box. It depends on their project timeline and how desperate they are to land experienced people. It may be that recruiters just don’t want to be bothered with explaining your situation even though potential employers might be OK with it. But I’ll shut up and let those who have lived it first-hand chime in.

5-5-2011 8-55-00 PM

image From California Dreaming: “Re: Alameda County Medical Center. Deep into a Soarian install, I hear.” I found the above in its 2010 annual report.

HIStalk Announcements and Requests

micky tripathi

image This week on HIStalk Practice: Micky Tripathi shares insights on Meaningful Use Stage 1’s Nasty Little Surprises in his Pretzel Logic column, about which a reader posted, “Adding Micky Tripathi to the HIStalk crew is further evidence of why HIStalk is one of the most worthwhile reads on the Web.” Emdeon acquires EquiClaim for $41 million in cash. St. Jude Medical integrates its Merlin.net Patient Care Network with GE’s Centricity EMR and Scottcare’s Oneview CRM. AMA introduces online tutorials to help physicians select and implement HIT systems. Only about 21% of eligible providers participated in the 2009 PQRS program and only 12% earned bonuses. If you are thinking to yourself that you don’t recall reading any of these stories on HIStalk, you are correct! Sign up for HIStalk Practice updates so you don’t miss a thing.

Jobs on the Sponsor Job Board: Segment Marketing Manager, Product Specialist – Physician, Software/Implementation Engineer. On Healthcare IT Jobs: Senior Systems Analyst – Financial Systems, Director, IT Business Services, Epic Reporting Specialist, Metadata Administrator.

Acquisitions, Funding, Business, and Stock

5-5-2011 8-28-33 AM

Start-up eMerge Healthcare receives $650K in investment commitments, including $250,000 from the Ohio state-supported venture development group CincyTech. The company was founded by a group of Cincinnati gastroenterologists who developed intra-operative voice command software to document surgical procedures.

image British software vendor Sage reports improving numbers for the six-month period ending in March, although its healthcare business fell 5%, with especially weak sales of its Medical Manager PM/EMR. The CEO declined to comment on rumors that the company is planning to sell Sage Healthcare, expressing a belief that stimulus money will eventually boost demand for Intergy.


St. Joseph Healthcare (CA) will use Emerge.MD’s OnePlace virtual clinic to support its telehealth pilot project and to expand services into other remote care services.

Downey Regional Medical Center (CA) signs a multi-year agreement with MedAssets to manage its patient financial services, including billing and collections for self-pay and third-party insurance accounts.

Conifer Health Solutions secures a multi-year contract to provide revenue cycle services to Memorial University Medical Center (GA).

Camden-Clark Medical Center (WV) signs for Allscripts Sunrise Enterprise and Enterprise Performance Management for recently acquired St. Joseph’s Hospital, replacing Meditech. Its Camden-Clark Hospital is already using those products.

5-5-2011 9-57-51 PM

image Salem Hospital (OR) is mentioned as an Epic customer, with a rumored price of $48 million and an expected HITECH payout of $14 million over five years. It’s hard to determine exactly what was being announced, but I think they were Epic before, at least on the ambulatory side, and they did just go live with MyChart.


5-5-2011 2-56-24 PM

image Harris Corporation promotes Jim Traficant from VP and GM to president of Harris Healthcare Solutions. An interesting quote from CEO Howard L. Lance: “Jim’s personal healthcare experience as a two-time liver transplant survivor drives his passion for transforming healthcare and informs his ability to understand the complex needs of patient and provider."

Skylight Healthcare Systems, a provider of interactive patient care systems, appoints Carla Hilts, previously with McKesson, as chief clinical officer.

5-5-2011 7-45-06 AM  5-5-2011 8-21-21 AM

MedSynergies adds Aaron Garinger and Amy Hartt from Baylor and Wellspring+Stockamp, respectively, as managing directors of its consulting services group.

5-5-2011 7-22-15 PM

MEDecision promotes Carole Hodsdon to EVP/COO, reporting to CEO Deborah M. Gage. She was previously EVP/CTO.

5-5-2011 9-55-20 AM

Kent Rowe, a former GE Healthcare VP/GM and IDX sales VP, joins Culbert Healthcare Solutions as VP of information technology services.

Announcements and Implementations

5-5-2011 9-13-20 AM

CIO Shafiq Rab ceremoniously flips a switch symbolizing the EHR go-live of Orange Regional Medical Center (OH) EHR. It’s moving its two hospitals to Epic as part of a $30 million HIT initiative.

The Varian ARIA oncology EMR receives ONC-ATCB certification as a complete EHR.

In New York, North Shore-LIJ and Montefiore announce a strategic alliance to share best practices, with Montefiore citing one of its own strengths as IT systems that support care management.

Government and Politics

image The HIT Policy Committee suggests delaying Stage 2 Meaningful Use one year until 2014. Providers and vendors have told the panel, ONC, and CMS that they need the extra year to develop and implement the new technology since the final Stage 2 rule is not expected to be released until mid-2012. An added benefit of the date push-back: more providers might participate in the Stage 1 qualification process since they would have an additional year to qualify.

Innovation and Research

5-5-2011 9-02-53 PM

image Interesting healthcare technologies are mentioned in an Indian newspaper: (a) a hospital’s smart card that can be used as a debit card and to store patient information in its 4 KB chip; (b) a Web service that allows finding blood donors by sending an SMS text message, with the same service also posting a message on Facebook and asking users to tweet it; (c) a smart phone-based personal case management system in which teams of experts monitor diabetics, send text reminders and advice, and intervene as needed; and (d) an online results service (Web, e-mail, SMS) offered by a chain of diagnostic centers.

5-5-2011 9-23-07 PM

UPMC and Alcatel-Lucent will jointly develop a telemedicine platform, extending their agreement that goes back to 2006. The “virtual exam room” will reach the commercial market in early 2013. UPMC will consolidate its telemedicine offerings, which are used in 16 service lines and 19 facilities.


The new iPad 2 TV commercial features medical imaging as one of its key uses. I’d guess it’s AirStrip’s app that is shown since Apple features them in nearly every promo, but I don’t know for sure.


5-5-2011 10-05-13 AM

Twenty-four percent of hospitals will invest invest in new transcription services, according to a new CapSite study. The report also finds that 61% of study participants currently take or plan to take a hybrid approach to capturing physician documentation to meet MU requirements and 53% would consider their current transcription vendor for data extraction and analysis needs.

KLAS’s latest report looks at the challenges and benefits of an anesthesia information management system (AIMS) and the most talked-about AIMS vendors. The vendors with the largest market share are Cerner, Draeger, GE, Philips and Picis. Similar to findings with other modalities, hospitals tend to prefer enterprise integration over best-of-breed.

image Vince Ciotti says you should watch his HIStory Part 7 (above) if you want to know the connection between IBM, men’s hair, and miniskirts.

image Weird News Andy can’t decide if a proposed New York law intended to reduce infections is “typical bureaucratic overreaching or actually a good idea.” It would prohibit doctors from wearing ties on the job.

image Kaiser Permanente finds that its use of health IT has allowed it to avoid using 1,044 tons of paper for medical charts annually; to eliminate 92,000 tons of carbon dioxide emissions by replacing face-to-face visits with virtual visits; to avoid 7,000 tons of carbon dioxide emissions by filling prescriptions online; and to reduce the use of toxic chemicals by 3.3 tons through the use of digital imaging. Kaiser also claims that despite the increased energy use and waste associated with PCs, its use of HIT has had a net positive effect on the environment.

5-5-2011 3-46-13 PM

image The ratio of the length of a man’s ring finger to that of his index finger is linked to facial attractiveness, according to researchers in Switzerland (who must have extra time on their, um, hands). Apparently, the longer the ring finger, the hotter the guy. It all has something to do fetal testosterone. I can’t wait to test the theory next time I am at a cocktail party.

Sponsor Updates

5-5-2011 8-37-45 PM

  • Catholic Health Initiative’s use of the Clairvia Care Value Management solution is presented as a case study in the latest issue of HFMA’s Leadership report. A quote from CHI’s SVP/CNO: “Instead of just sitting there with a list of nurses and a list of patients and trying to figure out how to match them, this system will make assignments that are not only best for the patient, but better for the nursing staff, too.”
  • Maury Regional Medical Center (TN) selects ProVation Order Sets as its electronic order set solution.
  • CynergisTek will showcase its on-demand and managed security solutions alongside partner Diebold at next week’s 2011 Amerinet Member Conference in Orlando.
  • Medicity expresses support for the ONC’s Direct Project specifications.
  • Voalté is hosting a one-hour Webinar on May 19 entitled 3 Steps to Get Your Smart Phone Strategy Rolling. Sarasota Memorial Hospital’s CIO Denis Baker is the featured presenter.
  • Mobile Anesthesiologists (IL) implements the Shareable Ink Anesthesia Suite for capturing clinical data and streamlining billing.
  • Lakeway Regional Medical Center (TX) selects Allscripts’ Sunrise Enterprise suite, including EHR and CPOE.
  • Olmsted Medical Center (MN) chooses the Access Intelligent Forms Suite to generate on-demand, pre-filled patient forms from its McKesson Series 2000 system.

EPtalk by Dr. Jayne

I recently attended a conference where I presented to community-based physicians on Meaningful Use. Now that we’re a good chunk of the way through 2011, it still surprises me that some physicians don’t seem to know much about it. Specialty and advocacy groups have done a good job of trying to educate the general physician population and CMS is also running journal ads, so even those folks who read print journals should have a rough idea what’s coming.

On the other hand, they could be like my colleague who insists on getting the print versions of all his journals even though he never reads them. His office is straight out of an episode of Hoarders. When we first went to tablet PCs for our EHR, he complained about the accuracy of the stylus. Turns out he had the tablet balanced on a giant unstable mound of mail on his desk, causing the tablet to wobble every time he tapped the screen. I jokingly moved the cardiac arrest crash cart next to his office because I’m sure I’m going to find him one day trapped under twenty-odd years of JAMA.

Back to Meaningful Use. I was not only surprised by these physicians’ lack of understanding of MU, but their lack of understanding of the operations of their practices in general. They were a mix of employed and independent physicians, all of them at a minimum on electronic practice management systems and about half of them on an EHR already. Several didn’t have any idea whether they’d even qualify for either of the incentive programs, with no idea of the size of their Medicaid or Medicare panels.

One of the challenges of technology is not just the implementation and adoption, but also optimization. I used existing software systems as an example in a breakout session. We talked about what several referred to as “billing systems” and how the practices use them. One physician sheepishly admitted that he had used pegboard billing until sometime in 2002, but had finally embraced the 1990s after payers forced his hand.

There was an overall lack of understanding of the role of a true practice management system as opposed to just a billing system. These physicians were not using on-board reporting, panel management, disease registry, or revenue-enhancing features of systems that had been in place for years.

If the practice is only using a small percentage of their capabilities, how in the world are they going to be able to implement, adopt, and maximize patient outcomes with an EHR? I guess that’s why consultants do so well. There are plenty of groups poised to drag these folks (kicking and screaming or not) into the Brave New World of healthcare IT.

I sent the group home with some basic homework to discuss with their practice management teams:

  • How big is your panel of active patients?
  • How big are your Medicare and Medicaid panels?
  • What are your top five payers, and are there any problematic trends?
  • What percentage of your patients are self-pay, and has it shifted in the last year?
  • What is your first-pass “clean claim” rate?
  • How many of your active patients have diabetes, coronary artery disease, hypertension, obesity, or another one of the Top 10 chronic diseases based on ICD-9 codes assigned at the time of billing?

Hopefully this homework will spur some important discussions and will set the groundwork for them to determine if Meaningful Use is worth the time and effort in their specific situations. With or without an EHR, these data points provide important information on the health of a practice. Physicians should be conversant about these metrics.

Understanding the “clinical” data already available in their practice management systems can position them to dip their toes into disease registries, quality reporting, and a wealth of other incentive programs that can be put in place with or without Meaningful Use, some even with (gasp!) paper charts. And better understanding of existing technology might just put a few more dollars in their pockets.


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

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Currently there are "10 comments" on this Article:

  1. Re: Re: ex-Epic employees. I’m within the ‘exile period”’ of a year and am curious about my realistic job options…

    I have heard /read about these Epic non-competes now for several years and still cannot understand how any vendor could enforce it, particularly if the employee is not at the exec level. I have worked at all levels in HIT firms for 30 years and in every conversation I have had with legal advisors I was told if your employer says you cannot work in your professional field after you separate (for the competition or clients) they MUST pay you for that period of time. Basically they must ‘buy’ a non-compete, pay you to ‘sit on the beach’. An employer cannot prevent you from making a living – although you must honor all trade secret, intellectual property issues, etc.

    My advice to every current and future Epic employee is get a lawyer to look over any employment agreement before you sign. And if you are a current employee see a lawyer before you leave. I believe if you are not paid during your ‘exile’ period you are being treated unfairly and the ‘liberal’ courts of Wisc just might see it your way.

  2. I left Epic when I moved away from Madison, and I chose to respect the non-compete since I was the one who signed the paper on day 1. I truly valued my experience at Epic and didn’t want to burn any bridges.

    I took a general project manager position at a large health benefits company to bide my time during the exile period. It helped me develop more industry-standard PM skills since that’s not something I focused on at Epic, and I earned my PMP.

    I found that the recruiters knew my 1-year-mark and the calls picked up at that time. I always thought I’d jump right back into the Epic arena, but instead I moved into a local health care system with a different vendor. I’ve found the broader exposure is aiding my professional develop in a way that returning to what I already know could not.

    I still maintain my Epic certifications since you never know how that will pay off in the future. For those worried about a decrease in salary when leaving the Epic niche, I found it only took about 2.5 years to recover, and my work-life balance has been much easier to maintain without the frequent travel.

  3. Re: Epic non-compete. I, too, have been told for years that employee non-competes are not worth the paper they are written on, unless there are special circumstances (ex-Executive, innovator, etc). BUT, most companies will shy away from hiring you if you have one, when there is a large pool of applicants who don’t, because they don’t want to even get close to having to fight a lawsuit, even a blatantly winnable one.

  4. Epic Non-Competes:

    1. Non-Compete enforceability depends on the state laws of the state that you worked in. In Wisconsin, they hold weight and are enforceable – that doesn’t necessarily mean you can be blocked from working eventually, but it does mean that you will have to go through lengthy and costly litigation. I would bet Epic has deeper pockets than most, and they do not back down from a lawsuit.

    2. Epic uses other ways to enforce their non-completes beside litigation. Consulting firms do not want to get on their bad side and risk not being able to send their consultants to training, attend UGM, etc. for the sake of a new employee.

    3. It’s true that if you are fresh out of college and do not have any other experience besides implementation, it can be tough to find a job within the same pay grade. However, a really great option is to work directly for a hospital that uses a different EMR – you can’t work for Epic’s customers or competitors, but you can work for a non-customer who uses a competitor.

  5. First Thing: The Epic Employment Agreement just says you cannot do anything that involves the implementation or support of Epic software for 1 year & there is a small list (maybe it has grown some) of direct competitors and large consulting firms that you are not allowed to work for… No where in the agreement does it say you cannot go work for a customer – you can do anything you want as long as it does not involve the implementation or support of Epic.

    Second Thing: Epic includes in their contracts with the health systems that purchase Epic that they will not for 1 year recruit/hire former Epic employees. Thus, even if someone leaving Epic thinks to themselves I don’t care about that silly piece of paper I signed when Epic hired me (and I didn’t have anyone else willing to take a chance on me right out of college with a liberal arts major) – getting a hospital system to void/violate their contract with Epic is another thing… That said – I have no clue what the repercussions are for violating the Epic contract? It’s not like Epic will sue their clients 🙂 They can prevent the individual from ever getting access to Epic resources – future training, User Web access, UGM, continued certification, etc…

    In short, honor your agreement and use the degree you went to college with and the experience (if any) you gained from working at Epic and get another job.

  6. Re: Epic uses other ways to enforce their non-completes..

    Sounds like a good anti-trust case to me. Now here’s a free entrepreneural idea for a legal firm…pull together enough past and present ‘exiled’ employees and file a class action suit. The bad press alone may rattle the Epic cage enough to get a nice settlement and maybe get Epic to change it’s nasty ways!

    Hey…its worked against Wal-Mart and other biggies..and maybe you can get Cerner/McK/GE et al to fund the initial effort!

    Or, are we all so terrorized by Ms. Judy we wouldn’t dare?

  7. Re: Maven: “Only nurses entered information into the computer, while the MDs and CRNAs did their documentation in the binder.”

    I continue to be amazed at how “HIT industry insiders”, generally lacking any demonstrable medical or scientific expertise, offer opinions about who should be doing what in medicine.

    Example of a similar statement:

    “I think HIT industry insiders should be helping mop the floors as this will reduce hospital acquired infections.”

    Why shouldn’t they?

  8. My two cents for Jen: “Re: ex-Epic employees.
    Although I’ve not worked for Epic (don’t fit their mold), I just started a new job after several months of actively looking and have a fairly current sense of the supply and demand. I would say that you don’t have much to worry about and should be very marketable, even more so if you can travel. A couple suggestions…check out all the websites for consultants who are HISTalk sponsors. Many have gigs needing your experience for 6 months to several years, both 1099s and W2s. Also, might want to find out what hospitals in your state are implementing Epic and approach them with your credentials. And finally, don’t forget to stay current on LinkedIn and let recruiters find you. Good Luck!

  9. Epic ahs a variety of ways to threaten customers who think about hiring an ex-Epic employee before their non-compete is up- resources, training schedules, fixes, etc. Same holds true for consulting partners. It helps hold up Epic’s prices for implementers, etc, as well as keeping folks at Epic. There is evidence of Epic having discussions about folks after their non-compete expires, or customer-to-customer job changes. There are a few early Epic customers who did not have non-competes in their contracts. There are some pretty nasty folks in the upper layers at Epic- or at least possibly mentally ill- lots of rumors in the old-time Madison IT community.

  10. When and if you leave EPIC or the EPIC client to a consulting firm, you become blackballed in the industry. EPIC raises their nose, and says, it’s not them. Ask all the people at a EPIC clients sites what will happen to them Clients are now calling EPIC and complaining that the industry is stealing their people – but these sites will not send them to training or certification. It’s funny – everyone loves EPIC – but they do have a large sense of arrogance. To EPIC – what watch you do on the way up and at the top to people – because you are going to see the same people on the way down!

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Reader Comments

  • Sam Lawrence: Except in this case, coding = medical billing, not development. Though the same warning may be true...
  • BeenThere: Partners will find the savings from their cuts of coders as fools gold. There are a lot of hidden costs running an outs...
  • JC: If there is not there can be. VistA has a reference lab interface that can create the manifests/labeling and such as we...
  • Tom Cornwell: Great stuff from Dr. Jayne as usual. One small typo, last sentence of second-to-last paragraph: should be 'who's' not 'w...
  • HIT Observer: What I find most interesting here, is people defending their common practices rather than truly taking this as invaluabl...
  • Bob: There's no incentive for the provider to spend time doing a price comparison for the patient. Nor is it a good use of th...
  • Peppermint Patty: Veteran - can you clarify what was "fake "? Was something made up (definition of fake) or did you disagree with Vapo...
  • Pat Wolfram: Such a refreshing article. Thanks -- there really can be a simpler version of an acute HIT implementation. But I do ...
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