News 10/18/13

Top News

HHS Secretary Kathleen Sebelius is reported to have no intention of quitting after Republican criticism of the Healthcare.gov online insurance exchange debacle. Sebelius has acknowledged the problems, but says fixes are being put in place and those who were unable to sign up should try again. Success rates for those attempting to enroll were less than 20 percent the week of its rollout on October 1 and under 13 percent the second week, although one researcher says fewer than 1 percent of those who tried to register were successful. Another report finds that the cost for the system ballooned from the original estimate of $94 million to $292 million, with those payments going to the US federal government division of Canada-based CGI. Other estimates peg the total cost of Healthcare.gov to be more than $500 million.

Reader Comments

From Dr. Travis: “Re: Color me pink. Breast cancer awareness month has jumped the shark this year.” Travis tells me he likes the innuendo of this poster’s message, which I believe was from the Twisted Taco restaurant in the Atlanta area. Thanks for the reminder to support breast cancer research, get screened regularly, and/or encourage your loved ones to be screened.

From Reader One: “Re: from a vendor-specific forum today. ‘We inadvertently assigned 5,000 accounts to a bad debt agency. Is there a way to mass cancel?’ Now that’s what I call exciting.”

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Boston Software Systems. The company offers an error-free workflow automation platform that allows its healthcare customers and business partners to streamline their business processes and improve productivity. Boston WorkStation lets IT departments efficiently solve problems and eliminate performance gaps in existing IT systems – integrating third-party registrations, performing eligibility checks, integrating lab results, posting payments and collections notes, performing mass updates, creating backup databases, running and distributing reports, and managing dictionaries and tables. Existing systems can be enhanced by creating new business rules and workflows and providing real-time access to external applications. IT departments love Swiss Army knife-type solutions that be used to enhance systems without vendor involvement or ongoing labor requirements, such as the hospital that’s saving 125 hours per month using Boston WorkStation to automatically create a pre-registration account at the time of scheduling or another that saves $500K by automating their materials management system to load inventory purchases and manage price updates. The company also offers Cognauto, the next-generation automation platform. The company’s products are used by over 2,500 hospital customers running many IT systems. Thanks to Boston Software Systems for supporting HIStalk and for issuing a very cool press release announcing that fact.

 
 
Thanks to Bonny and Catherine from Aventura, self-proclaimed “HIStalk minions” who volunteered to report from the American College of Emergency Physicians Scientific Assembly (ACEP13) in Seattle this week. They conducted some ED doc interviews about IT that I’ll have up later, but here are some of Bonny’s observations:

• The topic of scribes performing EMR data entry split the group, with some ED physicians expressing satisfaction in offloading tasks to what is often a pre-med student, but others feel guilty about making scribes do what some would say is their work.
• The best-of breed EDIS vendors were there (Picis, T-System, MEDHOST) as were the big enterprise vendors with EDIS, with Epic notably being MIA.
• Education and discharge instructions vendors (Discharge 1-2-3, Elsevier ExitCare, Krames) were exhibiting.
• Bonny says MEDHOST stole the show with a patient throughput solution that pushes preemptive communication about patients from the ED or OR, such as when a patient is likely to be admitted but whose emergency care is still underway. It also offers real-time and forecasted financial operational metrics for executives.
• ACEP rented out the Space Needle, the Chihuly Museum, and the Experience Music Project for attendee events.
• In the all-important vendor swag category, Bonny lauds Interactive Health Massage Chairs, whose booth was across from Aventura’s such that Bonny and Catherine could perform their own first-hand research as well as watch attendees shed their stress and exit happy. Check out the photo above – who wouldn’t want to have a chair massage while covered lightly with a blanket right on the show floor?

Highlights from HIStalk Practice this week include: a local paper profiles two physicians with opposing views on EMRs. CMS pushes a PQRS reporting deadline back three days. A vendor speaks out against shortened exhibit hours at MGMA. Most medical practices are concerned that ACA insurance exchanges will lead to increased collection burdens and lower reimbursements. Epocrates adds a provider directory to help members identify clinicians for consults and referrals. Emdeon will pay its departing CEO $2.4 million over the next two years. Thanks for reading.

Acquisitions, Funding, Business, and Stock

Athenahealth announces Q3 results: revenue up 43 percent, adjusted EPS $0.29 vs. $0.30, missing analyst estimates on both.

IVantage Health Analytics acquires Professional Data Services, a provider of managed care analytics and benchmarking solutions for hospitals.

StartUp Health admits 14 new companies to its three-year development program for health technology startups. Lt. Dan profiles the companies on HIStalk Connect.

Medical practice technology vendor Waiting Room Solutions changes its name to WRS Health.

Sales

Medical Services of America (SC) chooses Allscripts Homecare for its 70 home care service locations.

Elmcroft Senior Living (MO) will install Cerner CareTracker at its 85 assisted living facilities.

The 30-bed Aspire Hospital (TX) will implement clinical and financial applications from Healthcare Management Systems and physician documentation from Patient Logic.

The VA and DoD award Systems Made Simple a re-compete of the iEHR system contract for systems integration and engineering support.

Saint Luke’s Health System selects PeriGen’s PeriCALM fetal surveillance system for seven birthing hospitals in northwest Missouri and northeast Kansas.

The VA awards Harris Corporation a $60 million, four-year contract to design, install, and support the wireless infrastructure at 112 VA medical centers.

Riverside Medical Group (VA) selects athenaCollector for billing and practice management for its 300+ physicians.

The Texas Health Services Authority chooses EHNAC to develop a state accreditation program for private and public HIEs operating in Texas.

Texas Health Physicians Group selects StrataJazz from Strata Decision Technology as its integrated financial platform.

St. Luke’s Health System (ID) will implement Epic at a cost of $200 million and will offer Epic ambulatory to independent practices through an affiliate program.  St. Luke’s, defending itself against antitrust claims for its purchase of Salzer Medical Group, says Epic is a superior system that will allow providers to share information with patients and with each other more easily.

People

Northwest Community Healthcare (IL) names Glen Malan (Cadence Health) VP/CIO.

OpenTempo names Jim Crook (IDX) chairman of the board, Walt Marti (GE Healthcare) chief administrative officer, and John Jordan (dbMotion) VP of sales and marketing.

Announcements and Implementations

Quantros releases IRIS 2.4, a configurable dashboard to view overall hospital performance and display trends, distribution, and variations in performance.

Government and Politics

A California state appellate court rules that providers do not necessarily have liability to patients when medical records are stolen or misappropriated unless they are accessed by a third party. The ruling stems from a 2011 incident in which a UCLA Health physician’s laptop containing medical records on 16,000 patients was stolen from his home. The provider could have been liable for up to $16 million as part of the  class action lawsuit, even though there was never any indication the data had been accessed. The suit was dismissed. Rebecca Fayed, associate general counsel and privacy officer at The Advisory Board Company, tells me the ruling only applies to California, which has its own statute governing the disclosure of medical information and allows affected individuals to sue for damages for certain violations. She adds:

Although the ruling would not apply nationwide at the federal level, other states with similar state laws may look to this case for reasoning and may analogize to it even if it has no precedential value in any state other than California.

The ONC Tweeters seem happy to be back at the keyboard after a 16-day furlough.

Innovation and Research

 

Children’s Hospital of Philadelphia (CHOP) offers Harvest, an NIH grant-funded open source software toolkit that allows biomedical researchers to explore large data sets, such as those from EHRs and genomic databases. Researchers from CHOP’s Center for Biomedical Informatics are testing Harvest against several data collections, including the Longitudinal Pediatric Data Resource that tracks data from children with conditions detected in newborn screenings.

Technology

Deloitte introduces PopulationMiner, a data analytics solution that draws clinical, financial, and operational data from Intermountain Healthcare’s warehouse to support patient-outcome analysis.

ArborMetrix integrates surgical video analysis capabilities into its reporting and analytics platform, enabling healthcare organizations to improve performance benchmarking of surgeons.

Ninety percent of surveyed nursing home physicians say their use of drug references on mobile devices prevented at least one adverse drug event the month before the survey.

Other

Virtualization software and dictation with speech recognition applications are emerging as top areas for growth potential in hospitals, according to a HIMSS Analytics report on the US hospital IT market. The demand for ambulatory EMRs and ambulatory PACS also appears to be growing.

Joint Commission issues a sentinel alert warning for objects left inside surgery patients, which it says has caused 16 deaths in the past eight years. Most of the recommended actions involve processes and communication, but consideration of “assistive technology” such as RFID-tagged counting systems are also recommended.

In Canada, information on 2,000 patients of Parkwood Hospital is exposed when an unencrypted laptop is stolen from the car of a McKesson Automation employee.

Weird News Andy notes that California’s insurance exchange, Covered California, pulled down its online provider directory just eight days after go-live when the California Medical Association noted that obstetricians were labeled as ophthalmologists and doctors were incorrectly identified as speaking foreign languages. CMA also observed that some doctors were listed as exchange providers who didn’t actually sign up since insurance companies were permitted to add their in-network doctors to the list without their permission unless the doctor specifically opted out.

Staff and patients of Unit 5, the children’s cancer floor of the University of Minnesota Amplatz Children’s Hospital, create a video titled “Brave.”

Sponsor Updates

• SRSsoft hosts about 300 customers at its User Summit this week in Greenwich, CT.
• Sunquest and the Association for Pathology Informatics will offer an October 24 webinar on the topic of IT-driven virtual autopsies.
• Clinovations celebrates its five-year anniversary and highlights a few of its awards and honors.
• E-MDs integrates PatientPay’s online bill pay solutions within its PM software. The company will also integrate Phreesia’s point-of-care check-in solution into its EHR .
• St. Elizabeth Hospital’s (WA) use of e-form solutions from Access and hosted services from Inland Northwest Health Services helped the hospital meet HIMSS Stage 7 paperless requirements while eliminating the need for dedicated on-site hardware.
• Greythorn conducts a market survey for HIT professionals to analyze compensation, benefits, job satisfaction, hiring trends, and industry participation. Greythorn will donate $1 to the Boys and Girls Clubs of Bellevue and Chicago for every submission by November 20.
• Ed Bayliss, executive director for ChartMaxx, participates in a panel discussion on data exchange across the continuum of care at the eHealth Initiative 2013 Data Exchange Summit October 30-31 in Washington, DC.
• Humedica publishes a case study detailing how Mayo Clinic Health System prepared for value contracting using Humedica MinedShare.
• ZeOmega will embed Health Language technology from Wolters Kluwer Health into its Jiva care management platform.
• The Drummond Group certifies SRS EHR as a 2014 Complete EHR.

EPtalk by Dr. Jayne

You can tell that fall has arrived when every coffee vendor (including the one in the hospital lobby) is pushing pumpkin spice latte. Unfortunately, it is also the time I start sweating the fact that I need to come up with an extremely creative Halloween costume and come up with it stat. One of my favorite former bosses throws a massive party and the price of admission is a great costume. I enjoy Halloween immensely and have a closet full of costume options, but this party is peopled with brilliant individuals from academia, healthcare, and health IT so throwing on the Princess Leia braids simply will not do.

Maybe I’ll print a bunch of completely random attributes (some of which relate to me and some that do not) and go as my LinkedIn profile. I always laugh when people endorse me for knowledge of vendors I have never even heard of. I know several of the attendees are faithful HIStalk readers. Maybe I can convince my date to adopt a couples costume and we can go as Inga and Mr. H. Of course I could always go as Dr. Jayne, but that might be a little obvious. I guarantee at least one attendee will be wearing a bowtie and a Farzad-worthy grin.

The lobby of our medical school has a wall with pictures of our staff who have won various Nobel prizes. I could always dress as one of them and see if anyone picks up on it. Getting someone to identify that choice might be a little dependent on how far after the start of the cocktail hour I arrive, though, so not entirely a safe bet. I’m leaning towards possibly a World War I nurse just to have an excuse to purchase an awesome vintage cape. In medicine (and nursing) we used to dress more formally and I miss that. I understand that the current culture of scrubs is all about comfort and practicality, but I can’t help but think that if we dressed more seriously our patients (and administrators) might take us more seriously.

I took a course recently that covered communication and corporate culture. We did several exercises looking at how appearance plays a role in group dynamics. Watching several videos, we scored the characters based on believability, authority, seniority, and a host of other factors. Regardless of the scenario, those characters who dressed in traditional business attire scored higher than those who dressed casually. Besides dress, there are a lot of other factors at play with power dynamics, including the position of the participants (same height vs. seated/standing), tone, demeanor, etc.

I had the opportunity to rotate through a hospital in the UK during the late 1990s and was struck by the formality of the nursing staff. They still wore traditional dress whites (with caps) and nursing trainees wore blue. Physicians wore the long white coat and neckties. There were very few female physicians who I interacted with during my rotation, so I can’t particularly remember what they wore.

I trained at an academic medical center with an extremely traditional surgery department. Surgeons were never to wear scrubs outside the operating room. Trainees were not allowed to consume food or drink in the hallways – not even a sip of coffee – and white coats were to be fully buttoned at all times. Conversely, the OB/GYN house staff wore scrubs and sneakers 24×7, which created more than a few resentments. I wonder though if the patients or other hospital staff really perceived the departments differently? Was it a factor of dress code or of other factors that the dress code exemplified, such as discipline, order, and precision?

Scrubs and casual dress have become a way of life for most hospitals and medical offices. My hospital requires care teams to wear certain colors of scrubs depending on employee roles. Nurses wear navy, respiratory therapy wears light blue, patient care technicians wear khaki, etc. This seems to better help patients understand who is caring for them and what to expect. Unfortunately, physicians run the gamut between coat and tie and whatever scrubs they put on at the last hospital they rounded at. Some are so casual it’s hard to take them seriously. In response to a number of male physicians going sockless in loafers, one local facility created a rule requiring that “hosiery be worn at all times.” I’d like to have been a fly on the wall at the medical staff meeting where that was discussed: readmission rates, surgical site infections, ventilator-associated pneumonia, and bare ankles.

In the ambulatory care setting, the proliferation of scrub styles is mind boggling. We see a lot of “hip” medical assistants and patient care techs in low rider scrubs with flare bottoms that drag the ground to the point where they fray. I hope they never have to run to a code or crouch down to provide CPR, and if they do, that they have their waistband firmly in hand. One pediatrician I know has hand painted lab coats for every holiday and season. She’s the only physician on staff who wears a blue coat, so it really stands out. I smile every time I see her in the elevator, but I’m not sure what some of the patients and visitors think.

Generally I think the offices where staff dresses in a more uniform manner appear more organized and professional, but again maybe the dress code is a side product of management rather than a causative factor. Many of our offices provide staff with practice-logo polo shirts to be worn with khaki pants. This can be useful to reinforce an office brand as well as to help patients identify staff members, especially in busy offices with many ancillary services. That might be a great costume idea – maybe I’ll borrow a polo and masquerade as a staffer for a competitor practice.

I didn’t set out to write a fashion review, but perhaps Inga has been a greater influence on my writing than I previously thought. I could write an entire column on sassy patent leather hospital clogs, but we’ll save that for another night. I’m off to the internet for costume ideas. Got a great one? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Francisco Partners Will Acquire McKesson Automation

Private equity firm Francisco Partners announced this morning that it will acquire Pittsburgh-based McKesson Automation, which offers hospital pharmacy automation solutions. McKesson had announced plans to divest the business earlier this year.

According to a Francisco Partners spokesperson, “McKesson Automation is highly regarded in the healthcare industry for its system-wide approach to and deep understanding of the medication delivery process. We are excited to work closely with the existing leadership team to expand the automation business as a standalone company.”

McKesson acquired the former Automated Healthcare in 1996 for $65 million.

News 10/16/13

Top News

Cerner shares hit a 52-week high Tuesday following announcement of a partnership with Wolters Kluwer Health to develop a physician documentation system using Provation Clinic Note content with Cerner Millennium. CERN shares are up 52 percent in the past year, with the company’s market cap now at $19 billion. 

Reader Comments

From Veteran: “Re: insurance marketplace. I take it all back. This really is a disaster. A New York Times article this weekend chronicled a whole series of issues going back months, not the least of which was HHS’s decision to project manage this themselves when they (and everyone else) knew they had neither the expertise nor the experience. Hope this doesn’t set health reform back years.” Veteran (and a few others) were critical of my comment that the opening day of the insurance marketplace was a “failure” because I was unable to access the system. According to the Times, insiders were aware of the system flaws long before the launch, but because of political concerns, continued with the original timeline. By one estimate the project is now about 70 percent of the way toward operating properly, but the time frame for completion could be anywhere from two weeks to a couple of months. Apparently I am just one of a few thousand people who have opted to wait a few weeks before making additional attempts to enroll.

From CA/DC Fellow: “Re: failed health insurance exchange site. Will US CTO Todd Park take the fall?” Healthcare.gov is a high-profile political embarrassment. In politics and government, someone has to be lynched publicly to appease the press. Todd was sent out to try unsuccessfully to talk around the situation, which I think puts him at risk. Sebelius would toss him overboard in a second to save her image. Nobody ever blames the contractors since it was someone’s job to manage them.

HIStalk Announcements and Requests

Listening: Nada Surf, a nearly perfectly listenable alternative rock band that’s been around for 20 years. I’m playing them constantly.

Acquisitions, Funding, Business, and Stock

A report predicts that HIT funding will double over last year thanks to the implementation of the ACA and HITECH. Venture capitalists invested $737 million in 51 deals during the third quarter, compared to $623 million in 168 deals a year ago.

CareCloud CEO Albert Santalo tells the Boston Business Journal that his company may launch an IPO next year.

A business publication says transcription vendor MModal, saddled with heavy debt and slow sales, may need to seek restructuring if its current turnaround efforts fail.

Sales

Australia’s NSW Heath will implement iMDsoft’s MetaVision throughout the state’s adult, pediatric, and neonatal ICU beds.

Adventist Health System selects the Explorys suite of analytic and population health management solutions.

TeamHealth (TN) chooses Shareable Ink’s Anesthesia Cloud and ShareMU solutions for selected sites nationally.

Virginia Hospital Center Physician Group selects eClinicalWorks EHR for its 100 employed physicians.

People

Henry Schein appoints Steve Klis (CareFusion) president of global practice solutions.

CareCloud names R. Scott Lentz (Aprima Medical, Picis) CFO.

AtHoc names John Tempesco (Informatics Corporation of America) as senior director of healthcare operations and marketing.

Vocera Communications hires Paul Johnson (Intuit) as EVP of sales and services.

Announcements and Implementations

Heritage Valley Health System (PA) activates Allscripts Sunrise for its Beaver and Sewickley campuses.

Medfusion rebrands its recently reacquired Inuit Health patient portal technology back to its original name and adds Vern Davenport (formerly of MModal) and Buck Goldstein (UNC Chapel Hill) to its board.

For-profit surgical hospital operator Victory Healthcare (TX) implements Omnicell’s G4 Unity medication management system.

Optum and Dignity Health introduce Optum360, a new company that will address the back office functions of healthcare systems.

Unified emergency notification systems Vendor AtHoc announces the launch of its healthcare vertical with the launch of AtHoc Home Care Alerts, which offer home care service organizations with mobile duress and emergency alerting, field reporting, and personnel tracking.

Jordan Shlain, MD and Todd Johnson of automated patient follow-up solution vendor HealthLoop will present at the UHC Conference Innovation State on Friday.

Lewistown Hospital (PA) implements Summit Downtime Reporting System for business continuity.

Lucca Consulting Group and ICD-10 Coach announce a partnership to help small hospitals and practices implement ICD-10.  

Government and Politics

The VA names Health eTime the winner of its medical appointment scheduling competition and a $1.8 million prize. The open source app allows veterans to schedule visits across VA locations and gives VA providers the ability to share appointments with the personal digital calendars of veterans.

A Pittsburgh Tribune-Review investigation finds that the VA is one of the largest violators of health privacy laws. From 2010 to May 31, 2013, VA workers or contractors committed 14,215 privacy violations at 167 facilities that victimized at least 101,018 veterans and 551 VA employees. Violations included postings of anatomy on social media sites and identities stolen to create fraudulent credit cards.

Innovation and Research

CEOs of hospitals with high levels of advanced technologic capabilities earn an average of $135,862 more than hospitals with low levels of technology, according to a study published in JAMA Internal Medicine. Hospitals with high performance on patient satisfaction also compensated their CEOs more, but no association was found between CEO pay and processes of care, patient outcomes, or community benefit. Based on the findings, researchers suggest that hospital boards place more emphasis on quality when setting compensation.

Two graduate students in Israel develop a computerized system for diagnosing Parkinson’s disease consistently. The patient performs specific movements in front of a 3-D depth camera, whose data is the analyzed by computer to determine a diagnosis with 94 percent accuracy.

Other

Encore earns top scores in a KLAS report on go-live support vendors. Santa Rosa Consulting was recognized for having the most engagements overall, followed by Encore and ESD.

The Carolina eHealth Alliance (SC) reports that the four hospital systems participating in its electronic exchange network saved more than $1 million over a 12-month period by reducing unnecessary admissions and redundant procedures.

Clinithink posts an animated video depicting the role of clinical NLP in transforming healthcare.

An article in Medical Marketing & Media says that mobile devices are yesterday’s news for marketing drugs to physicians, concluding that “EHRs will become the dominant context for physicians” in promoting drugs at the time of e-prescribing. However, it warns that overly aggressive drug promotion could lead to regulation. A drug company spokesperson predicts  consolidation of the EHR industry, saying “a relative few will own the space and will own the access” for drug companies to promote their products as part of physician workflow. Drug companies are doing away with traditional field reps for product promotion.

The local newspaper writes up Novant Health (NC), which earned HIMSS Stage 7 EMRAM last week for its $600 million Epic implementation, which Novant says it finished three years ahead of schedule and under budget.

Sponsor Updates

• Caradigm will add predictive clinical analytics capabilities from MEDai to its Care Management platform.
• Sunquest announces a new partnership with the Boys & Girls Clubs of Tucson.
• Cynthia Davis, RN, FACHE of CIC Advisory will speak Thursday at the 2013 Annual Healthcare IT Symposium in Las Vegas sponsored by the Shriners Hospital for Children. Her topic will be “Paddling Upstream: From Data Collection to Better Patient Care.”
• Epic will allow direct use of the QlikView Business Directory platform within Hyperspace and will support content sharing between joint Epic and QlikView customers.
• NTT DATA’s Optimum Suite achieves 2014 Edition Complete EHR Inpatient certification.
• The SSI Group announces that both its clearinghouse services and RCM solutions are ICD-10 ready and that it is currently testing with provider and payer communities.
• An Imprivata survey finds that the adoption of server-hosted virtual desktops in the EMEA healthcare industry could increase 74 percent within 24 months.
• Trinity Health (MI) shares how it generated $3.1 million in profits and an eight to one ROI in five years using Medseek Predict for marketing campaigns.
• VitalWare partners with DCBA to create CDiDocuMint, a clinical documentation improvement tool that uses a query and tracking methodology.
• The Washington Business Journal recognizes Clinovations as the 10th fastest-growing company in the district.
• Utah Business Magazine honors Health Catalyst Chairman David Burton, MD for his lifetime achievement as a healthcare hero.
• Weill Cornell Medical College CIO Curtis L. Cole shares how he helped Intelligent Medical Objects develop its flagship product.
• UltraLinq Healthcare Solutions partners with Mobisante to integrate UltraLinq’s image management platform with MobiUS point-of-care imaging devices, enabling providers to deliver remote diagnosis and second opinions.
• LDM Group’s pharma messaging technology is featured in an article on engaging physicians through EHR messaging.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Monday Morning Update 10/14/13

From Alarm Fatigue: “Re: patient death. Alarms on hospital doors are ignored.” San Francisco General Hospital (CA) offers no explanation of how a 57-year-old patient reported missing from her hospital bed was found dead 17 days later in an alarm-equipped hospital stairwell. The hospital’s chief medical officer suggests that alert fatigue from “a cacaphony of chirps and beeps” may have contributed to the problem.

From Patient Advocate: “Re: retina surgeon follow-up appointment. My two drugs had a dosage change, given to me verbally. I started second guessing myself as I was sent upstairs to see my specialist, who reviewed the surgeon’s notes send by fax with different dosage instructions. The meds seemed to be pre-printed on the form, so I asked the tech to check with the surgeon. The specialist then added another drug, giving me a sample with no dosage label and verbal instructions. Most of this specialist’s patients are 50 an over, going home with verbal instructions only. How about a simple printout of dosage instructions? As I was leaving the exam room, the person charting on the laptop asked me about my other eye drugs so she could enter data.  Guess she was seeing the trees and I was walking through the forest … with less than perfect vision.” Technology should get neither the blame nor the credit for how providers interact with their patients. They are responsible for choosing and using whatever tools they need to get the job done. I can’t think of any other professionals who blame the computer for their inability to perform at a reasonable level, although I also can’t think of any professionals whose minute-by-minute behavior is managed by government, insurance companies, and unseen owners using the computer as a blunt instrument of control.

From The PACS Designer: “Re: 5th Gen iPad. Now that we have the news that October 22 is the launch for the 5th Gen slimmer iPad-mini, here’s an advanced look courtesy of the Sonny Dickson website. The smaller form factor is destined to be a hot item, and eagerly sought by those who are constantly attached to their device.”

The reader-requested poll about ICD-10 and liability and workers comp insurers yielded a scattershot of inconclusive responses. New poll to your right: what’s the cause of Healthcare.gov insurance marketplace technical problems?

Here’s John Lynn’s latest  Hangout, recorded live at CHIME 13.  

In Northern Ireland, medical imaging technology firm Cirdan Ultra acquires the assets of GE Healthcare’s Centricity Laboratory Division and will take over support for the former Triple-G product, which was at one time the highest-rated LIS (before GE acquired it, obviously).

ESD wins the Best Video Award at the CHIME CIO Fall Forum with a CIO-customized Diamond Dave-style version of “Just a Gigolo.”

Weird News Andy concludes that “this just doesn’t cut it.” A man in China suffering from arterial embolism saws off his own leg after being turned down by a doctor because he didn’t have enough money to pay for the procedure. He jammed a block of wood in his mouth and cut the leg off with a saw, also losing three teeth from biting down hard in pain. The man appealed for help to have the other leg amputated, resulting in a doctor offering his services for free.

The non-profit New Cities Foundation publishes a video describing its urban e-health project in Rio de Janeiro, in which GE Healthcare provided “e-health backpacks” to allow home visits for health maintenance in an urban environment.

For the geeks among us looking for a new technical toy, check out WearScript for Google Glass, which allows programmers to control and develop for Google Glass using Javascript. The developers hope to create an open ecosystem around Glass and to encourage accessibility.

Berlin will host the first HIMSS European mHealth Summit in May 2014.

The sold-out eClinicalWorks user conference started this weekend at JW Marriott Hill Country in San Antonio, TX.

On tap this week: Cleveland Clinic’s 2013 Medical Innovation Summit a the just-opened Global Center for Health Innovation in Cleveland. I’m surprised any healthcare work gets done at all in October given the number of people that seem to do nothing all month except attend conferences.

Crain’s Chicago Business names the board of Merge Healthcare as having the least-competent Chicago-area board of directors given their pay, noting that the company lost $28.8 million last year while the six-member board took home $8.2 million in compensation.

Vince launches his HIS-tory of McKesson, having tapped into the personal memories of several industry pioneers including Walt Huff himself (the “H” in HBO & Company). Vince also got some reader help in identifying some of the HIT faces of yesteryear. Vince spends a lot of time gathering information that you won’t find anywhere else, and I for one enjoy the heck out of every episode.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 10/11/13

Top News

The DoD issues a solicitation to EHR vendors to demonstrate their products the week of October 21 for market research and planning purposes. The DoD says it is interested in “off the shelf” enterprise EHRs, including VistA solutions, to replace its legacy systems and notes that participation in the demonstration “is not mandatory, required, or a prerequisite for any future procurement activities.”

Reader Comments

From Curious: Re: PatientKeeper. Does anyone know if PatientKeeper is MU certified? Couldn’t find them by name on the CHPL website, but that’s not the world’s most reliable or usable site.” The folks at PatientKeeper shared this response:

PatientKeeper is certified for 2011 Edition as a Modular EHR, including CPOE and Medication Reconciliation, and we will be seeking 2014 Edition certification by the end of this year.

From HIS Junkie: “Re: HIPAA. Does HIPAA apply to the ACA Health Insurance sites? If there is a breach, will OCR slap HHS with a $1.5 million fine for each breach. No doubt we’ll soon find out. In a recent report, testers identified five major breach weaknesses in the Health Insurance web sites. They were: fake sites, all access requests for other sites, click jacking threats, cookie threats, and scam psychology threats. Firms like HPs web security group and Trend Micro did the testing. Clearly the slapped together sites would fail a HIPAA compliance audit. With people registering having to put in all their family member’s SSNs, the report concludes, ‘Expect Mischief.’”

From Wannabe Recovering Consultant: “Re: anonymous CIO interview. Incredibly fascinating. I would love it if you could do more of them. His or her insights into the thinking of a CFO made me think that an anonymous CFO interview would be equally insightful as relates to IT expenditures and activities.” That would be fun, too, if anyone wants to volunteer.

From MoreCowBells: “Re: California Medicaid. Any truth to the rumor that they won’t be ready to accept ICD-10 by next October. Are other states in the same situation?”

HIStalk Announcements and Requests

I spent most of the week in San Diego at the annual MGMA conference and posted several updates on HIStalk Practice. Take a read to get my impressions on some of the sessions, what was cool and not so cool in the exhibit hall, the scoop on after-hours parties, and what folks were talking about. If you prefer a more visual experience, you’ll find lots of pictures, including one or two of hot shoes. I also encourage you to check out Dr. Gregg’s latest post, which offers a few comebacks to the EHR nay-sayers. Thanks for reading.

Welcome to new HIStalk Platinum Sponsor Medi-Span, part of Wolters Kluwer Health. Medi-Span offers customized drug databases and medication decision support modules that enhance patient safety, support interoperability, and decrease alert fatigue. Medi-Span makes EHRs and other clinical systems smarter, supporting functions that include prescribing, dispensing, and claims processing for 1,600 hospitals, 49,000 retail pharmacies, and all 10 of the top pharmacy benefits managers. In addition to drug information, decision support, and pricing tools, MediSpan’s new offerings include Controlled Substances File that covers both federal and state requirements; Alert Control customization capability, Patient Safety Programs File that identifies drugs that have Black Box Warnings, Medication Guides, tallman names, or REMS; and ICD-10 Mapping Files. Thanks to Medi-Span and Wolters Kluwer Health for supporting HIStalk.

Webinars

Health Catalyst will offer “Surviving Value-Based Purchasing: A Road Map to Success Under the New Reimbursement Model” on Tuesday, October 15 from 1:00 – 2:00 p.m. Eastern. Presenters will be Bobbi Brown, VP of financial engagement for Health Catalyst, and Jane Felmlee, healthcare consultant.

Acquisitions, Funding, Business, and Stock

Francisco Partners makes a strategic investment in EMR/PM vendor NexTech.

Three top executives of Bottomline Technologies take a pay cut from the previous fiscal year following the company’s 2012 net loss of $14.4 million. The combined compensation packages fell from $5 million to $4 million.

API Healthcare announces Q3 accomplishments that include a 23 percent increase in bookings and 35 new healthcare customers.

Sales

Augusta Health (VA) will implement community HIE technology from Sandlot Solutions.

Sentara Healthcare selects HealthMEDX to automate its clinical and financial operations for its skilling nursing, transitional care, and assisted living facilities.

San Luis Valley Health (CO) adds the iDoc document management software from CareTech Solutions.

Northern Colorado Anesthesia Professionals, LLC (CO) chooses Shareable Ink’s Anesthesia Cloud for data capture, billing, and scheduling and will use the company’s ShareMU program to help its providers earn EHR incentive payments.  

UNC Health Care (NC) extends its relationship with Practical Data Solutions, Inc. to deploy data models for Epic Resolute and Cadence, adding to its previous work with UNC on GE Centricity and Allscripts Enterprise.

People

Alere ACS hires Helen Figge (HIMSS) as VP of clinical integration.

St. Joseph’s Healthcare System (NJ) names Jane Tsui-Wu (Stony Brook University Hospital) as VP/CIO.

Streamline Health Solutions names Jack W. Kennedy, Jr. (PRGX Global, Inc.) as SVP/chief legal counsel.

Ian Gordon (Topaz Shared Services) joins McKesson Health Solutions as SVP/GM for decision management.

Liaison Technologies announces three new board members: William E. Kitgaard (Covance Global IT), David Parker (WebLogics), and Joseph B. Volpe III (Merck Global Health Innovation Group).

Announcements and Implementations

Knoxville Hospital and Clinics (IA) goes live on its $2.8 million Cerner implementation.

Bon Secours Health System (MD) integrates Wolters Kluwer Health’s UpToDate clinical decision resource within Epic.

Athenahealth will monitor and share population health information on flu outbreaks and other communicable diseases from its national database to fill the current gap in CDC reporting. Because of the government shutdown, the CDC has furloughed 8,754 employees (70 percent). Makes you wonder how much money the government could save if the private sector took over a few more tasks.

iMDsoft makes the MetaVision AIMS, MV-OR available via cloud-based hosting, with licenses offered on a subscription basis.

MEDHOST introduces AXON, a native iPad app that enables clinicians to interact with the MEDHOST EDIS.

Infor launches Health 3.0, the company’s vision for the future of HIT, which includes a suite of products that address the shift to value-based reimbursements.

Government and Politics

The VA Office of Information and Technology furloughs 2,754 employees, halting all software development on the VA’s benefits management system.

Union members of the Iowa City, IA VA medical center protest the effect of the government shutdown on the hospital’s IT workers. “Right now, the Information Technology section of our hospital that does all of our computer systems doesn’t have a budget, and those employees are currently working without pay. [Hospital employees] pretty much are at a loss for everything — charting, documentation, everything is at a loss.”

Innovation and Research

NIH awards Sutter Health, IBM Research, and Geisinger Health System a $2 million research grant to develop analytics methods to detect heart failure using EHR data.

Virtual assistant developer Next IT announces GA of Alme for Healthcare, which will respond to customer service questions and increase patient engagement.

Other

Epocrates introduces Provider Directory to help members easily identify other clinicians for consultations and patient referrals.

A RAND study finds that the primary driver of job satisfaction for physicians is being able to provide high-quality healthcare. EHR use impacts doctor job satisfaction because of worries that EHR use interferes with face-to-face patient interaction increases clerical work by doctors. Physicians also have concerns that medical record accuracy may be negatively impact when templates are used.

American Well expands its $49 a visit telehealth consult services to 44 states and DC.

The Orlando business newspaper lists the salaries of executives of Adventist Health System. CIO Brent Snyder made the list with $1.14 million in salary in 2011.

Kansas City’s City Council Planning, Zoning & Economic Development Committee unanimously approves a plan to give Cerner $1.63 billion in tax incentives for its $4.3 billion expansion project. The full council is expected to extend approval Thursday for the 11-building, 4 million square foot development that would be built in 14 phases over the next 10 years.

A quality incentive program for salaried physicians at Massachusetts General Hospital improved EHR adoption and hand hygiene compliance, reduced ED use, and increased efficiency in radiology and cancer centers, according to a study published in Health Affairs. Physicians could earn incentives of up to two percent of their annual income, leading researchers to conclude that even small incentives can impact behaviors that improve the quality of care.

Sponsor Updates

• eClinicalWorks hosts its national users conference October 11-14 in San Antonio.
• Gartner positions Informatica as a leader in its 2013 Magic Quadrant for Data Quality Tools report.
• Visage Imaging is exhibiting at this week’s ACR Annual Informatics Summit in Washington, DC, with GM Brad Levin participating in an October 11 vendor panel on mobile imaging solutions.
• Aprima Medical offers customers an option to use TSPi’s MicroCloud Platform as a Service solution to host their Aprima EHR.
• Billian’s HealthDATA and the Alliance for Home Health Quality & Innovation co-host an October 22 Twitter chat on mobile health and in-home technologies.
• CCHIT extends ONC 2014 Edition Modular EHR Certification to PatientTouch System 3.2.2 and PatientTouch System 3.3 from PatientSafe Solutions.
• Cerner will add Wolters Kluwer Health’s Provation Clinic Note content and decision support into Cerner Millennium.
• TriZetto releases details of its 2013 Executive Vision Summit November 12-14 in Scottsdale.
• The American Hospital Association extends its exclusive endorsement of data center hosting services from CareTech Solutions.
• Michael Mutterer, VP of senior services at Riverside Medical Center (IL), shares his thoughts about “I couldn’t live without … HealthMEDX clinical EMR.”
• pMD explains how its mobile charge capture solution can improve the PQRS reporting process.
• Technology from Awarepoint and Versus are featured in a 24X7 article on the growing use of RTLS in healthcare.
• EClinicalWorks adds Elsevier’s ExitCare technology for evidence-based patient education and discharge instructions into its EHR.
• Quality Systems’ subsidiary Mirth releases Mirth Connect 3.0, an open source healthcare integration engine for HL7 message integration.
• 3M Health Information Systems introduces the 3M Outpatient CDI Program, which offers consulting services for outpatient facilities and physician practices needing to improve the documentation and coding process.

EPtalk by Dr. Jayne

I’m completely disheartened by the behavior of our elected officials during this government shutdown and the months leading up to it. Regardless of your side of the aisle, it seems everyone is behaving badly at this point.

One of the things that surprised me is the shutting down of government websites. I was looking for information on a potential vacation site and discovered the National Park Service websites are down. I understand not paying people to create new content or update pages, but am not following the logic on how taking down the websites is saving a significant amount of money.

If they’re using commercial hosting at all, I doubt their vendors decided to quit charging them due to lack of appropriations. If they’re self-hosted, did they just turn out the lights at the data center and leave a few random servers up to share the message of gloom and doom? Are they hoping to cut their cooling bill as a way to balance the budget? I understand it’s all a political maneuver to make it as uncomfortable for everyone as possible, but it seems a little over the top. I decided to do some informal surfing to determine which websites were “essential” or not.

The National Park Service sites are down. Everything redirects to the Department of the Interior home page, which is up. Also live is the Deepwater Horizon oil spill page for those urgent updates from the 2010 spill. Not sure why that’s essential. The web pages of the USDA Forest Service are live with a disclaimer that they will remain available for public safety announcements and updates for wildfires, floods, and other natural disasters, which seems reasonable.

The Centers for Medical & Medicaid Services sites are up, with a disclaimer that information may not be up to date. That approach at least makes more sense than what the National Park Service has done. Is depriving fifth graders the ability to read about Old Faithful really the best way to serve the next generation of leaders? I think not.

One page that I found live with absolutely no disclaimer or mention of the shutdown is the HealthIT.gov page on How to Implement EHRs. Even the HHS HealthITBuzz blog is up without a disclaimer, although the last update was September 26. I wish the majority of physicians I worked with shared the same urgency for EHR adoption as the website does. Also, I was happy to see most of the Veteran’s Affairs websites still up (although there may not be people processing anything on the other side of the wires, which is shameful).

Those of us that work in healthcare IT are constantly preparing and refining our business continuity plans. We make sure we know how to deal with a business disruption and how to actually resume our processes when the systems come up. I wonder how many federal IT departments have the same level of thought or planning? I doubt they perform regular “government shutdown” drills and they probably don’t even have a downtime box because there would be no one there to use its contents. We can only assume that when the systems come back on line things will be messy.

Hopefully the parties involved will figure out a way to come together and start serving the American people again but, I think that’s probably asking a lot at this point. In the meantime the rest of us will continue doing our jobs, caring for patients, keeping the systems running, and paying our bills. And at least one of us will be dreaming of the Dry Tortugas. Got a seaplane? Want to sneak into a National Park? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 10/9/13

Top News

US CTO Todd Park tells USA Today that the Healthcare.gov insurance marketplace wouldn’t be failing if the site hadn’t drawn five times the expected number of simultaneous users. “Take away the volume and it works,” he said. Former National Coordinator and Republican appointee David Brailer wasn’t impressed with the Democratic appointee’s explanation: “Whoever thought it would draw 60,000 people wasn’t reading the administration’s press releases. The Medicare Part D site was supposed to have 20,000 simultaneous users and was (built for) 150,000, and that was back when computing was done on an abacus. It isn’t that hard.” A Wall Street Journal investigation finds that an Experian identity module is crashing frequently, the site contains orphan programming code that appears to do nothing, and caching was not employed for efficiency. It estimates that up to 99 percent of those people who try to register can’t complete the process. The previously chatty government contractors involved are now declining to return calls.

Reader Comments

From Patient Presents Without Comment: “Re: ICD 10. I wish I could see when, You’d be part of my past, and be gone; Your codeset is fine, but look: I prefer Nine. It’s opinion- how can it be wrong? There’s just under a year- it’s a while, but I fear, That there’s yet quite some Gantt chart to go; Could you install yourself? It’d be good for my health. So please MYOB, IMO.”

From Beer Reviewer: “Re: Monday morning news. The posts have been short. Is the news in short supply?” It is, actually. I go through the same steps every weekend to put together the Monday Morning Update, just like I’ve been doing since 2003. Lately news has been nearly non-existent. I could do like everybody else and pad it out with worthless, self-serving press releases masquerading as useful information, but I assume you would rather me not waste your time. Nobody has pointed out anything important that I’ve missed, a test I apply every single day to what I write.

From More Please: “Re: anonymous CIO interview. Fascinating! I would like to see more.” So would I. All I need are CIOs who are willing to be interviewed anonymously. If that’s you, let me know.

HIStalk Announcements and Requests

Everybody knows that most everything Yahoo is hopelessly antiquated crap, but I’ve stuck loyally with the paid version of Yahoo Mail for nearly 10 years because I like it better than the alternatives. No more. Yahoo is having a spam-related spat with Spamcop blacklisting that was causing my emails to fail and despite all the hoopla about improving the user experience, Yahoo has apparently removed every possible way of contacting support (even via an online form – thanks, Marissa Mayer). The best way to get me now is mr_histalk@histalk.com.

Acquisitions, Funding, Business, and Stock

Luminate Health, which offers a patient-friendly lab results portal, raises $1 million.

Nuance gives in to activist investor Carl Icahn by adding two of his nominees to its board in return for his support of the company’s slate.

Sales

Sacramento Family Medical Clinic (CA) is implementing Forward Health Group’s PopulationManager as it joins forces with The Guideline Advantage to improve quality outcomes and patient care.

Partners HealthCare (MA) selects InterSystems HealthShare to replace several integration engines as it consolidates to a single EHR.

The Valley Hospital (NJ) will implement Merge Healthcare’s CTMS for Investigators solution to organize and centralize its clinical research operations.

Aegis Sciences will implement Passport Health’s OrderSmart and PaymentSafe to automate transactions between its CBO and U.S. locations.

Washington Health System (PA) selects eClinicalWorks EHR for its 87 physicians and 21 residents in its family practice residency program.

In Brazil, Hospital Israelita Albert Einstein chooses Cerner Millennium.

People

St. Francis Medical Center (CA) names Judi Binderman, MD, MBA, MHSA (Encore Health Resources) as CMIO. 

Former ONC Principal Deputy Director David Muntz will join GetWellNetwork as CIO. We ran this as a reader rumor last week.

Encore Health Resources promotes Steve Eckert to partner of client services.

Alameda Health System (CA) names Dave Gravender (Kaweah Healthcare District) as CIO.

Clinovations hires Brian Morton (Halley Consulting) as VP of physician networks, Kim Tombragel (maxIT-Vitalize) as SVP of business development, and Robin Walters (Halley Consulting) as business development manager.

Announcements and Implementations 

A KLAS report finds that PatientKeeper is the most user-friendly standalone CPOE system on the market, with its 8.3 score on a nine-point scale beating Epic inpatient by almost a full point. All PatientKeeper customers interviewed by KLAS said they would buy it again, with an overall company performance score of 86.4 and reported physician user training time of as little as 10 minutes.

Nuance announces its Clinic 360 suite, an outsourced transcription service and application for physician practices and ambulatory clinics that manages dictation, review, editing, and sign-off for specialties such as oncology.

ADP AdvancedMD introduces its business intelligence solution AdvancedInsight during MGMA. The company also ADP releases its iPhone app.

Harris Healthcare achieves critical milestones while deploying its Service Oriented Architecture Suite across the US Department of Veterans Affairs and the DoD.

Vitera is previewing Intergy V9.00 at MGMA this week.

Capario introduces CaparioOne, its redesigned web portal application for revenue cycle management.

Next Wave Health launches Next Wave Connect, a problem-solving social network for healthcare organizations. Drex DeFord will serve as CEO and Mike Davis as EVP of research and analytics.

VHA Mid-Atlantic will offer its hospitals mobile patient satisfaction and experience tools from Marbella Technologies.

Peer60 offers HospitalTCO.com, which allows hospitals to determine total cost of ownership for IT systems over 10 years. It’s free.

Athenahealth announces its readiness for Meaningful Use Stage 2.

Mediware says it will expand the CPR+ platform it acquired in July 2013 to create a management tool covering home medical equipment, home infusion, specialty pharmacy, and home health.

Other

Officials of Dane County (WI) Regional Airport are planning a $30 million parking deck expansion to handle the increasing number of Epic Systems travelers.

HIMSS releases a photo of its Innovation Center inside the just-opened Global Center for Health Innovation in Cleveland.

The local newspaper covers the $125 million Epic project of WellStar (GA).

UNC Health Care (NC) says it expects to post an operating loss for the fiscal year due to reduced volumes caused by its Epic go-live. 

Sponsor Updates

• T-System launches two solutions to assist EDs overcome negative aspects of EHRs, including a paper-based note-taking tool (Doc Notes) and an ED physician documentation application (EV for physicians).
• InstaMed says use of its Member Payments solution, launched earlier this year, will exceed $100 million in patient payments.
• CareTech Solutions signs its first long-term care facility to its Clinical Service Desk support service.
• PeriGen will offer an October 9 Webinar, “Uterine Tachysystole: How much is really too much?”
• The HCI Group is honored as the fastest growing private company in Florida by the Florida Business Journal.
• Billian’s HealthDATA will host an October 16 webinar offering three perspectives on patient and provider engagement.
• Predixion Software CEO Simon Arkell briefs the Boulder Business Intelligence Brain Trust on V3.1 of Predixion Enterprise Insight and its Machine Learning Semantic Model.
• Genesis Health System (IA) discusses the performance efficiencies they’ve experienced since the integration of Vocera’s wireless communication system with their Cerner EHR.
• Intermountain Healthcare and Craneware will present “Structuring Multidisciplinary Teams for Revenue Cycle Improvement” during the 2013 HFMA MAP Event October 28 in Ft. Lauderdale, FL.
• Elsevier and Jefferson Medical College (PA) are co-sponsoring the “Art + Medicine: How Art Can Make Better Doctors” conference November 2-3 in Philadelphia.
• Health Care Software participates in the AHCA/NCAL 64th Annual Conference and Expo in Phoenix this week.
• Intelligent InSites will present “The Why’s and How’s of Reforming Healthcare Operations” on October 9.
• NextGen Inpatient Clinicals V2.6 receives 2014 ONC HIT certification as a complete EHR.
• Aspen Advisors Jody Cervenak is moderating a panel on the optimization of physician documentation during the CHIME13 Fall CIO Forum in Scottsdale this week.
• ZirMed signs over 900 clients processing over 2.2 billion transactions while launching three additional products in the first nine months of 2013.
• Greenway supports the national eHealth Exchange by joining Healtheway.
• Dan Charney, managing partner of Direct Recruiters, Inc. / Direct Consulting Associates, is named a “Forty under 40” honoree by Crain’s Cleveland Business.
• Orchestrate Healthcare is hosting an October 17 business intelligence Webinar.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Monday Morning Update 10/7/13

From Insider: “Re: David Muntz from ONC. Will join GetWellNetwork’s leadership team.” Unverified.

From The PACS Designer: “Re: iOS7. Now that the hoopla has subsided over the 5C/5S, thought it would be good to reveal what are the improvements that Apple brings us with iOS7. They say, ‘It has a new structure, applied across the whole system, that brings clarity to the entire experience. The interface is purposely unobtrusive. Conspicuous ornamentation has been stripped away. Unnecessary bars and buttons have been removed. And in taking away design elements that don’t add value, suddenly there’s greater focus on what matters most: your content.’ Other features are improved graphics, audio, and many other areas to numerous to mention here. With Apple’s acquisition of Cue, a personal assistance app, the solution will surely find is way into iOS7 healthcare communications software.”

From THB: “Re: Northwestern Memorial in Chicago. Leaving the Cerner fold and going to Epic, but I don’t see it mentioned in searching your site. Am I missing something? It’s been going on for the last several months, so is this a big secret, or is it hiding in plain sight?” I ran a reader’s rumor about the switch a year ago, and another reader’s rumor before that.

Most poll respondents don’t see customers of either Vitera or Greenway benefitting from their single ownership. New poll to your right (which is actually an earlier poll that few saw since it wasn’t the featured poll): how will hospitals handle liability and workers comp insurers that won’t accept ICD-10 data until 2015?

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

Kyle scored an interview with Aaron Levie, co-founder and CEO of Box, at Health 2.0.

Sunquest announces two new executives: Jonathan Pierson (MedAssets) as VP Solution Adoption Center of Excellence and Keith Laughman (MedFusion) as EVP of Community Care Solutions.

CaroMont Health (NC) announces a breach involving the records of 1,310 patients that were sent by an employee via unsecured email.

Weird News Andy says it’s usually a brother-in-law: a two-year-old boy in China with a swollen stomach and difficulty in breathing is found to have a parasitic twin with fully formed spine and limbs growing inside his stomach. Doctors removed the eight-inch-wide twin.

Vince identifies several vendor C-suite executives of long ago this HIS-tory edition, but he seeks help filling in some of the blanks.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 10/4/13

Top News

Lexmark International acquires PACSGEAR, which provides connectivity solutions for sharing medical images with PACS and EMRs. The price was $54 million in cash. The acquisition will be operated from Lexmark’s Perceptive Software.

Reader Comments

From Frank: “Re: certification scoreboard. A check of the certified inpatient systems still shows some big names missing. For full EHR certified systems missing are two biggies, Cerner and Siemens. Also no shows are Healthland, QuadraMed and NTT-Keane. A week ago Dr. Mostashari was quoted as saying that two-thirds of the systems in use were already 2014 (Stage 2) certified. That’s hard to believe with Siemens and Cerner still out, and McKesson only certified for Paragon. That’s got to cover at least half the hospitals in the country. Also somewhat ironic is Siemens is not certified. Remember John Glaser was a key member on the HIT Committees that set up the criteria for Certification/MU program. I remember him being quoted two years ago in an HIStalk interview saying that the program was not going to be easy and some organizations just won’t make it. Well he’s proving himself a prophet now!”

HIStalk Announcements and Requests

Some news you might have missed this week from HIStalk Practice: CareCloud and Box integrate Box’s content-sharing capabilities into the CareCloud platform. My top educational session pick for MGMA, plus my tentative party agenda. Most physicians are satisfied with the e-prescribing workflow for controlled substances. Medicare awards Arch Systems a contract to validate the accuracy of data submitted to the eRX and PQRS programs. Physicians claim EMR use is stressful. If you are headed to MGMA, you’ll want to peruse our annual list of Must See Vendors. The guide includes essential details such as vendor booth numbers, product offerings, and fun giveaways. Thanks for reading.

I’ll be reporting from MGMA beginning on Sunday so keep reading HIStalk Practice (or sign up for email alerts) for all the conference updates. Feel free to email me if you have any recommendations for conference sessions, exhibit booths, or after-hours festivities.

On the Jobs Board: Chief Medical Officer, Clinical Analyst, Epic Revenue Cycle Project Director.

Acquisitions, Funding, Business, and Stock

Mobile healthcare communications provider Duet Health secures an undisclosed investment from Baird Capital.

Sales

PIH Health (CA) selects Allscripts Sunrise EHR for its newly acquired PIH Health Hospital-Downey and extends its hosting and managed services agreement.

Southern Regional Medical Center (GA) engages MedAssets for A/R services and revenue cycle consulting.

People

AirStrip promotes Matt Patterson, MD from chief transformation officer to COO.

MaineHealth names interim CIO Andy Crowder as CIO.

Farzad Mostashari, MD will join the Engelberg Center for Health Care Reform of The Brookings Institution as a visiting fellow.

NorthCrest Medical Center (TN) promotes Randy Davis as president and CEO. He had previously served as VP/CIO.

Shelia Mitsuma, MD, who holds positions with Brigham and Women’s Hospital and Massachusetts General Hospital, joins EBSCO Information Services as deputy editor of its DynaMed clinical reference tool.

Announcements and Implementations

Newton Medical Center  connects its Meditech EHR to the Kansas HIN using ICA’s CareAlign interoperability platform.

Cerner announces a strategic relationship with Shawnee Mission Medical Center and TMC Lakewood and designates the organizations “Certified Maternity Partners” for its KC-area employees. Cerner says the arrangement is designed to “improve infant and maternal health outcomes,” while “managing rising healthcare costs for its associates.” I suppose that means that many Cerner employees or their covered spouses may need to change providers in order to receive full maternity benefits. I’ll be curious to see how receptive Cerner employees are to this change since my experience is that women in particular prefer to exercise maximum control over their own health issues, including their choice of providers.

The Georgia Department of Community Health launches its statewide HIE network with the Truven Health Analytics platform, powered by CareEvolution.

Government and Politics

ONC reports that as of July 31, 1,115 critical access hospitals and small, rural hospitals had attested for MU, which exceeded ONC’s goal of 1,000 by 2014.

The VA warns that the federal government shutdown will reverse its progress on decreasing the backlog of disability claims because claims processors cannot be paid overtime.

Innovation and Research

Inpatient providers report a high level of adoption for eligibility and scheduling solutions from RCM vendors, according to a HIMSS Analytics study. Many respondents say they intend to replace or purchase new RCM solutions to handle pre-certification, address validation, and bill estimation. The most-considered RCM vendors include Passport, RelayHealth, Emdeon, and MedAssets.

Technology

Athenahealth and Epocrates introduce Bugs + Drugs, a free app to identify the most common bacterial infections recorded in a geographic region using data collected  from athena customers.

Royal Philips and Accenture demonstrate a proof of concept for the use of Google Glass to aid in surgery. Researchers successfully transferred patient vital signs from Philips Intellivue software to Google Glass, giving surgeons continual access to patient data hands free.

Other

Xerox, provider of the Midas+ product,  is named the “vendor to beat” in a KLAS report on quality management solutions. Nuance and Premier earned the next-highest performance scores. Providers say they want more from their vendors than just regulatory reporting functionality and are looking for solutions that will facilitate operational and financial improvements to drive better outcomes.

A multi-day systems outage at a Scottish hospital trust that forced cancellation of hundreds of appointments is blamed on a corrupted Microsoft Active Directory.

A man who gave a phony name in his hospital admission rips out his IV, steals another patient’s iPhone and iPod, and slips out of the hospital. The man is a suspect in several similar incidents at other hospitals.

Sponsor Updates

• CTG Health Solutions publishes a white paper with recommendations and steps for setting up executive dashboards to manage EHR implementation project issues or risks.
• Elsevier names five winners of its third annual Mosby’s Suite Superheroes of Nursing contest.
• Vocera Communications previews its Vocera Collaboration Suite at the ANCC National Magnet Conference this week in Orlando. Also at ANCC: GetWellNetwork will demonstrate its new patient user interface.
• Levi, Ray & Shoup opens a Paris, France office to provide support for its LRS Output Management software.
• Truven Health Analytics establishes a Singapore-based regional office as its Asia Pacific headquarters.
• Infor CMIO Barry Chaiken, MD and Infor customer Joel Vengco, CIO at Baystate Health, will discuss learning to leverage social networking and user experience optimization tools to drive patient-centered clinical workflow at next week’s CHIME 13 Fall CIO Forum in Scottsdale.
• Aventura earns Gold status in the Golden Bridge Awards for its innovative, secure, and effective IT awareness computing platform.
• Forward Health Group reports it is poised to nearly double the number of deployments of its PopulationManager platform within a matter of weeks.
• HCS will exhibit at next week’s AHCA/NCAL 64th Annual Conference and Expo.

EPtalk by Dr. Jayne

The past week has been uncharacteristically low key for me.  Our IT teams have been working hard to knock out strategic projects because we know our EHR vendor is on the cusp of releasing their ICD-10 ready package to the general public. Once that happens, it’s going to be all hands on deck and full speed ahead.  Luckily we’ve been more efficient than usual so we have a bit of a lull while we wait.  It feels a bit like they describe the eye of a hurricane as we wait for the beating that’s surely coming.

I’ve been catching up on email, reassuring providers that we’re going to meet all our deadlines, and trying to stay away from any new projects the operations people try to sneak in. We’ve had a terrible time prioritizing new initiatives and finally have a good process in place, but there is one administrator who is always pushing a pet project. It usually doesn’t have funding or a well-defined scope, so I’m avoiding him at all costs.

I guess I shouldn’t be shocked anymore at how far some of his initiatives make it before someone finally says no. It seems like our hospital administration is increasingly reactive, responding to the squeakiest wheel or the sparkliest thing dangled in front of them regardless of its lack of purpose in context of our long term goals. There were a lot of strategic planning apple carts upset over the last few years as hospitals struggled to plan for upgrades and other initiatives around Meaningful Use and ICD-10. The only unknown on the horizon now is Meaningful Use Stage Three and I think we can at least make some reasonable plans based on what we think will make it in the final requirements.

I have appreciated the opportunity we’ve had to roll up our sleeves and take care of all the things we put on hold over the last few years. On the technical front we’ve expanded interface capabilities for our ambulatory sites, implemented some great new reports, and increased our patient outreach efforts. On the workflow front, we have had fewer new implementations so we can actually spend time going back to retrain staff and reinforce best practices. Our operations teams have actually had time to do some process redesign work and build on the clinical transformation we started with EHR.

Of course, we’re still doing all the day to day “care and feeding” activities such as maintenance and patches but it’s been nice to feel like we’re making up some of the ground we lost with all the focus on MU. Our compliance teams are starting to train ICD-10 in earnest and I’ve enjoyed fielding questions from colleagues who seem to have been under a rock or locked in a biodome for the last few months. Somehow they missed all the demos we did showing that yes indeed the system will be capable and ready come October next year.

I wonder if vendors are experiencing any of the lull that we are. It would be great to know that they’re able to focus on greater usability, expanded content, and designing the next best way to document patient visits rather than checking the box on regulatory requirements. Many of our vendors have been through the wringer during the last couple of years. It will never be the way it was before Meaningful Use, but I’m looking forward to a new normal where we can again collaborate rather than scrambling madly in the same general direction.

I figure I’ve got about two weeks of the good life left and then I’m going to be back in an upgrade cycle with all the standing meetings that entails. I’ll be back in the trenches testing workflows and trying to find defects as quickly as possible so that our vendor can roll them into patches before we go live. Every time we upgrade it reminds me more and more of some kind of military assault. I’m not sure if it’s just the way we run them or a little bit of post-traumatic stress. Maybe it’s a little of both.

Are you in the calm before the storm? Planning an upgrade or just trying to stay afloat? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 10/2/13

Top News

All but four of 184 ONC staffers are furloughed as a result of the October 1 government shutdown, along with about 40,000 (52 percent) HHS employees. ONC has also put on hold its Standards and Interoperability work, privacy and security policy activities, clinical quality measure development, and maintenance of the Certified Health IT Product List. Tweeting is apparently considered a non-essential service.

Reader Comments

From Ole: “Re: David Muntz. He won’t be returning to Baylor Scott & White. Matt Chambers is the new CIO, reporting to COO Bob Pryor. Both are from Scott  White. Vic Richey is the newly appointed CIO for the Baylor (Northern) division.” Verified from the LinkedIn profile of Matt Chambers (above).

From HIT Pundit: “Re: Leidos, the former maxIT-Vitalize. Major changes in leadership. The website confirms that people are gone.”

From Clafouti: “Re: Dr. Jane’s comments about Greenway. It was not only biased toward sponsors (which I understand to a point) it was verbatim of what Tee says in his speeches. Next time you claim to be independent, don’t quote the CEO and call it your own words.” Dr. Jayne has never met Tee or heard him speak. She wrote that post a year or so ago and decided it wasn’t appropriate to run at the time, but the Greenway acquisition made it more timely.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor pMD. You may note and appreciate, as did I given the dearth of it in healthcare IT, pMD’s appreciation for whimsy. The San Francisco company lets doctors record charges in seven seconds on a mobile device, or as one hospitalist says, “If you can hold a beer, then you can use pMD”  (many testimonials are here). Users report an increase in Medicare payments for post-discharge follow-up appointments and improved care coordination driven by its handoff tools. Native apps are provided for Android, iPhone, BlackBerry, and iPad and support is provided 24×7 by actual employees. Thanks to pMD for supporting HIStalk.

A YouTube cruise turned up this video describing pMD’s mobile charge capture solution.

Acquisitions, Funding, Business, and Stock

Evolent Health, which offers a population health and risk management platform, secures $100 million in Series B funding led by The Advisory Board Company and UPMC Healthcare, bringing the company’s total funding to $124.5 million.

Baylor Health Care System (TX) and Scott & White Healthcare (TX) complete their merger and form Baylor Scott & White Health, the state’s largest not-for-profit health system with $8.3 billion in assets.

Tenet Healthcare closes on its $4.3 billion acquisition of Vanguard Health Systems.

Healthrageous, a Center for Connected Health spinoff that offered patient engagement tools, sells off its assets to an unnamed “leading healthcare companies.” Even the website is gone.

Sales

Knoxville Comprehensive Breast Center (TN) will implement Sectra breast imaging PACS and RIS.

Adirondack Health (NY), Baylor Health Care System (TX), Mission Health (NC), North Shore Long Island Jewish Medical Center (NY), and University of Chicago Medical Center (IL) select Vocera’s Care Experience Suite.

People

Emdeon appoints Neil E. de Crescenzo (Oracle – on left) president and CEO, replacing George I. Lazenby, IV (right), who will become a senior advisor for Emdeon’s majority investor, Blackstone Capital Partners.

McKesson names James A. Beer (Symantec) EVP/CFO.

Johanna Epstein (Mount Sinai Doctors Faculty Practice) joins Culbert Healthcare as VP of strategy and executive leadership services.

PeriGen hires Rebecca Cypher (Madigan Army Medical Center) as chief nursing officer.

eHealth Ontario appoints its chairman Ray Hession to serve as interim CEO following the departure of Greg Reed, who quit six months into the job and left with a $406,250 severance package.

SRS names Peter Bennfors (Asset Control) CFO.

Infina Connect names Mark Hefner (Allscripts) as CEO.

MedData appoints appoints Stephen Ghiglieri (NeurogesX) CFO and Dustin Whisenhunt (Prognosis) VP of client services and sales.

Amy Amick (MModal) joins MedAssets as president of the company’s RCM segment.

Announcements and Implementations

The 25-bed Cobre Valley Regional Medical Center (AZ) goes live on Meditech 6.0.

The New York Giants converts the medical records of its players to eClinicalWorks.

Saint Luke’s Health System (MO) goes live on Covisint’s cloud engagement platform.

Family Service of Madison (WI) implements Forward Health Group’s PopulationManager to identify and monitor progress in patients with substance use disorders and depression.

Summit Healthcare adds Summit Care Exchange to its interoperability suite, allowing hospitals to exchange PDQ and XDS messages in sending continuity of care documents to external entities.

AirStrip announces the launch of AirStrip ONE Cardiology for Windows 8.1.

Health Catalyst receives the highest grade in the clinical analytics market in a Chilmark Research report.

Other

A Xerox survey (conducted online, and therefore with shaky statistical certainty)finds that more than two-thirds of American adults don’t believe their physicians gave them a good explanation about the switch to EMRs. Most are also concerned with the security of their records and less than a third want their records to be digital. However, 62 percent believe that EHRs will reduce healthcare costs and 73 percent think they’ll get better service from practices that use EHRs. In case it wasn’t already obvious, Americans are confused.

Cerner expects more than 10,000 attendees at its 25th annual conference in Kansas City that runs October 6-9.

John at EMR & EHR Videos will conduct a Google+ Hangout with Kareo CMIO Tom Giannulli, MD, MS on Thursday, October 3 at 1:00 Eastern.

An MGMA survey finds that medical practice IT spending has risen from $15,211 in 2008 to $19,439 in 2012.

I don’t know why this bothers me so much, but I continue to be annoyed by articles in the main stream press that suggest EMRs are a requirement of the Affordable Care Act. I’ve even noticed recently a few vendors have made this statement in their marketing materials. As a reminder: ARRA (specifically the HITECH ACT) was the legislation that included the requirement for EMR adoption and provided the groundwork for incentives and penalties. Maybe some of the confusion stems from the fact that the ACA includes provisions for the secure exchange of electronic health information. Regardless, I have read so many articles that tie ACA to EMR and Meaningful Use that I had to do some fact checking just to be sure I hadn’t incorrectly rewritten history.

While I am ranting, I am self-insured, so I decided it might be worth my while to investigate available options on the Health Insurance Marketplace. I first attempted to get on the site at 8:00 a.m. EST and despite multiple attempts, I’ve yet to be able to create an account (the security questions never appear). Several hours later, I’ve still not gotten a response from anyone using the online chat feature. I realize it is only Day 1, but so far I have to call the online process a failure.

On a much happier note, my veterinarian sent me an email to inform me that I can now set up a PHR for my pets. It took about three minutes to register and now I can see health histories online. I’m not really sure why I need online health records for pets, but it’s still cool to say it’s there.

Someone please assure me that none of my tax dollars were used to fund this study that developed BAPS (Belief About Penis Size Scale).

The family of newborn delivered at 24 weeks gestation creates a video thanking Fletcher Allen Health Care. I’m trying to preserve the feel-good moment by not thinking about the healthcare resources consumed by a 98-day NICU stay and the fact that similar babies are intentionally aborted at that same 24-week mark.

Here’s an Intermountain video describing its Cerner selection.

Sponsor Updates

• ESD sponsored Sunday’s Northwest Ohio Susan G. Komen Race for the Cure, with participating employees raising $1,500 in donations.
• Medseek partners with Vitals to help healthcare organizations connect consumers with providers and facilities.
• The Web Marketing Association recognizes CareTech Solutions with an Information Services Standards of Excellence Award and presents 2013 WebAwards to 10 CareTech customers.
• NCQA awards GE Healthcare’s Centricity Practice 11 Solution PCMH pre-certification status.
• Gartner places Perceptive Software in the Leaders Quadrant for enterprise content management solutions.
• INHS reports that its use of IBM server and storage technology has improved its delivery of cloud-based EHR services to physicians and medical facilities.
• Predixion Software launches an OEM program aimed at embedding its predictive analytics solutions into BI and analytics programs.
• Beacon Partners hosts an October 17 webinar on using data to optimize clinical and financial systems.
• Summit Healthcare adds Summit Care Exchange to its interoperability suite and introduces enhancements to its current Express Connect and Provider Exchange products.
• Divurgent will participate in the CHIME13 Fall Forum October 8-11 in Scottsdale, AZ.
• Hospitals that have implemented ProVation Order Sets by Wolters Kluwer Health report clinical benefits and ROI in as little as 13 months.
• Seamless Medical Systems posts a case study highlighting how a geriatrics practice streamlined patient workflow, reduced operational costs, and improved the patient experience though its use of SNAP Practice.
• Wellsoft will exhibit at the 2013 ACEP Scientific Assembly October 14-16 in Seattle.
• Dave Himes, IS group director for Billian’s HealthDATA, delivers a Letterman-style list of top ten CRM integration tips.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Monday Morning Update 9/30/13

From Cerner Rules: “Re: Intermountain. Finally the Epic backlash has begun.” I wouldn’t make that assessment without a review of the Cerner-Intermountain agreement since I don’t know the price or the concessions Cerner gave to earn the business. We heard similar partnership hype in 2005 when Intermountain struck a 10-year, $100 million collaboration deal with GE Healthcare to develop new technologies around Centricity that would “set the standard for the industry to follow.” The net result is that nothing ever happened, Centricity slid even deeper into irrelevance, and Intermountain bailed out early over dissatisfaction with the result and courted its next bedmate. Intermountain is a development shop with a long IT history and an unhealthy allegiance to its antiquated HELP system, which I would bet makes them a pain as the development partner of a bureaucratic and publicly traded vendor like either GE or Cerner. I don’t recall many examples like this where the vendor ended up with commercial software with wide appeal, not to mention that it’s the federal government that’s driving the development agenda anyway with prescriptive rules for Medicare payments, Meaningful Use, and ICD-10, most of which provides no benefit to patients at all. It’s a good deal for Cerner from a PR perspective and they may fare better than GE Healthcare, but I wouldn’t hold my breath in anticipation of a flood of amazing new Millennium functionality since Intermountain is hardly Cerner’s only smart customer (that’s another risk – alienating the lesser-anointed longstanding customers). Probably the best bet is analytics since Intermountain is strong there and Epic got a late start. I’m talking to Neal Patterson this week, so I’ll let you know what he says. Intermountain Health Care changed its name to make the “Healthcare” part one word and eliminated the previously acceptable “IHC” designation later in 2005, so the GE Healthcare announcement spelled it right even though it looks wrong. Now if we could just convince the “HealthCare” holdouts to spell it right …

From BigMoneyInPatient Portals: “Re: patient portals. A report says the market will jump from $280 million to $900 million in the next five years. I guess HCIT corporate development people have found their next acquisition target.” I don’t pay the slightest attention to those come-on press releases from market research firms that claim to know how big a particular market will be, information they will gladly share with you for several thousand dollars. I don’t see many follow-up press releases extolling the accuracy of their previous predictions, the reason for which you can probably infer. I think the patient portal hype is overblown given that every vendor offers one, meaning patients are supposed to log on to several depending on what system their providers use. Kaiser can do great things with MyChart because most of the encounters are within their system and the patient can get everything in one place, but I don’t think the concept will work in most areas. Imagine if your bank had separate portals for deposits, checks, loans, and investments, all with their own look and feel and log-in credentials. Not only would nobody use them, the banks would irritate their customers for even suggesting that they should. Portals are a proprietary distraction to interoperability, not a solution for it.

From Raj: “Re: UMass Hospital System. Missed the deadline to go live with CPOE and missed out on millions of dollars from the taxpayers. They have unionized nurses who stood up and demanded HIT accountability like in Ohio and California.” Unverified. I will say that I’ve worked rather uncomfortably with unionized nurses and that’s an experience I’d rather not repeat (or experience as a patient). The visual memories of watching nurses trashing hospital equipment and blocking ambulance access during an ugly labor dispute soured me for good on their concern for patients.

From IsItTrue: “Re: David Muntz. Rumor is he will return to Baylor to lead the newly merged Baylor Scott & White IT organization.” I wouldn’t be surprised. Quite a few of the departed ONC folks have gone back to their previous jobs after finishing their abbreviated government service. Baylor Health Care and Scott & White Healthcare agreed to merge in late June to create Baylor Scott & White (I’m really annoyed at the omitted commas), which will have 40 hospitals, $6 billion in annual revenue, and 34,000 employees.

From Patient Advocate: “Re: EHRs. My ophthalmologist appoint ran 90 minutes late. The doctor said it was because they were converting to a computer system, but nobody told that to the waiting patients. She started whining that it had been a month, they were still delayed, and she was working until 6 every night. I told her the practice should adjust the patient load to reflect the number they can actually see. She said, ‘We have to see patients’ and didn’t seem to agree as she stashed her iPad mini into her lab coat. I finally left two hours later, and as I fought rush hour traffic, I thought, you chose this profession. I did not choose to need an eye specialist. Don’t tell me how rough your life is with a computer system implementation for which someone set the wrong expectations. I left without making a follow-up appointment since I couldn’t find the energy.”

Most poll respondents expect population health and analytics opportunities to kick in within four years. New poll to your right: which customers benefit from combining Vitera and Greenway under a single private equity owner?

Upcoming HIStalk Webinar: “Strengthen Financial Performance: Start with Lab Outreach” on Wednesday, October 16 at 2:00 p.m. Eastern. Presented by Liaison.

Friday’s quarterly report from BlackBerry will probably form its epitaph as it announces a $1 billion quarterly loss, almost all of it due to unsold Z10 touch phones on which the company had bet the farm. It’s hard to believe people still actually work there, but the former RIM (renamed in January to distance the stench of failure) will hack another 4,500 jobs and move its focus to corporate customers. The one-hit-wonder company has evaporated $75 billion in market value in the past five years.

A Toronto surgeon develops an “OR Black Box” that records every aspect of surgical procedures by video and audio, although he points out that it probably couldn’t have happened in the lawsuit-happy USA.

Bridgeport Hospital goes live on Epic, completing Yale School of Medicine and Yale New Haven Health System’s $300 million project on time and under budget as CEO Bill Jennings throws the ceremonial switch.

Administrators at  at one of England’s highest-mortality hospitals open up staff access to Twitter and Facebook, with the intention of promoting “openness and transparency” but causing critics to warn that “the last thing this hospital and its patient needs is staff getting distracted by Facebook and Twitter whilst at work.”

Government subcontractor programmers are being pushed to fix the health insurance exchange software that is scheduled to go live October 1 whether it’s ready or not. Known problems include delays in the Spanish version, specific exchanges that can’t calculate federal subsidies, and erroneous displays. Oregon is so worried that it won’t let anyone try to enroll in insurance plans without the help of a trained agent. The system integrator is India-based Infosys. The saving grace is polls that show two-thirds of Americans have never heard of the insurance exchanges anyway.

Truven Health Analytics names Mason Russell (inVentiv Health) as VP of strategic consulting.

Private equity firm KKR will acquire Panasonic’s healthcare unit for $1.67 billion

Weird News Andy provides a “Man Bites Dog” story. A 33-year-old medical student falls onto a Boston subway track in a drunken stupor after celebrating passing his board exams. Onlookers jumped down to pull him to safety.

Sponsor Updates

• PeriGen will demonstrate the PeriCALM fetal surveillance system at the MedAassets Technology & Innovations Forum in Orlando this week.

Vince’s HIS-tory this week is about the people who founded and ran the early healthcare IT vendor firms. If you’ve been around for awhile and are good at matching names to faces, Vince is looking for help in identifying some of the industry pioneers pictured.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Intermountain Healthcare Chooses Cerner

Intermountain Healthcare announced this morning that it has chosen Cerner as a strategic partner for its 22 hospitals and 185 clinics. Intermountain will install Cerner’s clinical and revenue cycle applications.

Intermountain announced in January 2013 that it would not renew a much-publicized relationship with GE Healthcare because the systems they were building together were deficient in CPOE, clinical documentation, and coding/billing integration.

I spoke to Don Trigg (SVP and president of Cerner Health Ventures) and Neal Patterson (chairman and CEO) from Utah following the announcement. Trigg says the partnership may go well beyond electronic medical records specifically, potentially developing into a significant “accelerator for clinical computing in pursuit of high quality, low cost care.” Toward that end, Cerner will relocate several of its executives and employees to Salt Lake City, UT, including EVP Jeff Townsend.

Trigg and Patterson report that Brent James, MD, MStat, executive director at Intermountain Institute for Health Care Delivery Research and Intermountain chief quality officer, will present a keynote address at Cerner Health Conference. CHC will be held October 6-9, 2013 in Kansas City, MO.

I will interview Neal Patterson during the conference.

News 9/27/13

Top News

ONC Principal Deputy National Coordinator David Muntz will leave his post next month, according to an ONC email to staffers. Muntz, who joined ONC in January 2012 after six years as SVP/CIO of Baylor Health Care System, was considered by some as a potential successor to Farzad Mostashari, MD. Chief Medical Officer Jacob Reider, MD will serve as acting ONC director, while current Deputy National Coordinator for Operations Lisa Lewis will take over as acting principal deputy.

Reader Comments

From Frank: “Re: Consumer Reports list of patient medical gripes. Health IT can resolve many of these issues.” Actually, it’s the use of health IT that might solve some of these problems. I say that intentionally because doctors could fix most of these problems themselves without adding technology at all, and if they haven’t fixed them, turning themselves into technology users may not help.

From Jim: “Re: Jonathan Bush on CNBC. A classic quote on healthcare industry consolidation.” Per Bush, “The dinosaurs are mating as the ice cap is melting.”

From Horschack’s Laugh: “Re: RFI/RFP template for provided EDW/BI solution (build, buy, license options)?” I’ll allow readers to respond.

From Bo Knows: “Re: McKesson InSight in Orlando. So big it’s almost a mini-HIMSS.”

HIStalk Announcements and Requests

A few highlights from HIStalk Practice over the last week include: a chat with the CEOs of Vitera and Greenway about the impending shared ownership of their companies. A look at Practice Fusion and its plans to grow revenues and its customer base. CMS offers an online calculator to determine payment adjustments based on participation in Medicare’s e-prescribing, MU, and PQRS initiatives. A British Columbia newspaper provides insights into the province’s EMR adoption program. The American College of Physicians offers an online clinical decision support tool for internal medicine physicians. Jason Drusak, manger of consulting services at Culbert Healthcare Solutions, offers tips for preparing for Stage 2 MU. And, coming to HIStalk Practice this weekend: our annual list of must-see vendors at MGMA, all of which happen to be faithful HIStalk sponsors. Sign up for email updates so you don’t miss details on how to find these vendors and what they will be discussing at next month’s conference. Thanks for reading.

Acquisitions, Funding, Business, and Stock

Group purchasing organization Premier Inc. raises $760 million in its IPO. Shares rose 13.5 percent Thursday.

Shares of Compuware spinoff Covisint jumped 23 percent on their first day of trading Thursday.

Aventura completes a $4.3 million investment led by current investors.

Sales

F.W. Huston Medical Center (KS) will implement RazorInsights ONE-Health System Edition EHR and financials platform.

The VA extends a three-year, $8 million contract to Harris Corporation for a Correspondence Tracking Software system to improve communications between the VA and veterans.

Intermountain Healthcare (UT) selects Security Audit Manager from Iatric Systems to provide patient privacy auditing and incident risk management across its 22 hospitals and 195 clinics.

Orthopaedics & Sports Medicine Owensboro (KY/IN) selects SRS EHR for its 11 providers.

WellSpan Health chooses Perceptive Software’s vendor-neutral archive for enterprise clinical content management.

People

Shareable Ink appoints Dave Runck (Baxa Corporation) as CFO and announces the opening of an expanded office in Boston’s Innovation District.

Aventura appoints acting CEO John Gobron to president and CEO.

Announcements and Implementations

Cerner and Children’s National Medical Center (DC) invest several million dollars each to build an HIT center for pediatric technology innovation.

Henry County Health Center (IA) becomes the first healthcare facility to go live on the Iowa HIN.

Boston Children’s Hospital (MA)and IBM pioneer OPENPediatrics, a cloud-based learning platform for sharing best practices for the care of critically ill children.

Hillary Rodham Clinton will become the second Clinton in as many years to provide a keynote address at the HIMSS annual conference. President Bill Clinton drew such a large crowd last year that the overflow masses could only view the speech from a monitor outside the ballroom. Hillary may not attract the same numbers her husband did, but just in case, I hope HIMSS is securing a sufficiently large room to accommodate me and a few thousand of my fellow political junkies.

Fox Army Health Center (AL) goes live on Tricare Online and RelayHealth online portals.

The University of Mississippi Medical Center uses MediQuant’s DataArk active archive technology to migrate financial and patient records to a new information system.

Dossia rolls out Dossia Dashboard, a population health management system that works with the company’s personal health management platform with real-time data analytics and evidence-based health rules.

Specialty EMR vendor Modernizing Medicine will work with Miraca Life Sciences to develop an enhanced system for communicating diagnostic information between dermatologists and pathologists.

National eHealth Collaborative opens board member nominations.

Other

Regions Hospital (MN) reduces the average amount of blood transfused by 14 percent after implementing a decision support tool with its EHR. The tool, which Regions developed with the American Red Cross, uses evidence-based clinical guidelines to determine the appropriate use of red blood cells.

Doctors in Colombia amputate a 66-year-old man’s fractured and gangrenous penis after he intentionally overdosed on Viagra to impress his new girlfriend. No word on whether she remains impressed.

Weird News Andy adds a Rodney Dangerfield quote to this story: “I was such as ugly baby that when the afterbirth came out, the doctor said, ‘Twins!’” New mothers are practicing umbilical non-severance, or lotus birth, in which the baby’s placenta is left attached until it falls off on its own days later.

Sponsor Updates

• SCI Solutions announces details of its Client Innovation Summit next month in Braselton, GA.
• EDCO releases a recorded Webinar, “Point of Care Medical Record Scanning.”
• Intelligent Medical Objects releases new videos on ProblemIT and its mobile app.
• Shaun Shakib, medical informaticist for Clinical Architecture, offers some considerations for organizations implementing and utilizing controlled clinical terminology.
• HIStalk sponsors earning a spot on Healthcare’s Hottest recognition program for the industry’s fastest-growing companies measured by revenue growth include Allscripts, Beacon Partners, CTG Health Solutions, Cumberland Consulting Group, ESD, Impact Advisors, Imprivata, Intellect Resources, and The Advisory Board Company.
• AirWatch announces comprehensive enterprise management support for iOS7.
• Iatric Systems announces that its Meaningful Use Manager and all three Public Health Interfaces have been certified as modular EHRs.
• Martin’s Point Health Care (ME) details how Forward Health Group’s PopulationManager is helping improve patient care.
• Valence Health releases details of its November 12-13 thought leadership conference.
• Chilmark Research selects Wellcentive as a best-of-breed vendor in its 2013 Clinical Analytics for Pop Health Market Trends Report.
• Ping Identity CTO Patrick Harding joins the board of the Open Identity Exchange.
• Seven disease management programs supported by TriZetto’s CareAdvantage Enterprise solution earn NCQA Disease Management Systems certification.
• SuccessEHS hosts more than 475 attendees at its annual user conference this week in Birmingham, AL.
• Care Team Connects offers an October 8 webinar highlighting the upcoming Medicaid expansion and what it means from a care management perspective.
• EXTENSION will showcase its alarm safety and event response platform for nurses and other caregivers at the American Nurses Credentialing Center National Magnet Conference October 2-4.

EPtalk by Dr. Jayne

The recent announcement of the pending union of Greenway and Vitera has been hot news in the physicians’ lounge this week. One of my colleagues was even reading Inga’s interview with Tee Green and Matthew Hawkins while we were talking. Several of the providers at the table were Greenway customers and they are understandably concerned about where things are headed.

Once upon a time I was a user of Medical Manager and then of Intergy, both of which have been absorbed into the Vitera product line. Back in the day, the best part of Intergy was its use of the MEDCIN terminology as the framework for documentation. The process of building point-of-care templates was straightforward (although tedious) and it was fairly easy to document visits. Looking at Intergy now, it barely resembles its original self, which in the software life cycle is a good thing.

Since I’ve been around the EHR world a fairly long time compared to many of my primary care peers, I am sometimes asked to help a practice create an RFP document or to offer an opinion on their system selection process. Recently, I was asked to attend a demo of Greenway and to give my opinion, although my colleague wouldn’t divulge the identities of the other two competitors involved. I thought that was an interesting way to get an opinion without the pros and cons of the other products overshadowing what Greenway had to offer.

I had intended to write it up for HIStalk (after enough of a newsroom embargo to shield my identity) but didn’t want to appear as if I was just talking about a sponsor to talk about a sponsor. Now that Greenway is front page news, though, it seemed like the right time. As background, this was a web demo given by a seasoned Greenway rep and was targeted towards a solo physician in primary care.

He delivered the standard sales background, including number of specialties and clients live. Walgreens and their TakeCare business line was included, with it live in over 4,000 locations. I thought this was interesting given the prevalence of pharmacy-owned clinics in our area and thought that the potential interoperability on that might be kind of nice for the solo primary care doc I was with. He really sold the fact that PrimeSuite focused on the EHR and practice management infrastructure, positioning Greenway as a company that didn’t want to allow other business lines to distract from their core offering.

One surprise was that Greenway wasn’t keen on interfacing with an existing practice management system – it’s an all-or-nothing deal, which is generally a good idea. I’ve seen practices tank implementing a perfectly good EHR because they’ve slaved it to a dud of a practice management system using interfaces that led to dual data entry and a whole lot of headaches. In a lot of ways, refusing to interface would help a vendor choose its customers to some degree. I know several vendors who would benefit from being willing to walk away from practices who don’t understand the benefits of a unified system.

We continued on with the background including their high KLAS rankings over the last decade, which they attributed to word of mouth and happy customers. One of the reasons their customers are happy is their training approach. Their goal is to spell it out to customers as far as what it takes to be successful and how many training hours are needed – it sounded like they take a hard line with customers who don’t want to agree to the recommended amount of training. At the time, ongoing training was available with classes offered nearly every day. I’d have to check with actual clients to see if this is still the case, but it sounds better than what I’ve seen with other vendors, who let clients cheap out on training which leads to crises later.

The inclusion of upgrades in the monthly support fee is a benefit for the Meaningful Use crowd. Having been hit by one particular vendor for upgrade charges in the past, I know this can be a big deal. Greenway has been CCHIT certified a number of times and is offering a guarantee to ensure they maintain certification, otherwise they will compensate providers equal to the amount of lost stimulus funds. A pretty extensive list of happy clients was offered up without asking, including multiple sites within a 30-minute drive. That’s always a good thing to hear during a demo.

In addition to the flagship PrimeSUITE product, they have an interface engine, patient portal, mobile app, and clinical device integration, which I would expect from any vendor who plans to be a contender. Interoperability with Cerner and Epic was mentioned more than once. One offering stands out and that’s their clinical research module, PrimeRESEARCH. Not only does it have a system for managing clinical trials, it allows participating practices to network in hopes of increasing the number of eligible patients. I don’t think there are a lot of vendors offering that functionality, let alone the ability to track trial budgets, patient stipends, and sponsor funding, which it also apparently does. Monthly emails let the practice know if it has patients who would qualify for a trial. Having done outcomes research for a local medical school, this is a potential game changer for community physicians who want to participate in trials but hate the hassle.

With all that out of the way, we finally got into the product itself. Navigation was quick with the ability for users to configure it on the fly. It had everything I would expect in an ambulatory EHR as far as lab display, flowsheets, and tasking. Clinical alerts are generated based on criteria which can be customized from the base set they provide. There was an audible “ooh” from my colleague when he showed their clinical summary face sheet, which is user-customizable with drag-and-drop panes as well as the ability to hover over data elements for more information. Those of us who use products with these features every day tend to forget that a lot of systems out there don’t offer these niceties.

Visit note documentation was pretty standard, as was the ability to pull forward information from previous documents. I liked that abnormal physical exam findings displayed in red and italics. There seemed to be a lot of user-customizable features, but of course the proof is in the pudding when you actually get your hands on it rather than watching a demo. One feature that differs from some other vendors is the ability to keep multiple patients open at a time, which can be both a blessing and a curse. I have to admit I was taken by their document management (scanning) system. It has some nice features including fax integration and the ability to match incoming documents with outstanding orders, which is the holy grail for closed-loop order management.

A couple of months have passed and my colleague still hasn’t decided what she’s going to do. Thinking back on the demo as well as the company that Greenway will be keeping, it will be interesting to see what the future holds. I have several friends who work at Greenway, and for their sake, I hope it’s smooth sailing.

I’d love to hear from current customers on either the Greenway or Vitera products. What do you think the union will bring? Are there any product features you hope to jettison for something better? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 9/25/13

Top News

The FDA issues final guidance for mobile medical apps, saying it will exercise “enforcement discretion” (meaning it will not enforce requirements under the Federal Drug & Cosmetic Act) for the majority of health and wellness apps since they pose little risk for consumers. Examples of  low risk apps include those for self-managing a disease or condition and apps for the self-tracking of health information, exercise, or diet. Oversight focus will be on apps that present a greater risk to patients if they do not work as intended, such as those used as a medical device accessory (such as viewing a medical image on a smartphone) or as a mobile platform as a medical device (like an app that allows a smartphone to be used as an ECG to detect abnormal heart rhythms.)

Reader Comments

From The Fixer: “Combining Greenway and Vitera. I think the deal makes sense given that Greenway has more of a healthcare IT platform than Vitera does and Greenway is much more well run than Vitera. Over time, they will migrate all Vitera clients to Greenway’s platform and realize tremendous cost savings and synergies by leveraging Greenway’s infrastructure.” Perhaps they will head in that direction, but Matt Hawkins and Tee Green kept their plans pretty close to the vest when I talked with them Monday evening. Green noted that “maintaining multiple platforms probably isn’t going to be the long term strategy because that doesn’t create value for your customers and your team,” while Hawkins stressed that Vitera would continue to support, maintain, and update its various product platforms. Both declined to say who would lead the company going forward, but my money is on Hawkins taking the top spot.

From InsideOutsider: “Culture clash. Greenway has long had a reputation for its strong, family-oriented corporate culture. Kudos to Vitera for recognizing that and for trying to leverage Greenway’s better reputation and brand. Meanwhile, Greenway employees better hang on for the pending culture shock.”

From Upon Further Review: “Re: HIS Junkie’s statements about ONC systems. PopHealth is still an active project and has nothing to do with certification. Cypress had bugs, but it’s still being refined.”

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor Summit Healthcare. The company offers application integration tools that include Summit Express Connect (the industry’s most powerful integration engine) and the Summit Scripting Toolkit that can automate any process (budget updates, point-of-care device integration, patient self registration.) The company has been a Meditech integration leader since 1999. Summit Provider Exchange allows patient information to be exchanged between hospitals and physician EMRs, while the Summit Downtime Reporting System gives users access to a patient data snapshot for managing  scheduled or unscheduled downtime. Thanks to Summit Healthcare for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Practice Fusion raises $70 million in a series D round, bringing total funding to $134 million and valuing the company at an estimated $700 million.

PatientSafe Solutions closes an investment from EDBI, the investment arm of the Singapore Economic Development Board, bringing its total Series C funding to $27 million.

Mobile medication management solution provider MediSafe raises $1 million in funding, co-led by TriVentures and lool Ventures.

Online patient billing company Simplee raises $10 million in Series B funding, led by Heritage Group.

Inga interviewed the CEOs of Greenway and Vitera about their impending shared ownership on HIStalk Practice.

Sales

St. Joseph’s Hospital Health Center (NY) selects PeriGen’s PeriCALM Tracings fetal surveillance system.

University Health System (TX) licenses iSirona’s device connectivity solution for its 24 clinics, hospitals, and outpatient facilities.

South Jersey Family Medicine will replace its Alteer platform with e-MDs Solution Series EHR, PM, and patient portal solutions.

Michigan Spine Surgery Improvement Collaborative selects ArborMetrix’s registry solution to create a statewide database and reporting system for spinal surgeries.

Imaging Specialists of Charleston and Charleston Radiologists (SC) select Merge Healthcare’s Outpatient Radiology Suite and Honeycomb Archive platform.

The Houston City Council approves a $1.6 million contract with Oregon Community Health Information Network to implement an EHR for the city’s Department of Public Health and Human Services.

People

SyTrue hires Ketan Patel, MD (US Pain Management Corp.) as CMO.

Healthcare Data Solutions names David M. Thomas (IMS Health) to its board.

Transcription and coding solutions and services provider Amphion Medical Solutions appoints Subbu Ravi (Symphony Data Corporation) COO.

CORE Security names Eric Cowperthwaite (Providence Health & Services) as VP of advanced security and strategy.

Announcements and Implementations

The board of Greenville Hospital System (SC) approves a $97 million expense to implement Epic, replacing GE Healthcare and Siemens Soarian.

EClinicalWorks and Epic develop bidirectional interoperability between their EHRs.

Government and Politics

Seventeen GOP senators ask HHS Secretary Kathleen Sebelius for a one-year extension for Stage 2 MU to give providers extra time to meet the new requirements. The lawmakers agree that providers who are ready to attest to Stage 2 should be able to do so consistent with the current policy.

Other

MyMedicalRecords files a complaint for patent infringement against Allscripts, alleging that its Jardogs FollowMyHealth technology violates MMR’s PHR patents.

A KLAS report finds that EHR replacement rates are up in the small practice (1-10 physician) market. Athenahealth, SRSsoft, and Practice Fusion are having the most success delivering quick and easy implementations of value-based products. Pediatrics-specific EHR PCC earned the top performance score among 27 vendors, while customers of McKesson, GE Healthcare, Allscripts, and Vitera expressed the highest levels of dissatisfaction based on unmet product expectations, poor upgrade releases, and inadequate relationships.

Senior hospital IT executives say that exchanging patient information in robust, meaningful ways and budget and staffing limitations are the biggest barriers for health information exchange between other hospitals, according to a HIMSS Analytics report.

John Lynn of EMR and HIPAA will interview Mandi Bishop of Adaptive Project Solutions Thursday from 1:00 to 1:30 on “Healthcare Big Data and Meaningful Use Challenges.” The Google+ Video Hangout will stream live, with the recording available afterward.

Zirmed earns  the highest customer satisfaction rating from large hospitals and academic medical centers in a Black Book research report on the RCM industry. Among small / rural and community hospitals, SSI Group scored highest, while Relay Health earned the highest marks from hospital systems, IDNs, CINs, chains, and ACOs.

Weird News Andy finds more weirdness: a man who had just used a university’s computer lab to Google symptoms of pain, tightness of chest, and sweating is found dead in his car in the parking lot.

Sponsor Updates

• Elsevier launches SimChart for the Medical Office, a competency-based, simulated EHR that gives medical assisting students hands-on practice performing business and clinical skills.
• Visage Imaging announces upgrades to Visage 7 Enterprise Imaging and Visage Ease.
• VMware announces the GA of VMware vCloud Suite 5.5 and VMware vSphere with Operations Management 5.5. VMware also makes VMware Virtual SAN available for download and trial via a public beta program.
• Oracle awards NTT DATA the 2013 Oracle Excellence Award for Specialized Partner of the Year – North America in Health and Life Sciences for demonstrating outstanding and innovative solutions based on Oracle products.
• Intellect Resources President Tiffany Crenshaw talks about what’s behind the growth of her company after taking top honors in The Business Journal’s 2013 Fast 50 awards.
• Craneware EVP of Revenue Integrity Operations Karen Bowden will lead a session on preparing for audits at next month’s 2013 CH100 Leadership and Strategy Conference in Greensboro, GA.
• Orion Health offers scholarships and graduate recruitment programs through the University of Canterbury in New Zealand in an effort to attract talent and encourage more IT graduates.
• Hayes Management Consulting offers two white papers to help organizations improve clinical optimization.
• Nuance launches Clintegrity 360 | ICD-10 Education Services, an ICD-10 readiness program for physicians, coders, and clinical documentation specialists.
• Capsule’s business development manager Elizabeth Skinner will discuss medical device integration at this week’s McKesson’s Insight365: 2013 Annual Conference in Orlando.
• Caradigm introduces new versions of Caradigm Single Sign-On and Caradigm Context Management products, which feature tightened integration with virtual desktop technologies, simplified security compliance, and accelerated clinical workstation deployment.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Greenway Medical Technologies and Vitera Healthcare Solutions to Combine

Vista Equity Partners, which owns Vitera, will pay cash to acquire all outstanding shares of Greenway common stock for $20.35/share in a transaction valued at $644 million. The price represents a 62 percent premium to Greenway’s 90-day volume weighted average stock price and a 20 percent premium to Greenway’s closing share price the day before the merger agreement was signed.

It is anticipated that the Vitera and Greenway businesses will continue as Greenway Medical Technologies with the products and services of both Greenway and Vitera marketed under the Greenway brand. The combined entity will serve nearly 13,000 medical organizations and 100,000 providers.

How Not To Spend $1.3 Billion: A DoD/VA Interoperability Summit Recap

Lt. Dan is a veteran who works in healthcare IT and writes the morning headlines on HIStalk and daily posts on HIStalk Connect.

“I’m asking the Department of Defense and the Department of Veterans Affairs to work together to define and build a seamless system of integration with a simple goal: when a member of the Armed Forces separates from the military, he or she will no longer have to walk paperwork from a DoD duty station to a local VA health center; their electronic records will transition along with them and remain with them forever.” – President Barack Obama April 9, 2009

Last week I attended the DoD/VA EHR Integration and Interoperability Summit. It was an insightful opportunity that offered a lot of lessons on how stubborn and narrow-minded leadership can derail even the best intended projects being worked on by a committed and talented staff. It also served as a primer on how not to spend $1.3 billion.

The conference was only two days long, promised big-name speakers, was held in Washington DC in early fall, and still drew a crowd of under 100. I was surprised. Maybe the iEHR saga isn’t as interesting to others as it is to me. Everyone in healthcare IT is understandably distracted with MU2 and ICD-10.

Still, iEHR was an important program, not only to veterans and soldiers, but to anyone working in healthcare IT. iEHR would have been the single largest integrated EHR in the world, shared jointly between the VA and DoD’s combined 209 acute care facilities. It would have supported the largest group of employed clinicians in the country, with the VA employing more nurses and clinical social workers than any other organization and ranking as one of the largest employers of physicians and PAs as well. With military personnel, qualifying veterans, and all of their families eligible for care, iEHR would have contributed to the care delivery of up to 25 percent of the nation’s population.

iEHR was a promise made to develop a modern EHR that would pull clinical data from two large and complex organizations through a single application and into a single database, a platform that would have been capable of incorporating advanced tools like population health and telehealth, all while satisfying the workflow needs of the largest employee base of clinicians in the country. The cherry on top is that it was to be coded in an open-source environment, meaning that iEHR would be free to install at any facility in the country, private or public. Sound like something that would be valuable in healthcare today?

After spending $1.3 billion pursuing this promise, the VA’s CIO and CTO resigned and the DoD announced that they would be pursuing a commercial option instead of an open source option. The plan was unofficially abandoned. Thus far, no one has stepped up with a Plan B that would delivery anything resembling the initial promise.

Fast forward six months, and to my surprise, a conference is announced featuring some relevant, and high-ranking speakers:

•  Frank Kendall, Undersecretary of Defense for Acquisitions, responsible for issuing the DoD’s commercial RFP and running the DoD’s EHR vendor search.
• Seong Mun president of OSEHRA, the organization responsible for programming the VA’s current VistA platform and in line to take on coding of the new iEHR platform.
• Major Hassan Zahwa, Chief in the DoD/VA Interagency Program Office. The department is led by a DoD Director and a VA Deputy Director and is responsible for overseeing the development of iEHR and delivering on the president’s mandate for an integrated system.
• Patrick Sullivan, Director of the Lovell Federal Healthcare Center in North Chicago, the nation’s first fully integrated DoD/VA medical facility.

Frank Kendall was the big name that everyone came to see. Unfortunately, the Friday before the conference, he cancelled. Maybe it was just a conflict of schedules, but it set an undertone at the conference that the DoD just wasn’t as invested in the project as the VA or general healthcare IT community.

Seong Mun, President of OSEHRA

Seong Mun’s presented on the work that OSEHRA is doing with VistA. He described a project being developed to standardize the VistA code set across all 151 VA facilities. A common critique of open source systems is that there are as many variations within the code as there are users of it – meaning that everyone customizes it a bit here and there and it results in a rat’s nest of code to manage and integrate at an organizational level.

Seong Mun explained that the VA is actually well into a project that is standardizing the VistA code sets installed at VA hospitals and maintaining it with a new versioning control system. When he explained this, Major Zahwa – who works in the Interagency Program Office on the iEHR program – raised his hand to clarify, asking Mun exactly what the program is and what its goals are. He was impressed with the program, as we all were, but it’s disappointing that he found out about it only now and at a public conference. This program is already well underway and the key DoD iEHR representative, a chief in the Interagency Program Office, had just found out about this plan at the same time that I had.

The DoD was supposed to evaluate both the iEHR project and the VistA alternative during the famous 30-day “We didn’t know what the hell we were doing” Chuck Hagel reset. Had they done so with any seriousness, the VistA Standardization Initiative would not have been news to someone working so closely to the core of the iEHR project. The fact that VistA is standardizing its entire code set across all VA facilities should be common knowledge among anyone holding a leadership position in the government’s Interagency Program Office.

Major Hassan Zahwa

“Lead the Departments into the future DoD/VA inter-agency electronic health record. Bridge the gap between the functional and acquisition communities though active communication and interpersonal skills.” – LinkedIn

Major Zahwa himself presented at the conference earlier in the day. He chose to focus on the value HIEs could play in the path forward, and to that end, his presentation covered the work being done in BHIE (Bi-directional Health Information Exchange).

BHIE is an old DoD/VA HIE system installed in 2004 to replace an even older VA/DoD HIE program called FHIE. The system was in place when the need for iEHR was defined and funding was approved. But to Major Zahwa’s credit, there have been significant enhancements since that time and BHIE has grown into a fairly robust exchange, facilitating one million queries every month. It’s capable of sending and receiving patient demographics, problem lists, home medication lists, allergy data, lab results, radiology reports, and consult notes. If you were looking to put a rosy shine on the level of interoperability available between DoD and VA systems, the BHIE would absolutely be your topic of choice.

At this point in the conference, it was clear that the VA and OSEHRA wanted a single, integrated EHR, and that they had been working hard and effectively to fix any perceived weaknesses in the VistA platform to eliminate DoD objections to their system. It was just as obvious that DoD wanted the freedom to buy a commercial solution and was working on a sophisticated information exchange to validate that approach as a viable long-term solution. With BHIE, the DoD was working just as hard and effectively, making significant advances that support the validity of this strategy.

It was sad that all that impressive work was being done toward two opposite ends and that these clearly very talented and task oriented teams couldn’t have aligned their goals. I suppose the silver lining to it is that no matter what happens, everyone is better of if VistA has a single code set across all the VA facilities, and everyone is also better off if the Interagency Project Office develops a robust information exchange suite that interfaces with that VistA platform. If iEHR is going commercial, as everyone seems to think it will, then both of those tools will be useful down the road. If it does not go commercial, and DoD agrees to a single VistA architecture, it will be just as useful to have versioning control for VistA and an HIE capable of pushing data out of those EHRs and into commercial systems.

Patrick Sullivan, Director of the Lovell Federal Healthcare Center

The conference closed on what was supposed to be a happy story. A shared DoD/VA hospital was opened in North Chicago and it was being held up as a model of interoperability. The hospital was used to physically examine new recruits, treat active duty sailors, and provide care to local veterans and their dependents. To the public (and in the video above) it was advertised as a true, fully integrated VA/DoD facility. Clinicians work on a mixed patient population, and an integrated EHR was necessary. It was a setting prime for a happy ending story.

Unfortunately, behind the scenes, the VA and DoD could not agree on which EHR to use, so they implemented both. Care providers now have to switch back and fourth between the two systems depending on which type of patient they are seeing. Data does not flow between the two systems much better there than it does in most other VA or DoD facilities. At the end of 2012, an Institute of Medicine report identified a laundry list of serious HER-related inefficiencies. They issued a concluding recommendation that no new joint DoD/VA hospitals be opened until an interoperable or joint EHR system was made available.

The “good news” in this story was that the IT department had created a registration routine that auto-registered the patient in both systems, saving administrators a good deal of time. They had also created a single sign-on solution that opens both EHR systems in split-screen mode, so that users could navigate and have a view of both systems in a single window. Lastly, they created a view-only display that aggregates data elements from both systems and displays it on one screen. It was not actionable data, meaning that clinicians still needed to go to the primary EHRs to place orders or document notes or take any tangible action, but it was a single location where combined data could be viewed together to tell a complete story.

The North Chicago project was a $100 million IT investment and is still operating under these conditions. When you think about that, makes it easy to understand how $1.3 billion was spent on a national iEHR program with so little to show for it.

My walkaway impression from this conference was that there does not seem to be an empowered leader running the iEHR program. Technology projects of this scale need a clear vision that stakeholders believe in and a well-established and empowered leader to bring the project to completion. There isn’t now and hasn’t ever been any one person who was given ultimately responsibility and sole authority over the iEHR program.

There are too many cooks in the kitchen. The DoD leaders ultimately fight for DoD interests while the VA leaders lobby for VA interests. In the middle, programmers at OSEHRA are trying to code an entirely new EHR with no clear direction. Someone should have been put in charge of the entire project, empowered to lead and answering only to Congress, funded independently of either organization’s budget, and with the authority to make the sweeping changes that neither organization seems willing to compromise on.

In an environment so ripe with amazing leaders, I can’t believe it would be hard to find a good candidate to properly lead this project. Someone to define the vision, unify the team, and pursue it as efficiently as they’ve pursued the standardization of the VistA code or the the expansion of the BHIE structure. At the very least, the staff at Lovell Federal Medical Center should be using one HER. That alone is something worth fighting for.

Monday Morning Update 9/23/13

From HIS Junkie: “Re: ONC. I find it absolutely depressing that the government has created a monster bureaucracy to test and certify healthcare software and spends over $70 million a year to do that,  yet these same people cannot release one piece of software that works right from the get-go. There is an article in the Wall Street Journal entitled ‘Pricing Glitch Afflicts Rollout of Online Health Exchanges.’ Another buggy system brought to you by Uncle Sam. If that was the only  glitch, I could look past it. But consider that over the last two years ONC has issued three software systems to support the vendor certification process and all have bombed more than once. They were – POP Health, Cypress, and the Transmission Transport Test tool. They eventually killed POP Health. All were needed to pass ONC certification. Each one created major delays and resubmits for vendors, not to mention the related wasted time and costs. Amazing that a federal agency that can’t get relatively simple software right the first time is telling vendors of mission critical complex software how to build theirs. I think we need to create another federal agency to certify ONC software before we let them move to Stage 3.”

From Vandy Watch: “Re: Vandy VPIMS lawsuit. I wonder if other facilities could be at risk? According to Acuitec’s website, ‘Acuitec’s flagship products are VPIMS, an integrated clinical solution for the perioperative continuum of care, and Vigilance, a customizable remote presence monitoring solution. Our strategic relationship with Vanderbilt Medical Center (VMC) enables us to ensure our products are thoroughly tested and clinically verified.’" I wouldn’t be too worried. The government hasn’t proven their rather broad claims against VUMC and even if they really did use VPIMS to intentionally overbill Medicare, that doesn’t mean anyone else would be forced to use VPIMS in the same way. It’s unlikely that fraud was baked into the product.

From The PACS Designer: “Re: Google Glass. The Yale football team got a chance to test Google Glass in a practice game and found the experience exciting from a quarterback perspective. The Internet link could present some interesting uses in healthcare for physicians seeking to inform others of their daily wants and needs.”

Poll respondents say the most valuable part of an electronic medical records system is clinical decision support. New poll to your right: when will vendor opportunities for population health and analytics really kick in?

Listening: new from The Sadies, Canadians who offer a compelling blend of American music styles like country, surf, and psychedelia. One of the members is Travis Good, no relation as far as I know to Travis Good, MD from HIStalk Connect.

Welcome to new HIStalk Gold Sponsor AirWatch, the leader in enterprise-grade mobility and security solutions. More than 8,000 customers across the world trust AirWatch to manage their most valuable assets: their mobile devices. The company’s highly scalable solution provides an integrated, real-time view of an entire fleet of corporate, employee-owned, and shared iPads, iPhones, Androids, Toughbooks, and more. With AirWatch, healthcare IT can automate the management and tracking of all mobile assets; reduce the cost and effort of device deployments; improve the technical support experience for device users; and enable and enforce IT security and compliance policies that secure the device and its data. Thanks to AirWatch for supporting HIStalk.

Here’s a YouTube video I found on AirWatch’s mobile device management.

The local paper covers the move from Healthland to Epic of Heart of 20-bed Heart of America Medical Center (ND).

I interviewed a patient about her use of the Good to Go recorded discharge instructions system from ExperiaHealth.

The HCI Group creates an integration and testing services division, naming Scott Hassler and Mark Jackson as VPs of integration services.  Both were previously with Information Technology Architects.

ABC for Health, a Madison, WI-based nonprofit healthcare advocacy law firm, receives a $1.2 million NIH grant to develop software that determines if a patient is eligible for government health programs.

Upcoming Webinars

• Full Speed Ahead: Creating Go-Live Success, Tuesday, September 24, 2013, 1:00 – 1:45 p.m. Eastern (presented by Encore Health Resources)
• Predictive Analytics: It’s the Intervention That Matters,  Tuesday, September 24, 2013, 1:00 2:30 p.m. Eastern (presented by Health Catalyst)

Speaking of Webinars, I said when I started doing them that I wanted to showcase fresh ideas, giving a voice to folks who don’t usually do conference presentations. I’m really happy that several of those Webinars will be coming your way soon. I’m certain you will enjoy the topics and the presenters. Vendor-sponsored webinars make it possible to offer these non-commercial ones where everybody can use the Webinar platform I’m already paying for. If you have a great message that needs an audience, let me know.

FDA issues a rule requiring medical devices to bear manufacturer tracking codes. FDA will used the IDs to create a publicly searchable database. The likely next steps: (a) FDA, Joint Commission, Medicare, and insurance companies require logging the ID of each device implanted, and (b) vendors of systems used in the OR or elsewhere will be pressured to make recording and recalling this information easier.

Vince finishes up his HIS-tory of Cerner this week. Next up will be McKesson, which should be interesting.

Craig Richardville on the Future

Carolinas HealthCare SVP/CIO Craig Richardville followed up his September 13 interview on HIStalk with thoughts on the future.

As you look ahead over the next several years, one thing we can count on — it will be here and gone before you know it. The boost of HITECH has made technology more than an enabler as it has become a foundational element for all future endeavors. It is the common thread that not only provides the glue within service lines and organizations, but also connects the care, the care team ,and our patients across the continuum. 

The financing challenges of healthcare requires us to be more selective in our ideas, as only the best of the best will survive, and more innovative in how we deliver care and maintain the health of our consumer. As part of the Triple Aim, a main focus is on quality and high quality will become the norm to play in the game, and the other two elements — service and pricing — will become equally dominant as the industry continues its movement towards consumerism and choice. 

Healthcare will start to take on other characteristics of other consumer industries such as retail and banking. Online services will become the routine. Consumers will access a variety of comparative sources to make decisions, the same that we do today for other personal products and services, such as Consumer Reports, Angie’s List, Google Reviews, etc. Technology will be used to transform operations to be more efficient and provide access and engagement for the consumer, wherever and whenever it is required or requested. 

The care offered will continue to travel rapidly to the patient. Self-service tools will be a necessity. We will connect to patients via mobility, instant access, and migrate monitoring for fixed devices to smartphone apps and wearable devices. We will go to the patient, wherever they are and whenever they need us — the workplace, the home, across state boundaries, and while in motion. We will see competitive communities becoming connected and unifying for the benefit and health of the patient and of our populations.

Historically competitive organizations will start to share data and collaborate to ensure that we are reducing duplication and providing all information necessary to treat the patient. We will not compete on data, but rather on how we use the data. Predictors and analytics will be a core competency and those who get their first, will have a small advantage as others will get there as well, and then we will need to quickly move to the next prospect. 

Expectations will continue to rise and new innovations discovered and the ability to be agile and collaborative will create a competitive advantage. Look to the use of data, ensuring privacy and security, development of new evidence, analytics, genomics and be prepared for the next unknown and seize the opportunity not to compete on transactional data, but predicting and engaging. 

There is not a day that goes by that new opportunities to optimize and advance arise, times will be challenging, and also very opportunistic. The best of times are ahead for all of us, especially our patients.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Patient Report: Good to Go for Discharge Instructions

The PR folks working with Good to Go from ExperiaHealth (part of Vocera) offered to let me speak to an actual patient user who has used the company’s solution. Hospital nurses use Good to Go’s technology to record their discharge instructions as they are discussed with the patient. The patient, family, and caregivers can review the session recording at any time on a smartphone, iPad, desktop PC, or telephone.

ExperiaHealth, whose tagline is “Humanizing the Healthcare Experience,” says the technology improves the patient experience and reduces readmissions, citing a CDC report that found that 90 percent of adults can’t follow the medical instructions they are given because they can’t understand them or don’t remember them. Good to Go won the “Care About Your Care” award from the Robert Wood Johnson Foundation this year.

I spoke to Mrs. Beverly Sturm, a 69-year-old widow who lives alone in Cullman, AL. She was recently  discharged from Cullman Regional Medical Center after being treated for diabetes.

According to Mrs. Sturm, “We all need an advocate. It’s difficult to remember everything they’re telling you when your being discharged. Sometimes you don’t have time to read the paperwork immediately. It’s helpful to my daughter, who was giving me care at home, to be able to hear the discharge information first hand. I thought it was a pleasant experience and helpful.”

Mrs. Sturm’s daughter wasn’t able to be present during the discharge session with the nurse since she was bringing the car around to take her home. Mrs. Sturm says it would have been hard for her to remember on her own. “When you get home, besides having to go by the drugstore and get your medicine and read the paperwork, you’re tired and want to lie down and rest. It was extremely helpful.”

I asked her what kinds of things the recording helped her remember or understand. “I had a couple of changes of medication,” she said. “That’s one thing I needed to listen to again. I had one or two things that were eliminated and something new started, how to take it and when to take it. Then, too, when I was supposed to be back in and contact my doctor in the office. The medicine was the most important thing. I’m diabetic and I have to be careful of the information I get and what I have to change with my diet, the medicine, and the units of insulin. I could hear it while it was quiet and had my undivided attention.”

I asked Mrs. Sturm if having the information made her healthier. “Oh, yes. I’m certain at least being able to go over it again verifies my memory.”