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.”

News 9/20/13

Top News

The Greater Madison Convention & Visitors Bureau estimates the economic impact this week’s Epic user group meeting is $6.5 million, second only to the World Dairy Expo. Despite being behind the cow show, Judy Faulkner was apparently pleased to tell her 15,000 customers and employees that Epic now serves 51 percent of US patients and 2.4 percent of the world’s. She also reports that 86 percent of Epic implementation projects over the past two years have come in under budget.

Reader Comments

From Wild Duke: “Re: Caradigm. Did a major executive purge. Chief Medical Officer Brandon Savage and SVP of Product Management Mark Johnson both gone. COO Nigel Mason is heading back to GE. CTO Neal Singh is now running the show.” A Caradigm spokesperson responded to our inquiries by saying, “I can confirm that earlier this week Caradigm made some organizational changes within our product teams to drive greater alignment and focus on our healthcare analytics and population health solutions.” We’ll call it unverified since companies can’t comment on the status of individual employees.

FromPit Viper: “Re: VA. Under Secretary Petzel is resigning.” Unverified, but Pit Viper has been a good VA source previously. Robert Petzel, MD is Under Secretary for Health in the Department of Veterans Affairs.

From Would Like to Know:“Re: ICD-10. CMS is not requiring it for coding Liability Insurance, No-Fault, and Workers Comp until April 1, 2015. For vendors that rely on UB-04 billing data, this exception is causing some angst. We’ve heard hospitals will code in ICD-10 and then either crosswalk back to ICD-9 or code to ICD-9 for these insurers. Would you be able to survey hospitals about this? I love HIStalk and have promoted it inside my company, plus we are now a sponsor.” Thanks. I created a poll that will take hospital folks maybe 10 seconds to complete. I’ll share the results here in a few days.

From Movie Sign: “Re: open.epic. Epic’s big announcement to the world of modern startups looks like it was designed by an amateur. It doesn’t help accusations that legacy vendors are out of touch.” Nobody seems to know anything about open.epic other than what’s on the site, which indicates that it’s a connection from EpicCare to personal health devices. Folks attending UGM probably got more details.

HIStalk Announcements and Requests

Thanks to Jennifer Dennard (@SmyrnaGirl) of Billian’s HealthDATA for hosting Thursday’s #HITchicks tweetup, which happened to be the first TweetChat I’ve ever attended. The discussion covered women in the healthcare C-suite, mentoring, HIT week, and, my favorite: should women have to “harden” or “soften” themselves when in positions of leadership. I agreed with the consensus view that women (and men) must remain genuine and true to themselves. Nice job moderating, Jennifer!

I updated my iPhone 5 to iOS 7.0 last night (it took about an hour) and, so far, so good. I did have to delete about 2GB of videos to make room for the update, so beware if you are low on storage. I am excited about the new camera features, which include Instagram-like tools for enhancing photos and a faster shutter speed (which will be perfect for taking stealth photos of shoes at MGMA.) The iTunes Radio is also fun and should give Pandora a run for its money, especially since it’s ad free. I listened to a few tunes using the Bluetooth in my car, but then realized that too many tunes may be a quick way to eat up all the data included in my cell phone plan. Finally, the overall navigation is enhanced in several areas, resulting in fewer swipes to get where you are going.

Welcome to new HIStalk Platinum Sponsor Prominence Advisors. The company, founded by former Epic managers who hire Epic superstars, provides the country’s foremost healthcare organizations with Epic expertise, with over 90 percent of the company’s employees being Verona alumni. Prominence is a QlikView healthcare implementation partner, levering its knowledge of Epic’s data model to help organizations aggregate data from multiple systems to spot trends, predictively improve patient care, optimize revenue cycles, and monitor operational performance. High-profile projects require extraordinary, high-performing talent and Prominence has earned the reputation of deep domain expertise and exemplary character as it provides services in analytics, strategy, and execution. Thanks to Prominence Advisors for supporting HIStalk.

Bored? (a) sign up for email updates so you’ll be the first to know; (b) repeat for HIStalk Connect, where your signup gets you really cool HIT innovation news from Travis, Lt. Dan, and Kyle; (c) connect with us on Facebook, Twitter, and LinkedIn, including the HIStalk Fan Club that Reader Dann created a long time ago that now has 3,242 members, making my mom very proud even though she’s not sure why; (d) peruse and occasionally click the ads of the folks who keep me in keyboards and check them out in the Resource Center and Consulting RFI Blaster; (e) send me rumors, pictures, or whatever interesting stuff you have using the secure Rumor Report form that goes straight to my inbox along with any attachments you’ve included; (f) check out the Webinar Calendar and vow to learn something; and (g) accept my appreciation for your  support of HIStalk in whatever form that support takes (just reading it counts a lot.)

Upcoming conferences: Inga will be at MGMA in October, I’ll be at the mHealth Summit in December. That’s all we have on our dance cards for now.

HIStalk Webinars

Encore Health Resources will present “Full Speed Ahead: Creating Go-Live Success” on Tuesday, September 24, 2013, 1:00 – 1:45 p.m. Eastern, featuring William Sangster, MD. Dr. Bill will impart wisdom, I’ll say a few words that will be far less wise, and a lucky attendee will win a $50 Amazon gift card door prize. Register now.

Speaking of webinars, we’re doing quite a few of them and I could use a few more CIO-type reviewers. Here’s how it works: I’ll send you a link to the recorded rehearsal, you’ll spend 30 minutes or watching it and jotting down suggestions for improvement, and you’ll earn the same gift certificate as the Encore door prize winner. Let me know if you’re interested. Thanks to the folks who have been reviewing all along – your feedback is making the Webinars better and more enjoyable for everyone.

Acquisitions, Funding, Business, and Stock

Health tech business accelerator Healthbox selects its first Nashville class of seven companies, each of which will receive a $50,000 seed investment and four months of mentorship. Chosen were:

• Atlas Health (HIPAA-compliant developer tools)
• Axial Healthcare (credentialing and clinical appropriateness software)
• Daymark Health (digital advertising for hospitals)
• eClinical Healthcare (telemedicine software)
• Gema Touch (consumer tracking and brand engagement)
• PRSM Healthcare (patient relationship solutions)
• Remedify (sterile processing software)

DreamIt Ventures launches DreamIT Health Baltimore, a partnership with The Johns Hopkins University and BioHealth Innovative, to accelerate the growth of early-stage HIT companies.

HIMSS acquires Health Story Project, which focuses on standards related to non-EHR clinical documentation such as transcription and electronic documents.

Sales

Skilled nursing and rehab operator Greystone Healthcare Management selects HealthMEDX as its HIT solution.

The New York Office of Mental Health awards health system integrator CGI a $48.7 contract to implement an EMR platform, including NTT DATA’s Optimum. Document Storage Systems will provide additional implementation services for the vxVistA EHR.

Vanderbilt University Medical Center (TN) will deploy MedAptus Technical Charge Capture solution to code and bill hospital-based procedures.

UC San Diego Health System (CA) selects Merge iConnect Access to image-enable its Epic EHR.

Self Regional Healthcare (SC) selects McKesson Paragon .

The New York City Health and Hospitals Corp. awards IBM an one-year, $10 million contract to build an analytics platform to improve patient care and operational efficiency.

The Torrance Memorial Medical Center (CA) selects Daylight IQ for disease-based clinical protocols.

People

Bronson Healthcare (MI) hires Paul Peabody (Palomar Health) as VP/CIO.

Emmi Solutions names Steve Martin (Merge Healthcare) as SVP of sales.

Ron Strachan (Community Health Network) is named CIO of McLaren Health Care.

Health Care DataWorks Co-founder Jason Buskirk is named CEO, Ivo Nelson becomes board chair, and John Gomez is engaged as a development consultant.

Announcements and Implementations

Fairfield Memorial Hospital (SC) goes live on Cerner.

Duke University Health System reports that it has installed Epic ahead of time and under budget throughout the entire system, including 223 outpatient facilities and Duke University Hospital. Epic says it was one of the company’s biggest single-day go-lives with 16,000 Duke employees trained. Competing Research Triangle health systems WakeMed and UNC are also implementing Epic.

Pacific Alliance Medical Center (CA) deploys electronic patient signature and e-forms solutions from Access.

Government and Politics

CMS publishes an online ICD-10 implementation guide to help practices, small hospitals, and payers navigate the ICD-10 transition.

ONC names GenieMD the winner of its Blue Button Co-Design Challenge for its app that helps users diagnose their symptoms, find providers, and learn more about medical conditions.

From an ONC post I missed last week: 54 percent of EPs have 2014 Edition EHR technology available to them from their primary 2011 EHR vendor; 45 percent of EHs/CAHs have 2014 Edition EHR technology available from their primary 2011 Edition vendor. An additional 13 percent of EPs and 19 percent of EHs/CAHs have a primary 2011 Edition EHR vendor that is on track toward providing a 2014 Edition solution. Translation: one out of three providers attested with EHRs that are potentially not on track with 2014 Edition technology. Another interesting nugget: 31 percent of the 861 ambulatory EHR vendors on the Certified HIT Product List and 49 percent of the 277 inpatient EHR vendors don’t have a single MU attestation. In other words, look for a sizable reduction in the number of vendors listed for 2014 Edition certification.

Here’s a new ONC video on interoperability.

Other

The CMS Office of the Actuary projects that healthcare spending will increase at an annual rate of 5.8 percent from 2012 to 2022, or one percent faster than the GDP.

A former advisor to Australia’s billion-dollar eHealth system calls it “shambolic,” with incorrectly loaded data and doctors who don’t have the software to read it. The medical association pegs the odds of finding useful information for a given patient at 0.5 percent.

John over at EMR and EHR Videos has a Google Plus Hangout video featuring the always-fascinating Dr. Nick, aka Nick van Terheyden, MBBS, CMIO of Nuance Healthcare. You can also get on the update list and check the schedule of future events that are streamed live.

The Milwaukee newspaper runs an article about the growth in lucrative Epic consulting jobs, featuring a cool photo of Mark and Drew from Nordic, which has 350 employees and is adding 20 per month after bringing in $38 million in investor money in the past year. Frank Myeroff of Direct Consulting Associates is quoted in the article as saying the number of Epic consulting firms may approach 2,000. Also mentioned are Vonlay and BlueTree Network.

In Canada, Jewish General Hospital goes on diversion and elective imaging tests are postponed when its data center overheats, taking all of its servers down Thursday morning.

A report by Wells Fargo Securities says that CMS’s July attestation data suggests that the replacement EHR market will heat up in 2014 as practices drop productivity-sapping EHRs in favor of those products with a higher MU attestation rate. The report also says, “Replacement activity could
intensify further if CMS ever decided to audit providers who pocketed the Medicaid incentives instead of using them to fund actual EHR adoption. “

Weird News Andy, who as he says is “putting the ‘News’ in Weird News Andy for the past five minutes,” notes that Cleveland Clinic is shrinking. Employees were told this week that $330 million needs to be trimmed from the clinic’s 2014 budget and layoffs may be required.

At least it wasn’t healthcare: a BBC TV news anchor grabs a pack of copy paper instead of the intended iPad and bizarrely carries it around while reading the news. Anchors there hold the iPad to pretend they are technology-savvy journalists instead of talking heads reading off a screen, an illusion suffering mightily from this incident.

Sponsor Updates

• The Colorado Technology Association names Ping Identity winner of its Technology Company of the Year award.
• HCI Group posts an article titled “Credentialed Trainers – Secret Superstars of the Install.”
• Lifepoint Informatics serves as a gold sponsor for next month’s G2 Lab Institute Conference in Arlington, VA.
• Sunquest is attending ASCP in Chicago this week, exhibiting in Booth #219.
• Direct Recruiters is named a Weatherhead 100 winner as one of the 100 fastest growing companies in Northeast Ohio.
• Jeff Bell, director of IT security and risk services for CareTech Solutions, joins the HIMSS Privacy and Security Committee for a two-year term.
• CCHIT certifies that Medseek Empower enterprise patient portal is compliant with the ONC 2014 Edition criteria and awards it certification as an EHR Module.
• Merge Healthcare reports that radiologists use its certified EHR technology more than any other, according to HHS MU attestation data.
• Drummond Group certifies that two SuccessEHS products, SuccessEHS 7.0 and MediaDent 9.0, are compliant with ONC 2014 Edition criteria.
• CIC Advisory launches a Facebook page to provide an interactive forum on the operational and regulatory challenges facing HIT execs.
• API Healthcare President and CEO JP Fingado participated in this week’s Healthcare Workforce Information Exchange demonstration.
• Hospital Physician Partners (FL) reports on its experience using Ingenious Med’s business analytics platform.
• Xerox researchers address the challenge of big data and what to do with social media analytics.
• HCI Group details three areas a good credentialed trainer can impact during an EMR implementation.
• Beacon Partners outlines six steps to minimize ICD-10’s negative impact on revenue cycle.
• Nordic Consulting reports that its $38.3 million influx of capital from investment partners has allowed it to increase service offerings, bolster staff to over 300, and grow clients and partnerships to over 75.
• Quantros hosts an Advisory Panel this week to discuss the commercial viability of data in an intermediary role and the value of bundled safety products.
• Clients attending this week’s Verisk Health user conference prepared 2,000 food packs for Second Harvest Food Bank of Central Florida’s Hi-Five Kids Pack Program.
• Vitera Intergy EHR is tested and certified as a complete EHR under the Drummond Group’s EHR ONC-ACB program and is an ONC 2014 Edition-approved solution.
• Anita Archer, Hayes Management Consulting’s director of regulatory compliance, co-authors a HIMSS-published article entitled, “ICD-10 Documentation for State Medicaid Agencies (SMA) Health Conditions Categories.”

EPtalk by Dr. Jayne

Lt. Dan tweeted this morning about Google’s launch of Calico, a company that will focus on “the challenge of aging and associated diseases.” The venture will be led by Arthur Levinson, chairman and former CEO of Genentech. He’s also a director of drug giant Hoffman-La Roche and chairman of Apple.

My initial response to the announcement was that there are some significant conflicts of interest here. Others have had that thought as well, with Time posting a piece about it in the context of previous Google vs. Apple conflicts that received scrutiny from the Federal Trade Commission. My mind, however, was going more towards the conflict stemming from having a company like Google — which controls vast amounts of information about seemingly everything and everyone — cozying up with the pharmaceutical and genetic sphere.

For quite some time, I’ve had concerns about so-called personalized medicine. Farzad Mostashari tweeted about this earlier this week, sharing why personalized medicine might be bad for all of us. The focus of the opinion piece is that when people increase focus on themselves and their personal choices, they tend to decrease focus on population-based health, such as global vaccination efforts and other public health initiatives. It also mentions pharmacogenetics, where drugs can be targeted for patients who have certain mutations present. It mentions the example of vemurafenib as a drug for metastatic melanoma, which can help 25 percent of patients live seven months longer.

This kind of data leads me to my chief concern with personalized medicine – is it cost effective, and who is going to pay for it? Vemurafenib costs $56,400 for a six-month supply. (Surprise, when I did my Google search to find out the cost, I discovered it is made by Genentech.) If it only works 25 percent of the time for patients with a specific mutation, and their lives are only extended seven months, should we be routinely recommending it? As a primary care physician who has cared for numerous terminal patients, I understand the appeal. If it helps a father live long enough to see his daughter married, or a mother long enough to see her son graduate from college, these are the Hallmark moments we all want to think of. But in our situation where the healthcare system is collapsing under its own weight and excess, I could really make the argument that spending $56,000 to help fight diabetes, obesity, or heart disease for many patients is a better investment of our increasingly scarce healthcare dollars.

One could argue that personalized medicine is for those who can afford it, but then we will have the counter argument about healthcare being a right and about treating everyone equally. Eventually we have to come to the realization that we can’t afford to provide these expensive treatments for everyone no matter how hard our heartstrings are tugged. As a family physician, I’m all for health promotion and disease prevention. I am not, however, in favor of extending life just because we can, and I think this venture has the potential to drive efforts in the wrong direction.

I recently saw an elderly patient in her mid-90s who has been blessed with extremely good health. She has taken care of herself all her life, watched her weight, didn’t drink alcohol, and didn’t smoke. Her only “vice” was wearing high heels every day, which has caused some orthopedic problems. As for medications, all she takes are pain relievers that she takes as needed for aches and pains. She is a remarkable lady. She has been widowed for more than 30 years, outliving most of her close friends and some of her family members. She doesn’t want to live forever.

When people think of halting the aging process, I think they expect it to be something like the movie “Cocoon,” where you have a bunch of sassy septugenarians frolicking around. How are we going to fund retirement for these folks? Will they understand that if they’re going to live to be 100 they need to work until they are at least 75 or 80 because the average person cannot save enough money to fund a 35- to 40-year retirement during a 45-year working life? We already have people who can’t save enough money for retirement period, let alone an extended one. The focus on instant gratification and the “me” generation can only skew that further as people spend their current income rather than saving it.

Anyone who has worked on a medical/surgical unit at a hospital has seen the people who are not as fortunate as my ultra-healthy patient. What about the people whose lives have been prolonged through multiple invasive treatments but who are debilitated and have a very low quality of life? Wouldn’t it make more sense to talk about palliative care for the obese smoker who has had four heart attacks, multiple cardiac catheterizations and a bypass, and can’t walk to the bathroom without being exhausted than to bankrupt his family by pursuing more invasive treatments?

I’m sure the argument here is that they want to come up with technologies to help that patient have a better quality of life, but I’m not sure I buy it. Looking at the players involved (Genentech, Roche, Google, and probably multiple intermingled board members from other companies) this feels more like a profit-driven venture than a humanitarian one. Like commercial space travel, it will be only for the ultra-wealthy and will potentially divert resources and attention from important work that could benefit all patients.

What do you think about Calico? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 9/18/13

Top News

Here’s a news item that Judy Faulkner probably won’t mention when addressing the Epic masses in Verona this week. She earns the #243 spot on the annual “Forbes 400 Ranking of the Richest Americans” with an estimated net worth of $2.3 billion. Terry Ragon of InterSystems, which sells the Caché database that runs Epic and other healthcare IT systems, also makes the list, tying Cerner’s Neal Patterson in the #352 position with a net worth of $1.5 billion.

Reader Comments

From Spacey: “Re: Epic UGM. Over 15,000 people in attendance including 8,500 customers and 6,600 Epic employees. They now cover over 50 percent of US patients!” We reported in 2010 that attendance was 5,500 versus 3,800 in 2009. At the rate the Epic UGM is growing, it could surpass the HIMSS conference in a few years.

From GomiesGone: “Re: Nuance. Dropped the ball by failing to release Dragon Medical Network DM360 v2.0 as promised on September 16. Word is upper management is arguing over logistics.” Unverified.

From Curious: “Re: Epic. Looks like they’re no longer hiring project managers / installers for their US locations. Does anyone know why?”

From Reluctant Epic User: “Re: HIStalk. If you’re ever in my town and willing to blow your anonymity, I’d be thrilled to buy you a beer or two for the great work you do. People in my health system routinely think I’m a genius simply because of knowledge I have gained by reading your site faithfully for the last six years.” I appreciate both the nice comment and the six years of reading. I do like beer, so that just might sway me.

Acquisitions, Funding, Business, and Stock

In England, Emis, which provides physician practice systems, will buy hospital systems vendor Ascribe for $95 million.

A UK report says that CSC will pay $98 million to settle a class action suit in which shareholders claim the company knew its Lorenzo EMR, developed by iSoft, could never be implemented in the NHS’s NPfIT program long before a Department of Health breach of contract charge sent shares down sharply. Meanwhile, a watchdog’s report says costs continue to pile up for the failed NPfIT project because of ongoing liabilities and vendor termination fees, leading it to conclude that the project is “one of the worst and most expensive contracting fiascos in the history of the public sector” as updated cost estimates are revised upward to $15.5 billion vs. an estimated benefit of $6 billion.

Sales

Hunt Regional Healthcare (TX) will implement T-System PerformNext Care Continuity.

Tift Regional Medical Center (GA) will deploy RelayHealth’s RelayClinical platform for its HIE.

NYC Health and Hospitals Corporation selects Elsevier’s ClinicalKey to provide electronic medical reference and knowledge-based information to its clinicians.

CentraCare Health (MN) selects Strata Decision Technology’s StrataJazz for costing accounting, operating budgeting, capital planning, and rolling forecasting.

People

The Massachusetts Technology Leadership Council names athenahealth CEO Jonathan Bush CEO of the Year and Nuance Communications CTO Vlad Sejnoha CTO of the Year.

Voalte hires Kenda West (Johns Hopkins Medicine) as COO.

Amazing Charts names John Squire (Microsoft) president and COO.

Coastal Healthcare Consulting hires Gay Fright (Pivot Point Consulting) as EVP of business development.

Virtual Radiologic names Shannon Werb (Acuo Technologies) as CIO.

Bill Keyes (Allscripts ) is named SVP of sales of CoCENTRIX.

HIMSS recognizes Farzad Mostashari, MD, Congressman Tim Murphy, CMS Administrator Marilyn Tavenner, and Rhode Island State Representative Brian Patrick Kennedy with HIT Leadership Awards in recognition of their work to improve health with IT initiatives.  

WHITEC, the Wisconsin REC, provides a bow tie tribute to outgoing National Coordinator Farzad Mostashari, MD.

Announcements and Implementations

Mid Coast Hospital (ME) implements Gemalto’s Sealys MultiApp ID smart cards and LifeMed ID’s SecureReg solution to enable secure patient authentication.

Children’s Medical Center Dallas (TX) launches its TeleNICU, which will provide regional hospitals with access its neonatologists.

HIMSS awards the University of California-Davis Medical Center its 2013 Enterprise HIMSS Davies Award of Excellence.

HealtheLink connects three other New York state RHIOs to provide sharing for 5.4 million patient health records and links to 44 hospitals.

VitalWare introduces VitalCoder, a coding and compliance resource that includes real-time, automatic updates for organization-specific coding, regulatory, and financial data.

Nuance Communications announces an Epic-optimized version of its Dragon Medical 360 | Network Edition that contains 1,000 customized commands to enhance physician productivity in a Citrix environment.

PDR Network launches PDR+ for Patients, which incorporates drug  information into EHRs so that prescribers can discuss proper use with patients during the encounter.

Government and Politics

ONC releases online tools for providers and HIEs to educate patients about the electronic sharing of health information. 

ONC also publishes models for Notices of Privacy Practices for healthcare providers, which reflect the Omnibus Rule regulatory changes that go into effect September 23.

CMS commissions the National Academy of Sciences to study how best to add social and behavioral factors to EHRs without compromising privacy.

GAO identifies 12 potentially duplicate investments at three federal agencies that over the last five years have accounted for $321 million in IT spending, including $256 million for four HHS information security systems.

The House of Representatives is considering the TELEmedicine for MEDicare (TELE-MED) Act of 2013, which would allow Medicare providers to treat patients across state lines using telehealth technology without requiring them obtain medical licenses in multiple states.

Innovation and Research

A study published in The Journal of Maternal-Fetal & Neonatal Medicine finds that neonatal depression can best be predicted not only by common excessive uterine contractions, but also the concurrent presence of fetal heart rate deceleration. The study used tracing data from PeriGen’s PeriCALM system, which allows real-time detection of the condition.

Technology

PatientPoint releases PatientPoint Tracker, a patient engagement tool for tracking patients across the care continuum.

Caradigm releases Care Management, a population health management tool developed in partnership with Geisinger Health Plan.

Other

Canada becomes the thirteenth country to issue a patent to MMRGlobal’s MyMedicalRecords  subsidiary for its online medical records technology. In an MMR press release, the company notes it is negotiating an agreement with an investment fund specializing in financing the enforcement and licensing of global intellectual property rights which would “maximize MMR’s ability to exploit its global health IT patent portfolio.” “Exploit” sounds like an appropriate term to describe MMR’s apparent  modus operandi.

An Accenture survey finds that 40 percent of Americans would switch doctors to gain online access to their electronic medical records. That sounds like a suspiciously high number and no doubt it is – Accenture conducted the survey online.

CHIME President and CEO Russ Branzell pens a National Health IT Week piece called “HIT Capabilities – They Are Personally Important to Me.”

MU Stage 2 is accelerating EMR-specific patient portal adoption, though the trend is negatively impacting best-of-breed vendors that are not as well equipped as EMR offerings, according to a KLAS report on patient portals. Athenahealth, Epic, and Allscripts were the top-performing vendors.

A population health management report created for institutional investors by equity research firm JAAG Research concludes that the big PHM market opportunities are at least 10 years away; that lack of data standardization, timeliness, and completeness makes a “Big Data Mess;” and on the CommonWell Alliance “Maybe it’s just us, but all of this soft, ‘.org’ alliance, love-in, ‘we’re in this together for the good of the patients’ blather sounds more like a plan for each vendor to appear collegially engaged from a public policy perspective while keeping the government from forcing a solution on the market. Meanwhile, each ‘member’ works on its own, potentially more profitable solution, outside of the auspices of the happy ‘.org’ shell.” It concludes that “PHM will require a reengineering – almost a complete rebuild – of the healthcare payment and delivery process as we know it.” It’s an excellent report and a tremendously fun read.

R&D spend by major EHR vendors. #Epic #UGM2013 pic.twitter.com/wMfMREgfmx

— Jon Palma (@jonpalma) September 17, 2013

Me & 15,300 others. #UGM2013 pic.twitter.com/AwFx59cFu2

— Melissa MT (@LissaMinnesota) September 17, 2013

I found the Epic UGM tweets and photos above using the cool page that Vonlay built to curate the event. Look carefully and you’ll see Judy in her Avatar outfit.

Weird News Andy titles this story as “Doctor Gives Patient the Finger.” A Florida doctor grows back a man’s amputated finger by using a pig’s bladder as a mold.

Sponsor Updates

• CCHIT certifies that Wellsoft’s EDIS v.11 is compliant with the ONC 2014 Edition criteria and certifies it as an EHR Module.
• NCQA awards Case Management Accreditation to Alere and OptumHealth.
• Quantros hosts its first annual Pharmacy Quality and Safety Summit September 25-26 in Sarasota, FL.
• Valence Health launches its Pathfinder Accelerator Grant program, which makes $1 million available to hospitals and health systems to apply towards Valence Health’s Pathfinder services for transitioning from volume-based to value-based care.
• Vocera Communications CMO Bridget Duffy, MD will discuss improving the patient experience at two upcoming industry events.
• 3M Health Information Systems will offer its suite of ICD-10 and CDI consulting services and software integrated with MedPartners HIM’s credentialed and clinical documentation improvement staffing resources.
• Consulting magazine recognizes Aspen Advisors, Cumberland Consulting, and Impact Advisors on its list of “Best Small Firms to Work For 2013” and Deloitte Consulting on its list of  “Best Firms to Work for 2013.”
• Frost & Sullivan presents Vitera Healthcare Solutions its 2013 North American Customer Value Enhancement Award for outstanding performance and success, which recognizes the company’s focus on implementing strategies to create customer value.
• ReadyDock partners with IT provider Red River.
• Managed Health Care Associates will launch MHAuthorizeRx, a solution powered by CoverMyMeds and designed to streamline the drug prior authorization process for pharmacies.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

University of Iowa Health Care’s Pager Replacement Project

University of Iowa Health Care has been receiving a good bit of press after a local TV station ran a story called “Bye-Bye Beepers” that implied the health system is eliminating pagers. I spoke to Patrick Duffy, administrative lead of the technical operations division, who says that isn’t quite the case.

The health system still hasn’t figured out how it can replace pagers for off-campus use, but it has moved inpatient nursing unit communication to Voalte running on iPhone 4S phones. “We’re doing what we said we wouldn’t do – adding a device – while eventually moving off the paging system,” Duffy says. “Also integrating with nurse call, and hopefully eventually monitors and Epic.”

The hospital has 8,000 pagers with extensive workflows based on their use. But according to Duffy, “As good as they are at doing what they do, we were having more and more issues with not being able to close the loop and have that acknowledgment.”

The health system went through several technologies before deciding on Voalte. They tried several hundred proprietary NEC devices, but ran into problems with network access. Cisco Voice gave them full Wi-Fi coverage throughout their 4 million square feet, but users kept asking how to send text messages on the Cisco 7925 wireless phones. Some users favored Vocera’s hands-free capabilities, while Microsoft Lync was also considered.

”We wanted more of a platform and not just a pager replacement – two-way, secure, and with message acknowledgment,” Duffy says. “Voalte made sense since we wanted to make a decision right away.”

I asked Duffy how his department determined which pager users were candidates for iPhones. “We talked to the nursing managers and medical directors. We asked, who do you communicate with? We got a list of who had pagers, who had Cisco phones, who gets all of their pages during the day on the unit, what are the needs for external paging outside the facility.”

Wholesale replacement of pagers may occur down the road, but the health system has no specific timeline or plan. UI is looking at Voalte Me, which runs on personal iPhones and possibly eventually on Android phones. Hospital operators use Amcom for paging and it has its own mobile app that can run on personal devices. Users who don’t need alarming and alerting capability could get by with simpler paging capabilities running on their personal phones. For users who send messages via Amcom’s Smart Web paging application, messages can be sent to pagers, personal iPhones, and Outlook email, although guaranteed delivery of the message is up to the carrier. UI is also looking at HIPAA-compliant secure texting.

Eliminating nursing unit pagers has provided other benefits. “It’s quieter,” Duffy says. “Pagers aren’t going off, phones aren’t ringing. We’re trying to reevaluate the model for our wired phone presence and the impact of mobility on our legacy systems.”

Monday Morning Update 9/16/13

From Thinking UGMs: “Re: user group meetings. Our company is getting large enough to be considering holding our first user group meeting. Do you have ideas?” It’s a great question – quite a few companies are getting big enough to consider throwing a UGM. Let’s crowdsource the idea – take the survey I created and I’ll collect and publish all the ideas right here on HIStalk. What factors would help make a company’s first user group meeting successful?

From Neutron Jack: “Re: HealtheWay. It’s supposed to be the national backbone for clinical data traffic, but maybe it’s not ready for prime time production.” A reader forwarded an email detailing abysmal technical support from the public-private collaborative that supports the eHealth Exchange, formerly the ONC-run program known as Nationwide Health Information Network Exchange (NwHIN, although technically it should have been NwHINE).  A simple support ticket didn’t get a response for a week despite three requests and an email to the CEO.

From Keeping the News: “Re: MEA/NEA. Did you see the company that Lindy Benton runs has been acquired by Accel-KKR? MEA has grown with their esMD participation. This could take the company to the next level.” Lower middle market private equity firm Accel-KKR takes a majority position in EA Holdings, which owns National Electronic Attachment (NEA) and Medical Electronic Attachment (MEA). The companies offer a platform for the electronic exchange of medical and dental claims attachments.

From The PACS Designer: “Re: Big data. Recent comments on HIStalk about big data deserve a response. TPD never uses big data in early conversations with customers since it is so vague and can falsely represent giving data viewers valuable information about their practices. For big data to add the value proposition, you need to transform your data through vendor partnerships so the greatest gain in value can be achieved. Only when you impress intended users can the real value be realized for storage of big data.”

From Informatics Professor: “Re: HIPAA Omnibus webinar. Best information I have gotten on the topic. As always, HIStalk is the best source of info on anything related to HIT.” Thanks for those nice words, and thanks to Rebecca Fayed and Eric Banks of The Advisory Board Company for doing their presentation pro bono for HIStalk’s readers.

Webinar

 

Health Catalyst will present “Predictive Analytics: It’s the Intervention That Matters” on Tuesday, September 24 from 1:00 to 2:30 p.m. EDT. It’s a great topic: predictive analytics aren’t worth much if an organization doesn’t have the culture and process to intervene effectively to help the patient. Presenters will be Dale Sanders (SVP) and David Crockett, PhD (senior director of research and predictive analytics). Both are amply credentialed to speak on the topic — Dale’s been a CIO and data architect, while David is a PhD in biomedical informatics and pathology expert. I’ve signed up.

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

I’ve had two recent needs met by one free (for personal use) software tool: TeamViewer. It’s really cool for remoting into someone’s PC to fix problems and also for transferring files from their PC to yours. I leave my desktop PC on all the time and Dropbox is good if you know in advance what files you might on other devices (like a laptop or phone), but TeamViewer allows navigating the entire hard drive in a password-protected session. It can also be used like GoToMeeting to run desktop sharing, as in online meetings and training.

Welcome to new HIStalk Platinum Sponsor MedData and its company MedDirect. The Brecksville, OH-based MedDirect provides reimbursement for outstanding patient balances while improving the patient experience. Utilizing proven patient segmentation and outreach strategies that educate, engage and communicate with patients in a way that drives results, MedDirect ensures that patients are treated with dignity and respect, exceeding patient expectations throughout every interaction. MedDirect services include innovative solutions for outstanding patient balances, patient satisfaction services, appointment scheduling and reminders, registration Point of Service payment portal, and patient billing. Thanks to MedDirect for supporting HIStalk.

Former Merge Healthcare CEO Jeff Surges will be named Monday as board chair of population health management systems vendor Strategic Health Services. Co-founder Tasso Coin will continue as a director.

GetWellNetwork will on Monday announce that Karen Drenkard, PhD, RN (American Nurses Credentialing Center) will join the company as chief clinical/nursing officer.

Medical provider database vendor Enclarity is acquired by LexisNexis Risk Solutions, joining previous acquisitions MEDai (analytics) and EDIWatch (fraud detection technology).

Texas Health Presbyterian Hospital Rockwall is implementing patient engagement technology from Emmi Solutions.

Thousands of Epic users are in Verona, WI this week for UGM. Madison-based Vonlay provides a user guide for attendees that includes useful tips, such as how to get to a local brewery using the hotel shuttles and where to rent bikes.

It’s only slightly HIT-related, but fun. Jeff Travis, a biomedical engineer who developed the database architecture of the Premise Patient Flow solution years ago, is now a filmmaker. Dragon Day, his first feature-length film, will premiere in theaters on November 1. It’s an ingenious plotline and looks like a fun watch if you like doomsday thrillers (and I do).

A Covisint-Porter Research study to be released Monday finds that provider executives are comfortable with the concept of cloud computing. Also: a third of respondents say their EHRs lack population health management capabilities and accountable care is on the radar or providers but isn’t a reality for them yet. The fact that jumped out at me is that most providers are still getting most of their inbound information by fax. Healthcare: the retirement home for 1980s technology.

The Congressional Budget Office says that replacing Medicare’s sustainable growth rate (SGR) reimbursement formula will cost $175 billion of your taxpayer dollars. CBO also found that very few Medicare demonstration projects actually reduced Medicare spending.

The local paper profiles Mary Carroll Ford, SVP/CIO of Lakeland Regional Medical Center (FL), although it manages to misspell her name in its headline.  

Allscripts CFO Rick Poulton, responding to a Chicago business paper’s dismissal of the company as a poor example for the city’s healthcare IT sector, says Allscripts is recovering from “a lot of self-inflicted wounds in 2011 and 2012” but concludes that, “We may not be as pretty as we could be, but we’re not a rehabilitation case.” Poulton blames the company’s problems on its 2010 merger with Eclipsys. He says Allscripts is still trying to integrate its hospital and ambulatory systems to compete with Epic’s “one patient, one record” architecture. Poulton has been with the company for less than a year.

The respective investment firms of former Allscripts CEO Glen Tullman and Chicago entrepreneur Brad Keywell form Zest Health, which will offer mobile apps that include Talk to Me (mobile phone access to clinicians), Schedule Me (booking medical appointments) Inform Me (patient education), and Track Me (a personal health record). Tullman’s company includes former Allscripts President Lee Shapiro. Zest Health’s CEO is Karen Ferrell, former CEO of Apollo Health Street.

Weird News Andy calls this Migration Malfunction. Patients of a Tacoma, WA non-profit breast center find that their electronic medical records contain information from other patients after a system conversion going back to September 2012.  A medical record number glitch caused problems, especially with scanned documents, in converting to the center’s radiology information system. The patient who complained to the state found that her 900-page chart contained 141 pages of information that wasn’t hers.

WNA also likes this item, which he clarifies isn’t about chastity belts, but rather security “breaches.” An employee of Minnesota’s new health insurance exchange releases the confidential information – including Social Security numbers – of 2,400 insurance agents by accidentally sending the file to an insurance broker’s office.

Vince’s HIS-tory of Cerner Part 5 covers HNA and acquisitions.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 9/13/13

Top News

A newly unsealed Medicare fraud lawsuit against Vanderbilt University Medical Center claims that its internally developed Vanderbilt Perioperative Information Management System (VPIMS) was used to bill services for physicians who were not physically present. Documents filed with the lawsuit, which claims the fraud spanned more than 10 years, include a Vanderbilt email telling surgeons to avoid documenting which rooms they were actually covering because “it only confuses and complicates the billing and documentation process.” The lawsuit concludes, “VIPIMS’ purported improvements in billing efficiency are, in fact, largely a function of Vanderbilt’s development of mandatory default software settings that require its physicians, in all instances, to document that they meet Medicare’s conditions for payment.” VUMC says its own investigation has uncovered no billing irregularities and vows to defend itself vigorously.

Reader Comments

From Bronwyn: “Re: Cerner Dynamic Documentation. Do you know of any hospitals currently using it who would be willing talk to a CIO about their experience?” Readers, send Inga a note if you can help.

From Reviewer: “HIPAA violation. If this isn’t the most egregious HIPAA violation ever, I don’t know what is!” A parent of a three-year-old patient posts a negative review on Yelp following a visit to a Phoenix plastic surgery clinic. The practice’s operations coordinator posts a reply that includes significant details about the patient and the office visit, as well as some harsh criticism of the mother and her parenting skills. Rebecca Fayed, associate general counsel and privacy officer at The Advisory Board Company, provided us her assessment:

I think that providers (or any covered entity or business associate for that matter) need to be particularly careful when posting anything online, whether it be on Yelp or other social media sites, that could be interpreted as a disclosure of protected health information. In this post,  HHS-OCR could view the response by the provider as a  disclosure of protected health information not permitted by the HIPAA Privacy Rule.

From Former Employee: “Re: Experian Healthcare, formerly Medical Present Value. Underwent its third round of layoffs this week, including its entire SME group and other client support staff. Sales are significantly down under Experian.” Unverified.

From small_data: “Re: misuse of the ‘Big Data’ buzzword. Simply storing data for archival purposes without intent of using that data for any kind of quantitative analysis is surely not ‘Big Data.’” The solution in question stores medical images. Everybody with a database now has “Big Data.” If they can export that information to Excel, they have enterprise analytics and business intelligence. If that worksheet can be emailed, they offer interoperability. If the worksheet can be stored on a Web server, it’s scalable and cloud-based. These are no longer technical terms with precise meanings; they have been hijacked by the sales and marketing people.

From Over It: “Re: Jody Albright, CIO, Overlake Hospital. Internal email says her position was eliminated and chief compliance officer will take on CIO duties. She had limited involvement with the Epic project and the go-live was a firestorm on several levels.” Unverified, but above is a purported internal email forwarded my way.

HIStalk Announcements and Requests

The latest news from HIStalk Practice includes: use of an EMR that includes automated growth monitoring helps doctors pick up on cases of possible growth disorders among kids.The AMA offers a toolkit (perhaps a little late) to help physicians prepare for upcoming HIPAA changes. HIT expenditures in physician offices jumped 28 percent from 2008 to 2012. Will cloud-based EHR/PMs really save practices from acquisition? Patients from Advocate Medical Group file a class-action lawsuit following the theft of unencrypted computers. Rhode Island primary care practices can earn up to $10,000 to connect to the state’s HIE. Culbert Healthcare Solutions VP Brad Boyd offers some advice for defining and measuring an EHR’s ROI. Thanks for reading!

Welcome to new HIStalk Platinum Sponsor EXTENSION. The Fort Wayne, IN company offers contextual alerting, secure messaging, and care team collaboration technologies, including specific solutions that address Joint Commission’s 2014 National Patient Safety Goal, “Improve the safety of clinical alarm systems.” First-generation systems just throw out a lot of alerts, but EXTENSION’s next-generation platform combines alarm safety software with a secure text messaging solution to optimize the workflow involved with clinical event response. The company’s HealthAlert solution solves the challenge of getting important clinical event notifications in the hands of clinicians, routing critical lab results, stat orders, staff assignment, patient monitoring, and patient nurse call requests. The system prioritizes the alerts, escalates based on defined rules, announces the event verbally to the recipient, and maintains an audit trail. It works with Android, Apple, Ascom, Cisco, Spectralink, and Vocera devices, including a mobile app that can run on a clinician’s own smartphone.  Thanks to EXTENSION for supporting HIStalk.

I found this short introductory YouTube video from EXTENSION called “The Power of the EHR-Extender.”

On the Jobs Board: Manager North America Professional Services West, Implementation Engineer (East Coast), Services Operations Manager.

HIStalk Webinar

Informatica will present “Best Practices for Delivering Better Quality Care and Reducing Preventable Patient Readmissions” on Thursday, September 26 from 1:00 – 1:45 p.m. Eastern.  Speakers are George Brenckle, PhD, SVP/CIO of UMass Memorial Health Care and Richard Cramer, chief healthcare strategist of Informatica (I interviewed him awhile back). Register here.

I recorded the HIPAA Omnibus webinar given by Rebecca Fayed and Eric Banks of The Advisory Board Company earlier this week and posted it to YouTube. The slides are here. Thanks to Rebecca and Eric, who stepped up when I asked for volunteers to run through the changes with HIStalk readers. We had a nice turnout, and in typical Advisory Board fashion, not a second was wasted due to inadequate preparation or lack of focus.

Acquisitions, Funding, Business, and Stock

Covisint will raise at least $64 million in its IPO by offering 6.4 million shares at an expected price of $9 to $11. The company generated $94 million in revenue for the 12 months that ended June 30.

Three partners of Morgenthaler Ventures create a new management company and the $175 million Canvas Venture Fund that will focus on early stage investments of $5 to $15 million in mobile, health IT, financial technology, and enterprise technology. The parent VC company invested in physician social network Doximity and free EMR vendor Practice Fusion.

The CSI Companies acquires Atlanta-based IT staffing firm Anteo Group.

Lincor Solutions moves its headquarters from Ireland to Nashville.

Sales

Estes Park Medical Center (CO) will implement HealthCare Anytime’s patient portal technology at its hospital and outpatient clinic.

The Valley Hospital (NJ) selects Merge Healthcare’s CTMS for Investigators to manage its clinical research operations.

UHS-Pruitt Corporation, a provider of post-acute care services, will implement healthcare analytics and population health solutions from Caradigm.

The 110-provider Prima CARE (MA/RI) selects Ingenious Med’s mobile revenue capture technology.

Washington Orthopaedics & Sports Medicine (DC/MD) selects SRS EHR for its 11 providers and three locations.

People

Wellcentive names Tom Zajac (Elsevier) CEO.

Health Catalyst appoints David K. Crockett, PhD (ARUP Laboratories) senior director of research and predictive analytics.

Robert Porr (Accenture)  joins Sandlot Solutions as EVP of sales and marketing.

Nancy Killefer (Department of the Treasury, IRS Oversight Board, McKinsey & Company) joins the board of The Advisory Board Company.

University of Missouri-Kansas City hires Mark Hoffman, PhD (Cerner) as director of bioinformatics core and associate professor to establish its Center for Health Insights informatics program.

Stanford Hospitals & Clinics (CA) promotes Pravene Nath, MD to CIO and Christopher Sharp, MD to CMIO.

MGMA-ACMPE names Garth Jordan (EDUCAUSE) COO.

Prime Healthcare Services (CA) will implement  Infor financials, supply chain and human capital management, clinical bridge, and analytics.

Announcements and Implementations

Quest Diagnostics joins LabCorp and almost all of Colorado’s large hospital laboratories in connecting to the Colorado RHIO.

The HIEs Michigan Health Connect and Michiana HIN will share health records between Michigan and Indiana providers.

The Patient-Centered Outcomes Research Institute board of governors issues 71 awards totaling more than $114 million to fund comparative clinical effectiveness research, including studies to improve the applicability of data collected through EHRs and social media sites and methods for engaging minority patients and caregivers in patient-centered health research.

Ivo Nelson’s Next Wave Health forms Smart Social Media, Inc., a software company that will develop a healthcare social media platform. Next Wave Health acquired the OneXPage social media platform from Digiapolis, Inc., founded by Minneapolis entrepreneur Eric Lopez, who will be CEO of Smart Social Media.

Gastroenterology EHR vendor gMed will use behavior-based prescription management messaging from LDM Group to improve medication adherence and highlight therapy options.

Government and Politics

ONC launches a patient matching initiative to seek common denominators and best practices being used by private healthcare systems and federal agencies.

Innovation and Research

The use of an electronic decision support tool linked to patients’ EMRs helped reduce deaths from pneumonia in EDs by up to 25 percent according to researchers from Intermountain Healthcare and the University of Utah.

An athenahealth analysis of EHR data from its user network reveals no signs of a national decline in childhood obesity over the last three years. Athenahealth obviously has a wealth of clinical data at its disposal and this type of analysis is interesting and arguably beneficial. However, are practices and patients aware of how athenahealth and other EMR companies may be using personal health information? More importantly, should they? To the latter question I say yes, and mechanisms should be in place to allow practices and patients to opt in or out.

Technology

AirStrip will develop and optimize its AirStrip ONE solution for Samsung tablets running Android and Windows 8.1 operating systems, as well as Samsung convertible and all-in-one desktop and laptop PCs with touch screens.

Lt. Dan covers the iPhone 5S announcement in his excellent HIStalk Connect analysis, “Apple Comes Up Big On The iPhone 5S Unveil: What it Means for Healthcare.”

Other

The Tax Increment Financing Commission of Kansas City approves a $1.635 billion incentive for Cerner’s proposed plan to develop a 4.5 million square foot mixed-used campus.

VA psychiatrists and researchers are using natural language processing and query searches of doctors’ free-text notes to flag patients who present a clear risk of suicide.

Crittenton Hospital (MI) will provide free electronic copies of medical records to the families of patients treated by Farid Fata, MD. Fata is the Michigan Hematology Oncology physician accused of deliberately misdiagnosing patients and improperly administering chemotherapy as part of a $35 million Medicare billing fraud scheme. The hospital provides records free only to medical doctors, but reversed its policy after the doctor’s patients staged a protest.

The New England Journal of Medicine gets banned from posting pictures on Facebook after running a medical image of a patient with scrotal calcinosis, which Facebook found pornographic. Facebook changed its mind shortly after.

Sponsor Updates

• Aventura publishes an informative and entertaining HIT Survival Handbook.
• Allscripts will add Inovalon’s quality improvement and risk score accuracy analytics  to its EHR platform.
• Health leaders in Leeds, UK will evaluate whether outcomes can be improved by using Alere’s healthcare platform.
• Medseek Empower 5.0 earns CCHIT certification as an EHR Module and is compliant with the ONC 2014 Edition criteria.
• Campbell Clinic (TN) reports that its use of Emdat’s medical documentation solutions has improved documentation completion, workflow, and transcriptionist productivity.
• Billian’s HealthDATA interviews Collin Searle, social media manager for Intermountain Healthcare (UT), about the health system’s social media strategy. 
• Clinovations CEO Trenor Williams discusses the need for pharma companies to  use technology and think more strategically about communications with health providers and patients. 
• Innovative Healthcare Solutions offers a white paper series that includes tips for a successful project outcome.
• Hot jobs on the site of Henry Elliott & Company, which specializes in Caché and M/MUMPS technology positions, include Senior M/Caché P/A, Caché M/Mumps Web Developer, VistA Analyst, and .NET/Caché Developer.
• Cleveland Clinic’s use of BI dashboards from Harris Healthcare has driven significant ROI and performance improvement, including a $10 million increase in net income.
• Intelligent InSites announces details of InSites Build 2013, an RTLS learning event October 28-30 in Fargo, ND.
• Sunquest Information Systems and the Association for Pathology Informatics will host a September 26 educational webinar on pathology informatics featuring Walter Henricks, MD of Cleveland Clinic.
• Florida Hospital Celebration Health realizes increases in key HCAHPS categories since implementing GetWellNetwork’s Interactive Patient Care and Clinical Practice Design solutions.
• UnitedHealth reports its use of InstaMed online payment option has resulted in over $3 million in payments since its late July rollout.
• Trinitas Regional Medical Center (NJ) enhances staff safety with Versus Visibility Staff Assist RTLS technology.
• Hayes Management Technology adds its go-live support and legacy support services to its website.
• Divurgent and Medix will host a Retro Arcade Event during Epic UGM. Readers may RSVP here.

EPtalk by Dr. Jayne

Mr. H mentioned that PatientSafe Solutions has joined us as a Platinum Sponsor, but I wanted to offer my own shout out for its PatientTouch system. I first saw it at HIMSS13, and as Inga can attest, was really geeked out about it. I’d love to see it installed at my institution, so maybe I’ll “accidentally” leave their information on my boss’s printer.

I spent the earlier part of this week at the AMIA Clinical Informatics Board Review Course in Chicago. There were enough sassy young female physicians in attendance, so I feel fairly safe in admitting it while being able to still remain anonymous. I even saw some sassy shoes, so I felt like I was in good company.

Why a board review, and why now? This fall marks the first opportunity for physicians to actually seek board certification in the subspecialty of Clinical Informatics through the American Board of Preventive Medicine. There’s also a pathway through the American Board of Pathology – based on the number of pathologists in the class I don’t want to neglect to mention that because I know if they’re reading they’ll correct me – but the majority of informatics physicians I know are not pathologists.

As a new specialty, they’re offering a “practice pathway” for those of us who are not fellowship-trained to seek certification, through 2017. Candidates in this pathway have to demonstrate at least 25 percent practice in clinical informatics during three of the five years preceding application. In 2018 and later, candidates will have to have completed a minimum of 24 months in an ACGME-accredited Clinical Informatics fellowship program.

Many of us are not fellowship trained. Instead we’re homegrown informaticists who have been at this quite a while. We may have done some coursework in informatics or had intensive mentoring in order to reach our level of performance. In my case, the thought of trying to go back and do a formal training program on top of working the number of hours I do currently made my skin crawl, as did the idea of spending $40,000 or more on a degree that wouldn’t raise my income or the level of respect from my peers.

After a little cajoling from a colleague, I decided to aim for certification in the first round through the practice pathway. It’s a bit daunting because it’s a brand new exam. None of us really knows what to expect, and although the Board has published an “examination content outline,”  it’s pretty daunting since the level of detail they could be expecting could be all over the map. The application process was also daunting, as I had to track down former bosses who could best attest to the time I’ve spent in the field. I’ve had five bosses at three jobs in the last five years and only one is still working at the hospital where we were colleagues.

I’ve never taken a board review course before, so this seemed like a good time to try it given the breadth of the material. The class was a nice mix including average working CMIOs and high-powered names from major academic institutions. The VA and military were well represented, as were ambulatory organizations, payers, and vendors. I’m happy to report a Bowtie Index of 3.67 bpd (bowties per day) with one attendee having particularly fetching choices.

The group was pretty social and there were some key themes heard during the cocktail hour and various breaks. One is that there are quite a few institutions out there that still don’t value the contribution that a CMIO brings to the table. Many CMIOs are forced to try to do the job without the title or the appropriate level of authority. If you’re at one of those facilities who still question whether you need a CMIO, check that exam content outline to learn more about what we do and what we can bring to the table.

Another key theme is that there is never enough money to do the work that needs to be done. That goes right along with the theme that there are always more projects to be done than can be humanly accomplished. I also learned that many physician informaticists are very driven and devoted to the field – so much so that one physician sitting near me said his colleague’s inhuman level of work product clearly means that she’s a cyborg.

I’m unfortunately having to play catch up for the days out of the office, so you’ll have to wait until Monday’s Curbside Consult to hear about the rest of the course and some fun things I learned including some informatics jokes. I’ll leave you with this one in the interim:

A programmer is asked by his spouse to get some groceries. She asks, “Can you pick up a loaf of bread, and if they have eggs, get a dozen.” He returns home with 13 loaves of bread. She asks, “What happened?” His response: “They had eggs.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 9/11/13

Top News

Healthcare learning and performance improvement systems vendor HealthStream acquires Baptist Leadership Group, a consulting practice owned by Baptist Health Care in Pensacola, FL, for $8.5 million. The company also announced that the health system will use its talent management software.

Reader Comments

From Warrior: “Re: telling clients about unethical sales tactics after quitting a vendor job. The answer to the question is an easy one. Take the severance package and agree to keep the pie-hole closed. Any unethical sales techniques will eventually reveal themselves. A couple of years ago I was a victim of senior management lies and deceit, to say nothing of what was being done to clients. I quit without calling customers or the competition regarding the egregious business practices. Three months after I resigned, several of the morally bankrupt executives were shown the door with very generous golden parachutes. Blood money – what goes around, comes around. My hands are clean!” My take: unless a former employer was doing something illegal as opposed to something unethical, keep the dirty secrets to yourself. If you were one of the “good guys,” your departure will make enough of a statement.

From More Cow Bells: “Re: Sutter EHR downtime. The spokesperson cited the uptime percentage as 99.4. It bothers me that the systems handling the clinical and financial information of our hospitals are estimated to be unavailable for more than 52 hours per year. I’m not sure any other industry that deals with public safety and well-being would tolerate being down an hour a week (air traffic control?) What about striving for the old standard of five nines?”

From Dirk Diggler: “Re: Sutter EHR downtime. You mentioned news articles whose come-on headlines don’t deliver anything but an advertiser click. Here’s one.” A HIMSS-owned publication lures readers in with the cutesy and eventually misleading headline above. The article it sits astride contains nothing but shallow information extracted from old press releases about Sutter’s Epic (actually Citrix) downtime. When you finally read down through an extra click to Page 2 (banking an extra click to impress advertisers), the healthcare IT expert cited is the hospital’s nursing union rep, who offered three suggestions: (a) train people on downtime procedures; (b) communicate well; and (c) get nurses involved in system design. You can decide whether the advice is more insulting to the healthcare IT experts targeted by the publication than the article itself. At least the headline didn’t start with a number (“Eight Reasons Apple is Really Cool”) or require clicking an idiotic slideshow of unrelated photos lifted from other sites. I don’t like getting fooled and I hate wasting time, so I stop reading sites that promise more useful information than they deliver.

From Not Intuit: “Re: Intuit Health. Fifty percent staff cuts today, including me. All seniors leaders except for the product development lead gone.” Unverified, but the source is not anonymous. The former Medfusion’s name is still Intuit Health temporarily, but it’s a private company again after being bought back by founder Steve Malik a couple of weeks ago. My August 27 interview with him is here.

HIStalk Announcements and Requests

 

Welcome to new HIStalk Platinum Sponsor PatientSafe Solutions. The San Diego-based company offers smart point-of-care mobile solutions for the future of accountable care, delivering measurable safety and quality improvements that fit into care team workflows. The company’s flagship PatientTouch system, with 70 implementations, offers iPhone-powered software solutions to eliminate harm, reduce waste, and improve productivity. New York-Presbyterian Hospital chose PatientTouch a few months ago and Parkview Medical Center (CO) recently extended its use and integrated it with Meditech 6.0. Thanks to PatientSafe Solutions for supporting HIStalk.

I found this YouTube video on PatientSafe’s PatientTouch.

Upcoming HIStalk Webinars:

The Transition to ICD-10: Building the Bridge as You Walk on It (Thursday, September 12, 2:00 Eastern)
Using Infrastructure and Application Monitoring to Assure an Optimal User Experience  (Thursday, September 19, 1:00 Eastern)

Acquisitions, Funding, Business, and Stock

Disclosure management services company MRO Corp. acquires the assets of MTT Enterprises, a release-of-information service provider.

Santa Rosa Consulting completes its acquisition of IT security company EGIS Systems and renames it Fortified Health Solutions.

ZappRx, a developer of a mobile e-prescribing platform, raises $1 million in seed funding lead by Atlas Venture and Life Sciences Angel Network. 

Scotland-based Craneware says its revenue and EPS were up for the year despite not hitting its target of 1-2 big-hospital sales that can be worth up to $20 million each.

A Forbes editorial urges Nuance to put Carl Icahn on its board instead of fighting him off with a poison pill provision. Reasons: (a) financial results and management guidance have been poor; (b) Nuance shareholders should want Icahn involved given his past performance; (c) it can’t hurt; (d) Nuance doesn’t seem to have a strategy other than acquiring other companies; (e) CEO Paul Ricci is overpaid, having made $78 million in the past three years; and (f) the company should break up into separate business to make its Siri-type voice offerings more attractive, or as the article says, “If I’m Apple, I don’t want a medical transcription company with a bunch of transcription workers in India, but I’d be very interested in just the mobile speech piece.”

Sales

Sentara Williamsburg Regional Medical Center (VA) selects Versus Advantages Asset Tracking and Fleet Management.

Kmart will offer LDM Group’s PharmacistCare and CarePoints messaging solutions to pharmacists and patients to improve medication adherence.

People

Healthcare consulting firm Decision Resources Groups hires Courtney Morris (Truven Health Analytics) as EVP of solutions.

Geeta Nayyar, MD (AT&T) is named CMIO of PatientPoint.

Clarity Health Services names Karlynn Billings (McKesson Specialty Health) VP of business development.

Announcements and Implementations

Children’s Hospital Colorado will extend its use of T-System’s ED facility coding solution to two new locations that will open in 2014.

A total of 101 Ohio hospitals are participating in the Medicity-powered CliniSync HIE.

JIT Healthcare Marketing launches to offer ad-hoc marketing, PR, and design services with a simplified payment process.

Mediware will invest $2.8 million on enhancements to its rehabilitation and respiratory care electronic documentation solutions.

Memorial Health Hermann Health System (TX) takes almost 600 providers live on eClinicalWorks EHR and adds an additional 200 user licenses.

Infor announces GA of Infor Implementation Accelerator for Healthcare for the management of financials, human capital, and supply chain processes. Infor also releases Infor EMS Integrated Healthcare suite, which provides a real-time exchange of data between EMS and hospitals.

ImageTrend releases Version 3 of its patient registry system.

Liaison Healthcare announces the launch of EMR-Link, which allows clinicians to view lab and rad results reported through its hub on any smartphone.

Corepoint Health adds Direct Project protocol support to the latest version of its integration engine, giving customers a simpler way to exchange information with external organizations.

ICA announces its SmartAlerts service, which identifies high-risk patients in real time to reduce readmissions.

Government and Politics

The Meaningful Use Workgroup of ONC’s Health IT Policy Committee plans functionality goals for MU Stage 3.

ONC releases “Certification Guidance for EHR Technology Developers Serving Health Care Providers Ineligible for Medicare and Medicaid EHR Incentive Payments,” designed to help developers of EHRs for providers who don’t usually fall under HITECH (mental and behavioral health, non-acute care settings) design systems that are interoperable with HITECH-influenced EHRs.

Innovation and Research

A study published in JAMA finds that implementation of EHRs  Kaiser Permanente Northern California in 2004-2009 was associated with a slight but statistically significant reduction in ED visits (519 vs. 490 visits per 1,000 patients) and hospitalizations (251 vs. 239 per 1,000 patients) for diabetic patients. Office visit rates exhibited no association.  Another JAMA published study finds that EHR-powered small practices produced slightly better outcomes working under a pay-for-performance program.

Mike Wasser creates the very cool BloomAPI v 0.1.0, a free self-hostable API that queries the automatically updated latest version of the National Provider Identifier database. It also supports simple and complex online queries. You’ll be interested if you want to look up doctors in real time by name, ZIP Code, address, or NPI.

Brian Norris (@Geek_Nurse) follows up his Tableau-powered MU attestation slicer and dicer with one on data breaches. He seems to enjoy tearing into large, publicly available data sets to provide new insights and the results are cool, so he might accept suggestions (that’s where the breach idea came from).

A keyword-based search of online help wanted ads finds that healthcare IT-related job postings have increased by 86 percent since HITECH passed.

Southern Polytechnic State University in Atlanta will host the CDC Health Game Jam September 20-22, challenging entrants to quickly produce games that address CDC’s health priorities, such as disease prevention and healthy lifestyles.

Technology

The European Patent Office will grant PeriGen a patent that covers specialized techniques for displaying patient data to help OBs recognize trends and deviations from normal conditions.

Streamline Health Solutions releases its dual coding enhancement for the eCAC and eAbstract applications that allows users to assign ICD-9 and ICD-10 codes simultaneously.

Other

A HIMSS Analytics survey on clinical and business intelligence finds that only 9 percent of respondents plan to buy a dedicated solution that integrates with their EHR, but among those who do, Truven, Elsevier, and Cognos, all of which significantly trail buying whatever their EHR vendor offers.  

A debt collection agency that previously worked for the University of Chicago Physicians Group announces that an incorrect security setting on its Web server opened up information about 1,344 still-active claims to anyone who happened to find it. The problem was reported by a debtor who noticed that they could see the information of other debtors.

Hospital bond ratings may suffer from the costs and problems introduced by an Epic implementation, but the bonds of Dane County, WI (home of Epic) enjoy a AA+ rating from Fitch because of Epic’s employee growth.

Speaking of Fitch bond ratings, Mary Washington Healthcare (VA) gets a low rating and downgrade after a $28 million profitability hit in FY2012 due to a billing systems conversion and another $2 million drain due to CPOE implementation, causing the hospital to write off $25 million. I believe both systems are Siemens Soarian.

Weird News Andy wonders what the funniest or most interesting things providers have experienced from their patients as in this story, where a man coming out from surgical anesthesia notices a woman next to his bed and says, “Man, you are eye candy. Whoa. You may be the prettiest woman I’ve ever seen. Are you a model?” When reminded that the eye candy in question was in fact his wife of six years, he exclaimed, “"Oh my God, I hit the jackpot.”

Sponsor Updates

• Capario announces it is ready to begin ICD-10 testing and offers customers an online ICD-10 submitter testing tool at no charge.
• Aprima Medical integrates NoteSwift into its EHR system.
• A Forbes article on the use of IT to advance the delivery of healthcare highlights QPID Health, which it calls a “promising startup software development firm.”
• Convergent Revenue Cycle Management will offer RCM solutions to Siemens customers.
• HIMSS Analytics reports that Imprivata OneSign is the most widely selected SSO solution among hospitals using EpicCare.
• ZirMed will offer tools to help providers transition to ICD-10.
• ATT offers a white paper discussing how providers can use a collaborative care approach to earn incentives and prepare for accountable care.
• Sumit K. Nagpal, president and CEO of Alere Accountable Care Solutions, shares his thoughts on how the use of technology can improve patient outcomes.
• Etransmedia CEO Vikram Agrawal discusses the lack of access to qualified programmers.
• Greenway Medical adopts the EHR Developer Code of Conduct issued by the HIMSS EHR Association.
• Divurgent posts tips for go-live personnel on how to make the most of relationships with recruiters.
• HIStalk sponsors listed on the 2013 InformationWeek Top 500 include: ATT, CommVault, Emdeon, Informatica, InterSystems, McKesson, MModal, NTT Data,  TriZetto and Xerox.
• The CSI Companies acquires IT staffing firm Anteo Group.
• The GE Foundation awards The Guideline Advantage an $880,000 grant to provide 12 FQHCs with quality improvement technology from Forward Health.
• Billian’s HealthDATA hosts an #HITchicks tweet chat September 19 to discuss four gender-related HIT topics.
• Nuance partners with Hyland Software to enable eCopy ShareScan to scan directly into Hyland’s OnBase EMC system.
• Benson Area Medical Center (NC) reports that it has reduced IT costs and improved security of patient data by utilizing the e-MDs EHR software within the ClearDATA HealthDATA cloud platform.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Quality Systems/NextGen Acquires Mirth

Quality Systems announced this morning that it has acquired Mirth Corporation, which offers the Mirth Connect open source integration engine and related tools. QSI says the acquisition will allow its NextGen Healthcare subsidiary to offer better data exchange capabilities, including participation in HIEs.

In the announcement, QSI President Steven Plochocki was quoted as saying, “The acquisition of Mirth will further strengthen QSI’s capabilities across the board, based on the new level of data integration and migration functionality it brings us. We intend to expand our client base and position the company for continued growth, particularly within both the connectivity and EHR replacement markets, as we work to meet the needs of hospitals and physicians as well as their patients. Mirth’s solutions, coupled with the depth of our current portfolio, will enable us to emerge as one of the most connected solutions in the industry. This will help accelerate our ACO strategy, support our rapid expansion into the interoperability market and give us the opportunity to cross-sell Mirth’s solutions."

The company says the Mirth brand, team, and offices will remain unchanged.

Monday Morning Update 9/9/13

From The PACS Designer: “Re: Apple’s fingerprint reader. With Apple possibly launching several products next week, TPD thought it would be good to give you a glimpse of what’s coming next. The fingerprint reader, if introduced, brings an interesting security solution for healthcare in that lost devices will be unusable as long as the security lock remains active.” Above is a leaked photo of a new iPhone start button with what appears to be a built-in fingerprint reader, from Sonny Dickson.

From IT Guy Turned Patient: “Re: Apple and healthcare. Interesting perspective. I could still argue persuasively for the Windows model. but what I know about the healthcare system could be inscribed on the top of a pin and still leave room there for me to ice skate. From my perspective as a recent user of healthcare, what seems to be the driving factor is simply referrals. I go to a primary healthcare provider who by most standards would be considered way better than average. I am listened to regarding symptoms, then referred to a specialist to whom I give the same answers to regarding symptoms, I am tested, receive boilerplate textbook treatment, and ushered out the door as I hear a receptionist behind me say, ‘Next.’ Meanwhile, five months later, nothing has changed. I am in exactly the same boat as I was pre-visit to either facility except about $1.800 lighter. I’ve never been called to be asked, “How are you? How did we do?” There’s no warranty. No one really seems to care once you’re out the door, which is interesting since the industry that I work in routinely makes that call. Why do people not howl at the moon over piss-poor healthcare the way they do over even mediocre or worse car care or home remodeling? I don’t know what it would take. I don’t know whether the Apple model or the PC model would work better, but from my point of view the entire experience seems so institutionalized and insulated from capitalism and the rest of the world. Something needs to change, but getting government more involved rather than less won’t accomplish that. One thing I know for certain is that we live in the United States of Unintended Consequences.” I’ll say again as I always do — you get what you pay for. More precisely, you get what insurance companies and the government pay for, and that’s patient and procedure volume. Unfortunately for now, nobody’s paid very much to care about how you like it.

From Caveat Emptor: “Re: ethics. Is a sales employee who feels their former employer engaged in unethical sales practices obligated to inform customers instead of accepting a generous severance package that prevents disclosure of those practices” I’ll open it up to readers for comments, but my answer is no. It’s not appropriate (much less an obligation) for a company’s former employee to start calling customers making accusations about company ethics. If the sales practices were all that bad, customers will find out and make their own complaints (possibly legal ones) that would carry more weight than those of someone who didn’t speak up while drawing a paycheck from that company, but suddenly feels moved to do so after quitting. I don’t have specifics about the practices mentioned here, but I’ll ask readers to weigh in anonymously on that issue as well – what are some really abhorrent sales techniques you’ve seen used?

Half of poll respondents attend the HIMSS conference because they want to see other attendees, while only 15 percent are primarily drawn there by the educational sessions (which is probably a good thing based on my perception of the slide in quality of the education track). New poll to your right: which of John Halamka’s five CIO challenges will be most important?

George Giorgianni, who has worked for HBOC, SIS, DocusSys, and Unibased in his 35 years in healthcare IT, will retire on October 4.

Cornerstone Advisors names John McGuinness, MD (Meditech) to the newly created position of CMIO.

Baylor Health Care System wins a local technology trade association’s innovation work for its development of add-on modules for Allscripts Sunrise Clinical Manager, including a physician documentation tool.

Jimmy Weeks posted on Twitter this photo of the Bridgeport Hospital appointment conversion team beginning the move to Epic. They’re part of Yale New Haven Health.

A business site says that Aetna once offered to buy physician appointment scheduling app vendor ZocDoc for $300 million, but the founders turned the deal down, probably wisely since the company is valued at a lot more than that now.

Vince’s HIS-tory Part 4 on Cerner looks at the company in its early LIS-centric days in the form of a customer’s system search.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 9/6/13

Top News

The HIT Policy Committee approves multiple recommendations presented by the FDA Safety and Innovation Act (FDASIA) Workgroup, including:

• HIT should not be subject to FDA premarket requirements except when it constitutes medical device accessories or involves certain forms of high-risk CDS, such as computer-aided diagnostics. EHRs, decision support algorithms, and HIE software may be subject to regulation.
• Vendors should be required to list products that are considered to represent potential risk.
• Post-market surveillance of HIT should include reporting from users and vendors and also include post-implementation testing.

The committee also called for adoption of existing standards and creating new standards to address specific areas, including HIE. The recommendations now go to the FDA, ONC, and FCC, which are expected to release a proposal for public comment early next year.

Reader Comments

From Dr. Loredana: “Re: male vs. female physician compensation. A study found that women docs spend more time with patients. Therefore, they see fewer patients and thus make less money. Physicians’ time should be valued and addressed just like any other resource in healthcare. It is finite and scarce and we only have 24 hours in the day like anybody else.” A quick Google search uncovered a number of studies indicating that female physicians spend an average of 10 to 50 percent more time with patients than their male counterparts. Now I am curious if there are any studies tying outcomes with time spent per patient encounter.

From Tallman Letters: “Re: consulting firms and vendors. I’m turning to you, our most trusted source! Which healthcare consulting firms or vendors are most qualified to (a) provide technical consulting to providers about what technical architecture they should use; (b) build a healthcare data model; and (c) implement the tech architecture for full EDW/BI? Keep up the great and amusing work you do for us all!” I’m turn to my most trusted source – readers. Please leave a comment with your thoughts for TL.

HIStalk Announcements and Requests

Some of this week’s highlights from HIStalk Practice include: athenahealth reveals development plans for its recently purchased Arsenal complex, including walking and biking paths, an incubator for HIT startups, and a beer garden. Minnesota State Fair visitors are given coupons for free healthcare e-visits. More than half of all medical students use tablets as part of their medical training. The IT administrator at an orthopedic practice accesses a physician’s electronic signature to forge prescriptions. Dr. Gregg discusses the darker side of vendor-provider relationships, including Practice Fusion’s opt-out policy for sending patients emails that appear to come from providers (I also share my view.) Thanks for reading.

On the Jobs Board: Healthcare Customer Advocate, Clinical Applications Consultant, Project Manager.

Acquisitions, Funding, Business, and Stock

Agilum Healthcare raises $1.43 million in a debt offering.

Teladoc acquires fellow telemedicine services provider Consult A Doctor for an undisclosed amount.

SAIC announces Q2 results: revenue down 12 percent, EPS $0.13 vs. $0.32, missing expectations and cutting its 2014 outlook. Its health an engineering segment did better, but only because of the recently acquired maxIT Healthcare. SAIC plans to split itself into two companies, with its national security, health, and engineering operations to be moved to a new company called Leidos, with headquarters in Reston, VA. Healthcare is the smallest of the three operations with 6,000 employees.

Sales

Tenet’s Saint Louis University Hospital selects iSirona’s device connectivity solution.

Pekin Hospital (IL) selects Interbit Data’s NetSafe business continuance and downtime protection software.

The VA awards AMC Health a five-year, $28.8 million contract to provide telehealth solutions and services.

Mt. Washington Pediatric Hospital (MD) contracts with HealthCare Anytime for its Enterprise Patient Portal Suite.

Community Medical Centers (CA) selects Infor Cloverleaf.

People

Cerner promotes Zane Burke from EVP of the company’s client organization to president. Neal Patterson, who covered the president role since former President Trace Devanny left in 2010, will retain the titles of chairman and CEO. Cerner says that Burke’s promotion does not represent a formal succession plan announcement.

HIT consulting firm Meditology Services names Michael Flynt (Workday) VP of sales.

Patient engagement portal provide Omedix appoints Shay Pausa (ChiKiiTV/Magnet) CEO.

Caradigm appoints Joel Ratnasothy, MD (Fujitsu) as medical director for Europe, the Middle East, and Africa.

Anil Chakravarthy (Symantec) joins Informatica as EVP/chief product officer.

Diane Cecchettini, RN, president and CEO of MultiCare Health System (WA), announces her retirement next year. She served as a flight nurse in Vietnam, was a troop commander in Desert Storm, was president of the Washington State Hospital Association from 2005 to 2007, and won several IT awards.

Marc Donovan (World Wide Technologies) joins Nexus as sales director for the company’s connected healthcare practice.

Announcements and Implementations

Virginia Hospital Center will invest five to $10 million to consolidate its 100-plus employed physicians into one multi-specialty group and migrate the currently separate practices to eClinicalWorks.

Cerner will integrate Elsevier’s CPM CarePoints and InOrder evidence-based content solutions into its PowerChart EHR.

Artemis Health Group will add Health Language’s clinical language management tools from Wolters Kluwer Health into the Artemis OB/GYN EHR, PM, and patient engagement solutions.

Carolinas HealthCare System will use aggregated claims and clinical data from Verisk Health to analyze and manage population health.

Castle Medical Center and Hawaii Pacific Healthcare will join Health eNet, Hawaii’s statewide HIE.

A new KLAS report on enterprise patient access finds that best-of-breed solutions are common, with the most important functions to users being calculation of estimated patient responsibility, eligibility verification, and preauthorization.

HealthTech’s YourCareCommunity.Com v1 earns ONC-ACB certification as a modular EHR.

Intelligent InSites adds integration with HyGreen’s hand hygiene monitoring system to warn workers who haven’t washed their hands.

The UHC alliance announces plans for an automated program that will extract clinical and administrative information from the IT systems of its members and transfer it to UHC for benchmarking. NYU Langone Medical Center and Cleveland Clinic will be the first adopters, with the system expected to be available to all UHC members by the end of 2013.

NextGen Healthcare client Willamette Valley Providers Health Authority (OR) deploys a clinical decision support tool developed by the Clinical Decision Support Consortium that takes a request for CDS from NextGen Ambulatory EHR, delivers it to an enterprise clinical rules service at Partners HealthCare for analysis, and immediately returns recommendations within the NextGen application. The “cool” factor here: community-based physicians can access CDS data from a large academic medical center across the county and retrieve recommendations at the point of care. The Consortium aims to establish nationwide consistencies for CDS recommendations and is comprised of members from provider organizations and EHR vendors, including Partners and NextGen.

Government and Politics

Brian Norris of Social Health Insights LLC  created a cool visualization page for Meaningful Use attestation data using tools from Tableau Software.

Innovation and Research

GE, Under Armour, and the National Football League launch the GE NFL Health Health Challenge, which will award prizes of up to $10 million for concussion-related solutions that can include technologies to detect and measure brain injury.

Palomar Health expands its Google Glass incubator Glassomics to include smart watch technology in healthcare. For some background on the smart watch market, see Lt. Dan’s post on HIStalk Connect, “A Primer on the Up-and-Coming Smartwatch Market and What It Means for Healthcare.”

A Mayo Clinic study finds that data from the Fitbit activity tracker can help predict the mobility of post-op patients and help clinicians customize their care plans.

Research by the Pennsylvania Patient Safety Authority finds that EHR default values cause quite a few errors in drug doses and times, although nearly none of the errors caused patient harm.

Other

John Halamka’s five biggest CIO challenges for the next few months:

1. IT requirements driven by mergers and acquisitions
2. Regulatory uncertainty related to ICD-10, HIPAA Omnibus, and Meaningful Use Stage 2
3. Meaningful Use Stage 2 requirements, particularly at shops like BIDMC that build their own applications
4. The ability of provider organizations to keep the doors open while trying to meet all the regulatory requirements as revenue declines and risk-based reimbursement increases
5. Leading in real time

I am ashamed to admit that I found this story just a teeny bit amusing, though so pathetically wrong. A patient files a civil lawsuit against Torrance Memorial Medical Center (CA) after discovering that an anesthesiologist had decorated her face with stickers while she was unconscious during surgery. A nurse’s aide snapped a photo of the patient, who was freshly adorned with a black mustache and teardrops. The anesthesiologist and other involved employees were disciplined but not fired.

Three UK doctors face a loss of their medical licenses after allegations that they copied material from a book to create an iPhone app that helps evaluate clinical evidence. One of them faces an additional charge of posting a positive review of the app on the App Store without disclosing that he has a financial interest in it.

A Forbes article wonders if Cleveland Clinic can save its home city with its $6.2 billion in revenue, $300 million in operating income, $10.5 billion in assets, 42,000 employees, its own 141-trooper division of the state police, and now its plans to spin off for-profit companies and jump start the local economy with the Global Center for Health Innovation, scheduled to open next month with HIMSS as its largest tenant. Cleveland’s population has dropped 10 percent in the last decade and median income fell 60 percent, with its only economic bright spot being healthcare.

Anybody see a HIPAA problem with this pre-med student’s Google Docs-based patient tracking solution?

Cardiologist Eric Topol, MD, who is also editor-in-chief of Medscape as of February 2013, interviews Farzad Mostashari, MD. It’s good. Some snippets and factoids:

• Mostashari came to the US from Iran at 14, then went to Harvard and Yale.
• “Ninety percent, probably, of what happens in healthcare today has no basis in evidence. At the very least, I think what we owe ourselves and our patients, what we really want to do is: If we have variation, if we make a decision that is not based on the general guideline, it should be studied so that we learn something from that variation.”
• “The dream is that with every encounter, you know everything about the patient. You know everything about any medical knowledge that has ever been generated and you know everything about what is happening right now in the community where we are. Because the treatment for a sore throat is going to be different in January with the flu epidemic than it is going to be in September when asthma is peaking. So you have to bring in the 10 to the 6th power, the 10 to the 3rd power, and the 10 to the zero in that encounter. Whatever you do generates and goes back to teaching everybody else what is going on in the community, what is going on in medicine, and contributes to this patient’s knowledge. Right now my visit doesn’t even contribute to my next visit.”
• On $37 billion in HITECH incentives: “I think doctors would say that they earn it. No one gives out anything.”
• Mostashari and US CTO Todd Park roomed together when they moved to Washington, DC four years ago in July, sharing a small apartment with no air conditioning.
• On the jokes that ONC stands for “Office of No Christmas” because of the push to get the work done. “That is what it felt like — that there is this incredible urgency. You have a day, a week, a month, and pretty soon the opportunity to make a difference is gone.”
• “Meaningful Use, it is a tool. Take that certification, take that decision support, take that quality measurement. Don’t have quality measurement done to you or say, ‘I am going to be paid and judged based on quality. I can’t control that.’ What you can do is make it meaningful; take the tools and make them meaningful. Help your staff make the tools meaningful.”
• “We are going to solve this path that we have been on towards unsustainable cost growth. One out of every $5 spent in this country is being spent on healthcare. It is just amazing, and it is not sustainable. It is not sustainable for people, for families, for businesses, for state governments, for federal governments. It is not sustainable for anybody. We are going to solve that. I think we are going to solve it not by cutting people back, not by saying ‘You can’t get that,’ but by delivering better care. I really believe that.”

Weird News Andy thinks it’s cool that a University of Michigan 3D-printed lung splint saved a child’s life. The surgeon says he hand-carves such devices when necessary, but he can’t match the accuracy or speed of the computer.

Sponsor Updates

• Forrester Research names Ping Identity a leader in its identity and access management report.
• EDCO creates  a video explaining its point-of-care medical records scanning process.
• Truven Health Analytics releases ActionOI Practice Insights, which allows hospitals and practices to compare productivity, costs, and utilization.
• ZirMed partners with EHR Integration Services to provide Allscripts PM and GE Centricity Group Management customers integration with ZirMed’s RCM, clinical communications, and analytics solutions.
• Kareo tops Black Book’s list of Top 20 Seamless Software Vendors for EHR, Practice Management, and RCM.
• NYC REACH, the REC for New York City, assigns Aprima the Medical Meaningful Use Champion status in its vendor recognition program.
• Medseek reports that 10 healthcare organizations are using its Empower enterprise patient portal and another 11 will go live in the next six months.
• Paul Taylor, MD, CMIO of Wellcentive, outlines the performance and improvement part of the Health Care Network Maturity Model.
• Vitera hosts a September 25 webinar on preparing for the PCMH transformation.
• An SiS blog post lists the “Top 6 Things Anesthesia Providers Should Know When Evaluating AIMS.”
• GetWellNetwork shares data from its healthcare system customers that demonstrate the relationship between patient engagement and improvements in patient satisfaction, quality and safety, and finance and operations.

EPtalk by Dr. Jayne

I wrote last week about a Wall Street Journal Health Blog piece. It referenced a survey about what motivates doctors as they make care decisions. More than half felt physicians want to do what’s best for the patient, where the choices of “fear of lawsuit” and “business / financial considerations” each received 21 percent of the response.

Since I covered fear of lawsuits already, let’s talk a little bit more about financial considerations. It’s easy to see a response of “business / financial considerations” and assume that means “what’s in the provider’s best financial interest.” I don’t think the vast majority of clinicians think that way. If we were constructing this survey, we’d have more granular choices. One of the main things I think about (after discussing the clinical appropriateness of a proposed procedure, treatment, or test) is whether there is a way to pay for the test. It was bad enough when all I had to worry about was whether the patient had insurance that would cover it, but today it’s so much more complicated. It doesn’t do any good to recommend a treatment if there is no way the patient can receive it due to financial constraints.

First, we have to think about whether the patient even has insurance coverage or not. If they do, is this symptom or condition related to anything pre-existing that may or may not be covered? If not, do I need to contact the payer for an authorization? How difficult is it to obtain the authorization? Are there tests, documents, or examples of trials of therapies that have to be provided for a medical review board to determine coverage? Does the payer have arcane rules that have been grandfathered into the plan regardless of recent legislation to ensure services are covered?

Should the authorization be obtained, are there limits on where I can send the patient? Does the patient have geographic or transportation issues that would make it more feasible (economically or otherwise) to do it at one facility over another? Does the patient have religious preferences that are in conflict with the mission of the preferred facility? Do I have to write a letter to explain the distress it would cause if allowances can’t be made for a non-preferred facility?

The next consideration is that even though the patient may have insurance and the procedure may be authorized, the out of pocket cost for the patient may be more than he or she can bear. Those under high-deductible plans are electing to defer care to the end of the year in hopes that they will meet their deductibles by then. If it’s a preventive service, we may have the opposite time shift: some plans have yearly aggregate limits on preventive services, so if they’ve already met the limit for the year, they may elect to push it to the next calendar year. Regardless of the kind of coverage, we have to know whether the patient can afford the patient portion of the cost, whether it’s a deductible, co-pay, co-insurance, or something else.

Let’s say the patient does not have insurance coverage. We have to think through whether the patient qualifies for any public assistance programs and if so, how long it would take to become enrolled vs. how acute the need for the test / treatment / procedure might be. If they don’t qualify for public assistance, are there any grant programs? Are there public health resources? Is there a hospital or imaging center doing a free outreach program? If not, do I have any colleagues in my hip pocket who would be willing to perform the procedure with a payment plan or under other medical hardship arrangements? Does the facility make allowances for self-pay patients and do they allow them to negotiate price? If so, what is a reasonable price? Where can the patient get more information?

Once we get through figuring out if we can proceed and how we’re going to pay for it, can the patient afford to take off work to have surgery, complete treatment, etc.? Is he or she covered by the Family and Medical Leave Act? Does he or she have to wait until they are eligible for coverage? Is there a short-term disability policy in place, and if not, does the patient have enough vacation time or other resources to be able to be off work? Or does he or she have to take the time off unpaid? Are there other family dynamics or barriers to care, such as who will take care of small children while the patient is in treatment? (Remember assessing barriers to care is part of being a patient-centered medical home and participating in pay-for-performance and accountable care initiatives. Believe it or not, worrying about the patient’s childcare arrangements has become our problem.)

If you’re not a provider, are you exhausted just reading this? I know I am. The absolute last thing to cross my mind in these situations is whether my practice will make any money ordering the intervention. Looking at the costs in the office for clerks, paper pushing and administrative shenanigans, multiple phone calls, faxes, the patient’s time, and my time to work through all of this, we’ve already lost money before the order even leaves the EHR. When you think about it this way, I’m surprised that business and financial considerations didn’t rank higher in the survey because it seems they’ve become part of nearly every clinical decision we make.

Maybe elements like this roll up under the attempt to do the right thing for the patient. Or maybe the average person taking the survey didn’t think about all these different factors. This wasn’t really a scientific survey, but I bet if you wanted to create one, the qualitative researchers would have a field day. I’d enjoy seeing the comparison between a survey of the general population vs. a survey of healthcare providers.

What do you think motivates doctors as they make care decisions? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 9/4/13

Top News

A new Robert Wood Johnson Foundation project called “Flip the Clinic” looks for ways to redefine the patient-provider encounter, including examples such as OpenNotes, Blue Button, and the Project ECHO telemedicine program. The program, bring run with a social innovation consulting company and a design firm, will launch a toolkit in early 2014.

Acquisitions, Funding, Business, and Stock

Quantia, the developer of physician social networking and learning platform QuantiaMD, raises $10 million in Series B financing, led by Safeguard Scientifics and Fuse Capital.

A Crain’s Chicago Business column ponders “Why is Chicago so bad in health care IT?” saying that at Merge Healthcare and Allscripts, “sales are shrinking and losses are rising at both companies; each has endured upheaval in the executive suite.” It concludes that both companies need to turn around before the HITECH well runs dry and laments that local healthcare IT startups “don’t have have better role models.”

Sales

Jamaica Hospital Medical Center (NY), Catholic Health, INTEGRIS Health, (OK) and about 40 additional provider organizations select Nuance Clintegrity 360’s computer-assisted coding platform.

Long-term care provider Nexion Health selects the Daylight IQ clinical outcomes management system.

People

Kristi Syling (Vanguard Health Systems) joins PerfectServe as compliance officer.

Announcements and Implementations

Novant Health Presbyterian Medical Center (NC) will deploy Epic October 5, the first of the health system’s 14 medical centers to go live. Novant’s 1,205 providers are already using Epic across 316 clinics as part of the organization’s $600 million EHR initiative.

The New Zealand Ministry of Health implements the Health Identity Programme, a standardized interoperable platform built on IBM’s Infosphere Master Data Management to identify patients and providers across the country’s health sector.

HIMSS names eClinicalWorks customer White River Family Practice (VT), winner of the 2013 Ambulatory HIMSS Davies Award of Excellence for its success in improving quality of care and patient safety while achieving a demonstrated ROI. In its award application, the practice hits on a point too often overlooked by providers unwilling to dedicate the time and money required for EMR success:

“Return on investment is critically dependent on how quickly the practice returns to typical patient-visit volume. To that end, investing time and resources to learn the chosen EHR system up front will expedite the office’s return to pre-EHR patient volumes, obviating the need to spend late nights trying to catch up.”

Cheyenne Regional Medical Center (WY) will pay about $50,000 a year to participate in the state’s MyWy Health information exchange, which is currently funded with a $4.9 million HHS grant and $260,000 from non-governmental sources.

Allscripts announces GA of Professional EHR 13.0.

Microsoft shows off sports-related applications that use its products, including the National Football League’s eClinicalWorks EMR and the X2 sideline concussion diagnosis system.

Truven Health Analytics announces that Micromedex NeoFax and Pediatrics now support HL7 integration with EHRs for clinical decision support and CPOE.

Merge Healthcare’s iConnect Enterprise Archive is named the leading vendor-neutral archive solution in the US and the world, accounting for 32.6 percent of all studies stored in a VNA in the US and 22.7 percent worldwide.

Government and Politics

The HIT Policy Committee will meet Wednesday from 9:30 a.m. until 3:15 p.m. in Washington, DC (with live streaming) to review the FDASIA Workgroup’s recommendations and to hear from the Meaningful Use Workgroup on progress toward Stage 3.

England’s Department of Health announces $375 million in funding for information technology for hospitals, surgeries, and EDs, raising the total money placed in the Technology Fund at more than $1.5 billion.

Other

Nine out of 10 hospitals report they experienced RAC activity in the first half of the year, according to an AHA survey of 12,000 hospitals. Requests from Medicare for medical records are up 47 percent since the fourth quarter of 2012 and complex audit denials by Medicare RACs rose 58 percent in the second quarter of 2013.

A Missouri orthodontics practice notifies 10,000 patients that their information was stored on unencrypted computers that were stolen from the practice in July.

The CIO of the Marine Corps says, without referencing the source, that 25 percent of surgery liability lawsuits are related to software.

Sign of the times? Mayo Clinic Health System announces the closing of its Blooming Prairie, MN (population 2,000) facility after the resignation of the practice’s sole provider. Mayo says the closing is temporary and encourages patients to travel 15-20 miles to other locations.

Bradford Regional Medical Center (PA) opens the country’s first inpatient treatment program for Internet addiction, which will cost $14,000 for a 10-day stay that insurance won’t pay for.

I’ve noticed several eye-catching headlines this week highlighting the continued inequities in compensation between male and female physicians. Research published in JAMA finds that the gender pay gap among healthcare workers has grown over the last decade, with male physicians earning about $56,000 (or 25 percent) more than their female peers. Researchers note that a physician’s specialty or practice type may account for some of the difference, but say more research is required to understand if specialty and practice choices are due not only to the preferences of female physicians but also unequal opportunities to enter high-paying specialties. The Gloria Steinem in me would love to hear readers’ theories for the compensation gap.

MMRGlobal not only terminates its patent infringement settlement with WebMD and refiles its original lawsuit, it also adds an additional complaint related to its newly issue patent entitled “Method for Providing a User with a Service for Accessing and Collecting Prescriptions.”

A startup called Handshake lets Internet users broker the sale of their personal data to interest companies, disintermediating market research firms and companies like Google and Facebook that grab it for their own bottom lines and instead allowing the user to negotiate their own deals. The site estimates that individuals could earn up to nearly $8,000 per year. Imagine the possibilities with health-related data.

A report by the Federation of Indian Chambers of Commerce urges the Indian government to restrict the importation of medical technology and instead encourage local innovation that will allow making services more affordable for all.

Sponsor Updates

• Etransmedia highlights a video describing how its Direct Care Coordinator software helped doctors at the Albany Med Faculty Physician Group communicate with other physicians.
• NextGen Healthcare releases an updated version of its Patient Portal, which incorporates Spanish and two dialects of Chinese.
• Beacon Partners hosts a September 13 webinar on using data analytics to improve population health management.
• CommVault reports earning a 96 percent customer satisfaction rating its support services survey.
• Xerox has processed and disbursed more than $1.7 billion in federal payments to providers for MU incentives through its State Level Registry tool.
• Jon Hamdorf, healthcare solution manager for Perceptive Technologies, participates in a panel discussion on the challenges of health information exchange at this month’s Health IT Summit in NYC.
• A Billian’s HealthDATA report lists 112 US hospitals that demonstrate positive net patient margins and 30-day readmission and mortality rates above the national average for heart attack, heart failure, and pneumonia, according to CMS.
• Divurgent co-authors a white paper with Bon Secours Kentucky Health System that provides both a client’s and vendor’s perspective on implementing an EMR.
• Wellcentive SVP Mason Beard and CMIO Paul Taylor, MD host a September 17 webinar on implementing an effective population health management and data analytics program.
• Ryan Uteg and Lyndon Neumann of Impact Advisors discuss EHR roadmap evaluation at a September 18 CHIME College Live Session.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Monday Morning Update 9/2/13

From The PACS Designer: “Re: TPD’s back. Since development efforts on a cloud based ICD-10 solution are winding, down it allows TPD the time to post again. A significant event took place concerning Apple this week which could be of interest to HIStalkers, and that is Apple’s acquisition of software company AlgoTrim. Their software improves access speeds to large file sizes typical  and larger diagnostic imaging studies that are more prevalent than ever in today’s practices. The AlgoTrim Fast Compression Library is the fastest lossless codec (compression) on the market, with speeds four times faster than similar codecs.”

I’ve been saying for years that companies need to override their lead-happy sales and marketing people and make their advertising material (like white papers and case studies) freely available on the Web without requiring completion of a sign-up form. My survey results back that up all the way. Half of a company’s prospects run for the hills when faced with a form, and another quarter provide phony information to avoid the dreaded follow-up call. Add in the number of people who sign up but don’t return calls and you’ll see the futility of trying to drum up product interest via an intrusive data collection form. New poll to your right: if you routinely attend the HIMSS annual conference, what’s your primary reason?

Just a reminder: a couple of folks with outstanding credentials will present a free HIStalk Webinar, “The HIPAA Omnibus Rule: What You Should Know and Do as Enforcement Begins” next Tuesday, September 10 at 2:00 p.m. EDT. Their presentation is not sponsored – they just stepped up when I asked for volunteers to go over the changes for readers now that the enforcement date is upon us. Thanks to our presenters from The Advisory Board Company: Rebecca Fayed, associate general counsel and privacy officer; and Eric Banks, information security officer. I watched their practice session and it’s meaty and fluff-free in the admirable Advisory Board fashion.

Financially struggling 68-bed Gila Regional Medical Center (NM), a Stage 6 EMRAM hospital and Meditech customer, eliminates its CIO position after the departure of David Furnas (and most of the executive team) earlier this month.

Joe Miccio (Divurgent) joins ESD as regional sales VP.

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

I’m constantly annoyed by websites (including healthcare IT ones) that tart up worthless “news” stories with catchy headlines, gratuitous graphics, annoying slide shows, and shameless ploys to get more clicks to impress potential advertisers. That’s all I’ll say since I can’t outdo The Onion’s eloquent criticism of CNN’s decision that Miley Cyrus is the most important news in the world, packaged as a phony confession from CNN’s editor, which is summarized as, “All you are to us, and all you will ever be to us, are eyeballs. The more eyeballs on our content, the more cash we can ask for. Period. And if we’re able to get more eyeballs, that means I’ve done my job, which gets me congratulations from my bosses, which encourages me to put up even more stupid bullshit on the homepage … Advertisers, along with you idiots, love videos.” Right now on CNN as some of its top stories: “The best cat video of all time is …”, “What Miley’s saying now”, “Twin baby pandas now fuzzy, cute,” and “Hear painful beauty pageant blunder.” You won’t find any of those stories on the BBC, although it probably gets a lot less traffic in not pandering to the average American reader. In healthcare IT, you get the added bonus of writers who have never worked in healthcare IT trying to explain it to experts or even editorializing about it, which would be like an unathletic sportswriter telling Peyton Manning how to throw a football.

The non-profit Medical Identity Fraud Alliance launches with founding members that include AARP and the Blue Cross Blue Shield Association. The group says its goals include driving policies, laws, and technology to reduce medical identify fraud.

Wake Forest Baptist Medical Center’s botched Epic implementation caused it to lose $55 million in the fiscal year on the operations side, according to its preliminary financial report. The hospital says the Epic implementation “did have a substantial negative impact on fiscal 2013 operating performance through both direct implementation expenses and associated indirect expenses,” causing a $54 million hit due to go-live disruption, deferred operational improvements, and billing problems.

The US Army is preparing for a major upgrade to its MC4 battlefield EMR that will include a move to Windows 7, replacing Micromedex with Lexicomp, adding a graphical user interface to TC2, and requiring a PKI-E certificate for security.

In England, NHS expects up to 50,000 clinicians to learn the basics of programming under its Code4Health initiative, which hopes to encourage them to develop prototypes that NHS can turn into open source tools. The program is based on the US Code for America program, which encourages government employees to learn programming. Code for America is described above in a TED talk by its founder and CEO.  

A North Carolina comprehensive clinic for the uninsured closes, blaming a loss of funding, the state’s decision not to expand Medicaid coverage, and a loss of productivity caused by its new EHR.

The Federal Trade Commission files a complaint against  Atlanta-based LabMD, claiming that a patient-specific billing worksheet with information on 9,000 of its lab test patients was found on a file-sharing network and later in the hands of identity thieves.

Vince continues his HIS-tory of Cerner, from which I learned where the name originated and how the IPO came about.

Happy Labor Day, especially to those actually laboring on healthcare’s front lines. It may seem like the end of summer, but officially you still have three more weeks to wear those snazzy white shoes and seersucker suits.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 8/30/13

Top News

HHS and the Illinois attorney general announce that they will investigate the July 15 theft of four unencrypted Advocate Medical Group desktop computers that contained the medical information of 4 million patients, announced last week. An HHS spokesperson signaled the financial exposure the medical group is facing in describing the “high-profile actions that have sent clear messages to the industry that we expect full compliance with privacy and security rules.” Advocate admits that the information should never have been stored on the hard drives. Obviously encryption technology would be throwing off some impressive ROI right about now, which might be something to consider if your organization hasn’t implemented it.

Reader Comments

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: Physicians are split when it comes to publicly sharing Medicare payment data. New York physicians are required to consult an electronic prescription database before writing scripts for controlled substances. The benefits of a practice’s ACO participation reach beyond the patients covered by the ACO. MGMA offers online scheduling tools for its annual conference. More than 90 percent of office-based physicians accept new Medicare patients, which is about the same percentage that accept new privately insured patients. The AMA urges CMS to prohibit insurers from paying physicians less than contracted amounts when reimbursing providers with plastic or virtual credit cards. Doximity says it has more physician members than Sermo. I look at the Stage 2 dilemma, highlighting the recommendations of various professional organizations and offering my opinions, namely that CMS should keep the January 2, 12014 start date but extend the deadline for meeting Stage 2 requirements. You won’t find any of these stories – and others – on HIStalk so keep reading HIStalk Practice if you like staying current with happenings in the ambulatory HIT world. Thanks for reading.

Welcome to new HIStalk Platinum Sponsor InterSystems. The company is a global leader in software for connected care. Its products empower healthcare professionals with the information they need to make the best clinical and business decisions. HealthShare is a strategic platform for healthcare informatics, enabling information exchange and active analytics across a hospital network, community, region or nation. Cáche is the world’s most widely used database system in healthcare applications. Ensemble is a platform for rapid integration and the development of connectable applications. InterSystems has more than 35 years of experience as a trusted partner serving thousands of physicians, hospitals, and health systems around the world, including Johns Hopkins, Kaiser Permanente and Memorial Care; five statewide HIEs; and the national health systems of Sweden and Scotland. The company’s technology is also used by over 100 leading healthcare software vendors in their solutions, including 3M Health Information Systems, Epic, and GE Healthcare. Thanks to InterSystems for supporting HIStalk.

A YouTube cruise turned up this video about InterSystems. I thought I knew the company pretty well, but I learned a lot about them.

On the Jobs Board: Staff Engineer (Java), Clinical Applications Consultant, Project Manager.

HIStalk Webinars

CareTech Solutions will present “Using Infrastructure and Application Monitoring to Assure an Optimal User Experience” on Thursday, September 19, 2013 at 1:00 p.m. Eastern. The presenter will be John Kaiser, senior director of the Pulse IT monitoring service. The abstract:

It’s time for hospital IT monitoring to mature – from reactive to predictive. Supporting the highly-complex healthcare technology environment with only individual monitoring tools or relying on an application vendor to identify system degradation is not the most effective means to providing users with a reliable, optimal IT experience. A comprehensive monitoring solution includes eyes on servers, network, application performance, and real user monitoring. CareTech Solutions will discuss an integrated approach to comprehensive monitoring of both the infrastructure and applications, with an emphasis on delivering a consistent solution based the hospital’s IT maturity level. The target audience is CIOs, CMIOs, CNO, IT directors, and IT analysts.

Acquisitions, Funding, Business, and Stock

The healthcare IT business unit of Tennessee-based Parallon Business Solutions, itself a subsidiary of Hospital Corporation of America (HCA), merges with Vision Consulting to form Parallon Technology Solutions, with Vision President Tim Unger taking the CEO role. Parallon Business Solutions has 24,000 employees and provides services to 1,400 hospitals and 11,000 non-acute care providers.

Carl Icahn boosts his stake in Nuance to 16.9 percent of the outstanding shares, according to an SEC filing Tuesday, saying he may want to talk to the company about adding his slate of nominees to the board. Above is the one-year NUAN share price in blue vs. the Nasdaq in red.

Sales

Blessing Physician Services will deploy Phytel’s population health management suite.

Rideout Health (CA) will roll out Perceptive Software’s Enterprise Content Management solution integrated with its McKesson Paragon HIS.

People

McKesson Specialty Health and the US Oncology Network appoints Michael V. Seiden, MD (Fox Chase Cancer Center) CMO.

Physician RCM provider MedData promotes Ann Barnes from president to CEO.

Announcements and Implementations

Australia’s Noarlunga Hospital activates Allscripts Sunrise Clinical Manager.

Novant Health (NC) reports that 343 of its physician clinics are now live on Epic’s PM platform and 316 are live on EHR. The five-year project was completed three years ahead of schedule and under budget.

Humana and Centene join Verisk Health as founding members of its pooled data initiative, which uses Verisk’s database of cross-payer information and analytics to identify illicit billing practices.

Hawaii Advanced Imaging Institute upgrades to RamSoft’s PowerServer RIS/PACS/MU radiology workflow application.

Home device manufacturer Bosch Healthcare and health content vendor Remedy Health Media announce a partnership to develop and sell products for remote patient monitoring.

Government and Politics

ONC opens the Behavioral Health Patient Empowerment Challenge to highlight existing technologies to help patients manage their mental health or substance use disorders.

A Washington Post article says that the Department of Veterans Affairs was paying bonuses to its disability claims employees despite a mammoth backlog, thereby encouraging them to game the system by pushing the tough claims aside to boost their numbers. It does point out that employees were handling high claims volumes even though the number of claims made the backlog grow.

Other

Skyline Exhibits provides trade show stats that vendors might use to justify for exhibiting: (a) 81 percent of trade show attendees have buying authority; (b) the top reason for attending is to see new products; and (c) building brand awareness is the highest marketing priority for most exhibitors. Marketing execs may very well need to look for justification considering that a 10×10 booth at HIMSS costs about $4,000. Tack on drayage, shipping, travel, trinkets, and personnel and you’re at $20K in no time.

Coming to a baby shower near you: a smart sock from Owlet Baby Care that monitors a baby’s vitals and sleep position and includes a four-sensors pulse oximeter, an accelerometer, a thermometer, and a transmitter to send data to a smartphone or computer. The company’s cofounder says the device does not require FDA clearance, though a version that includes an alarm system for oxygen levels will. Owlet is seeking $100K in crowdfunding.

Here’s a story of interest to anyone in charge of their organization’s encryption efforts. UT Physicians (TX), the medical group practice of the UTHealth Medical School, notifies 600 patients of a potential data breach after the theft of an unencrypted laptop. Unlike similar thefts at other organizations, UTHealth has a comprehensive encryption policy that covers more than 5,000 laptops. The stolen laptop was overlooked, however, possibly because it was attached to an electromyography machine in the orthopedics department and is considered more of a medical device than a standard computer. The laptop included patient names, birth dates, and medical record numbers, but no financial information.

Researchers in Canada find that the use of RFID badges raised the handwashing compliance of nurses from 33 percent to 69 percent. Their study appears in the current issue of CIN (Computers, Informatics, Nursing). I wasn’t familiar with that journal even though it’s been around in various forms since 1983, but it looks decent.

Fourteen-hospital Baptist Memorial Health Care Corp. lays off 61 employees, including pharmacists and nurses, but urges them to reapply for 500 open positions, many of those newly created to support its Epic rollout.

If you’re a fan of evidence-based medicine or Coldplay, you’ll like this video, which was tweeted by Farzad Mostashari.

Spectrum Health (MI) fires several employees after one of them takes a picture of an ED patient’s rear and posts it to Facebook with a caption of, “I like what I like.” The health system fired the employee who took the picture and all of those who gave it a Facebook Like, including an ED doctor.

Marin General Hospital (CA) asks the FBI to investigate a possible scam that shut down the phones in labor and delivery and the ED last week.

Liviam announces its Facebook-like site for long-term hospital patients, which offers the CareStream timeline, a dashboard from which the patient can request help, a blogging tool, and an events calendar.

New York prescribers issuing prescriptions for pain meds must first check an online registry of pharmacy-reported filled narcotics prescriptions as of this past Tuesday, implemented to help curb the abuse of addictive drugs.

Sponsor Updates

• Truven Health Analytics offers free access to Micromedex iPhone apps for customers outside the US and Canada. Truven also announces enhancements to its Unify Population Health Management solution, which is deployed in partnership with CareEvolution.
• Iatric Systems announces that its Meaningful Use Manager and Public Health Syndromic Surveillance products have earned 2014 ONC HIT certification.
• IHS names Merge Healthcare the leading provider of vendor-neutral archive solutions in the world and in the Americas.
• iSirona adds Singapore-based telehealth services provider myHealth Sentinel as a reseller.
• The Massachusetts eHealth Institute awards Aprima Medical a $101,000 grant to advance the interoperability of EHRs with the state’s HIE.
• Besler Consulting releases a review of the FY2014 Hospital Inpatient Prospective System final rule.
• InstaMed achieves Phase III CAQH CORE certification.
• EClinicalWorks names HealthNet (IN) the winner of its Improving Healthcare Together video contest. Auburn Medical Group (GA) and Open Door Family Medical Centers (NY) took second and third places.
• Aspen Advisors shares details of the ICD-10 preparation services it delivered to East Jefferson General Hospital (LA).
• Dearborn Advisors discusses the need for healthcare organizations to optimize their EHRs in order to thrive in today’s regulatory climate.
• API Healthcare highlights the importance of meeting the needs of an aging workforce.
• pMD announces that its mobile charge capture solution will support iOS 7, which has a possible September 10 general availability.
• Visualutions will resell Wellcentive’s Advance to FQHCs.
• RazorInsights will showcase its ONE Enterprise HIS solution at the 15th Annual HIS Pros Buyer’s Seminar next month in Rosemont, IL.
• Medicomp hosts its annual strategy update webinar September 18 and 19 and opens registration for MEDCIN U sessions November 3-5 in Reston, VA.

EPtalk  by Dr. Jayne

It’s quite a challenge to try to keep up with Mr. H and Inga in finding newsworthy items each week for EP talk. Between our day jobs and our staggered publishing schedules, it’s easy to be scooped by another member of the HIStalk crew. In the spirit of mixing things up, we’ll be taking EPtalk in some new directions. I may write up an interesting product, discuss a recent journal article, or respond to something I’ve seen in social media. Since EPtalk runs with the news each week with a slightly different audience than Curbside Consult, I may do some multi-part pieces to allow reader responses to influence the next week’s piece.

Yesterday, @ONC_HealthIT tweeted a recent Wall Street Journal Health Blog piece that asked readers what doctors use as the basis for care decisions: business or financial considerations, fear of lawsuits, or doing what is best for patients. I was gratified that with over 1100 votes, 56 percent of respondents believe we want to do right by patients. The other two options tied at 21 percent.

I’ve spent a good part of my career working in emergency departments and urgent care situations. I have to agree that fear of lawsuits can be an important driver. Financial considerations are also important, but there are many nuances other than what this survey can capture. Case in point: at one of the hospital-owned urgent care centers where I moonlight, the leadership issues a monthly report that looks at our utilization. On the surface, this aims to encourage us to provide more cognitive medicine and perform less defensive medicine.

Although thoughtful practice is a nice goal, I’d be kidding myself if I thought the report was aimed at encouraging us to use our brains rather than tests. The fact of the matter is that our population is largely uninsured, with Medicaid and Medicare closely behind. The hospital has been hemorrhaging money for the last decade despite extremely good management. It’s largely due to payer mix and other external economic factors in the community. Across our department, the Family Medicine physicians have much lower service utilization than do the Emergency Medicine physicians, and I think it’s partly due to the way we see the patient population

As a family doc, I’m used to seeing patients quickly in the office, treating their self-limited problems, and moving on. There’s a relationship between the patient and the physician. We tend to think that if the patient is becoming worse or not improving, they’ll be back. We don’t feel that pressure to try to cover all eventualities while they are in front of us, although it’s become that way with the advent of the Patient-Centered Medical Home, Accountable Care, and other initiatives where every visit has become a preventive/full-service visit as we try to cram as much as humanly possible into each encounter.

I really try not to order tests if I can make the diagnosis based on clinical history and physical examination. Not just for cost reasons, but also because tests are not without risk. Even a simple urinalysis can give false positives that lead to unnecessary follow-up, including not only financial cost but the burden of patient anxiety.

I’m also not afraid to play the bad guy with patients when it’s indicated. I don’t care if your husband’s primary doc gave him antibiotics for his viral illness. Just because you came to the urgent care and have the same symptoms, you’re not going to get them from me. I don’t care if your copay was $50, it’s not the right thing to do. It’s likely you’ll mark me down on your patient satisfaction survey, but I’ve reached a point in my career where I simply care less about satisfaction scores than I do about quality care and antibiotic resistance. You’ll get my empathy, sympathy, and some symptomatic treatment, but no Z-pack for you.

My peers that trained in emergency residency programs tend to order more X-rays for vehicular trauma even if the clinical story isn’t that impressive. Maybe it’s fear of being sued or maybe it’s just the way they’ve been habituated from working in higher acuity and trauma centers rather than the ambulatory office. Maybe because there was that one case where they missed something and it came back at them later. It’s definitely harder to try to help a patient understand why decision support rules say it’s OK to not order an x-ray than it is to just shoot a film, and sometimes I order those films too. None of us is perfect and medicine still has some art to go along with the science.

The most interesting thing about the utilization reports, though, is that over the last year, they have done very little to drive any of physicians at the high end of the test ordering spectrum into a lower bracket. Right now, the only “incentive” provided is seeing your name on the report and where you fall against your peers. Some docs may consider these reports the way I see the physician satisfaction numbers – as something that’s not on the top of their list for the many things we have to worry about when we’re seeing patients. Others may need education or potentially something more tangible before their behavior will change.

The bottom line, though, is that defensive medicine is alive and well regardless of steps towards tort reform, provider education, and other interventions. I’ve been doing some thinking about the other 21 percent as well. I’d liked to have seen the “financial considerations” choice expanded to include other options but you’ll have to tune in to the next post for those thoughts.

I’ll still throw in the occasionally newsy tidbit especially if it involves both shoes and technology. A new CT scan technology by CurveBeam called pedCAT shows what the foot and ankle actually look like when weight bearing. I was fascinated by the YouTube clip from the Royal National Orthopaedic Hospital. Since I was hobbling around this afternoon due to a loose heel on my favorite pair of pointy-toed mules, it’s a sure bet that my scan would have more than one ICD-10 code associated with it. I’m leaning toward “Unspecified soft tissue disorder related to use, overuse and pressure” and “Grief reaction” since I ultimately had to pronounce said mules dead at 6:59 p.m.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

News 8/28/13

Top News

Two Kansas HIEs, one covering Kansas City and the other serving the rest of the state, risk losing their federal grant money if they can’t agree on data exchange terms by the state-imposed deadline of September 30 (already extended from July 30). LACIE and KHIN could be forced to shut down by the end of the year if they haven’t worked out their differences by then. KHIN doesn’t want the network to share data with insurance companies that aren’t KHIN members, while LACIE says the agreement would prohibit organizations that are connected to an ACO from accessing the network’s data. At issue is aggregated information that could be used for non-patient care purposes. The Kansas HIE board voted to shut itself down in September 2012 and let the Kansas Department of Health and Environment take over its duties, which means the state is in charge. Kansas has no secondary data use policy.

Reader Comments

From Joyce: “Re: Mission Hospital, Asheville, NC. Laying off 70 workers, which is big news in a small town where healthcare supports the local economy.” The 730-bed hospital will cut the CEO’s salary by 26 percent, slash management salaries from 13 to 20 percent, eliminate merit increases, implement a three-month PTO freeze where time off is not accrued for worked hours, reduce its 403(b) matching, and reduce the employee wellness incentive. The hospital’s CEO made $480K in 2010, while the CIO was paid $349K. That’s the problem with hospitals – they provide growth to their local economy, but much of that is paid for by federal taxpayers in the form of unsustainably rising national healthcare costs. Building an economy based on healthcare won’t work, which politicians seem reluctant to admit since hospitals employ a lot of people and write nice political donation checks.

From HealthPlans: “Re: WellPoint. AJ Lang is no longer with the company, an internal employee tells me.” A WellPoint spokesperson confirms that Andrew J. Lang, senior VP of application development since December 2008, is no longer with the company.

From Mennonite Rockstar: “Re: BIDMC IT security after the Boston bombing. I had the impression they rearranged the setup of their homegrown application’s security from reading the Fast Company article. Perhaps Mr. HIStalk can get Halamka to clarify?” John says that his IT shop made no changes to their applications, but did tweak their audit log reports to allow the hospital’s compliance department to monitor the specific situation.

Acquisitions, Funding, Business, and Stock

Group purchasing organization Premier Inc., owned by 181 hospitals, health systems, and other healthcare organizations, files plans for an IPO of up to $100 million in common stock. Premier had $869 million in net revenue for the fiscal year that ended June 30, up 13 percent from the prior year.

Merge Healthcare Chairman Michael Ferro, Jr. resigns and is replaced by board member Dennis Bell. Ferro, Merge’s top shareholder, has indicated that he may eventually explore ways to boost shareholder value, including taking the company private. MRGE shares were unchanged on the news.

Federal HIT provider Systems Made Simple projects 2013 income of $260 million, up from $167 million in 2012.

The strategic venture arm of Canada’s TELUS makes an unspecified investment in Rockville, MD-based Get Real Health, which offers the InstantPHR personal health record. Three of the company’s seven executives came from US Web, while two were Microsoft HealthVault developers.

Sales

Southern Prairie Community Care ACO (MN) will deploy technology from Sandlot Solutions to manage patient health information and give providers access to data  at the point of care.

HealthproMed (PR) selects eClinicalWorks EHR for its two-location FQHC.

Greenway Medical will develop an HIE for more than 500 physician members of the Denver-area Rose Medical Group, Rose Medical Center, and their patients.

Grady Health System (GA) selects Strata Decision Technology’s StrataJazz for cost accounting, operating budgeting, and capital planning.

PinnacleHealth will use Care Team Connect’s integration and rules engine to integrate biometric data from Honeywell monitoring devices with other patient health data.

Palmetto Health (SC) chooses 3M 360 Encompass System for automated coding, clinical documentation improvement, and performance monitoring.

The National Football League signs a 10-year agreement for the ININITT Smart-NET PACS, which will allow the medical images of players to be viewed remotely or from mobile devices on the sidelines.

People

QHR Corporation, a Canada-based HIT company, names Owen Haley (Allscripts) chief commercial officer.

Tony Scott (Microsoft) joins VMware as CIO.

Cumberland Consulting Group adds Joseph Serpente (McKesson) as director of business development.

Announcements and Implementations

PeaceHealth’s Peace Island Medical Center (WA) goes live on Epic September 1.

Emdeon launches a self-service testing exchange solution for ICD-10, allowing providers and channel partners to submit ICD-10 test claims and receive claim status feedback. The Emdeon Testing Exchange for ICD-10, which Emdeon purports is the first of its kind in the industry, requires no additional software and is a free service to Emdeon providers, channel partners, and payer customers. Sounds like a great service that would be even more valuable if more payers were ready and if providers already had ICD-10-ready software updates from their vendors.

Greenway presents Innovation Awards to Boulder Community Hospital Physician Clinics (CO), Regional Obstetrical Consultants (TN), and Albuquerque Health Care for the Homeless (NM) at its PrimeLEADER user conference in Washington, DC.

Sonora Regional Medical Center (CA) goes live on Cerner September 4.

Vocera announces enhancements to its secure messaging platform that include on-call scheduling, new smartphone clients, an improved Web console, and server enhancements.

I came across this tweet today. Ah, athenahealth, I don’t think you can convince me that switching EHRs is as easy as switching from Time Warner to AT&T U-verse.

Innovation and Research

University of Florida researchers are developing a scoring model that will use hospital EHR information to identify inpatients most likely to experience an adverse drug event, allowing those patients to be more aggressively monitored. The result will be rolled out to 13 hospitals for validation in the study’s second year.

Technology

An Ohio surgeon wearing Google Glass during a surgery broadcasts the procedure over the campus network, also using it to consult with a colleague.

Other

Apple is rumored to be planning a trade-in program for iPhones in an attempt to increase the percentage of units it sells directly. What Apple is really trying to do is get  more people like me to walk into their retail stores and spontaneously drop $50 on the latest, greatest cool Apple accessory. The speculation is that Apple will tie the trade-in value to the cost of an upgraded iPhone and offer an amount less than the open market value or what third-party companies like Gazelle would pay. I’m not due for a discounted upgrade any time soon, but my 16GB iPhone 5 is almost filled up. Maybe I’ll be one of the nerdy folks queuing up in line at the Apple store the first day the newest iPhone is released, supposedly in late September.

Cerner and Epic are winning three-fourths of all new large-hospital EMR deals, according to a new KLAS report on clinical market share. Cerner and Epic dominate in community hospitals, though McKesson Paragon and Meditech are gaining some traction. Biggest net customer losers for 2012 were McKesson and Siemens, while Epic was the only vendor that didn’t lose any customers. Allscripts, GE Healthcare, and QuadraMed had no wins at all.

HIMSS opens registration for its annual conference February 23-27 in Orlando. Aetna CEO Mark Bertolini will deliver the keynote address bright and early Monday, while Wednesday afternoon’s keynote speaker is still TBA. The Thursday afternoon keynote is “world class blind adventurer” Erik Weihenmayer, who unfortunately may not be enough of a draw to prevent weary crowds from making a mass exodus Thursday morning.

A California Nurses Association press release claims that Sutter Health’s Epic system went down Monday at its Northern California hospitals following an eight-hour upgrade-related downtime on Friday. A union spokesperson was quoted as saying, “This incident is especially worrisome. It is a reminder of the false promise of information technology in medical care. No access to medication orders, patient allergies and other information puts patients at serious risk. These systems should never be relied upon for protecting patients or assuring the delivery of the safest care.” While the union did not issue an equally passionate press release extolling the virtues of paper charts, it did throw in unrelated shots at management for urging nurses to enter patient charges correctly, apparently preferring that Sutter not bill what it’s owed even though those funds allow it to generously pay unionized nurses.

The Gainesville, FL newspaper profiles 12-employee RegisterPatient (now using the name Ingage Patient)and its CEO Jana Jones, who was formerly CEO of BCBS of Tennessee subsidiary Shared Health. According to the company’s site, the product offers appointment scheduling, alerts, registration, secure messaging, check-in, health education, a PHR, care plan integration, renewal requests, and electronic referrals.

This photo by @Nurse_Rachel_ is surely embarrassing Sinai Hospital of Baltimore as it lights up Twitter. Nobody should be surprised that hospitals and doctors do whatever pays them the most; to expect otherwise is naive.

Weird News Andy says, “Nurse, doctor, what’s the difference?” A draft VA policy would eliminate the requirement that advanced practice nurses, including nurse anesthetists, be supervised by physicians. Take a wild guess at how the American Society of Anesthesiologists feels about that.

WNA also notes an AARP report warning  that 20 years from now, aging baby boomers won’t have enough family members to take care of them because of increased longevity, fewer children, and a high divorce rate. Family care is worth an unpaid $450 billion per year

Technical problems with the site Sunday and early Monday forced me (for reasons too hard to explain) to remove Vince’s HIS-tory of Cerner in the Monday Morning Update and simply link to it instead. Here it is again. Meanwhile, the site is now running on a supercharged new server that will better handle the readership growth. I’ll probably appreciate that more after I’ve caught up for all the sleep I lost over the weekend as the web hosting people fixed the inevitable problems.

Sponsor Updates

• Imprivata introduces OneSign ProveID Embedded for use within virtual desktop environments.
• GetWellNetwork announces the call for presentations for its seventh annual user conference June 3-5, 2014 in Chicago.
• Frost & Sullivan recognizes Merge Healthcare with the 2013 North America Award for Product Leadership in Interoperability Solutions for its iConnect Enterprise Clinical platform.
• Wakely Consulting Group will process data from Truven Health MarketScan Research Databases through its Wakely Risk Assessment Model to help health plans meet HHS requirements for risk adjustment and reinsurance.
• Jason Fortin, senior advisor at Impact Advisors, discusses MU deadlines.
• The HCI Group is named to the Inc. 5000, coming in at #3 with 24,545 percent revenue growth in the past three years.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

Morning Headlines 8/26/13

The CIO: Healthcare’s New Million Dollar Man

SSi Search surveys 178 healthcare CIOs on changes to their roles and responsibilities post-HITECH and compares that with associated salary increases. 23 percent of respondents reported a 50 – 75 percent increase in responsibility since HITECH was passed, but reported receiving less a 10 percent salary increase over the same period.

Kaiser Permanente Opens New Information Technology Center in Greenwood Village

Kaiser Permanente opens a five-story, 350-person IT office in Greenwood Village, CO which it estimates will house 700 employees by 2015.

NYC Macroscope Puts Data at the Fingertips of City Officials

New York City public health workers are developing a big-data surveillance program that promises real-time population health monitoring of the city. The program will rely on EHR data aggregated into a surveillance tool that will drive public health decisions.

Class 2 Recall Picis EDIS PulseCheck

Picis recalls its PulseCheck EDIS due to problems with prescription comments being dropped from electronic prescriptions when filed or printed.

Monday Morning Update 8/26/13

From Todd: “Re: FDA security guidance. FDA has published radio frequency guidance for wireless medical devices that includes information about authentication and encryption to prevent hackers from gaining control. FDA has a draft out for comment that includes a requirement that vendors develop a plan to apply operating system updates and patches to address security flaws.” It’s strange (or typical government efficiency) that a document that went to draft in January 2007 finally gets published years afterward. The cybersecurity draft came out in June.

From Digital Bean Counter: “Re: Optimity Advisors. Anyone have experience working with them?”

From Keith: “Re: EHRs. If they aren’t medical devices, why is the vendor reporting to the FDA and recalling its care controlling system?” Picis announces a Class 2 recall of its ED PulseCheck emergency department information system due to a problem printing entered notes along with prescriptions. My guess is that Picis (part of OptumInsight) commendably reports through FDA even though they aren’t required to since I’ve seen their entries in the MAUDE database over the years. Demands for FDA oversight would be reduced to almost nothing if vendors reported and tracked software defects with the same enthusiasm as they do unpaid invoices.

Most poll respondents don’t think the FDASIA report will improve IT-related patient safety since it limits its scope to a user reporting mechanism and other forms of post-marketing surveillance. New poll to your right: when a vendor requires you to register before downloading a white paper you want to see, what do you do? I will, as the poll maker, unprofessionally expose my bias in stating that I think hiding advertising material behind a lead-gathering signup form is both stupid and insulting. We hospital people are smart enough to figure out how to contact you if your material inspires us to further action; we aren’t fans of being cold called as punishment for being willing to give your material a look. Do the sales and marketing people a favor and ignore their faulty advice. I always sign up with phony information, inserting the vendor’s own phone number in the required slot.

I  ran a reader’s question in Friday’s news asking for hospitals that have switched from Cerner to Epic. Readers provided these: Aurora, Legacy Health Portland, Children’s Dallas, University of Utah (underway), Rex Healthcare, Loma Linda, and Lucile Packard (underway). I appreciate the information, which then led me to another question as it often does: have any hospitals voluntarily switched from Epic to Cerner?

XIFIN, which offers revenue cycle solutions for laboratories, radiology,  and pain management, acquires PathCentral, a vendor of cloud-based digital anatomic pathology vendor with big-name customers such as Johns Hopkins, Mass General, and University of Southern California.

A medical assistant / IT administrator at an orthopedics practice is arrested for stealing a pre-signed blank prescription form from the the practice’s EMR and writing himself a prescription for Percocet.

The Washington Post profiles Altruista Health, a 75-employee Reston, VA company that offers predictive algorithms that identify a provider’s highest-risk patients. I ran a Readers Write article by CEO Ashish Kachru in December 2012.

URAC and the Leapfrog Group announce the second annual Hospital Website Transparency Awards, which recognizes websites that portray quality measures honestly and contain information that’s actually useful instead of the far more common marketing BS (stock photo photogenic doctors, community chest-puffing, and unsubstantiated claims that locals are incredibly lucky to have a world-renowned medical facility in a town too small to even have a mall.)

Wisconsin Statewide Health Information Network says it will go live soon, running on the Medicity platform.

A 178-respondent CIO survey performed by SSi-SEARCH finds that the average CIO makes $286K, but despite greatly increasing workload and responsibility, receives single-digit annual salary increases. Still, almost 60 percent of respondents say their pay is satisfactory. They report that people- and team-related issues are both their biggest challenge and their biggest accomplishment. Only 11 percent of the CIOs aspire to a non-IT role, but those who do are interested in a COO position despite responses indicating that it’s tough for a CIO to be recognized as a strategic leader outside the IT realm.

An Allscripts promotional video filmed at Sarasota Memorial Hospital (FL) celebrates the hospital’s 15 years on Sunrise and features VP/CIO Denis Baker.

New York City is piloting NYC Macroscope, which aggregates EHR data into a public health surveillance database that will allow city officials to monitor the health of the population in near real time. Their only concern is that its data is, by definition, limited to those patients who receive medical care, so the city will still need to conduct traditional survey-based surveillance. Data exchange has been established with 3,200 providers in the NYC Primary Care Information Project, which uses eClinicalWorks and distributes queries through the Hub Population Health System.

Advocate Medical Group (IL) announces that four unencrypted desktop computers were stolen in a July 15 burglary that contained basic patient information and Social Security numbers on 4 million patients.

Bats Global Markets, the nation’s third-largest stock exchange with $101 million in 2012 earnings, is discussing a merger with another exchange that would make it larger than Nasdaq. Bats was started by former Cerner employee Dave Cummings in 2005 as an electronic trading company. The company was supposed to go public in 2012 by being listed on its own exchange, but a software bug froze its systems seconds after its executives rang the trading bell, causing Bats to cancel its IPO as the word spread and underwriters feared a steep share selloff. Cummings may have learned email etiquette from his former boss Neal Patterson as he immediately sent a scathing ready-fire-aim internal email cancelling all bonuses.

Texas Health Resources names Luis Saldaña, MD as CMIO of the 25-hospital system.

Two executives of Eastern Connecticut Health Network, including VP/CIO Charlie Covin, leave the organization abruptly as it prepares to sell itself to for-profit Vanguard Health Systems.

Kaiser Permanente opens an IT center in Greenwood Village, CO, with the current 350 employees working there expected to double by 2015.

The accounting department of University of Mississippi Medical Center accidentally sends an email to 190 students Wednesday evening with an attached worksheet containing the Social Security numbers, GPAs, and other personal information of all 2,300 of its students. It frantically tried to recall and then purge the message, but 115 of the students had already opened it and three had forwarded it to an external email address.

The Roanoke newspaper reports that the former president and CEO of Carilion Clinic (VA) received $6.2 million in final compensation when he left in 2011.  Another Carilion CEO who retired in 2001 received a $7.4 million lump sum payout that was only one of two installments he earned for honoring his non-compete agreement.

A former employee of MedCentral Health System (OH) files a lawsuit against his former employer, claiming that he was unjustly fired after complaining that Open Systems, a Cleveland-based technology vendor, was bribing the hospital’s IT department to buy its overpriced computer equipment with travel, sports tickets, and food. The employee says he complained to the former IT director, who told him he would be running the department some day and should just mind his own business.

Microsoft CEO Steve Ballmer announces his retirement as CEO, causing shares to jump 7 percent Friday, ironically raising Ballmer’s personal fortune of $15 billion by another $800 million by his own departure. A Reuters article summarizes his many mistakes with a quote: “That is the most expensive phone in the world and it doesn’t appeal to business customers,” Ballmer laughed in a TV interview after the launch of Apple’s iPhone in 2007. Five years later, iPhone sales alone were greater than Microsoft’s overall revenue.” The article also mentioned the infamous “Monkey Boy” video, in which Ballmer leaps and screams all over a sales meeting stage hoping to generate enthusiasm that the company’s performance couldn’t.

Vince Ciotti says this device might entice older doctors to use an EMR.

Robert Wood Johnson Foundation says the use of patient-shared medical visit notes (OpenNotes) is spreading, with Beth Israel Deaconess Medical Center rolling it out now with similar plans by the VA, Group Health Cooperative, Geisinger, Cleveland Clinic, and Mayo Clinic. RWJF will issue a $2.1 million grant to share lessons learned and to help health systems implement it.

Weird News Andy perhaps inevitably title this article “Sh*t for Brains.” California’s Department of Public Health fines three UC Davis Medical Center doctors who injected fecal bacteria into the brains of three cancer patients as an experiment, hoping to kill tumor cells. Instead, the resulting infections trigger septicemia-induced seizures, with one patient dying shortly after. The doctors admitted that they had no plan to address problems that might have developed and couldn’t explain why they chose those particular patients.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 8/23/13

Top News

Steve Malik, the Cary, NC entrepreneur who sold his Medfusion patient portal startup to Intuit in 2010 for $91 million, acknowledges that he has bought the business back from Intuit, which had announced its intention to divest Intuit Health Group to focus on its core tax and financial software business. Intuit wrote down $46 million earlier this year when partner Allscripts decided to look elsewhere for a portal solution. Revenue was down to $16 million in 2013. Malik says he looked at healthcare IT startups before realizing that his former company held the highest potential. Malik, the sole owner of the company, says he hasn’t decided whether he will revive the Medfusion name (my vote and expectation would be yes even thought the name isn’t descriptive.)

Reader Comments

From Boy Wonder: “Cerner and Epic. Are you aware of any health systems that have switched or are in the process of switching from Cerner to Epic? Just wondering.” I was thinking that Aurora had done so. I assume the specific interest would be those that switched voluntarily rather than being forced by acquisition. Readers?

From Vendor Venting: “Re: McKesson Horizon. As a customer, we have noticed that support and services have steadily declined since the ‘Better Health 2020’ announcement in December 2012. The average tenure of support employees supporting us has dropped severely with resignations. We have to run a gauntlet of triage and bottom-tier support before most of our issues are escalated to a rare senior resource. They are exerting pressure for us to migrate to Paragon while failing in their commitment to support us on Horizon. In the BH 2020 announcement, we were assured that there would continue to be a commitment to Horizon customers, but the executives who made those commitments have moved on. Actions speak louder than words and customers have been left to deal with the fallout.” Unverified. I would be interested in speaking to a customer that has moved from Horizon to Paragon since those mentioned by the company seem to be happy.

From CDiff: “Re: ICD-10 codes for High Life in the ER. Wondering if Weird News Andy has reported the need for five ICD-10 codes for beer?” A Johns Hopkins Hospital study of the one-third of ED visits that are alcohol-related finds that the beer brands most often involved are those most appropriately consumed from a paper bag koozie rather than a tulip glass: Budweiser, Steel Reserve, Colt 45, Bud Ice, and Bud Light. They’re planning to extend the study to see if it’s just a Bal’more thing.

From Pacific Girl: “Re: CIO Unplugged 8/12/13. Mr. HIStalk, that is by far the most moving post I’ve read from your site, and it couldn’t have come at a better time. Thank you, thank you, thank you.” I think people sometimes underestimate how hard it must be for Ed Marx to write soul-baring articles like “Falling from Grace” and post them publicly for his peers with his name on them, opening himself up to criticism from folks who enjoy the benefit of anonymity. Ed doesn’t seem to mind as long as he makes them think.

From Boston Beans: “Re: John Halamka. Why do people feel the need to run him down? He’s doing his job at BIDMC or they wouldn’t keep him.” Long-time readers may recall that I was unflaggingly cynical about him years ago given his ubiquity, but that changed when I met people who know him and then met him myself (as me, not Mr. H) He’s the real deal and I detected no self-serving agenda at all. He won’t take money for doing work external to BIDMC because he considers his time paid for by them, he is patient in explaining what he knows when I’m sure I wouldn’t be, and I think he really cares about patients more than anything else. I interviewed him in 2010 and was impressed at his lack of pretension or ego. I may or may not agree with every IT decision he’s made and he’s got some biases unique to Harvard and Boston, but he’s a good guy. Folks who say he isn’t usually haven’t actually met him. If you’re looking for egotistical douchebag CIOs or executives, you have many more deserving choices.

HIStalk Announcements and Requests

Some HIStalk Practice highlights from the last week include: MGMA urges HHS to not penalize physicians who have met Stage 1 MU requirements but may miss the Stage 2 deadline. The Air Force’s 62nd Air Division highlights its use of RelayHealth’s secure messaging platform. An AHRQ report concludes that the use of HIT in ambulatory care settings has a positive impact on care delivery and provider satisfaction. Physicians can expect an average salary increase of 2.4 percent in 2014. Thanks for reading.

Inga needed a new laptop and asked me if this one from Office Depot was OK (Toshiba Satellite C55-A5286). I was shocked that an Intel-powered 8GB memory Windows 8 laptop with a memory card reader, USB 3.0, a decent screen, and a DVD drive could be bought for $380 after rebate, to the point that I joined Inga in buying one and so did our newest HIStalk colleague. I’m extremely happy with it after doing the usual setup tasks: opening Internet Explorer long enough to download Firefox and Chrome, de-installing all of the bloatware that the manufacturer gets paid to include, and installing a utility that bypasses the new (and confusing) Metro interface in favor of the old Win 7 start menu.

Listening: the entire catalog of Portland-based indie band The Thermals. Also, new Superchunk.

Ed has updated his CIO Unplugged “Falling from Grace” post with a response to the comments left by readers.

Acquisitions, Funding, Business, and Stock

Bottomline Technologies reports Q4 earnings: revenue up 5.86 percent, adjusted EPS $0.32 vs. $0.26, beating analyst estimates of $0.29.

Nuance adopts a poison pill defense, hoping to prevent investor Carl Icahn from taking control of the company and selling it off in pieces.

Orange Health acquires the software assets of ExtendMD, which offers patient-physician communications technology.

Connecticut Innovations, which provides funding for Connecticut technology startups, extends a $200,000 follow-on funding commitment to tablet computer sterilizer manufacturer ReadyDock.

Sales

The Lott AQ Group, a healthcare IT quality assurance and consulting firm, will use VitalWare’s VitalSigns auditing and financial risk assessment tool for ICD-10 testing.

People

Jim Jirjis, MD (Vanderbilt University Medical Center ) is named chief health information officer for HCA.

St. John’s Riverside Hospital (NY) appoints Daniel Morreale (Kingsbrook Health System) VP/CIO.

Denis Connaghan (etrials) joins clinical trials network provider Clinverse as CEO.

The San Francisco Department of Public Health names Bill Kim (Dignity Health) to the newly created position of CIO.

Announcements and Implementations

EHNAC releases updated and final 2013 criteria for the electronic exchange of clinical data.

The Southeast Michigan Beacon Community names Quest Diagnostics its first provider of diagnostic information services for its HIE, BeaconLink2Health.

Allscripts names healthfinch the grand prize winner of its Open Apps Challenge for its automated prescription renewal request app. We interviewed healthfinch CEO and Co-Founder Jonathan Baran on HIStalk Connect last year.

AirStrip and Vivify Health will develop a remote care platform for the AT&T mHealth Platform.

Innovation and Research

Robert Wood Johnson Foundation offers $100,000 in prizes for entrants who combine healthcare with public health data to improve community health.

Other

The CVS drugstore chain notifies 36 prescribers that it will no longer fill their controlled substances prescriptions after an analysis of its million-prescriber database indicates a high likelihood of improper prescribing.

In England, the final tab for the failed NPfIT project is tallied at nearly $16 billion, having delivered an estimated $4 billion in benefits.

Meditech announced to employees this week that it has acquired a six-story, 108,500-square-foot office building from Adobe Systems in Waltham, MA on Route 128. The company will fully occupy the 400-seat, three-year-old LEED Certified Platinum building when existing tenant leases expire in late 2015.

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Peer60, which offers customer intelligence tools, has put together a pretty funny downloadable e-book called “Executives Are Idiots,” which pokes fun at getting executive feedback.

A major national health system work group studying copy-and-paste issues in EMRs recommends monitoring the practice within existing documentation audits, according to an internal PowerPoint presentation forwarded by a reader.

Dubai Health Authority orders 3,000 Android tablets, vowing to provide one for every patient bed toward its plan to use “the latest IT technology to enhance customer service experience.” The hospitals will roll out their EMR in the next 2-3 years.

UMass Memorial Medical Center (MA) pays $66,000 to settle fraud charges in which it was accused by a whistleblower of intentionally mailing bills to a homeless shelter so it could then bill the state for the unpaid amounts.

Weird News Andy says of the story headlined German Doctors Remove Tumours From Liver Using an iPad that he would have used a scalpel instead since it’s sharper.

WNA also likes this story, which he titles “Herniating Money.” A man is told by a hospital that his hernia surgery will cost $20,000 upfront with his insurance company covering the rest. Instead, he heads over to another hospital and has the surgery done the next day for a total price of $3,000 without using his insurance at all. The surgeon who penned the article concludes, “It was clear to both of us that the only way to make health care more affordable is to diminish the role of third-party payers. Let consumers and providers interact through market forces to drive down prices and drive up quality, like we do when we buy groceries, clothing, cars, computers, etc. Drop the focus on prepaid health plans and return to the days of real health insurance—that covers major, unforeseen events, leaving the everyday expenses to the consumer—just like auto and homeowners’ insurance.”

In England, a patient dies after employees omit the an apostrophe in her last name while looking up her electronic records, causing them to miss her history of depression. She was discharged and killed herself with a sleeping pill overdose shortly after.

Sponsor Updates

• Sunquest held its annual Executive Summit last week in Scottsdale, AZ at the beginning of its SUG annual user group conference.
• Emdat releases a video highlighting the advantages of using its medical documentation system within an EHR.
• LG Electronics will integrate Imprivata’s OneSign authentication solution into its V-Series zero client systems.
• Zirmed partners with Catch Data Systems to provide GE Centricity customers integration with ZirMed’s RCM, clinical communications, and analytics solutions.
• The Washington State Hospital Association endorses Besler’s Transfer DRG and IME revenue recovery services.
• Vitera Healthcare Solutions announces details of its VIBE 2013 user conference, to be held September 10-13 in Orlando.
• Forbes features Xerox in an article about 3-D printing in healthcare.
• Two KishHealth System hospitals advance their EHR initiatives with the implementation of Access’s e-form on demand solution.
• Care Team Connect hosts an October 8 Webinar highlighting the implications of Medicaid expansion on care management.
• Greenway Medical adds Krames Staywell’s Integrated Patient Education solution to its online Marketplace as a certified API.
• T-System CMIO Robert Hitchcock, MD discusses an all-in enterprise model for data needs.
• Sunrise Women’s Medical Group (CA) shares how its use of ADP AdvancedMD PM/EHR improved workflow and coding and billing.
• Cornerstone Advisors is named to Inc. 500’s 2103 Fastest Growing Companies in America. Also on the list is Intellect Resources.
• Direct Recruiters made the Inc. 5000 list announced this week.

EPtalk by Dr. Jayne

I’ve heard a lot of complaining recently about the Medicare Physician Compare website. The AMA and other physician advocacy organizations have complained about the redesigned site and its errors, which include problems identifying physician location, hospital affiliations, board certification, and other practice information. I searched for myself and even broadened the criteria to a 100-mile radius around my hospital but still can’t get myself to display, so yes, I would agree it’s inaccurate.

I seem to be running into more and more physicians who are integrating scribes into their practices. Some cite EHR as the reason, feeling like it has turned them into data entry clerks. Others see the scribe as a key partner in team care, freeing up the physician to perform cognitive work rather than data gathering and results tracking. I found this nice document from the American Academy of Family Physicians that outlines the potential duties of a scribe (which they expand on using the concept of a clinical assistant) during a routine office visit.

Having implemented EHR with several hundred physicians, I know the importance of helping physicians realize that the support staff is a great asset in prepping both the chart and the patient for the office visit. The document points out the staff role in collecting any recent lab/diagnostic test results and updating preventive care information before the physician ever sees the patient. Whether you use scribes or not, seeing patients in the age of Accountable Care, Pay for Performance, and Meaningful Use definitely takes a village.

AAFP also offers its Family Practice Management Toolbox, which was one of my favorite sites when I was in traditional primary care. Check out their section on practice improvement tools for some interesting practice assessment and improvement worksheets.

The American College of Emergency Physicians will be hosting its annual Scientific Assembly this October in Seattle. I had hoped to attend, but I have an unavoidable conflict that week. I don’t see a huge number of ED physicians in the informatics realm, but I am interested in what products ED docs think are hot and which are not. Ever thought of seeking fame and fortune as a roving reporter? If you’re a HIStalk reader and planning to attend, I’d love to hear from you.

Speaking of the emergency department, quite a few of you reached out to offer your condolences after I wrote about the closing of the quick care unit at one of the facilities where I was seeing patients. I’m happy to report that another facility has offered me a part-time position, although I’m not sure how much inspiration it will provide for writing since its physicians document on paper. Going electronic isn’t an impossible dream, however, as our paper system is provided by HIStalk sponsor T-System. I was happy to see the smoking doc logo on their website.

My email inbox is always deluged with invitations to various webinars, symposia, and conference calls. Some are from vendors and others are from professional organizations, but nearly all suffer from lack of lead time. Some arrive less than two days before the event being promoted. Word to the wise, marketing people — if you’re really trying to reach CMIOs or other C-levels, you should allow at least two weeks notice. Happily Mr. H advertises our HIStalk webinars well in advance – I’ll be listening in on the ICD-10 webinar on September 12. Hope to see you there!

Contacts

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

More news: HIStalk Practice, HIStalk Connect.