Giving a patient medications in the ER, having them pop positive on a test, and then withholding further medications because…
News 4/6/12
Top News
From the earlier news blast: The Gingrich Group LLC, doing business as the Center for Health Transformation, has filed for Chapter 7 bankruptcy in a Georgia court. The for-profit organization, which makes up the majority of Newt Gingrich’s net worth in the form of money it owes him for his share of ownership, struggled to survive after Gingrich resigned as its chairman last year to run for the presidency. The organization listed its assets as less than $100,000, with liabilities stated as $1 million to $10 million. Several healthcare IT companies are listed among its creditors, including Cerner, Greenway, and Health Trio.
My initial reaction to CHT’s tanking:
- So much for pretending that Center for Health Transformation was anything more than a way for Newt to sell his political influence to high-paying vendors under the guise of healthcare advocacy. The business folded almost immediately once he quit to run (badly) for the presidency.
- How could CHT owe vendors money? Membership refunds? Or maybe the value of services not yet rendered?
- Thanks to immediately available electronic images of the bankruptcy filing, you can learn Newt’s home address and read a list of the CHT staff members getting stiffed, like the recently hired project assistant who left her Dress Barn sales job to work there.
- There weren’t many employees left by the time the bow slipped beneath the waves since most were apparently smart enough to have abandoned ship as soon as Captain Newt sailed off in his political life raft.
- The most surprising aspect: why doesn’t Newt pump a few dollars into CHT to keep his seat warm since he’ll be needing a job shortly? That one seemed to have compensated him very well. Maybe political jab-taking had tainted the CHT name and his involvement to the point it was more of a liability than an asset.
Reader Comments
From 1Sign: “Re: Dell. After the Wyse acquisition, Dell is in discussion with Imprivata to complete their Mobile Clinical Computing solution. Imprivata is the last major SSO vendor not acquired and the Board is pressuring the leadership team.” Unverified.
From Rommel: “Re: shakeup coming at [vendor name deleted.] One executive gone in some manner, just the beginning. Q1 numbers are way off and the CEO is on the hot seat and may be clipped shortly.” Unverified, so I’m not comfortable naming the company. I would say the mood there probably is tense, though.
From Boston: “Re: Partners HealthCare. Enterprise-wide EMR decision has been postponed until later in the spring, probably June.” Unverified.
From K-Federal: “Re: [practice EMR vendor name deleted.] Heard from two reliable sources that it’s on the block to either Greenway or Allscripts.” Unverified, so again I’ll omit names. We snooped around a little and nobody’s talking, which may or may not mean anything. Supposedly a significant investor in the company may be selling some of its stake, but maybe there’s more to the story.
From Loquacious: “Re: Vitera. Lee Horner is no longer listed as SVP of sales and marketing on their site. Is he still there?” His LinkedIn profile says he’s still there, although I’ve found that people often forget to keep those current when they change jobs.
From WildcatWell: “Re: HITECH incentives. If an EHR vendor offers their system as ‘free’ and a subscriber then demonstrates MU and pockets $44K, that’s not a cost-offsetting incentive, it is stealing from taxpayers. Where is the taxpayer outrage? Is anyone policing this stuff?” HITECH doesn’t require a provider to spend one penny to collect their check. Meaningful Use money is not a rebate or subsidy – it’s just free money from generous taxpayers helping subsidize some high-earning professionals and organizations. Practices or hospitals that are running systems they bought years ago get a surprise windfall, although they might have to use those systems more intensely to qualify. Enjoy that thought as you send in your tax form and as you watch the national debt rise from $16 trillion to who knows where as politicians bribe us with our own taxpayer dollars not to touch our Medicare, welfare, and social security. In the likely event that elected officials won’t suddenly grown spines, you just may get to see Greece-style fiscal meltdown and near-anarchy first hand without the pesky jet lag.
HIStalk Announcements and Requests
The latest and greatest from HIStalk Practice: CMS extends the deadline for EP Meaningful Use eligibility appeals. CareCloud’s Albert Santalo says the new JOBS bill may help his company go public sooner. E-prescribing payments jumped 83% and PQRS grew 65% between 2009 and 2010. Medical schools teach students how to stay connected with patients while using HIT. Dr. Gregg ponders whether the clinical narrative is really dying. Julie McGovern of Practice Wise offers some great tips for successful EMR implementations and their ongoing success. None of these goodies can be found on HIStalk, so make sure you are receiving and reading your HIStalk Practice. Thanks for stopping by.
On HIStalk Mobile, Dr. Travis covers incubator Healthbox’s investor day.
Listening: Mew, brilliant, dreamy alt rock (or is it progressive?) from Denmark that’s reminiscent of Muse or Sigur Ros. If you like complex, almost orchestral music like early Genesis or Yes minus the overwrought excesses, they’ll hook you right in. Amazing stuff that you can feel smugly superior having discovered when nobody else has heard of them. And sometimes people ask what series I like on Netflix, so here’s what I’m watching at the moment: Frasier, Peep Show, and The Killing. Since I have 60 minutes of free time at most per day and that’s only if I sleep less than six hours, those will take awhile to finish.
On the Jobs Board: Soarian Clinical and Financial Go-Live Support, Epic and Cerner Resources, NextGen Go-Live Support. On Healthcare IT Jobs: Manager IS Enterprise Systems, Epic Principal Trainers, Technical Project Manager.
Acquisitions, Funding, Business, and Stock
TriZetto will build its new $40 million headquarters building in the Denver area, giving it space to house up to 750 jobs over the next five years.
CSC, trying to minimize the billions worth of damage it took from the NPfIT fiasco in England, now says it will use the knowledge it gained there to launch iSoft in the United States. A freelance journalist writing for ComputerWeekly doesn’t mince words in expressing his thoughts:
But from whence had its chutzpah come? Not only had CSC still not satisfied its NHS contract, it hadn’t even finished writing the software. Initial roll-out was due in 2007. Complete delivery was due this year. Hains told Wall Street CSC was now at last ready to roll out phase one but for a contractual settlement with the UK’s coalition government. But this was okay. Because CSC had a plan. This was not a plan for the reparation of 10 years of time and money the NHS has wasted on CSC. Nor was it a plan to recompense for the opportunity cost the NHS incurred while CSC dawdled over its clinicians’ request for better patient information. It was a plan to get its own finances in order, negotiate a firm settlement with the NHS and dazzle Wall Street with a come-back launch into what is tipped to be one of the few global growth markets: healthcare IT. Wall Street analysts privileged with the opportunity to ask Hains about this glorious transformation neglected to get his estimation of the value the British public subsidy had added to his corporation’s healthcare business in the last 10 years. British tax payers are due a share of this tremulous global growth machine, no?
Sales
Jefferson Radiology (CT) will implement TeraMedica’s Evercore Smartstore DICOM module at 11 regional imaging facilities.
Lutheran Medical Center (NY) will deploy PatientKeeper charge capture software.
People
Jean Schat, former of Curaspan Health Group, joins PerfectServe as a VP of sales.
South Dakota-based FQHC Horizon Health Care promotes Gin Wingen to director of clinical informatics.
Announcements and Implementations
The statewide ConnectVirginia HIE goes live with DIRECT messaging, free to registered providers through April 1, 2013.
Hurley Medical Center (MI) goes live on its $40 million Epic system.
Allscripts releases Wand, a native iPad app that extends functionality of its Professional and Enterprise EHR solutions.
OTTR Chronic Care Solutions launches OTTRbmt, a patient management system for bone marrow transplant centers that manage patients long term.
In Iowa, University of Iowa Health Care and Mercy Medical Center of Cedar Rapids announce plans to collaborate, including creating an Medicare ACO. UI Health Care, which has been live on Epic for more than three years, will help Mercy with its Epic implementation when it gets underway this summer. The organizations say they will use Epic to share information once Mercy is live.
Government and Politics
Members of the HIT Policy Committee express concern about several aspects of the proposed Stage 2 MU regulations. Specific issues:
- Requiring 10% of patients to receive secure electronic messages is too high.
- Public health agencies are not ready to receive electronic data.
- Communities with one dominant EHR vendor may make it difficult for providers to electronically exchange 10% of transition care summaries to other organizations on a different platform.
- Too many of the measures require EPs to collect data.
Innovation and Research
AHRQ is conducting a study about its offerings and is interested in talking to high-level professionals who either (a) develop health IT tools for patients, or (b) work for organizations that select those tools (hospitals, practices, health plans, government purchasers, etc.) They’re doing 90-minute interviews from mid-April through mid-May. Participants will be compensated for their time. If you’re interested, contact Jonathan Wald MD, MPH, director of patient-centered technologies the Center for the Advancement of Health IT for non-profit RTI International, which is working with AHRQ.
Other
A new KLAS report says that Cerner, Meditech, and Siemens are the only HIT vendors that provide their solutions to all world regions. Most purchasing activity is centered in Asia, the Middle East, and the UK. Few sites outside of North America are doing deep clinical adoption, largely due to economic and governmental challenges.
Weird News Andy wants to know if this is where we’re going. In the UK, a surgical practice drops an 83-year-old patient they had been treating for 30 years because of “green travelling issues” that make it “advisable to register at surgeries nearer to where they live.” The distance from her house to the office that raised the carbon footprint concerns: two miles. The woman thinks she was sent packing because she complained about a doctor.
Advocate Lutheran General Hospital (IL) settles for $8.25 million in a lawsuit brought against it after the death of a 40-day-old premature baby in 2010, caused by a pharmacy technician who incorrectly entered a post-op order into the IV compounder that overdosed the baby on 60 times the intended amount of sodium chloride. The hospital admitted that the compounder had the capability to issue automated warnings about potential entry errors, but they were turned off.
I’ve seen this several times recently at work. Someone who is offsite “attends” a meeting remotely by getting someone to conference them in on speakerphone. Everybody in the room forgets that person is on, and when the meeting is over, everybody walks out (more like “sprints” if the meeting was soul-sucking, as is often the case.) The person on the line, who has muted their phone in order to sleep or mow the lawn or whatever, finally pipes up, only to realize that a new group has taken over the conference room.
Adam Gale posts on KLAS’s blog about a Cerner turnaround that has moved them up the KLAS rankings from seventh to second in the past four years. He credits a new leader or two at Cerner, but I’ll offer my more cynical analysis: they didn’t have a choice unless they wanted to hand the keys to Neal’s soccer team over to Judy Faulkner, because Epic was tearing them a new one.
Sponsor Updates
- CTG Health Solutions announces an extension of its stock repurchase plan.
- Practice Fusion announces plans to add drug formulary and clinical messaging functionality to its EHR.
- Elsevier releases its 2012 spring eLearning schedule, which includes a revised ICD-10 Readiness Assessment tool.
- Premier Healthcare Alliance adds MedPlus to its ambulatory EMR software agreement portfolio.
- Kokua Kalihi Valley Comprehensive Family Services (HI), a FQHC, selects the e-MDs EHR suite for its 13 providers.
- Memorial Health System (CO) realizes a $2 million savings within three months of joining the MedAssets GPO.
- Mike Mistretta, CIO of MedCentral Health System (OH) details how his hospital’s use of SIS in the OR has provided data to control costs and improve efficiencies.
- Bill systems vendor AdvancedMD integrates its product with RaomSoft’s RIS/PACS.
- Aspen Advisors releases a case study on its work helping Akron General Health System (OH) develop an ICD-10 project management office.
EPtalk by Dr. Jayne
It’s all about the data. Studies indicating a decline in hospitalizations and deaths from pneumonia over time may not be due to better care, but rather a change in coding practices. Investigators propose that the coded diagnosis of pneumonia often took a back seat to sepsis or respiratory failure. As one who stalks the hospital floors, I know this to be true. We’ve been increasingly pushed to put more significant diagnoses first in our problem lists and discussions to indicate more complexity and support higher reimbursement. I wonder how the data would skew under the constraints of ICD-10?
It’s all about the audience. A recent study in the International Journal of Medical Informatics finds that EHR medication alerts are geared around how pharmacists think rather than prescribers – typically physicians and nurse practitioners. Alert fatigue is a constant danger and the authors recommend that alerts should leverage patient labs, balance the strengths of automation with human cognition, and support both pharmacist and non-pharmacist prescribers. My favorite of their recommendations: reduce alerts that contradict broadly accepted clinical practices. I hope this initiative succeeds, although I might be at risk for missing the lovely alerts that warn me that the diabetes medication I’m prescribing “might lower blood sugar.”
It’s all about perception. The New York Times publishes a piece about dressing for success. When subjects were told white coats they donned belonged to doctors, their attentiveness increased. When they were told the coats belonged to painters, no improvement was noted. The new phenomenon is being called enclothed cognition (the effects of clothing on cognitive processes.)
Speaking of dressing for success, one colleague shared news that her employer (a prominent health system) recently changed the dress code for physicians in response to patient satisfaction surveys. Previously recommending that neckties be avoided due to infection concerns, they have reversed course to now require them for male physicians because of a patient marketing survey that indicated that physicians with ties were viewed more favorably. Female physicians are not allowed to wear dresses without stockings or hosiery – no bare legs. I wonder what’s next – will they put nurses back in caps?
Being a patient and also a family member of patients myself, I take particular offense at one of their new rules – requiring surgeons to change into street clothes before they speak to a family after surgery. Nobody wants to be confronted with bloody scrubs (a true rarity) but I for one don’t want them wasting time changing clothes to come out and talk to me in the operating room waiting area. Just put on a cover gown or a white coat and come tell me what happened and how my loved one is doing.
Speaking of scrubs, Nurse TECH Talk launches its Most Bodacious Scrubs Contest. Entrants must join HITR and submit a picture of a bodacious scrub top to be in the running for the $100 gift card prize. I’ve got a crazy one that I’ll post just for fun if I can find it – on a transplant mission a few years ago it somehow made it into my bag because it was simply too strange to be believed. Think Nurse Chapel on the original Star Trek.
I’m happy to be surrounded by smart people and Weird News Andy is one of them, educating me on Wickard v. Filburn as the depression-era case responsible for Justice Breyer’s comments on growing wheat and its relationship to interstate commerce regulations. He also cites that decision as “a stretch worthy of Mrs. Incredible,” which made my day. Jonathan H. also commented that the home marijuana growing comment related to another precedent. Some happy Googling reveals that case to be Gonzales v. Raich.
Contacts
Mr. H, Inga, Dr. Jayne, Dr. Gregg.
More news: HIStalk Practice, HIStalk Mobile.
“HITECH doesn’t require a provider to spend one penny to collect their check.”
Leaving the politics aside, you can’t possibly argue that EMRs don’t cost providers anything. The amount that is paid ($44k) is about 1/3 the cost of implementing an EMR, according to the studies that looked at such costs prior to ARRA (in the $150k range). ARRA required ONC to pay the lesser of either $44k or some fraction of the estimated cost (forgetting at the moment), and $44k was the lesser amount. Actual software license cost is <20% of the total (probably closer to 10%), so don't let "free" EMRs fool you in any way. In my last organization, where I ran MU and the EMR program, best case MU incentives would have defrayed less than 20% of the overall cost of the project. I don't know many solo or small group practitioners that can absorb ~$100k loss w/o adversely affecting something in their business, which is why the uptake in that group was so dismal.
Now, somebody other than the physician might be incurring the cost (like the practice group, for instance), but in all instances of that that I've heard of, the practice group is recouping most or all of that MU money to pay for a fraction of the EMR costs. Those providers may not be paying in $$, but they're also not making any $$ from it either.
And yes, it actually is a subsidy to get a group of businesses to go along with something that the government thought was priority enough to make it into a law. We might think that they should have done it anyway, but the reality is that they weren't. People who got their EMRs prior to the incentives maybe shouldn't have received money, but somebody probably understood that if they made that the case, every existing EMR project would have halted for 2 yrs in order to qualify; not exactly their goal, plus many required substantial upgrades to systems and/or processes. Also, as far as subsidies go, it's a pretty crappy one because you don't get the money unless you do a bunch of things with it, buying it alone isn't sufficient; this is very different than the tax break subsidies that oil companies and corn growers get.
I'm not an MU apologist or fan by any means, and there's plenty to criticize if one was so inclined, but saying it doesn't actually cost anything is just incorrect.
Confirmed…. Lee Horner has resigned from Vitera under his own choice. He gave notice in February and they asked him to stay through March 31st to finish a dismal sales quarter…. he didn’t fit in with the new Vista appointed group.
Now they will bring in a friend of the management team and start all over with a new SVP of sales who needs to learn the model and 5 products that the company sells and supports ( PCN, Medical Manager, Medware, Intergy and now Intergy Cloud) … and by the way, their new role out of Intergy Cloud, is not even Intergy, its a different product with the same name… I smell a bait and switch so Buyer beware.
I’m glad someone else appreciates the delightfully filthy gem that is Peep Show
Regarding the wearing of scrubs outside surgery, we recently implemented a compromise solution: Scrubs can be worn outside the OR, but must have a lab coat over them. And booties off too. It’s for both appearances and infection control.
re: KLAS turnaround for Cerner
I have subscribed to HISTalk for the last few years and have seen comment after comment regarding either Neil Patterson, or Cerner in general, routinely posted by you. I am really curious what event in your own career that caused you to be so jaded by Neil, Cerner and the things we are doing (YES!!!!! I work for Cerner). I know everyone has their own opinion, and I respect that, but I’ve just never seen any type of an explanation on how you came to this mindset. I can tell you that the Cerner of 5-10 years ago is a distant memory of who we are today and where we are going in the future.
re: my previous comment…please allow me to “auto correct” my iPad’s reverting Neal to “Neil” prior to posting.
LabJock –
It’s not so much Cerner trashing as it is Judy-worship, which is pretty much the only complaint I have about HISTalk.
Cerner has improved? It must be because Judy forced them to.
It’s good to be the Queen.
McCynical,
If you think it’s Judy-worship, you have a short memory. Remember when KP was trashed for going with Epic? I would say there has been an evolved Judy-respect, based on performance.
Hey WildcatWell – if you really believe there are ‘free’ EMR systems, I have a bridge in NY you need to look at.
There is no such thing as a free lunch, but vendors are great at convincing the unsuspecting that there is.
There’s a subtle nuance to the KLAS report about global market penetration. Some, like Siemens have multiple offerings, tailored to each target market. Others, like Cerner, bring basically the same system with them everywhere, tweaked for local use. Medicine is practiced so differently around the world, it’s no wonder companies like Cerner have crashed and burned when trying to tap into the perceived global cash cow EMR market.
Re: Worldwide
Please explain the difference between “multiple offerings” and “tweaked for local use”.
Jonathan –
Yes, Judy has certainly proven, based on performance, that any success her competitors have is because she forced them to improve. Pure rubbish.
I am no fan of Neal, but he has proven – based on performance – that he knows what it takes to succeed in this industry. Even if there were no Judy, Neal would still be driven to try to be #1. Anyone who has ever been around him would attest to that.
And one criticism several years ago vs. this type of Judy-worship? Really? That is the best rebuttal?
Judy is winning. It’s good to be the Queen. But I will pass on the deification.
I have read HIStalk since 2004 because it is one of the only blogs that covers the HIT industry in which I work. I’ve worked for Cerner for many years (10-20), and I usually just roll my eyes at the anti-Cerner, anti-Neal bias Tim has. Clearly we underwhelmed him somewhere along the line (shame on us), and we’re going to keep paying for it over and over and over again.
People love to hate, and Cerner is a convenient target. There’s just one problem. Facts. Cerner is an amazing, future-focused company, and it’s leaders are remarkable people, warts and all. They lay out a plan 5-10 years in the future and they accomplish it. Go back and read their 1986 IPO prospectus. At a time when they had only a lab system, they described the fully integrated clinical architecture and systems they were going to build, and then they built them. There was nothing like that that even existed. Time and time again, Cerner has pushed the HIT industry forward. Whether it’s integrating inpatient and outpatient at a time when Judy Faulkner said it wasn’t ever going to be necessary, or remote hosting, or uptime/service level agreements, or integrating genomic medicine into HIT…
You can go on hating, and Cerner will still be here in 25 years when a number of other companies are not. Part of that is leadership. Part of that is bright, hardworking, good-hearted people who treat their jobs like a mission to save someone they know.
No company is perfect. We always have to be critical of ourselves, to keep improving. I’m a big Frank Capra/It’s a Wonderful Life fan. Sometimes when I hear all the Cerner slights, I wish that Neal could run his car into the tree and see what the HIT world would have been like without him & his company. When you talk about the benefits of competition on Cerner, Mr. H, perhaps you should contemplate the benefits of Cerner’s competition on the companies you seem to like better.
And don’t go pull out the one favorable piece you wrote about Cerner some years ago. I read it. And liked it. But it’s not enough.
McCynical, I don’t understand why you claim that the existence of competition is not the driving force for a corporation to improve its products. Besides, Inga reported from HIMSS the following about a Cerner demo: “The demo featured a high-level look at a new (or coming soon?) version that includes a new chart note entry screen. The most curious part of the demo was the sales guy’s comment that the chart note entry is now laid out more like Epic’s.”
It seems that Mr. HIStalk’s comments are a direct consequence of the above quote. Or are you implying that Inga lied and the whole thing is just one big Judy-worship conspiracy?
I wish that everyone would remember that all these systems, Cerner, McKesson, Epice etc… are just tools. What makes them a success are the people and the processes put in place to use the tool. None of them, and I stress again, NONE of them are without fault. For all of us that work in the healthcare industry, we can and do hear on a daily basis the praises and complaints against each and every one of them. EPIC may be the talk of the town now, but it is not the only game in town. Anyone that purchases and implements a system by popularity vote as opposed to which system will help your organization to obtain its strategic goals, is just kidding themselves. If everyone took the time they spent complaining about their current system, and used that time to maximize their system’s effectiveness, we would all be in a better place. I understand that there are situations when it is necessary to change vendors and systems. But sometimes I wonder how many changes are made with the “grass is always greener” mentality.
Eddie –
Competion is the driving force for companies to improve. Competition existed before Judy. Completition will exist after Judy. And yes, there just may be life after Judy…..
And thanks for the strawman, but no one is accusing anyone of lying. However extrapolating a single report of a “sales guy’s comment” at HIMSS as proof that Cerner’s success is primarily attributable to Epic – that seems like a pretty big stretch for those of us who just sip the Epic Kool-aid.
@LabJock – since you work at Cerner I’ll give you a free pass since you and your bosses at Cerner obviously don’t know any better. A product that is tweaked for local use is the same product built in the US with minor modifications to adapt it to another country’s health system. “Multiple offerings” refers to a single company that has multiple products, each market-specific – for example Siemens, which has a hospital EMR for the US, one for Europe/Germany, and one for the developing world. They’re all called Soarian for branding purposes but are completely different products.
Worldwide –
How is that working out for Siemens? Or are those rumors of recent layoffs for the former-MedSuite-now-Soarian personnel untrue?
And is the US Soarian Clinicals and the Euro/German truly 2 different products? Or the same code base branched for 2 different markets?
Answer truthfully – we may not hand the free passes out as generously as you do.