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Monday Morning Update 5/27/13

May 25, 2013 News 21 Comments

From HIPAA Faxing: “Re: HIPAA rules. Our esteemed EMR vendor wants $20,000 to connect each lab. The lab wants $19,990 to connect their side (funny how they charge the same). That’s $40,000 per lab connection and we use 17 labs and can’t afford that, so we use a fax server. What are the HIPAA rules around faxing? What do we need to do?” Experts, here’s your chance to contribute.

From Delta Don: “Re: Philips iSite. I’ve never seen anything like the disaster of the iSite 3.6 to Intellispace 4.4 upgrade. System and functional instability have pushed the go-live date back three times. It’s now six months late with new issues every day, but Philips personnel are enjoying their extra-long Memorial Day weekend. With vendor-neutral archives making migration among PACS vendors more feasible, you’d think there would be more effort. I won’t even start on the product name when we still have users calling it Stentor.”

5-25-2013 8-43-42 PM

Respondents weren’t overly impressed by the value to the public of the Medicare pricing information released by CMS. New poll to your right, as suggested by a reader: should Meaningful Use be ended after Stage 3 or continued? You’ll get a link to add your comments after voting, so you might as well expound on your position.

5-25-2013 9-20-46 PM
Photo: Pete Marovich/EPA

Monday is Memorial Day, set aside to honor those one million US Armed Forces members who died while serving. Their sacrifice allows you the luxury to decline to fly the flag, visit a military cemetery, or think about those who made the ultimate sacrifice on your behalf. That’s not to say it wouldn’t be nice to do it voluntarily. 

5-25-2013 9-56-11 PM

I impulsively bought Mrs. HIStalk a Google Nexus 7 tablet when I went to the office supply store to get several packs of the index cards I like to write on since she’s computer-averse and always gets my hand-me-down laptops. My initial assessment of the $199 device is that it’s very nice, in some ways better (sharper display) and some not as good (fewer apps) as the iPad mini, but at just 60 percent of the mini’s price, it’s a much better deal. Don’t buy it yet, though – an upgrade is imminent that will add greatly enhanced video.

From the Cerner shareholder/analyst call:

  • Neal Patterson was not only on the call, which is rare, but he actually chaired it and reminisced a bit with good humor about the company’s origins. Fellow founder Cliff Illig was on, which I don’t recall ever happening.
  • The company says the number of physicians using its ambulatory products doubled to 45,000 in the past two years.
  • EVP Zane Burke says Cerner’s competitors are no longer other EMR vendors, but rather companies involved in insurance and big data.
  • Responding to an shareholder’s question about Epic, Neal Patterson said, “They like to say they don’t have shareholders. I’d like to point out to the reality that they do actually have shareholders, it’s basically almost a single individual. And they also point out the fact that in this country, you can’t pass on an ongoing operation … our plans are to take away their advantages and make our strengths stronger and make their strengths weaker on a relative basis … we’re the most innovative company in this industry, we have always been.”

Jamie Stockton with Wells Fargo Securities sliced and diced CMS’s hospital EHR attestation database to find that 7 percent of hospitals that qualified for Year 1 incentives didn’t attest with the same vendor in Year 2. The interpretation was that the Year 2 incentives, which required participation for a full year, were too difficult for some hospitals to meet. The worst-performing vendor was McKesson, which saw its attestations drop off from 10.5 in Year 1 to 6.5 in Year 2, a 38 percent washout rate of an awfully low starting number.

5-25-2013 8-15-52 PM

Allscripts adds two board members that include former Epic CFO Anita Pramoda, who left Epic in 2012 and founded senior PHR vendor TangramCare.

5-25-2013 9-08-46 PM

Allscripts files a lawsuit against its landlord, Chicago’s Merchandise Mart, claiming its lease was violated by allowing excessive noise in renovating five floors just below the Allscripts offices for new (and largest) tenant Google. Allscripts is demanding that the Merchandise Mart stop using nail guns and pneumatic hammers during business hours.

Ed Marx posted an update to his most recent CIO Unplugged about a salesperson who hijacked Ed’s presentation with an overwrought sales pitch disguised as a post-presentation question. I’ll side with Ed. As much as salespeople have been educated (or brainwashed) to believe that their particular hammer is appropriate for any nail, I don’t think it’s acceptable to harass a speaker and audience just because they perceive that nobody’s returning their cold calls. Whatever happened to respecting the prospect enough to let them decide what products and services they want to consider and how they would like to evaluate them?

A New York Times piece by Tom Friedman says that Obamacare, the HITECH program, and HHS’s release of its databases has created a healthcare Silicone Valley that may improve care and lower costs because of the availability of information. Friedman spoke to a family doctor who thought she was giving appropriate colorectal cancer screening recommendations until her EHR showed only 43 percent of her patients had actually received the screening. Adding EHR alerts raised the number to 90 percent, leading to early cancer detection in three patients, which was obviously good for the patients but also for healthcare spending since early-stage treatment costs less. White House CTO Todd Park bragged on entrepreneurs who developed apps around HHS’s databases and kicked off a health data industry. Friedman met with Eviti, Teladoc, Humedica, and Lumeris.

5-25-2013 10-28-11 PM

The White House Blog brags on EHR adoption, crediting the President who spent the money rather than the taxpayers who provided it.

Two people with no transportation experience are named finalists for the position of interim director of the Capital Area Transit System (LA.) One of them is Bob Mirabito, former CIO of Baton Rouge Radiology Group, who says his position was eliminated last year and he needs a job.

The Canadian government revokes the passport of a Quebec doctor who is of defrauding US Medicare of $375 million by submitting phony claims for homeless patients when he was practicing in Texas.

Weird News Andy says he has printing on the brain after reading that 3D printing allows replacing 75 percent of a person’s missing skull.

Vince continues with the very interesting HIS-tory of Allscripts.


Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

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Currently there are "21 comments" on this Article:

  1. “The White House Blog brags on EHR adoption, crediting the President who spent the money rather than the ***taxpayers who provided it. ***”


  2. The EMR connection fee quoted by HIPAA Faxing is extremely high. Many EMR vendors don’t charge any fee to the practice, and those that do charge are more in the $2000-$5000 range. And labs usually don’t charge the practice because they want to keep your business.

    You should consider talking to a lab hub vendor. They may have connections to many of the labs you are using and, if not, they can arrange connectivity to the lab at no cost to you. A lab hub can deliver results in several formats, including HL7 and PDF, over a secure web connection, and you can avoid the need to scan faxes into your EMR.

  3. Really? After all the @&$!? The Administration took over HITECH and the ACA you now think they aren’t giving enough “credit the taxpayers”?

    Taxes pay for everything the govt does idiot. Seems like that is only a complaint when a Democrat is in the Whitehouse.

  4. The POTUS seems to be bragging, but where is the beef? There remains zero evidence that spending the $ billions have reduced costs or improved outcomes, not withstandingthe anecote Tom Friedman cites. Is that the best he can do? Have ER visits been reduced by Teledoc programmes?

  5. In reply to HIPAA Faxing, SCI Solutions has Order/Results Facilitator, a hub solution that integrates EMR, Fax, and Web orders from referring physicians for lab, radiology, therapy, oncology, and surgery orders and delivers reports and results back to the offices, either via EMR integration, web, mobile (iPhone, iPad) or fax.

    This solution would help you because (1) you can accommodate a mix of methods for receiving orders, including EMR integrated orders from open, interface-friendly EMRs (e.g., eClinicalWorks), web orders from those with closed EMRs (e.g., AthenaClinicals), and faxes you get from low-volume physicians; (2) SCI’s Order Facilitator then serves as a hub for pushing all orders, through one pipe, to downstream clinical systems, including ancillary systems (e.g., lab) and document management systems (to store all faxed images). After the test is done, through a single outbound interface, Results Facilitator delivers the result/report back to the physician via EMR integration, and, alternatively and additionally, to an iPhone/iPad, to a web portal. Lastly, Order Facilitator includes deep and flexible referral management for MD-to-MD communications, to address leakage, maximize volumes, etc. In addition to the business benefits of managing referrals for employed physicians, the benefit of combining orders and referrals in one platform is simplicity for all the physicians involved, simplicity for the health system, and one platform for reporting.

    SCI’s view is the future to simple, future integration will increasingly be via Direct integration and away from HL7 (one reason Order Facilitator has added Direct support). The key will be for EMR vendors to actually open up their products — some EMR vendors (I won’t repeat their name) are all talk when it comes to being open — they lambast “closed, silo systems,” but then you discover they are as closed as the traditional HIT vendors they routinely attack. Oh the hypocrisy.

  6. Wasn’t the taxpayer who provided the HITECH money, unless you’re talking about the Chinese taxpayer. It will eventually be the children of the American taxpayers who pay it off.

    My take is that some current Americans including Apple, Google and the 1% should be paying a lot more so that other people’s kids won’t have to pay so much.

    However, the HITECH money is trivial in the big picture ($20bn over 5 years) and much moire useful than most government spending we’ve seen in the past decade. But stop me before I start a long lecture about the evils of the Bush Administration’s fiscal, foreign and regulatory policies which destroyed America for a decade and counting….

  7. HIPAA and faxing…
    You may want to check out Telcor.com, does extensive lab outreach /commun. Realy good products & great support.

    Also following is from Biscom, cloud based fax service. Biscom.com

    HIPAA has specific requirements for faxing PHI, designed
    to ensure security at point of dispatch, during transit, and
    at delivery, including:
    Placing fax machines in a secure and inaccessible area.
    Ensuring only authorized personnel have access to the
    fax machines.
    Verifying destination fax numbers before transmission.
    Notifying recipients of received faxes.
    Including a cover page clearly stating the fax: contains
    confidential health information; is being sent with the
    patient’s authorization; should not be forwarded to
    other parties without express consent; and should be
    destroyed if not received by the intended recipient.
    Including patient data in fax body, not in any data
    Storing of received faxes in a secure location.
    Maintaining transmission log summaries.

  8. I love Neal Patterson’s optimism regarding Cerner beating Epic, but at this point Epic has so many large health system installs–just how will Cerner outcompete Epic? By getting Epic uninstalled at a number of places? I just don’t see that happening.

  9. Re: Cerner “says the number of physicians using its ambulatory products doubled to 45,000 in the past two years”.

    Skeptical. Gaining 22,500 docs in 2 years? With what new US installs? Clearly not on the international front either (e.g. UK and Aussie).

    Smoke and mirrors to help their many shareholders not fear Epic’s one. Resistance is futile.

  10. When you see wasteful government spending then do the logical thing and “follow the money”. Many of those spending taxpayer money are not idiots, they are often incented/forced to spend money on programs and products which are not useful.

    Next time you are upset about how the federal government spent your tax dollars on healthcare look for the firms whose CEOs are sitting on federal panels or advisory boards. Do you think they are more often advocating finding ways to cut overall spending to best help the health of the country and the taxpayers or finding ways to get more EHR subsidies to better line their pockets?

  11. Hey Hans,

    Didn’t you read Ed Marx’s article about sales people high jacking presentations ( and articles) to make a sales pitch?

  12. Regarding the comments to the HIPAA fax question: Why do vendors choose to THROW UP on their customers? Some vendors responded by diving in and telling them all the “features and functions” on their product without answering the customer’s question! The prospect asked for the rules around HIPAA faxing. Now if you were a smart vendor, you would realize their pain was around WORKFLOW. The client wants to improve their workflow without spending an arm and a leg. Please help the other sales people in our industry by trying to listen better.

  13. @Skeptic

    Cerner’s ambulatory numbers have largely came from their installed base and they have added a large amount of new clients as well. Many of Cerner’s acute clients had previously been on paper or went with a different ambulatory system, but decided to move to an integrated platform.

  14. Create a law that pays people to do something they don’t want to do, then penalizes them if they still don’t take the money. Sounds like good government to me. Well done White House.

  15. To HIPAA Faxing, being compliant using fax has more problems at the ends than it does in the middle. Simple things can cause big problems. Does the receiving end leave the faxes on the machine for a long time while people without the rights and training to handle PHI have access? Is the sender sending it to the right recipient? If you are storing the TIF images somewhere there are security measures you have to be compliant with.

    As Ken Willett posted, I have only seen vendor’s charge Physicians $2000-$5000 dollars for connecters. That number can be higher for a Hospital’s system.

    Holon Solutions has a methodology of dealing with Faxes, and other unstructured data formats, that is completely HIPAA compliant. We also facilitate communications between participants of different technical levels – Meaning one side can use fax and the other can be direct connected to their EMR using HL7. They handle everything in between.

    From their website: http://www.HolonSolutions.com

    Holon Results Facilitation is a cost-effective solution that automates the collection and distribution of clinical results information, in any format – digital, scanned, fax or email – across your facility’s entire IT infrastructure.

    The Holon Framework was designed to take all parameters and variables into account and automatically route results to each physician based on his or her preferences, enhancing physician satisfaction, loyalty and quality of care, while reducing your costs.

  16. “The White House Blog brags on EHR adoption, crediting the President who spent the money rather than the taxpayers who provided it.”

    Now that’s not really fair, is it?

    If EHR adoption was low despite spending all that money, you wouldn’t blame the taxpayer for that. So you can’t credit the taxpayer if it works, and blame the President if it doesn’t. Credit and blame rightly belong to those responsible for the decisions.

  17. Unfortunately the value to the public of the Medicare pricing information released by CMS is low, and will not provide significant value to providers. Most physicians we talk with prefer Meaningful Use be ended after Stage 3.

  18. Sorry for the double post but I just found this service which provides a free fax with online document storage to all registered doctors. This is not my company, but I wanted to share it with the doctors who were being forced to pay 40k for a similar service.

    Faxes are 40 year old technology, it should not be expensive or difficult.


  19. a few things to mention regarding HIPAA Faxing

    1. Fax is not structured data, it will not help you with lab result MU compliance
    2. If your practice has enough volume, the laboratory most times picks up the cost of the interface. While our lab does not contribute towards the cost of the EMR, we do cover the interface. Rest assured, if your laboratory volume is there, there is a lab that will pay for it all.

    We use Lifepoint’s EMRHub to connect our lab to different EMRs, Practice Fusion, eClinicalworks, Greenway, etc. They also have a Lab CPOE plugin for those EMRs that do not have lab order entry yet. We pay yearly what you’re being quoted for a single interface. Check them out. They’re a HISTALK sponsor; that’s how we found them.


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