News 3/28/14

Top News

The House of Representatives approves, by an unusual voice vote, a hurriedly presented bill that would delay the mandatory implementation of ICD-10 until at least October 1, 2015. The bill, presented Wednesday and approved Thursday, primarily addresses a Sustainable Growth Rate fix that would prevent the 24 percent reduction in physician Medicare payments that will otherwise occur on April 1. The ICD-10 date change was contained in a single sentence in the bill, which will become law if it’s approved by the Senate on Monday and then signed by the President. HHS has been insisting the deadline wouldn’t change after two previous delays, providers and vendors should have been ready given the generous lead time and remaining six months, and most organizations agreed that it was time to rip the Band-Aid off and just do it. Now a delay gets snuck into an unrelated bill and pushed to approval in less than 24 hours, most likely by politicians who didn’t have a clue about what they were voting for. The bill proves how ineffective Congress can be – they can’t figure out how pay for fixing SGR, so they delay its implementation, and despite HHS claims that ICD-10 is vital, it’s easier to keep delaying it than to reach an actual decision about its merit.

Reader Comments

The saying is, “Build a better mousetrap and the world will beat a path to your door.“ The saying is not, “Build a different mousetrap, pay out 19 billion dollars in incentives to use the mousetrap, mandate its use by law and punish those who fail to adopt it. Then shove the world kicking and screaming against their will through your door” … For the federal government to mandate the use of EMRs by every physician out there just because it works at the VA would be like telling the entire world, “OK, we made it to the moon. Now it is your turn. Any country that has not put a man on the moon within the next five years will be bombed. Every country that complies with this mandate will get a check for $1B. For those countries who fail to comply with this mandate, shelling will begin at 1:00 a.m, five years from today.” …The EMR had become the primary influence in the interview. The dynamic had changed. The patient and I were now both in the room to feed the hunger of the software … Physicians used to write their orders and clerks would enter these data into the computer. Under the new mandates, the physician is now a data entry clerk. What’s next? Is each hospital CEO going to be required to spend two hours a day manning the switchboard?

From Dim-Sum: “Re: DoD EHR. DoD looked at Judith’s big Kaiser win, calculated additional funds for development of a down range medicinal solution, and added a chunk for COTS vendors to certify their teams for Tier 1,2 & 3 support. That figure, for all practical purposes, is $5.5 billion USD. The SI prime wants 40 percent of the pie. COTS EHR vendors will want $1.8 billion USD . Does anyone see the math does not add up? To add to the confusion and muffled numbers is the fact that a CMMI 3 firm will come in and state that COTS can’t create or engineer a down range solution, so they will want $500M – are we seeing a trend here? COTS EHR vendors cannot fathom Agile Scrum, let alone CMMI 3 mediocre results, Everyone forgets that software vendors in the US usually charge 16-20 percent of original software list for ongoing annual support — those numbers are included, so the hopes and dreams of the average EHR vendor is shattered. They will have to come down by $0.5 billion, round down their fee so they can recoup recurring revenue of 20 percent ($200 million a year) of the leftover amount to secure a more realistic number of $800 million. Your SI buddies want COTS vendors to be realistic, stop your silly dreams – you never heard of SPAWAR (Latin meaning “Beltway ONLY.”) SIs deserve the cash because they have no idea how to develop competitive software, so they want your knowledge on the cheap, they are program managers, they are the conduit in to the psyche of the DoD. The DoD does not value software, they value stability and sustainability and salute predictability. That is why it is so hard for COTS vendors to believe that the DoD blew $10+ billion USD for the monstrosity they have today and are hoping COTS EHR vendors can save the day.”

From Bill O’Sayle: “Re: FDA recalling McKesson’s anesthesia software. Both Cerner and Epic (for example) now have products to consume medical device data straight into their EMRs (i.e. Cerner iBus). Do you think this means then that EMRs with such capability are now at risk of such a recall? I can’t see Cerner putting their PowerChart install base at risk of a recall just so they (Cerner) can claim medical device integration. But if this is the logic of the FDA, then that seems to be the case, no?” The lab software model is that the instrument interface requires FDA’s approval, but the system that uses its information doesn’t (except for blood banking systems). I’m speculating, without knowing the details, that McKesson’s anesthesia product may have medical device integration built in, which puts the whole product within FDA’s purview. But given my “without knowing the details” disclaimer, I’d be interested to hear from someone who knows more than I.

From HIMSS EHR Association: “Re: EHR Developer Code of Conduct. A correction to Mr. H’s thoughts on the McKesson/FDA matter. The EHRA  strongly recommends that all vendors developing EHR products, regardless of membership in the EHRA, adopt the Code of Conduct. However, it is not a condition of membership in the EHRA. The 17 vendors that  adopted the Code of Conduct as of February were recognized at HIMSS14. Since then, three additional vendors have adopted the Code. The EHRA is hosting a webcast on Friday, March 28 to educate more vendors on the elements included in the EHR Developer Code of Conduct and the benefits of adoption.”

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: Dr. Gregg asks if being OK is OK and notes that the hard part isn’t achieving perfection but learning to be OK with OK. CMS warns EPs of possible system delays as providers submit MU attestation data by the March 31 deadline. The American Academy of Ophthalmology launches IRIS Registry, a centralized data repository that aggregates outpatient clinical data from EHRs. Epic, eClinicalWorks, and Allscripts claim the biggest shares of the ambulatory EHR market. Naval Branch Health Clinic Albany (FL) offers secure messaging services through RelayHealth. AHIMA warns that the use of copy and paste functionality in EHRs should be permitted only in the presence of strong technical and admin controls. While checking out these stories, why not sign up for the spam-free email updates so you won’t miss something important? Thanks for reading.

This week on HIStalk Connect: Six senators send a letter to the FDA seeking clarification over medical app regulation. Beth Israel Deaconess Medical Center will expand the use of Google Glass by ED clinicians after finishing a successful three-month trial. Reflexion Health raises $7.5 million to expand development of a Microsoft Kinect-based platform designed to support physical therapists and their patients.

I had some site problems over the weekend through Wednesday, which caused some downtime and the temporary disappearance of some posts and comments. Hopefully it’s all fixed now. Geek details: the webhost monitors web traffic and noticed IP traffic containing HIStalk’s server password, leading them to discover a root trojan that would have allowed its creator to take control of the server. That required building a new virtual server and migrating all the settings and large MySQL databases over to an environment containing fresh installs of PHP and Litespeed, which often brings up odd permissions and database problems. It’s been quite a pain – I watched the site and the open support ticket for 15 hours on Saturday alone and slept only a couple of hours, but problems delayed the actual migration until Tuesday evening.

Upcoming Webinars

April 2 (Wednesday) 1:00 p.m. ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.

April 16 (Wednesday) 11:00 a.m. ET. Panel Discussion: Documents, EMRs, and Healthcare Processes. Sponsored by Levi, Ray & Shoup. Presenters: Charles Harris, senior technical lead, Duke University Health System; Ron Peel, technical advisor, LRS; and John Howerter, SVP of enterprise output management, LRS. IT department in hospitals implementing EMRs often overlook the role of document-driven workflows. Prescriptions, specimen labels, and discharge orders, and other critical documents must be reliably delivered with minimal impact on IT and clinical staff. This panel discussion will discuss the evolving use of documents in the “paperless/less-paper” environment.

Acquisitions, Funding, Business, and Stock

AirStrip acquires the assets of wireless fetal/maternal monitoring provider Sense4Baby and licenses the technology from the Gary and Mary West Health Institute.

Sales

Southern Illinois Healthcare selects CPM CarePoints, ExitCare, Mosby’s Nursing Consult, and Mosby’s Skills from Elsevier.

Gracepoint Management (FL) will implement the Plexus Revenue Cycle Management service from Netsmart across its network of 48 behavioral health and drug and alcohol treatment centers.

People

TeleTracking Technologies hires Susan Whitehurst (Joint Commission Resources) as managing director of consulting services.

Innovative Consulting Group names David Kissinger (Leidos Health) regional VP.

Wellspring hires Matthew Joyce (Stout Risius Ross) as SVP of sales.

Announcements and Implementations

Bradley Healthcare and Rehabilitation Center (TN) begins transitioning to PointClickCare EMR.

Henry Ford Health System (MI) joins the Michigan Health Connect HIE.

Government and Politics

The HHS OIG finds that a federal database for tracking Medicaid fraud isn’t working as intended, with 17 states and the District of Columbia failing to provide information on providers banned from billing Medicaid. The database also contains missing National Provider ID numbers and  names of “terminated” providers who are actually dead.

Technology

Medicity earns a patent for its technology for connecting referral networks and another for its technology to centralize communications between providers and patients using cloud-based mobile technology.

Other

Continua Health Alliance announces availability of its 2014 Design Guidelines.

The eHealth Initiative launches its 2020 Roadmap to guide the transformation of the nation’s healthcare system by 2020. The roadmap will focus on recommendations tied to Meaningful Use, system interoperability, care delivery transformation, and a balance of innovation and privacy.

Online second opinion service Best Doctors launches the Medting medical exchange.

Weird News Andy calls this story “dueling paramedics.” A woman being transported by ambulance for possible stroke gets out of the ambulance after the two paramedics started arguing bitterly about a personal issue. WNA also observes the skyrocketing healthcare salaries in Cuba, where huge percentage boosts will give nurses an income of $25 per month, while physician specialists will earn $67 per month, up from $26.

Sponsor Updates

• HealthMEDX hosts its user group meeting next week in Branson, MO.
• CommVault publishes a white paper highlighting findings of a nationwide survey of healthcare IT managers, which suggest that healthcare data from a variety of sources could overwhelm the healthcare delivery system.
• HCS announces that all of its Interactant modules meet ICD-10 standards.
• Craneware hosts a series of one-day user group meetings in advance of its October Revenue Integrity Summit in Las Vegas.
• PDS provides details of its 2014 Tech Conference October 22-23 in Madison, WI.
• Nordic Consulting CEO Mark Bakken will deliver the keynote address at Madison’s startup incubator Gener8tor’s winter premiere night on April 3.
• Wolters Kluwer Health enhances its UpToDate App for the Android mobile platform.
• Kareo CEO Dan Rodrigues discusses his company and the power of cloud computing for small- to medium-sized practices.

EPtalk by Dr. Jayne

Everyone at the hospital is buzzing about the possibility that ICD-10 will be delayed as part of the legislation addressing the Medicare physician payment cut. Both CHIME and AHIMA have come out against the ICD-10 provision, stating that delaying it would negatively impact innovation and health care spending.

Athenahealth’s VP of government affairs, Dan Haley, quickly blogged about it in response. His main assertion is that a delay would only reward vendors who didn’t work hard enough to meet deadlines which have been published well in advance. His secondary point is that for the legislature to delay ICD-10 after the head of CMS has said multiple times that there will be no further delays is akin to a child receiving dessert after his parent had previously told him no.

As much as I’d hate to see my colleagues and their employers suffer when their vendors are not ready, it may take something this dramatic to really thin out the vendor herd. We’ve known this deadline was coming for a very long time and for vendors to still be unable to meet it is inexcusable. We can blame it on MU and the fact that we have a perfect storm of governmental requirements massing to hit us all at once. We can blame it on all kinds of things but the bottom line is that many vendors have delivered despite all those factors.

I don’t have a crystal ball to see how this is going to morph as it works its way through Congress, but it just goes to show that there’s never a dull moment in health IT. Many of my colleagues are already using it as an excuse to stop working on ICD-10 even though the legislation hasn’t been signed. In the words of Julia Roberts as Vivian Ward: “Big mistake. Big. Huge.”

Speaking of mistakes, several readers have written about the issues mentioned in Monday’s Curbside Consult. One of the problems I encountered was an issue with having multiple aliases in a hospital’s patient portal. A reader pointed out that issues like this are not only patient safety issues, but can also play into national safety:

I’m sure you’ve seen the articles about the so-called “Boston Bomber” entering the US undetected because he spelled his name differently than what was on the official watch list (Tsarnayev v. Tsarnaev). Seriously? The CIA was confounded by the unexpected insertion of the letter “y” into a person’s name … a person on a monitored watch list?  Seems incredible. If the CIA can’t figure out how to address probable name variances, then I’m not so surprised that your large academic medical center can’t figure out how to fix an alias name in its EMPI.

Other readers sent their own stories of IT systems run amok not only in healthcare, but in other industries as well. The pace of change is so great that little things like accuracy and completeness can’t seem to keep up. As long as the majority of people think technology is the solution to everything, I don’t see things slowing down.

I haven’t mentioned shoes or wine in a while, so I was excited to find this piece about a way to remove the cork from a wine bottle using only a man’s dress shoe.  The article contains an engineering explanation of the fluid dynamics responsible for it working. Unfortunately ladies’ heels don’t work well due to the angle of the sole, so Inga and I are out of luck. If you’re looking for a few good laughs, however, make sure you check out the comments section.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

News 3/26/14

Top News

The GAO looks at HIE efforts in four states and  finds a lack of sufficient health data standards, variations in privacy rules across states, difficulties matching patient records,  and concerns over covering exchange costs. GAO recommends that CMS and the ONC develop and prioritize specific actions to advance HIE and develop milestones with time frames to gauge progress.

Reader Comments

From The Reverend: “Exemption letter. A little mentioned part of the exemption that was offered up as “Vendor Certification Issues” for Meaningful Use 2 is that it requires the vendor to provide the EP with a letter. There is no guidance on what the letter must contain, who it needs to come from (vendor CEO, sales person, tier I tech support), or how to attach it to the exemption itself, but it a required (marked with a *) part of the exemption. The exemption also requires the EP to list the exact version they are currently running…which is obviously not the 2014 certified version (*because if it was, we wouldn’t be applying for the extension.) I am quite certain I am not the only concerned/confused person about this. It sure seems like it may be hard to extract this ‘letter of shame’ from the vendor. Can you help me?” If anyone can offer The Reverend some advice, please share.

HIStalk Announcements and Requests

Mr. H is taking the night off, hopefully doing something fun, meaning I’m flying solo. Thanks for reading.

Upcoming Webinars

April 2 (Wednesday) 1:00 ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries. 

Acquisitions, Funding, Business, and Stock

Healthcare data analytics firm IMS Health expects to set its IPO price at $18 to $21 a share, giving the company a valuation of up to $6.97 billion.

Cloud storage provider Box looks to raise $250 million in an IPO. For the year ending January 31 Box reported revenue of $124.2 million with losses of $168.6 million. 

Sales

Prime Healthcare Services’ Roxborough Memorial Hospital (PA) selects Wellsoft EDIS.

Baptist Health Care (FL) signs a multi-year agreement with MedAssets for multiple cost management and operational efficiency solutions.

People

Physician connectivity platform provider Updox hires Pat Bickley (Health Care DataWorks) to lead product management.

Xerox names Robert Zapfel (IBM) president of Xerox Services, replacing the retiring Lynn Blodgett.

Marc Krellenstein (Relay Technology Management) joins Decision Resources Group as SVP/CTO.

Health Revenue Assurance Holdings appoints Dennis Veasman (MModal) SVP of business development and sales.

Announcements and Implementations

Aprima Medical and Etransmedia announce an upgrade program for Etransmedia customers using the Allscripts MyWay platform. Etransmedia customers, which include providers that purchased MyWay through Costco, have the option to become an Aprima client, or, to use the Aprima system but remain a hosted client of Etransmedia. Both options provide current Etransmedia customers with one free Aprima licenses for each existing MyWay license.

ProHealth (WI) utilizes consulting services from Perficient to become the first healthcare system to produce reports and data out of Epic’s Cogito data warehouse in a production environment.

St. Francis Health System (OK) will go live across its 70 physician offices in May and at its hospitals in June.

The Robert Wood Johnson Foundation launches Flip The Clinic, an initiative meant to transform the average doctor visit to be more satisfying. The idea is to have the Flip The Clinic website serve as a hub for patients, providers, and other stakeholders to share ideas for improving the physician visit experience so that it’s more satisfying for patients and optimizes physician expertise. After reading Dr. Jayne’s latest Curbside Consult I’m hoping she will evaluate the site and share her opinions.

The South West Alliance of Rural Health’s Portland Hospital (AU) implements TrakCare Medication Management from InterSystems.

Government and Politics

Provider uncertainty is slowing implementation of the Designated Test EHR Program according to a representative from Meditech, which is one of three companies serving as test vendors. The ONC admits receiving a “decent amount” of questions on the program and says documentation is being developed to guide providers. Meanwhile, John Valutkevich, Meditech’s manager of interoperability initiatives notes that the ONC information already exists but many physicians and staff “don’t even know where to start.” I did a quick surf of the both the CMS and HealthIT.gov websites and I wasn’t able to locate relevant details, so I’m not surprised that providers are confused. Not for the first time I’m left to conclude that CMS and the ONC have plenty of “opportunities” to improve navigation on their sites.

HHS announces it strategic plan for 2014-2018 which includes an objective to meaningfully use HIT to improve healthcare and population health. Some of the noted HHS-supported initiatives include the promotion of HIT and standards through the MU programs; support for remote patient monitoring and telemedicine technologies; and promotion for programs such as Blue Button to engage and empower patients.

Massachusetts eHealth Collaborative CEO Micky Tripathi tells participants at a Federal Trade Commission workshop that HIT and HIE are “beginning to take off” now that the market is better rewarded for their adoption. He also warns that the industry is now seeing “a lot of tension” over the appropriate role of government in Stage 2 and Stage 3. I don’t know the full context of Tripathi’s statement but it seems the “tension” is less about the government’s role and more about what objectives and measures should be included and what tweaks should be made to the timing of the program. After all, doesn’t the government’s “role” include “owner” of the MU program?

Innovation and Research

Analysis by West Health Institute finds that widespread medical device interoperability could eliminate $36 billion in waste in the health care system and increase clinician efficiencies. Direct cost savings could be driven by avoiding redundant testing and reducing adverse events.

Other

EHR usage in small physician offices has helped spur overall EHR adoption to 61 percent, according to an SK&A report on physician office EHR use.

Disturbing: a Topeka, KS man opens a dumpster in his office complex and finds discarded medical records, complete with patient names and social security numbers. Perhaps not coincidentally a document scanning service also has an office in the same complex. The state attorney general’s office have removed the charts for further investigation.

The Federation of State Medical Boards consider a telemedicine policy that would require physicians to be licensed in the state where the patient is located and would require the same standards of care for both virtual and face-to-face encounters. Opponents of the proposal believe the licensing requirement creates an unnecessary barrier to telehealth expansion and adoption.

Scientists from Johns Hopkins University (MD) and George Washington University (DC) claim their flu tracking method using Twitter was 93 percent accurate during the last flu season when compared to CDC-collected data. Google’s Flu Trend tool was recently criticized for overestimating flu prevalence by more than 50 percent.

Some features of EMRs are unintentionally contributing to patient harm according to the recently released Maryland Hospital Patient Safety Program Annual Report. The report notes that the Office of Health Care Quality “received numerous reports of adverse events in which IT system omissions or glitches contributed to adverse events.”

Sponsor Updates

• Healthx will add InstaMed Member Payments to its member portal solution.
• Madison Magazine names Vonlay to its list of best places to work in technology for employers with over 100 employees.
• CareVia will integrate its remote patient monitoring capability with the Harris FusionRX healthcare integration platform.
• Surescripts awards e-MDs its White Coat of Quality award for applying best practices to the use of e-prescribing technology.
• PatientPoint will deliver its population health management solutions with HealthTronics IT solutions for urologists.
• Consulting Magazine names Akhila Skiftenes of Aspen Advisors and Ryan Uteg of Impact Advisors to its list of 35 Rising Star consultants under the age of 35.
• Vecna, a provider of patient self-service solutions, will add Fujitsu’s PalmSecure technology to Vecna’s On-Site Registration solution.
• TriZetto recommends that organizations identify the top ICD-9 codes used in their highest dollar claims to reduce claim rejections after the ICD-10 transition.
• Health Catalyst profiles Texas Children’s Hospital and how the organization used Health Catalyst’s late-binding Enterprise Data Warehouse and analytics apps in its Pediatric Radiology department to improve patient care and achieve $400,000 in savings.
• Health Catalyst hosts a two-day Healthcare Analytics Summit September 24-25 in Salt Lake City.
• Dallas Business Journal names MedAssets to its list of 2014 Healthiest Employers.
• CareTech Solutions serves as a technology sponsor for IABC Detroit’s Renaissance Awards, which honor the best in business communication in Southeast Michigan.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Monday Morning Update 3/24/14

Top News

Three Detroit hospital systems – Beaumont, Oakwood, and Botsford – announce plans to merge into an eight-hospital, $3.8 billion system, citing shared electronic medical records as one of their four goals.

Reader Comments

From Tom: “Re: McKesson’s FDA Class 1 recall. The description of their product Anesthesia Care could generically be applied to almost any EMR/EHR/CIS vendor’s AIMS product and yet the FDA’s decision-making clearly does not apply to vendors equally. Also I wonder how the regulation of CDS would affect a hospital who develops their own CDS?” FDA’s highest-level recall of McKesson Anesthesia Care may be sending a message that the agency considers even software-only clinical decision support to be high risk. McKesson defines its product as an anesthesia information management system, which it also calls an “anesthesia EMR.” McKesson sought and received FDA premarket clearance apparently because the system collects data from physiologic monitors. McKesson did a voluntary recall of its product in March 2013 after a customer reported that the software pulled up the wrong patient’s information, with two other customers reporting later that it had lost medical history comments and misconnected to a physiologic monitor, affecting one patient in each instance. Some thoughts:

• McKesson Anesthesia Care is a software-only system that does not control medical devices. It collects and uses information from patient monitors. Other than that, it’s like any other high-acuity, unregulated EHR (surgery, ICU, ED, etc.)
• FDA would not have been involved if the patient monitor connection hadn’t pushed the product into its regulatory arena. FDA regulates software that makes independent patient decisions or connects to regulated devices, with the idea being that those systems are devices working on their own rather than simply providing guidance to users.
• Software vendors usually hide contractually behind the “professional judgment” test that says even if their software gives incorrect information or bad advice that harms patients, the clinical professional who uses the system makes the final decision and is solely responsible for the result.
• The danger to patients is the same as for any other clinical decision support or even EHR software. Mixing up information between patients could be disastrous any time software is presented information or recommending actions. However, high-acuity systems give users less time to make important decisions, so that probably should be a consideration in determining patient risk.
• McKesson planned to announced a Class II recall (meaning the problem wasn’t likely to cause patient harm) but FDA overrode that proposal and initiated a Class I recall indicating that patients could be harmed.
• McKesson notified users almost immediately when the first problem was reported in March 2013, but FDA’s recall didn’t go out until a year later.
• It’s not clear what users of the system should do as an alternative, or what action they may have taken since the original McKesson notification last year.
• Vendors of systems that perform equally critical functions that aren’t connected to medical devices can take whatever action they want if they are faced with the same problem since their software isn’t regulated by FDA. Other than to avoid legal exposure, they could arguably not inform customers at all.
• McKesson is a member of the HIMSS Electronic Health Record Association, a trade group that requires them to sign the EHR Developer Code of Conduct asserting, “We will notify our customers should we identify or become aware of a software issue that could materially affect patient safety, and offer solutions.” The other inpatient EHR vendor members are Allscripts, Cerner, Epic, GE, NextGen, and Siemens.
• McKesson backed legislation introduced last month (along with athenahealth, IBM, and trade groups) that would reduce “unnecessary regulatory burdens” by limiting FDA’s oversight of “low-risk health IT, including mobile wellness apps, scheduling software, and electronic health records.” 
• FDA is running late in producing a report that it says will explain its position on regulation of clinical decision support systems.

From LochnessMonster: “Re: McKesson. Reduction in force 3/20/14, roughly 300 under Pat Blake organization (uncertain number).” Unverified, but reported by multiple readers, one of them saying that the targeted areas were Horizon and Paragon.

From Bootay: “Re: vendor-convened panels. You should participate or report the results.” I don’t think so. I’ve seen many times where properly objective people turned into fawning, attention-starved glad-handers just because some company tries to buy their love by inviting them to be a speaker or advisor. It makes my skin crawl to see the obvious mutual sucking up as mutually expectant backs wait to be scratched.

HIStalk Announcements and Requests

A slight majority of respondents don’t think patients should have a greater role in the HIMSS conference. New poll to your right: who’s most responsible for the problems with health insurance exchanges?

Welcome to new HIStalk Platinum Sponsor ScImage (pronounced sye-image). The Los Altos, CA-based imaging and informatics company offers solutions that include enterprise imaging, radiology, cardiology, Echo PACS, ECG, cloud PACS,  EMR content management, vendor-neutral archive, and a Web-based DICOM exchange. Case studies include Missouri Baptist Medical Center’s cardiology PACS, Blessing Hospital’s enterprise PACS, and US Air Force’s cardiology consultation program. The privately held, employee-owned, debt-free company says it has never sunsetted a product or required a forklift upgrade. According to a physician at Cedars Sinai Heart Institute, the company’s products are the “ultimate value proposition” to its cardiology practice. Thanks to ScImage for supporting HIStalk.

Here’s ScImage PACS consolidation overview I found on YouTube.

Teach for America teacher Ms. A sent pictures of her students using the Chromebook that we as HIStalk readers provided to her first grade classroom in Maryland via DonorsChoose. They’re using it to access online reading and math programs.

Upcoming Webinars

April 2 (Wednesday) 1:00 ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.

Acquisitions, Funding, Business, and Stock

WelVU, which offers a personalized patient education application, raises $1.25 million in an initial seed round.

People

Effingham Health System (GA) promotes Mary Pizzino to CIO.

CHIME promotes Keith Fraidenburg to EVP/chief strategy officer.

Announcements and Implementations

Physicians at Jupiter Medical Center (FL) are piloting the use of email alerts and status updates when their ACO patients are seen in the ED or urgent care center. The press release is poorly written and the product has a confusing name: MicroBloggingMD. I saw their booth at HIMSS and thought it was yet another doctor writing a blog.

Government and Politics

Connecticut officials say Massachusetts owes the state $10 million of the $45 million in federal money it received to build its struggling Massachusetts Health Connector. The original grant called for Massachusetts to share its technology plans with other New England states, but those other states realized they could get their own federal money for building exchanges and went their own way, with Connecticut receiving $140 million, Rhode Island $113 million, Vermont $168 million, and Massachusetts a total of $179 million. Massachusetts says the money wasn’t intended for the other states – they were added on to the grant application at the last minute after pressure from the White House and Governor Deval Patrick to make Massachusetts a model for the rest of the country. Access Health CT’s CEO says that unlike the dysfunctional, CGI-built Massachusetts exchange, their Deloitte-created one works fine, adding, “Some states were trying to build a Maserati. We built a Ford Focus. It might not be as glamorous, but it runs. It can get you to the store.”

Technology

Google is a bit touchy over Google Glass, having previously urged its users to avoid the “Glasshole” label by not being “creepy or rude.” Now it shares “The Top 10 Google Glass Myths,” the one above being notable considering that people (some of them Glassholes, no doubt) are already using it in patient care. Google published the statement on Google Plus, which means almost nobody other than its own employees will see it.

Other

Duke University Health System (NC) will pay $1 million to settle charges that it overbilled the government by unbundling claims and billing for PA services in heart surgery. Duke says its mistake wasn’t intentional, but instead “resulted from an undetected software problem and through possible misapplication of certain technical billing requirements.” A former Duke employee had filed the whistleblower lawsuit.

In England, the local newspaper reviews the 2012 Meditech go-live at Rotherham NHS Foundation Trust that caused delays in cancer treatment, lost appointments, and cost the hospital $2 million in revenue. It mentions the project review, which found that delivery targets weren’t specific, penalties clauses were vague, and the 18-month timetable was unrealistic given that the system had never been implemented in the UK. Taxpayers got stuck with $17 million in cost overruns on top of the budgeted cost of $49 million.

A two-doctor cardiology practice in Texas will pay $3.9 million to settle Medicare fraud charges for conducting unneeded procedures. Authorities requested data from 100 nuclear tests that had been performed, but the doctors provided only 37, saying their computer had crashed and the other results were lost. The investigators found that 19 of the 37 tests had been interpreted incorrectly and 75 percent of them were performed wrong. The same foreign-born doctors were part of a group that settled for $27 million in a 2009 Medicare fraud case.

Stanford Hospital & Clinics and its former collections agency are expected to pay $4.1 million to settle charges that the information of 20,000 ED patients was posted online for nearly a year. Stanford says it encrypted the information sent to the agency, but that company forwarded it to get help creating a graph and the worksheet ended up on a student homework site.

A Motley Fool review of mobile health in China, which a Brookings Institution report says will be worth $2 billion per year by 2017,  says the three publicly traded companies that will benefit most are IBM, Microsoft, and Lenovo. It says the market won’t behave as it does here because Chinese medicine has different workflows, the language is hard, cloud-based security is a tough sell, and Apple’s mobile devices are much less popular than Android ones. It misses some facts: (a) most mHealth companies aren’t publicly traded; (b) those three companies are so large that whatever happens with mHealth in China isn’t going to move the share price; (c) it touts Microsoft as having implemented “a single, cloud-based system” that turns out to be the nearly forgotten HealthVault; (d) it predicts Lenovo’s success because it makes hybrid devices (laptop/tablet) that run Windows 8 and because it bought Motorola and found itself owning 11.8 percent of the smartphone market in China, although the article fails to mention Lenovo’s huge benefit: it’s a Chinese company.  

Sponsor Updates

• Health Data Specialists will exhibit at the Cerner Southeast Regional Users Group March 30 – April 4 at the Sheraton Sand Key in Clearwater Beach, FL.

Exhibitor Costs at the HIMSS Conference

Readers had asked for details on what it costs a company to exhibit at the HIMSS conference. I greatly appreciate the vendor executive (let’s call him “Larry,” just to keep things anonymous) who provided complete information from last month.

Booth construction: $132,000
Booth space (20×40): $26,000
Booth power and connectivity: $20,000
Breakfast briefing: $11,000
Hospitality suite: $15,000
Printing: $6,000
Giveaways: $4,000
Booth graphics: $2,500
Buying the attendee list: $1,800

Including some other smaller costs, the company’s total expense was $222,000. That doesn’t include employee salaries or travel costs.

Larry says he’s happy with the outcome. The company had 400 people visit the booth for meetings or to see a demo. About half of those had been scheduled in advance, which is an efficient way to meet with prospects, and the other 200 were walk-ups who might become prospects. He also sees value in the employee bonding experience and being able to learn from attendees.

It’s the same as for attendees, in other words: HIMSS benefits from putting interesting people in the same place at the same time. The attendees derive their value from each other.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 3/21/14

Top News

Transcription and software vendor MModal files for Chapter 11 bankruptcy protection less than two years after being acquired by One Equity Partners for $1.1 billion. The company, which lists its assets and its liabilities between $500 million and $1 billion,  says it is in “constructive discussions” with its lenders and bondholders regarding the terms of a consensual financial restructuring plan and expects to continue normal business operations throughout the restructuring process.

Reader Comments

From Experienced CIO: “Re: reader survey. I had to write to admire how many ways you politely declined to go down rabbit holes and chase information that is not within your (broad) span of knowledge. You are great at delivering what you know and show a comprehensive understanding of the business. Thus, I welcome your personal opinions and commentary. I also recommend that you discontinue HIStalkapalooza, which is a wonderful gesture when you were smaller, but has become unmanageable. Just invite everyone to get together at a cash bar and it will take care of itself in a year or two. Good job, well written, and you stick to your knitting. That is why your publication is so popular.” I appreciate the comments. I like the idea of a simpler, cheaper HIStalkapalooza, having initially envisioned a big parking lot or park with kegs of beer, grill-your-own hot dogs, and a band. Dr. Travis from HIStalk Connect wanted me to put something like that together for startups at HIMSS, but the idea didn’t come up until too late. I’m considering options for next year. Party planning isn’t my core competency.

From Arcanity: “Re: your poll about professional certifications on your business card. I think this guy takes the cake.” Looks like either a big ego or a small … well, you know. Diplomate-ically speaking, his business card must be the size of a poster board.

HIStalk Announcements and Requests

A few of the stories you may have missed this week on HIStalk Practice: CMS offers a free online tool to help small practices transition to ICD-10. Over 60 percent of practices don’t plan to participate in an ACO. A reader suggests that Practice Fusion, CareCloud, and ZyDoc might follow Castlight’s IPO lead within the year. The potential costs associated with information loss during the ICD-10 transition could be substantial. Four major insurance carriers tell the AAFP they’ll be ready for ICD-10 by October 1. NCQA intends to raise its PCMH recognition standards in 2014. Thanks for reading.

This week on HIStalk Connect: Castlight Health shares soar 149 percent on the day of its IPO. Physician-only social networking site Doximity reaches 40 percent market penetration with US physicians. SharePractice launches a mobile app designed to let doctors use crowdsourcing to collaborate on and rank the best approaches to treating specific conditions. Dr. Travis dissects the recent failings of Google Flu Tracker and its implications on big data at large.

Welcome to new HIStalk Platinum Sponsor NYeC (New York eHealth Collaborative). NYeC is New York State’s not-for-profit public resource for healthcare IT, facilitating the EHR transition for providers and improving healthcare for all New Yorkers. Its activities include the SHIN-NY HIE; NYeC Regional Extension Center serving the upstate region and Long Island; the multi-state EHR-HIE Interoperability Workgroup; and the Patient Portal for New Yorkers that will go online this year. It runs the New York Digital Health Accelerator along with the Partnership Fund of New York City, supporting early- and late-stage digital health companies working on care coordination, patient engagement, predictive analytics, and workflow management. Chosen companies, which are required to have a New York presence, receive $100,000 in upfront funding and participate in a leadership program of healthcare leaders, entrepreneurs, and investors for the five-month term. Applications for the 2014 class are due April 11. The class of 2013 included ActualMeds, Aidin, Avado, CipherHealth, Cureatr, MedCPU, Remedy Systems, and SpectraMedix. Thanks to NYeC for supporting HIStalk.

Here’s my free “how not to look stupid” tip of the week: don’t reply to business emails on your phone. I see this constantly: the sender doesn’t notice incorrect spellcheck changes, they write barely intelligible terse text that makes little sense, and the tiny keyboard makes it too much trouble to make desirable changes to the subject or to the “Sent from my iPhone” email signature that indicates they are dashing off a reply on the fly while doing something else. You would be better composing a more thoughtful reply on a real computer later unless it’s an emergency.

Upcoming Webinars

April 2 (Wednesday) 1:00 ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.

Acquisitions, Funding, Business, and Stock

Augmedix, a startup building clinical applications for Google Glass, secures $3.2 million in venture funding.

CitiusTech announces an investment partnership with General Atlantic. The company, which works with 50 healthcare organizations worldwide, reported 2013 revenue growth of 51 percent.

HIMSS acquires Harrogate, England-based conference promoter Citadel Events, renaming it HIMSS UK.

Social health management vendor Welltok acquires wellness game developer Mindbloom.

Procured Health, which offers software that manages hospital purchases of medical devices, raises $4 million in a Series A round.

Sales

The New England Healthcare Exchange Network will implement the Ability Secure Exchange Platform across its member hospitals and provider sites.

Mercy Orthopedic Hospital Springfield (MO) selects Emmi Solutions for patient engagement.

Adventist Health Hospitals (CA) will deploy Aperek Ellipse for real-time anytime spend visibility and analytics.

BJC Healthcare (MO) selects Health Language to assist with its transition to ICD-10.

People

Clinovations promotes Kevin Coloton from COO to president.

Announcements and Implementations

Methodist Healthcare (TN) deploys MedAptus Professional Charge Capture for inpatient coding and billing.

La Clinica del Pueblo (DC) goes live on Forward Health Group’s PopulationManager and The Guideline Advantage.

The Nashville paper profiles RoundingWell, the patient engagement software company launched by the founder of bulk email software provider Emma. It uses EHR-generated information to send patients questions, education, and guidance from a proprietary content library developed with Vanderbilt University School of Nursing and The Center for Case Management. A tiny study found that patient engagement rates were at 60-70 percent over 90 days, with the average patient having eight risks identified that it says wouldn’t have been addressed otherwise.

Aprima offers Etransmedia customers running Allscripts MyWay a conversion to Aprima Patient Relationship Manager, hosted by either Aprima or Etransmedia.

HealthEast Care System (MN) goes live with an early intervention program for heart failure patients that uses patient engagement technology from Pharos Innovations.

Catholic Health System (NY) deploys Juniper Networks Meta Fabric, an open standards-based architecture for data centers. 

Sanford Health (ND) completes the installation of  RTLS technology from Sonitor Technologies and Intelligent InSites at Sanford’s soon-to-be-opened Moorhead clinic.

Government and Politics

OIG testing of the 28-hospital Indian Health Services computer network reveals inadequate security and significant network vulnerabilities. OIG hackers were able to gain unauthorized access to the IHS web server and an IHS computer, as well as obtain user account and password data and records in the IHS file system.

The HHS Office of the Assistant Secretary for Preparedness and Responses and ONC launch an initiative to promote the use of HIT in emergency medical services.

ONC announces that its open source popHealth tool to process electronic clinical quality measures has been certified as a 2014 edition EHR module.

Oregon Governor John Kitzhaber fires the head of the state’s health authority and asks Cover Oregon to replace its senior management team, including the CIO and COO, following an independent investigation. Cover Oregon remains the only state whose exchange, which cost $200 million, hasn’t enrolled a single person after its planned October 1 rollout failed. The report concluded that the state’s managers had too much confidence that Oracle, which has been paid $160 million so far, could deliver what it promised.

Innovation and Research

Harvard University Medical School researchers find that use of the EarlySense monitoring system on a medical-surgical unit was associated with a significant decrease in length of stay, code blue events, and ICU stay times. EarlySense uses a sensor that is placed under a patient’s mattress to detect potential adverse events, as well as monitor heart and  respiratory rates and movement.

A study finds that facial recognition software beats humans at detecting patients who are faking pain, with accuracy of 85 percent vs. 55 percent.

Other

An ONC-commissioned review of nine RECs finds that their most difficult challenges are poor EHR product usability and the “unsavory” business practices of some vendors. Other struggles include physician resistance to EHRs and the MU program, sustainability of RECs once federal funds are depleted, and difficulties communicating often confusing details of the MU program. The authors also note three best practices that emerged for helping providers achieve MU:

• Maintain strong partnerships with the community
• Hire technical employees who that have a mix of IT skills, clinical understanding, and general business understanding
• Work with a physician champion.

The Business Journals names its “10 Markets with the Strongest Brainpower”: Washington DC, Madison, Bridgeport-Stamford, Boston, San Jose, Durham, San Francisco-Oakland, Raleigh, Minneapolis-St. Paul, and Colorado Springs.

Supply chain software vendor Global Healthcare Exchange, acquired by private equity firm Thoma Bravo a week ago, reportedly lays off 130 of its 500 employees.

Google CEO Larry Page, speaking at a TED conference in Vancouver, touts the sharing of medical records, saying, “Wouldn’t it be amazing if everyone’s medical records were available anonymously to research doctors? We’d save 100,000 lives this year. We’re not really thinking about the tremendous good which can come from people sharing information with the right people in the right ways.” He described losing his voice because of an undocumented condition and finding thousands of people with the same problem after posting a description online.

St. Luke’s Health System (ID), which lost an antitrust lawsuit filed when it attempted to buy a physician group and used its Epic system as one of the benefits, receives a $10 million legal bill from the the hospital, surgery, center, and attorney general that successfully sued it.

Cerner is among 23 Kansas City-area employers recognized for their commitment to lesbian, gay, bisexual, and transgender equality.

Doctors in England using Skype to check on a home dialysis patient notice her husband collapsing in the background and send an ambulance to help the 70-year-old man, who was later found to have bowel cancer.

Sponsor Updates

• ScImage will deliver its PICOM365 PACS with Cedaron’s CardiacCare.
• Direct Consulting Associates joins the HIMSS Innovation Center in Cleveland as a Supporting Collaborator.
• CommVault will add 250 jobs in the next three years at its 275,000 square foot headquarters under construction in Eatontown, NJ.
• Pandodaily.com spotlights Validic and its data pipeline solution for healthcare.
• GetWellNetwork sponsors the 28th annual National Disabled Veterans Winter Sports Clinic March 30-April 4 in Snowmass, CO.
• Emdeon CEO Neil de Crescenzo tells the Nashville Business Journal that his company has hired 100 people in the last six months.
• AdvanceNet Health Solutions will add the CoverMyMeds ePostRx automated prior authorization solution to its enterprise pharmacy management platform.
• Summit Healthcare partners with Indigo HIT to offer complimentary services to enable clients with streamlined and scalable CCD integration.
• Kareo adds Rignadoc to the Kareo Marketplace to help physicians with phone triage.
• ICSA Labs certifies First Databank’s MedsTracker as a 2014 Edition Ambulatory and Inpatient Modular EHR.
• The Ethisphere Institute names Premier a 2014 “World’s Most Ethical Company” for the seventh consecutive year.
• Angela Hunsberger, senior consultant for Hayes Management Consulting, discusses the need to balance security and usability in patient portals.
• Healthcare services firm Accreon partners with identity management solution provider NextGate to deliver services and technology for enterprise data awareness and exchange.
• RelayHealth Financial releases RelayClearance Plus 5.0, a pre-service financial clearance solution that includes an eligibility benefits detail viewer.
• Clinithink launches its suite of CLiX Online Solutions to translate unstructured clinical narrative for real-time use.
• TeleTracking Technologies names Hill-Rom a licensed reseller of TeleTracking’s asset and temperature tracking software, while Hill-Rom extends re-sale rights to TeleTracking for its hand hygiene compliance solution.

EPtalk by Dr. Jayne

I spent all day Tuesday at yet another continuing education class to recertify a life support certification. This is the last one until summer, so I’m glad to have a break.

I understand why they require us to stay certified, but the odds of my actually having to participate in a code situation in the hospital are pretty slim based on my clinical practice patterns. I’m more likely to have to use basic CPR at the supermarket than any of the other skills, which I guess is a good thing. This year I took the “independent study” course, which included an online pre-course as well as the in-person practice and skills testing sessions using a computerized mannequin.

In some ways, the certification seems like a racket. This week confirmed my thoughts. The health system I work for has a master license to be able to train staff on adult cardiac life support because they require most of the clinical staff to maintain certification. I have no idea how much that master license costs, but I know that the individual certification fee is $220 because I had to pay it out of pocket.

In a quirk of rule-making, since I’m not employed by the hospital in a clinical service line (my Emergency Department work is through a third-party contracting firm), there isn’t a department to cost it back to. Apparently neither the administration or IT cost centers are valid for the education department to use, which makes me nervous that someone thinks administration and technology don’t need continuing ed.

At other hospitals (such as the one where I take my pediatric course) the fee for the all-day course includes the textbooks and lunch, but ours doesn’t. I’m a girl who knows how to brown bag and I don’t mind not being allowed to keep the books because I’m never going to look at them again. Neither of those are that big of a deal, but the twist at the end of this course was unbelievable. When we turned in our evaluations at the end of the day expecting to pick up our certification cards, we were asked to pay an additional $2.25 (in cash) for the actual card. Talk about unbundling!

Hospitals are infamous for nickel and diming patients. I suppose I shouldn’t be surprised that they’re now doing it to the medical staff and the independent contractors who fill the positions they can’t staff on their own. When I registered for the course, I had to wait until my check had cleared to actually schedule it and borrow the text books. I thought that was a little weird, especially since I’ve been on staff for more than a decade and they know where to find me if the check bounced, but I understand not everyone is that reliable. Incidentally, the pediatric hospital takes online payments for their courses, so they don’t have the check cashing issue.

My suggestion to the education department was to just raise the course cost to $222.50 (or even $225) so that they’d have the full payment up front and not ask for cash at the end of the course. I was told that the clinical departments only allowed $220 for the course and the reason they charge for the card was because the “regular employees” don’t actually need the card, they just need a statement from the education department that they had passed the course. Only “external” attendees need the card, hence the extra charge.

I guess external is a nicer way to say that I’m an irregular employee, or to possibly admit that our hospital is so cheap they won’t pay $2.25 for the 20 or so “external” attendees who take the course each year. Or that they’re ignoring the cost savings of recycling textbooks that they’re charging individuals for.

I’m afraid that as healthcare reform evolves, this is only going to get worse. Our hospital has hired a fleet of financial staffers to micromanage every facet of patient care (without admitting they’re telling physicians how to practice medicine) at the same time they’re cutting positions for nurses and patient care technicians. They were already in the business office, where I did battle over the fact that I can only order one printer cartridge at a time (despite the fact that they’re cheaper in a two-pack) due to new purchasing rules. They were already on the hospital floors, where we have to bar code scan every gauze pad and bandage we touch. Now they’re even in CPR class.

We are the embodiment of penny-wise and pound-foolish. I’m curious about the trends our readers are seeing in the hospital or clinic. Has everyone gone as mad as my employer seems to have gone? Are we headed towards the level of care seen in other parts of the world, where patients are expected to provide their own bandages and meals? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Reader Survey Results 2014

Right after the HIMSS conference every year, I survey HIStalk readers. The responses, which are always smart and insightful, help me plan the next year. That’s important since I rarely see readers in person – they don’t seem to stray often into the spare bedroom in which I write HIStalk alone, which is probably a good thing since I don’t have any extra chairs.

Some demographics of the 600 survey respondents:

• 38 percent of respondents have worked in the industry for more than 20 years, while another 31 percent have more than 11-20 years of experience.
• 45 percent of respondents work for vendors, 20 percent for consulting firms, and 27 percent for hospitals or practices.
• 6 percent of respondents are CEOs, 5 percent are CIOs, and 2 percent are CMIOs.
• The most-appreciated features of HIStalk are news, rumors, humor, and the morning headlines.
• 86 percent of respondents say they have a higher appreciation of companies I’ve mentioned on HIStalk.
• 37 percent of readers say they’ve recommended HIStalk to others in the past month, while people whose world revolves around social media might be surprised that only 11 percent of respondents saw even one of our tweets.
• My favorite stat: 92 percent of respondents say reading HIStalk helped them performed their job better in the past year. That’s the metric I watch most closely.

I’ve learned not to overreact to individual comments on the survey. Like everyone else, I think I’m representative of all readers and therefore can see obvious things that should be changed, but that’s not really the case. I don’t run HIStalk by committee because the result — as happens when software vendors let user groups dictate their entire R&D — would be a product that nobody hates but that nobody loves either.

Not everybody likes the same parts of HIStalk. Some people love interviews, some hate them. For every person who complains about music reviews, several say they love them and want more. Readers Write articles are often vendor fluff pieces even though I’m rejecting more of those, but some people don’t even like the really good ones because they just want to read news presented as tersely as possible. The bottom line on content is that I have to write and report what I think is relevant and interesting. I write something I would want to read. For those who don’t agree, other sites do it differently.

I’m also careful not to let my reach exceed my grasp. I get a lot of suggestions to cover more international news, to dig deeper into the payer market, or to cover more healthcare news in general and not just the healthcare IT side. I don’t have the time or interest to cover entire new subject areas well,  so I’ll stick with what I know. I’ll always try to make HIStalk better, but I don’t really want it to get bigger because then it wouldn’t be fun for me. It’s been 11 years since I started it and I would have quit long ago if I wasn’t having a good time.

I ask a couple of open-ended questions on the survey and will address some of the responses. I should add, though, that the most common comment was “don’t change anything.”

Get deeper into the implementation cycle. Do stories about how people get solid benefit realization.

I’m happy to do this. Providers are busy and don’t often have time to participate, but I almost always ask questions around benefit realization when I’m interviewing CIOs. Maybe that’s the opportunity – if you work for a health system in a non-CIO role but can speak authoritatively on implementation lessons learned, optimization, and benefits, I will interview you, anonymously or otherwise (since I know many hospitals don’t allow interviews without approval).

That answer applies to several suggestions. Readers want more information from providers just like I do, but it’s hard to bring those people into the conversation.

Create a moderated forum for further discussion.

I did that awhile back and participation was pathetic. Everybody loves the idea, including me, but a lesson I’ve learned is that while many people enjoy consuming content, few want to create it. It’s hard to solicit engaging comments and thoughtful guest articles except from people who are pitching something.

Express more opinion in your observations.

I agree. Sometimes I get so busy, especially for the Tuesday and Thursday night posts when I’m getting tired, that I focus on summarizing complex news items without adding as much personal commentary. That’s one takeaway from the survey – I will do more of that, although the folks who say “less commentary and just the facts” won’t be thrilled.

Add the patient experience of IT to the mix. It is a missing voice in HIStalk. Otherwise, it is off the charts incredible.

That would be great, but I don’t know to get them involved since they likely don’t read HIStalk. I just thought of something that I might be able to do along those lines, so let me think it through and I’ll report back.

I would add some basic educational materials targeted at folks who are new to healthcare IT.

I keep thinking about how to do this, but it’s a big job for me to take on alone.

The webinars still feel a bit too vendor sales focused.

We’ve tried to make the ones we’ve produced more educational, but the bar was set low and we haven’t been able to raise it as quickly or as far as I’d hoped yet. We’ve had vendors come to our rehearsals without the presenter even having seen the slide deck. We have drawn the line in some ways – I review the slides and rehearsal ahead of time and if I think it’s irrelevant except as a sales pitch to prospects, I make them say so in the abstract’s target audience. The one thing I’ll say is that the webinar you see will always be better than it would have been without our guidance. Whether it could have been better still is the issue we’re addressing.

Let’s hear more from front-line nurses, like a Dr. Jayne column.

I agree. I would need someone insightful with the time and ability to write well and regularly. I’ve solicited that kind of talent before and have struck out. I would be happy to hear from a nurse in an actual caregiving role who is IT savvy, opinionated, and an engaging writer.

Add tags for discussion, links to specific story items, or improve the search function.

I haven’t found an easy technical way to do any of these things. The “one post, many items” format is perfect for reading, but doesn’t lend itself to breaking out discrete data elements for searching or filtering. I would contract out doing some manual indexing if I could figure out what the result would even look like. Someone suggesting reaching out to an informatics professor to have their students devise a solution, which would be fun.

Stop being so pro-Epic.

I report about Epic the same as any other vendor. They are successful and a driving force in the industry, but they also aren’t perfect and I report that too (questionable non-competes, hospital bond ratings that suffer because of Epic rollouts, and weaknesses in specific product lines). Epic will get mentioned more than some vendors because they are big and many readers, especially the big-hospital ones, are involved with their products and have more to say about them. Everybody either loves or hates Epic  (often breaking down into Epic users vs. Epic competitors), but I think I’m as much in the middle as anyone. Of course everyone thinks they are unbiased and I’m no different.

Do more interviews with non-sponsoring companies.

I will interview almost anyone who sounds interesting and who volunteers or who agrees when I reach out, although for companies I only interview at the CEO level. I don’t guarantee sponsors that I will interview their executives, but their PR people often make the CEO available and I’ll usually accept under my rules (no blatant promotion, no advance screening of the questions, no approval editing of the transcript, I’ll talk about what I want to talk about and that probably won’t be the usual PR fluff.) I love interviewing providers, but they rarely volunteer. Typically the only interviews I decline are non-CEOs and CEOs of companies that aren’t doing anything interesting or important enough for most readers to care.

Avoid the whining sour tone that creeps into HIStalk.

This is another area where opinions vary. Some people claim I’m an industry cheerleader oblivious to the facts, while others see me as a negative naysayer. I can only say that I’m being myself when I write and you either like it or you don’t. I’m not changing.

Have you considered charging people to write "Readers Write" articles? They have become self-promotional advertisements for consultants or software vendors.

I agree that they had become tedious until a couple of months ago. My policy was to accept anything that wasn’t promotional. Lately, I’ve started rejecting articles that don’t present useful information appropriate to a knowledgeable audience and I’ve alerted the PR people who were ghost-writing them that I can’t use those articles. I will also say that anyone who interviews or submits guest articles is promoting something, even themselves, or they wouldn’t bother, so it will never be perfect unless I stop accepting guest content altogether.

HIStalk seems to be getting rather smug and self-congratulatory, especially in the case of HIMSS coverage and the HISsie awards and the HIStalk party. It seems you are beginning to think that what HIStalk does IS the news rather than you report the news.

We do cover ourselves at HIMSS since everything we’re doing there involves readers, but not to the exclusion of anything else. It’s tongue in cheek – it’s not news, just acknowledgment that HIMSS brings a lot of readers and us together. I barely mentioned the HISsies awards and only enough about HIStalkapalooza to allow people to sign up and to read the recaps afterward. It isn’t news, but then again neither is most of what happens that week.

I would like to see more B2B opportunities for sponsors and other companies to connect with each other for partnerships, staffing, or even acquisitions.

I’ve always liked the idea, although I’m not sure I have any particular expertise to make it happen. I’m open to ideas.

I believe there’s an opportunity with HIStalk for readers to share with the entrepreneur community what are the real world problems that still exist and still remain unsolved. 

Readers would have to step up and contribute and that doesn’t usually happen. I could ask for volunteers to serve as an ongoing provider panel, contacting them every six months or so.

Morning headlines don’t seem very useful. The information is usually covered in more detail during the following news post.

That’s the point. Some people just want a quick glance at the most important news. It stands to reason that stories important enough to be included in the headlines would also be covered in the regular HIStalk post, with the assumption that someone short on time might not get to the latter right away.

The email updates don’t offer anything helpful. They just say something new was posted to the website.

That’s all they are intended to do. I’m not writing a newsletter, I’m just letting people who signed up for the updates know there’s a new post. The majority of readers come to the site by clicking the email link. I am willing to put Lt. Dan’s morning headline posts into their own full email if people want that, and a few respondents do.

Include more regular content from healthcare M&A investors.

I would be happy to do that, but those folks are busy enough that nobody has volunteered. People like the idea of writing regularly for HIStalk, but then realize that it’s a fair amount of work on a fixed schedule. I’ve tried several people as regular writers and they dropped out not long after they started.

More information about cutting edge technologies.

I’m willing. It’s hard to tell which startups are BS or doomed to a mercifully quick death (and quite a few are both), but I will interview CEOs (or even better, their customers, if they have any) since that’s the best way to find out what they’re doing.

Filter comments more to get the non-productive ones out.

That’s a slippery slope. I generally approve all comments except those that are potentially libelous or are of a suspicious nature (like someone making unsubstantiated claims about a publicly traded company.) I would love having more thoughtful and balanced comments, but I can’t make people submit them. I have started deleting the incessantly anti-EMR whining ones from the many fake names of the reader known as Not Tired of Suzy, RN because they all say the same thing.

A bit less content. It’s a lot to read 

It is quite a bit of reading, maybe 10 minutes per day, but it’s everything important going on the industry. I reject 95 percent of the “news” that’s out there because it’s irrelevant and what’s left is what I think is important. Certainly you could skip some sections that you know in advance won’t interest you as being hard news (probably the reader comments, sponsor updates, upcoming webinars, etc.) but I’m writing for people with a lot of backgrounds, some of whom find information on sales, business news, and people changes to be the most useful parts of HIStalk. In other words, everyone would like to see content tailored to their specific interests, but those interests vary.

Create a cleaner front page design.

I have to be honest that I’m more of a content guy. Everybody likes the idea of a different page design, but when I looked at it awhile back with reader input, nobody had any great ideas given the nature of the content. However, I will take this chance to remind that you can click the “View/Print Text Only” link at the bottom of the post to get a simpler layout that some find easier to read. It also makes it easier to copy/paste if you want to send a snippet to someone. Try it right now.

Interviews with users and not just C level.

I’m willing to interview anyone who is interesting, but I can’t make them volunteer. I don’t have any good way to get in touch with floor nurses or hospitalists from hospitals all over the country.

How about a column from someone at ONC or a member of the HIT Policy Committee? Also, The Investor’s Chair has tapered off and it would be good to see more of him.

I’m certainly willing on the former. On the latter, I love running Ben’s stuff but I guess he’s been busy, same as Dr. Rick Weinhaus’s “EHR Design Talk.” Volunteer contributors  have jobs and lives that come first. Writing isn’t their primary activity.

I would love a section for analytics.

I probably need to dig a little deeper into that, but there’s an awful lot of frothiness out there (or maybe that’s a reason do to it instead of a reason not to.) I will figure out how to get more education on the topic since I’m a casual follower for now. 

Create an HIStalk podcast or audio format of HIStalk for the morning commute.

I could do that, but I don’t know if enough people would care to make it worthwhile. I’m biased because I’d much rather read words than listen to audio or watch video where I can’t skim, but it might be fun for commuters.

Bigger venue for HIStalkapalooza.

HIStalkapalooza has turned into a headache as it keeps getting bigger and expectations are raised, but I’ll try to make it better where I have enough influence with the company that’s paying. I dread it every year because I get into emotional arguments about how many people I can invite, where it will be held, and how we’ll handle things like guest requests or special diets. Then I get into a Vietnam of requests from righteously indignant people who didn’t sign up or who I couldn’t invite because of capacity. I said after this year’s event that I was done with it, but I’ll probably change my mind over the summer.

Don’t dilute your brand with things outside your core of news and comments.

I’m keeping close to the core, I think. The only new offering involves webinars and I let Lorre manage those so I don’t get distracted. I received probably 30 or more ideas of things I should get more involved with, but I will likely pass on most or all of them and stick to my knitting. I have enough challenges already.

I would make the "Anonymous CIO" interviews a regular feature.

I would love to. I asked for volunteers and got the one you saw. That’s it.

Bring back the old logo. Don’t give in to the PC police!

I didn’t drop the smoking doc logo because of political correctness. It’s still at the bottom of every post, in fact. The problem was that it wasn’t designed as a logo. It was cool, but the size, shape, and detail didn’t work as a logo. I still get occasional hysterical emails from people who don’t get the intentional irony of a 1950s, reflector-wearing, pipe-smoking doctor, who think that they are the first to have noticed that a healthcare IT site features smoking.

Most of your content is regurgitated news from other sources.

News almost always comes from other sources no matter what you’re reading, although I will take exception in that some of the reader comments, rumors, and interviews provide news that nobody else has. None of the big-budget publications have people out there on the street doing investigative journalism or first-person reporting – we’re all somewhat reliant on announcements, journal articles, vendor propaganda, and lame survey results (and in the case of many sites, using what they find on HIStalk and pretending they didn’t get it there.) The HIStalk difference, I hope, is that I won’t run space-filling stories that don’t interest me, I summarize the stories and put them into perspective, and I’ll add my own commentary when I think I can add value. I’ve been on the provider side for a lot of years, so I would hope I can do a better job than a reporter fresh off a fashion magazine. 

Separate out the content areas into separate sections in their own posts.

I don’t want to do that. People want one quick glance to see everything, not to go clicking on several separate posts just to see what’s new. I know other sites do it that way, but I think they are wrong.

Take a break and get some R&R more often so you don’t flame out prematurely.

I’ve been writing HIStalk for almost 11 years and I still look forward to it every day. Sometimes the administrative parts take more energy than I’d like, but that’s why I got smart and brought Lorre and some other folks on board to help out so I can do the parts I care most about.  

A couple of readers have asked about my succession plan. There isn’t one. If I flame out prematurely or otherwise, HIStalk flames out with me. That leaves Inga or Lt. Dan to post my obituary, which I hope in honor of my tiny legacy will be crisply concise and snarky.

News 3/19/14

Top News

The comment period opens for a CMS proposal that would allow it to recoup improper PQRS and e-prescribing incentive payments in a four-year project that would look for errors, inconsistencies, and gaps related to data handling, program requirements, and clinical quality measure specifications.

Reader Comments

From Cupola Dogs: “Re: Epic Emeritus Program. Interesting.” Forwarded documents describe a program in which Epic will offer vetted, independent “Epic Emeriti” (Epic-experienced retirees who are least 55 years old) who will help customers as Epic subcontractors. It’s an interesting concept, especially considering that the average Epic employee is probably under 30. Obviously most of the Emeriti will come from hospitals, where experience is considered an asset rather than a liability. Maybe Epic is finally acknowledging that while industry newcomers can follow a carefully documented project plan, sometimes it’s nice for nervous customers to have someone who has walked in their shoes standing beside them.

From TooMuchCoffee: “Re: Mass Health Exchange. Cuts ties with CGI Federal. There has been a lot of finger-pointing over the poor-performing sites, but the one common factor in the lousy sites is the lousy contractor CGI Federal, period. WA state was done by Deloitte and is doing fine.” My cynical suspicion is that the combination of governmental and contractor incompetence creates a lot of dysfunctional software that neither party wants publicized. The insurance exchange sites just happened to be public-facing and political, ensuring that their problems make the papers.

From Parker: “Re: McKesson. Still struggling to find a major health system on their Horizon product to convert to Paragon in order to prove to the naysayers that Paragon can manage complex systems. Atlantic Health was going to, but now is not going to move until they see more progress before making a final decision.” Unverified. It’s tough to get customers to switch to a different product offered by their incumbent vendor without their at least going out to the market first, so that may be causing indecision. It’s also tough to convince them to stick with a vendor who’s retiring the product they bought, which will require a painful new implementation no matter whose product they choose. That’s not a reflection on Paragon, just the reality of why most customers aren’t going to be thrilled, especially the larger ones that can afford to buy another system instead of accepting a free one.

HIStalk Announcements and Requests


Welcome to new HIStalk Platinum Sponsor VisionWare. The Newton, MA company provides a healthcare-focused data management platform that provides world class operational and analytical integrity. Its Master Data Management solutions address data management, integration, and data visualization. VisionWare’s Patient 360 brings in information from a variety of enterprise systems (including retired ones) to provide providers, payers, and HIEs a 360-degree view of a person (patient, member, or customer) and meet the needs for Meaningful Use Stage 2, ACO reporting, and fee-for-value reporting. Provider 360 manages provider engagement, credentialing, referral management optimization, and relationship management. Specific solution components include an EMPI, provider registry, data verification, data visualization, and data governance. Long-time friend of HIStalk Paul Roscoe joined the company as CEO in January after running The Advisory Board Company’s Crimson analytics unit and Microsoft’s Health Solutions Group. Thanks to VisionWare for supporting HIStalk.

Listening: reader-recommended Lake Street Dive, skilled jazz/soul featuring amazing vocals and a female upright bass player who rocks it. They even sound great in a driveway.

Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.

April 2 (Wednesday) 1:00 ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.

Acquisitions, Funding, Business, and Stock

AbilTo, a provider of behavioral health telehealth services, closes a $6 million Series B round.

Castlight Health signs a deal to turn Leapfrog Group’s 2013 hospital survey information into report to help consumers understand hospital performance.

Varian Medical Systems will acquire the oncology team imaging collaboration software product of Atlanta-based Velocity Medical Solutions.

Bloomberg Businessweek profiles CrowdMed, where patients whose unusual conditions have stumped their local doctor post their the symptoms and offer a reward for a correct diagnosis. The site says 180 people have gone through the process, with 80 percent of them reporting that they received a useful diagnosis.

Sales

The Veterans Health Administration Midwest Health Care Network will deploy Lexmark’s Perceptive Software Acuo VNA to consolidate medical image storage.

Meridian Health Systems ACO (CA) selects Halfpenny Technologies to provide analytics modules and an interface engine for exchanging lab information.

Capital Regional Medical Center (MO) selects Summit Healthcare’s Exchange technology to enable CCD integration and Direct messaging.

Saint Peter’s Healthcare System (NJ) selects athenahealth’s athenaOne EHR, PM, and communication system.

Health Choice (TN) selects Valence Health to build a clinically integrated network for population health management and clinical integration.

UNC Health Care (NC) chooses FrontRange HEAT for its newly consolidated service desk, replacing ServiceNow.

New Hanover Regional Medical Center (NC) chooses Strata Decision Technology’s StrataJazz for cost accounting, budgeting, planning, forecasting, management reporting, and productivity improvement.

Valley Hospital (NJ) will upgrade to Meditech 6.1, including the company’s new CCU/ICU application.

People

R. Andrew Eckert (CRC Health Group/Eclipsys) joins TriZetto Corporation as CEO.

CynergisTek hires Erin Fulton (T-System) as VP of operations.

NexTech names Eric Nilsson (Surgical Information Systems) CTO.

Home health and hospice EMR provider HealthWyse appoints Graham Barnes (HealthyCircles) CEO.

Lois Rickard (Press Ganey Associates) joins Streamline Health Solutions as SVP/chief people officer.

Deloitte names Sarah Thomas (NCQA) director of research for the Deloitte Center for Health Solutions.

Box appoints Aneesh Chopra (Hunch Analytics) and Glen Tullman (7WireVentures) as advisors for its healthcare and life sciences practice.

SSM Health Care (MO) SVP/CIO Tom Langston will retire on July 3 after 33 years with the health system.

GetWellNetwork appoints Bart Witteveen (Matrix Medical Network) CFO.

Announcements and Implementations

Three teams share $85,000 in prize money for winning NewYork-Presbyterian Hospital’s InnovateNYP, a two-day hackathon to develop patient engagement ideas for its patient portal. The winning concepts were: (a) a platform that allows inpatients to connect with each other for games, communication, and education; (b) an app that allows patients to connect with other patients, mentors, friends, and families; and (c) a tool that streamlines appointment check-in and rewards patients for healthy activities.

The Boone County Health Center (NE) and clinics go live on Cerner.

Grady Memorial Hospital (GA) implements RTLS from Intelligent InSites to track mobile assets and tissue and blood samples.

InstaMed launches InstaMed Go, which allows providers to collect patient payments via smartphones from any location with the payments posted automatically to their practice management systems and receipts emailed to patients.

Government and Politics

A salary review of Colorado’s health insurance exchange finds that its 36 employees are paid generously with mostly federal tax dollars, with 20 percent of them making more than $100,000 per year and all of them receiving a  10 percent contribution to their retirement plan. The executive director makes $191,000 per year and was given a $18,500 bonus within nine months of being hired. According to a healthcare policy expert for the Independence Institute think tank, “This is a bunch of people really responsible for nothing other than getting government grants.”

Innovation and Research

Inpatient EHR information can be used to predict sepsis, according to a study published in JAMIA. Researchers are working on a sepsis risk algorithm that an EHR can automatically calculate.

Technology

Google beats Apple to the smartwatch punch by announcing Android Wear, available later this year. The watches, which will be tethered to Android-powered phones, will offer voice control, a Siri-like personal assistant, Google Maps, and fitness-tracking sensors. Android Wear may eventually power other wearables, such as a smart jacket.

Other

UNC Health Care System-owned Rex Healthcare (NC) will pay $28 million this year for its portion of UNC’s Epic implementation, which is scheduled for a summer go-live.

CDC’s flu tracking data is better than Google Flu Trends even taking its lag time into account, with Google Flu Trends overestimating flu prevalence by more than 50 percent in the past two flu seasons.

AHIMA, CHIME, and other ICD-10 stakeholders urge Congressional leaders to continue to move forward with the October 1, 2014 ICD-10 implementation deadline and ask for support for the Medicare Audit Improvement Act, which addresses challenges with the RAC program.

A doctor in England is caught by fraud investigators for falsifying electronic medical records to earn NHS quality care bonuses. He enlisted the help of an IT person to enter fraudulent data, but after getting caught, blamed the technician and then computer coding errors for the falsified records. Some of the patients he claimed to have treated were imprisoned, abroad, or dead at the time. 

Weird News Andy titles this, “Lungfish?” Student engineers program at Rice University (TX) enrolled in a program that addresses the problems of hospitals in developing countries create an affordable bubble CPAP device (it helps newborn breathe by pushing air into their lungs) made from two aquarium pumps and a Target shoe box. The device has been deployed in hospitals in Malawi and is being rolled out to other countries. One of the students visited a hospital in Malawi and was told by a nurse there that their device had saved her own baby’s life.

Sponsor Updates

• Nuance will host a free “Art of Medicine” panel discussion on Thursday, March 27 from 9:00 to 11:00 a.m. at the W Hotel in Boston, MA that features Beth Israel’s John Halamka, MD; the AMA’s Steven Stack, MD; and Mass General’s Keith Dryer, DO, PhD discussing demands that take doctors away from patients. Email to register.
• SyTrue is chosen to participate in the first Wharton DC Innovation Summit on April 29-30, which will bring together investors, innovators, entrepreneurs and academic leaders. CEO Kyle will present a session on “Innovation Tools.”
• Gartner positions NTT in the Challengers Quadrant of the 2014 Magic Quadrant for Global MSSPs.
• Canon USA introduces Nuance eCopy ShareScan v5.2, which features an email and folder-watching service to simplify electronic workflows.
• The Drummond Group certifies Kareo EHR for MU 2014 Stage 2.
• Truven Health Analytics reports that its Treatment Cost Calculator tool for estimating out-of-pocket medical costs now reaches 20 million consumers through its client base of employers and health plans.
• Culbert Healthcare Solutions VP Brad Boyd and Oschsner Health System medical director of accountable care Philip M. Oravetz,MD will discuss strategies for extending EHR technology to affiliated practices at next month’s AMGA conference in Dallas.

Contacts

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

More news: HIStalk Practice, HIStalk Connect 

Monday Morning Update 3/17/14

Top News

Castlight Health’s share price climbs dramatically after its Friday IPO, surging 149 percent from $16.00 to $38.90. The company was valued at $1.39 billion at the IPO price, placing it in the $3 billion plus range after Friday’s market close. The company had $13 million of total revenue last year and lost $62 million, reportedly placing its loftily priced IPO price (107 times revenue) as the highest multiple since the dot-com era. Still, the company’s underwriters left a lot of Castlight’s money on the table at pricing the shares so far below their first-day closing price. Nobody’s saying how much shares owned by the already-loaded founders are worth (Todd Park, CTO and co-founder of athenahealth; Bryan Roberts, PhD, chairman and co-founder of venture capital firm Venrock; and Giovanni Colella, MD, founder of RelayHealth.) They might want to sell their shares soon: studies show that shares of companies valued at this level of frothiness have historically had a three-year return of –92 percent.

Reader Comments

From Krikey: “Re: ongoing column writers. There are some very perceptive and witty folks out there, just a challenge to find and encourage them to contribute. I have ideas, but hesitate to name names.” I enjoy the writings of Ed Marx, Darren Dworkin, Dr. Gregg, and others on the provider side who have an interesting perspective and an entertaining way of presenting it. I’m happy to entertain the possibility of adding to that roster, but with the added comment that lots of folks think it sounds great until they realize it’s an ongoing commitment.

From Orange Belt: “Re: hospital salaries. Why are you so down in paying high-performing executives what the market demands?” Because non-profit hospitals shouldn’t be a market – they are a charity for taking care of sick people and should pay comparably to other charitable organizations even though they are inexplicably forced to run like a big business instead. I’m pretty sure that while the talent pool might be different if a health system paid its CEO only $500K instead of several million dollars, that amount would still be sufficient to hire a committed and skilled candidate. Making excuses such as (a) “We have to pay too much because everybody else does”; (b) “We have to compete against the giant corporations our executives would be lured away to run given their vast experience in dealing with nurses and insurance companies in a non-consumer driven market”; and (c) “Our executives are worth every penny because we’ve made a fortune since they took charge” are just excuses to avoid admitting that running a hospital has become a lucrative profession rather than a selfless calling and has attracted leaders who would wander off in an instant if they were paid responsibly.

HIStalk Announcements and Requests

Quite a few readers reported their annual job compensation, breaking out into the categories above. New poll to your right: should patients have a greater role in the HIMSS conference?

Thanks to everyone who completed my reader survey. I’ve emailed $50 Amazon gift cards to three randomly selected winners (I use a random number generator to choose from the available Excel rows of responses). I will be reviewing the results carefully over the next several weeks and will report back, but the item above is the one I watch most carefully, in which 92 percent of respondents said that reading HIStalk helped them perform their job better in the past year.

Another DonorsChoose classroom update: Mrs. Pew’s Louisiana second graders are already enjoying the books you and I bought them four weeks ago using proceeds from the top HIStalk banner ads during the HIMSS conference. She reports, along with sending the photo above, “Your donation has helped make it possible for all students to be actively engaged in my classroom in one way or another. They are able to interact with one another, discuss the books they listen to, and learn new words. Thank you for your generous donation and for bringing such joy to my classroom.”

Listening: Dead Confederate, country-tinged hard rockers from Athens, GA.

Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.

Acquisitions, Funding, Business, and Stock

Mobile open source healthcare network vendor Cytta and telehealth technology provider ViTel Net announce plans to merge some or all of their companies. Sounds like they suffer from either commitment issues or premature declaration.

Announcements and Implementations

As expected, formerly high-flying Accretive Health is notified by the New York Stock Exchange that its shares have been delisted because the company has not filed its revised 2012 annual report. Above is the five-year share price chart of AH vs. the DJIA. The company’s market capitalization is still at $790 million, but shares are down 75 percent from their July 2011 high. The company tangled to its eventual disadvantage with Minnesota’s attorney general in early 2012 over is aggressive collection practices for hospital patients, including strong-arming patients with no outstanding balances who were still in their ED treatment rooms. I explained my mixed feelings about the company’s practices at that time:

The question raised by the Accretive mess that nobody wants to ask or answer is this: how much collection effort is too much? If the model forces a hospital to operate as a business, is it fair that some customers get away without paying, quite a few of them perfectly capable but just unwilling to do so because it’s not exactly a pleasurable purchase? Or that they don’t pay because hospital list prices are absurd, with insurance companies getting huge discounts on the $4 aspirin that cash-paying patients are expected to pay at list price? Accretive probably went too far, but it’s a slippery slope. They are the symptom, not the problem. Imagine if a restaurant couldn’t turn away hungry but broke patients, has to serve them steak and lobster if that’s what they want, and has to welcome them back for meal after meal even though they’re capable but unwilling to pay. Is that fair to the other diners who will have to make up the difference?

Duke LifePoint Healthcare, a joint venture between Duke University (NC) and for-profit LifePoint Hospitals, will acquire Conemaugh Health System (PA) for $500 million, adding to its total of 60 hospitals and 29,000 employees. LifePoint, whose annual revenue is $3.68 billion, paid its CEO $9 million in 2012, with its other six officers making between $1.8 million and $3.4 million each. 

Government and Politics

The VA Secretary Eric Shinseki says the VA will enter its VistA Evolution in the Department of Defense’s EHR procurement project, claiming that the upgraded system will be equal to the commercially sold EHR systems that the DoD seeks. The VA announced its interest in receiving bids for developing VistA Evolution in late January, allowing eight business days to receive responses. It requested $269 million for 2015 to develop it.  I can’t decide if Shiseki is just yanking the DoD’s chain, calling DoD out publicly knowing they would rather use stone tablets and chisels than admit that the VA’s systems are better, or if he really thinks the DoD is open-minded and taxpayer-respectful enough to use what makes sense instead of what it can control with an iron hand and an army (pun intended) of government contractors. Hopefully he won’t trigger a DoD-led military healthcare junta.

At the same House Veterans Affairs Committee meeting, the American Legion scolded both agencies in written testimony, saying the agencies “squandered more than a billion dollars of taxpayer money and wasted years in an ultimately empty pursuit of a joint electronic medical record system that would have streamlined and simplified logistics between the two agencies …The warfighter turned veteran is the same patient and deserves a system that honors that person with continuous care and seamless transition between agencies.  It is unforgivable that DoD and VA have spent the past several years infighting rather than actively developing a comprehensive solution that is in the best interest of the American service member.”

The Defense Health Agency expects to spend $1.5 billion in 2017-2019 to buy a new EHR, according to new budget documents. I’m guessing that line item didn’t come from the VA’s RFI response.

Innovation and Research

Patrick Soon-Shiong says on Larry King that like fellow billionaires Warren Buffet and Bill Gates, he has signed the Giving Pledge and will thus donate more than half of his wealth to charitable causes.  He also announces his latest invention: a $300 hearing aid that can be tuned by smartphone, making hearing correction affordable for the 700 million people who need it. He used the same technology to develop the $100 Notes personalizable headset and will donate a hearing aid for each two headsets sold, hoping to give away one million hearing aids in the next five years.

Other

Washington’s state medical commission files unprofessional conduct charges against the former physician head of Harborview Medical Center’s burn unit, finding that he testified about the value of using flame retardants in furniture without disclosing that he was being paid by the companies that produce the chemicals. Government scientists had concluded that the products are toxic and don’t work, leading the chemical companies to create a phony three-member consumer watchdog group to create public fear about fire danger and to pay experts for favorable testimony. The group was quietly shut down in 2012. The doctor is also accused of making up compelling patient stories and violating patient privacy laws by using a minor patient’s photo without permission. 

Valley View Hospital (CO) notifies 5,400 patients that technicians found an encrypted, hidden server folder that contained their credit card, Social Security, and demographic information, adding that the information may have been used for identity theft. An unnamed virus collected and stored screen shots of online web pages that may have been sent outside the facility. The hospital says it has since improved its antivirus and firewall systems.

The Sacramento paper profiles Davis, CA-based Cedaron Medical, which offers software for cardiac care, rehab documentation, speech pathology, occupational therapy, and worker’s compensation evaluation. I’m fascinated that founders Malcolm and Karen Bond also started Bondolio, an award-winning olive oil business.

An editorial in BMJ says that doctors would provide better care if they knew that patients were recording their encounters, even suggesting that doctors record sessions themselves and offer patients a copy. It addressed a debate in England in which the UK General Medical Council eventually changed its position that such records would not be admissible in professional practice reviews. The article concludes that there’s no way to stop patients from recording their physician interaction, so the medical profession might as well figure out how to use that information to improve care.

Former Epic project manager Brian Stowe is sentenced to 38 years in prison for sexually assaulting six of his female Epic co-workers and a 17-year-old girl and filming the attacks. The victims were unaware of his activities until video from his computer surfaced years later, leading to the unproven possibility that he drugged them, that speculation bolstered by the fact that one his computer’s video folders was labeled “drug assaults.” One set of photos was apparently made during an Epic business trip. Stowe apologized, said he was “out of control,” and added, “The only part about getting caught that truly upsets me is that it’s caused the lives of all these people I love and care about to implode.” Stowe, who had pleaded guilty, faced a sentence of more than 400 years for 62 felonies, but that count was reduced to 27 felonies in a plea deal.

A former contract ED doctor working at Spectrum Health (MI) sues the hospital group, claiming it banned her from working there for making a Facebook comment. She thought she recognized a patient depicted in an ED nurse’s Facebook photo of a woman’s backside, so she added a comment, “OMG. Is that TB?” The doctor claims the hospital was unhappy that she was planning to consult with other EDs using materials she had developed, so they falsely claimed her comment was a HIPAA violation. She adds that a nurse was reprimanded rather than fired for leaving a comment, “I like big butts and I cannot lie.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 3/14/14

Top News

Validic, which offers a platform for accessing data from mobile health devices and wearables, secures a $1.25 million convertible note.

Reader Comments

From Professional Zac: “Re: Mat Kendall. Has given ONC exemplary service in leading its workforce, REC. and rural programs as director of the Office of Provider Adoption Support. He is leaving.” Mat is one of those people who gets a lot done, not only running those ONC programs, but before that working for New York’s EHR program and before that leading a FQHC. Like everybody who works for ONC, he sacrificed income and lifestyle for public service since it’s generally true that only low-level government employees fare better than they might in the private sector. I haven’t heard where he’s going.

HIStalk Announcements and Requests

This week on HIStalk Practice: Practice Wise CEO Julie McGovern addresses EHR users who refuse to admit they might be causing their own system problems. Users of drchrono’s free EHR will be rushing to apply for MU hardship exemptions after the company announces that its Stage 2 certified release won’t be ready until  “later this year.” A Rand study finds that physicians recognize the value of EHRs in concept but believe they undermine professional satisfaction and can negatively impact patient care. Between 2011 and 2012, the percentage of EPs participating in  Medicare’s MU program dropped 16 percent and the percentage dropping out of Medicaid’s program fell 61 percent. CareCloud CEO Albert Santalo discusses a possible IPO, company growth, and how its offerings differ from athenahealth’s. While you are checking out the latest in ambulatory HIT news, take a moment to subscribe to the email updates so you’ll never miss a post. Thanks for reading.

This week on HIStalk Connect: Proteus Digital Health announces large-scale trials and plans for a new manufacturing plant in the UK. Nintendo will refocus its strategic direction to capitalize on the growing health and wellness market. Validic raises $1.25 million to expand its mHealth integration engine.

Last chance to help me out plus be entered into a drawing for three $50 Amazon gift certificates: complete my reader survey before I close it Saturday. I appreciate it.

Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.

Acquisitions, Funding, Business, and Stock

Telus Ventures invests $3 million in PatientSafe Solutions and becomes the exclusive reseller of the PatientTouch point-of-care mobile system in Canada.

Covisint announces preliminary Q4 revenue of $24-$25.5 million, short of estimates, and appoints Sam Inman (Comarco Wireless Technologies) as interim CEO.

Accretive Health says it will probably not meet the SEC’s deadline to file restated financial results from the last three years, which will likely cause its stock to be delisted from the NYSE next week. 

General Atlantic is said to be the frontrunner to make a $100 million investment for a 30 percent stake in 1,400-employee healthcare IT services firm CitiusTech, which seeks capital to fund growth in Europe and the Middle East.

People

Validic hires John Turnburke (MedFusion) as SVP of business development, Chris Edwards (Allscripts) as VP of marketing, and Ben Clark (Allscripts) as VP of operations.

Janet Dillione, executive vice president and general manager of Nuance’s healthcare division, will step down on March 21, according to an SEC filing.

Richard Paula, MD (Tampa General Hospital) is named CMIO at Shriners Hospital for Children (FL).

Brian Ahier (Advanced Health Information Exchange Resources) is named director of standards and government affairs for Medicity.

Connance names Michael Puffe (Huron Consulting Group) SVP of sales.

Announcements and Implementations

MMRGlobal announces a confidential patent agreement with Cerner relating to MMR’s MyMedicalRecords PHR portfolio, including the one above submitted in 2005.

OCHIN and Health Choice Network launch Acuere QOL, a data aggregation, analytics, and quality solution powered by the Caradigm Intelligence Platform that will help CHCs and PCAs manage populations and improve quality.

PatientsLikeMe launches a media campaign urging people to share their medical information. How the for-profit PatientsLikeMe makes money: selling the medical information people share to drug and device manufacturers.

Government and Politics

A GAO report recommends that HHS pay more attention to the reliability of EHR data used for quality measures and use them to measure progress.

Other

BIDMC CIO John Halamka reports that the ED has been beta-testing Google Glass since December to view the patient dashboard during examinations. He says its greatest strength is being able to provide real-time updates at the bedside and will become valuable when tied to location services.

Executives of three Madison, WI-area healthcare IT companies were among the 35 invitees who were briefed by White House and HHS officials on healthcare innovation and entrepreneurship last week, including a session with National Coordinator Karen DeSalvo, MD.  The companies were Nordic Consulting, Forward Health Group, and healthfinch.  

Speaking of the White House meeting, HIStalkapalooza winner and Nordic Consulting President Drew Madden broke out socks appropriate to the occasion. It’s apparent that he has worn them before, with the obvious question being, “To where?”

I recently mentioned that I rarely complete a HIMSS member survey because the are so long and poorly designed. I just received one asking for feedback on the annual conference that ran eight online pages and 1,100 words. Needless to say my incompletion record remains intact.

A Fitch Ratings report says hospitals may face weakened credit ratings as a result of their ICD-10 conversion.

The Department of Homeland Security warns users of the now-unsupported Windows XP that they should at least replace Internet Explorer with a more secure browser for which security updates will be issued.

The Society of Thoracic Surgeons will connect its clinical database to CMS claims data, allowing researchers to track readmissions, second procedures, and long-term survival.

Weird News Andy wonders if the hospital gets a commission on tickets as local police install a red light camera near the ED of University Hospital of Tamarac (FL), snaring at least one patient experiencing chest pains. WNA quotes a related story in which most people with chest pain in Northern Utah drive themselves to the ED, slowing their treatment since ambulances can run ECGs during transport and alert the cath lab team to be ready at the door.

Sponsor Updates

• Shareable ink Founder/CTO Steve Hau will run in the Boston Marathon on April 21 and will personally match up to $10,000 in donations for victims and survivors of the 2013 bombing. 
• Capsule Tech will showcase Capsule SmartLinx Medical Device Information System at the American Organization of Nursing Executives annual meeting in Orlando.
• Fujifilm Medical Systems and Fujifilm SonoSite will participate in the National Consortium of Breast Center Meeting in Las Vegas March 15-19.
• Perceptive Software launches v10.3 of its Enterprise and Workgroup Search.
• Holon Solutions and Texas Organization of Rural & Community Hospitals (TORCH) will build a health information exchange (HIE) that will connect North Texas Medical Center (TX) to local clinics.
• HealthCare Anytime offers two-minute video overviews of their enterprise and SaaS portals.
• NTT Data is doubling the size of its US headquarters in Plano, TX.
• Seven healthcare CIOs shared strategies for managing IT cost while maximizing its value at the CIO Summit in Chicago co-sponsored by Impact Advisors.
• NexxRad Teleradiology Partners selects Merge PACS to integrate with its NexxRIS.
• ZirMed partners with Precyce/HealthStream to offer client ICD-10 education to the ambulatory market.
• WiserTogether and Truven Health Analytics partner to help consumers make better healthcare decisions.
• Porter Research President Cynthia Porter shares her thoughts on the Health IT Marketing and PR Conference in Las Vegas April 7-8.
• pMD announces that all of its new mobile charge capture implementations will be ICD-10 compliant.

EPtalk  by Dr. Jayne

I was pleasantly surprised in my personal Yahoo mail account this morning when they returned a feature that was taken away with its redesign last fall. Although I’m glad I can now see my folders and their contents, I still wish they would bring back the tabs across the top that allowed multiple emails to be open at the same time. They also followed up with an email response to my original complaint letting me know. After the original annoyance of the upgrade, I moved most of my real email activity to Gmail, so pretty much all I use Yahoo for anymore is coupons and shopping promotions.

Inga tipped me off to this piece regarding physician professional satisfaction. The study showed multiple factors as having a positive impact on physician professional satisfaction:

• Perception of whether high-quality care is being delivered
• Control over work environment, pace, and content
• Common values shared with leadership
• Respectful professional relationships
• Fair and predictable incomes

Not surprisingly, these have more to do with how practices and physician organizations run rather than with EHR. Although there are problematic EHRs and other IT systems out there, my sense over the last few years is that physicians often use them as a scapegoat. My local colleagues have voiced the thought that they can have some degree of control over EHR (refusing to use the system, demanding de-installation, blaming the vendor) but that some of the other factors (control over work environment, salary issues) are simply untouchable.

Thinking about this from a pure behavioral health standpoint, this is classic behavior. When people experience trauma, they tend to cling to the things they can control even when the rest of their lives are out of control.

Although the timing of the study didn’t allow assessment of the impact of the Affordable Care Act, I see a lot of physicians ready to use it as a scapegoat even though the majority of its changes have not yet impacted anything other than the access issue. I liked the fact that the study had a qualitative portion, which included open-ended interviews rather than just survey-type items. Those types of questions allow respondents to share direct responses without feeling the need to fit them into a predefined response box.

Unfortunately, the responses may also fail to allow full understanding of or exploration of the results. Physicians stated that “their EHRs required them to perform tasks that could be done more efficiently by clerks and transcriptionists.”

Since I spend a lot of time working on efficient clinician workflow, I would have wanted a follow up question. Is it really the software that is requiring the workflow, or is it also impacted by organizational policies that require physician data entry where it is not necessary? Is it impacted by continued administrative cost cutting that forces work onto physicians because they are perceived as “free labor” since the hospital doesn’t bill for their services as community physicians? Of course those would be rather leading questions, but that’s what I see a lot of in our metropolitan area.

Due to my CMIO responsibilities, I cobble together my clinical experience at several different hospitals. Two of them have the same EHR vendor, yet the user experience difference is night and day. One system has been configured to require endless busywork. The order sets are poor, in a confusing order, and missing seemingly key components. Physicians are required (by administrative decision) to key a PIN for each individual order rather than being able to authenticate a cohort of orders at once. That kind of thing is fixable through educating the decision makers and ensuring that physicians are part of that decision-making process.

Don’t get me wrong, there are a lot of bad EHRs out there. It’s hard to sort that out though when poor leadership, incomplete training, and lack of understanding can cripple a perfectly good system. We need to remember that there are plenty of “causal” factors to go around, In order to truly deliver physician usability, we have to address both the hardware/software issues and how the system is implemented and governed.

In addition to EHRs, physicians cited multiple sources of dissatisfaction:

• Obstacles to care, such as unsupportive practice leadership or payers refusing to cover recommended services
• Income instability
• Burdensome regulations, including Meaningful Use

Unfortunately, these aspects of physician practice are mostly outside our control. We can’t control payers and spend countless hours of uncompensated time trying to get care for our patients. We can see more patients, but we can’t control the wide variation in payments for the same service that we see across payers. We certainly can’t control the regulatory environment.

So what do we do? We circle back to the EHR as something we think we can have some control over.

I don’t have any good answers here and wish I did. I’d love to have a magic wand or even a sparkly Band-Aid to make it all better. How do we empower physicians to be part of the solution? How do we help administrators make rational decisions around system selection and implementation? How do we get them to share the reins with providers? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 3/12/14

Top News

The HIT Policy Committee submits its Meaningful Use Workgroup’s Stage 3 recommendations.

Reader Comments

From Pointy Toes: “Re: CEHRT Hardship Exception Guidance. This is a joke. All you have to say to qualify for the Medicare hardship exemption to avoid the 2015 payment adjustment is say you  had ‘2014 Vendor Issues.’ Tavenner previously said some ‘narrow’ hardship exemptions would be granted. Sounds like anyone wanting an exemption can request it and presumably one will be granted one. Why not just push the deadline back for everyone instead of requiring providers to jump through an extra hoop?” CMS issued guidance Tuesday for EPs and hospitals worried about being hit with penalties, even going so far as to provide instructions to choose “2014 Vendor Issues” no matter what their actual issue. It is ridiculous – setting the bar high officially, then accepting a wink-wink rubber stamp excuse for anyone who can’t make it. Maybe someone should track the vendors whose non-compliant yet certified products forced their users to claim hardship.

From Canuck: “Re: rumore that UHN in Toronto is replacing QuadraMed EHR with Cerner. I believe instead it came down to Cerner and Epic and Epic won.” Unverified.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor SyTrue. The Chico, CA-based company offers a business and clinical intelligence platform that tells hospitals how their clinical objectives are being deployed; what physicians are doing; and who in the market is providing services at a given cost and outcome. It integrates and structures disparate EHR information for predictive and clinical analytics used for data analysis, electronic abstraction, outcomes analytics, operations, population management, clinical research, and patient engagement. Thanks to SyTrue for supporting HIStalk.

Here’s one final mug shot featuring Tammi’s office de-stresser, which must have traveled furthest from Orlando while still not leaving the continental US (the UFO on a stick in the background should give a strong hint of her location).

Thanks to the 355 folks who have completed my reader survey so far. That number provides respondents with good odds of being randomly drawn for one of three $50 Amazon gift cards, but represents only around 1 percent of HIStalk’s 30,000+ readers. Spend less than five minutes completing the survey and you’ll help me plan the next year of HIStalk and earn my appreciation besides.

I’m always looking for interesting people to interview. Know someone who would be stimulating, fun, and a straight shooter? Let me know.

Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.

Acquisitions, Funding, Business, and Stock

First-half results from Scotland-based Craneware: revenue up five percent, pre-tax profit up seven percent.

CompuGroup Medical acquires three European HIT providers: lab software provider vision4health Laufenberg & Co and office-based physician software vendors Imagine Editions and Imagine Assistance.

Quest Diagnostics completes its acquisition of Solstas Lab Partners Group and raises its full-year 2014 financial guidance.

Employer benefits platform provider Castlight Health raises the price range of its IPO to $13-15 per share, up from the $9-11 range it set just a week ago. The company, which lost $62 million on $13 million of revenue in 2013, would receive proceeds of $140 million, valuing it at $1.5 billion. The company’s founders are Todd Park (US CTO and co-founder of athenahealth); Bryan Roberts, PhD (chairman and co-founder of venture capital firm Venrock); and Giovanni Colella, MD (founder of RelayHealth).

Sales

The Royal Free London NHS Foundation Trust selects OpenText to manage its scanned legacy case notes.

The Community of Hope (DC) is implementing Forward Health Group’s PopulationManager and The Guideline Advantage.

The VA awards Leidos three contracts worth $16 million to support blood bank software and the MyHealtheVet program.

People

TeleTracking Technologies names Diane Watson (Tilt, Inc.) COO and Joseph Tetzlaff (inVentiv Health) CTO.

Michael Hart is promoted to VP of IT applications at Arkansas Children’s Hospital.

Craig Joseph, MD (Agnesian HealthCare) is named ICD-10 and EHR physician advisor at Texas Children’s Hospital (TX).

Announcements and Implementations

Cox Health (MO) deploys Phytel’s population health and patient engagement platform.

McKesson announces QICS for Cardiology, a CVIS-based workflow and critical results communications platform. OSF Healthcare (IL) is piloting.

QuadraMed announces GA of its QCPR 6.0 enterprise EHR, which includes bar code medication administration, a comprehensive problem list, a Web-based patient portal, the ability to create a CCD, and Canada-specific architecture requirements.

In Canada, Bluewater Health will roll out patient flow software from Oculys.

University of Colorado Physicians goes live on the DocASAP self-scheduling system.

Government and Politics

Office of Civil Rights fines the public health department of Skagit County, WA $215,000 for HIPAA violations involving information on 1,581 people exposed in its public web server, the first time a HIPAA fine has been levied against a local government.

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The White House launches #GeeksGetCovered, encouraging technology entrepreneurs who can now buy their own non-employer health insurance because of the Affordable Care Act to start their own businesses.

President Obama riffs hilariously with comedian Zach Galifianakis, appearing on “Between Two Ferns” to plug Healthcare.gov (“I wouldn’t be with you here today if I didn’t have something to plug … Healthcare.gov works great now.”)

The phrase “healthcare exchange” always seems to be preceded by “troubled,” so add Maryland’s $200 million version to the list.  Like other states, it decided to create its own site, hired a contractor that it later said underperformed, missed its go-live date, and had to create a backup plan to accommodate people who wanted to enroll but couldn’t. HHS announces that it will investigate.

Hillary Clinton’s financial disclosure forms for 2012 reveal that her husband Bill took a $225,000 speaking fee from the struggling, non-profit Washington Hospital Center as it was laying off employees. The hospital also brought in George W. Bush to speak, but since his wife isn’t running for office, his fee remains confidential. Bill made a bunch of money in 2012 for addressing money-losing non-profits. Somewhere in those records is the payment he received from HIMSS if anyone knows how to locate them. I’d bet $400K.

Innovation and Research

A NIST report says that inadequate workflow integration forces users of ambulatory EHRs to develop system workarounds, suggesting that EHR vendors develop these capabilities:

• At-a-glance physician views of patient schedules
• Task reminders from previous patient visits
• Redacting and summarizing lab results
• Draft creation of patients orders in advance
• Conversion of working diagnoses to formal diagnoses
• Skip or defer tasks when workload requires
• Role-based views of progress notes
• Visually differentiate copied-and-pasted progress note text from newly entered documentation
• Manage referral and consultation messages with specialists
• Track scheduled consults and lab results review

The Charlotte, NC newspaper says that Carolinas HealthCare System will use innovative (unnamed) software and the information collected by its multiple EMR systems to identify ED patients who are likely to be readmitted, allowing team-based intervention and remote management. The system’s chief medical officer weighs in on hospitals that don’t use electronic medical records: “You don’t know how bad it is until you actually go back. It was like a time warp. The care is unsafe, it’s uncoordinated. It’s a nightmare…The system was absolutely stupid, and frightening.” I interviewed SVP/CIO Craig Richardville in September 2013. It might be time for a follow-up to talk about analytics.

Technology

Wellocracy provides a well done comparison chart of wearable activity trackers.

Other

A column by InfoWorld’s executor editor says a disconnect exists between complex government EHR requirements and the stubbornness of the healthcare industry to embrace them, summarizing, “We have a mess of proprietary EHR systems with highly customized processes, a set of HIEs that use different standards and protocols to connect them, and a mandate to provide human-readable data from these disparate systems. What could possibly go right?”

In England, University Hospital of North Staffordshire plans to conduct video consultations via Skype, saying the service will reduce outpatient appointments by 35 percent.

The Gainesville, FL newspaper profiles Shadow Health, whose founder licensed avatar technology from the University of Florida to create nursing school education tools that students buy for $89.

A study finds that incorrectly flagging patients as being allergic to penicillin increases overall inpatient days by 10 percent and increases resistance to broad-spectrum antibiotics. Up to 95 percent of patients who say they are allergic to penicillin really aren’t.

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New York-Presbyterian Hospital will host a hospital hackathon this weekend in which teams will design apps for its portal that improve patient access to care. The hospital is offering $85,000 in prizes and has filled all of its slots with 120 participants. Dr. Oz provides the video introduction.

Sponsor Updates

• Kinetic Data names CareTech Solutions “Innovator of the Year” for realizing $4.7 million in cost savings by implementing Kinetic Request.
• Premier enhances its OperationsAdvisor labor management solution to give healthcare organizations the ability to analyze labor efficiency across multiple care settings.
• Ryan Uteg, senior advisor for Impact Advisors, is named to Consulting Magazine’s “35 Under 35.”
• Allscripts Sunrise is selected by Black Book as top inpatient EHR.
• Iatric Systems will deploy integration in the EDIS and vital sign monitors as Southeast Alabama Medical Center (AL) upgrades its McKesson Paragon HIS.
• MedAssets’ National Sourcing Collaborative cumulatively saves providers $135 million over the last three years.
• Wolters Kluwer Health launches Bates’ Visual Guide demonstrating evidence-based physical exam techniques.
• Santa Rosa Consulting’s Fred L. Brown is inducted into Modern Healthcare’s “Health Care Hall of Fame 2014.”
• Kareo announces that its ICD-10 Success Checklist is available on a write-on poster.
• NextGen Healthcare’s CMO Sarah Corley is elected to serve on the EHR Association Executive Committee.
• Medical Economics spotlights e-MDs customer John Bender, MD of Miramont Family Medicine (CO) for expanding his practice while 30 percent of local practices have sold or closed.
• Health Catalyst publishes a free white paper with a candid 12-point review of population health management software vendors.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

Monday Morning Update 3/10/14

Top News

The Wall Street Journal reports that transcription and speech recognition software vendor MModal will file bankruptcy this week, loaded with $750 million in debt as a result of its leveraged buyout in August 2012 and facing declining sales. The company expects to work out a debt restructuring plan in advance that will allow some of its creditors to swap the money they are owed for equity in the reorganized company. UPDATE: MModal provided this statement in response to the HIStalk news item:

MModal is continuing discussions with certain of its lenders and bondholders regarding a range of financial restructuring options to enable the company to reduce its debt and enhance its financial flexibility. We believe these discussions have been constructive and we are working towards a resolution that has the support of our lenders which would provide a positive outcome for all of our stakeholders, including our customers, employees, and suppliers. We fully expect to continue operating in the ordinary course of business and providing our customers the high level of support they have come to expect from MModal. The company has solid revenue, strong operating margins, cash flows consistent with industry norms, a large customer base, and we are continuing to invest in the future. Our operations are strong and we are generating exceptional quality metrics and high customer satisfaction. We are executing on our vision to provide the healthcare industry’s most advanced clinical documentation solutions.

Reader Comments

From Caterwaul: “Re: readers during HIMSS. How many do you get?” Around 8,000 visits daily during the conference, peaking this year at 9,000 visits and 17,000 page views on Wednesday, February 26. For the month, it was 125,000 visits and 207,000 page views. The graph above covers the last 30 days.

From The PACS Designer: “Re: iPhone 6. Excitement is starting to build for the next generation of the iPhone, will feature for the first time a quad-core 64 bit processor along with iOS 8. Also expected at  launch is a heart rate monitor along with the much anticipated iWatch. It looks like Apple’s going for a big splash of new products in 2014.” Sometimes it feels as though the iPhone is like the iPod – a mature, somewhat commoditized market in which minor feature differentiation passes for innovation. Apple and competitors can do only so much in screwing around with the screen size and construction materials, so the real improvements have to come from the OS.

From Jeff: “Re: headlines. Is is possible to get the morning headlines and any M&A news in a daily email?” I hadn’t thought of doing that since I assume most readers just go to the site, but it’s possible. Weigh in on the reader survey if you’d like since that’s where my to-do list will come from.

From Olga: “Re: reader comments. I get the feeling that comments are filtered since controversial topics don’t always have many.” Comments are not filtered. I approve every one except these: (a) unverifiable claims that a specific person is quitting or being fired; b) repetitive, annoying diatribes posted by the same person using different names, as in the multiple anti-EMR identities of Not Tired of Suzy, RN; (c) comments trying to publicize a company or site. I should add that the Akismet spam filter automatically deletes comments that come from known spammer IP addresses or that contain questionable content, like a bunch of links. You might be surprised at some of the comments that I’ve rejected: claims that a specifically named CEO forced a female VP to attend an orgy, assertions of deviant behavior by well-known industry figures, and full-out personal attacks on people named in given post.

HIStalk Announcements and Requests

Half of the HIMSS conference attendees who responded to my poll said it was a good overall experience, with the remaining 25 percent each declaring it to have been either poor or great. New poll to your right, just for (anonymous) fun: how much money did you make from your primary job in 2013?

Here are more mug shots. Theo, 18 months old, doesn’t seem to mind Dad’s mishap traveling home from HIMSS that will require Mom to fix the handle. To the right, Colleen says she has one wish for Christmas since nurses need high-capacity mugs.

Every year right after the HIMSS conference I ask readers to complete my survey telling me what they like, don’t like, and recommend for HIStalk. It only takes a few minutes and I plan my entire year from the feedback. You will make a difference, earn my gratitude, and be entered in a drawing for three $50 Amazon gift cards. Thank you.

I won’t overdo the DonorsChoose project updates, but I wanted to share an example of the student letters you receive when you fund a classroom project. This one from a second grader says, “Thank you for the nonfiction books. We use them for learning and reading stations. We love them.” Lots of charities do good work but spend too much of their donations on fundraising and salaries. DonorsChoose has amazing stats: 94.4 percent of donations go toward programs and services instead of overhead, the CEO is paid only $240K, and it earns an amazing score of 67.83 out of a possible 70 on Charity Navigator. I was jaded about charities having worked in wasteful hospitals until I did my homework and came up with DonorsChoose and Salvation Army. I don’t donate a penny until I check Charity Navigator because marketing overhead can be up to 90 percent for some causes that run TV ads.

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.

Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.

Acquisitions, Funding, Business, and Stock

The private equity owners of payer-provider connectivity vendor Ability Network are seeking a buyer for the company, expected to fetch up to $500 million.

Government and Politics

Former White House advisor and oncologist Ezekiel Emanuel, MD, PhD (Rahm’s brother) writes a Wall Street Journal piece on the infighting involved in creating the Affordable Care Act. Everybody knows that HHS on one hand declares itself technologically innovative and its ONC organization demands that healthcare providers advance their technology prowess, while the CMS side of HHS’s house spends vast taxpayer fortunes on its primitive systems and the marginally competent bureaucracy required to maintain them. On bundled payments:

We presented the idea of phasing in bundled payments, especially for chronic conditions, to the rest of the White House reform team, where we found some strong support. But then we hit a brick wall. Many of our colleagues who worked for Medicare feared that creating the bundles would be too hard and warned that Medicare didn’t have the computer infrastructure to handle it. The arguments went back and forth, but the Medicare bureaucracy wouldn’t budge. Ultimately, the ACA authorized 10 demonstration projects that could be expanded if they worked—a good start, but a far cry from the more ambitious bundling plan many of us had hoped to see.

Delaware’s health department wants $87 million in FY2015 capital to upgrade its eligibility systems to meet Affordable Care Act requirements, adding that it’s too good of a deal to pass up since federal tax dollars will cover 90 percent of the cost. A Republican state representative isn’t impressed with the department’s plans. “We could have started our own endowment. It’s just staggering. This math is out of control. It’s extremely, extremely disingenuous to say this (Affordable Care Act) is saving us money.”

Innovation and Research

Engineering cadets from the United States Air Force Academy develop Neumimic as their capstone project, working with a local hospital to design a stroke recovery application based on Microsoft Xbox Kinect. The system allows patients to exercise specific muscle groups at home without a physical therapist.

Other

It’s spring-forward time as I write this on Saturday morning. Thanks if you are one of the folks who will be babysitting hospital systems tonight to make sure everything works with the change to Daylight Saving Time.

The folks at SIS put together a hilarious video that parodies vendors preparing for the HIMSS conference. It contains quite a few inside references from HIStalk (like companies that claim “HIPPA” expertise). Leave a comment with those you notice since I’m sure I didn’t catch them all.

An interesting and scary use of big data: auto repossession companies are using vehicle-mounted recognition technologies to cruise the parking lots of malls and stadiums, capturing the license plate numbers, location, and timestamp of every car they pass. The information goes to a company in Texas whose database contains 1.8 billion scans that include the majority of American vehicles. The company is just beginning to realize the value of that information, planning to sell it to private investigators, insurance companies, and banks, who only need to match up the plate numbers to other state databases to know where any given person has been.

Somehow this local newspaper’s headline seems Onion-like.

Family members of deceased patients in China, like those in India, are increasingly turning violent toward the doctor or hospital involved, with 17,000 recorded incidents in 2010. An ED doctor in Guangdong province was forced last week to march with 100 friends and family members of a patient who died, accusing the doctor of malpractice. The hospital called police and he was released 30 minutes later.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 3/7/14

Top News

The Defense Health Agency, established in October 2013 as a successor to TRICARE, requests $1.6 billion to support its health IT systems in 2015. It also wants $91 million for R&D to develop a new EHR by 2017 and $68 million to integrate its systems with those of the VA. Meanwhile, the VA’s 2015 budget requests include $269 million for EHR development.

Reader Comments

From TooMuch Coffee: “Re: WA state healthcare insurance exchange. You mention that 15k applications are stuck in limbo. I agree that’s not great, but they have signed up around 500k successfully. The site basically works, unlike OR and HI sites.” I’ve written about Oregon’s struggling exchange, so here’s the story on Hawaii’s: it received $204 million in federal funding, went live two weeks late due to software problems, has enrolled fewer than 5,000 people (at a cost of about $46,000 each), and has already been declared unsustainable without ACA rule changes since few potential customers and insurers are interested and it’s supposed to be self-funding its $15 million annual operating budget with 2 percent of the take. Meanwhile, the US Government Accountability Office says it will audit Oregon’s exchange, which cost $304 million and hasn’t enrolled a single person without manual help.

From Concerned: “Re: UHN in Toronto. Can anyone confirm that they are replacing QuadraMed EHR with Cerner?”

From Nobody Knows: “Re: value-based risk contracts. Is there a resources that details which payers and providers are engaging in them vs. those doing fee-for-service? I’ve tried AIS, HIMSS Analytics, and Billian’s and so far, no dice. Even a high-level report would be nice.”

HIStalk Announcements and Requests

This week on HIStalk Practice: You won’t want to miss the summary of my chat with eClinicalWorks CEO Girish Navani, who shares his thoughts on the MU program, population health, and health information exchange, plus provides an estimate of the company’s valuation if it were to go public. Despite the growing number of  employed physicians, work still needs to be done to integrate physicians and develop performance-based reward programs. The pay gap between primary care providers and specialists narrowed in 2013. I recap some vendor announcements from last week and muse on various HIMSS sights and sounds, including the future of Practice Fusion; Allscripts and its new tag line; what’s driving Aprima’s recent growth; and, the hot topic of ICD-10. Thanks for reading.

This week on HIStalk Connect: Samsung unveils the Galaxy S5, which integrates with both its two new smart watches and its new activity tracker. Basis, the maker of the B1 activity tracker, is acquired by Intel for a rumored $100 million. The FDA is looking for a vendor to develop social media analytics tools.

On the Jobs Board: Chief Market Strategist – Healthcare, EHR Tester, Epic Activation Consultant.

Welcome to new HIStalk Platinum Sponsor CompuGroup Medical. You see the count of big global customer numbers in their graphic above and the owner-led and publicly traded company is expanding its US sales. Offerings include CGM Clinical (integrated PM/EHR), CGM DAQbilling (PM), CGM webEHR (EHR), CGM webPRACTICE (PM), and CGM Enterprise (PM/EHR for community health centers); LIS, outreach, and reference lab solutions; the eSERVICES Patient Portal, EMEDIX Reimbursement Solutions, and the SAM disease management platform. The new CEO of CGM US is Norbert Fischl, who has an interesting background as leader of the company’s Northern European region, managing director of a software company, McKinsey consultant, and an Internet entrepreneur. Thanks to CompuGroup Medical for supporting HIStalk.

Here’s another update on one of our DonorsChoose projects that was paid for by the top-of-the-page ads. The 35 freshman girls in the Illinois high school taught by Teach for America teacher Ms. Schwartz are using the notebooks and colored pencils we provided to create College Bound Journals. They will fill them with goals, thoughts about their futures, and information they gather about college campuses and majors. You can see in the photo sent by the teacher that they’ve already started.

More remote mug sightings.

Anne-Marie wasn’t able to get way from the family medicine practice she manages to attend the HIMSS conference, so she made her own mug. She says it’s not nearly as cool as the original, but I disagree.

It’s time for the once-yearly HIStalk Reader Survey. It’s quick and I use the results to plan the entire next year of HIStalk, so I would really appreciate your taking five minutes or less to give me some guidance. I’ll sweeten the pot by randomly drawing three responses to receive $50 Amazon gift cards. Thanks in advance – most of the good ideas I’ve put in place came from responses to this survey.

Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.

Acquisitions, Funding, Business, and Stock

MedAssets reports Q4 results: revenue up 4.1 percent, adjusted EPS $0.28 vs. $0.25, beating estimates on both.

Clinical prediction software vendor Health Outcomes Services completes a $5 million financing round. CEO Jim Wilson has worked for McAuto, EDS, and Cerner and was president of Craneware before joining HOS.

People

ArborMetrix appoints former CMS administrator and FDA commissioner Mark McClellan, MD, PhD (Brookings Institution) to its board.

Idea Couture hires James Aita (Medicomp) as head of healthcare solutions.

Bart Foster, founder and CEO of self-service medical kiosk maker SoloHealth, is replaced by Chairman Larry Gerdes (both above.) The company’s CFO has also resigned and an undisclosed number of employees have been laid off. Gerdes sold transcription vendor Transcend Services to Nuance for $300 million in 2012. One of SoloHealth’s investors is healthcare IT long-timer Walt Huff, the “H” in HBOC, where Gerdes was an executive from 1977 to 1991.

Tamyra Hyatt (McKesson) joins Azalea Health as VP of marketing.

Announcements and Implementations

The New York eHealth Collaborative and the Partnership Fund for NY call for applications for participation in the second class of the  NY Digital Health Accelerator, where 10 early- and growth-stage companies will each receive mentoring and $100,000 of investment capital.

North Dakota officials announce the official rollout of the state’s HIN, which will connect all of North Dakota’s hospitals by the end of the year.

The US Army deploys a software upgrade to its battlefield Medical Communications for Combat Casualty Care EMR, also known as the MC4 system, that includes an upgraded operating system, enhanced security, and patient safety improvements related to allergies and medication history.

Government and Politics

HHS includes $75 million in its 2015 budget for ONC, a $14 million increase over last year.

ONC updates its Health IT Dashboard to include a Rand Corporation-prepared review of literature on the impacts of HIT, with a focus on MU functionalities.

Analysis of full-year 2013 MU attestation data by Wells Fargo Securities finds that 92 percent of hospitals stuck with the same vendor for at least two years. Meditech, Allscripts, and Siemens topped the list of hospitals that stayed the vendor course, Cerner and CPSI were average, and Healthland, McKesson, and HMS lagged. It also finds that small hospitals seem to be dropping out in big numbers by the third year, perhaps because they’ve paid their EHR costs in the first two years and don’t want to deal further with MU complexity.

Innovation and Research

Hospitalization rates declined at nursing homes that used after-hours telemedicine services, according to a Commonweath Fund-sponsored study. Researchers estimate that the use of telemedicine services could net Medicare a $120,000 savings annually per nursing home.

Technology

Azoi announces Wello, a $199 case that turns an iPhone into a monitor for blood pressure, ECG, heart rate, blood oxygen, temperature, and lung functions.

Other

Epic, Orion, and Siemens earn the highest customer satisfaction scores in a KLAS survey on HIE solutions. Overall provider satisfaction with HIE solutions has dropped an average of eight percent since last year.

Becker’s Hospital CFO looks back at hospitals whose bond ratings have been downgraded by Moody’s Investors Services because of EHR-related budget problems: (1) Health East Care System (MN), which is spending $145 million on Epic; (2) Community Medical Center (MT), which is having cash flow problems after installing Cerner and NextGen; (3) Saint Luke’s Health System (MO), implementing Epic for $200 million; (4) Scott & White Healthcare (TX), seeing increasing costs with Epic; (5) Washington Hospital Healthcare (CA), having increased costs and a negative margin after implementing Epic; (6) Robinson Memorial Hospital (OH), with losses partially attributed to its Allscripts Sunrise implementation.

Bloomberg News calls Mount Sinai Hospital (NY) “a heart surgery factory with obscene levels of pay,” claiming the hospital coaches patients to feign heart attack symptoms in the ED to get their stents covered by insurance, earns referrals from doctors with financial ties to the hospital, and pays its head of interventional cardiology $4.8 million per year. The head of another New York interventional cardiology program summarizes, “You essentially have physicians combing the streets of Staten Island, Queens, Brooklyn, and Bronx looking for patients they can screen on a treadmill to feed into the cath lab, where the big reimbursement comes.”

In Canada, Pierre Le Gardeur Hospital cancels all elective procedures after experiencing an unspecified computer system problem.

Weird News Andy has his ear to the UK ground in noticing this story, in which the British public reacts to news that a marketing company used a 47 million-record hospital data extract to target Facebook and Twitter ad campaigns. Another company was found to have loaded the entire database to Google’s servers to create interactive maps. The Hospital Episodes Statistics database had been made available by the government to researchers and approved private companies. The government has a PR nightmare on its hands because de-identification is hard to describe to laypeople who react to “my hospital records are on the Internet.”

Sponsor Updates

• Vonlay concludes an Epic engagement with Aspirus (WI).
• Physicians Interactive and McKesson Patient Relationship Solutions will jointly deliver Coupons on Demand, which will provide clinicians access to online cost-saving offers for medications.
• Kinston Pulmonary Associates (NC) will implement NextGen PM and EMR from TSI Healthcare.
• InterSystems joins the Global Alliance for Genomics and Health.
• Gastroenterology-specific EHR provider gMed will add medical content from Health Language to its system.
• E-MDs releases details on its June 5-7, 2014 User Conference and Symposium in Austin, TX.
• CIO profiles ICSA Labs, which is now the largest government-approved EHR testing and certification body.
• Hardin Memorial Hospital (KY) reports improved clinical response times since integrating telemetry alarms with Voalte smartphones.
• Divurgent raises $5,000 during HIMSS for the Florida Hospital for Children.
• RazorInsights ONE-Electronic Health Record achieves Stage 2 ONC certification.
• Daniel Flanagan, executive consultant for Beacon Partners, discusses in the company’s blog his recommendations to ensure a clearinghouse is ready for the ICD-10 transition.
• MedAssets estimates that its latest National Sourcing Collaborative event will drive $5 million annually in added value for its participating clients.
• Connance expands its patient-pay solution to include predictive analytics and additional platform reporting and consumer engagement functionality.
• On the company’s blog, MEA | NEA CEO Lindy Benton explains the significance of electronic submission of medical documentation (esMD) and health information handler (HIH).

EPtalk by Dr. Jayne

One of my fondest memories from medical school is working the ER during Mardi Gras. I sewed up more than one reveler who didn’t really need anesthesia because they were already feeling no pain. I chuckled when one of my former classmates sent me this story about the germs residing on Mardi Gras beads. Who would have thought that beads that have been thrown around in the midst of public drunkenness might have germs? I wonder if there’s an ICD-10 code for that? Maybe there’s one for choking on the baby in the King Cake as well.

One thing I found lacking at HIMSS was the presence of wearable devices (other than on attendees). I didn’t see much vendor promotion or anything cool enough that I’d consider it (although watching people try to interact with Google Glass was pretty funny). I don’t have any experience with Fitbit, but after reading this article I heard about on Twitter, I might consider one just to have this app. The Sleep Tracker Hack, which emerged from the recent Netflix Hack Day, helps a viewer find her place after sleeping through streaming media. I just might know someone who has fallen asleep in the middle of re-watching “Grey’s Anatomy” for the last several weeks. Unfortunately the hack was part of an internal hackathon, so it may never see the light of day.

I believe in patient engagement and making health-related technology accessible to patients, but there’s such a thing as going too far. I was reading a piece about the Bellabeat Connected System that turns a smart phone into a fetal heart monitor. It also mentioned the Huggies “TweetPee” that sends a tweet when the baby wets its diaper. Seriously? Unless your infant has a urologic problem, I’m not sure tracking urination on social media will do much more than drive followers crazy.

One of my favorite HIMSS connections reached out earlier this week to ask if I would be willing to help mentor a physician who would like to join the CMIO ranks. When I first started out, I had no one to look to for advice, so I was happy to oblige. One of his questions was what I think is the most important CMIO function. I’m not sure I can pin down a single one, but one of the most important in my book is being able to be the peacemaker among IT, the operations folks, and the physicians. Certainly there are other constituencies, but those are the three that tend to be the most contentious.

I’m still surprised that nearly a third of health systems still don’t have a CMIO. The organization where my mentee works falls into that category, but at least they understand that they need to work towards filling that role even if they aren’t ready to admit they need an honest to goodness CMIO. Whether we’re called Medical Directors or Directors of Informatics or Physician Champions, we can still help organizations move forward.

His hospital is currently struggling with physician engagement and clinical oversight, so it makes sense that a physician would be uniquely positioned to assist. He’s not highly techy, but I think that’s OK – if we can master anatomy and pathophysiology, we can learn enough about networks and software to be meaningful participants. The key is knowing who our experts are and being willing and able to leverage them appropriately.

He’s worried that his hospital isn’t really ready to formalize physician leadership in the IT space. There have been comments made about fears that the CMIO “will come in and boss IT around because he’s a physician” or that he will preferentially take the physicians’ side in arguments. I’m encouraging him that even though his role is emerging,  he should ensure that  it’s well defined and that leadership is prepared to support him. Without those elements, the risk of frustration will be fairly high for all involved.

At this point, I think he’s wise to negotiate for a formal position, but I’d recommend going for something part time that lets him dip his toes in the waters of clinical informatics without locking in at an organization that might not be as ready to move forward as he thinks they might be. That will buy him some time to work on professional development and to build the skills he’ll ultimately need if he wants to make a career of this. I’ll keep you posted as I hear from him. I’m looking forward to remembering what it was like to be young and idealistic before the CMIO life started beating me down.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Lorre’s HIMSS Conference Summary

Last week as I was staring into the House of Blues stage lights at HIStalkapalooza wearing a gown, high heels, and a sash reading, “HIStalk To Me,” I was struck by how different it was from any other job I have had. I had to pause for a moment to remember how it all happened. Twenty years ago I was a mining industry accountant and usually wore steel-toed boots and a hard hat. That seems like another lifetime now.

A seemingly random opportunity landed me in healthcare IT, where I have been for 18 years. I worked for vendors in operations leadership and business development. I have an MBA and I am an LSS Black Belt. I thrived on the never-ending challenges, non-stop travel, and endless demands for my time.

Finding myself on stage with this dream job was the culmination of a whirlwind of recent events, too many to list. I love working with the HIStalk team and I know I am in an enviable position.

HIMSS14 started for me at the beginning of September. I had just joined the HIStalk team when I met with Mr. H and Inga to discuss my role. We already agreed I was going to be responsible for the webinar program and HIStalkU, but we knew that I as the only non-anonymous member of the team could do more.

We talked about trade shows in that September meeting, but it wasn’t until the mHealth Summit offered HIStalk a free booth as a media partner that we decided to try it since we had nothing to lose other than time and travel expenses. I have been to HIMSS and AABB many times and worked in the exhibit hall. I showed up at our impressive vendor booth and stood around talking with customers and prospects all day. How hard could it be to create a micro version of that for HIStalk?

We considered mHealth Summit a trial run for HIMSS and decided to go with the bare minimum. I had never furnished a booth and the logistics are daunting. I learned that nothing comes with the booth. Mr. H and I debated about whether there would be a table at the front of our booth and decided to wait and see. We didn’t have any giveaways.

When I finally found our booth the morning before the exhibit hall opened on a snowy December day outside of Washington, DC, there was only a tiny patch of green carpet holding a chair and a trash can. There was no table or separation wall. Fortunately I was able to rent a table with a skirt and it was delivered in plenty of time. I had amazing booth neighbors who helped me hang our banner and they even let me use one of their power outlets.

There were 400 exhibitors and 5,500 attendees at mHealth. I was pleasantly surprised by how much booth traffic we generated. We weren’t selling anything or giving anything away. I was there to say thank you for reading and thank you for sponsoring, nothing more. There was a steady stream of people each day even though the conference doesn’t draw our core reader demographic. I met writers who later contributed to HIStalk and a few people interested in sponsoring. The best part was how much people just wanted to say hi and express their dedication to HIStalk. I was convinced a booth at HIMSS was a must-do.

HIMSS is a much bigger deal when compared with mHealth with 1,230 exhibitors and 37,000 attendees. It was painful trying to choose one of the available booth locations, all on the fringe and all seemingly uninteresting, but we did. We learned a lot from the mHealth Summit and acted on some great ideas for inexpensive booth signage.

Our giveaways were simple but fun. We designed two lanyard pins, one to commemorate the 10-year anniversary of HIStalk this past June and the other representative of our first HIMSS conference as an exhibitor. We had coffee mugs printed with the top HIT news stories of 2013 according to HIStalk. They turned out to be a hit, and even readers who didn’t attend the conference have asked for the pins and the mugs.

When I visited the exhibit hall Sunday afternoon, I was shocked to find it far from ready for the next day. Some of the giant booths looked only half built, debris was everywhere, and forklifts raced dangerously back and forth. I couldn’t imagine everything being ready in time to open the hall at noon on Monday. I wanted to deliver the HIStalk sponsor booth signs, but the hall was such a mess and the odds of being struck by a forklift were so high that I decided to wait.

I hosted a cocktail reception for our sponsors Sunday evening. It went smoothly and everyone said they had a great time. I met a lot of interesting and energetic people and I was impressed by their obvious affinity for HIStalk. Dr. Gregg was on hand to assist me and Inga and Dr. Jayne spent some time there (anonymously, of course.) Even Mr. H made a quiet appearance, after which he left just as quietly.

Monday morning I arrived at the exhibit hall early and raring to go. I had to hustle to cover every square foot of the exhibit hall, my arms loaded with signs. Thankfully Dr. Gregg was there, too, and when we realized I was running out of time, he helped me get it done. According to my Fitbit, I exceeded my 10,000 steps/five miles goal before 10 a.m.

Our little booth was quite a way from the major thoroughfares, so I was surprised by the immediate flow of visitors when the exhibit hall opened. It was consistent throughout the show. Countless readers and sponsors stopped by to say hello and to tell me how much they love HIStalk. We had even heavier traffic when one of our VIP guests (Ed Marx, Vince Ciotti, and Robert Murphy, MD) greeted their fans in our booth.

Once again, Dr. Gregg was a life saver. Not only did he help me with the booth setup and delivering the signs, he gave me breaks throughout each day so the non-stop visitors wouldn’t be disappointed to find an empty booth. Mike Cannavo (“The PACSman”) was also a blessing. He covered the booth, brought me lunch, and kept our swag collection current. The number of people visiting our booth was so remarkable that someone in the booth next to ours asked, “What are you selling?” I smiled when I replied that we are selling nothing — we are just saying hello and thank you.

There was so much fun on and off each day that it would be impossible to mention it all. My top 10 are:

1. Working with the people in the Epic booth to stage a picture of them looking at their cell phones
2. Watching people apply temporary tattoos to the strangest places (Ed Marx takes the prize for his lower back tramp stamp)
3. Arriving at the booth one morning to find a box of warm scones from MedData
4. Handing out the HIStalk sponsor booth signs and seeing how everyone lit up
5. Chatting with Ed Marx, Vince, and Dr. Murphy
6. Seeing the women who stopped by to show me their shoes
7. Having Inga, Dr. Jayne, and even Mr. H stop by the booth without anyone realizing it except me
8. Receiving my own copy of Struck by Orca
9. Trying on a Super Bowl ring
10. Receiving countless comments and compliments and passing them along to the team

I reconnected with many colleagues and customers from the past. I receive e-mails regularly from people who see my LinkedIn profile and wonder if working for HIStalk is a real job. Talking with them wasn’t any different. Yes, it is a real job, although it is fun and exciting and it doesn’t usually feel like work. I love to chat with readers and sponsors and work on webinars. I get a lot of satisfaction from helping them develop and deliver interesting and educational productions.

The event that was a personal stretch for me came when Mr. H asked me to accept HIStalk’s “Sunquest Industry Pioneer Award.” In my 16 years working for Sunquest, I received many opportunities to learn and grow and I almost always loved it. The same team presenting the award fired me two years ago. I can almost hear the collective gasp — why would I admit something like that publicly, and in writing no less? Let’s face it — we are all one merger, acquisition, unattainable goal, or difference of opinion away from being redundant or no longer a fit for the position. It isn’t personal. I showed up at the booth and everyone was friendly and warm. The HIStalk team stood within earshot and watched proudly. I thanked Sunquest not only for the award, but for their support and sponsorship of HIStalk. It was closure and it felt good.

Participating in the planning of an event like HIStalkapalooza was a whole new experience for me. Since the sponsor is responsible for it, it should be easy for the HIStalk team, right? No way! There is constant back and forth interaction and negotiation. It isn’t easy to strike a balance between what our readers and sponsors expect and what the sponsors of the event think they should get out of it. It was both frustrating and fun to be part of it. I learned a lot, along with everyone else, and I’m sure next year will be better because of it. The event itself was a huge success. The HISsies were entertaining and Farzad, Carl, and Ed all made an appearance to accept their awards. The food was terrific and people raved about the band for days afterward. Imprivata and all of the co-sponsors did a great job.

HIMSS14 was great for me. I met a lot of terrific people, I gained a whole new appreciation for those responsible for planning events, and I had fun. I am already thinking about what to do next year in Chicago.

Email Lorre or follow her on Twitter.

News 3/5/14

Top News

FCC Chairman Tom Wheeler announces the formation of a task force that will seek ways to increase use of broadband to deliver telehealth, mobile apps, and telemedicine. Heading up CONNECT2HEALTHFCC will be Michele Ellison, a lawyer who runs the agency’s enforcement bureau. Wheeler said in the announcement, “We must leverage all available technologies to ensure that advanced health care solutions are readily accessible to all Americans, from rural and remote areas to underserved inner cities. By identifying regulatory barriers and incentives and building stronger partnerships with stakeholders in the areas of telehealth, mobile applications, and telemedicine, we can expedite this vital shift.”

Reader Comments

From Just Tim: “Re: MU stages beyond stimulus payments. What is the legislative basis to extend the MU program? MU requirements were supposed to run in conjunction with years in which payments were made, not years after penalties kick in. I’d certainly agree that if someone never got to Stage 3, they could reasonably be penalized on an ongoing basis. Otherwise, we’ve just created a large bureaucracy with the power to continue to push unfunded mandates.” Legal scholars and political junkies, the less legislative among us are calling.

From Dim-Sum: “Re: military EHR replacement. Word on the street is that the vendors of choice and partners are as follows. Six service integration (SI) firms will bid Epic. The team that is getting the most news is Leidos/Accenture/Harris. Cerner has a single exclusive SI partner (still doing research to see who that SI is). Allscripts cannot find a partner for their Sunrise. Meditech has the incumbent Northrop Grumman. McKesson walked away from GDIT/Vangent. Siemens has a yet to be named DoD giant. Competitive bids will require an investment by prime and sub software solution firm of about 1.5-2 percent of the total contract value. That means that to win a $5B deal with the DoD, the investment for resources, capabilities, compliance, and regulatory wherewithal (see FISMA, FedRAMP, DIACAP, 508, JITC etc) is $50 million USD. Good Luck beltway bandits and COTS EHR dreamers.” Unverified.

From Brenda: “Re: Washington’s insurance exchange. Add it to the list of those having issues. By the way, I’ve recommended HIStalk to countless people and I’m glad our company has been a sponsor for about a year now.” The Healthplanfinder exchange has 15,000 applications that are stuck because the user-entered information can’t be matched to the state’s Medicaid benefits database or contain incomplete information (hello, programmer edits?) I speculate that the state incurred the wrath of the grammatical gods when it combined “health plan finder” into a single word.  

From Charger: “Terrific correspondence from Orlando; much appreciated since I could not attend! I’m sure you have been deluged with coffee mug requests and are out of stock, but may I place an order for one upon receipt of any new inventory? I will gladly swap you one of my local Karl Strauss Brewery pint glasses in return.” Thanks for the generous offer, but sadly all the coveted coffee mugs are gone. Lorre and I are trying to convince Mr. H that the timing is perfect for the opening of an online store featuring HIStalk swag. Beauty queen sash, anyone?

More mug sightings: Investor’s Chair contributor Ben Rooks, who obviously works standing up while looking at green ivy outside his San Francisco office; and Mike Jefferies of Longmont United Hospital, whose Spotify-HIStalk two-monitor setup looks a lot like mine. I still have a few more photos to run next time.

From Dr. Travis: “Re: Nordic’s new office. Thought this was very cool.” I had to clarify with Travis since this is a Midwestern, tailgating, and college thing that much of the country won’t understand: it’s a cornhole platform.  

From Ion Exchanger: “Re: HIMSS booth. You had traffic in your booth back in the hall. You should get another exhibitor to give you space free in return for drawing people.” That idea has come up on occasion, although not usually from people offering space. Our first-time exhibitor experience was good, especially since it was a low-rent, homebrew operation designed solely to give Lorre a way to say hello to interested readers and sponsors. I think I’ve decided to do it again in Chicago.

From Dr. Matt: “Re: QlikView. First there’s an Epic partnership and now I find at HIMSS that Health Catalyst offers QlikView on top of their data warehouse. Why are these big players using it?” I’ll let those organizations speak for themselves.

From Doctor N: “Re: HIMSS conference. It was my first one. Only the HIStalk people made me feel valued as a practicing physician. The insults, lack of humility, time away from my clinic, and the lack of vendor understanding of how medicine really works will keep me from returning soon. The sessions could have been done online and the networking conversations were shortened because everyone was in a hurry to get somewhere else. I believe I have seen the American medical industrial complex at its worst. I was surprised at the number of vendor folks who are physicians and how little they know about how we pay for healthcare: SGR (which will worsen matters for providers) and $156 billion being cut from Medicare Advantage plans. They have no clue that I’m not paid for population health and most docs in my community hardly even know the meaning of the term. It is like we are buying the horseshoe, barn, and saddle in the hope that we’ll get a horse for a present. HIStalkapalooza, however, did not disappoint!”

From Spelling CMIO: “Re: a tech solution to HIT spelling problems. As technology professionals, we ought to be able to bring our expertise to bear on the current plague of spelling confusion. I suggest we start to use regular expressions, like: HIM*S* and HIP*A* so that all variants can be brought under the welcoming umbrella of mediocrity. Heck, we could even bust out CM*S to obscure the failure to include ‘and Medicaid’ in the name of our favorite bureaucracy. We could even try E[Pp][Ii][Cc] to free the caps-lock crowd from their yoke of humiliation.” Scanning for “HIMMS” news stories turns up 56, which is pretty sloppy.

From Frank Poggio: “Re: ONC. Issued new 2015 test criteria while at HIMSS last week. They kept repeating that this new (and extensive at 242 pages) test criteria is ‘voluntary’ for vendors. Here comes another wolf in sheep’s clothing. Do you really think the 2015 Criteria will be ‘voluntary’? How can they generate a revised list of criteria that fixes bugs and not make it required? How can they add something critical to patient safety such as UDI and not make it required? Breaking out CPOE components has been something niche vendors have been asking for since the start. So will those vendors ignore it and stick with 2014 criteria? I have worked through dozens of tests with clients since the inception of ONC and every time they expand or make a test update it soon becomes mandatory by the authorizing testing labs … and with some ATLs sooner than others. I give the 2015 version at most four months before it becomes mandatory.”

HIStalk Announcements and Requests

Listening: new from the all-female, LA-based spacey rock quartet Warpaint, which sounds a bit like Cocteau Twins (and that’s a good thing). I’m also enjoying defunct, brilliant Irish pop band The Thrills.

Some random thoughts I had regarding the HIMSS conference:

• I was surprised and happy that the vendors of much-hyped analytics and population health management products were restrained in their pitch. Many companies talked about those products, but I didn’t hear a lot of wild claims.
• The terms “big data” and “cloud” weren’t repeated reverentially and annoyingly to the extent that might have been expected.
• What is population health management, exactly? It will be whatever payers say it is, no different than “quality.”
• I’m not impressed with “big data” when healthcare is woefully indifferent to “little data.” We ignore evidence-based medicine, warnings for inappropriate or duplicate tests and drugs, and quality measures. We are sloppy about monitoring our supply chain and controlling our labor and materials costs. We pay little attention to the free exchange of information we hold about patients. We don’t like the idea that patients themselves should see our digital secrets. We should be using the information we have to its fullest before trying to tackle giant databases containing even more insights that we’ll ignore. Speak up if your hospital is different.
• I’m not sure if patient engagement was just a token HIMSS nod or a real movement. I don’t see stretched providers getting excited about engaging patients unless government or competitive pressures force them to. It was nice to see patient advocates at the podium, even if only sporadically.
• People are beginning to realize that EHRs aren’t necessarily the center of the universe. Small vendors are creating specific applications that use the EHR, which makes them easier to develop, cheaper, easier to use, and easier to buy since any buyer’s remorse will be several zeroes cheaper than the EHR itself. A question to ask of the dwindling number of EHR vendors might not be what their system does, but what does it allow to have done by other sources? Those companies were in the hall.
• The government has taken a lot of innovation out of the system with Meaningful Use and ICD-10. I said from the beginning that taking MU money means making the federal government your incessantly nagging partner, but with penalties following rewards it wouldn’t have mattered anyway. I got the sense that attendees were more interested in what HHS and ONC say than what vendors were telling them.
• Financial uncertainty as well as a big implementation and optimization ramp-up business has increased the willingness of providers to pay a premium to use consultants since they don’t want to get locked into salaried employees for specific short-life tasks. Consulting companies seemed to be generating a lot of interest.
• Hospitals, like every swollen, inefficient, and political bureaucracy, will do whatever it takes to protect their own interests. They have money and clout and they aren’t just going to happily reduce their profits, headcount, or ambitions to reduce overall healthcare spending. Integrating their acquisitions will be a target market.
• HIMSS is always like a boat show, but this year I’m not sure many boats were sold.

Acquisitions, Funding, Business, and Stock

Telus Health acquires Med Access, a British Columbia-based vendor that claims its EMR is #1 in Canada with 4,000 users.

Clinicient, a provider of RCM and clinical solutions for rehabilitation therapy, raises $15 million in Series C funding from Catalyst Investors and names Rick Jung (Medsphere) chairman and CEO.

Castlight’s IPO could raise up to $140 million based on a revised filing made this week.

Sales

PatientPoint awards Xerox a $28 million contract to work with hospitals and physician practices to introduce PatientPoint’s digital check-in and population health management software and to provide training and support.

Denver Health selects Besler Consulting to assist in the identification of Medicare and Medicare Advantage Transfer DRG underpayments.

UCSF Medical Center will implement Oneview Healthcare’s patient empowerment program at three Mission Bay hospitals.

The University of Miami Health System selects Lockheed Martin to manage its healthcare data, develop predictive models for risk identification, and build automated systems to give providers data at the point of care.

Florida International University’s faculty practice chooses PatientKeeper Charge Capture.

Citizens Medical Center (TX) selects MModal for transcription services and front-end speech recognition.

West Florida ACO will implement eClinicalWorks Care Coordination Medical Record.

Forbes names Epic’s Judy Faulkner as #520 on its list of “The Richest People on the Planet,” estimating her net worth at $3.1 billion.

People

Accretive Health appoints Patrick Funck (Segwick) SVP/CIO.

HCI Group names Bill Bria, MD (Shriners Hospital for Children) as CMIO and Robert Steele (Sterling Healthcare Initiatives) as SVP of delivery operations.

Greater Houston Healthconnect CEO Jim Langabeer, PhD resigns to return to his previous employer UT Health Science Center, with CTO Phil Beckett, MD named acting CEO.

Carolinas HealthCare System hires Nancy Olson, RN-C, MBA, PhD (Providence Health & Services) as its first chief nurse informatics officer.

Announcements and Implementations

WEDI, in partnership with EHNAC, will create a Practice Management Accreditation Program to review PM vendors in the areas of privacy, security, mandated standards and operating rules, and operational functions. While I am all for having minimum performance standards, is this really the best time to ask vendors to jump through one more hoop to remain competitive in the marketplace? It’s no surprise that we are seeing limited advances in product usability and innovation.

The local business journal profiles St. Francis Hospital (CT), which goes live on Epic next month following a two-year, $120 million transition. Above is VP/CIO Linda Shanley.

Summit Health (PA) implements Wellcentive’s population health management solutions and services.

Ontario’s Group Health Centre goes live on Epic.

Wellmont Health System (TN) transitions to Epic in its physician offices and hospitals.

North Oaks Medical Center (LA) goes live with a two-way interface between Epic and the Masimo Patient SafetyNet remote monitoring and clinician notification system.

GetWellNetwork debuts GetWellNetwork Ambulatory, which is available on mobile and stationary devices and integrates with EHRs to provide personalized information, healthcare tools, and patient pathways.

CoverMyMeds launches an API that enables providers of EHRs, e-prescribing systems, and PM systems to offer an NCPDP standards-compliant electronic prior authorization solution.

John Gomez launches Sensato, which will offer healthcare privacy and security assessments, guidance, and tools.

UC Irvine Health deploys WANdisco and Hortonworks Hadoop data technology to provide real-time information for patient care. They run Allscripts Sunrise, I believe, and an unnamed data warehouse technology described in the announcement as one that “struggles with availability issues as well as the volume and variety of data it can handle.”

Government and Politics

The FDA is seeking a contractor to monitor social media chatter about drugs, medical devices, and other regulated products in order to track conversation shifts following FDA warnings. I found this move especially interesting in light of the heavy Twitter traffic during HIMSS and my realization of  the potential value of mined Twitter data. Now I’m wondering if anyone has figured out a way to combine data from social media chatter with old-school opinion polls from phone and mail surveys. That could be powerful.

ONC releases additional draft electronic clinical quality measures for review and testing for the possible inclusion in the MU and other federal programs.

The front-page story of the March 10 issue of Time says that Healthcare.gov had so many problems that the White House was ready to shut it down and start over right after its launch. It says that it’s not clear even now who was supposed to be in charge of the launch and that people knew upfront that the site’s design was flawed.

Speaking of Healthcare.gov, HHS says it will need $1.8 billion in FY2015 to run the federal health insurance exchange.

Other

A three-year study finds that patient-centered medical homes do little to reduce costs, decrease utilization, or improve care, leading researchers to conclude, “Medical home interventions may need further refinement.”

The use of patient portals for secure messaging does not significantly change the frequency of face-to-face visits, according to a Mayo Clinic study. Weakness of the study are that portal messages were studied in a vacuum rather than in the context of all provider communication, it looked only at the number of visits rather than patient outcomes, and most of the study subjects were Mayo Clinic employees.

Baylor Regional Medical Center announces that it will not accept the Malcolm Baldridge National Quality Award following allegations that it improperly managed a neurosurgeon who is accused of botching surgeries while under the influence of drugs. An extensive profile in the Dallas Morning News paints a disturbing picture of a physician who was labeled a sociopath and serial killer by colleagues. We featured the story in September 2013 with this summary:

A Dallas news magazine recounts the fascinating tale of a newly licensed MD-PhD neurosurgeon whose incompetence left several patients maimed or dead while the state’s medical board couldn’t stop him from practicing. Colleagues called the doctor the worst they had every seen and said his skill level was no higher than a first-year resident as he kept inadvertently slicing arteries causing patients to bleed to death, and in one case the OR team had to forcibly remove him from the OR to prevent him from killing his patient. His marketing team and his 4.5 star Healthgrades.com rating brought in plenty of new patients to his loftily named practice, Texas Neurosurgical Institute. Surgeon readers will be horrified by this recap by a peer who had to clean up one of his messes: “He had amputated a nerve root. It was just gone. And in its place is where he had placed the fusion. He’d made multiple screw holes on the left everywhere but where he had needed to be. On the right side, there was a screw through a portion of the S1 nerve root. I couldn’t believe a trained surgeon could do this. He just had no recognition of the proper anatomy. He had no idea what he was doing.” The article blames the situation on malpractice caps, laws that hold hospitals liable for damages only if their intentions are provably malicious, and a nearly powerless medical board charged more with keeping licensure records and counting CE hours than watch-guarding patient safety.

Mike “PACSMan” Cannavo summarizes HIMSS14 from the imaging perspective in an Aunt Minnie article (simple registration is required.) He tells me that HIMSS rules even though RSNA is a bigger conference because, “The balance of power has definitely shifted from departmental solutions to facility-wide ones and IT and the CIO/CTOs make those decisions here.” Another of his observations:

HIMSS may, and probably will, command the lion’s share of the trade show budgets for VNA and cloud companies from now on. Considering there were more than two dozen vendors playing in this arena alone, plus the majors who showed various central data repository (CDR) solutions, this can affect other trade shows in terms of booth size and revenue. Given that attendance at most radiology-specific shows has been flat or declining and time spent at the shows has declined each year, HIMSS poses even more of a threat.

A group of former senators (Tom Daschle, Trent Lott, John Breaux) forms the noble-sounding Alliance for Connected Care, which will lobby Congress to protect the interests of its big-company members (Verizon, WellPoint, CVS, and Walgreens) as well as patients who benefit from telehealth services. In addition to seeking friendly governmental consideration, the group wants to lift geographic treatment limitations and build the case for telehealth as an effective care delivery mechanism. Surprisingly, HIMSS isn’t among its lengthy list of advisory board organizations. I’m always suspicious of the motivations of retired politicians anxious to make up for the income they lost while holding office, but in this case their announced intentions seem appropriate.

Brian Ahier got a one-on-one interview with National Coordinator Karen DeSalvo at the HIMSS conference. She says everybody has been focused on collecting information via EHRs, but now it’s time to allow patients to participate and acknowledge that “health is more than getting people to a doctor” since only 10-20 percent of outcomes can be attributed to the healthcare system. She clearly has a public health mindset as did her predecessor and she gets a “bravo” for that.

The CFO of Wake Forest Baptist Medical Center (NC) lists reduced Epic expenses as one element of its improved financial performance in which six-month operational losses were reduced from $49.8 million to $23.5 million. The hospital still has high expectations for Epic, saying in a bond ratings agency report, “Management believes that future financial performance must be improved from current levels, and continues to aggressively pursue both short- and long-term strategies to drive growth, reduce cost and leverage our investment in Epic.”

In England, a three-year-old cardiac surgery patient dies when the scheduling system of the hospital to which he was transferred fails to generate his follow-up appointments. According to the hospital’s pediatrics manager, “Samuel’s appointment request must have fallen through the cracks between the old and new system. The new system is now up and running as best as it can be, but as long as there is still humans entering the information there will always be room for error.”

Weird News Andy notes that Banner Health didn’t have a banner day when it inadvertently printed subscriber Social Security numbers on its health magazine’s mailing labels.

Sponsor Updates

• Greenway Medical names Phreesia its Marketplace Partner of the Year.
• Aprima Medical announces that over 1,500 former Allscripts MyWay customers have migrated to its platform.
• PerfectServe introduces automatic electronic PHI filtering capabilities that remove ePHI from the body of messages sent to non-secure mobile devices.
• Lisa Reichard, director of community healthcare relations for Billian’s HealthDATA, writes a fun blog post that includes her top 10 tales and takeaways from HIMSS14.
• Extension Healthcare will participate in the AONE 2014 Annual Conference in Orlando March 12-15.
• The Tennessean interviews Cumberland Consulting Group CEO Jim Lewis about the company.
• Boston Software Systems offers a white paper that examines three steps to a successful migration. 
• An HCS case study highlights Christian Health Care Center (NJ) and the benefits it realized following the implementation of HCS Interactant.
• TriZetto Provider Solutions advises customers that it will continue to accept claims in print image, NSF, and legacy formats even after the ICD-10 implementation deadline.
• E-MDs publishes video testimonials from multiple providers.
• Clinithink’s VP of solutions Russ Anderson suggests leveraging the use of Clinical Natural Language Processing to control patient leakage.
• Health Catalyst offers a white paper with keys to a successful data warehouse and analytics implementation.
• Vital Images experiences significant growth across Europe, the Middle East, and Europe.
• CommVault achieves certified integration with its Simpana 10 software and the SAP HANA platform.
• TeleTracking Technologies, Hill-Rom, and GOJO will co-market integrations with the Hill-Rom Hand Hygiene Compliance solution.
• Cornerstone Advisors reports that its staff has grown to 39, a 25 percent increase in the past year.
• Divurgent will provide support to Medsphere clients in their MU, ICD-10, and value-based purchasing initiatives.
• Gartner positions Qlik in the Leaders Quadrant of the 2014 BI and Analytics Platform Magic Quadrant report.
• HIMSS Analytics names Allscripts its first Certified Educator of the EMR Adoption Model.
• The Cleveland Clinic and Dell will offer Epic EMR consulting and implementation services to other health systems and practices.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

Monday Morning Update 3/3/14

From Elizabeth: “Re: HIStalk mug. Thanks so much for the HIMSS coverage this year, as always. It was great that you had a booth because I’m pretty sure others would agree that the HIStalk gang are celebrities, albeit anonymous, in this space. I am sending you a little pic of my coveted HIStalk mug in its new home in snowy, cold NY. I think it fits in very well. It was by far my favorite takeaway from the conference, so much so that I wrapped it in a t-shirt from another vendor so it wouldn’t break on the flight home. I am happy to report that it remained safe and intact.” I can’t explain why I like seeing pictures of reader workspaces, but I do.

From Sipper: “Re: HIStalk mug. Big fan of HIStalk for many years, read it every day, loving my new mug!”

From Posit: “Re: HIMSS thoughts. Educational sessions were strayed, put together in silos, and not given by industry leaders but more by committee members trying to get placed on the HIMSS board. Educational content had nothing new. Hillary was dry, useless, and added nothing to the conversation of healthcare. The CIO Forum was the usual boy’s club, mostly just CIO wannabes as the majority of CIOs were out sunning themselves. The attendance count seemed to include anyone walking in the door. The HIMSS14 handbooks had many typos – sloppy work.”

From Dr. Info: “Re: HIMSS video. I saw this gem out of the corner of my eye and then had to endure many painful minutes of this insipid self-promotional video before it came around again for a quick photo for your blog. I’m probably the only person who watched the whole thing, including the producers and editors! Maybe they should just change the acronym already.” You would think HIMSS could spell its own name, especially when it was shilling its HIMSS14 TV informercials (“one-third of air time will be dedicated to our sponsors,” which puts even network TV to shame.)

From Eager Cleaver: “Re: cost of exhibiting at HIMSS. You should get someone with a modest-sized booth to anonymously provide all line-item costs to exhibit. Readers would be shocked.” I did this a few years ago and would be happy to do so again if a company would be willing to share. I would do it for the HIStalk booth, but it was tiny and we did everything on the cheap, so it’s not really representative. Meanwhile, money alone won’t buy you prime hall space, as booth selection is driven by HIMSS points, which is like your grocery store loyalty card with a lot more zeroes. The annual conference brought HIMSS $25 million in revenue, half its total take. Dues made up only 18 percent of its total revenue. According to its 2011 tax forms, Steve Lieber was paid $925K, so he’s surely well over the million-dollar mark by now. Also in the footnotes of the form: HIMSS owns 81 percent of MedTech Publishing (book value $8 million), which means if you get your industry news from Healthcare IT News, mHealth News, or Government Health IT, you’re getting it from the vendor-friendly, HIT-cheerleading HIMSS.

From GreenFlamed: “Re: Dragon Medical Network. v12.50.200.089 is not ready for prime time, especially in Virtual Desktop environments. It takes a crazy amount of support to sustain and keep your end users happy. The new service pack is riddled with bugs and the dictation box transparency feature is broken. We are facing a major Dragon buy-in and adoption crisis currently because it keeps crashing. Are there any other Dragon360 Network users out there using Dragon on a Virtual Desktop environment?”

Only 20 percent of respondents say their business card titles include a certification. New poll to your right: if you attended the HIMSS conference, how was it overall?

Some of the classrooms we helped via HIStalk’s donation of proceeds from the big ad at the top of the page to DonorsChoose projects are already benefitting. Mr. Delperdang reports (and sends the photo above left) that his Mississippi high school students are using the inexpensive supplies we donated (remanufactured printer cartridges and a file cabinet, which he calls “a blessing”) to print and file assignments and college applications. Ms. Vega’s Illinois second graders have created a reading station from the set of non-fiction books we purchased, which she says is the most popular learning station in the classroom and that “even my students whom were afraid to speak and share ideas are now sharing their background knowledge with us.” Ms. Opatz’s Utah fourth graders have formed reading groups around the books we purchased for them (photo above right.) We funded a bunch of projects from the ad revenue and will be doing more, so stay tuned.

Oracle – like its CEO, Larry Ellison – rarely passes on the opportunity to exhibit boorish behavior. The company’s sloppy technical work reportedly assured the failure of Cover Oregon’s health insurance exchange, with the resulting outcry shaming Oracle into making a public promise to fix the problems it caused at no charge beyond the $90 million it was already being paid. The still-dysfunctional site isn’t likely to get better – Oracle has decided without explanation to pull 60 percent of its employees assigned to the project.

California’s health insurance exchange, fresh off a five-day system outage, says 14,500 people whose applications were partially completed in the days before the unplanned downtime will need to start over.

The General Accounting Office reviews the progress of the VA and Department of Defense in deciding to pursue their independent EHR plans and make them interoperable. They aren’t impressed: GAO says those organizations don’t have proof that it will be cheaper to run their separate systems than to create a single one. It also points out that despite the VA’s plan to pilot its system by September 2014 and the DoD’s intention to take its system live by the end of FY2016, neither have said what their systems will consist of, when they will be finished, or what they will cost. The report also says the VA and DoD are still fighting over control, with the federally mandated Interagency Program Office (IPO) having no power over funding and staffing. Both the VA and DoD, strangely enough, agreed with GAO’s recommendations that they perform a cost analysis, justify choosing the more expensive choice if that’s the case, create interoperability plans, and strengthen the control of IPO.

McKesson, bowing to shareholder pressure, reduces the pension of Chairman, President, and CEO John Hammergren from $159 million to $114 million, although one analyst says the company’s executive pension plan is still “the richest in corporate America.” Perhaps an earlier announcement of his forced impoverishment would have allowed him to escape the indignity of winning his second consecutive HISsie award last week for “Industry Figure In Whose Face You’d Most Like to Throw a Pie.”

It occurred to me while Mark Bertolini was delivering the HIMSS conference’s opening keynote address, his Aetna employees were setting up the company’s booth in the exhibit hall. Somehow that seems wrong. If it weren’t for HIMSS trying desperately (and unsuccessfully) to get people to stick around later into the week, they would have put the second consecutive keynoting Clinton (Chelsea next year?) in that spot as they have done with politicians in the past.

People have asked what my favorite conference giveaway was. I’ll go with the iPhone 5 cover from zCover. I wasn’t initially impressed because they had a tableful of them and they were packaged in plastic bags, to the point I was about to just toss it in the trash when I got home. It’s a really nice case that fits the phone perfectly (including little covers for each port) and a clip-on back that ties the package together. It has its own buttons that cover the ringer volume and home buttons that make them easier and more satisfying to use. I’m really glad I picked it up – it has replaced my rubber bumper cover.

It’s hardly news since Intermountain Healthcare announced that it was choosing Cerner as a partner last fall partly because it wasn’t confident about hitting Meaningful Use dates, but CIO Marc Probst says Intermountain will forego incentives and accept penalties for not being ready for MU2 in 2014.

Streamline Health Solutions promotes Richard Nelli to COO.

Greenway acquires PeopleLynk, which sends patient relationship messages based on EHR events.

Infor signs a letter of intent to acquire assets of GRASP Systems, including patient acuity, workload management, and patient assignment systems.

Ingenious Med launches its patient encounter platform One by Ingenious Med (IM1), providing care coordination and patient management to acute and sub-acute spaces.

Strata Decision Technology announces sales of its StrataJazz financial platform to Yale New Haven Health System (CT), Northwestern Medical Center (VT), and Southern Illinois Healthcare (IL).  

ONC and ANA will present a free one-day summit for nurses on March 21 at The Baltimore Washington Medical Center in Glen Burnie, MD. The agenda includes a keynote by Deputy National Coordinator Judy Murphy, a panel discussion about using health IT to exchange information, afternoon breakout sessions, and a town hall discussion. I recommend as a counterpoint to all of that healthy discussion a side trip to my favorite place in Glen Burnie, Ann’s Dari-Creme.

In Canada, New Brunswick doctors question their medical society for striking a deal that allows only one EHR – the one sold by a for-profit company co-owned by the medical society — to access the province’s databases. Only 240 of 950 eligible physicians have signed up ahead of the March 31 deadline to earn a 50 percent government subsidy, with only 34 of those actually using the mandatory Velante software. Doctors question whether the medical society’s motivation is business success rather than patients, while the province’s health minister says it may have to take over the system if too few doctors sign up. A similar situation exists in Nova Scotia, where the province gave Nightingale exclusive rights to provide a subsidized EHR that connects to the government’s information.

The VA creates a development portal that explains how to create mobile apps for its use.

CareSync wins the most promising startup contest at the HIMSS conference.

”How the Medical Establishment Got the Treasury’s Keys,” an interesting article by economics professor Uwe Reinhardt, recounts irrational and naturally inflationary creation of Medicare in the 1960s as flawed grand plan to reduce poverty:

To help implement that vision, these proponents reluctantly paid the price the providers of health care extracted in return for accepting the legislation: Congress surrendered to the providers the keys to the United States Treasury, full well knowing that this social contract could have only a short shelf life. One would assume that physicians and hospital leaders knew that as well. In other words, the proponents of Medicare who signed on to the deal were anything but stupid. When confronted by the health care sector with a harsh trade-off between their cherished vision for health care, on the one hand, and a sensible payment policy, on the other, they let their vision override economically sound payment policy. Millions upon millions of America’s senior citizens are indebted to them for a program that remains highly popular to this day.

Weird News Andy wonders, “Does the noise in my head bother you?” in reading of a British tourist hearing scratching noises inside her head that turned out to be a happy family of eight flesh-eating maggots. WNA also likes this story, in which stethoscopes were found to carry more bacteria (especially MRSA) than anything other than the fingertips of doctors. It’s probably not realistic that doctors who can’t be convinced to wash their hands would sterilize their stethoscopes. 

HISsies 2014 Winners

Sponsor Updates from Last Week

• Sagacious Consultants launches Sagacious Dispatch for Epic customers with short-term projects for optimizing their EMR.
• Orion Health launches Collaborative Care for ACOs.
• MEDHOST joins CommonWell Health Alliance.
• Shore Medical Centers (NJ) selects CareTech Solutions Clinical Service Desk for night, weekend and holiday support.
• Truven Health Analytics introduces Micromedex Pharmacy Intervention and Micromedex Infection Prevention.
• CynergisTek expands its collaboration with Iatric Systems to offer support and management of Iatric’s Security Audit Manager.
• Premier reports 90 percent of respondents experienced at least one drug shortage in the last six months that may have caused a medication safety issue or error in patient care.
• Aventura releases Roaming Aware Desktop Version 5.0.
• Kaleida Health (NY) selects Orion Health’s Rhapsody integration engine.
• Covisint receives full accreditation with the Direct Trusted Agent Accreditation Program from DirectTrust.com and the EHNAC.
• iMDsoft announces its MetaVision for NICUs will be featured at the 20th annual Cool Topics in Neonatology conference.
• DrFirst’s controlled substance e-prescribing software will be integrated into Greenway’s EHRs.
• ADP AdvancedMD offers an ICD-10 transition program with preparation resources, product enhancements, and a revenue cycle financing program.
• UnitedHealthcare announces that InstaMed’s online bill payment service myClaims Managers has grown to 50,000 participating care providers with $20 million in payments processed since July 2013.
• Emdeon publishes an ICD-10 transition white paper.
• API Healthcare, a GE Healthcare Company, launches Patient Classification, which matches provider skills to patients.
• Nuance announces that eCopy ShareScan is integrated with NextGen Ambulatory EMR.
• First Databank releases FDB AlertSpace for Siemens Soarian.
• NextGen Healthcare and Cerner announce bilateral integration.
• Infor offers a promotion package for eGate customers interested in migrating its Cloverleaf product.
• Infor introduces PeopleAnswers Talent Science to assist healthcare organization to select, retain, and develop clinicians.
• DrFirst’s Patient Advisor delivers $21 million in prescription savings opportunities for uninsured patients during its first three months.
• Imprivata will integrate its two-factor authentication management capabilities with DrFirst’s EPCS Gold solution to securely prescribe controlled substances electronically.
• Physician First ACO (FL) selects eClinicalWorks Care Coordination Medical Record.
• ADP AdvancedMD announces general availability of its reporting suite AdvancedInsight for physician practices.
• Central Valley HIE (CA) joins Inland Empire HIE expanding the reach of the Orion Health Collaborative Care within California to 48 central and southern California organizations.
• Wolters Kluwer Health announces the beta launch of its integrated clinical decision support and workflow management platform POC Advisor.
• Northeast Georgia Physicians Group achieves Stage 7 of HIMSS EMRAM with Allscripts TouchWorks.
• Covisint offers three reasons to physicians to avoid PQRS penalties.
• Etransmedia expands its RCM services with the acquisition of Medigistics.
• Intel-GE Care Innovations and Caradigm partner to integrate remote patient monitoring and smart sensor technologies to improve care plans.
• E-MDs launches a SaaS-based RCM service.
• AT&T announces plans to expand Digital Life into the healthcare market.
• Predixion Software announces availability of its predictive analytics software on the Windows Azure cloud platform.
• Baylor Scott & White Health (TX) expands its use of AtHoc Critical Communications platform for IT outages, emergency preparedness, and clinical alerts.
• Optum launches Optum One analytics platform.
• Advocate Health Care (IL) selects PerfectServe as its enterprise-wide clinical communications platform.
• Healthy Catalyst reports that 76 percent of organizations lack basic analytics for Meaningful Use measures in a recently published white paper.
• Imprivata will integrate HIT Application Solutions’ Notifi platform with Imprivata Cortext, enabling secure communications for continuum of care.
• The Health Centers of Family Health Care join The Guideline Advantage, which uses Forward Health Group’s PopulationManager platform.
• Siemens Healthcare launches CareXcell a subscription based solution for population health management.
• Memorial Hospital at Gulfport (MS) selects Health Catalyst’s Late-Binding Data Warehouse and Analytics platform to provide a unified view of clinical and performance data from their McKesson and Allscripts EHR applications.
• Capsule Tech reports a 24 percent increase in revenue for 2013, with 1,650 healthcare facility clients worldwide.
• University Hospitals (OH) will deploy PeriGen’s PeriCALM at UH MacDonald Women’s Hospital and UH Geauga Medical Center, which will include sending OB content into its Allscripts EHR.
• NantHealth introduces NantHealth Clinical Operating System, developed after consolidating of several healthcare IT companies including iSirona.
• Capsule Tech introduces SmartLinx Medical Device Information System for point-of-care data delivery.
• North Memorial Health Care (MN) is awarded joint second place in the annual Healthcare Informatics Innovator Awards after incorporating Health Catalyst’s EDW platform and analytics solution.
• EClinicalWorks, Greenway, ICA, InterSystems, Medfusion, Medicity, Optum, and Orion Health found Carequality, which will focus on interoperability between existing and emerging HIE networks.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

From HIMSS 2/27/14

From Spelling Recognition: “Re: ‘documention.’ Is this a misspelling or or marketing gone wrong?” I suspect the former and dread the possibility of the latter.

From Born Free: “Re: HIMSS opening session. It was nice of the HIMSS chair to recognize physicians in the audience, but as soon as the recognized physicians sat down, the speaker then dissed them through sarcasm about their ego and the 6,500 physicians in his organization that think they know best. It was a little uncomfortable and not very wise considering HIMSS’s desire to add physicians to their membership rolls.” I missed the presentation since I was protesting having an insurance company millionaire talking about how healthcare should work. I don’t like having vendors as keynoters.

From IT Director: “Re: HIMSS. It was a pleasure to meet Lorre in the booth on Tuesday. If you are going to have a public face I can’t think of a better one! She was engaging and knowledgeable and fun to talk with even if just for a few minutes. I love the fact that you had a booth — that was a cool thing to do.” HIMSS booths are breathtakingly expensive, but it was worth it to be able to meet readers, sponsors, and passers-by (most of them on their way to bathrooms right by our booth given our tiny HIMSS clout and budget). It was great having Lorre there since as the only non-anonymous HIStalk team member since she kept me updated with who dropped by, what they had to say, and what it was like being on the show floor with the other exhibitors. That was all new to me – my only view of HIStalk is sitting alone in front of a PC all day and night. It was cool that other exhibitors brought celebrities to our booth, sent Lorre scones and fun giveaway items, and helped us figure out the exhibit process since we were clueless. I’ve asked Lorre to do a writeup on what it was like for her to meet readers, work the booth, attend the events, and accept our Sunquest Industry Pioneer Award.

From Brian Ahier: “Re: Ed Park of athenahealth at HIMSS. Gave the best presentation at HIMSS.”

I’m glad the HIMSS conference is over. I’ll be catching up over the next few HIStalk posts. Your comments about the conference, exhibits, companies, and educational sessions are welcome.

I have to say I’m already dreading going to Chicago for the conference next year. All I remember from last time is snow, surly unionized conference center staff, outdated hotels that cost at least double what they were worth, endless cab lines because of the weather, and wearing winter clothes. I like Chicago as a tourist, but not as a conference attendee. HIMSS loves it, of course, because the travel is easier for their people and they get to deal their home city some payola.

Here’s Lorre’s new BFF Bob Murphy, MD, CMIO of Memorial Hermann Healthcare System (TX), meeting people in our booth.

Orlando attendance set a record at an announced 38,828, although I don’t know how that number was derived. I assume all registrations were counted, including exhibitors and press, but I don’t know if HIMSS counted people sitting at home who paid $49 to watch streamed sessions on the Web. I know this: all event promoters like to provide optimistic attendance statistics and there’s no good way to audit their claims.

PeriGen was a booth neighbor and CEO Matt Sappern dropped by to say that “HIStalk is the only thing to read each day.”

This week on HIStalk Connect: Epic and Walgreens launch a wide-reaching interoperability partnership to rival CommonWell. HIMSS publishes the findings of its mHealth Technology Survey. Glooko unveils a population health tracker focused on improving care within the diabetic population.

Jennifer Dennard (@SmyrnaGirl) tweeted out this photo, saying she’s reading up on HIStalk while sipping from our mug now that she’s home from the conference. Our mug supply is exhausted other than a few we set aside for loyal readers who asked us to mail them one since they weren’t at the conference. I like Jennifer’s photo – if you took a mug home, send a picture of it in its new home.

I didn’t hear much about Hillary’s Wednesday keynote other than (a) it was extremely short; (b) like any skilled politician, she didn’t really say anything other than predictably lauding the work of the crowd that brought her there and kissing up to HIMSS. I would have been mad about waiting an hour or two to squeeze into the huge room for her talk given its lack of substance. Hillary’s rumored minimum speaking fee is $200K plus expenses, so she took home a big paycheck in addition to potentially impressing would-be Presidential voters who were apparently happy just to bask in her celebrity.

Hillary mentioned in her speech that corporations don’t have enough females on their boards. She didn’t define “enough” quantitatively.

HHS confirmed during the conference that neither ICD-10 nor Meaningful Use Stage 2 deadlines will change.

Hearst Health’s newly formed venture unit invests in Tonic Health, which offers an iPad-based data collection tool that counts Partners HealthCare and UCLA Health among its customers.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

From HIMSS 2/27/14 – Inga’s Update

It’s early afternoon on Thursday and I just returned home. My feet look like little sausages from all the walking and the flight, so I am putting my feet up and getting out a quick summary of random impressions from Wednesday. I’ll provide a wrap-up by the end of the weekend.

A couple of folks advised me that the guy in the red suit I noticed in the CareCloud booth was not an attendee but Stelle Smith from CareCloud. Maybe it’s the Miami influence? I had a chat with CareCloud CEO Albert Santolo, by the way, and will share more details on that later.

A word of advice: don’t walk around in public, especially at a place like HIMSS, and carry on a cell phone conversation that includes confidential information. As I was walking to the convention center I overheard a gentleman talking about “John Smith” who is over-compensated in his role, especially compared to the hardworking “Joe Brown”. Just so happens I know Joe Brown (who has a much less common name than Joe Brown) so it took me about two minutes to figure out the name of the company and the probable manager who is about to axe poor John.

I love, love, love this photo that the GetWellHealth folks sent over. I considered asking them if they had an extra  pair in a size 8 but then realized I’d probably never have the right occasion to wear them. Well, maybe they would be fun for Mardi Gras.

As I walked by the Surescripts booth there was a representative standing out in the aisle who looked directly at my badge before saying hello. I was wearing an exhibitor badge and she immediately apologized and said she was told they were really only interested in marketing to providers so she was trying to see where I was from (before she wasted her time engaging me). I proceeded to tell her that that didn’t make much sense since they partnered with vendors (maybe she has never heard of “Surescripts certified products.”) I am pretty sure she was an employee and not a hired gun and she was clearly not some 22 year-old marketing intern. Odd.

I went 45 minutes early and snagged a seat for Hillary Clinton’s keynote address. I happen to be sitting next to a guy from one of the better known HIT publications and he was telling me about the insanity of the whole “no press allowed” situation. His publisher was also exhibiting so he was able to use an exhibitor badge to get in. I laughed out loud when Clinton mentioned something about the “anti-journalist” mentality in Russia, wondering how many people caught the irony. Aside from that drama, I found Clinton to be very smart and a seasoned speaker. If she was reading from a teleprompter then she concealed it quite well. During the Q&A session she was just as quick on her feet as during her 20 minute prepared speech and she managed to throw in a little humor now and again. While she of course discussed the importance of HIT, I was fascinated with her comments on Russia, Ukraine, and the tracking of Bin Laden.

Nuance had a huge booth but I thought the lighting was odd. It was as if someone forgot to turn on the lights at the demo stations.

I played Pac Man at the Medseek booth. It took me 15 seconds to lose.

What was with the dead bushes decorating the NantHealth booth? I just realized that NantHealth is the new name for iSirona, which might explain why I found next to no signage with the company’s name.

I felt sorry for the exhibitors that were in the section past Cerner (7000s and above) because there was definitely less traffic than in the other section of the hall. There are probably a lot of people like me that make a conscious decision to start in the 100s and work their way through the hall, only to be fatigued before completing the journey.

API Healthcare was proudly displaying its four KLAS trophies.

I met Brian Ahier who is a big Tweeter (@ahier) and HIT writer who often sounds good stuff to Mr. H and me. I get so excited when I get to meet HIT superstars.

3M’s booth was much larger than I recall in recent years and all the signage was about getting to ICD-10. Strike when the iron is hot, I guess.

Speaking of ICD-10, I saw some Tweets that CMS Administrator Marilyn Tavenner said in her Thursday morning keynote that the ICD-10 transition would not be delayed.

A few folks that didn’t get an invite to HIStalkapalooza decided to have their own party, which they called “HIStalk-a-Pa-Losers. They tell me they spent at least 10 minutes creating their banner and ended up having a fabulous time.

Several exhibitors told me that they were staying a few miles away from the convention center because there were not enough rooms in walking distance, especially if you wanted a large block of rooms. Unfortunately that’s probably going to be the case again next year in Chicago.

Holly sent me this picture of the guy I loved from SIS who was aggressively handing out goodies to folks passing by and even to  the people on trams. I incorrectly said he was asking, “Would you like gum, mints, or analytics for your EHR.” Actually SIS offers analytics for the “OR.”

Dr. Jayne and I passed by the Greythorn booth and actually caressed the winning pair of shoes from the Inga Loves My Shoes contest. Apparently we were not the only ones so I am glad they had fun with the sash.

Ross Martin, who co-emceed the HISsies and provided some musical entertainment to start the evening, posted the above note on Facebook Sunday. He told me that at least a dozen people had asked him to find them a HIStalkapalooza invite.

The CareTech Solutions folks wanted to make sure we knew they were proud of their sign.

The Versus folks put out this Tweet on Tuesday. I definitely took advantage of their hospitality.

The T-System ladies were decked out in fun red shoes.

PeriGen had adorable baby Uggs as pen holders and baby flip flops right by their sponsorship sign. They were also giving out USB drives, which they had arranged to create the letters, “OB.” Very clever.

Mr. H had commented that people in the exhibit hall were “zombies” Wednesday and I was definitely one of them. Inga may perpetually be a 28 year-old party girl but unfortunately she has taken residence in body that is a little more mature. I think I’ll spend the rest of my day and evening on my couch wading through 2,000 emails and hoping my feet return to normal.

Email Inga.

From HIMSS 2/26/14

From SoreThroat: “Why did CCHIT leave the ONC Testing & Certification program? Why were they really losing money? What was the ‘exit plan’ and who benefited? Who will be left to turn off the lights on CCHIT once the relationship with HIMSS is consummated? CCHIT rolls down hill: vendors, hospitals and others don’t like the feel or the smell.”

From Soft Skills Are Key: “Re: consultants. When will vendors learn that consultants are not the enemy? We approached the SCC Soft booth at HIMSS, introduced ourselves to the booth sales rep, and asked if we could see a quick glimpse of his product. We explained to him that we we’re consultants and wanted to familiarize ourselves with their product at the interest of our clients. The sales guy’s response, along with the stone-cold stare, was, ‘I don’t see the point,’, and then walked away. Soft Lab, ‘Yes’, but Soft Skills, ‘No.’”

The lessened enthusiasm of the throng of attendees and exhibitors was palpable Wednesday. The coat check stations were full of bags of folks taking flights out Wednesday, the exhibit hall energy level was a fraction of that Monday and Tuesday, and most of the big social events were over.

I started my day noticing that every single men’s restroom on the main level was closed. Two had signs saying the conference center was being improved, while another just had a barrier stuck in front of it.

SIS was demoing their analytics application.

Health Catalyst had big booth crowds Wednesday morning.

Optum had a disturbingly large display that was like being at a drive-in movie with men in suits milling about in front of the screen.

I noticed multiple occurrences of odd grammar usage that’s as common as uptalking in young folks: saying “yeah, no,” usually expressed when agreeing with someone making a negative point.

Someone forwarded me a HIMSS email intended for working press saying that because of the contract HIMSS signed with Hillary Clinton for her keynote, reporters not only couldn’t cover her speech, they weren’t even allowed inside the hall to see it. I verified that HIMSS people were indeed turning away reporters at the door, although checking every badge must have slowed down the entry process. I say “must have” because having arrived early last year to see Bill, I still ended up sitting on the floor in front of a TV monitor and decided I would rather just beat the crowds out the door instead of in, so I left the conference early.

Athenahealth wasted no time in printing up big booth signs proclaiming themselves as the top-rated software vendor in KLAS. A reporter asked Judy directly what she thought of it and she said it was a scoring anomaly that won’t happen again. The reporter followed up with KLAS and found that she is technically correct because KLAS is getting rid of the category.

We’re first-time HIMSS exhibitors working on the cheap, so Lorre got a lot of help from many folks, including our booth neighbors and readers. She would especially like to thank Dr. Gregg and Mike “PACSMan” Cannavo, who covered the booth when she needed to step away, brought her lunch, and otherwise made her day a lot better.

Speaking of Lorre, I have received a ton of positive comments about how well she represented HIStalk at our events and in the booth. I had little doubt when I brought her on board, so I’m not surprised. I’m gratified that after spending time at Sunquest and Mediware, she is loving her HIStalk role in running Webinars, supporting our sponsors and readers, and managing all the details that I wasn’t handling well because of time constraints. Above is Dr. Lyle Berkowitz, James Aita, Lorre, and Amy Gleason at HIStalkapalooza.

Here’s Lorre wearing the Super Bowl ring of Stephen Baker the Touchdown Maker while he visited our booth, also showing her HIStalk party nail. Note that SB isn’t just trading on his former athletic glories: he is a substitute teacher and supports several charitable causes related to children.

Lorre and I now know that we have a lot of readers from Epic because several of them dropped by our tiny booth to say hello. Lorre says the taxi-themed shoes were her favorite of the entire conference.

Epic people were great about being attentive to their customers and not staring at their phones until we tweeted my desire to capture at least four booth reps doing so at once. They helpfully staged a photo shoot in the Epic booth just for Lorre. They are a fun group.

We have around 1,200 professional photos from HIStalkapalooza. These will provide good memories for those who where there until I can go through the entire set.

Dr. Jayne’s HIMSS Report – Tuesday and Wednesday

More hours in the exhibit hall means more interesting things to see. I must say I like the HIMSS decision to not close the hall during lunch. It may make it more challenging for exhibitors but it made it easier for me to see more booths. Unfortunately, I also forgot to eat on Tuesday, so maybe the forced break was a good thing.

Inga and I spotted this walking carrot earlier in the week but couldn’t catch a photo fast enough. I finally found her at the Phytel booth. She was there to promote their service project where attendees could stuff backpacks with food for Second Harvest, which provides it to children who may not have meals when they’re not able to receive a free or reduced price lunch at school. I wish I had known about it earlier and would have made time on my schedule to participate if I hadn’t already been double-booked.

I had the opportunity to cruise the hall Tuesday afternoon with Dr. Ross Martin, who not only sings fabulous songs about HIStalk by night, but is part of the leadership team at AMIA by day. I always like to visit the first-time exhibitors and we were over in the low numbers when the staff of Nobl engaged us with cookies. They were also kind enough to allow Ross to charge his dying cell phone while they showed us their Vigilance product. It’s a proactive nurse rounding program designed to improve patient satisfaction (and therefore HCAHPS scores). They also have the ability to notify family members about the activities of their loved one – whether he or she is sleeping, eating, taking their medications, etc. I’ll be interested to see how they fare over time.

Ross also granted me a provisional degree of Fellow for ACMImimi, the American College of Medical Informatimusicology. He assures me the board will formally approve my candidacy at their next meeting, but I better brush up on the show tunes in case they ask for an audition tape.

I attended a nice presentation at Aventura about their instant-on and roaming solutions. I particularly liked the fact that they had actual clients delivering the presentations rather than sales reps. They were also very interested in feedback from attendees and prospects which was a nice change. The lovely Bonny Roberts also had her HIStalk beauty queen sash on display.

I stopped by to watch Inga play Quipstar at the Medicomp booth. Although she didn’t win, she did score a $1,000 donation to her favorite charity. Thanks to Medicomp for allowing us to be their celebrity contestants and for their support of worthy causes. Of course Inga had her usual security detail – two handsome men in black who made sure Inga’s many admirers kept a safe distance. Although they didn’t have the shoe-cam this year, she was sporting some sassy heels with bows on the toes.

Inga and I sampled some of the Tuesday afternoon cocktail hours including Aventura, FormFast, and Sunquest. Tuesday night I hit a couple of parties including PatientSafe Solutions and the Athena Cloud Party. I had several others on my dance card, but the distance between Universal CityWalk, Downtown Disney, and Pointe Orlando was pretty daunting. Roving reporters let me know that the band at Greenway was good and the NextGen clients were having a great time at Pub Orlando.

Orchard had a large tree in their booth. I liked the crates as well. After so much walking around, I needed a break, so I went back to find the quiet sofa on the fourth floor that I had spotted on Monday. Unfortunately today there were several screens blaring a HIMSS14TV broadcast that no one was watching. It was kind of annoying.

I missed the #HITchicks tweetup, but Lorre brought me some swag from the event, which was much appreciated. I’m a little jealous of her non-anonymity because she’s had some great networking opportunities at the booth. Inga and I stopped by several times over the last few days and there seemed to be a lot of others passing by as well.

Imprivata had various different people presenting in its booth with its realistic care setting. On one pass through the area, they had these folks dressed as care team members. I generally don’t like people trying to act like doctors and nurses even if it is in the name of marketing. At least if you’re going to do it, make it more realistic. Their scrubs should be rumpled, they should have overstuffed pockets, and they should look much more haggard.

Siemens had an awesome presentation using a dynamic array of tablets to display content. One attendee commented that he didn’t know anything about their products but the presentation was amazing.

CMS had a relatively large booth with virtually no one in it. Your tax dollars at work, folks. Speaking of tax dollars, on Tuesday ONC released a new Data Brief reporting results from the 2012 ONC Consumer Survey on Privacy and Security. The data was gathered from a telephone survey of 2,000 adults conducted in 2012. That’s not a tremendous sample size and the writeup makes it look like there were only four questions asked, so I wonder why it took so long to release the data? If anyone has insight, let me know.

Wednesday was a short day for me due to an early flight home. I really wanted to stay through Thursday to hear keynote speaker Erik Weihenmayer, but work responsibilities and the lack of a hotel room for Wednesday night conspired against me. I’ve heard him before, and if you can spare the time, he delivers an extremely compelling story. Although I do enjoy HIMSS it’s just exhausting and I can’t wait to get home to my own bed.

Dr. Gregg’s HIMSS Report

HIMSS this year was a short, fast blur. Well, for me anyway. I made a fairly late decision to go when Lorre wrote to ask if I might be able to help out at the sponsor dinner and the all-new HIStalk HIMSS booth. It’s a tough thing for a solo doc to take time away from practice, so I was thinking of skipping it. But I like being able to connect in live mode with old friends, see the latest HIT tech, hear new and fresh (or sometimes even old and stale) vendor pitches, but mostly I enjoy supporting the HIStalk efforts.

Flying in later Sunday afternoon, I made it in time for the 2014 HIStalk Sponsor Dinner. It was held at the same place as last time HIMSS was in Orlando, Maggiano’s. There’s a good reason for the repeat booking: Maggiano’s does a great job. They have a lovely place and make spectacular dishes. (The stuffed mushroom caps were divine.) Despite Mr. H’s less-than-happy take on the turnout, it was a very enjoyable event.

By the way, Mr. H, I had several vendor folks tell me later that they regretted not making it, but they had legit reasons such as booth set up issues that kept them tied up until the dinner was over or they had out-of-their-hands air travel delays. Lorre did a very nice job arranging the dinner and her HIStalk mugs were a real hit, both there and at the booth.

I hope Mr. H rethinks not holding it. It’s a nice gesture of appreciation for the generous HIStalk sponsors (and saying “thanks” isn’t about getting a “you’re welcome,” right?) Maybe it gets arranged a little differently, perhaps more casually next time, but I’d offer one suggestion more: Mr. H, Inga, and Dr. Jayne should make an appearance as they did last time we were at Maggiano’s. Their anonymous allure is certainly a special draw.

The HIStalk booth was an undeniable hit. For a small, first-time booth back in the uncharted regions of the HIMSS exhibit hall hinterlands, it had a slew of traffic. Lots of folks made a point to hike back just to say “Hi” and “Thanks for what you guys do.” Lorre did such a great job. The HIStalk swag including buttons and mugs and tattoos and magnets were snatched up by many/most who visited. The traffic was so remarkable that nearby vendors eyed the booth covetously. Lorre told me one looked over after a while and said, “Who are you guys? Why do you get such great traffic?” Booth envy.

Speaking of Lorre – what a gem! I had not met her before Sunday’s dinner, but I gotta tell you, she is a real delight. If you haven’t had the honor, you’ve a treat in store. Smart, pleasant, and just plain nice. Her one flaw may be that she’s too humble. (Wait… that’s not a flaw; that’s refreshing!) Mr. H found a real keeper.

As I mentioned, my time was very limited, but I got to know the vendor landscape early on helping Lorre deliver the HIStalk sponsor signs. (Shame on those who neglected to display them!) The exhibits are overwhelming at first. It takes a trip or three before you can really discern wheat from chaff. I can’t honestly say that I saw anything that really knocked my socks off. Lots of (too much) chatter about data analytics and population health. Minimal, if any, Meaningful Use hubbub. (thank goodness.) A dearth of “wow” overall, though there were some cool things to see.

I took another look at CareCloud. Got a great demo (thanks, Brian) and spoke with Brad and John (big CC wigs) about some of the cool stuff they’re developing. I also got a view at the next phase for athenahealth. It’s definitely a good direction for them. Thanks to Pierre and Maria and the nice Athena folks who showed me their new UI (and for the new Kindle!) Jonathan Bush was not around, off in Sochi at last spotting.

I enjoyed a couple of rounds of Quipstar at the Medicomp booth. FYI: Inga was robbed; she actually would have won on total points, but they missed that she had been first to respond on a question. Nevertheless, she and her charity made out. As did all the charities and those participants who walked away with cash or iPads. The illustrious James Aita (no longer with Medicomp having returned to his Canuck roots working at Idea Couture) flew in for a command performance and yet again gave Alex Trebek a run for the money as a game show emcee. Heck, the whole crew, including Cindy and Shannon at Thomas Wright Partners and Patrice of Bzzz Productions, does a really nice job with that event.

Speaking of Medicomp, their CEO, Dave Lareau, walked me over and introduced me to “Marck and Mark” at Clinical Architecture. They do a middleware mapping and a form of NLP (it isn’t really natural language processing, more a “terminology processing”) thing that is simply amazing. They create more connections than eHarmony. Truly awe-inspiring, cool stuff that will undoubtedly have a huge effect on indexing and connecting all this disparate data we’re now digitizing.

I was really lucky running into the guys (Omar, Rufi, and Asad) from Panacea EHR. They are some of my favorite folks – really nice and trying to things for the right reasons. They didn’t opt for a booth and were just taking meetings and checking the floor – a pretty good, more cost-effective idea for a smaller vendor, in my opinion.

I enjoyed seeing lots of good folks, such as Dr. Travis who was there in the Startup Showcase with his new company, Catalyze, and Amy Gleason, Travis Bond, et al, from CareSync, also in the Startup Showcase. (CareSync won the top honors in contest there, but I’m sorry, I don’t remember the contest’s name.) It was great seeing Dr. Lyle who was even more bubbly than usual since his new company, healthfinch and their RefillWizard are performing magically, by all counts.

Of course, my cohorts from Health Nuts Media were roaming the hall, too. It’s weird; for as often as we speak, HIMSS is one of the few times I get to actually see them live and in person.

There’s a laundry list of friendly folks I won’t have time to mention much – such as Jason from Health Care Dataworks, Andrea and Fred from the Ohio Health Information Partnership, Marcy from Fleisher Communications, and more – with whom I really enjoyed getting a little face time.

For anyone I didn’t mention, please know I still really enjoyed connecting. And, for all the folks who took time to stop by the booth or stop me somewhere else to chat or share kind HIStalk words, thanks!

Though I doubt the Twittersphere noticed, I didn’t get to tweet (or take any pix) as my phone’s battery started dying on Sunday and wouldn’t hold a charge well. It was actually sort of nice not being too plugged in for a bit!

Lastly, as I was getting ready to fly out Tuesday night, I got to enjoy a nice dinner and some super conversation when we held little impromptu pediatric geek get together. CMIOs from Ivy League and top-ranked hospitals sharing with trench grunt peds. Thanks to Drs. Andy Spooner and Allen Hsiao for the great time.

HIMSS for the little guy: too big, too fast… and too fun!

From the trenches…

"Everyone is trying to accomplish something big, not realizing that life is made up of little things.” – Frank A. Clark