News 12/19/12

Top News

A Wells Fargo Securities analysis of EHR attestation data finds a surge in the number of hospitals and practices qualifying for Meaningful Use money, which it expects to continue through the February deadline. It also notes that Epic is starting to dominate in all measures, leading in the number of physicians that have attested in with a success rate of 35 percent and representing 21 percent of the total attestations. Athenahealth was also noted as performing at an above-average rate, with neutral numbers for Allscripts and slightly negative numbers for Quality Systems. I ran the cumulative percentages by vendor and found that 80 percent of attesting providers are represented by just 22 of the 391 vendors listed: Epic, Allscripts, eClinicalWorks, NextGen, GE Healthcare, McKesson, Greenway, Cerner, Practice Fusion, athenahealth, Vitera, e-MDs, Community Computer Service, Eyefinity, Amazing Charts, Compulink, BioMedix Vascular Solutions, MedPlus, Medflow, Aprima, Partners HealthCare, and MedInformatix.

Reader Comments

From The PACS Designer: “Re: X-rays using your phone. Two engineers from California Institute of Technology have developed a microchip that can produce images inside objects without using the normal radiation method. The circuits operate with existing mobile phone technology but use the terahertz operating region to produce the viewable image for the phone. Terahertz radiation can penetrate through the body without damaging the tissue it passes through.”

From Vendor Middle Manager: “Re: clinician compensation. Can you ping the vendor community on the levels of compensation (salary, bonuses, options, etc.) being paid to clinicians? It’s hard to find out because of inherent reluctance to disclose compensation and the variety of titles that don’t reflect true roles. It would be great to hear anonymous examples of physician and nurse compensation with the primary role specified (doing demos, designing user interfaces, developing content, etc.)” I’ll collect and anonymously report your responses if you would care to either e-mail me or use the anonymous Rumor Report.

From Mini Me: “Re: iPad Mini. I’m interested to know how doctors are using the iPad Mini.” Me, too. If you are a clinician using an iPad Mini or an IT person involved in its rollout for clinical use, let me know why you chose the Mini and how it’s being used.

Acquisitions, Funding, Business, and Stock

Investment firm Elliott Management offers to buy Compuware for about $2.4 billion, a 15 percent premium over last week’s closing price. Elliot, which owns 8 percent of the company, says Compuware’s “execution, profitability, and growth have meaningfully underperformed.” Above is CPWR’s five-year share price (blue) vs. the Nasdaq (red). Compuware filed for a possible IPO of its Covisint Corp. unit last week and could conduct the IPO in three to six months.

Revenue cycle software provider Recondo Technology acquires eHC Solutions, an Indianapolis-based developer of EDI solutions.

pMD releases a mobile version of its patient handoff product.

PatientSafe Solutions (formerly IntelliDot) raises $13.3 million in equity financing, about half of the amount it is seeking, raising its all-time financing total to $83 million. The company offers bedside scanning solutions for medications, specimens, and breast milk along with documentation and caregiver messaging.

Sales

Rideout Health (CA) selects McKesson’s Paragon HIS as its financial and clinical solution.

ARcare (KY/AR) selects SuccessEHS PM/EHR for its 45 community health center locations.

MemorialCare Health System (CA) will implement the KnowledgeEdge Enterprise Data Warehouse from Health Care DataWorks.

Trustees of St. John’s Medical Center (WY) decide to spend $240,000 to buy eClinicalWorks as a replacement for McKesson Practice Partner, which it has been running for five years. They say Practice Partner is not user friendly and makes it difficult to document office visits.

People

The Premier Healthcare Alliance names Gary S. Long (Surgical Information Systems) chief sales officer.

CCHIT adds Janet M. Corrigan (National Quality Forum) and Grace E. Terrell, MD (Cornerstone Health Care) to its board of trustees and promotes Executive Director Alisa Ray to CEO.

The National Quality Forum names Christine K. Cassel, MD (American Board of Internal Medicine) president and CEO effective mid-summer 2013.

James D. Morris (Western Digital) joins Harris Corporation as group president of the Integrated Network Solutions business, which includes Harris Healthcare Solutions.

The SSI Group appoints Brian Campbell SVP of sales and Tom Myers chief strategy officer. Both will maintain their roles with MedWorth, an SSI subsidiary.

Meditech promotes Carol Labadini to associate VP for development, implementation, and support of Meditech’s ambulatory solution and Hoda Sayed-Friel to EVP of strategy and marketing.

Billing company PatientFocus adds Philip Hertik (Windsor Health Group) and Lucius E. Burch, IV (Burch Investment Group) to its board of directors.

Ormed names Bill Hockstedler (Connance, Inc.) VP of sales and marketing.

Imprivata names Carina Edwards (Nuance) as SVP of its new Customer Experience Group.

Informatica names Margaret Breya (HP) chief marketing office and EVP.

Announcements and Implementations

New Horizons Health Systems (KY) goes live on Healthland Centriq EHR.

Hutchinson Clinic (KS) exchanges CCD from its Allscripts EMR to the Kansas Health Information Network using the ICA CareAlign Exchange platform.

Orion Health announces the release of Orion Health Mobile, which allows users of Orion Health HIE to view real-time patient information on their iPhones and iPads.

Ormed sells its Canadian business to a subsidiary of Constellation Software, saying it will now focus on selling it ERP, HR, and decision support products to the US healthcare market. Constellation has completed several acquisitions this month, including buying documentation and charge capture systems vendor Salar from Nuance. Constellation also owned 21 percent of Mediware, or about $40 million worth, when that company was acquired by Thoma Bravo last month.

A profile of NewYork-Presbyterian Hospital SVP/CIO Aurelia Boyer, RN, MBA describes the organization’s use of Caradigm Amalga to analyze quality measures in real time, which she says saved $1.5 million in discovering CHF treatment variations.

Medecision’s Aerial care management system earns NCQA disease management certification.  

Government and Politics

ONC recognizes Ohio for coordinating its Regional Extension Center, HIE, and Beacon Community in supporting Meaningful Use and interoperability. More than 8,200 Ohio providers have met Meaningful Use requirements, receiving $368 million in federal payments.

In England, the chair of the Public Accounts Committee says paying trusts to implement CSC’s Lorenzo system are “bribes.” An earlier report from eHealth Insider says that CSC has offered $1.6 million each to the next 10 hospitals who sign up for Lorenzo, with funds coming from the Department of Health and CSC. CSC says the report contained factual errors, while Department of Health denies the suggestion that the incentives give CSC an advantage over competitors.

Other

An article in a North Carolina newspaper illustrates why hospitals are snapping up medical practices. Simply by buying the practice, hospitals can bill up to double or more what the same physician in the same office would have been paid for performing the same service. Non-profit hospitals argue that they deserve to bill extra because of Medicare underpayment, a higher level of regulation, treatment of the uninsured, and a higher level of staffing. The article says North Carolina Attorney General Roy Cooper is considering using of antitrust laws to keep hospitals from raising healthcare costs by buying up their practice-based competitors. It cites an example of a patient’s echocardiogram, whose cost to her jumped from a $60 co-pay to a $952 bill even though the same technician performed the same test. In the Charlotte area, more than 90 percent of cardiologists are now hospital employees, spurred by a decline in their incomes of 30 to 40 percent in the past three years.

Weird News Andy says this baby was saved by scissors, but not like you’d think. UK doctors decide to save a baby born after 23 weeks of gestation (within the limit of legal abortion in almost all US states) because she weighed the minimum one pound to be considered viable. Only later did they realize that she had been weighed without removing a pair of scissors from the scales, with her actual weight being only 13 ounces. She’s been discharged after six months (after what must have been a monumental taxpayer expense) and is doing fine.

Sponsor Updates

• Several Marines pay a visit to eClinicalWorks’ Westboro, MA headquarters to collect donated toys for Toys for Tots.
• CommVault will pay $5.9 million for land in Tinton Falls, NJ to build its new headquarters.
• A Wolters Kluwer Health survey finds that 80 percent of consumers believe they would benefit from have more control of their healthcare, though only 19 percent have a PHR. Nineteen percent also say that the most important consideration when selecting a physician is the practice’s level of technology.
• Surgical Information Systems showcased its AIMS solution at this week’s PostGraduate Assembly on Anesthesiology in New York City.
• PSS World Medical will offer Wellcentive’s population health management and analytics platform to its customers.
• GetWellNetwork integrates Stanley Healthcare’s RTLS with its interactive patient care solution to identify caregivers entering patient rooms.
• Dx-Web will offer LDM Group’s PhysicianCare and ScriptGuide products to its network of EMR vendors, expanding the relationship between the companies.
• The Center for Medicare and Medicaid Innovation awards the Mayo Clinic, Philips Research North American, and the US Critical Illness and Injury Trials Group over $16 million to improve critical care in the ICU.
• Billian’s HealthDATA offers strategies for providers to reduce re-hospitalization rates in a blog post.
• AirStrip Technologies will add secure messaging to its applications using Diversinet’s mobiSecure SDK.
• RazorInsights will incorporate Health Language, Inc.’s software into its EHR system to support standard terminologies.
• Clinithink publishes the seventh installment of its seven-part blog series entitled, "Clinical NLP in Plain English."
• DrFirst is ranked by Black Book as the #1 vendor of standalone electronic prescribing systems.

Report from the Healthcare Privacy and Security Forum
December 2-3, Boston, MA
By MrVStream

If you are not serious about your patient information security and privacy issues, the Office of Civil Rights (OCR) is, and it will have both financial and legal consequences for the entity. Just check out the Case Examples and Resolution Agreements (more on OCR to follow.)

I had the very good two days attending the inaugural Security and Privacy Forum sponsored by Healthcare IT News and HIMSS in Boston last week. It was well attended with over 250 registrants and 15 corporate sponsors. It does remind me of the early days for HIMSS (I won’t tell you how many years ago that was). It was serious, interactive, and had relevant subjects.

Here are some of the highlights and noteworthy points.

• The keynote was delivered by Tim Zoph, SVP of administration of Northwestern Memorial Healthcare. He shared the greatest impact of a lack of focus on patient security and privacy is the erosion of confidence from patients and consumer towards healthcare providers, with the reported 435 breaches that affected 500 or more individuals since September 22, 2009, now totaling more than 20 million impacted individuals. Tim offered hopes and guidance to healthcare leadership that through creating a culture of security, simplifying the technology environment, using a standards-based security model, being proactive, and most importantly applying the right governance structure that is multidisciplinary, we can avoid security as one of these blind spots outlined in How the Mighty Fall by Jim Collins.
• Barbara Demster, chair of the HIMSS Patient Identity (PI) Integrity Work Group, outlined that PI Integrity has direct impacts to privacy and security in the areas of operations and finance. She offered a HIMSS white paper from the Patient Identity Integrity Toolkit. The current estimate is that records are duplicated in the eight to 12 percent range, with institutions experiencing 47 percent false negative and 51 percent false positive (more problematic). The financial impacts range from administrative, regulatory, and patient care-safety. Barbara also suggests that PI integrity processes need to include stakeholders across the organization. Barbara emphasized that commitment and explicit organizational guidelines towards data governance are imperative.
• Lisa Gallagher (senior director of privacy and security for HIMSS) and Bob Krenek (senior director of Experian Data Breach Resolution) presented the summary results of the 2012 HIMSS Security Survey, released December 12. Summary: (a) security budgets hold steady at 3 percent of the IT budget; (b) those organizations not conducting formal risk assessments will not qualify for MU incentives; (c) organizations need to establish a robust patient information secure environment in order to be able to safely share data externally; and (d) physician practices are not as advanced as other healthcare organizations in many areas of data security.
• Sharon Finney, corporate data security officer for Adventist Health System, shared that her approach in meeting the needs and prepare for an OCR audit is moving her department from internal audit functions to risk assessment, focus on the potential risk impact, quantifying the financial risk, and engaging other departments. She also urged understanding people and process and to focus on the connecting points between each steps. She said she expects MU audits to be performed on all the institutions received funding.
• Edward Ricks, VP/CIO of Beaufort Memorial Hospital suggested that to prepare for an OCR audit is to simplify the process and use outside consultants for support.
• Mobile access and BYOD in healthcare are still major issues for patient information security and privacy with no single strategy, especially in the areas of device-to-device communication of PHI and home or consumer data collection. Sample strategies: Kaiser (do not allow any BYOD), Partners (restrict to technology standards — iOS only), Children’s Hospital of Central California (provide a virtual desktop environment), and others using network security to limit information access. The general agreement is that leadership is required to create a culture of patient information security. There is plenty of work to be shared by all the functional roles, but the reality is, a low amount of resources devoted and focused on the efforts of patient information security and privacy from both the administration and the white coats.
• Jennings Aske (CISO of  Partners HealthCare) and Darren Lacey (CISO and director of IT compliance of Johns Hopkins University and Johns Hopkins Medicine) discussed the role of cloud computing. They suggested that it is necessary for the cloud supplier to sign a BAA, disclose underlying infrastructure, obtain third-party certification, and to demonstrate disclosure transparence. They did suggest that hybrid cloud services architecture is a good compromise.

Leon Rodriguez, director of the Office for Civil Rights (OCR), made these statements in an interview:

• HHS OCR enforces the HIPAA Privacy and Security Rules as well as the HITECH Breach Notification Rule.
• The final HIPAA Privacy and Security Rules are expected very soon.
• The greatest challenge is the transformation of the agency from a regulatory body to an enforcement agency, where the scope is expected to be broader in nature.
• The director position requires a balance of business needs and the need to comply with the regulations.
• OCR expects from providers a well-documented procedure and we expect the entity to follow the process. The focused is on encryption, encryption, and encryption.
• The awareness of management is still lacking, which makes it difficult for healthcare organizations to meet the regulations.
• OCR has to work to help  consumers to understand privacy violations.
• OCR is starting to move from a reactive mode to proactive audits based on risk analysis.
• OCR expects more monetary restitution in the future and to expand the agency using the proceeds of the fines. $4 million was collected in 2012, but that is expected to grow.
• OCR most likely will offer technology guidance, but will focus on the process.
• OCR is still trying to assess the level of resources necessary to complete the audit.
• Healthcare entity leadership will separate the successful implementation of a security and privacy plan from the unsuccessful ones.

Do you hear the OCR coming down the chimney to your facility? Plan to attend the Forum next year. I think you will find it worthwhile, and it may get you on the official Good List.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

HIStalk Advisory Panel: Use of Mobile Devices

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This month’s question: What interesting uses of mobile devices are you seeing by hospital employees and physicians?

We have very limited use of mobile devices in our organization due to security-driven policies. We are hoping that once we complete a virtual desktop infrastructure install we’ll be able to be more flexible.

Jordan Hospital in Plymouth, MA has a terrific mobility approach. They had a serious noise problem on the patient floors. They decided to implement a "quiet hospital" program. They banned the use of the PA system for any reason on penalty of being fired. They bought a large number of iPhone 4s (at a great discount since the 5s have debuted).  They disabled their cellular functionality, making them usable only on a WiFi network (the hospital’s). At the beginning of each shift, the nursing staff picks up a phone from a large charging bay. He or she types in a code and that phone automatically rings to his or her personal extension during the shift. In addition, when the nurse logs in, he or she has immediate access to all of the patient EHRs (Meditech) that have been assigned to him or her for that shift. The charge nurses can assign patients individually or take a single nurse’s entire patient load and assign it to another nurse on the next shift with only a few keystrokes. Patient calls to the nursing station are automatically forwarded to the iPhone of that patient’s nurse. If the nurse doesn’t respond in 15 seconds, the call is automatically forwarded to the charge nurse. Doctors affiliated with the hospital also get iPhones, but theirs have their cellular functionality left intact, so he or she can be reached whether or not they are in the hospital. Individual extensions never change, and the on-call physicians in each specialty can be dialed or texted with a single keystroke. Jordan has not lost a single iPhone since the nurses’ units don’t work outside the four walls of the hospital. They were very surprised when they analyzed what functionality was being used by the nurses most frequently. It turned out to be texting, which was not expected since the average nurse’s age is 54. Within two weeks of implementation of the program, patient satisfaction scores went from the low 70s to the mid 90s.

We are using Clinical Expert to do some clinical surveillance relative to sepsis. These alerts are sent to response team via iTouch and iPad app.

[from a vendor employee] We’re definitely seeing increased uses of mobile devices by the people we connect with in revenue cycle, finance, and department heads. They’re relying on their mobile devices to have up-to-date information, dashboards, and reports on the overall financial status of their facility or system. These reports range from AR, productivity, and charge capture for revenue cycle. Department heads are moving toward utilizing mobile devices for up-to-date reports on physician performance and relative ranking within their department. Upper management likes to have this information "at their fingertips" during meetings or ad-hoc discussions. Properly designing these reports and dashboards for viewing and interaction on mobile devices hits the spot.

On the positive side, many hospital employees and clinicians continue to use their mobile devices as a reference tool to assure they properly understand diagnoses, medications, etc. We continue to see good use of these devices for continuing education and various other apps in that regard. One tremendous use of mobile devices done by our IT staff recently was to utilize FaceTime to allow a seriously ill patient to virtual attend their daughter’s wedding. On the dark side, hopefully everyone in the industry is aware that unsecure, unencrypted texting between staff and clinicians continues to be a risk that will not be eliminated without a secure texting solution. The lure of convenient, asynchronous communication is considerable and individuals will disregard policy and use available means to do so if we are not providing them with an appropriate and approved tool.

Nothing out of the ordinary. They are proving to be great for quick communications and coordination. Many providers are very HIPAA security aware and asking that we provide secure messaging apps. We do see responsiveness and coordination to be better than using pagers or other means for contacting individuals.

[from a vendor employee] At a recent visit to see a family member in the hospital, I noticed that all of the staff had a phone that they had clipped to their pockets. It wasn’t the size of a cell phone, but was a little smaller than cordless phone you would have at home (back when people had home phones). I asked one of the nurses what they used them for and she said, "I don’t know, but I hate it." Another nurse said that she loved it because it gave her all of the "notifications" she needed without having them broadcast over the intercom. She did say however, that it was very heavy and that it pulls on the her clothes (scrubs aren’t stiff enough to hold it). I noticed the staff checking theses phone constantly – like my teenager does when he’s texting his girlfriend.

Nothing good. Right now I’m fighting the battle of nurses using their personal cell phones to take pictures of EKG strips (PHI is blacked out) and sending them via unencrypted text to the physician. Evaluating our options right now.

Secure e-mail/calendar access. Texting between providers.

[from a vendor employee] I talk a lot about how the market niche we serve (enterprise clinical content management) has become much more than about how data is managed through its lifetime but rather now how data is accessed within a patient context. I believe the unprecedented demand for clinical data drives a greater need for data liquidity across healthcare IT applications. That said, as we continue to achieve a higher level of data liquidity, we will see clinical content accessed through many mobile devices. Heck, I’d argue that the platform becomes unimportant, data should just be available. Therefore we should be able to access the internal EMR, external EHR, even the HIE, though any device. On top of this, these devices are becoming the portal to multiple types of high definition content – be it pictures, movies, or other Internet-elivered content – why can’t clinical content be just as rich. As we move towards what I like to refer to as the High Definition EMR, I believe all clinical content will be accessed through any device, including mobile devices – especially by hospital employees and physicians.

We have rolled out Epic’s Haiku and Canto for our clinicians using iPhones/droids and iPads. The early response has been very positive. It’s read-only, but we will be adding Dragon functionality soon. We also have over 300 wireless mobile carts roaming the units using virtual desktop (VDI), thin clients, and Imprivata single sign-on with proximity access. Also a big satisfier.

Airstrip OB for fetal heart monitoring. Residents and younger attendings are using lots of apps for providing care instead of textbooks.

Communication! They are doing it now with all sorts of devices, so we are exploring a way to make it (1) integrated with the EMR (e.g. choose from a patient list), (2) more secure, but easy to use, and (3) widely adopted, but we recognize there may be more than one use case scenario (e.g. one use case might be about confirming orders, another about relaying a lab value, another about sending a photo, and another about getting a quick consult). We’ll see if one solution can solve all, or if more than one is needed.

Naturally, mobile devices on the public WiFi (as opposed to the hospital firewall) are not censored like the hospital intranet. So when you can’t get to the breast cancer walk site (because the hospital thinks it might be porn), you whip out your portable device. Same for ESPN.

While we use UpToDate Mobile and Epic’s Haiku and Canto, the cool thing we use today we developed and patients use is called WebAhead. Allows access to our urgent care locations and clinics and you can pick your appointment time on the fly… we call it WebAhead. There may be others being used by staff, but we don’t control the mobile aps nor are we pushing any right now as we are coming our Epic install.

Not seeing a lot. We are throwing new laptops and Dragon with PowerMics at our docs and for most of them that is plenty of technology at one time. We have also upgraded their desktops if they were very old. We have had a couple of request for the iPhone app for our EMR, but since interest is low key, we will add it later.

Curbside Consult with Dr. Jayne 12/17/12

ONC released the 2014 Edition Test Method for EHR Certification on Friday. In case you didn’t have anything to do over the holidays, now you can curl up in front of the fire with some cute and cuddly Test Procedures.

I have to be honest. I still struggle with Meaningful Use. I completely understand the goal. I also understand that there are a number of baby steps that must be taken in order to make data more transparent and transferrable. It’s extremely frustrating as a clinician, however, to have to codify data in ways that are seemingly meaningless.

Take the certification criteria for smoking status, for example. The Test Procedure document includes the approved SNOMED CT concepts “to assist the developers and implementers of EHR technology in the implementation of this requirement.” The concepts are:

• Current every day smoker
• Current some day smoker
• Former smoker
• Never smoker
• Smoker, current status unknown
• Unknown if ever smoked
• Heavy tobacco smoker
• Light tobacco smoker

For a minute, I’m going to take of my informatics hat and put on my average primary care provider hat. Let’s assume the only thing I know about SNOMED is that it’s some kind of coding system that sits under my EHR (if I even know that much, which I might not). Although the coding allows each of these to be uniquely identifiable, I’m not sure any of these (other than “Never smoker”) have specific levels of meaning to the majority of primary care physicians without detailed explanation.

For example, what is the definition of a heavy vs. light tobacco smoker? There are significantly different clinical risks to the former smoker depending on whether they’re a former heavy smoker vs. a former “only when I drink with friends” type of smoker.

There is a clarification that “smoking status includes any form of tobacco that is smoked, but not all tobacco use.” There are different risks to pipe smokers and cigar smokers than to cigarette smokers, but we’re not required to capture that nuance. In the old world, I could write TOB: 2ppd x 20y and 99 percent of clinicians would translate that to “cigarette smoker, two packs per day for twenty years” and could appropriately assess the patient’s risk. Now, to meet Meaningful Use, I’m going to be steered towards selections that don’t have a lot of clinical meaning.

Some vendors who had detailed and granular ways of documenting this information prior to Meaningful Use have kept their ability to gather that useful data and mapped it to the required codes. I can’t help but think that this will cause the data to lose something in translation.

Other vendors who are focused more on certification have added the new fields alongside their old ones. This forces clinicians to document the data twice – once for clinical significance and once for a federal program. Although it meets the letter of the law, it makes for unhappy users and poor design. I know of at least two products out there, however, which function in this way.

ONC works through the paradox of mapping on page 3 of the smoking status document. It gives the sample of a “pack a day” smoker that the Certified EHR maps to “current heavy smoker.” It notes that when the transition of care document is created, the additional text description and any other metadata could be included along with the SNOMED. It continues”

Note that “heavy smoker” is not the only concept that is appropriate here, and we leave the decision regarding which of the eight codes is the most accurate descriptor of clinical intent to the judgment of those implementing the form, template, or other EHR data capture interface.

I’m not sure that makes me feel much better. Unless they have dedicated clinicians working through these design specifications, it leaves us with software developers deciding how to best document clinical intent.

As the document continues, they include language from the 2011 preamble of the Health Information Technology standards document. It specifies the definitions of the various selections:

… we understand that a “current every day smoker” or “current some day smoker” is an individual who has smoked at least 100 cigarettes during his/her lifetime and still regularly smokes every day or periodically, yet consistently; a “former smoker” would be an individual who has smoked at least 100 cigarettes during his/her lifetime but does not currently smoke; and a “never smoker” would be an individual who has not smoked 100 or more cigarettes during his/her lifetime. The other two statuses (smoker, current status unknown; and unknown if ever smoked) would be available if an individual’s smoking status is ambiguous. The status “smoker, current status unknown” would apply to individuals who were known to have smoked at least 100 cigarettes in the past, but their [sic] whether they currently still smoke is unknown. The last status of “unknown if ever smoked” is self-explanatory.

I wonder how many of my primary care peers have read this language and share this definition? It’s been awhile since I was in medical school and residency, but I’m pretty current on my continuing education classes and haven’t seen this emphasized in recent articles about the risks of smoking. What’s magical about 100 cigarettes? Is there solid data that shows a difference in risk once a smoker hits that number? Maybe I need to go back to school.

Continuing on, the document clarifies the cutoff of “heavy vs. light” smoking as being more than 10 or fewer than 10 cigarettes per day, “or an equivalent (but less concretely defined) quantity of cigar or pipe smoke.” What if they smoke exactly 10 cigarettes per day? They don’t meet either definition.

I realize I’m splitting hairs here and some of you may have tuned out by now, but that’s the point. We’ve taken data that had clinical meaning and was easily understandable and turned it into data that is confusing and potentially meaningless. I’m not sure if that’s really taking us forward. The data is only as good as the staff entering it and the likelihood of physicians understanding the concepts (let alone training their staff to understand the concepts) may be low.

Compared to other parts of MU, the documentation of smoking status seems fairly straightforward. That’s not very reassuring considering a program which will continue to become more complex as we move forward. We’re not even to Stage 2 yet and I need a break. As they used to say, smoke ‘em if you got ‘em.

E-mail Dr. Jayne.

Monday Morning Update 12/17/12

From John: “Re: ONC. What happened to its announced intention to publish an EHR safety action and surveillance plan? It was announced in November 2011 and was supposed to be finished within 12 months.” 

From California Dreamin’: “Re: MMRGlobal’s patent trolling lawsuits for patient portals. I hear ONC and the California Attorney General are interested in the company’s reason for e-mailing individual hospitals about its patents. The company seems to be going after hospitals rather than vendors for patent infringement.” The former is unverified, while the latter does seem to be the case as the company’s lawyers cast the net wide, apparently including just about every hospital as a potential patent violator.

From Former Allscripts Employee: “Re: HHC lawsuit. I know for a fact that Glen and many others at Allscripts (as well as many outside of the company) are convinced that Epic is fleecing its customers. They feel Epic’s costs – especially the undisclosed long-term costs of operation – are outrageous and are hurting healthcare. As a former employee who participated in many C-level conversations, I’m guessing that they hope to use the lawsuit to bring those costs to light through the discovery process. Moreover, Allscripts has in fact demonstrated the integration of its ambulatory and inpatient EHRs at least one live site. And I’m sure they feel HHC could benefit from connectivity to Allscripts systems currently in place at Columbia, NewYork-Presbyterian, Memorial Sloan-Kettering, North Shore Long Island, and other NYC-based health systems serving millions of local patients whose records would be helpful to HHC providers. So while I agree it’s a dumb PR move for Allscripts, it’s not necessarily a bad business decision.”

Allscripts filed the lawsuit because NYCHHC failed to even address, much less resolve, significant concerns that Allscripts’ raised in its agency-level protest concerning the propriety of HHC’s iCIS award decision. Documents produced by HHC indicate that the agency failed to follow the rules governing the competition and overlooked hundreds of millions of dollars in potential savings offered by Allscripts’ proposal. In these times, it is critical that public procurements be awarded through the conduct of fair competitions that objectively assess the merits of competing proposals and document a reasonable basis for the decision. From all available information, the HHC award to Epic is lacking in all of these respects. Allscripts’ product is currently being used by some of the most prestigious organizations in New York, we offered substantial cost savings over the life cycle of the project, and we committed to creating more than 100 new technology jobs in the City. Had proposals been evaluated properly, we believe that our offer was clearly the best value for the City. Our goal remains the same: We want transparency in the process… we want the bid process reopened so that the competing proposals can be reviewed fairly, consistently and side-by-side to ensure that the taxpayers of NYC obtain the best value Electronic Health Record solution.

Communications. Combine the following medical, cultural, and technical TLAs and FLAs  into a meaningful sentence. You may use one pronoun, one verb, two prepositional modifiers, and a gerund.  Ex: IMHO, CMIO NCQA PCMH FAQs without LOINC, HL-7, or SNOMED FYIs were DOA and SOL. SNAFU. 

PS: if you know all these, you do not need to complete the rest of the test.

1. SQL, LOS, CMS, PDQ, CDS, MSSP, MRSA, TIN, RAC
2. HTML5, CVA, TJC, CFO, FYI, CXO, EDW, HIE, AKA
3. CPOE, CTO, SOL, HIPAA, ACO, TIA, IMHO, GOMER
4. PERL, TWAIN, ACA, VTE, PHR, CAPTCHA, POS, POC

Patient management. Who will have the most useful problem list?

1. Five different hospitalists, NPs, and nurses using a combination of ICD9/10, SNOMED, and homegrown synonyms, with no one in charge
2. A 70-year-old GP using free text
3. Surgeon – two items for 84-year-old ICU patient
4. Neonatologist — 27 SNOMED items for a three-day-old
5. Patient’s PHR

Training. Which of the following techniques works least badly?

1. Day-old pizza and handouts in the lunch room
2. Department meetings at 7 a.m. on a Monday
3. E-mails from people no one has heard of
4. At-elbow support by people who just heard about  the project yesterday

Leadership. You have 15 hospitals over four states. Which model of leadership works best?

1. Central (disconnected, jet lagged, and intermittent)
2. Local (random, quirky, and adversarial)
3. Democratic (but only certain people can vote)
4. A CMIO with no direct reports, graded on “influence”

Fill in the correct phrase or words.

1. CFO is to Budget as Sphincter is to __________.
2. Twitter is to Communications as Static is to ____________.
3. Regulation is to Efficiency as Friction is to ____________.
4. ACO is to HMO as Deja vu is to ___________.

Order management. You are leading a CPOE installation and want to use the latest evidence-based guidelines. What is the right approach?

1. Call a meeting of department leads, take two years, then make them up yourself
2. Use third-party content, send to department leads, wait six months, then make them up yourself
3. Use your paper-based content and sneak in the latest content with the one guy who comes to your meetings (i.e., make them up yourself)
4. Google

Support. You are stopped in the hall and asked to design a new system that will save this physician maybe 2 –3 clicks a week, but will take your team at least two months of design, development and testing, two more months of training the entire staff, along with disrupting everyone else’s workflow. What is your response?

1. Ask them to send you an e-mail describing the effort, knowing that they are “too busy” to get around to it
2. There is no other correct answer

Software selection. You have been asked to select a new EMR for your 200-bed hospital. What  are the first steps you should take?

1. Change your bed number to 500 so Epic will talk to you
2. Watch the Cerner salespeople twitch when you ask one of them to demo the entire “standard implementation”
3. Read KLAS, develop detailed requirements, do reference visits, then cave in to the most powerful docs (that couldn’t be bothered to come to demos) because they heard that System X was hard to use
4. Go to HIMSS for wine and dine, then play spin-the-pocketbook and pray you get the “mature” implementation team promised by a sales guy you will never see again

Statistics. Which of the following principles are true?

1. Pareto principle – 20 percent of the producers will make 80 percent of the product, but they will not be paid like it
2. Death panel principle – 5 percent of the population consumes 50 percent of the costs, but you can’t do anything about it
3. Incentive principle — the other 80 percent (see Pareto) will spend more energy gaming the system than producing
4. Software development principle – 3 percent of the use cases will drive 80 percent of the timeline delays

Meetings. As CMIO, you are invited to a 2.5 hour mandatory budget meeting. What is your response?

1. Attend with iPhone and iPad charged and catch up on e-mail
2. Dial in while getting work done from your office, knowing that the CFO’s secretary will not be able to figure out the teleconference link
3. Attend, listen closely, and wait for the moment when a physician’s fiscal wisdom will be most appreciated
4. CMIOs do not get invited to budget meetings, and if they do, that is when you use the spam filter excuse.

Alerts. What is the most effective method of providing meaningful alerts to busy clinicians?

1. Goldilocks – community-based balanced approach that will still get you eaten by the bears, and the “ community” will be nowhere around
2. Overalerting — as determined by docs who just want to know when they are definitely going to kill someone
3. Underalerting — as determined by your legal representation
4. Individually tuned for relevancy, with actionable orders easily accessible within the order, highlighting only important info that you didn’t know and makes a difference in this unique patient (available in the next release)
5. Horror stories in the physician’s lounge

User interface. Which of the following is the most effective modality for communicating key clinical information?

1. A 24-inch LCD monitor with 5,347 elements in three-column view, vertical scrolling, and 23 colors
2. An iPhone with no information on the top screen, but multiple branching links which will eventually lead you to YouTube
3. An angry nurse that  you have not returned pages to for over an hour
4. An intern whose pre-med major was theatre arts

13.  Pa55Words. Which of the following is optimal policy?

1. Same password for all your applications “HckerPLsDoEmails2OK?”
2. Four factor – iris scan, voice profile, 10-character randomly generated password changed every three months, with RFID embedded chip, Comrade
3. Three strikes, you get pepper spray
4. Prefilled sticky notes attached when shipping monitors

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

HIStalk Interviews Yann Beaullan-Thong, CEO, Vindicet

Yann Beaullan-Thong is CEO and founder of Vindicet.

Give me some background about yourself and about the company.

I’m the founder and CEO of Vindicet. We started the company in 2009. Prior to that, I was the vice president of e-business at Aetna for a division called Intellihealth. It was the first public healthcare website prior to WebMD.

My intention when I started the company was to create a software company that would provide affordable, process-oriented solutions to providers. In 2009, I met Dr. John Votto, CEO at Hospital for Special Care and a thought leader for long-term acute care hospitals. I was asked to provide a system to make the referral process more efficient.

As we started to build a patient referral tool, I took the bet that bundle payments and ACOs will be here to stay and will need systems to support these new business models. We morphed our referral tool into a coordination tool to manage the patient through the continuum of care.

Who does the company compete with?

Indirectly, we can compete with a lot of other players, like Curaspan, Cerner or Allscripts. The patient management process, the referral process, the compliance process , the admission and discharge process are supported by many vendors. They are part of the problem — too many vendors supporting different processes at the facility level.

We are the only system that can support all these processes for the ACO or enterprise health system level using one platform. We are able to provide a safe transition care tool using a light Enterprise Resource Planning approach.

Describe the referral process as it exists and how you think it will look under the new models of care.

Today with a fee-for-service payment, each facility operates as an island. Referrals are no more than a discharge to home or a post-care facility. Moving forward with ACOs, the referral is becoming a central component. The financial compensation will be tied to the overall outcomes. Tracking the patient through the entire continuum of care and managing the coordination of care between the different providers will be essential to optimizing outcomes.

Let’s assume that a patient comes in for congestive heart failure and they are a Medicare patient. We know that out of 10 patients, five to six might will end up into a post-care facility. Suddenly everybody has to be very well aware of how well they’re going through the entire episode. Not just from the acute side, but when they are discharged to a long-term acute care and then moved into an inpatient rehab center and finally discharged home under the supervision of a home health agency.

Under a bundled payment model, you’re going to be responsible for that whole episode. Under this coming model, absolutely nobody is prepared to deal with this new challenge.

Initially, we designed a referral system for standalone post-care facilities. Through the years, we modified it to become a multi-facility transitional and coordination care system. Our unique approach allows us to integrate the enterprise coordination process with patient management and compliance reporting.

Do you see new companies starting to try to do what you’re already doing?

There are a lot of companies that are coming to the space, but we are about 18 months ahead. We have been approached by some large companies, very large payers who are looking into the ACO space.

I am looking to make the coordination of care more efficient between providers, including primary care physicians. I would say that the problem I’m trying to resolve is transitional care. An EMR is not solving that problem. An EMR is designed to provide care at the delivery point. It’s not designed to manage care across providers.

It’s interesting, because when I started the company about three years ago, a lot of people were asking me to build an EMR. My answer was, “There’s plenty of EMRs. The last thing you need is another one.”

Also, talking to CEOs and CFOs, I often hear, “OK, now that we have an EMR, we need to integrate with the ambulatory care services and post-care facilities.” And in the same breath, they will say, “We are running out of money with this EMR project.” Literally people are looking at each other around the room and saying, “How are we going to do this? How are we going to pay for it?”

Either you build what I call islands — EMR for post care, EMR for ambulatory care, and for acute care — and spend a ton of money to add the bridges. Or, let’s look into a system that will allow us to have one view of the patients across the continuum. That’s when I come in with my poor man’s solution.

Do you think providers believe that HIEs will provide that capability or that interoperability is the answer? Are they beginning to realize that just talking to other systems may not be enough?

Executives are starting to realize that it’s not as easy as it sounds to integrate legacy systems. HIEs don’t address the process issues. Also, I’ve noticed a trend of information overload. It is not just pulling the information, but making it relevant and usable.

The other riddles that need to be solved when we’re talking about the HIEs — besides the exchange of information — is integrated process. You’d have to integrate various processes if you’re going to go through a longitudinal-type of continuum of care. It’s not just tracking the information at each point of care with different providers. You need a seamless process on how you can move a patient from one place to the other.

Do you think providers are ready not only technologically, but as you said process-wise, to be able to function effectively in that kind of environment?

I’ll try to give you a response that is apolitical. I’m absolutely convinced in my fiber that as a country, if we don’t resolve our healthcare problem, we will go bankrupt. We’re already at 16 percent of GDP.

If you’re going to do reimbursement based on outcome, which is where the industry is going (the Kaiser model), we are going to need to collect a lot of data and use key performance indicators to increase efficiency. We are already there. 

I just built a CMS data quality tool for 17 long-term acute care hospitals where they had to report outcome within 24 hours for discharges and within four days when it comes to admissions,. They need to report outcomes to the government in order to avoid the 2 percent penalties.

Moving forward, the government is going to ask for more data. Collecting data is a very expensive business. Healthcare systems out there are struggling to implement an EMR system, and now we are asking them to track outcomes through the different providers. Most of providers have no funding left following an EMR implementation, and now we want them to fund projects to track patients across the continuum.

I guess hospitals aren’t happy when they have to come to you, then?

They’re not, but I came up with a value proposition that makes the solution affordable. A lot of clients tell me, “How do you make a living with the way you’re selling it?” I say, “Don’t worry. I’m OK.” I moved away from the licensing per bed to unlimited number of users. It’s time as an industry to think out of the box and come up with solutions that are affordable.

Will other vendors get that model of following a long-term strategy rather than just charging the absolute most they can?

I think they will have to. One of the reasons why I believe that system is going to do well is transparency. I truly believe that transparency will exist in healthcare. I come from a payer and they’re probably not the most transparent players, but they have the tools to become more transparent.

They are data-driven companies. I learned one thing. If you want to be efficient, you need to change your mindset from being non-profit to a mindset of better outcomes in order to stay in business. You need to be transparent. You need to be transparent in front of the patient. You need to be transparent with physicians. I think as an industry, it’s time we start to be transparent. If we do not become transparent, we’re going to go broke, period. It cannot stay the way it is.

I think there’s a movement out there toward change. All of us recognize that there’s need for a change, and I think the change will come from the outside. I always say when an industry has a problem, the answer is not within. Usually the guys that start to find the answer are guys that come from other industries.

Any concluding thoughts?

As an industry, in healthcare, we need to change our mindset from a non-profit mindset to what I’m calling for-profit, where we’re going to be more accountable. To be more accountable, you need to collect data. To collect data, you need to build systems that implement new processes. I envision healthcare facilities being managed like a Walmart by the minute to keep costs down.

When I go to see CFOs in hospitals, they manage their business by quarter or a year ahead. There’s a need to manage your business by the minute. To get there, we need to start to collect data. Not just clinical data, but financial data and administrative data .We need to create key performance indicators, or KPIs. If you don’t run the business according to KPIs, there’s no way in the world that you’re going to change the way you are operating.

The government is probably going to make people more accountable and switch from fee-for-service to pay-for-performance. However, we’re a long way from being efficient. I see  government mandating more and more data collection for compliance. As an industry, that’s where we’re going. Whether you’re from the left or the right doesn’t matter. Accountability is the buzzword. I think it’s going to force the entire industry to learn to do more with fewer resources.

Time Capsule: Community Physicians and Technology: Think Convenience Store Owner, Not Society-Minded Scientist

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in February 2008.

Community Physicians and Technology: Think Convenience Store Owner, Not Society-Minded Scientist
By Mr. HIStalk

I have had the magic revelation. I know now why we healthcare IT people can’t figure out the seemingly puzzling behavior of small-practice doctors when it comes to technology adoption.

Here it is. Once they hang out a shingle, they’re no longer society-minded scientists. They’re small business owners.

The next time someone talks about physician practices, replace that term with “convenience store owner.” They’re on every corner, they compete vigorously for business, they watch expenses with an eagle eye, and they pay themselves only after everybody else gets paid. And unlike convenience store owners, they have to deal with insurance companies who tell them what they’ll get paid and hammer them with a mass of ever-changing regulations.

They’re also going to look at IT a lot differently than doctors in hospitals. Or especially, than hospitals themselves. Any money they spend on IT comes out of their own pockets. Any help they need doesn’t come from the friendly IT department — they have to find someone and pay high rates for even simple tasks, like installing a PC or figuring out connectivity problems.

Technology cheerleaders get frustrated that docs don’t just buy systems and get with the program so everybody can benefit. The problem is that everybody doesn’t benefit. Doc has just made a donation to insurance companies, patients, and hospitals who all appreciate the boost in their well-being from his or her investment. That doesn’t even include the extra time required to maintain electronic documentation, which always takes longer than scribbling. Physicians have just one thing to sell: time. They protect it strenuously, as they should.

We hospital types forget that 90 percent of a general practitioner’s time and even more of his or her income comes from their small business. Seeing patients in the hospital is a cost of doing business, not the day’s focus. While the hospital folks are going to meetings and delivering care as part of a big team, Doc’s out there on the front lines taking all comers, armed only with a few minimally trained assistants and whatever’s in his or her head, trying to improve health and provide a positive customer experience in an average of six minutes per visit.

The people they deal with in hospitals have, for the most part, never run a small business. They’ve always worked for someone else. The world looks a lot different when the only employer who’ll take care of you is you.

From an economic standpoint, doctors are paid to work. If we’ve got some kind of beef about excessive use of diagnostic procedures or esoteric treatments, we need to stop paying for them. That convenience store owner will sell you cigarettes and beer that are bad for you because (a) you want them, and (b) it adds to their bottom line. There’s a word for those civic-minded C-stores that stop selling them on principal: defunct.

Doctors are pretty much stuck in the small business model. The problem is that we’re expecting them to hold hands and join the choir even though they’re struggling to keep the doors open given rampant competition, reduced payments, and a fickle market.

I’m making a point to think twice before ripping doctors for not jumping all over e-prescribing, pay for performance, or interoperability. Unless you’ve got a rock-solid argument that would convince a convenience store owner, you’re wasting your time.

KLAS Releases 2012 Best in KLAS Awards 12/14/12

Epic takes top honors for Overall Software Vendor,  Overall Software Suite Vendor, and Overall Physician Practice Vendor in the 2012 Best in KLAS Awards.

Epic sweeps eight Best in KLAS award categories and athenahealth receives the second most Best in KLAS wins. Impact Advisor was named the number one Overall Services Vendor.

News 12/14/12

Top News

Allscripts files suit against NYC Health & Hospitals along with Epic Systems over the $303 million contract HHC awarded to Epic in late September. The complaint says the award is “arbitrary, capricious, an abuse of discretion, and lacks a rational basis” because it claims Epic’s proposed cost is $535 million more than that of the Allscripts proposal. HHC says it will defend its decision and added, “Allscripts’ claim that it underbid Epic by more than half a billion dollars is absurd and strikes us as an ill-fated attempt to reassure investors and inflate its sagging stock price. Unfortunately, as our multi-year review has revealed, Allscripts lacks a truly integrated EMR solution and has repeatedly lost business to Epic and other vendors as a result.” MDRX shares closed Thursday at $10.80, down 2.44 percent and indeed sagging at less than half their February price.

Reader Comments

From Bain Marie: “Re: Allscripts sore loser lawsuit against New York HHC. They had to deal with Hurricane Sandy and now will spend a fortune to defend themselves against Glen’s bizarre public accusation that its prospect would pay almost anything to avoid buying its product. Would you say this is the dumbest move in HIT history?” It’s certainly in the top handful, and probably the undisputed #1 in the “desperation” category (HBOC’s frenzy to mate with McKesson was even more desperate, but Allscripts wins on style points for suing a non-profit hospital.) I won’t editorialize further since Allscripts employees, shareholders, prospects, customers, and potential acquirers (if indeed any are still interested) are probably already amply embarrassed by this latest in a string of bad company decisions that always send competitors running gleefully to the scanner to make sure prospects get copies. That’s my opinion. If you work for a hospital, especially one with Allscripts connections, I’d like to hear yours. If you work for Allscripts, I’d be even more interested.

From Nasty Parts: “Re: Mike Lovett. Promoted to replace Scott Decker at NextGen.” Unverified. His LinkedIn profile shows a new job of SVP/QSI Division Leader – Ambulatory Division.

From  Kaiser Surgeon: “Re: video by KP ambulatory surgery staff at Fremont Ambulatory Surgery Department. They are well known for high-volume cataract surgery on our Kaiser patients. They do seem to have an esprit de corps.” I’m always a sucker for hospital music videos like this one.

From Former Stanley Tool: “Re: Healthcare Informatics Associates. Stanley Healthcare Solutions is shutting it down.” Unverified, but searching LinkedIn finds at least one former employee who is freshly entering the job market.

HIStalk Announcements and Requests

If you have been busy holiday shopping and missed reading HIStalk Practice this week, here are some highlights. Two-thirds of EPs will apply or have applied for MU incentives. ONC says that more office-based physicians are using EHRs that have higher-level functionality to meet MU objectives. ED use declines when patients have access to after-hours service from their primary care provider. HHS offers tools to protect PHI on mobile devices. Physicians spend more time on health content-specific websites than any other health sites, though more are also visiting EHR portals. Epocrates releases a native app for iPads and iPad minis. Dr. Gregg pronounces the consumer the heir to throne of healthcare. I made the “nice” list again this year, but the only gift I need is a few more e-mail sign-ups on HIStalk Practice. Thanks for reading. (P.S. If you are a shoe distributor, own a wine shop, or are a male admirer who likes to give expensive jewelry, please disregard the “only gift I need” statement.)

Welcome to new HIStalk Platinum sponsor RazorInsights. I’m guessing the Kennesaw, GA-based company found HIStalk because I’ve run several non-anonymous hospital reader comments about the company’s ONE Enterprise HIS for rural, critical access, and community hospitals. It offers a single-database, certified, cloud-based hospital EHR. Every one of the company’s live hospital clients have earned Meaningful Use payments. Customers enjoy one database, one simple user interface, and capabilities that include a master patient registry, patient encounter management, nursing documentation, CPOE, and physician offline orders. It’s available in multiple editions that include clinicals only, clinicals plus financials, clinicals plus ambulatory, and the Enterprise Edition including all of those. Customers can go live in as little as 90 days, enjoying cost-effective training services and around-the-clock support. People always bemoan the lack of new companies and new, scratch-built technologies in the inpatient EHR business, so here’s one for you. The company’s management has plenty of industry experience, including folks with pharmacy and nursing degrees along with vendor experience. To learn more, sign up for a live product webinar on their site or check them out at the HIMSS conference in a few weeks. Thanks to RazorInsights for supporting HIStalk.

I always head over to YouTube when introducing a new company just to see what’s out there, so here’s an introductory video from RazorInsights. You’ll get a hint about the company’s name early in the video, although you might have to Google the reference like I did.

It’s an odd time of year to be swamped at the hospital and at HIStalk, but that’s the case. I work on HIStalk until at least 10 every night and I’m back in the same chair by 5 the next morning before I head out to work. I try to respond to requests quickly, but it often doesn’t happen, and re-sending the e-mail or expressing indignation doesn’t change my time constraints one bit. I usually catch up over the weekend, though.

Acquisitions, Funding, Business, and Stock

Cerner will repurchase up to $170 million of its common stock.

Global Record Systems acquires the eCastEMR platform and service business from eCast Corporation.

Streamline Health Solutions reports Q3 results: revenue up 51 percent, EPS –$0.11 vs. $0.03.

LocalMed, a patient self-scheduling software company that won $3,500 in seed capital from the LSU Student Incubator, will establish its headquarters in Baton Rouge, LA and plans to hire 52 employees by 2016.

Sales

Sales Battle Mountain General Hospital (NV) selects ChartAccess EHR and FinancialAccess from Prognosis HIS .

HealthInfoNet, the HIE for Maine, signs a three-year agreement with Arcadia Solutions for its Analytics and Quality Data Warehouse platform for clinical data warehousing. Aracadia will also test the linkage of the HIE’s clinical data with claims data from the state’s All-Payer Claims Database.

People

The Brooklyn Hospital Center (NY) names Bill Moran (Dell) SVP and CIO.

Lisa Rawlins (Broward Health) joins SRG Technology as director of health care.

Norman Joseph Woodland, who co-invented the bar code as a graduate student in 1951, has died at 91.

Announcements and Implementations

Joslin Diabetes Center (MA) will use de-identified clinical data from Humedica for education and research activities.

Government and Politics

ONC launches a mobile device security initiative that provides white papers and articles to help providers understand how to protect patient information on mobile devices. The site is a product of HHS’s March 2012 Mobile Device Roundtable along with tips and information contributed during its 30-day comment period. Included is a video titled Worried About Using a Mobile Health Device for Work? Here’s What to Do!
 

Technology

AT&T unveils a prototype of Asthma Triggers, a wireless sensor that sends air quality data to mobile devices.

Other

The Leapfrog Group, criticized by hospitals to which it assigned below-average patient safety grades last month, announces a partnership with Johns Hopkins Medicine to fine-tune its scoring methodology, also vowing that, “the Hospital Safety Score is here to stay.”

More than half of HIT professionals report a budget increase for information security, according to a HIMSS survey. Other key findings:

• Most hospitals are conducting risk analyses, with 71 percent performing an analysis at least annually
• One in five respondents say their organization experienced a security breach in the last year
• More than half the organizations spend three percent or less of their IT budget on securing patient data
• Two-thirds report that their organization conducted an audit of their IT security plan.

Paper medical records belonging to a recently raided and closed unlicensed pain management clinic in Florida are found in the dumpster of a nearby Dollar Store. Also found in the trash: used syringes and uncashed checks made out to a contracted pain doctor who was apparently being paid $1,500 per day to crank out oxycodone prescriptions.

Tampa General Hospital’s bond ratings agency calls out the hospital’s “compressed profitability” as being due to Epic implementation costs, lower inpatient utilization, and state Medicaid cuts.

Weird News Andy continues his armchair medical reviews with this article, in which Children’s Hospital of Philadelphia injects a disabled form of HIV into a six-year-old whose leukemia was expected to kill her within two days, hoping to stimulate her immune system enough to allow her to receive a bone marrow transplant. Six months after the infusion, the T-cells are still working and she’s in remission.

Sponsor Updates

• Mercy Regional Health Center (KS) expands its use of the Access Intelligent Forms Suite into its human resources department.
• Vitera Healthcare announces the general release of Live Chat, which provides customers with immediate online access to Vitera customer support.
• Surgical Information Systems enhances its perioperative information systems to provide interoperability with Siemens Soarian Clinicals.
• Agilum Healthcare Intelligence publishes a white paper that includes strategies to help small and mid-sized hospitals overcome common obstacles to obtaining useful business intelligence.
• Levi, Ray & Shoup sponsors this week’s Next Generation Healthcare Summit in San Antonio.
• Emdeon discusses the benefits of utilizing check reader devices at the point of service in a newsletter article.
• Adirondack Radiology Associates (NY) shares how it has increased coder productivity and reduced denials since implementing the Optum Computer-Assisted Coding solution. 
• API Healthcare’s Deborah Moore shares thoughts on the use of HIT to increase quality of care and patient satisfaction in a blog post.
• Informatica offers predictions on where technology is heading in 2013.
• Fourteen CareTech Solutions customers win a total of 20 eHealthcare Leadership Awards for their CareTech-designed websites.
• RSource, a provider of receivables management recovery solutions, and Streamline Health Solutions will cross-market each other’s services within their client bases.
• Winthrop Resources Corporation will offer equipment financing and advice to customers of MPC, an IT asset lifecycle management company.
• The British Columbia Ministry of Health selects McKesson as the vendor of choice for its radiologist peer review initiative.
• First Databank and JAC Pharmacy sponsor the Improving Patient Safety award at the NHS Isle of Wight Awards 2012.
• NextGen Healthcare will offer Aviacode’s cloud-delivered medical coding services to its customers.

HIStalk Interviews Winjie Tang Miao, President, Texas Health Harris Methodist Hospital Alliance

Winjie Tang Miao is president of Texas Health Harris Methodist Hospital Alliance of Fort Worth, TX.

Tell me about yourself and the hospital.

I’ve been in healthcare for about 12 years now, all with Texas Health Resources. I guess it’s rare nowadays to be with an organization that long. THR is a faith-based, not-for-profit healthcare system in the Dallas-Fort Worth area. We have about 25 hospitals, a large physician group, and other healthcare services.

In my 12 years, I’ve been really privileged to work in three of our facilities, but most recently at Texas Health Harris Methodist Hospital Alliance, a brand new hospital that just opened in September.

When you look at the organization’s overall positioning and strategy, how important is IT?

I think it’s essential. Our stakeholders are demanding more of us, “us” being healthcare and the healthcare industry as a whole. We need technology to help us met their expectations of us, and honestly, our own expectations of ourselves.

Do you see the technology becoming more visible to patients or becoming more of a competitive differentiator?

Yes, I think it’s definitely already more visible to patients. For example, in our facility, we have technology now where you can look at your medical record in real time while you’re lying in your bed. You know what the physician has ordered for you in the morning and the afternoon. 

The education that’s been ordered for you now gets automatically pushed out. If I’m a congestive heart failure patient and I require some smoking cessation education, for example, technology enables us to make sure that patient gets that education and that they receive the education as documented in real time. All of that is direct technology that the patient sees.

I think there’s a lot of technology, though, that is really there to enhance the human capacity that patients may not necessarily see. Those are some of the things that I’m most excited about. How do we make the environment more user friendly for our caregivers, our physicians, our nurses, and all the staff that are at the facility? Because as we know, as the baby boomers retire, the workforce is going to shrink. We really need that technology to help bridge that gap.

In terms of being a competitive edge, I think there are certain parts that are going to be non-negotiable. I think an EMR is going to be non-negotiable. You’re going to have to have it, so I don’t think that’s a competitive edge. But I think having some other technologies — like proactive tools that will help improve management of chronic conditions and those type of things — would be a competitive edge.

What is the most innovative of the technologies that you’re using or planning to use?

What I would say is innovative is not necessarily the technology in itself. We do have a patient information device. We do have RTLS throughout our facility. But it’s not the technology that is innovative for me.

I think what is innovative in this particular facility is how we’re integrating all those technologies together. How does Vocera talk to RTLS and to nurse call? How does that mean that, OK, now that I have I have a patient discharged, I can just take their RTLS locator tag, dump it in a box, and because it’s in that box, it automatically sends a note to TeleTracking to say, “Now it’s time to clean this room.” The housekeeper on Vocera automatically gets notified because through RTLS, we know that that’s the housekeeper on that floor. A process that normally would take either multiple phone calls or multiple clicks on a computer is now automated in real time.

As a new facility, you’ve probably had conversations with vendors about what technology you’re going to use and how you’re going to use it. Is that different from what the other Texas Health Resources hospitals use?

I think the extent that we’re integrating all the technology is more than what other Texas Health facilities have. That required many vendors to come into the room and have a conversation that they’ve actually never had. Vendors who had never met each other, even though we’ve had their systems in some of our hospitals for years, because it was very siloed. We bought the nurse call system or we bought the Vocera system or we bought Epic or whoever it was. We bought these systems, we implemented them vertically, and then we integrated them horizontally. 

There were a lot of vendor meetings that we had. In fact, as we were choosing what systems to go with, one of the most essential criteria that we made the decision on which vendors to go with was either past history and experience that they could demonstrate a
successful collaboration and integration or a willingness that they showed to be able to do that.

Is the IT support centralized, do you have some IT people locally in the hospital, or some of both?

All of our IT is centralized at the system office. From the system office, there are certain members of our IT team that are deployed locally.

What expectations do you have of the IT department and the folks leading it?

I have the same expectation that I have of any leader in the organization, which is one of collaboration, transparency, communication, and all those good things.

In terms of specific IT leaders, though, I’ve had the opportunity to work with a variety of IT leaders in my career. I think that what separates the good IT leaders from the exceptional IT leaders are the ones who are able to balance that creativity and desire to be on that leading edge and try new things with an understanding of hospital operations. Having that knowledge, having the common sense, and really sometimes the humility to say, “You know what? That’s a great technology. I’d love to put it in, but it really doesn’t make sense for us, and here’s why.”

In terms of the risk involved with being innovative, is there conclusion about how much IT innovation is the right amount?

I really think it’s based on the culture of the organization that you’re in. Implementing new technologies and being innovative is really about change management. If you have a culture that is used to change, open to change, wants that change, is able to function still and maintain high performance while going through change, then that organization, I think, can tolerate more innovation.

In an organization where perhaps you don’t have as talented of leaders, both from the IT and the operational side, to manage that change through, then it doesn’t matter if it’s even the smallest of innovations, managing that is going to be difficult. You’re not setting yourself up for success. I think being able to gauge the level of tolerance in an organization is important, but for those who have that capacity, then I think go for it.

Between the operational leadership and the IT department, who should look for something innovative and who should lead that change if and when it happens?

I hate to give “it depends” answers, but I think it depends. [laughs] When I look at how we created this facility and all the technology that we’re integrating, some of the best ideas came from the IT side and some of the ideas came from the hospital operation side. It’s really a blending of the two.

I think ultimately deciding whether or not to pull the trigger on a specific technology requires everybody at the table. Then once that decision is made, clear delineation of roles and responsibilities for that particular technology, because again, all technologies aren’t created the same, either. 

You may have something like telephones. We made a decision to go with a particular platform. While that’s really read better from the IT side, it’s not as invasive from a clinical standpoint, Obviously we all need telephones, but it doesn’t require a whole lot of clinical expertise to do telephones. We just need to make sure they’re programmed correctly so the clinicians use them properly. But you take something like Vocera or nurse call or AirStrip OB, which is much more clinical, I think the ratio changes. 

I think having a “one process fits all” solution is unwise. I’ve seen that happen sometimes. I think that’s where the roadblocks come in and some organizations have run into trouble. But to really look specifically at the innovation, and for this particular innovation, what are the roles and responsibilities going to be? A strong PM does that and can manage that through the organization for a successful implementation.

In large health systems, the smaller facilities or the bigger ones or the ones that are furthest away sometimes feel they’re not getting the right amount of IT attention. What’s the IT secret to making sure that you’re engaged and feeling like you’re well served as part of an organization that has several people who want those same things?

It’s funny you ask me that question. I mentioned that I’ve been with Texas Health for 12 years. I’ve been at one of our largest facilities — it’s 850 beds. In fact, that’s where I started my career. Then I went to literally the smallest facility in our system, which had 36 beds.

What I’ve always said is I think the key to success from an IT standpoint is understanding that smaller facilities don’t have less needs, they just have different needs. I say that from a management standpoint, too.

I remember being in a larger facility early in my career. I’d  look at the smaller facilities go, “Gosh, they have it so easy. They only manage this and it’s a small patient population. Of course they’re outcomes are great, because they only have 18 patients to manage compared to the 800 that we’re managing here.”

And I remember when I first got to the smaller hospitals, I’d look at the larger hospitals and think, “Gosh they have it so easy. They have all these layers of support and people that just do education. Whereas at the smaller facilities a lot of times, the managers take on additional roles and wear multiple hats because you can’t have a million FTEs taking care of 36 patients.”

When I had those two experiences, I remember one day sitting back and going, “It’s not that one job is easier or harder than the other,” which is the perception when you’re in those facilities. They’re just very different jobs. I think from an IT standpoint, it’s the same thing. The needs aren’t less, they’re just different. The good IT leaders can go in and understand what those needs are and deliver on those.

I would think it’s unusual for someone with a degree in biomedical engineering to be in a leadership role. Do you think that gives you more affinity with the IT operation or are you an outlier among your peers who went through a more traditional undergraduate program?

I would say that I’m definitely an outlier amongst my peers. I’m not familiar with any of my peers who have an engineering degree.

I think that having an engineering degree and understanding systems and processes and being trained in that gives me less angst in terms of dipping my toe in the technology waters, because I have a little better understanding of how things work. Clearly I’m not a computer programmer — the last time I programmed was in C++ , so that’s definitely not something you want me doing [laughs], but at least the philosophy behind that and how it works. I think the mystique is maybe less and so the apprehension is less.

You went through a construction project, which forces you to be as innovative as you can knowing that you’ll be stuck in that footprint for a while. What are some of the innovations in the new facility that would not have been common in older facilities?

I think that if you look at older facilities and facilities that were planned 20-30 years ago, most healthcare was provided in a hospital or in a doctor’s office. You sought healthcare because you were sick.

Today, your healthcare happens in a variety of environments — from your home thanks to telehealth, to the doctor’s office, to even your local drugstore. Walmart now has minute clinics or different things like that. Or you go to a surgery center or a freestanding lab. There’s a lot more venues now to deliver healthcare.

We understand that we need to optimize well-being in order to really control healthcare costs, not just take care of people when they’re sick, which is what we were focused on doing 20-30 years ago. For us, designing a new facility was trying to design a system where care is rendered where it makes the most sense. Going back to that engineering background that I have, how do you optimize the system, both from a cost and a convenience perspective? 

In our facility, for example, we don’t have a large outpatient imaging area because a hospital isn’t the most cost-effective place to the get that service. In our facility, we have a separate ambulatory surgery center that’s wholly owned as part of the hospital. We did that for two reasons. One, patients don’t want to pay a high hospital deductible in order to have some-day surgery. They want to pay whatever it is on their plan, $250 co-pay and have their surgery and go home. But a lot of times, we’re still doing those outpatient surgeries in a hospital.

Secondly, I can build that surgery center space at significantly less cost than I can build hospital space. I’m not going to get into the details of why that is, but that’s just how it is. If we know that we can deliver that care in a more efficient setting, we’re going to do that.

And of course, technology has played a big part in building design as well. The most obvious example is the first hospital I worked in had a medical records department the size of a football field. At our facility, we have a fully deployed EMR, so we didn’t build medical records storage at all. We get to use that space for other things. Those are just a few examples.

In that planning of what the future looks like, both healthcare in general and your organization and your facility specifically, what are the most pressing opportunities and threats looking five to ten years down the road?

I think the biggest opportunities are being creative and developing those new processes and systems to address things like coordinated care across the continuum. As we move towards managing the health of populations and ACOs, what does that look like? Do we build that? Do we partner with somebody who’s already an expert in that? Do we acquire that? How does that all work together? 

Getting to create something new in an industry is fun and exciting and a great opportunity for a lot of innovation and growth. I think the challenge to that, though, is that our current reimbursement system is still build on that per-click system. We take care of you when you’re sick, and when you come to my hospital and you need your appendix taken out, I get paid for that appendix to be taken out.

What we need to be careful of is that as we transform our organization and as we optimize health and well-being, that the timing is appropriate and sustainable for the organization. 

The final wildcard which I’m sure everybody is aware of and throws out there is, we still do not understand the full impact of the Affordable Care Act. All that is still being developed and rolled out. How do we implement the exchanges and what are the rules for exchanges? All that good stuff is still coming, so I think that’s still a big wildcard.

What would surprise people most about what it’s like running a hospital?

I will tell you, what surprises most people that I talk to outside of the healthcare industry is that either (a) we do not employ our physicians, or (b) a physician does not necessarily run a hospital. People really think, “Oh, physicians don’t work for you in the hospital?” That’s really the thing that surprises people the most.

What do you like best and least about your job?

I think what I like best is that at the end of the day it’s very fulfilling and challenging work. It’s an exciting time to be in healthcare. There’s a lot of change going on. What we’re doing hopefully at the end of the day improves the lives of the people in the community you serve. Having that fulfilling, big-picture goal drives me and sustains me.

In terms of what I like least, I think that just like anybody else, the parts I like least are the parts that aren’t necessarily value-added to meeting the goals of the organization and making necessarily our stakeholders’ lives better. Things that perhaps required from a regulatory standpoint, or certain things that we do that we have to do for governmental reasons.

Mediware Acquires MediServe

Mediware Information Systems announced today that it has acquired inpatient rehabilitation and respiratory services documentation systems vendor MediServe. Terms were not disclosed.

Mediware President and CEO Thomas Mann was quoted as saying, “Most analysts agree that the percentage of care delivered outside traditional hospital rooms will continue to increase over the next 20. To meet these growing needs, Mediware has aggressively pursued technologies that improve the effectiveness of these organizations, looking to improve quality and efficiencies while lowering costs. Our expansion into home infusion, home medical equipment, and home health are examples of this strategy.”

The Chandler, AZ-based MediServe has 2,500 facilities as customers and has been in business for more than 25 years.

News 12/12/12

Top News

WebMD Health Corp. will eliminate 250 jobs, or about 14 percent of the company’s workforce, in an attempt to reduce operating expenses by about $45 million. The company has suffered declining ad and sponsorship revenues and its stock price has fallen 63 percent since the start of 2012.

Reader Comments

From Former MCK’er: “Re: Dave Souerwine, president of McKesson Provider Technologies. Gone and ‘pursuing other opportunities,’ according to an e-mail sent to employees Monday.” Several readers forwarded the internal e-mail from McKesson Technology Solutions EVP/Group President Pat Blake, to whom Dave’s former management team now reports. I confirmed Dave’s departure with a McKesson spokesperson: “After an intense period of execution and putting McKesson Provider Technologies on a positive strategic course, Dave decided to leave to reassess where he wants to spend the remaining time of his career. Dave played a key role in our Better Health 2020 strategy working with other presidents across our Technology Solutions businesses, and those efforts will continue as we focus on helping our customers prepare for the complexities of health reform.”

From Unbarred: “Re: Epic’s lawsuit against a consulting firm. It’s an intellectual property lawsuit in which Epic claims tortuous interference, breach of contract, trade secret misappropriation, and other related transgressions. They say the defendants inappropriately logged into the customer area of Epic’s website to access an ambulatory training video. Epic wants all of its material returned and removed from any website on which it was loaded, along with punitive and actual damages.”

From The PACS Designer: “Re: IT convergence. With all of the mobile devices and desktop workstations accessing data of all types in daily activities, it becomes more important for IT management to control the platform running everything viewed by users. Microsoft realizes the need and is addressing the challenge by incorporating Windows 7 and 8 in their .NET Framework software. As more vendors migrate to Windows 7 and/or 8, the pressure will build to move towards Microsoft’s .NET Framework solution to enhance IT convergence.”

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum sponsor Ormed of Austin, TX. The employee-owned company’s product line includes financial management  (AP/GL, asset management); decision support (EIS, cost accounting, budgeting, dashboards); supply chain management; human capital (scheduling, HR, payroll, employee self-service); e-commerce transaction services; and accounts receivable. Ormed MIS decision support for healthcare includes Cyberquery information access, which delivers vital business intelligence information to authorized employees as graphs, reports, or spreadsheets. The fully integrated Ormed MIS software and Ormed X2 B2B portal help create efficiency, cost savings, and controls across the entire organization. The company has been working since 1989 to provide hospitals and other healthcare organizations with tools for timely and informed decision-making, cost-effective growth, and improved service and satisfaction levels, with over 5,700 software applications in use in the US and Canada (see the interactive user map, which lists its customers). Thanks to Ormed for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Sutherland Global Services will pay $184 million for the business process outsourcing unit of the India-based Apollo Hospitals Enterprise, which provides IT support services to more than 150 US healthcare organizations.

A Nuance Communications investor day presentation predicts a paradigm shift that will favor the company’s speech recognition and natural language processing products, observing that nearly every mobile device includes capabilities covered by a Nuance offering. Key product lines include the Dragon family, OEM versions of its speech recognition products increasingly being incorporated directly in computer hardware, voice-enabled televisions, and cloud-based speech recognition. Nuance’s healthcare division reports strong growth, aided by the HITECH act and relationships with EMR vendors such as Cerner and Epic.

Rothman Healthcare, which developed the Rothman Index for analyzing data points to identify hospitalized patients whose condition is worsening, renames itself PeraHealth and hires Stephanie Alexander (MedAssets) as CEO.

Kansas City-based Health Outcomes Sciences will relocate to Overland Park and expand from 13 to 37 employees in the next five years. The company, which is seeking incentives from Kansas state government for the move, offers the ePRISM clinical predictive modeling tool for improving outcomes. CEO Jim Wilson was previously president of Craneware and has worked for Cerner and Oacis.

The parent company of LifeCare Holdings, which operates 27 long-term acute care hospitals in 10 states, declares Chapter 11 bankruptcy to allow the company to be acquired by a group of its lenders.

LSU announces plans to form public-private partnerships for the operation of three of its hospitals, hoping the $12 million it will receive in advance lease payments will help it avoid the previously announced layoffs of hundreds of employees. The state announced similar privatization agreements for two additional hospitals in Houma and Lafayette as it dismantles its charity hospital system.

Sales

Duke University Health System (NC) will implement TeraMedica’s Evercore Smartstore and Univision modules for medical image management.

The University of Kentucky contracts with CSI Healthcare IT for project management and support services for current and future software applications.

Providence Health Care (BC) selects MModal Fluency for Transcription as the speech platform for all Lower Mainland Health Authorities hospitals and facilities.

North Oaks Health System (LA) selects iSirona’s device connectivity solution to integrate with Epic.

Cumberland Center for Healthcare Innovation (TN), a 29-practice ACO, will use clinical data analytics technology from Clinigence.

Sanford Health (ND) chooses Click Portal from Huron Consulting Group to manage HHS-mandated conflict of interest disclosure rules.

Sentara Healthcare (V) chooses Accalarad’s medical imaging solutions for its imaging centers and hospitals in Hampton Roads.

People

Clearwater Compliance hires Ashley Bampfield (Bampfield Communications) as director of marketing.

Cone Health (NC) promotes Steve Horsley to VP/CIO, replacing the retiring John Jenkins.

Ross Martin, MD, MHA (Deloitte Consulting) is named VP of corporate relations and business development of AMIA.

Jay Colfer (Prognosis Health Information Systems) joins Surgical Information Systems as sales EVP.

Phil Pead (Allscripts) is named president and CEO of application development tools vendor Progress Software. He was serving as executive chairman and interim CEO.

I interviewed Joseph Kvedar, MD of the Partners Center for Connected Health about his involvement with Wellocracy on HIStalk Connect.

Peter Cyffka (O’Melveny & Myers, House of Blues) is named CFO of Epic Systems.

The National eHealth Collaborative elects six officers including Janet Corrigan (National Quality Forum), Tom Fritz (Inland Northwest Health Services), Paul Uhrig (Surescripts), Bill Spooner (Sharp HealthCare), Michael Barr, MD (American College of Physicians), and Leslie Kelly Hall (Healthwise).

Announcements and Implementations

MaineHealth and Maine Medical Center go live on their $150 million Epic system, with which the organization hopes to qualify for $50 million in EHR incentives.

HIMSS names Mount Sinai Medical Center (NY) as the winner of the enterprise Davies Award. HIStalk sponsor Culbert Healthcare assisted Mount Sinai with the application process, including developing quality improvements measures and a return on investment model.

Bassett Medical Center (NY) goes live on Epic.

Community Health Solutions of America deploys Cognizant’s ClaimSphere HEDIS for compliance measurement and reporting.

Meridian Health (NJ) upgrades to ICA’s CareAlign Exchange platform, which includes Direct messaging, CCD repository, a patient identity manager and registry, HISP capabilities, and global opt-out for patients.

Oroville Hospital (CA), the first hospital to self-deploy the VA’s VistA, releases a self-developed, open source e-prescribing module under the name eRx VistA, which meets Stage 2 MU requirements.

University of Utah Health Care offers online access to its database of 40,000 patient satisfaction surveys, including comments about its 1,200 physicians.

Emmi Solutions announces EmmiPrevent, a population health management application that initiates interactive calls to patients to encourage then to take preventative action.

Government and Politics

National Coordinator Farzad Mostashari becomes a Blue Button user on behalf of his parents, finding that the straight download of claims data is hard to interpret even for a physician like himself. However, he finds that the iBlueButton app, which recently won an ONC programming challenge, does a nice job of reformatting the information into a usable list of problems, diagnoses, encounters, and treatments. In a suspiciously dramatic story, he reports that he downloaded the data Thanksgiving day, his father developed an emergent medical condition on Black Friday, and he was able to immediately share his freshly downloaded data with a specialist.

Innovation and Research

It happens every year right after the mHealth Summit concludes: an mHealth expert and advocate expresses frustration that the few clinical studies involving mHealth technologies usually fail to show any conclusive benefit, with most of the positive accounts coming from purely anecdotal reports. Or as NIH Director Francis Collins, MD, PhD said succinctly, "The plural of ‘anecdotes’ is not ‘data.’"

CardioMEMS, an Atlanta-based company that is developing wireless body monitors, wins the Intel Innovation Award.

An article in The Atlantic profiles a non-profit South Dakota "patient-less hospital" that provides long-distance critical care to rural hospitals in six states. Avera Health Network uses two-way video consulting to provide what it calls "hands in pockets doctoring," covering 60 percent of the ICU beds in South Dakota. They’re expanding to cover nursing homes and prison infirmaries. While the program reduces the cost of sending patients to major hospitals, it says its main benefit is to limit the decline of small, rural communities.

UCLA gastroenterologists test a program in which patients with inflammatory bowel disease are given free iPads to enter their information for remote monitoring by nurses. The software also provides education, a job coach function, mental health coaching, and even traffic reports for patient trips to the office. The UCLA Center for Inflammatory Bowel Diseases originally announced the program in September.

Technology

FDA is developing guidelines for how drug companies can promote their products using social media, but in the mean time, the manufacturers are finding new and unregulated ways to market their wares in potentially deceptive ways. Way back in 2010, the agency sent warning letter to Novartis for using a Facebook widget to market a leukemia drug by placing ads on the news feeds and profile pages of individual Facebook users.

Other

Epic seeks to buy an additional 38 acres of land from a zoned subdivision southeast of its existing 811-acre property. The company presented conceptual plans to Verona, WI city officials that include proposals for a fourth and fifth campus. Some residents expressed concern that Epic’s never-ending construction projects are encroaching on nearby homes and creating noise and traffic throughout the area, but others expressed support for Epic’s plan to reserve part of the land for a park and said the company at least makes a better neighbor than closely spaced apartment buildings.

A KLAS report covering business intelligence finds that the most significant impact of BI solutions involves knowledge dissemination and end-user adoption.

India launches its first cloud-enabled eHealth Center for delivering primary care in remote regions. It provides remote medical consultations and sends SMS-based patient reminders.

Russian hackers hijack and encrypt the electronic patient files of a clinic in Australia, demanding $4,200 to restore the information. Experts say the clinic doesn’t have much choice but to pay up in this latest episode of so-called ransomware, but warn that paid-off hackers often hit the same victims again to demand more cash.

Greek hospitals are struggling in the country’s economic crisis, facing supply shortages and budgets cut by half. A neurologist says pay cuts have left him making $1,600 per month for a 100-hour workweek, while patients can’t get medication because the government can’t pay its pharmacy bills. Greek healthcare, critics say, is like the rest of the country’s economy in suffering from corruption and mismanagement.

Weird News Andy likes this “pacemaker for brains” story in which Johns Hopkins researchers implant a stimulation device in the brain of an Alzheimer’s patient in the hopes it will stop cognitive decline. Also from the infectious weirdness that is Andy: five Cedars-Sinai heart valve transplant patients contract staph infections when the gloves of their surgeon develop tiny tears, allowing bacteria from the wound on his hand to infect them. The hospital says the surgeon is no longer performing operations there.

Sponsor Updates

• Besler Consulting President Brian Sherin addresses the company’s growth over its 25 years in business in a newsletter article.
• Emdeon reviews the top priorities of its channel partners.
• William Bithoney, MD of Truven Health Analytics and Jeffrey Softcheck of Silver Cross Hospital address the future of healthcare and improving care quality and outcomes at this week’s IHI conference in Orlando.
• StartUp Beat profiles PatientPay and its billing and collections technology.
• NextGen launches its 8 Series EHR content, which includes embedded MU criteria and an optimized seven-tabbed clinical workflow.
• The Orange County Register names Kareo a “Top Workplace in Orange County.”
• Prognosis will integrate its EHR platform with DrFirst’s e-prescribing solution.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Readers Write 12/10/12

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Note: the views and opinions expressed are those of the authors personally and are not necessarily representative of their current or former employers.

Baseball Traditionalists: Whose “Use” was More Meaningful?
By Robert D. Lafsky, MD

Isn’t it fascinating to follow the daily progress of a battle that pits traditionalists against digitally-armed insurgents? On the one side are deeply-entrenched practitioners of an ancient art dependent on subjective judgment calls that, in their view, can only be described in descriptive natural language. On the other side are advocates of a granular hard data approach that, although tedious and opaque to the untrained, reveals insight into previously unseen trends and realities.  

Ain’t baseball something?  

You do have to admit, if you’ve read the sports pages lately, that the battles in the sport eerily reflect arguments that run through the pages and comment sections of this blog. I cite as the crowning example the brouhaha over the naming of Miguel Cabrera as this year’s National League Most Valuable Player.

The traditionalists have a powerful argument for Cabrera. For one thing, his Detroit Tigers won their division and went to the World Series, while second place Mike Trout’s LA Angels finished third in their division. And Cabrera was the first Triple Crown winner (highest batting average, most homers, and runs batted in) in 45 years. He had a knack for hitting when it really counted, and he selflessly agreed to move to third base from first when the Tigers acquired the powerful but slow Prince Fielder. The traditionalists say it’s obvious he’s the MVP.

But the “Moneyball” guys have their points about Trout. Using highly sophisticated and detailed data, they determined using a measure called “wins over replacement,” — using not only batting statistics, but defensive and even individual ballpark factors to compare Trout to an average replacement player — he accounted for 10.7 additional wins for the Angels over 6.9 Tiger wins for Cabrera. And that, to them, is what matters. All that other stuff is dismissed by these “Sabermetricians” as mere “narrative.”

But the traditionalists could ask, I suppose, the following cogent question:  whose “use” during the season was more “meaningful”? 

That’s an obvious parallel  to current trends in medical computing, right? Well, let’s not forget an obvious point. Baseball has always been a thing entirely made up by humans. Before these high-end statistics were developed, it had a clear-cut set of rules and a clear-cut goal–scoring the most runs in the most games.  

Medicine’s rules, on the other hand, are essentially defined by nature, and after more than 40 years in the field, I still wonder what the goals of practice really are. Fewer deaths, of course, but that’s really hard to count. And we know that people focus on a lot of other things that don’t affect critical outcomes like death and disability.

So, no — it’s way more complicated.  And advocates of evidence-based practice make valid points. We won’t settle any arguments here. But I know that obtaining and analyzing data is hard.  

Which is why we need baseball.  Go ahead and break for home, Bryce Harper. When that happens, we don’t need no stinkin’ statistics.

Robert D. Lafsky, MD is a gastroenterologist and internist in Lansdowne, VA.

The EHR Conversion Staffing Dilemma: Cost vs. Go-Live Disaster
By Don Sonck

With the window to initiate participation in the Medicare EHR Incentive Program expiring in 2014, the next two calendar years are certain to be chaotic within the EHR arena. With an ever-increasing number of hospitals and physician groups already scheduled to implement an EHR and still others in the final selection stage, internal and external resources necessary to staff these critical and expensive projects are already at a premium.

Particularly on the acute support side of these projects, professional consultants (internal and external) who possess clinical experience and know firsthand the inner workings of a hospital or ambulatory environment should be utilized. Ratios of one acute EHR professional for every four to five core clinical staff members is optimal. Any ratio greater typically results in frustration and morale decline, extended end user adoption, residual training, and of course, increased expense.

Far too often I’ve encountered healthcare systems of all sizes (as well as physician practices) that underestimate the importance of clinical support staff. During EHR post-mortem discussions, leadership rues the fact they overlooked or underappreciated the skill and expertise that clinical resources bring to the table, particularly during the critical 4-6 weeks just prior and subsequent to go-live. Too often, the main focus and budget allocation is on the EHR build and associated infrastructure costs. IT consultants are justifiably a majority slice of the overall project budget pie, but these same resources are ill prepared for and lack the “soft” skills to prosper as super users with core clinical staff during that chaotic go-live window.

My advice? Do not rely solely on overtime utilization of existing staff, the float pool, or seasonal staff. Make sure you pay for the ala mode on top of that budget pie in the form of nurses, therapists, and physicians who are seasoned in both go-live experience and the particular EHR vendor software to which you are migrating. When blended with existing core staff, these clinicians can assist in both patient care and technical guidance on the electronic charting process, easing your clinical team’s anxiety, reducing overtime, minimizing the need for additional EMR training consultants, and accelerating the adoption and knowledge of the EHR software.

When considering the employment of third-party clinical support staff, avoid the pitfall of waiting until the eleventh hour to pull the trigger. Human resources and nurse recruiting teams have enough on their plate without the added burden of answering these questions for themselves:

• How will nurses and physicians learn the system and treat their patients at the same time?
• What scheduling challenges will we experience due to the temporary decrease in productivity?
• Who will handle my core employees’ technology aversion?
• Will overtime compensate for coverage during classroom training time?
• What will be our electronic charting standards be day one, week two, and month one?
• Who will be taking care of orientation, credentialing, and my other duties during implementation?
• What will my patients experience be during go-live?

Be an early adopter of the clinical staffing question, at least six months prior to go-live. Your CFO, CIO, and CNO will all thank you.

Don Sonck is director of EMR staffing solutions of AMN Healthcare of San Diego, CA.

Questions for ONC and the Obama Administration
By John Gomez

The Meaningful Use program requires technology to be adopted and utilized by healthcare providers and payers throughout the United States. The funding for these programs is coming from federal tax dollars  All that is well and good. In the long term, we will hopefully see a good return on these investments through standardized care, lowered administrative overhead, and a reduction in medical errors that affect patients.

The technology that is designed, developed, tested, and deployed to support Meaningful Use requires literally thousands and thousands of engineers, consultants, product and program managers, not to mention all the system administrators, network managers, and others. It is perplexing to me though, that in these times of economic hardships, many healthcare software vendors and secondary software service providers offshore these positions. 

For instance, companies like Allscripts have huge staffs in India and smaller presence in Canada. Some companies are offshoring to Israel, China, and Europe. Given that we as taxpayers are funding the Meaningful Use program, shouldn’t there be a provision requiring that those companies benefiting from these programs only utilize US-based resources? 

There is potentially a silly argument that could be made that if were to require these companies to use US resources, they would need to charge more for their products and services and that would ultimately cause a deeper burden to the taxpayer. That is an accurate knee-jerk response based on lack of information and research.

We could keep these jobs here in the United States and not increase the cost of operations for these companies if these companies fill these positions in areas of the United States that are hardest hit by the current state of our economy. The level of talent, required training, and other factors would be similar if not better then that which is encountered outside our borders.

I realize that this is not a simple problem. Wall Street and private equity firms are more interested in margin improvement then really considering the long-term benefit to our country. But in my eyes, I think that creating jobs here is a priority. 

We should do what we can to get more Americans working, even if it impacts the margins of healthcare software companies or slightly raises the cost of software or services. When you have a program as big as Meaningful Use, the benefit should be well beyond that of its primary objective.

John Gomez is CEO of JGo Labs of Asbury Park, NJ.

Stage 2: You Ain’t Finished ‘till the Paperwork is Done
By Frank Poggio

Many years ago I saw a cute little cartoon that pictured a three-year-old climbing off a commode. Standing next to him was his mother, instructing him that he wasn’t finished until his paperwork was done. Well now, the characters in that cute cartoon can be replaced by a vendor and the ONC, respectively.

Two new Stage 2 test scripts for certification will require vendors to supply documentation previously not needed under Stage 1. They are:

1. Safety Enhanced Design – 170.314(g)(3), and
2. Quality Management System – 170.314(g)(4)

Safety Enhanced Design (SED). In early drafts of Stage 2, this criterion was referred to as User-Centered Design. The primary impetus for SED came from the November 2011 IOM report (Health IT and Patient Safety: Building Safer Systems for Better Care) that lamented the lack of built-in safety elements in many clinical software products.

An excerpt from the ONC test script describing SED follows:

This test evaluates the capability for a Complete EHR or EHR Module to apply user-centered design for each EHR technology capability submitted for testing and specified in the following certification criteria:

§ 170.314(a)(1) Computerized provider order entry

§ 170.314(a)(2) Drug-drug, drug-allergy interaction checks

§ 170.314(a)(6) Medication list

§ 170.314(a)(7) Medication allergy list

§ 170.314(a)(8) Clinical decision support

§ 170.314(a)(16) Inpatient only – electronic medication administration record

§ 170.314(b)(3) Electronic prescribing

§ 170.314(b)(4) Clinical information reconciliation

The Tester shall verify that for each EHR technology capability submitted for testing and specified in the above-listed certification criteria, the Vendor has chosen a user-centered design (UCD) process that is either:

A) UCD industry standard (e.g.; ISO 9241-11, ISO 9241-210, ISO 13407, ISO 16982, and ISO/IEC 62366); and submitted the name, description, and citation or,

B) Not considered an industry standard (i.e. may be based upon one or more industry standard processes); and submitted the named the process(es) and provided an outline and description of the process(es)

The Tester shall examine each Vendor-provided report to ensure the existence and adequacy of the test report(s) submitted by the manufacturer. The Tester shall verify that the report(s) conform to the information specified in NISTIR 7742 Customized Common Industry Format Template for Electronic Health Record Usability Testing.

Full EHR vendors must address this new requirement, while EHR Module vendors can skip it if your certification request does not include any of the above criteria. On the other hand, if your EHR Module includes even one of the above, you then must address the SED for that criteria.

The second new criterion questions the use of a Quality Management System 170.314(g)(4). The ONC-published test script states the following:

For each capability that an EHR technology includes and for which that capability’s certification is sought, the use of a Quality Management System (QMS) in the development, testing, implementation and maintenance of that capability must be identified.

– The Vendor identifies the QMS used or indicates that no QMS was used in the development, testing, implementation and maintenance of each capability being certified

– The Tester verifies that for each capability for which certification is sought, the Vendor has

1. Identified an industry-standard QMS by name (for example, ISO 9001, IEC 62304, ISO 13485, ISO 9001, and 21 CFR, Part 820…)
2. Identified a modified or “home-grown” QMS and an outline and short description of the QMS, which could include identifying any industry-standard QMS upon which it was based and modifications to that standard
3. Indicated that no QMS was used for applicable capabilities for which certification is requested

Clearly ONC is interested in learning more about what QA tools vendor use (if any) for each of the submitted Stage 2 criteria. Under Stage 2, per step 3 above, you do not have to have a formal (or any) QA process available. No QMS is an acceptable answer. But, you can easily guess what will happen in Stage 3. Words to the wise: if today you do not incorporate in your systems development a formal and documented QA process, better get one soon.

Last year in a previous HIStalk post I referred to the FDA coming to EMR systems through the back door. SED is a big step in. I fully expect the criteria covered to expand in Stage 3, and expect the depth and extent of the documentation submission to expand as the test agencies (ACB) gain more experience in 2013.

Lastly, if your staff is not familiar with the ISO and IEC standards, better do some homework. I suspect that the best of breed /specialty and new HIT startup firms would have a more difficult time in addressing SED than the large legacy firms. Documentation and QA are typically not their strongest suits.

All the new Stage 2 criteria and test scripts can be found here.

Frank Poggio is president of The Kelzon Group.

The Jury is No Longer Out
By Nicholas Easter

Very recently, I was a summoned to District Court for my civic responsibility of jury duty. Unlike many Americans, I relish the opportunity to sit for a jury trial, as it affords me the great opportunity to assist in the beautiful process of democracy. Unfortunately, the attorneys did not choose me this time around. But there is always next week, when I will be summoned to return.

Due to my freedom from this specific trial, I can comment on some of the particulars, but the important message from this trial comes from the other panelists as the voir dire was conducted.

In short, the case was/is an inmate at a federal detention facility (prison) attempting to sue members of the healthcare team at the facility for negligence in treating his life-threatening illness. A mix of guards, nurses, PAs, and a doctor being sued by an inmate for violation of the 8th Amendment to the US Constitution, since it is a constitutional question, was remanded to Federal District Court.

Eighteen lucky people were selected to move from the pews to the comfy seats in the jury panel. Each was interviewed by the judge and asked a series of questions to whittle the number down to 10 jurors.

Among the questions was a seemingly innocuous one: “What is your opinion on the healthcare provided to inmates?” Each of the 18 responded that they believed it was a right for each and every prisoner to receive fair and adequate medical attention. Of the panelists, there were teachers, engineers, consultants, unemployed persons, and the director of a local emergency room’s nursing team. I repeat, every single one thought it was the duty of the Federal Department of Corrections to provide ample and adequate healthcare to its inmates.

I believe it is time to formally reaffirm that a majority of this country believes that access to quality healthcare is a right afforded to each and every citizen, even felons. It is this basic comment on the structure of our society that gives a full and formal mandate to our leaders in Washington DC to complete the process of unifying the delivery of healthcare in America to make it accessible and affordable for all Americans.

If 18 randomly selected Americans above the age of 18 without any prior convictions for felonies can confirm that this basic right is required for criminals, then it ought to signal that it is high time to continue to find ways to make this an affordable reality for the remainder of Americans.

Social scientists agree that the “Social Strain Theory” is accurate. The greatest impetus to criminal behavior is poverty. America’s healthcare system can easily push even the most well-heeled patients into poverty. Hopefully the healthcare system of tomorrow will recognize the sharpness of its sword as it begins to eradicate a lot of ills that befall our society.

Curbside Consult with Dr. Jayne 12/10/12

It was cold and rainy, so I decided to file my state license renewal this weekend. When I was in a community practice, the office manager used to take care of that (as well as credentialing, liability insurance renewals, and just about everything else). Now that I’m in informatics, I’m on my own. The administrative assistant I share with four other people barely has time to open the mail and manage our calendars, let alone handle something like licensure renewals.

My state requires a certain amount of Continuing Medical Education (CME). Although I meet that requirement without issue each year just through routine activities and journal articles, it’s only half of the amount required by my specialty society. I was grateful for the reminder to catch up on my hours. Coincidentally, CMS continues to send e-mail bulletins about ICD being “closer than it seems” and one sent this week stated they had CME available.

(Apparently they partnered with Medscape Education back in September, but I must have missed the original announcement.)

I decided to check out the ICD-10 CME. There are two modules and an article offered. The modules are targeted towards small to medium practices and large practices, respectively, and are specifically for physicians. The article is more general for all health care providers. Since I work in Big Healthcare, I made a cup of tea (Earl Grey – hot) and settled in for the large practice video.

The video is narrated by Daniel Duvall, MD MBA of the Hospital and Ambulatory Policy Group at CMS. I liked that it didn’t claim that ICD-10 was going to improve care or make our lives easier. It was clear about stating that there would be “much more specificity in information sharing” and that the key point of relevance for physicians was that it is necessary for claims submission and those who delay may not be reimbursed.

I’d have liked the CME better if it had been self-paced. It wouldn’t allow me to fast forward and one couldn’t forward the slides at his or her own pace. I can generally read faster than I can listen to someone read slides to me, and find that I learn more reading things on my own rather than being lectured to. There was some choppy editing that was a little annoying, so by six minutes into it I was pretty much “done” but couldn’t blast through it.

Luckily it did allow me to skip to the test (which I aced – it only had three questions) and the subsequent course evaluation. I was disappointed that the evaluation wasn’t specific to this kind of educational activity. It asked me if I planned to modify treatment plans, change screening or preventive practices, incorporate different diagnostic strategies into patient evaluations, or use alternative communication methodologies with patients and families. It’s always nice to have questions that are actually relevant to the course just taken.

For a physician who doesn’t know much about ICD-10, the course provides a reasonably good base. For anyone who is deep into an ICD-10 playbook, it’s not worth the time unless one is killing time or needs CME hours. I realized when I got to the end of the course that I probably should have verified how I was logged in to Medscape. At least it will make a nice addition to the certificates on the wall of my home office.

E-mail Dr. Jayne.

Monday Morning Update 12/10/12

From HITEsq: “Re: Epic. It appears they aren’t happy with some consultant, suing two individuals and three similar sounding entities (KS Information Technologies). They were granted a motion to seal the complaint to protect sensitive information. Maybe someone knows more.”

The government should get more proof that providers have met Meaningful Use requirements before sending them a check, according to 72 percent of poll respondents. New poll to your right: should FDA create an Office of Wireless Health as proposed by Rep. Michael Honda (D-CA)? I’ve generously included a “don’t know/don’t care” option for those anxious to participate despite indifference to the topic.

My latest Spotify playlist includes the usual mix of music I like, including Villagers, This Providence, Gov’t Mule, Faith No More, and going back decades, Mountain, Throwing Muses, and even the virtually unknown 60s Detroit band Frijid Pink. I spend a fair amount of time choosing what I think is worth listening to and then play the list several times to make sure it makes sense, not that I’m in need of extra work. Give it a listen if you’re stuck in a musical rut.

I never look at (and in fact am annoyed by) infographics, those trendy, huge, multi-font pictures that fool short attention span Internet skimmers into thinking they understand a complex topic, often created by someone who hopes their agenda will be accepted as truth instead of opinion because it’s easier to stare at dumbed-down pictures instead of using your brain to read something more challenging and informative. If you don’t feel that way, cruise over to ONC’s EHR infographic for consumers. At least theirs is footnoted.

The secretaries of Veterans Affairs and Defense say they will present a plan in January to speed up the VA-DoD EHR integration. The planned go-live date of 2017 may be moved up. 

Manitoba’s eChart HIE  will allow users to hide their information even though they can’t opt out of the service. It will contain prescription information, immunization histories, demographics, and lab results.

The Jewish Healthcare Foundation, the Pittsburgh Regional Health Initiative, and Health Careers Futures form the Pittsburgh-based QIT training center, funded by the foundation and the County tourism office. It will offer training to healthcare executives and workers on emerging technology. ONC Deputy Director Jason Kunzman is former CFO of the foundation. Also announced was the QIT Health Innovators Fellowship program for graduate students in the health professions, who will submit IT solutions for judging in a 10-week program.

Healthcare provider CIOs on the 2013 Computerworld Premier 100 IT Leaders list:

• Horace Blackman, Department of Veterans Affairs
• George Brenckle, UMass Memorial Health Care
• Thomas Bres, Sparrow Health System
• Sonya Christian, West Georgia Health
• Chad Eckes, Cancer Treatment Centers of America
• Randall Gaboriault, Christiana Care Health System
• Theresa Meadows, Cook Children’s Health Care System
• Mark Moroses, Continuum Health Partners Inc.
• Stephanie Reel, Johns Hopkins Health System
• Kathleen Scheirman, Kaiser Permanente
• Thomas Smith, NorthShore University HealthSystem

A new KLAS report on revenue cycle performance finds that Meaningful Use, reduced payments, and ICD-10 fears are forcing providers to examine their revenue cycles more closely for efficiency and effectiveness, with many of them engaging outside assistance.

RSNA attendance was down 9 percent this year, with possible reasons being lack of technology breakthroughs and a new policy that required guest attendees to pay.

A technical school in the Philippines creates a telenurse training program, preparing nurses to offer their patient consultation services via smart phones. ClickMedix, an online health company is participating, offering the nurses access to its smart phone application, doctors, and medical library in return for a percentage of their billings. Experts say it’s time to create business models for nurses to become online health consultants. I tracked down ClickMedix, which turns out to be a US-based company (Rockville, MD) formed by faculty and students of MIT and Carnegie Mellon to address global healthcare challenges. The company’s mHealth platform offers modules for delivery of medical services, patient management, administration, and healthcare services purchasing.

Ergonomics researchers warn that the increased use of EMRs and other keyboard-based technologies for long periods of time raises the risk that providers will sustain repetitive stress injuries as happened when offices computerized in the 1980s. A small study found that more than a third of doctors reported RSI-related pain in their neck, shoulders, back, or wrists. In what could be an indirect measure of the uptake of EMRs, another small provider study found that more than 90 percent use a computer, averaging more than five hours a day.

An article in the Rochester paper describes the use of contracted scribes in the ED of Rochester General Hospital, which says its 60 ED scribes cost $1 million annually but save the health system $1.6 million per year. According to the associate ED chief, “When you come to see the doctor, you want to see the doctor. You want eye contact. You don’t want us standing at a computer screen. I care for people. I’ve never been trained to be a good typist or a data entry specialist.”

An Atlanta nephrologist serving as the medical director of a clinic owned by dialysis provider DaVita files a whistleblower lawsuit against the company under the False Claims Act after noticing that its computer systems showed large amounts of wasted drugs. His suit claims DaVita overcharged Medicare for up to $800 million over eight years by intentionally using oversized vials of medication and discarding the remainder, billing Medicare for unavoidable waste. The doctor was noticed by his fellow whistleblower, a nurse who says the company was pushing employees to increase their drug revenue. The company says CMS approved all of its practices.

Scheurer Hospital (MI) renovates its patient rooms to include technology improvements, placing a computer in each room to allow nurses to document at the bedside. They also added a new patient call system that alerts nurses on cell phones.

The former executive director of Syringa General Hospital Foundation (ID) is sentenced to six months in prison and is ordered to pay $115,000 in restitution after pleading guilty to using the hospital’s computer system to transfer money to her personal accounts.

Aetna will pay $120 million to settle lawsuits claiming that it used databases from UnitedHealth Group’s former Ingenix unit to intentionally underpay insurance claims for members using out-of-network medical services. UnitedHealth paid $350 million in 2009 to settle a similar lawsuit in New York, at which time Aetna also settled by agreeing to stop using the Ingenix database and paying $20 million to help create an independently developed replacement for it.

Weird News Andy says he now knows how your mom always knew what you were thinking. Researchers find that a mother’s brain often hosts living cells from her children born decades earlier. WNA also digests new medical research as being an explanation for crazy cat ladies: a common cat parasite is found to have the ability to enter the human brain and to possibly cause behavioral changes.

More on CPSI in this week’s HIS-tory from Vince, putting it into current perspective by reviewing the MU success of its customers and how its practices parallel those of Meditech and Epic. Next up is NextGen’s inpatient division, so connect with Vince if you can help him out with background information.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Time Capsule: Sun Was Right: The Promise of Healthcare Applications Requires a Grid, Not a Data Center Full of Servers

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in February 2008.

Sun Was Right: The Promise of Healthcare Applications Requires a Grid, Not a Data Center Full of Servers
By Mr. HIStalk

Sun Microsystems has been saying for years that “the network is the computer.” I hooted when I first heard that because it seemed so transparently self-serving, but I actually think the company was right all along. Sometime, maybe sooner than later, your data center won’t need servers. In fact, you probably won’t need a data center or IT staff at all (so in an ironic twist, you can use that space to store paper medical records).

I came to this conclusion after realizing that those Sun thin client blowhards were right, too. All the software that’s important or cool these days runs over the Web, not on a desktop PC. I’ve traded Office bloatware and piggish e-mail clients for free, stripped down versions that run on the ubiquitous information grid known as the Internet. Tastes great, less filling. I can get my job done, derive and create greater value, and let somebody else worry about what’s under the hood.

In other words, I don’t need a loaded PC any more than I need a gas generator, a TV antenna, or an outhouse. The grid is better, cheaper, and more reliable to meet those needs. All I need is a connected appliance. But more importantly, the network adds tremendous value. You contribute a little by joining, but you get a lot in return (well, hopefully not in the outhouse part of my labored analogy, but you know what I mean).

That’s how physician billing vendor athenahealth works. It applies the collective knowledge of thousands of customers to instantly update reimbursement rules for all the practices on its grid. Doctors’ offices don’t need a roomful of souped-up computers or an expert on arcane billing practices. They just need a connection to the grid.

Back in the hospital, we’re still using the same old (literally) applications, monolithic piles of esoteric and proprietary hardware that require skilled care and feeding, connected by a fragile spider web of interfaces and middleware that often causes problems with response time, downtime, and botched upgrades. Even when they’re up and running, those systems have plenty of functionality but zero intelligence, obediently regurgitating stored data in a format that’s little different than how it was entered.

The Holy Grail is to pull data back out in a way that lets hospitals learn something actionable, like which antibiotics work best or which lab values correlate with genomic profiles. Few hospitals have the capability to even get that kind of information from their own locally stored data. Fewer still can tap into the collective knowledge of their fellow IDN members. And nearly none can focus the accumulated intelligence of hundreds of peers when making important clinical and business decisions.

New technologies such as Software as a Service will allow hospitals to move to the next level of collaboration – actually pooling their collective expertise with that of their fellow grid users. The applications themselves could be expertly managed by experts and paid for as a service instead of buying racks of servers and installing patches.

Organizations centralized IT in the first place to gain leverage, reduce costs, and reduce risk. Hosted applications are the next step up the food (and value) chain. Capital requirements should be less, space and people requirements minimized, and they’d get the best IT talent money can buy, not just the best that’s willing to move to International Falls, Minnesota.

Hospitals are uniquely positioned to share knowledge compared to nearly every other industry. Most of them are non-profits, those more than 50 miles a way aren’t competitors, and few disagree that healthcare costs are sucking the wind out of our economic sails. For that reason, it will soon make good sense to shut down the endlessly duplicated silos of locally maintained hospital IT and get on the grid instead.

HIStalk Interviews Don Menendez, President, White Plume Technologies

Don Menendez is president of White Plume Technologies of Birmingham, AL.

Tell me about yourself and the company.

I began my career with IBM. I’ve been in software for a long time. I got into healthcare in the late 1980s. I joined a company that had a billing operation, a Unix-based PM system, and an RCM element. The real interesting thing was that we had a shared resource, a large IBM mainframe that we were selling time on. Clients didn’t incur technological or cost risk — they paid on a monthly basis. We didn’t even know it, but we had an ASP before we knew what it was.

That’s how I got to the healthcare side of it. We sold that company to a publicly-held company and then I was looking for a problem to solve. I believe software should solve real problems in a simple way.

I looked at  two things. There were two big gaps in the workflow in the physician offices that I saw. One was, back in 1999, clearly the EMR gap. I felt from a timing perspective and the amount of disruption that it would cause for physicians the timing didn’t make sense at all.

There was another one that was kind of interesting. It was what we ultimately got into. It was the automating of the front end of a revenue cycle management process.

It had been the same for quarter of a century. I’d always known that the first time you automate a manual repetitive, complex, confusing process, that’s when you get to ring the bell financially for your costumers, as opposed to what version 10.1 does for him. That was what this area was. A lot had been done on the back end, but very little on the front end. We felt that if we could push the process use technologies and know-how at the front end without negatively impacting the doctor, we had a real winning solution for him.

Why would practices that already have a PM/EMR system need your products?

It’s really interesting because probably in the last 18 months, the great majority of our new clients are exactly that – people who have an EMR already installed and a PM system. 

I think what happens is this. We approach a number of these practices when they’re in an EMR evaluation stage. Many of them feel like they’re going to be able to achieve the results that are provided by the kind of solutions that we provide once the EMR is implemented. What a  lot of them seemed to find out was that for any number of reasons, they’re all different. The EMR solution is working well, but they’re not satisfied with the results they were able to get as it related to the automated charge capture and coding process.

Sometimes these physicians find the charge capture process too time-consuming and they won’t do it, or it just doesn’t work for them. Other times it doesn’t match the workflow within the practice of how to do what we call post-encounter coding, taking that encounter and adding all the additional things to it necessary for it to get paid correctly. It’s not all done by the physician, and so there are some real workflow issues.

Other times, what ends up happening is they come to us because they’ve figured out that to solve this problem, they’ve had to hire additional administrative people just to do additional work to get the charges in correctly now because they’re starting with physicians than a different manner they started before.

While they took a step forward in the clinical process, it seems like they either made no progress on the RCM side, or worse yet, they took a step backwards. It’s been really interesting that most of our new business is coming from those folks. I would not have predicted that, to be honest, three or four or five years ago, but that’s really what happened.

Do you think it’s a surprise to physicians that when they finally get a PM or an EMR system, much of the benefit accrues to someone else?

My personal opinion is it’s all across the board. For some of them, they predicted that forever. They were very skeptical in the beginning and it was borne out. For others, they were skeptical and it’s borne out differently. They’ve really gotten some value out of it.

In our particular area, the niche that we serve, and what we’re trying to accomplish — quite frankly, the functionality that we provide is an afterthought for both the physician practice and the vendors that are trying to sell the EMR product. Automated charge capture and coding is an afterthought. Many times is an afterthought in the design process, during the sales process, and during the implementation process.

For what we do, they really haven’t thought much about it during the evaluation and implementation process. But when they get down to the point where they’ve rationalized all that technology and are starting to move forward, we find the administrative people say, “We’ve taken a step backwards” or “We made no progress on this at all, and we didn’t realize that there were something out there that could solve some of these problems.”

Describe how your system works differently from the PM and EMR.

Our whole approach was that you can’t slow the physician down for an administrative task or process. It just didn’t make sense. It was counterintuitive to do that. Everything that we’ve done has been designed around that. The part of the process that starts with the physician needs to help them with their productivity, or certainly not slow them down.

This is an odd thing. It sounds counterintuitive, but when we started this business 13 years ago, the great majority of physicians out there — I’ll bet 90 to 95 percent of physicians — were marking encounters on a paper encounter form. They would spend somewhere between three to 10 seconds with that form. That would be enough information to start the process so they can get reimbursed with that encounter. That’s a pretty high standard against which to take an electronic system and try to make that work. 

We’ve focused on the charge capture device, whatever that is, to be productive for the physicians. We’re agnostic towards that. We don’t care. We’ve always had a real open attitude. The best way to get a charge into the system is whichever way is the best for the individual doctor. It could be an iPad. It could be another tablet device. It could be an iPhone, an Android, or other mobile devices. It could be EMRs, keyboards, and lab systems. It could be paper. Regardless of the tool used to capture that data, it should complement and leverage the process and the workflow of the practice. That’s what’s important.

Like most software companies, we learn on the back of our customers. We’ve been doing this same very focused process for 13 years. They’ve taught us a bunch about how it works. It’s not slowing the physician down.  It’s not pushing administrative tasks to the physician. It’s leveraging productivity and accuracy on the front end of the process as opposed to the back end of the process where most of that’s been.

How does it integrate with the PM/EMR?

We originally integrated with PM systems because EMR adaption was so minimal that it just wasn’t an issue for most of our clients. We probably have upwards of 30+ different interfaces that have been in place for quite some time now. Over the last three or four or five years, we have been doing many more EMR interfaces, so that once the doctor is finished with the patient encounter from an EMR basis, they will send us the important bits of data that we need for the charge encounter.We’ll run it through our automated workflow and coding system and then electronically send it to the PM system as if it had been keyed in by the PM system itself.

Obviously, there’s a real benefit there when you got an environment where there’s one PM system and a different vendor for the EMR system. We provide a nice middleware bridge for them just to pass the data, but when we pass it, we clean it up.

I notice you just brought AccelaMOBILE for mobile capture of physician hospital charges. Explain how physicians bill for the hospital services they provide.

It’s really interesting. In the ambulatory setting when they’re in clinic, the administrative personnel will put all sorts of procedures and processes in place around the physician to make sure they get the information they need to get an encounter paid. But when those physicians go out to the hospital, they’re on their own. 

It’s almost like the Wild West out there. It’s every way possible you could think about it. Some are doing along 3×5 card. Some of them get a rounding list printed off from their PM system and they jot those things down. I’ve seen physicians jot it down on their scrubs. They run into a colleague in the hall and they do a consult that nobody knows about and they forget do it. They go to the football game or the music recital right from the hospital and they lose their charges.

One of the big problems with mobile charge capture is just getting decent good data back to the billing staff so they can clean it up. That’s the real allure of mobile charge capture and the concept of AccelaMOBILE. It’s always been about getting the form factor and a technology used by the physicians. 

We looked at doing this 10 or 12 years ago, but the technology just wasn’t there. But now, with physicians being 10 years younger than they were, they’re accustomed to the form factors of smartphones and iPads and those kinds of things. We can now at least solve that first part of the problem — we can get the data back to their billing office in a legible manner that’s complete about what they were doing in the hospital. That’s what the real excitement of the mobile product is.

The second piece is that once you get the data in, it does need to be cleaned up and appropriately done so that you get paid for it. The mobile product is the front end for remote charge entry by the physician. That is complimented by our back-end suites of products that do the workflow and the coding on it.

For some companies, it’s a whole different ballgame to develop their first mobile application and do it right. What did you learned in bringing out AccelaMOBILE and seeing how physicians are using it?

I’ll sound like a broken record, but we’re dealing with high-knowledge professionals that are extremely busy. They were trained to see one, do one, and teach one. That’s the way we try to do the user interface. It has to be simple, it has to be quick, it has to have very few clicks, it has to provide them shortcuts necessary so that they can get into the technology and get out of it very quickly. That’s a continually improving process, and frankly, our physicians are the ones that teach us the most about that. But the simpler the better for them.

How hard is it to make a business case for a practice that may have stretched themselves to buy another new system and now you’re offering them a different one still?

A big issue for everybody is the bandwidth of the practice. Intellectual bandwidth, time to do another project, certainly finance is a commitment, that kind of thing. That is a big issue for us in the marketplace at this juncture, but we try to do things to minimize that. Our whole approach is focused on minimizing that.

We believe that if you’re seriously looking to improve your automated charge capture and coding process on the front end, you can take a look at what’s out there in the marketplace. You can evaluate the systems. You can evaluate what’s available and how it’ll work, probably within a week or two if you could devote a little bit of time to it. 

For us, implementations are typically three days. We’re in and we’re out. It’s a pretty quick process, so it’s pretty light as it relates to the staff itself, but the bigger issue is just the idea that you’d even think about looking at something there.

On your website, it says that HITECH has skewed the EMR market and the vendor accountability to customers with what was described as a checkbook and a gun. How do you see the EMR/PM market evolving over the next several years?

I’m bullish about that, for two reasons, primarily. We believe that once Meaningful Use settles down a bit, the same market forces that have been in place for years will be refocused on, and that’s downward pressure in reimbursement — we don’t see that changing – and increasing complexity and cost associated with physicians figuring out how to get that reimbursement. We expect the focus to shift back to operational efficiency in the ambulatory setting.

I may be wrong about this, but it seems as if none of the current incentive programs are really incenting operating efficiency for the practice. What they’re about is about driving data. Once that moves a bit, I think we’ll play really well, and that as they start to turn towards maximizing efficiency again.

The other piece, the wild card that everybody’s talking about and knows about, is ICD-10. It’s a huge, huge threat to physician productivity and to revenue cycle performance. That’s not about driving data — although for the government it is about driving data — but to practices just trying to see their patients and do what they need to do, it’s a huge threat to both those areas. That’s where we focus. We hope that it doesn’t get pushed out. It’s a distraction. We understand the importance long term about it, but we think it’s an unfortunate distraction.

We think that once all that quiets down a bit, it will return to some of the basic issues. Frankly, they’re going to be harder. The economics are going to be different in an acute setting than it is the ambulatory. The hospitals are buying up all these practices. As they move out of that acquisitive mode and they start to try to rationalize their acquisitions, I think there’s going to be more focus on maximizing operational efficiencies. They’re going to look for help in the ambulatory setting with revenue cycle systems and that kind of thing without having staffs.

Any concluding thoughts?

I’m grateful for the great team we have here. I started this because I thought that business is a part of the fabric of life. You can do both. You can have a great team, you can compete effectively, you can be profitable, but you can have a place where people can live balanced work lives. I’ve been fortunate that the folks that decided to work here really care about our customers and find ways to solve problems. I’m grateful for that. 

I’m grateful for that and I’m grateful for our customers. We have learned so much from them about the challenges that they face and how to make our product a better result of that. Software companies learn on the backs of their customers. I’ve been in the software business since I got out of college and they never get credit for teaching us, but they do teach us. I’m grateful for that.

This is a great time to be in the business. I don’t know what’s going to happen, but as long as physicians wake in the morning, see patients, and hope to get paid for what they do, they’re going to need to get encounter data to the payer and we seem to know how to do that pretty well. There are lots of different ways of making that happen, so we think that means that there’s going to be an opportunity for us. Even as a small player, we’re bullish on what the next three to five years might look like for us.

News 12/7/12

Top News

Reuters reports that PE firms Thoma Bravo LLC, Thomas H. Lee Partners LP, and Francisco Partners have submitted revised takeover offers for Merge Healthcare and are awaiting a decision from the company.

Reader Comments

From Nasty Parts: “Re: MedeAnalytics. Oracle backed out of a deal to buy the company, so they’re re-orging and putting a number of folks on the street.” Unverified.

From Spamalot: “Re: funny vendor spam. The ridiculous image and hilariously misspelled text caught my eye before I could hit the delete key.” Could it be that the company has decided to offend as many of the senses as possible, with your delayed “delete” validating their cunning premise of turning your head like a gruesome car wreck? Surely it was not a native English speaker who composed the pitch for business “coninuity” and referred to network security as a “new sexy term.” The company’s two addresses appear to be mail drops, and the Facebook link in the spam goes to a marketing person’s personal page that features family photos and cutesy kitty porn. I’ll hazard a guess that their incoming lines won’t be overwhelmed by clamoring prospects.

HIStalk Announcements and Requests

In case you have missed any HIStalk Practice posts in the last week, here are some highlights. Most physicians who e-prescribe believe it reduces prescription fraud and facilitates decision-making. Vermont’s eight FQHCs go live on five different EMRs. OIG finds that physicians who protest the denial of Medicare claims win their cases 61 percent of the time. Spring Medical Systems will offer its EHR clients an analytics solution from Clinigence. The AMA argues that pre-payment MU audits would be too burdensome for physicians. None of this news can be found on HIStalk, so if you are interested in the ambulatory HIT world, make sure to sign up for the HIStalk Practice e-mail updates. Thanks for reading.

On the Jobs Board: Director of Reimbursement, Cerner Activation Consultant, Director of Marketing, Marketing Programs Manager.

I’m not really interested in two front teeth for Christmas since I don’t have a spot for them, but I could use some holly jolly reader gifts that cost nothing: (a) take 10 seconds max to sign up for spam-free e-mail updates from HIStalk, HIStalk Practice, and HIStalk Connect; (b) sleuth us out on Facebook, LinkedIn, Twitter and make the electronic connection; (c) support the companies that pay the bills by checking out their ads to your left, reviewing their offerings in the Resource Center, and sending out an effortless request for consulting information via the RFI Blaster; and (d) graduate from spectator to player by sending me news, rumors, and guest posts. I note that Dann’s HIStalk Fan Club on LinkedIn now has 2,881 members, all of whom get extra attention when requesting something because I’m reassured that they aren’t ashamed of reading HIStalk. A reminder: we’ve got the top headlines each weekday morning on HIStalk, courtesy of the newest crew member, Lt. Dan. You won’t get an e-mail blast to remind you since I figured that would be really annoying, so just head over to the main page and you’ll see what’s new before you head out for work (like I do).

Acquisitions, Funding, Business, and Stock

Toronto-based Constellation Software purchases 100 percent of the fully diluted shares of Salar from Transcend Services, a division of Nuance. Transcend purchased physician documentation and charge capture systems vendor Salar in July of 2011 for $11 million, followed by Nuance’s acquisition of Transcend for $300 million in March 2012. We ran an accurate reader rumor report of the then-unannounced sale on November 30.

EMR vendor Modernizing Medicine raises $12 million in Series B financing to expand into the orthopedic and ENT markets.

SAIC announces Q3 results: revenue up 3 percent, EPS $0.33 vs. –$0.28, missing on expectations of $0.35. The company said it signed over $100 million in contracts from its recent acquisitions, maxIT Healthcare and Vitalize Consulting Solutions. SAIC also announced that it will cut 700 jobs in advance of possible fiscal cliff federal spending cuts that would decrease defense spending. Shares that were at $20 in early 2010 closed Thursday at $11.26, valuing the company at just under $4 billion.

Sales

Presbyterian Healthcare Services (NM) signs a multi-year agreement with IT service provider T-Systems to manage the health system’s data center operations.

Martin’s Point Health Care (ME/NH) selects athenahealth to provide EHR, billing, PM, and care coordination services for its 90 providers.

Catholic Health Initiatives will partner with Encore Health Resources to create a suite of electronic healthcare intelligence solutions focused on quality, performance, and risk analytics.

Indiana University Health selects Healthcare Quality Catalyst’s data warehouse platform for reporting and analytics.

Mercy Medical Center (IA) will implement iSirona’s device connectivity software to automate the flow of patient data from more than 150 devices into Epic.

Abington Health System (PA) selects the Surgical Information Systems perioperative IT solution for its two hospitals.

WellSpan Health (PA) subscribes to the CapSite Database to improve its purchasing processes.

Maury Regional Health System (TN) selects Medseek’s patient portal solution.

Ophthalmic Consultants (MA) adopts the Professional Charge Capture solution from MedAptus.

People

Interoperability software provider Compressus names Joe Lavelle (Results First Consulting) as COO.

Clinithink hires Fiona Lodge, PhD (Microsoft) as director of technical operations and Nathan Skorick (Altos Solutions) as business development executive.

Huntzinger Management Group VP William Reed (above) joins the company’s board of directors, along with Richard Sorensen (US Health Holdings.)

Emdeon adds former Allscripts Chairman Philip Pead and former Harris Corp. CEO Howard Lance to its board.

Hospitalist Fred Chan, MD is named to the newly created position of CMIO for GBMC HealthCare System (MD).

Jardogs names Ken Mikesh (MyHealthDIRECT, above) as SVP of strategy and business development and Brenda Stewart (Merge Healthcare) as SVP of marketing.

Homer Warner, a cardiologist and medical informatics pioneer, died November 30. He started developing clinical software at University of Utah and Intermountain Healthcare in the mid-1950s and wrote Intermountain’s ground-breaking and still-used HELP system in the 1970s, one of the first electronic medical records and clinical decision support systems. He was chair of University of Utah’s Department of Medical Informatics, the first such program offered by a medical school. Intermountain opened the Homer Warner Center for Informatics Research at Intermountain Medical Center in 2011. He remained active, vital, and humorous until his death at age 90, as evidenced by this video interview conducted a few weeks ago.

Announcements and Implementations

Vitera closes its hardware support business unit through a partnership with DecisionOne, which will hire Vitera’s field technicians. Vitera notes that it has added more than 270 employees this year and anticipates filling another 200 positions.

The University of Texas at Austin launches the country’s first HIE laboratory, which is funded by ICA, Orion Health, eClinicalWorks, and e-MDs.

DrFirst announces Akario, a free secure clinical messaging system.

GE Healthcare launches its Centricity Business 5.1 RCM solution.

Allscripts releases Sunrise Financial Manager, a revenue cycle solution designed for accountable and value-based care payment models.

The HIEs of West Virginia and Alabama, both customers of Truven Health Analytics, earn federal recognition for reaching milestones for full query-based and directed information exchange.

MModal opens a medical transcription center in Mysore (India), where the company plans to create 100 jobs over the next two years.

Cisco Systems is providing video calls with Santa to patients at 31 children’s hospitals (including Children’s of Alabama in a photo from Tuesday, above) via its Santa Connection Program, which runs through December 21 .

Government and Politics

The IRS releases a final rule subjecting the sale of medical devices to a 2.3 percent tax beginning in 2013, which is expected raise $29 billion in tax revenue through 2022.

Innovation and Research

Independence Blue Cross, Penn Medicine, and DreamIt Ventures create Philadelphia-based DreamIt Health, yet another digital healthcare accelerator. It offers $50,000, a four-month boot camp, office space, mentoring, and a demo day. It gets 8 percent of the equity in return.

Other

Athenahealth will buy the 29-acre, 11-building, 760,000 square foot Arsenal on the Charles complex in Watertown, MA from Harvard University for $169 million. The company was already leasing 330,000 of space in the complex for its headquarters.

A CapSite survey finds that one-third of US hospitals have adopted a vendor-neutral archive, while another 19 percent plan to do so.

Kaiser Permanente will open a new IT center in the Denver, Colorado area and will hire 500 IT employees by 2015.

A survey finds that 94 percent of healthcare organizations suffered at least one data breach in the last year. Other findings: (a) 69 percent don’t secure PHI-containing medical devices such as insulin pumps, and (b) almost all of them use cloud-based solutions and allow employees to use their own medical devices even though half of the organizations question the security of those technologies.

The CDC reports that 40 percent of office-based physicians now use an EHR with a basic level of functions, up from 34 percent a year ago.

At a dermatologist appointment this week, I noticed signs on the window urging patience, as the one-doc practice had just changed EMR systems. I asked the doctor and got an earful in return. He had already attested for Meaningful Use Stage 1, but was convinced by a salesperson to trash his EMR and move to GE Centricity. He said it’s the worst business decision he has ever made, not because Centricity is bad, but because he spent a lot of money, he’s being hit constantly with additional upgrade and maintenance fees, and to top it all off, he now realizes that he has no chance of collecting Stage 2 money because the bar is set too high for his practice. Not to mention that as a specialist, the EMR is not providing much patient value. He says he’s hoping to hold on for the 2-3 years it will take to get his practice back on its feet again, as the EMR is now his single largest expense. I can only describe his behavior as ashamed, followed by relieved as he realized from our discussion that he’s not the only one struggling to pay for something that he probably should never have bought in the first place. Needless to say, he’s not exactly thrilled with the HITECH program. It’s an eye-opener to realize that these little practices are cash-strapped businesses run by folks who may be excellent clinicians, but who are also marginal, accidental businesspeople just trying to keep the doors open and their employees paid. Derms are usually well paid and minimally stressed thanks to acne and Botox, so I can only imagine what it’s like for a primary care practice.

In Canada, Vancouver Coastal Health fires a long-time clerical employee for looking up the electronic records of five local media personalities out of curiosity.

Hello, Doc, Internet porn is free: a female employee of a doctor’s practice notices a red light glowing behind supplies in the restroom. She finds a video camera pointed at the toilet. The doctor finds his career potentially in that same toilet, as police executing a search warrant find the camera-controlling software on his computer. Maybe he should claim that the restroom doubles as a telemedicine station.

A privacy “weakest link” example. MC and Mel, a couple of morning zoo-type deejays from Australia sporting the worst fake British accents in history, call up the London hospital treating the Duchess of Cambridge for morning sickness, doing hilariously unskilled and giggling impersonations of Queen Elizabeth II, Prince Charles, and barking Corgi dogs. They get through to a nurse who provides a full update on the former Kate Middleton’s condition, learning that Kate “hasn’t had any retching with me.” The hospital is evaluating its privacy practices. UPDATE: in a not-so-funny ending to the story, the nurse who took the prank call has apparently committed suicide.

Sponsor Updates

• Billian sponsored the December 4 Health IT Leadership Summit at the Fox Theater in Atlanta, which attracted 600 attendees. Above are Ellen McDermott (University of West Georgia), Jennifer Dennard (Billian Inc.), David Hartnett (Metro Atlanta Chamber of Commerce), and Cynthia Porter (Porter Research).
• AT&T adds a remote interactive patient monitoring solution from Ericsson to its ForHealth remote patient monitoring platform.
• Mercy Regional Hospital (KS) implements a paperless employee time off request process using Access Evolution.
• Healthcare Clinical Informatics offers ten tips for realizing the value of EHR.
• Shareable Ink will exhibit at next month’s ASA Conference on Practice Management in Las Vegas.
• Beacon Partners and its employees donate over $9,500 in support of the Red Cross’s Hurricane Sandy relief efforts.
• ChartWise Medical Systems will integrate TruCode’s grouper, pricer, and editing Web Services into its ChartWise:CDI software.
• Imprivata publishes a white paper highlighting best practices for realizing care team collaboration and productivity benefits using HIPAA-compliant texting.
• CPU Medical Management Systems, a MED3OOO company, partners with RISARC Consulting to provide CPU customers an option for secure electronic document exchange.

EPtalk by Dr. Jayne

ONC holds its annual meeting on Wednesday, December 12 in Washington, DC and also accessible by webcast. It will include sessions on HIE and interoperability, patient engagement, and of course Meaningful Use.

A study in the December issue of Pediatrics lists five key features needed for pediatric EHRs: well visit tracking, support of growth chart analysis, immunization tracking, immunization forecasting, and weight-based drug dosing. Although the article notes that “it’s nearly impossible to find an EHR that meets those standards,” I guess I’m lucky because my system supports all of these. One of my friends is looking to replace her system and I’m attending a demo with her over the holidays. We’ll have to see how that vendor stacks up.

Over on HIStalk practice, Inga mentioned a survey on e-prescribing. Although I’m optimistic about its potential, I’m skeptical about the ability of pharmacies to keep up. Case in point: e-prescribing of controlled substances. Although the DEA finally approved this and several vendors piloted it in a handful of states, there is still a lack of awareness. I happened to stop by the pharmacy at a local supermarket chain and ask if they’re ready to receive such scripts (because I’m more than ready to start transmitting them) and received a stern lecture from the pharmacist about how he’s been told it’s illegal to do so.

Weird news story of the week: A New Orleans ambulance crew finds their vehicle immobilized with a parking boot, applied while they were on the scene with a patient.

I previously mentioned Scanadu, the startup that hopes to make a Star Trek-style medical scanner a reality. The company unveiled its SCOUT product, which is headed to the FDA for approval as a home diagnostic device. If it really delivers what it says – five vital sign results in 10 seconds with 99 percent accuracy – I think they’re missing a major market. For physician practices where rooming patients quickly is essential, this would be a killer app.

One of my favorite Tweeps is @MeetingBoy. Since I shared my holiday party recipes, I’ll share his piece on Eight Reasons Why I’m Skipping the Office Christmas Party.  I’ve never been to a real-life office Christmas party – we don’t have those in non-profit land. The closest we have is the holiday potluck. I’d love to live vicariously through HIStalk readers and of course promise to keep you anonymous. Bonus points for anyone who has received a corporate logo holiday gift worse than what I received one year: jumper cables.

Flu season has arrived early. If you haven’t received the vaccine, there’s still time. Whether you’re vaccinated or not, please keep covering those coughs, stay home when you’re sick, and keep washing those hands. And in case you wondered, paper towels spread fewer germs than drying your hands with a blower.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.