Giving a patient medications in the ER, having them pop positive on a test, and then withholding further medications because…
News 5/18/12
Top News
Big Meaningful Use news: 3M, as part of its deal with the VA and DoD to help create a shared electronic medical records system, makes its Healthcare Data Dictionary available to all providers, payors, and vendors anywhere in the world for free. The dictionary translates to and from standard terminologies such as LOINC, RxNorm, ICD-9, ICD-10, and SNOMED CT, allowing disparate systems to communicate via concepts that support semantic interoperability. Check out the company’s white paper on the dictionary. You may recall that the feds licensed SNOMED for the entire country a few years back, making it free. This announcement may be even more important for interoperability, although I don’t see much buzz about it for some reason.
Reader Comments
From HIT Cynic: “Re: Cal eConnect. Looks like another state HIE bites the dust.” Not exactly. California’s HHS announces that it will move oversight of the state’s ONC-supported HIE program from Cal eConnect to the Institute for Population Health Improvement, which is part of UC Davis Health System. IPHI’s director is Ken Kizer MD, renowned for whipping the VA into shape in the mid-1990s.
From Wise Guy: “Re: new Allscripts board member Judge Cindrich. He’s a major consigliere to UPMC CEO Romoff, whose former right-hand man Phil Green is also on the Allscripts board.” I assume their UPMC connection is a coincidence. It’s a sure bet that they are Glen-friendly, though. I’ll be interested to see this quarter’s announcements and results since it’s pretty much go-time, one way or the other.
From Grand Cru: “Re: Partners HealthCare. They are all in with Epic. A catalyst was the Siemens rev cycle project, which needed a significant cash infusion over and above the existing budget. They were supposed to have all hospitals live by now and only one is (barely). This got the board’s attention since they were already looking for a clinical solution. I heard the write-off will be around $100 million on top of the cost of moving to Epic. Yikes! Siemens had an entire floor of one of the Partners office buildings, with employees who had moved their families and been there for years. Within two hours of Siemens getting the Epic decision, the floor was empty – they were told to move out ASAP.” Unverified. But in the mean time, Partners goes public with its plan to spend $600 million on Epic, which I’ve heard from several folks is a soup to nuts implementation, not just clinicals. I either didn’t know or forgot that former National Coordinator David Blumenthal MD has a Partners position – chief health information and innovation officer, according to the article.
From Dr. Gregg: “Re: health literacy. I was on a focus group call for the AHRQ-sponsored Center for the Advancement of Health IT concerning health literacy, which you mentioned on April 6. We were asked how to best get the word out about their health literacy guide and someone suggested popular HIT blog sites. Someone said, ‘Great idea, like HIStalk’ and it sounded as though everyone the call enthusiastically agreed. The moderator concurred with gusto that many of their focus group participants had come by via HIStalk.” I’ll try not to get all soapboxy, but I’ve been an obnoxious advocate of readability for many years. Everybody’s talking about software usability, but we medical people are even more deficient in content usability – the words we speak and write for patients are poorly thought out, full of jargon, and way beyond their level of comprehension. It’s hard – I once researched and wrote 100 or so patient education handouts (conditions, meds, treatments) and got the readability down to around 6th grade level, but it took a lot of careful wordsmithing and translating. This AHRQ publication contains most of my secrets, including a super-handy checklist at the end. I wish someone could convince the medical journals to break the self-sustaining cycle by eliminating their snotty, third-person dry recounts of studies in their articles – providers learn absolutely everything wrong about how write, resulting in articles that no human being can possibly understand even with the fivefold increase in time it takes to try to pry apart the dense, lifeless, code-worded verbiage to extract the tiny bit of useful information. I guarantee I could summarize a stack of medical journals in a couple of easily-read pages and you wouldn’t miss anything important. Anyway, the AHRQ pub is good whether you’re a readability beginner or just need a refresher. It’s a free download and, as you might expect, it’s easy to read.
From Radar Love: “Re: InfoLogix. It’s hard to believe the company, which largely failed in the RTLS market, is owned by Stanley Black and Decker and is acquiring AeroScout. They have maybe two installs that I can recall.” A rumor posted by a business publication in Israel (where AeroScout was founded) says Stanley Black and Decker will acquire AeroScout for $200-250 million via its healthcare division (meaning InfoLogix). InfoLogix lists quite a few customer testimonials on their site (Baylor, Tucson Medical Center, Albert Einstein, Swedish, etc.) so either your two installs number is incorrect or there’s something going on with the testimonials.
From Dennis “Doc” Gross: “Re: Captain Donna Rowe and National Nurses Week. I will always be grateful to Capt. Donna Rowe. She was the triage nurse the night our Dustoff helicopter went down bringing in a scout dog injured by shrapnel. We flew out of Dong Tam in the Mekong Delta and were bringing the dog to the Army’s veterinary hospital in Saigon. Our tail rotor blew out and all I remember was a big bang and then the helicopter did six 360s and we dropped into the trees from about 400 feet. I woke up the next day in the 3rd Field. A few years back, I was in contact with Capt. Rowe by e-mail. She and all of the nurses that served in Vietnam will always have my respect. They are special people and did a thankless job with compassion and professionalism. Many of my buddies and other soldiers owe their lives to these wonderful nurses. May God bless them.”
HIStalk Announcements and Requests
Highlights from this week’s HIStalk Practice: MGA-ACMPE asks HHS for a six-month deadline extension for submitting e-prescribing exemption requests. Vitera CEO Matthew Hawkins says his company will add up to 100 employees and spend $25 million on new technology. The AMA asks CMS to push the ICD-10 deadline to October 1, 2015. CureMD, Practice Fusion, and athenahealth take the top spots in KLAS’s review of SaaS ambulatory EMRs. Aaron Berdofe explores the definition of health informatics. Julie McGovern of Practice Wise offers advice for providers investing in IT hardware and services. Thanks for reading!
Constantine Davides felt pangs of responsibility to update his healthcare IT vendor family tree with your suggestions, so here’s the new version he did. I was thinking about it today. With consumer application software, companies buy each other and usually just keep selling the same software with no new claims. Purchasers continue to be happy since they have no new expectations and already got what they thought they would get. In healthcare, companies try to convince prospects that the mess of thrown-together unrelated products have become seamlessly integrated and synergistically improved just because the marketing people said so, happy to take the customer’s money even though they are sure to be disappointed in the futures they bought but may not receive. If you are industrious, you could plot number of acquisitions against KLAS scores and see if there’s a relationship.
On the Jobs Board: Business Development Executive, Director Solution Sales EPSi, Clinical Pharmacist.
Inga, Dr. Jayne, and I aren’t as smart as that $20 billion brat Zuckerberg. Instead of inventing Facebook (aka the OS for Farmville), we toil anonymously on HIStalk, trying to inform our healthcare IT audience while we actually work in healthcare IT (a novel concept). We’re on the non-profit side of the house, which means that a few muckety-mucks at the top of our org charts make millions, but down at our pagers-and-cubicles level, the perks are few and far between. You can, however, provide us with an emotional payday without spending a cent. Sign up for the spam-free e-mail updates by clicking the Subscribe to Updates link at the top of the right column (or by clicking here). Bond with us on all of the social not-working sites, or join Dann’s “no dues, no benefits” HIStalk Fan Club on LinkedIn as 2,460 cool people have done (check the list … impressive.) Choose a color and click each sponsor ad to your left that uses it, possibly finding an interesting offering purely by chance. Play with the searchable Resource Guide and give the Consulting RFI Blaster a try if you need consulting help. Send me news and rumors. I’m sure you can think of other ways to stroke our fragile egos, but I’ll leave that up to you. Reading HIStalk is the best way, of course, as is using your beguiling charm to get others to do the same. Thanks for hanging out with us.
Acquisitions, Funding, Business, and Stock
DICOM Grid, which offers a SaaS platform for medical imaging applications, closes a $5 million financing round. The company also announces sales to Frederick Memorial Hospital (MD), Ella Health (PA), and Texas Medical Center.
Emdeon reports Q1 results: revenue up 5.4%; net loss of $17.3 million versus a profit of $7.3 million a year ago. The company attributes the loss to the cost of taking the company private last year when PE firm Blackstone Group purchased the company for $3 billion.
Measurement technology vendor Agilent will acquire Denmark-based cancer diagnostic company Dako for $2.2 billion.
Sales
Catholic Health Initiatives signs a 10-year agreement with Tenet Healthcare subsidiary Conifer Health Solutions to manage revenue cycle services at CHI’s 56 hospitals. The agreement calls for CHI’s revenue cycle employees to transition to CHI and for CHI to receive a minority position in Conifer.
People
Healthcare RCM provider Adreima names Bob Wilhelm (TriZetto, Cerner) CEO. Former CEO Connie Perez is moved to the position of president.
Paul Black (Genstar Capital and former Cerner COO) is appointed to the board of Allscripts. Also named is Robert Cindrich (UPMC). All directors will stand for re-election at the June 15 shareholder meeting.
iSirona promotes Philip Sawa to VP of sales.
Medicomp Systems promotes Dan Gainer from senior software engineer to CTO.
CynergisTek hires Neil Buckley (Partners Healthcare) as VP of technology solutions, Eric Nelson (Secure Privacy Solutions) as a contributing principal, and Arnold “Van” Zimmerman as a contributing principal.
Announcements and Implementations
Bon Secours Charity Health System (NY) chooses MediRevv to provide A/R management for its three hospitals.
Wolters Kluwer Health will integrate its ProVation Order Sets with Meditech Client/Server and Magic version 5.64.
Government and Politics
Here’s a dynamic Farzad Mostashari from ONC, effectively explaining Meaningful Use in five minutes to an oddly boisterous audience.
Other
Over a third of all prescriptions were sent electronically by the end for 2011, up 22% from a year ago. An estimated 58% of physicians were e-prescribing.
Verizon Wireless will phase out its unlimited mobile data plan this summer, making Sprint the sole remaining carrier to offer an all-you-can-eat data plan. A saturated cell phone market means carriers will look to existing subscribers to preserve their margins, and now that everybody’s addicted to mobile data, customers will likely gripe but pay up. Cell phones and TV cable were considered expensive luxuries not long ago, but now even people who complain that they’re broke still pay $100 plus per month for each and can’t conceive of giving them up (much like alcohol, cigarettes, sports tickets, and gasoline).
A federal appeals court upholds the conviction of a UCLA Health System employee who was charged with violating HIPAA after accessing the information of over 300 patients without authorization. The employee said he didn’t know it was illegal, but the court ruled that’s not a valid excuse.
Eclipsys founder Harvey Wilson gets voted off his Florida private island by $15.6 million, pocketing a tidy $4.2 million profit for owning the tropical property for 2 1/2 years. Harvey’s former 11-acre barrier island off the coast of Vero Beach, FL has a 16,800 square foot mansion, a two-story guest house, a tennis pavilion, and a citrus grove for when Harvey felt like having an orange. He bought the island new in 2009 for $11.4 million. The unnamed buyer also bought all the furniture and paid the $1 million in closing costs. The listing I ran across said it was offered at $25 million, so maybe the buyer got a good deal, although Harvey is a slick enough salesman that I doubt it. Just in case it isn’t obvious, selling software is a lot more profitable than buying or using it.
Utah’s director of technology services resigns following the theft of about 780,000 online medical records from state computers. Hackers broke into the state’s Medicaid eligibility server March 30 and officials say the security tools were improperly installed.
Fairview Health Services (MN) admits that it was getting a ton of negative feedback from its employees about Accretive Health’s collection efforts, even as Accretive was given the authority to fire those hospital employees who weren’t producing big collection numbers. An internal survey found that 40% of hospital employees weren’t comfortable collecting money from patients as soon as they hit the door. An administrator complained that Accretive people were tying up all the ED rooms trying to extract money from patients, not all of which had previous balances. Fairivew’s CFO, on hearing of Accretive’s practice of giving top collectors gift cards, asked the company, “Do you also understand that this practice violates our corporate policy?” Fairview finally dropped Accretive after the company ignored the concerns of auditors who found that they were violating an agreement with the previous attorney general to lay off the heavy-handed debt collection.
The question raised by the Accretive mess that nobody wants to ask or answer is this: how much collection effort is too much? If the model forces a hospital to operate as a business, is it fair that some customers get away without paying, quite a few of them perfectly capable but just unwilling to do so because it’s not exactly a pleasurable purchase? Or that they don’t pay because hospital list prices are absurd, with insurance companies getting huge discounts on the $4 aspirin that cash-paying patients are expected to pay at list price? Accretive probably went too far, but it’s a slippery slope. They are the symptom, not the problem. Imagine if a restaurant couldn’t turn away hungry but broke patients, has to serve them steak and lobster if that’s what they want, and has to welcome them back for meal after meal even though they’re capable but unwilling to pay. Is that fair to the other diners who will have to make up the difference?
El Camino Hospital (CA) opens a health center for Medicare patients, applying the medical home model for patients who can’t find doctors willing to accept Medicare as payment. The director is a geriatric medicine specialist, iPads are used for data entry, and staff provide services such as nutritional counseling, social services, and physical therapy.
Conservative political commentator Michelle Malkin says “Chicago cronyism over the White House” got a program run by “one of President Obama’s closest golfing buddies” at University of Chicago Medical Center a $5.9 million HIE grant from HHS’s Center for Medicare and Medicaid Innovation that will “enable Mrs. Obama’s cronies to build a government-sponsored electronic medical record-sharing system.” She says (and feel free to chime in if you have an opinion):
I warned two months ago that the Obamacare Innovation Center and its multibillion-dollar slush fund smacked of "another pipeline for political payoffs and Chicago-style boodle that will result in less patient autonomy, fewer health-care choices, more government intrusion and lower-quality care." The University of Chicago Medical Center grant walks and talks like just such a political payoff. I have reported extensively on how Mrs. Obama helped engineer the Urban Health Initiative’s plan to offload low-income patients with non-urgent health needs. With consulting help from Obama senior adviser David Axelrod’s Chicago-based PR firm and the blessing of fellow Chicago pal Valerie Jarrett (who chaired the hospital’s board of trustees), Mrs. Obama sold the scheme to outsource low-income care to other facilities as a way to "dramatically improve health care for thousands of South Side residents." The program guaranteed "free" shuttle rides to and from the outside clinics. In truth, it was old-fashioned cost-cutting and favor-trading repackaged by a nonprofit, tax-exempt hospital as minority aid. Clearing out the poor freed up room for insured (i.e., more lucrative) patients.
A federal appeals court allows a whistleblower lawsuit to proceed against Partners HealthCare and two of its researchers, accused of submitting falsified Alzheimer’s data to obtain a $15 million NIH grant. The whistleblower is a PhD statistician who says he was fired for refusing to work with data known to be bogus.
Weird News Andy needs ICD-10 coding help for a condition he calls “Liar Liar” while noting that the story is set in San Onofre State Beach, CA, home of a nuclear power plant and close to a navy firing range. A woman whose children picked up some orange and green rocks on the beach puts them in the pocket of her cargo shorts, which later ignite after they went home. She “stopped, dropped, and rolled” as her husband tried to put out her hot pants, giving himself second-degree hand burns and scorching her wood floor. She was hospitalized with third-degree burns. The rocks (above) are being tested, but appear to contain phosphorus, which is used in making flares.
The body refrigerator at the Oklahoma Medical Examiner’s Office breaks down, requiring 28 bodies to be moved to refrigerated trucks just as the state legislature debates funding of a new building for the office. Coincidence or leverage?
Sponsor Updates
- GetWellNetwork will offer CBORD’s room service offering in its interactive patient care solution.
- The Ontario Ministry of Health and Long-Term Care signs a two-year contract extension with TELUS Health Solutions for its Health Network System.
- MEDecision hosts more than 150 customers at its client forum.
- T-System is selected as a finalist for Red Herring’s Top 100 Americas Award, which honors the most promising private technology ventures.
- DrFirst recognizes 10 of its client hospitals for being named to the Thomson Reuters list of Top 100 Hospitals.
- New York eHealth Collaborative will honor Jeffrey Immelt, chairman and CEO of GE, and Samual Palmisano, chairman of IBM, at its 2012 gala in October.
- Allscripts and dbMotion will host a June 12 seminar discussing the connecting of healthcare communities.
- Beacon Partners offers new Webinars on MU Stage 2, project management, and Epic Community Connect.
- A Billian-sponsored Webinar presents results of a post-implementation EMR perception study.
EPtalk by Dr. Jayne
Inga already mentioned this on HIStalk Practice, but I have to put my two cents in. The AMA recently sent a letter to HHS Acting Administrator Marilyn Tavenner, requesting an additional delay of ICD-10 until at least October 1, 2015 citing “inadequately aligned” federal programs. Although I don’t disagree about the number of competing initiatives, this sort of feels like a child trying to renegotiate bedtime. They already extended it once, and since we’ve known about this for years, many of us just want to be done with it.
Speaking of HIStalk Practice, I really enjoyed the Practice Wise piece that Inga published earlier this week. Topics like proactive network support and asset management are often overlooked by small practices (and frankly some large ones) who later are surprised by their importance when something goes wrong.
Many physicians are worried about the loss of privacy (for both physicians and patients) resulting from the boom in social media. Cyberstalking is certainly easier when someone has an online presence, but I didn’t realize how many physicians have been impacted by old-fashioned stalking. A recent report presented at the American Psychiatric Association annual meeting notes that more than 20% of surveyed physicians said they have been stalked by a current or former patient at some point. Having been on the receiving end of stalking a few times, this is worrisome.
Recently I’ve seen an uptick in the number of spam e-mails I receive. One today asked me if I’m the person responsible for adding content to a particular HIStalk page from 2008. This was clearly not from an HIStalk reader based on other things in the e-mail, so off to the trash can it went. Of course I couldn’t avoid going to see what the topics of the day were and I wasn’t disappointed: bad decisions at Allscripts led the news.
I’ve heard the phrase Goat Rodeo used to describe various IT projects, but I’m wondering if we’re going to have to retire it from the lexicon? Apparently it’s also the title of a recent album by acclaimed cellist Yo-Yo Ma. Speaking of goats, I enjoyed reading a recent blurb about a New York emergency doc who found happiness on a goat farm. In the midst of a go-live right now, I agree that career alternative is starting to sound awfully appealing.
Speaking of go-lives, I wanted to share a hilarious email I received last week in response to my piece on EHR upgrade training. I was lamenting the difficulty of finding the training room. This reader earns the coveted “Laugh of the Day” award:
Don’t blame IT for lack of signage to your training room. I’ve gone around and around with facilities on this. They won’t put up permanent signs because not that many people need to know this information on a regular basis. TJC and the fire marshal prohibit 8 1/2 x 11 paper signs. I’m not sure how many people are killed annually by these things spontaneously combusting.
In the same spirit, some top pieces of advice from this go-live:
- When your implementation team recommends you reduce your schedule, they’re not kidding.
- When they asked you six months ago to start cleaning up your illegible paper problem lists and medication histories to make go-live easier, they weren’t kidding then either.
- Don’t be afraid to ask questions – we won’t laugh at you (at least not to your face – at happy hour, however, it’s another story.)
- Please, for the love of all things, let your support staff support you.
- If you’re going to drink from the secret bottle of bourbon you keep in your desk, the least you can do is share.
Have a favorite piece of go-live advice? E-mail me.
Contacts
Mr. H, Inga, Dr. Jayne, Dr. Gregg.
More news: HIStalk Practice, HIStalk Mobile.
Harvey’s house isn’t the result of selling software. Precious little of that was really sold for much at Eclipsys.
What was bought and sold were shares of ECLP stock on the public market.
This is the fleecing of shareholders in American public companies.
Glen and company are carrying on that tradition under a new name hoping people forget that it was already done once.
I think it is a bit misleading to call a 3M brochure for the HDD a whitepaper…While I think the HDD will be a good resource for HIT, we should probably resist the urge to assume it is a silver bullet that will magically solve all of our problems. This “OMG we’re saved” (which happened with SNOMED-CT and RxNorm), tends to stop progress while we discover that it is not all that was promised. It could just be a company cashing in on a legacy dataset because they could not find a commercial market. The military has been using the HDD for over a decade and they seem to have the same issues as the rest of healthcare. Go into the new HDDAccess browser and search for ‘warfarin’ or even just any term beginning with ‘warf’ with the ‘Pharmacy’ subset checked…
Given Ms. Malkin’s tendencies to lie with no shame, I would venture a guess that there isn’t really much to her story. Too bad you found it necessary to link to the political pornography that is her blog, without any independent confirmation for at least some of the claims…
re: Accretive and collection practices
Is that fair? There’s a long list of “things that aren’t fair” leading up to someone arriving at the ER without any money to pay for life-threatening (or at least livelihood-threatening) conditions. And the “unfairness” generally happened >to< the person who shows up in need of assistance.
Re Partners. A win – win – win the way i see it. Soarian Rev Cycle got better for the experience and now has a “floor of available resources” to use elsewhere, the table is now set for Partners to accept Epic’s “everybody does it our way” approach, and Partners is prepared to conform in a way they never were before. With Blumenthal himself driving, how can the transition to Epic be anything but smooth??
Phil Green showing up on the board for GlenT is a good sign. He is a behind the scenes mover who has the juice to replace management. Even though he is probably too deep in the bag with stock to do so. will still be interesting to watch.
Hmmm. Patient Burned by Wayfinding Sign Combusting Spontaneously. Is there an ICD-10 code for that?
Reply to techexec–If the patient was going down the hall on waterskis, it would be V91.07XA
The analogy of hospitals to restaurants clearly fails on the point that food is available from others sources, while much of health care, especially when you need it most, is not.
I don’t think the comparison fails there at all. You’re actually aruguing a different point. Whether there are 100 restaurants in an area or one, the metaphor talks about the decision of a given restaurant to feed a hungry and broke person. In both cases (100 restaurants or one), continuing to feed hungry and broke people is not sustainable for that organization without outside help (other diners in this example).
It was not a floor of siemens resources. They flew in and out and didn’t relocate. The hardest hit were partners employees. I know someone who works there and they say it should have happened years ago. Also the project was supposed to end in 2015.
I pity the shareholders of Allscripts. Cindrich knows nothing of HIT but does know how to strong arm doctors who complain about the dysfunctional work flows caused by EHRs and CPOEs.
He is also too old to be on an EHR vendor’s BOD.
Surprising that Neal Patterson did not pick him.
Regarding HIT Cynic – consensus is eCal Connect was a bust. Ask what was transferred to UC Davis. No common defintion of the goal much less progress. Held town hall meetings but delivered nothing – exec team and BOD lacked business experience and execution was very poor.
Not sure who halted it or how much money sunk but seen as total waste of taxpayer dollars. The best thing they delivered was the adios press release that covered their tracks.
Ken Kizer is a hero but the VA had different challenges than the commericial HIT and highly political and competitive healthcare market in California. Wish Ken and UC Davis well.
Re: This (3M) announcement may be even more important for (semantic) interoperability, although I don’t see much buzz about it for some reason.
I agree with Not So Fast. The 3M HDD will be a good resource for HIT, but it hasn’t been and won’t be the silver bullet. With so many standard classifications and terminologies as well as “local codes” (Why does every clinical lab in the country insist on making up its own lab codes?), maintaining the maps becomes an extraordinary, human challenge.