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September 1, 2011 News 3 Comments

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9-1-2011 9-03-43 PM

CMS issues its final rule on changes to the e-prescribing incentive program and includes multiple hardship exemption categories for EPs. EPs have until November 1, 2011 to request a hardship exemption for the 2012 eRX payment adjustment.

Reader Comments

mrh_small From CDH: “Re: Epic trainers. More disgruntled ones, this time at Central DuPage Hospital. Of 27 hired, eight have left. They were told they would be certified, but in reality were only credentialed. The principal trainers have purely HR backgrounds without any go-lives under their belt. Training plans are being revised daily as they have not yet stopped the back-end build for the November 6 go-live.” Unverified.

9-1-2011 7-15-58 PM

mrh_small From Arch Moore: “Re: WVHIN and Thomson Reuters. You reported that deal back on January 24, more than seven months before they announced the contract. I heard contract negotiations hit a big snag in June when Thomson Reuters announced to the world (and Wall Street) that they were thinking of getting rid of their healthcare business. Rumor is it was a surprise to everyone. WVHIN must have been impressed with CareEvolution since the deal went through.” Thanks for reminding me. I was thinking I’d said something about this from a reader’s rumor report back in the winter.

HIStalk Announcements and Requests

9-1-2011 9-06-15 PM

inga_small Wondering what you may have missed this week because you still haven’t signed up to get HIStalk Practice? Wonder no more: EHRA tells CMS that requiring providers to submit patient-level data for CQMs is too big a burden. I annotate toenails using Healthfusion’s MediDraw. athenahealth launches a PCMH accelerator program.  Retail medical clinics are flourishing.  If it’s fall, then it must be time for user group meetings.

9-1-2011 9-07-28 PM

mrh_small On HIStalk Mobile, Dr. Travis covers all the news about apps, home health technology, and mobile health, but also summarizes what it takes to succeed in developing successful apps for consumer health.

mrh_small On the Jobs Board: McKesson Consultants, Epic Implementation Project Manager, SCC/SMM Consultants. On Healthcare IT Jobs: Epic Physician Trainer, Clinical Nurse Analyst, NextGen Trainers / Consultants.

mrh_small Allow me to compress my usual Thursday spiel into one-word imperatives, just for the sake of brevity: (a) subscribe; (b) Friend; (c) report; (d) click; and (e) thanks. Did you get all that?

mrh_small Listening: Ghost on the Canvas, a moving last studio album from Glen Campbell, diagnosed with Alzheimer’s this year. I was never much of a fan, but maybe I should have been given this album’s outstanding songwriting, vocals, and guitar work. To my ears, the 75-year-old, who has sold 45 million records in his 50 years in music, has never sounded better or benefitted so much from fresh-sounding production and contributions from folks like Jakob Dylan and Billy Corgan. It’s everything you’d expect from someone looking back at a life well lived: reflective and poignant, but optimistic (A Better Place says it all). Glen never got much attention from the music industry because he straddled genres (country? pop?) and was goofy on TV and movies, but somebody must be blackballing him if this album doesn’t reap a truckload of awards even without the sympathy vote.

mrh_small Happy Labor Day, celebrating the rapidly diminishing ranks of us who aren’t out of work or happily drawing government entitlements while practicing leisure. You fashion purists will no doubt be placing your white clothing and seersucker suits into storage next week as summer unofficially ends. For me, it’s college football, perhaps some well-crafted barbeque, and a beer or two unless Mrs. H unveils plans of her own. I will most likely post Monday Morning Update this weekend since that’s what I do, even though fewer folks will read it (time to slip in something really scandalous!) Enjoy the holiday.

Acquisitions, Funding, Business, and Stock

9-1-2011 9-11-09 PM

inga_small Despite reporting “disappointing” Q2 results Wednesday, SAIC CEO Walt Havenstein speaks positively about the company’s recent acquisition of Vitalize Consulting Solutions:

The addition of Vitalize will expand SAIC’s health solutions portfolio in both commercial and federal markets to help customers better address electronic health records implementation. The combination of Vitalize’s expertise and integrating commercial off-the-shelf software for electronic health records and systems with SAIC’s information integration data analytics, and cyber security capabilities creates a powerful combination in the marketplace.

SAIC’s Q2 numbers: revenue of $2.6 billion (a 6% y/y drop), EPS of $0.32. Analysts expected $2.77 billion and $0.35. Shares fell 13.5% on Thursday, making it the top loser on the NYSE and hitting an all-time low, after the company said reduced government spending is hurting its top line.

Ingram Micro announces a Healthcare Partner Network of healthcare VARs and managed service providers.

9-1-2011 9-13-23 PM

Shares in NextGen parent Quality Systems hit a 52-week high Wednesday before slipping a little on Thursday. Market cap is $2.66 billion. Big holders Sheldon Razin and Ahmed Hussein own $459 million and $423 million worth, respectively.

9-1-2011 9-15-05 PM

IV equipment maker B. Braun Medical sues CareFusion for patent infringement, claiming CareFusion’s Alaris smart IV pumps violate its patents that include wireless communication with hospital clinical information systems.


9-1-2011 6-51-42 PM

Twelve Community Health Centers in Puerto Rico choose SuccessEHS EHR/PM for their 190 providers and 26 sites.


9-1-2011 5-40-17 PM

AHIMA names Lisa Spellman as its representative to lead the health informatics committee for the international standards organization ISO/TC215. She was previously with HIMSS and Allscripts.

9-1-2011 7-50-40 PM

Steven Liu MD, founder and chairman of Ingenious Med, is named Physician Entrepreneur of the Year by Modern Physician.

Announcements and Implementations

9-1-2011 8-38-32 AM

The Buchanan County Health Center (IA) goes live on its first phase of Meditech.

9-1-2011 8-43-52 AM

The Greater Dayton Area Hospital Association and HealthBridge announce the go-live of the Greater Dayton Area Health Information Network, which connects four hospitals and over 200 physicians.

The fishing city of Navotas in the Philippines rolls out EMR at nine health centers and one “lying-in” clinic. Midwives will be equipped with 22 BlackBerry smartphones, allowing them to collect patient data as they make house visits.

9-1-2011 4-05-49 PM

Physicians connected to Brooklyn HIE can access patient records via from their ClinicalWorks EHR.

9-1-2011 3-53-21 PM

Optum enters a strategic relationship with Monarch HealthCare (CA) to manage the clinical operations of its 2,300 independent physicians.

athenahealth launches athenaCoordinator to facilitate care delivery among hospitals, practices, and other caregivers.

Government and Politics

mrh_small A scathing and well-written reader editorial about “inane” Maryland Medicaid isn’t too keen on accountable care organizations:

Mr. Ransom seems to think that doctors, including the rural ones, will flock to the idea of reward for cost savings and better care management. The people who are enamored with these payment models are mostly lawyers, journalists, politicians, medicolegal pundits, bureaucrats and software companies, especially the last that endlessly inundate the medical profession with ideas that neither materialize in enhanced care for patients nor in increased income for doctors. Instead these ideas have resulted in jobs and increased income for government auditors, care deniers and people who connect doctors to the care deniers, paper pushers and bean counters; folks who will never set eyes on a patient in their lifetime.

Innovation and Research

A doctor from Wichita State University (KS) develops an iPhone concussion symptom detection app for high school football teams. Concussion Manager, which costs $25 per player, tests before-and-after balance, memory, and reaction time on the sidelines, allowing coaches to take the player out if warranted.


Insiders are responsible for the majority of PHI breaches, with 35% involving employees snooping on their co-workers and 27% the records of friends or relatives. Loss or theft of physical records or equipment account for an additional 45% of breaches.

Fred Trotter reviews the VA’s recently announced VistA Custodial Agent, concluding that, “it doesn’t suck (much).”

mrh_small Weird News Andy finds the Yale School of Medicine announcement of a paper-free curriculum a little weird (there’s that word again), balancing the $100K annual savings against the $600K upfront iPad cost, inevitable repair bills, and the likelihood of buying Apple’s hot new model every couple of years as being similar to “federal government thinking.” He likes the idea, but finds predicted print savings to be an unconvincing way to justify the cost.

mrh_small Weird News Guy sent over this link: if you insist on removing animals from their natural habitat and locking them up thousands of miles from home so humans can stare at them, at least give them iPads like the Milwaukee County Zoo has done for orangutans. They play with apps on the donated iPads and will soon have Skype, which will allow them to videoconference with their inmate counterparts elsewhere. That’s obviously a testament to the iPad’s ease of use. Wonder how they’d fare with an EMR? 

mrh_small Former Carthage Area Hospital (NY) CIO Skip Edie says he was interviewing an out-of-work CIO for an IT position when the hospital’s CEO called the candidate in Edie’s office to tell him he should interview for Edie’s job. Edie says he saw the writing on the wall and turned in his four-week notice, only to be marched off the property. Two days later, Edie’s wife, a patient accounting manager for the hospital, gave her four-week notice and was also escorted out within 10 minutes, she claims. The CEO says both left on their own and would not comment further.

9-1-2011 8-54-45 PM

mrh_small Strange: the Christmas Eve death of a radiologist from Jackson Memorial Hospital (FL) is ruled an accident by the sheriff’s office, which determined that the woman’s necklace became entangled in the shiatsu massager she was using in her bedroom, strangling her. Her husband, also a doctor, says he found her unconscious. The FDA is advising owners to not only throw the specific massager (above) away, but to break it into pieces and put the parts in different batches of trash.

9-1-2011 10-20-58 AM

inga_small Great news if you are good looking: more attractive people earn an average of $250,000 more during their careers than those who are less good-looking. Not only do the best-looking third of the population earn 5% more money than the average or ugly, they also get better deals on loans. And if you are a pretty woman, you are more likely to marry a higher-earning man. I’m now wondering if Mr. H would give me a raise if I invest in some “cosmetic upgrades.”

Sponsor Updates

  • Merge Healthcare’s OrthoEMR v4.0 receives ONC-ATCB certification.
  • Hayes Management Consulting reports that Ohio State University Physicians’ use of MDaudit has helped the practice reduce regulatory risk.
  • Lancaster General Hospital (PA) selects Wolters Kluwer Health’s ProVation MD software.
  • Healthwise will participate in next week’s The Forum 11  Annual Meeting of Care Continuum Alliance in San Francisco.
  • NextGen is offering a webinar September 12 to demonstrate its Inpatient Clinicals.
  • API Healthcare is exhibiting at the this month’s ASHHRA Annual Conference in Phoenix and the Healthcare Staffing Summit in Philadelphia.
  • Vocera smart phones and badge communicators can now receive alerts and notifications from Extension, Inc.
  • Greenway Medical announces that PrimeMOBILE now available on iPad as a native app.
  • Healthcare Innovative Solutions will participate in this month’s Kansas Hospital Association’s Meaningful Use Summit in Topeka and the South Carolina Hospital Association / South Carolina Medical Association TAP Conference in Hilton Head.
  • The Orthopaedic Institute of Central Jersey and Orthopaedic Spine Institute select SRS EHR for their combined 19 providers.
  • 3M Health Information Systems partners with Krames StayWell to encode Krames StayWell’s patient education library using the 3M Healthcare Data Dictionary.
  • Imprivata and Teradici announce updates to Teradici PCoIP firmware and Imprivata OneSign software that will provide integration and interoperability of PC-over-IP (PCoIP) zero client devices with authentication management and single sign-on software.
  • Medicare awards Faith Community Hospital (TX) incentive funds following its successful Meaningful Use attestation using to Prognosis EHR.
  • Aspen Advisors publishes two new case studies: Fairview Leverages Seasoned Project Managers to Ensure Successful EMR Rollouts and University Hospitals Prepares for Meaningful Use Attestation
  • The Fullerton Radiology Medical Group (CA) picks McKesson’s Revenue Management Solutions for its 10-physician practice.
  • The Advisory Board and Mercy Clinics announce their inaugural Health Coach Training course in Des Moines, IA in October and November.
  • ZirMed partners with training solutions provider Contexo Media to launch ZirMed University, an online portal that provides training on the ZirMed solution as well as courses for continuing education credits.

EPtalk by Dr. Jayne

9-1-2011 6-58-42 PM

Earlier this year, the American Medical Association launched a contest to identify an innovative new application for handheld use. The top ten finalists have been announced and voting is open through an AMA website. You do, however, have to be a member to vote. Finalists are in two categories (Physician and Resident/Medical Student) and include applications for tracking hospitalized patients, surgical equipment preferences, and resident duty hours. Personally, my favorite is “What’s Not Covered,” which helps determine what organisms might escape a patient’s current antibiotic regimen.

9-1-2011 6-59-18 PM

Speaking of apps, HHS, through the Office of the Assistant Secretary for Preparedness and Response (ASPR) has issued a challenge for a Facebook application to connect friends who agree to check on each other during emergencies and communicate to the community via social media. “Additional accolades” are promised to entries with a “fun or game-like atmosphere for the user.” Maybe some smart developer can cross Angry Birds with a zombie apocalypse theme. Even smarter Facebookers will be sure to friend Inga, Mr. H, and yours truly.

I mentioned last week that Hofstra North Shore-Long Island Jewish School of Medicine is training their incoming medical students as emergency medical technicians. According to a reader, it’s not as new or revolutionary as it sounds – this was done in 1980 at The Medical College of Pennsylvania:

Bradley K, Anwar RA, Davidson SJ, Mariano J. A time efficient EMT-A course for first year medical students. Ann Emerg Med. 1982 Sep;11(9):478-81. PubMed PMID: 7114594.

Another reader alerted me to news about the Kentucky All Schedule Prescription Electronic Reporting system, or KASPER, which I mentioned as recently announcing it would interface with a similar system in Ohio. Kentucky House Speaker Greg Stumbo is seeking information regarding the system’s use (or lack thereof) by the Kentucky Board of Medical Licensure. Stumbo wants to know why the Board isn’t using data on prescribing habits across various geographic areas to investigate suspect physicians.

The article notes that only 30% of Kentucky physicians are using the system. Let’s see: I’d wager that 0% of suspect (or even slightly shady) physicians would use the system, so I’m not sure how more scrutiny of the data would really be a benefit. It goes on to mention that Public Citizen ranks the state as having the twelfth strictest board for disciplinary actions per 1,000 physicians, having been third and second in previous measurement periods.

9-1-2011 7-02-33 PM

September is Women in Medicine Month. I’m thankful for the women who came before and paved the way for the rest of us. I’ve been privileged to have some outstanding women as mentors. We’ve come a long way since Elizabeth Blackwell became the first woman to graduate from a US medical school in 1849. There’s still a bit of inequality out there, however: even with record numbers of women in medicine, my medical class was the first one in our institution’s history where women outnumbered men. We felt this acutely when 60+ women were crammed into a gross anatomy locker room designed to hold 20 women. The men’s locker room had 40 empty lockers. Go figure.


Duplicate Drug Checking
A Reader’s Response

I’m one of those readers who works for a vendor of a clinical drug database, though not the one referenced in the article. For the sake of transparency, I’m in product management at First Databank (FDB).

I agree that duplicate therapy is one of the more challenging domains of medication decision support. In the article under discussion, there was a scenario in which two different physicians wrote aspirin orders five minutes apart for a patient who had undergone a cardiac stent procedure. The authors agreed with the duplicate therapy alert that was fired (though they brought to light that the doctor missed it because it was buried amongst nuisance alerts, which I’ll touch on below).

However, in another context, two orders for the same drug will not warrant a duplicate alert (for instance, when a patient gets a one-time dose in the ED and then the order is continued on the floor). Venue matters. And that’s just one context among a number of different contexts that need to be considered, such as change in level of care, timing of the order, same or multiple clinicians placing the order, etc. Most of these factors are outside the purview of the drug knowledge base.

But I am not passing the buck. It is critical for the drug knowledge base to keep evolving to providing decision support that considers additional context.

One approach is to have the duplicate therapy knowledge driven off of pre-configured orders rather than the drug products. This requires that structured orders be employed by the vendor system, but can more easily identify orders that are intentionally given together, such as a bolus with a continuous infusion, or an order for which the nurse decides on the route (also referenced in the article). One of your sponsors, an MD, uses our structured orders, along with their own logic, and asserts that duplicate therapy does not have to overwhelm. 

Of course, as many have pointed out, dialing back the sensitivity in the content is another obvious component. We have done a lot of work on this over the last year. When I entered some of the key examples in the article into our test system, I found that we matched the authors’ recommendations.

We hit on the previously mentioned example of two aspirin orders, but not on the other alerts which the authors felt were spurious and caused the doc not to notice the true duplicate. Similarly, we satisfied the recommendation to generate a hit for an order for metoprolol IV on top of metoprolol PO.

Mr. H.’s insight that attributing severity for duplicates so that a site can turn off the less severe ones “en masse,” as is done with drug-drug interactions, also needs to be tackled. We do support our users with a solution that enables them to easily customize—turn off, or selectively turn on—alerts even without that attribute. 

We recognize that the volume of alerts is still too high for duplicate therapy as well as other domains and are investing heavily in addressing alert fatigue.


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

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Currently there are "3 comments" on this Article:

  1. “…at least give them iPads like the Milwaukee County Zoo has done for orangutans. They play with apps on the donated iPads and will soon have Skype, which will allow them to videoconference with their inmate counterparts elsewhere. That’s obviously a testament to the iPad’s ease of use. Wonder how they’d fare with an EMR?”

    Great idea Mr. Histalk! Let the orangutans suffer through the setup and “meaningful use” of an “cerfitified” EMR before subjecting us physician primates to unproven technology. They can even do “COOE”– the orangutan version of CPOE.

    Better yet, let’s put President Obama, Sebelius, Glen Tullman, and all the others that have associated with the inception of HITECH and put them into the same cage, iPad and all. They might learn something…

  2. I will most likely post Monday Morning Update this weekend since that’s what I do, even though fewer folks will read it (time to slip in something really scandalous!) Enjoy the holiday.

    Of course we will read it… It may be on Tuesday, but most of us would not miss it! Thanks for doing what you do (Inga, Dr. Jane,etc. included).

  3. I’m now wondering if Mr. H would give me a raise if I invest in some “cosmetic upgrades.”
    I don’t know about Mr. H,, but I might!

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