News 8/15/12

Top News

SAIC completes its acquisition of maxIT Healthcare, making SAIC’s Health Solutions Business Unit the nation’s largest commercial consulting practice in EHR implementation and optimization.

Reader Comments

From Neal Patterson’s Evil Twin: “Re: new research group survey of hospital CIOs. It compares the cost of a major EHR upgrade to the original contract price: Epic (40-49%), Cerner (30-35%), Allscripts / Eclipsys (20-22%), and McKesson Paragon (10-13%). Epic had the lowest cost for minor upgrades at 1%. Amazingly, the CIOs surveyed seem to have been caught off guard – they didn’t develop an adequate total cost of ownership model.” Unverified, since the company producing the report requires registering to get a copy of it and I refuse to do that on principle. I agree that Epic, often bought recently at the height of organizational optimism and as a knee-jerk reaction to previous experience with unresponsive vendors, is going to be a big budget problem for a lot of hospitals that will never realize the ROI. I don’t know of any examples where IT on its own has ever changed the trajectory of an organization – it usually just accelerates it slightly. If your organization has always sucked at management, planning, and delivering quality care efficiently, it’s probably not lack of Epic that caused that situation nor implementation of Epic that will fix it for you. Like all non-profits, hospitals change only to threats to their existence.

From Don: “Re: E.J. Noble Hospital hiring a CFO to improve their financial software. They are CPSI even though the CFO’s relevant experience was with Meditech.” Trying to confirm which system a given hospital is using is almost impossible. I always Google and try to find a couple of items that seem to confirm and none that contradict (announcements, posted jobs, physician newsletters, etc.) but I always say it “appears” they’re using the system since you never know what’s changed. In the case of E.J. Noble, I turned up one Meditech user list that included them (perhaps that site incorrectly assumed that they are the same facility as Noble Hospital, a Meditech hospital in Massachusetts) and, most convincingly, E.J. Noble Hospital’s employment application specifically asks whether the applicant has Meditech experience, which is not a common question for non-Meditech sites. I assume the reader is correct, but I can’t prove that, either.

From Dell Encore: “Re: Encore Health Resources. In serious negotiations to be acquired by Dell.” I asked EHR CEO Dana Sellers, who says she hadn’t heard the rumor and says the company isn’t for sale. I believe her since she’s always been a straight shooter, but I should mention that when I ask CEOs about acquisition rumors, I get one of three possible outcomes: (a) they don’t respond, which leads me to assume the rumor is true and I’ll run it as an unverified; (b) they tell me the rumor isn’t true, although in at least two cases CEOs who I would consider to be friends of HIStalk flatly denied a reader’s rumor that turned out to be deadly accurate all along shortly thereafter, which I don’t really consider to be uncool since they can’t have me blasting it everywhere right in the middle of their negotiations; or (c) the CEO tells me off the record that the rumor is true, but implores me to hold off mentioning it until the announcement, which I usually do (sometimes they offer me an exclusive story or interview in return). Occasionally I get briefed even before anything is announced, allowing me in several cases to conduct an interview and have it ready to blast out the second the news hits the wire. The best ever was when a CEO arranged to call my house one evening to tell me that the company was going to be acquired for huge money by a publicly traded company, which was fun because, (a) he treated me like a real journalist, trusting me not to do something stupid like leak the news or trade the stock of the company that was involved, and (b) it was priceless when Mrs. HIStalk asked me who I was talking to and I casually mentioned that a CEO just wanted to chat with me about selling his company for a few hundred mil the next day. For at least 30 seconds, I felt like more of a big shot than just some hospital guy and spare bedroom blogger, but then I had to get back to work.

From Horshack’s Laugh: “Re: predictive analytics solutions. Lots of vendors and providers are talking about the need for them without offering a standard definition of what they are or aren’t. Have you looked into who might be the reportedly top 5-10 vendors? Thanks much … love your stuff.” My stuff loves you right back. I’ll defer to readers on the question since I know better than to opine in the presence of experts.

From Dr. Nancy: “Re: article in The Atlantic. It’s old, but worth reading if you haven’t seen it. You are the best.” The perspective of the 2007 article by Shannon Brownlee (Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer) is interesting and timely: do we have too many rather than too few doctors? It says that the usual arguments that aging Baby Boomers will increase demand just as aging doctors retire, causing a decline in patient outcomes, just might be wrong, quoting a physician researcher who said, “If we sent 30% of the doctors in this country to Africa, we might raise the level of health on both continents.” The article observes that docs congregate where business is good (bigger population, more insured patients) and generate their own demand by ordering more stuff for patients, but outcomes aren’t any better in those doctor-rich areas like Manhattan and Los Angeles. Doctor-patient ratios at academic medical centers are 2-3 times higher at UCLA and NYU than Mayo and Duke with no better results, it says, possibly because all those docs need to justify their existence, like by ordering unnecessary tests and not communicating with the hordes of competing specialists roaming the halls.

Acquisitions, Funding, Business, and Stock

Emdeon posts a loss of $35.4 million for Q2 compared to a net income of $9.2 million a year ago, attributing the red ink to the costs of its acquisition last year by Blackstone. Revenue was up 4.4% to $294.5 million.

HIM consulting firm TrustHCS acquires Legacy Coding LLC, a clinical coding and auditing form.

Health accelerator Healthbox starts its three-month Cambridge, MA program today, with 10 companies getting office space, mentoring, and $50K in seed capital in return for a 7% stake. I got distracted (and annoyed) by the write-up of Bon ‘App, which says its nutritional app has “simplistic language.” As Inigo Montoya says, “You keep using that word. I do not think it means what you think it means” (either that or its app is one to avoid).

Sales

Texas Health Resources selects Medicity’s HIE solutions to power information exchange among its facilities and physicians.

Winkler County Memorial Hospital (TX) will implement financial solutions from Prognosis HIS.

The George Washington University and the National Institute of Child Health and Human Development will use PeriGen’s PeriCALM Patterns alerting system for maternal in a research project involving the use of intrapartum fetal heart rate monitoring to predict neonatal outcomes.

People

Former Siemens Healthcare President and CEO Eric R. Reinhardt joins the board of Varian Medical Systems.

Seattle Children’s Hospital promotes Wes Wright from VP/CTO to SVP/CIO.

Beacon Partners promotes Kimberly Post from controller to CFO.

Announcements and Implementations

Harris Corporation will expand Florida’s HIE secure messaging service to 11,000 physician offices that use Care360 solutions from Quest Diagnostics.

Regional Medical Center at Memphis completes implementation of the Siemens perioperative management solution by SIS, which will interoperate with Soarian.

The Kansas HIN and ICA announce that Via Christi Health Systems and HCA Wesley have successfully transferred data into the KHIN production environment.

MEDSEEK will incorporate GetWellNetwork’s GetWell@Home into its patient portal.

University of Michigan Health system goes live this week on Epic’s MyChart patient portal. The article in the Ann Arbor paper also mentions that hospital executives attribute part of its fiscal year loss, announced in June, to the cost of implementing Epic.

Health Care DataWorks announces Value-based Purchasing, which tracks the 20 CMS VBP quality outcomes measures that affect hospital payments starting in October.

Government and Politics

Innovate Primary Senior Care (IL), Treasure Coast Healthcare (FL), and Virginia Commonwealth University Health System and the Medical College of Virginia Hospitals and Physicians (VA) join 16 independent practices in CMS’s Independence at Home Demonstration.

You might think the VA is paperless given the high marks its VistA system receives. Not so, as a VA OIG inspector knows after writing up its Winston-Salem, NC office for piling 37,000 claims folders on top of file cabinets, to the point that the sixth floor office’s floor was sagging and in danger of collapsing. The VA cleaned up the area and will spend $400K for a filing system to be located in the basement.

Innovation and Research

A group of 14 organizations in 10 European countries begins trials of the DebugIT antibiotic decision support system they developed, which applies statistical methods to their collective susceptibility information to recommend optimal antibiotic therapy to clinicians.

Other

The Kansas HIE board postpones voting on the proposal to dissolve the organization and instead forms a committee to analyze the proposal and return with a recommendation for the board’s September 12 meeting.

Greg Reed, CEO of the embattled eHealth Ontario, declines his $81,250 performance bonus for the second year in a row. The Ontario government is facing a $15 billion deficit and wants all public sector workers to take a two-year wage freeze.

The Surgeons of Lake County (IL) announces that an unauthorized user hacked into its computer system, encrypted the server, and demanded money in exchange for the password to regain access the EMR and corporate e-mail files. The practice refused to pay the ransom and instead turned off the server and contacted law enforcement. It’s unclear whether the practice had a backup, but the server remains unplugged. The practice believes the intent of the authorized access was to extort money rather than obtain patient information.

Ed Marx has an article called “CEOs, CIOs must look to IT for success” in Modern Healthcare (registration required).  

The Siemens folks at their user meeting sent this photo of John Glaser with Cal Ripken, Jr., who looks disturbingly like Uncle Fester in this shot.

Speaking of Baltimore, HL7 is holding its annual meeting there September 9-14. A reader invites you to attend a session on standards-based approaches for PACS-EHR integration, which will focus on DICOM and IHE workflow profiles. That session is September 13 from 11:00 a.m. to 3:30 p.m. at the Hyatt Regency Baltimore at the Inner Harbor. I would almost make the trip just as an excuse to revisit one of my all-time favorite restaurants, the brilliant Woodberry Kitchen.

Weird News Andy captions this article as “Say What?” but stop reading now if you’re one of those people that worries about bugs crawling on (or in) you while you sleep (or whether China has a HIPAA policy). Doctors at a hospital in China, examining a woman complaining about itching in her head, find and remove a spider that had burrowed into her ear five days earlier, easily discernible in the creepy photo above.

Speaking of HIPAA, the firefighter’s unions in Las Vegas, trying to convince insolvent cities to stop considering outsourcing non-emergency calls to private ambulance services, may have inadvertently violated HIPAA privacy laws by posting a list of private ambulance calls that took longer than their 12-minute contractual maximum. The list contained home addresses and reason for the call, which included such items as suicide attempts and drug overdoses. The image above blurs those reasons, but the one on Latefor911.com didn’t.

A New York Times article covers the huge profits being made by HCA and the mind-boggling money that private equity firms like KKR and Bain are making in orchestrating its complex financial transactions. How HCA does it: aggressive billing of private insurance, creative use of the coding system, turning non-emergent patients away from its EDs, and cutting clinical staff. On the other hand, the company at least pays taxes, unlike its non-taxpaying counterparts sometimes use those same tactics to boost their bottom lines. All of this was inevitable when the decision was made, going back to the early days of Medicare and Hill-Burton if not earlier, that hospitals should be run as businesses rather than as charities or religious outreaches. The new rules said you had to make money but weren’t specific about the limits of how you could do that beyond your organizational conscience.

Union representatives in Contra Costa County, CA say correctional system nurses filed 142 complaints about its new $45 million Epic system in July, claiming that they are Epic’s detention facility guinea pig. A nurse says super-users told management about the problems and warned that the two-hour training sessions weren’t adequate since the training system wasn’t fully set up. “What nurses want is for the Epic program to go away until it’s fixed,” she says.

A cardiac perfusionist sues Mount Sinai Hospital (NY) and her former boss for creating a hostile work environment, claiming everybody knew that he regularly watched porn on his smartphone while working cases in the OR.

Sponsor Updates

• Forbes includes Greenway Medical Technologies as one of its five favorite growth stocks.
• Like Kareo on Facebook by August 17 for a chance to win a Kindle.
• St. Joseph Health (CA,TX, NM) adds additional revenue cycle technology solutions from MedAssets.
• Simonmed Imaging will deploy Merge’s radiology and interoperability solutions across its 50+ sites.
• A Vitera Healthcare Solutions study finds that 91% of doctors want a mobile EHR solution, yet only 6% connect to an EHR through a mobile device.
• Allscripts says it will debut new mobility functions and integration between acute and ambulatory settings at this week’s ACE 2012 in Chicago. Wednesday’s opening address is available on the website.

Report from the Allscripts Client Experience – Day One
By Bill Rieger, CIO, Flagler Hospital

Today was a pre-conference workshop day. As CIO, I attended the executive session, which started off with Glen talking about transformation and change in a session titled, "It’s not about IT."  

He talked about the open approach Allscripts has, both from a philosophy and a technical perspective. He talked about Allscripts’ CLEAR values: Client experience (client always first); Leadership (inspire, innovate, grow);  Extraordinary people (learn, grow); Aspire (think different, think big); and Results (say, do).  

Kevin Larson from ONC spoke next and really didn’t enlighten us with any more information than we already had about MU and ONC initiatives. He brought up the concept of semantic interoperability (I saw a bunch of folks looking it up on their phones, me included!) and it became a buzzword that I heard multiple times throughout the day.

There was a panel discussion where LIJ, Brown and Toland, and Jefferson Medical college talked about accountable care and the iterations each organization has engaged in. Maureen Kahn, CEO of Blessing Hospital in Quincy, IL told a great community story and how the successful implementation of ADX 1.5 has impacted their organization.

Finally before lunch, Cliff Meltzer, VP of development at Allscripts, talked about what has been delivered since last year’s ACE conference: automated testing features, a client advisory group, and an early adopter program. He talked about the performance improvement with MSSQL2012 and how in 6.0 the whole environment can be virtualized. One of the things I liked that he talked about was end user performance monitoring.  I believe that the hourglass is the enemy of adoption, so I was glad to hear that they were focusing on that a bit.  

After lunch there were breakout / roundtable sessions that I found to be very valuable. I attended two of them. One discussed linking outcomes to income and heard several stories about using data to improve physician behavior leading to additional revenue. The other one was related to HIE, and dbMotion was there. There were some roundtable discussions that showed me that we are all not on the same page when it comes to simply defining what HIE is and what are the problems they are suppose to solve. Interesting, but frustrating.  

Finally, Thomas Atchison spoke. It was very entertaining, and I walked away with two thoughts. One is that in the absence of information, the void is always filled with negativity. The other is that words lie, behaviors never lie. Two things for me to chew on there. Looking forward to tomorrow when the regular conference begins.

Contacts

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

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