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September 8, 2015 News 7 Comments

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The New York Times profiles cost analysis work being done at the University of Utah Health Care, kicked off when the CEO found that nobody could tell her what it costs to operate an MRI or OR for an hour. Medical costs have declined 0.5 percent a year since the health system was able to compare costs with outcomes. Sixty seconds in the ED costs $0.82 vs. $12.00 for operating an OR for an orthopedics case, for example. Experts say the health system’s VDO database with 200 million rows makes it one of very few health systems that have any idea of their true costs. The health system saves $200,000 per year simply by requiring medical residents to justify each lab order that they otherwise were cranking out by habit. The depressing aspect is that it’s still novelty news when a health system actually wonders what its true costs are, much less does something about them, which is unfortunately not all that uncommon with non-profits who get to stick someone else with their overhead.

Here’s a video overview of University of Utah Health Care’s VDO (value-driven outcomes) project.

Reader Comments

From Slightly Jaded Epic CIO: “Re: UGM. I was overall underwhelmed by this year’s UGM experience. On the plus side, I continue to be amazed at the show and presentation Epic is able to put on, drawing almost entirely from the talents of their own employees. It is still an amazing group of people to be around at all levels. The new features they demo always have a few real whiz-bang moments, as well.The headlining Judy did regarding aggregating data for clinical research grabbed my attention, but it’s coming in the broader environment of a whole bunch of other services and ideas that have not been executed very well. Epic’s new consultancy service was mentioned, but we and every organization I talked to that had been interested in using it were told that there were no staff available. A program to help implement new features with every upgrade touched on several UGMs ago. Nothing happened until just recently, and my sense is that it doesn’t cover anywhere near the services originally advertised. Also mentioned several UGMs ago (I think originally in 2008) was a move towards a Web-based architecture that could replace Citrix. Several years later, this is still in limbo. It wasn’t even mentioned this year. What is not in limbo is all the money we’re paying to Citrix. I hope some of these big ideas come to pass, but it’s getting harder and harder to walk around all the opulence in Verona and not wonder if our money has been buying an illusion.”


From Former Epic CMIO: “Re: UGM. Someone committed suicide that the Marriott where all the CIOs and CMIOs were staying, apparently jumping from a high floor into the main atrium. Very sad.” The only mention I found confirmed that the suicide occurred on September 1 at the Marriott in Middleton. My first thought was that it must have been someone associated with the event given the number of hotel rooms the user group meeting requires.


From Clarity Disparity: “Re: Nordic. I followed your sponsor link to their site, which is clean and well presented, but it contains an error.” It does indeed, although the number of folks who misspell or mispronounce Epic’s analytics and reporting product Cogito Ergo Sum (“I think, therefore I am”) is in my experience quite high. I like the incorrect name Cognito, though – “incognito” means “unknown,” so “cognito” should mean “known” and is also easy to pronounce. I think Nordic (or is that Nordnic?) is on to something.


From Torn Ligament: “Re: Healthcare Tech Outlook magazine. I received an email that our company has been ‘shortlisted’ for an elite opportunity to sponsor the magazine for $3,000 (woo!) A magazine about healthcare technology that spells HIPAA wrong on its cover? Sign me up!” They also got creative in spelling “administration” as “admisidtration”  right above their “HIPPA” gaffe. I tried to figure out who publishes the magazine, but Google turns up nothing about the company, the editor isn’t on LinkedIn or anywhere I could find, and the owner of the web domain is hidden. The magazine’s address suggests that the publisher is SiliconIndia, a Bangalore-based community of Indian professionals that also publishes magazines, with a handful of people working from Fremont, CA and everybody else in India.

From Bamboozled Public Healther: “Re: Mitchell & McCormick EHR/PM for public health. It’s like going back to the 1980s – DOS-based, the company provides no training materials, there’s no MPI, it takes 25 minutes to register, and multiple family members share a single MRN. We’ve had multiple data breaches (of luckily a small number of records) since the system has only three roles – admin, clinician, and business ops – and both clinician users and business ops can see and access all records. According to ONC’s database, no a single health system or provider used this certified EHR to meet Meaningful Use.” Unverified, but this comment is from a system user. 

HIStalk Announcements and Requests


Three-quarters of poll respondents haven’t seen a “gag clause” in a vendor’s software contract. A CIO says the closest he’s seen is a clause requiring both parties to review public announcements or publications involving the other organization. New poll to your right or here, brought on my nostalgia for programming I’ve done: have you ever designed or written software that was used by clinicians?

I planned to write a Monday morning post as usual, but after I wrote up all the available news, it would have been a waste of reader time. I just retitled what little content I had and moved on from there.


Welcome to new HIStalk Platinum Sponsor Crossings Healthcare Solutions. The King of Prussia, PA company’s parent is Universal Health Services, which addressed workflow gaps it found in rolling out Cerner solutions to 25 of its hospitals. The Crossings development team optimized the EHR for clinician use by building many software components as mPages and Advisors, focusing a significant part of their effort on Cerner’s Dynamic Documentation solution to move physician documentation from dictation and paper in 11 hospitals in 2015, with 12 more scheduled in the next five months. Those hospitals have seen voluntary transcription reductions from 50 to 90 percent with good physician feedback from all specialties, earning the company Cerner’s “2015 Physician All Stars Award for Physician Documentation.” A CMIO of a large health system says, “You should be incredibly proud … the best client innovation I’ve seen in my 10 years working with Cerner.” Just released is TPN Advisor, which aggregates patient nutrition information on one Millennium chart, decreasing TPN ordering time and calculating compounding instructions that are sent electronically to the pharmacy (a pharmacist describes it as “the most sophisticated clinical decision support tool I have ever seen.”) Future releases include a CNO Dashboard, daily physician documentation with Core Measure advisors, a discharge package, and an DKA advisor. The company will exhibit at Cerner’s CHC15 in Kansas City, MO on October 11-14. Thanks to Crossings Healthcare Solutions for supporting HIStalk.

I found this YouTube video that describes and demonstrates  enhanced Dynamic Documentation from Crossings Healthcare Solutions.


Mrs. S sent photos of her Oklahoma third graders using the two iPad Minis bought via our DonorsChoose project, adding that they love playing educational games on them during listening and word study sessions.

Sites keep running new polls about ICD-10 readiness. Why? It’s happening no matter what, so just wait three weeks and we’ll find out who’s ready.

My latest grammar and usage peeve: people who say something such as, “I went to two different doctors,” inserting the pointless “different” to proactively address any misconception that they visited two of the same doctors.

Last Week’s Most Interesting News

  • ONC revokes certification for the SkyCare EHR after the company appears to go belly up.
  • Salesforce announces Health Cloud, its patient relationship management foray into healthcare.
  • Voalte raises $17 million in funding with Cerner as one of its investors.
  • Epic announces formation of a research network in which the information of its opt-in clients can be searched.
  • MEA|NEA acquires The White Stone Group.
  • Former BIDMC CEO Paul Levy calls for an attorney general anti-trust review of Epic in his blog.


September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services.

Acquisitions, Funding, Business, and Stock


Cerner announces that it will repurchase up to $245 million in shares of its common stock. Neal Patterson says that “the repurchase of our stock is a good use of funds,” although I’ve never understand how a company buying its own shares from investors does anything more than provide the market with reassurance that it thinks they are undervalued despite what shareholders might otherwise believe.


Craneware announces FY15 results: revenue up 5 percent, adjusted EPS $0.38 vs. $0.34.


Long-term care software vendor PointClickCare files its IPO forms with the SEC. In it, the company reports $102 million in 2014 revenue, up 24 percent even as its losses widened from $3.3 million to $11 million.


Preservation Wellness Technologies, of which no Internet trace exists except for lawsuit filings, sues Allscripts, Athenahealth, Epic, and NextGen for patent infringement. Its patent is summarized as, “A portable heath care records system employs a server on which the health care records of participating patients are stored. The patients may access the system using cards or CD-ROMS that are inserted into the patient’s computer. The patients can review their own records via Internet and can edit them.” The inventor appears to be a hairstyling salon owner.


Franklin, TN-based patient engagement technology vendor Relatient will move into larger office space to accommodate its 24 employees.


Post-acute care EHR vendor Netsmart acquires Trend Consulting Services, a Solon, OH-based IT outsourcing and infrastructure support services vendor.

Community Health Systems files the initial SEC paperwork to spin off 38 of its small-town hospitals and management consulting subsidiary Quorum Health Resources to form Quorum Health Corporation.


In China, Qingdao United Family Hospital will deploy the InterSystems TrakCare healthcare information system.



Dann Lemerand (Evariant) joins Infor as director of healthcare industry and solution strategy. He started the HIStalk Fan Club on LinkedIn many years ago, which has grown to 3,634 members. I should have a random drawing or something since it’s cool to have a fan club and it would be nice to give folks something for signing up.


Darthmouth-Hitchcock Medical Center (NH) Chief Innovation Officer Terry Carroll resigns


Chris Longhurst, MD, MS (Stanford Children’s Health) will join UC San Diego Health Sciences as CIO, replacing the retired Ed Babakanian on November 2. He will also serve as a faculty member in the Department of Biomedical Informatics. 

image image

Surgical ICD-10 coding vendor Vincari hires Maqbool Patel, PhD (YourCareUniverse) as CTO and Hugh Lee (Perigen) as RVP of sales.


Todd Cozzens (Sequoia Capital) joins Leerink Capital Partners as managing director.

Announcements and Implementations


The Tucson paper tells the locals that Banner Health will replace its $115 million Epic system with Cerner in early 2018 at the former University of Arizona Health Network it acquired earlier this year. The article summarizes, “Installing the Epic system and training employees to use it was one of the key reasons the former University of Arizona Health Network, acquired by Phoenix-based Banner March 1, struggled financially throughout 2014 … The investment in Epic was so expensive that the UA Health Network experienced unprecedented operating losses in its 2014 fiscal year, including $32 million in unbudgeted costs.”

Versus announces VUE16, its third Versus User Experience, May 4-6, 2016 in Scottsdale, AZ. 


Peer60 releases “Trends in Clinical Lab & Digital Pathology,” which finds that the top LIS mind share leaders are Epic, Cerner, Orchard, and Meditech. Half of the respondents say they’ll switch LIS vendors, not surprising given that they scored their existing vendor an average of 5.2 on a 10-point scale (although that means they’ll most likely be switching to a different but equally low-ranked product). When asked what LIS vendors could do to retain clients, additional functionality and better support rose to the top, but about the same percentage said it wouldn’t really matter since the lab won’t get to make the decision. Half say they’ll never buy digital pathology, most because they don’t offer on-site pathology. Three-quarters say they’re seeing more requests for genetic testing, molecular testing, or both.

Vital Images licenses HeartIT’s zero-footprint patent portfolio.

Government and Politics

The CDC awards a four-year grant worth nearly $4 million to the Kentucky Injury Prevention and Research Center to integrate the state’s KASPER prescription drug monitoring database with EHRs.

The West Texas VA system, which was reporting 43 percent of its positions as vacant, admits that nobody had updated the national computer system for months. The actual vacancy rate was 22.3 percent, still the third-highest in the VA.

Privacy and Security

A Wired editorial on the Ashley Madison breach concludes,

There is a naiveté to how we use the Internet. We never read the small print. We scroll to the bottom, check the box and cross our fingers. We are still terrible at basic online security. The top two passwords used to access Ashley Madison were "123456" and "password", just like everywhere else on the Internet. We trust people we shouldn’t to look after the most personal information about ourselves. "There is no such thing as the cloud", the saying goes, "it’s just someone else’s computer." The data held by Ashley Madison, although embarrassing, was small fry. Every mobile phone in our pockets, every sat-nav in our cars, and every smart meter in our homes is recording something about our lives. We as humans are creating the richest source of information about ourselves in history. Unfortunately for social scientists and historians, that information is held securely by private corporations. Unfortunately for everyone, that information isn’t always held as securely as we might hope.


A Microsoft Research study finds that legacy-friendly database encryption systems such as CryptDB and Cipherbase aren’t very good at protecting EHR information, mostly because the encryption key is held in memory where it can be extracted by exploits. The researchers conclude that CryptDB shouldn’t be used to secure EHR databases.

Innovation and Research


Researchers at the Scripps Translational Science Institute enroll 4,000 people in the first clinical trial of the Scanadu Scout. The six-month study invites participants to use the Scout however they would like to measure heart rate, blood pressure, blood oxygen level, and temperature by touching the device to their temples for 10 seconds. Scanadu’s CEO describes the choice of Scripps for the trial by using one of my least-favorite expressions, calling it “a no-brainer.” The Scout doesn’t sound nearly as cool, useful, or innovative as the early Tricorder hype suggested.


Dell will sell Microsoft Surface Pro tablets and services to enterprises starting next month.


This is both brilliant and life-changing for some people. The Brightly wearable abdominal belt monitors bladder conductivity to alert incontinent wearers via their smartphone that they need to find a restroom. A similar product in Japan provides the same service for people with fecal incontinence. In either case, wearers suffer less embarrassment and dependence on external pads.


A hospital in England installs an arrhythmia scanner at its visitor entrance, with the palm-scanning technology looking specifically for atrial fibrillation that can cause strokes. Results from the 30-second test are emailed to the hospital’s cardiology department, which can offer a same-day EKG. The hospital wrote the software that uses RhythmPad system of Cardiocity, which was formed in 2011 to use car racing telemetry for mobile health.


The mother of a Penn student who committed suicide sues Amazon for selling her daughter cyanide, which is banned for sale in the US. Amazon stopped sales of a cyanide-containing product from Thailand in early 2013, but the lawsuit claims 52 customers had purchased it by then and 11 of them died shortly after receiving their order.


Monadnock Community Hospital (NH) turned patients away, diverted ED patients, and cancelled surgeries last week during a four-day computer outage caused by a failed network upgrade.


An independent panel hired by Texas Health Resources to assess the 2014 death of Ebola patient Thomas Duncan and the infection of two of its nurses finds that (a) THR employees were overly reliant on Epic to convey critical information; (b) the hospital’s Epic configuration didn’t place the patient’s travel history on the standard patient assessment screen; (c) caregivers failed to monitor the patient’s clinical information; (d) the hospital worried too much about patient satisfaction instead of outcomes; and (e) the hospital didn’t get Ebola treatment information into the right hands quickly. The committee suggested that all hospitals be prepared to react as THR did in quickly reconfiguring Epic to improve caregiver communication. It also notes that the care team was presented with an electronic warning via Systemic Inflammatory Response Syndrome Score, but either didn’t understand it or ignored it as the patient was discharged with a temperature of 101.4 degrees. Another problem is that nobody understood CDC’s role in managing the patients or suggesting caregiver protection, which is advisory only.

A law review journal suggests that medical malpractice attorneys scour the defendant’s EHR to find a single data element that is incorrect or falsified, then have their entire medical record dismissed as being untrustworthy.


Weird News Andy says the subject of this story hasn’t showered for three years, with WNA adding that he hasn’t either because his typically last around five minutes. An MIT-trained engineer creates Mother Dirt, a spray that contains live bacteria intended to replace baths and showers. He theorizes that humans have killed off good skin bacteria due to over-cleaning, with his company’s GM adding, “We’ve confused clean with sterile.” A single bottle contains 3.4 fluid ounces, which lasts about a month and costs $49.00.

Sponsor Updates

  • Dimmit County Memorial Hospital (TX) documents its love of T-Systems in video and song.
  • VisionWare and ZeOmega will exhibit at the Accountable Care & Health IT Strategies Summit September 10-11 in Chicago.
  • VitalWare will exhibit at the QHR Vendor Fair September 10 in Orlando.
  • ZirMed will exhibit at the California Ambulatory Surgery Association conference through September 11 in Huntington Beach, CA.

Blog Posts


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

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Currently there are "7 comments" on this Article:

  1. Shortlisting is the new form of vanity spam, similar to Who’s Who Directories of yesteryear. In the past month or so, my company (Cerner) has had the dubious honor of being shortlisted “based on merit” by publications such as The Silicon Review, CIOReview and the aforementioned Healthcare Tech Outlook. It’s always an honor, and they always want a $1,200-$3000 sponsorship to share the great news with thousands of CXOs and senior decision-makers they influence. Here’s a sampling of some of the titles: “50 Fastest Growing IT Services Companies,” “20 Fastest Growing IT Services Companies” (in case 50 wasn’t good enough?), “50 Most Promising Healthcare Solution Providers 2015”, and “Top 20 HIE Solution Providers 2015.”

    With a little creativity, you too can generate your own shortlisting honor using this formula: nice round number + splashy adjective + an actual category you belong to, probably garnered from a paid list. Have fun!

  2. Jaded CIO… as an Epic end-user, I have seen quite a few activities migrate to the web infrastructure over the past two releases, although obviously the application is still being delivered conventionally. As a non-technical person, it seems to me that they must be making the infrastructure changes incrementally. Perhaps someone more technical could shed more light.


  3. Slightly Jaded Epic CIO – Tell your fellow CIOs/CEOs to quit extending the contract of all the Epic Consultancy employees and there will be some available.

  4. EpicConsultant, you can see why the very fact that a few clients can lock up the entire supply of Epic Consultants proves Jaded CEO’s point that in several years Epic hasn’t been able to make Consulting into a significant project…

  5. There hasn’t been a shortage of Epic consultants (nor will there be again) since early 2010. There are far too many available today. And guess what? Rates are falling for us.
    Sorry Non-EpicConsultant, a few clients are not locking up the entire supply. Now go back to your McKesson gig.

  6. I agree SlightlyJadedEpicCIO way to much opulence in fair Verona and not enough true development work coming to fruition. I’m starting to wonder if the price of admission is worth the ride.

  7. Re: Slightly Jaded Epic CIO
    Epic has been gradually transitioning VB-based client components to web pages (unfortunately .NET-based) for the last few versions. The process is largely transparent to end users since the transitioned web pages are hosted within an embedded browser in Hyperspace during the transition period. The transition will probably take a few more years (there is an enormous amount of code obviously). Slightly Jaded Epic CIO should simply talk to his/her IT staff–they would definitely be aware that with every new version, more activities are being converted to HyperspaceWeb. I wouldn’t count on saving money on Citrix though as there are many reasons why one would want to keep it even for a web application (security, roaming sessions, and of the predictability of web browser settings/behavior). One bright spot is that they are testing with non-Internet Explorer web browsers.

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Reader Comments

  • Matthew Holt: Non EMR user here, but isn't the answer cloud-based systems, non configurable by locals?...
  • David Butler: Great list. You're spot on. These were the EXACT issues I was frustrated with Epic in the early-mid 2000s. After goin...
  • WestCoastCFO: Re: Olive. Not seeing it, what am I missing? They seem to have found a nice niche, but they are not what I would call...
  • rxpete: Politico reporter didn't see "No Time for Sergeants" which leaves no doubt as to the spelling of cavalry based on the pr...
  • AnInteropGuy: Of the six EHRs I am familiar with, I have seen at least one or two of the problems described in each of them. Certainly...

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