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.

News 8/21/13

Top News

From Left Tackle: “Re: Intuit Health Group. Was bought back Monday by Stephen Malik, who founded Medfusion and sold it to Intuit in the first place.” Verified. He was saying just a few weeks ago that he had no interest in buying back the Cary, NC-based company he sold to Intuit for $91 million in 2010. That probably means the asking price and/or the number of interested suitors dropped since then.

Reader Comments

From MoJo: “Re: Allscripts reorg. Allscripts made an internal announcement of (yet another) reorganize to ‘further improve accountability, performance.’” Some of the changes noted in a company memo: the addition of new business units (international, Sunrise, and enterprise); the hiring of Greg White (Cerner) and Ricker Berner (Caradigm) to head the enterprise and international segments, respectively; the addition of new client sales regions and changes to leadership; and the realignment of the client advocate and solutions management teams.

From Partner: “ACE. Dozens of companies are spending big marketing dollars to exhibit at ACE.” The Allscripts annual conference kicked off Tuesday in Chicago. Attendance hasn’t been announced, but the exhibitor directory includes at least 50 vendors.

From Broadway Joe: “Re: North Shore LIJ. Buying a stake in Allscripts.” Unverified.

From Turk: “Re: Rose Harr. Interesting news about the CEO of BlueWare, a small imaging system that claims to be an EHR.” The former Brevard County, Florida Clerk of Court is arrested on a variety of corruption charges that include approving $8.52 million in county scanning contracts with BlueWare for personal financial gain. State law enforcement agents say that BlueWare didn’t own any scanning equipment at the time and 75 percent of the records they were paid to scan could have been discarded without scanning. BlueWare CEO Harr turned herself in was arrested for bribery and bid tampering, but is out on bond. She has an interesting LinkedIn profile that includes running companies that are flipping properties, making a cartoon about Boston Terriers, and selling big imaging deals to NHS hospitals in England.

From I’m Not Creative: “Re: Siemens Soarian customers. Only getting six weeks to upgrade from version 3.3 to 3.4 due to the number of clients who need to get upgraded to meet MU2 requirements. Talk about feeling the burn.” Unverified.

From TexasHeart: “Re: ONC Blue Button announcements. Is this smoke and mirrors because state HIEs are failing and most docs, include a fourth of them in Epic, don’t want to trade? Why would people use Blue Button as a portal? Will docs even accept records sent by a patient?”

From Escapade: “Re: CIOs. You should do some CIO interviews and leave them anonymous so they can be brutally honest and vent. “ That’s a brilliant idea. I would happily do that, as well as running anonymous blog posts (either one-time or ongoing) by CIOs who want provide uncensored opinion without fear of reprisal.  Contact me if you’re a CIO who likes the idea as much as I do.  The anonymous interview would be a super easy and great fun.

HIStalk Webinars

 

Beacon Partners will present “The Transition to ICD-10: Building the Bridge as You Walk on It” on Thursday, September 12 at 2:00 Eastern. With the transition to ICD-10 only 15 months away, healthcare organizations will have to find inventive ways to create their roadmap and execute on their plans. Rather than taking valuable time to complete a gap analysis and then create the plan, leaders and project managers should consider how to do these tasks concurrently. Examples from healthcare organizations will provide ideas for choosing the right partners, defining program strategies, and incorporating ICD-10 work into already existing teams. Even if you assemble the plane as you fly it – or build the bridge as you walk on it – it’s time to move forward and make the ICD-10 transition a reality. The target audience for this presentation is mid-senior level financial, clinical and IT, CFO, COO, CIO, ICD-10 program manager, and ICD-10 team leads. The speaker will be Chris Kalish, national practice director in the Strategic Advisory Group. One of my reviewers summarized, “With approximately only one year to go and a lot of work still to be done, this Webinar provides hospitals with strategies to prepare for ICD-10 if the hospitals are late starters.”

Speaking of Webinars, there’s a list of those upcoming in the column to your right. Clicking on one brings up the full calendar.

Acquisitions, Funding, Business, and Stock

Summit Partners invests $14 million in specialty EMR provider Modernizing Medicine.

Champion Medical Technologies, which sells tracking software for implanted medical devices, receives an unspecified investment from Jump Capital.

The SSI Group acquires Medtelligence, dba Medibis, a provider of analytic, dashboard, and mobile applications.

Greenway reports Q4 earnings: revenue down 2.34 percent, adjusted EPS -$0.08 vs. $0.10, missing analysts’ estimates of -$0.02. Shares rose 3 percent Tuesday after Monday’s announcement. CEO Tee Green notes that the results reflect the company’s continued transition from a one-time system sales and training model to a recurring revenue model. From the earnings call:

• Greenway is live with CCD exchange at Epic and Cerner sites
• Up to 80 percent of new customers are choosing cloud solutions paid for via the subscription model, which is driving training revenue down
• Only 10 percent of users are using the company’s mobile EHR access app
• The company’s growth is expected to be driven by EDI and services
• Greenway says it expects to lose $5-6 million in FY14, with system sales down 50-60 percent

Above is the one-year GWAY stock chart, with Greenway in blue, Allscripts in red, athenahealth in green, and the Nasdaq composite index in brown.

Teleheath software provider SnapMD raises $600,000 in a seed round led by Shea Venture and Whittier Trust.

First Databank acquires medication reconciliation software vendor Design Clinicals. More information and thoughts from Design Clinicals CEO Dewey Howell, MD, PhD are available in the Tuesday morning announcement on HIStalk.

Sales

Wahiawa General Hospital (HI) will implement MEDHOST’s EDIS.

The Healthcare Access San Antonio HIE will offer consumers access to a portal developed by Intellica Corp.

The Defense Logistics Agency awards McKesson a $29.9 million medical imaging technology contract.

Community Health Information Collaborative (MN) selects Orion Health to power its statewide HIE.

Arcadia Solutions selects the Compuware Application Performance Management platform for EHR infrastructure performance optimization.

People

AHRQ names Richard Kronick (HHS) director, replacing the retiring Carolyn Clancy, MD.

Lisa Stump is promoted to VP/associate CIO of Yale-New Haven Health System.

EBSCO Information Services hires Elizabeth Jones (American Medical News) as VP of medical product management and chief content officer.

Announcements and Implementations

UnitedHealthcare adds online electronic bill payment services to its plan participant portal via the InstaMed payment network.

The Liverpool Heart and Chest Hospital (UK) and Robinson Memorial Hospital (OH) go live with integrated OnBase ECM and Allscripts EMR solutions.

Qstream announces new clients for its mobile healthcare education platform that include Boston Children’s Hospital, Partners HealthCare, Mayo Clinic, and Baylor College of Medicine.

Vivature EHR chooses Liaison Healthcare for connecting its Oracle-based EHR to more than 120 labs and imaging departments via Liaison’s EMR-Link hub.

HCA says in an entrepreneur workshop that it likes doing business with Boston-area companies that have an MIT or other academic connection, including Meditech, PatientKeeper, eClinicalWorks, and EMC.

Government and Politics

Florida Senator Arthenia Joyner introduces a bill that would force insurers to pay for telehealth visits. Critics say the bill is flawed because the state’s Board of Medicine allows telemedicine consultations only when a patient relationship has already been established and it also would require insurers to pay the same amount for a telemedicine visit as an in-office visit. Similar bills have failed previously.

Innovation and Research

Via @cascadia:  Intermountain Healthcare looks at the “Personalized Patient Room,” including an in-room camera; a server to support teleconsultations by pharmacists and interpreters; and video chat for bringing in remote family members to participate in the patient’s care. They’re also considering using touchscreens instead of pillow speakers for pushing educational content, entertainment, and information in languages other than English.

Three entrepreneurs form Oscar, a technology-powered insurance company that hopes to reform healthcare via the PPACA-mandated health insurance exchanges. Users of its application can enter their symptoms and click a button that will let them find nearby providers or speak live to a doctor through a partnership with TeleDoc. Patients can request prescription refills through a Twitter-like timeline. The company is analyzing large data sets to guide patients through rational medical decisions. They’ve raised $40 million in funding and will launch in 2014.

Technology

Greenway Medical launches PrimePATIENT, a patient portal integrated with PrimeSUITE.

Allscripts introduces Population Health Analytics, a real-time chronic disease management solution that provides comparative analytics at the point of care. Allscripts also announces the GA of its native iPad app Wand 2.0 for Enterprise EHR.

Other

Virtual Radiologic and its NightHawk Radiology subsidiary file a lawsuit claiming patent infringement by Tandem Radiology related to its teleradiology and order creation technologies.

Mayo Clinic’s Center for Innovation offers $89 Web stream access to its Rochester, MN-based Transform 2013 conference September 8-10.

An Oracle survey finds that 84 percent of CFOs are working more closely with their CIO peers as technology becomes their second-highest focus area, placing behind only industry knowledge.

A Nebraska woman lands in the ER after a post-baby shower brawl in which another woman stabs her in the face with her own six-inch stiletto heel. Police said the altercation resulted from the stabber’s “relationship with the father of the victim’s child.” Once again I am reminded how mundane my life is.

Weird News Andy urges, “EMT, heal thyself.” A Detroit EMT performing in-transit CPR on a patient has a heart attack himself, ending up recovering three hospital beds over from his patient after both receive identical stents.

Sponsor Updates

• iHT2 releases details of its August 21-22 Health IT Summit in Seattle.
• A Triple Tree report, ACOs: The Accountable Care Opportunity, says the organization was impressed by population management and clinical analytics solutions from Forward Health Group.
• Jennifer Dennard of Billian is appointed to the board of the Technology Association of Georgia.
• The Massachusetts eHealth Institute awards eClinicalWorks a $150,000 grant to advance the use of EHRs with the state’s HIE.
• Helix Health Solutions will distribute Wolters Kluwer Health’s Provation Medical software to healthcare organizations outside of North America.
• Greenway Medical adds Seamless Medical Systems to its online Marketplace as a value-added partner.
• The Truven Health Advantage Suite healthcare data and analytics platform version 5 achieves Oracle Exadata Ready status through Oracle PartnerNetwork.
• Laura Kreofsky, principal advisor with Impact Advisors, discusses Stage 2 MU challenges.
• HIStalk sponsors named to the 2013 Inc. 5000 list of fastest growing companies in America include Beacon Partners, Clinovations, Cornerstone Advisors, CoverMyMeds, CSI, Culbert Healthcare Solutions, Cumberland Consulting Group, DIVURGENT, eClinicalWorks, Enovate, ESD, eTransmedia Technology, Forward Health, Iatric Systems, Impact Advisors, iSirona, Intellect Resources, Kareo, Kony, Santa Rosa Consulting, SRSsoft, Strata Decision Technology, and Virtelligence.
• Clinical Architecture introduces Symedical Content Portal, which acquires and maintains clinical and administrative vocabulary files.
• PatientKeeper hosts a September 24 webinar explaining how to make the ICD-10 transition a non-event for physicians. (sent to us)
• T-System CMO Tom Ward, MD discusses ICD-10 compliance in the ED.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

First Databank Acquires Design Clinicals

First Databank announced this morning that it has acquired Seattle-based Design Clinicals, which offers the MedsTracker clinician-friendly hospital medication reconciliation solution. FDB says the acquisition will support its ability to help hospitals meet the medication reconciliation requirements of Meaningful Use Stages 1 and 2. Terms of the acquisition were not disclosed.

According to Chuck Tuchinda, MD, MBA, executive vice president of FDB, “I am very impressed with the success that Dewey Howell has been able to achieve so quickly with Design Clinicals and MedsTracker. He has helped solve a vexing industry problem. We will now work together to develop an embedded solution so that our health information system partners can more easily integrate this medication reconciliation functionality within their systems.”

Seattle-based Design Clinicals has 40 hospital customers. The company was started by Dewey Howell, MD, PhD in 2005.

FDB will offer MedsTracker beginning immediately.

We spoke with Dewey Howell ahead of the announcement, who says the companies share a vision of reducing medication errors and improving patient safety. Design Clinicals built its modern Web app around FDB’s data capabilities. “The problem with med rec is that it involves nurses, pharmacists, and physicians,” Howell says. “All have important but distinct roles, and if any player doesn’t do their job, it all falls apart. We took three complex workflows and merged them into one so that each person has their role.”

“When medication reconciliation first came out, it was all about documenting lists and looking for drug duplicates and interactions,” Howell told us. “With Meaningful Use Stage 2 and beyond, a hospital might get feeds from an HIE or outpatient EMR and will have to decide what to do with these disparate sources of medication data. How will the meds get reconciled? It will be a much bigger problem a couple of years from now.”

FDB is transforming itself as more than just a data supplier. The company has developed Web services, widgets, and end user applications, with the customizable alerts tool AlertSpace being its first product. I interviewed Gregory Dorn, MD, MPH — now EVP and deputy group head of Hearst Business Media and president of First Databank — in September 2012, who described his vision for FDB and its new focus on raising the company’s visibility with end users.

The five-employee Design Clinicals team will stay on with FDB, with Howell taking a San Francisco-based role as VP of clinical applications. FDB will use the team’s knowledge to develop new tools for medication reconciliation at the point of care.

Monday Morning Update 8/19/13

From DanburyWhaler: “Re: Norwalk Hospital. No longer hooking up with Western Connecticut Health Network, now part of Yale-New Haven. Stay tuned for lots more consolidation in Connecticut” That would be interesting since Norwalk just signed up as a WCHN affiliate in January.

From Jon: “Re: HIMSS. They emailed members about the ICD-10 Playbook, and when I click the links, I get the infamous registration form before I can view it. It is sponsored by vendors, which is appropriate, but it should be available to all members with no strings attached for all the money we spend on dues. Now we will be bombarded with sales calls. No, thanks. I think my HIMSS membership days are over. Hopefully others will join me in sending a message.” HIMSS has gotten so commercial and so intertwined with its vendor members that I treat them like any other vendor, i.e. I always assume anything they send is spam. I’m rarely wrong on that. All the resources that require registration are on the site of MedTech Media (Healthcare IT News, Government Health IT, etc.), a private company of which HIMSS bought the majority position of shares in 2011.

The more important debate to me is this: are vendors doing themselves a favor by hiding their promotional material behind a registration form? Vendors think this way: we need leads, and any names we can get, even of people with marginal interest, make us feel more successful. I think this way: why in the world would you make it harder to see your advertisement? Nobody wants to be cold-called just because they took a quick look at a white paper. I would bet people often do as I do in just inserting phony contact information to avoid the dreaded phone call (note to vendors: if you are trying to reach a CIO named Scatman Crothers who used a phony email address, that’s me.) Don’t listen to your marketing and sales people – put your stuff out there where everybody can see it. Do the right thing and the HIMSS problem goes away with it.

Two-thirds of respondents say it’s OK if Farzad Mostashari’s replacement isn’t a physician, although most of the respondents probably aren’t members of Congress who may expect to see an MD in charge. New poll to your right: will the FDASIA report help improve patient safety with healthcare IT? Vote first, then click the Comments link at the bottom of the poll to explain your thoughts because “yes” or “no” votes don’t create rich debate.

Speaking of FDASIA, I made that the lead item in “This Week in HIT,” a partly serious, partly snarky weekly news update that I’ll do on Fridays. It will focus on the most important stories of the week, which admittedly aren’t all that fascinating at the moment given the summer doldrums before the inevitable September pickup (hint to vendors: it’s a great time to make announcements.) Long-time readers will remember the format from the Brev+IT weekly newsletter I used to send out until the volume of work overwhelmed me, much of which went toward coming up with Onion-like headlines. People have asked for a weekly summary of just the major news items, so this is it.

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

Wake Forest Baptist Urgent Care – Clemmons goes live with UrgentQ, a “fastpass for healthcare” that lets patients choose an open visit time and receive text message updates of when to come in. It’s from Lightshed Healthcare Technologies, a new company founded by Dialog Medical Founder Mike Burke.

Cerner will develop the biggest office project in Kansas City history if its plans for the former Bannister Mall are approved. The campus will cover 4.5 million square feet on 251 acres and will be valued at $4.1 billion upon completion. It will house up to 15,000 employees. Cerner wants $1.2 billion in tax incentives to build it, offering to chip in $2.9 billion of its own money.

Readers have asked for an update on the HIPAA Omnibus Rule, for which enforcement begins in just a few weeks. I publicly solicited pro bono volunteers to to review the changes via Webinar. Doing so will be a couple of excellent presenters from The Advisory Board Company: Associate General Counsel / Privacy Officer Rebecca C. Fayed and Information Security Officer Eric Banks. Sign up for The HIPAA Omnibus Rule: What You Should Know and Do as Enforcement Begins, which will be held on September 10, 2013, from 2:00 to 2:45 p.m. Eastern. I reviewed their slides and they are excellent in the usual Advisory Board fashion – very meaty and to the point as they cover changes related to business associates, breach thresholds, and everything else covered entities need to know and do. This is a non-commercial presentation offered strictly to benefit readers by Rebecca and Eric. I appreciate their involvement.

The West Virginia Health Information Network has added several hospitals recently, bringing its total to nine.

Louis Kraml, CEO of Bingham Memorial Hospital (ID) pleads guilty to stalking charges for illegally wiretapping a former hospital physician, aided by three of the hospital’s IT department employees. Charges were dropped against two of the employees because they were following the instructions of IT Director Jack York, who had been accused last year of running a bogus consulting company that was charging the hospital for IT services. The court has issued a warrant for the arrest of York, who didn’t show up in court. The charges aren’t mention on LouisKraml.com, the CEO’s official website.

HIMSS urges HHS to start Meaningful Use Stage 2 as scheduled, but suggests extending the attestation window to 18 months.

The Fort Lauderdale, FL newspaper covers the use by several hospitals, most of them VA facilities, of the GetWellNetwork patient engagement solution.

The National Science Foundation issues a five-year, $10 million cybersecurity grant to Trustworthy Health and Wellness program that will develop tools for authentication and privacy, malware detection, and medical IT auditing. Experts from Dartmouth, Johns Hopkins, University of Illinois at Urbana-Champaign, and University of Michigan are on the team.

Sidney Health Center (MT), a 25-bed critical access hospital, will implement Epic as part of an agreement with Sanford Health (ND).

Vince commences his HIS-tory coverage of Cerner, aided by Neal Patterson (who responded quickly and warmly to Vince’s inquiry) and the archives of Cerner’s April Martin. The details they provided are fascinating.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 8/16/13

Top News

CareCloud secures an additional $9 million from Adams Street Partners as part of its Series B financing round, bringing the company’s total funding to $55 million.

Reader Comments

From Frank Poggio: “Re: certification scoreboard. Here we are just six weeks away from the termination of Stage 1 vendor Certifications on 9/30/13 and there are only six Inpatient EHR vendors with 2014 Edition Certified systems (aka Stage 2). They are: Epic, McKesson (Paragon only), Allscripts, Meditech, HMS, and CPSI. No-shows for full EHRs are Cerner, GE, Siemens, Healthland, QuadraMed, and NTT-Data (Keane). If you are running a Stage 1 Certified system on 10/1/13, it will be considered a non-certified product even though you’ve not changed a line of code. As I have said on this blog before, the process and details under 2014 are far more difficult than ONC would admit, and even today the test scripts are still changing. In fact, while working through some test data with several of my clients this week, we came across three situations where the test data is in error. When we brought this to the attention of the test labs they simply said, ‘We’ll notify ONC, but for now just ignore it.’”   

From Dodging a Bullet: “With all the praise and glory for the soon-to-be former ONC head, you have to wonder about the timing of his departure. Does this really mean that MU2 will be pushed back and he doesn’t want to be at the helm when that takes place?” I can’t imagine the timing of Stage 2 would be enough to make Farzad leave. He’s been through Congressional grillings, has taken every kind of criticism there could be, and works for an agency that rarely sticks to dates it sets.

From Potha Cary: “Re: Allscripts tip of the week. Tells you how to look up a zip code on the United States Postal Service website. Asinine.” It would be nice if the app could do the lookup itself, but at least if not, they gave users good instructions that they may or may not need. I don’t see a problem with that.

HIStalk Announcements and Requests

Hot news from HIStalk Practice this week includes: the AAFP urges CMS to add a 12-month extension to the timeframe for Stage 2 MU compliance. MGMA-ACMPE adds almost 600 new members as HCA Physician Services joins the association. The majority of physicians believe EMRs have at least some positive impact on patient care according to an athenahealth / Epocrates survey, though 17 percent believe they worsen care. Thanks for reading.

Facebook reports that 128 million Americans and 24 million UK users access Facebook every day. A mere 278 of those are my friends, which happens to be a few more than Mr. H and Dr. Jayne but far less than the 2,271 who like our HIStalk page. We are collectively of the belief that you can never have too many friends, so send us a request and we’ll be happy to join your inner circle. If you prefer to keep it professional, you can connect with Mr. H and me through LinkedIn.

Welcome to new HIStalk Platinum Sponsor Symantec, which secures the IT systems and health information of medical practices, hospitals, and payers. Symantec Backup Exec simplifies backup and disaster recovery for practices. The company’s healthcare software solutions provide security, data loss prevention, HIPAA compliance automation, business continuity, and storage and infrastructure management (the list of specific products is surprisingly long, and Mobile Management is probably worth a look, as is Endpoint Virtualization for managing applications and standardizing single sign-on). Many of these tools are available as free trial downloads. Thanks to Symantec for supporting HIStalk.

Surescripts Mini-Interview

Surescripts announced Tuesday that it has added 19 state HIEs and health information providers to its clinical interoperability network, allowing them to exchange referrals, discharges lab results, CCD, prior authorization, and notes via the Surescripts network. I spoke to Jeff Miller, SVP/GM of clinical interoperability for Surescripts, who says the company “decided to move out of just electronic prescribing and support a wider set of clinical information on the Surescripts network.”

Surescripts network members have always been able to communicate with each other through the network directory, but Miller says that “communities of networks have significant populations we need to reach.” Now that Greater Rochester RHIO is on the network as one of the 19 new participants, for example, any of its members can communicate with any member of the Surescripts network and vice versa. Surescripts is paid by hospitals and EHR vendors, who may or may not pass along charges to their own users, but there’s no extra charge to use the gateway. 

Miller says the connectivity marketplace consists of HIE applications that poll EHRs to get information and send messages and EHRs that can exchange information within their own vendor-specific network or through partners such as Surescripts. The EHR-based solutions allow that communication to be integrated into user workflow, so that an Epic user discharging a patient can look up a provider in the directory and send a message out without launching another mailbox-type application. Miller says over 600 EHR vendors are connected to its network.

I asked how this type of messaging could support population health management. He says networks need to support three models: (a) a push or message-based model; (b) a pull or query-based model; and (c) a publish model, such as moving data to a repository to support managing populations. The benefit to patients, he says, “is to get rid of that clipboard you get at the practice. Let the doctors become more proactive. Take cost out and improve quality.”

Acquisitions, Funding, Business, and Stock

Imprivata announces that Q2 bookings grew 30 percent and headcount was increased to 250 with the addition of 48 new employees.

A stock analysis firm starting its coverage Quality Systems with lukewarm enthusiasm claims that the company’s customers, and presumably those of other EHR vendors, are being lost to enterprise vendors such as Cerner and Epic as hospitals acquire practices.

Sales

The NY eHealth Collaborative awards Mana Health a contract to build the “Patient Portal for New Yorkers.” 

Orthopaedic Associates of Augusta (GA) selects SRS EHR for its 14 providers.

Charleston Area Medical Center (WV) contracts with Besler Consulting to assist with the identification of Transfer DRG underpayments.

The NFL’s Buffalo Bills will implement medical imaging technology from Carestream at the Bills’ Ralph Wilson Stadium to provide early detection and monitoring of brain injuries.

People

James McDevitt (GE Healthcare) joins API Healthcare as VP of human resources.

The Integrating the Healthcare Enterprise Patient Care Device Domain Technical Committee names Iatric VP Jeff McGeath co-chair.

Jeff Finkelstein, MD, former chief of emergency medicine and CMIO of The Hospital of Central Connecticut (CT), joins Hartford Hospital (CT) as chief of emergency medicine.

Standard Register Healthcare names Kevin Lilly (McKesson) as VP of marketing and product management.

John Halamka,MD is named to the board of Imprivata.

Announcements and Implementations

Hawaii Health System concurrently implements Perioperative Management by SIS and Siemens Soarian.

The Central Illinois HIE launches Direct communication between its members and other HIEs using ICA CareAlign Connect technology.

Prime HealthCare Services will connect its 23 hospitals to the Inland Empire HIE, which is based on the Orion Health HIE platform.

Appalachian Regional Healthcare System (NC) goes live on Allscripts Sunrise Clinical Manager.

Diagnotes launches a mobile clinical communications system for patient information, caregiver communication, and documentation.

Innovation and Research

ShiftyBits, LLC releases ID My Pill, a $4.99 iPhone app that identifies prescription tablets using the phone’s camera.

Other

Weird News Andy concludes about a story he titles “En Fuego” that, “Well, they are part of the fire department.” Two Washington, DC ambulances catch fire in separate incidents on the same day, fortunately with no injuries. WNA also likes this story, in which a surgeon intentionally lied to a patient for reasons unknown in claiming that he had removed her brain tumor, when in fact he had not.

An OIG audit finds that Medicare paid $449 million too much in 2011 to hospitals that shouldn’t be considered critical access hospitals because they aren’t in rural areas and aren’t far from other hospitals. States were allowed to override the location criteria until 2006; OIG says it’s time to take their exemptions away and CMS seems to agree.

Sponsor Updates

• Greenway Medical approves Master Mobility iPad and iPad mini applications as certified API solutions for its PrimeSUITE platform.
• An article by Brad Levin of Visage Imaging covers radiology’s “imaging IT disorders.”
• Intelligent InSites celebrates its 10th anniversary.
• Aprima reports having over 600 participants at annual user group conference earlier this month in Dallas.
• A Santa Rosa Consulting article offers a test to determine whether an organization needs to conduct an IT cost optimization review.
• GetWellNetwork publishes an e-book on transformative health trailblazers.
• Ohio State University’s Wexner Medical Center and GE Healthcare collaborate to find ways to make healthcare more enjoyable for patients.
• HIStalk sponsors earning a spot on “Best Places to Work 2013” are Aspen Advisors, CTG Health Solutions, Cumberland Consulting Group, Divurgent, Encore Health Resources, ESD, Hayes Management Consulting, Health Catalyst, Iatric Systems, Impact Advisors, Imprivata, iSirona, Sagacious Consultants, Santa Rosa Consulting, and The Advisory Board Company.
• ORA Orthopedics (IA/IL) reports that its implementation of Emdat’s clinical documentation technology has yielded operational and administrative advantages.
• Direct Consulting Associates and Direct Recruiters expand their offices, staff, and services. 
• HIMSS Analytics’ James Gaston, senior director of clinical and business intelligence, will participate in a panel discussion on leveraging analytics in clinical operations at next month’s Midwest Hospital Cloud Forum. 
• Wolters Kluwer Health introduces iPad and iPhone apps of Lippincott’s Nursing Drug Handbook.

EPtalk by Dr. Jayne

Now here’s an app I’d use. A group of New York University researchers has developed a mathematical model to help identify which preventive measures would most improve a patient’s life expectancy. Responding to the challenges physicians face when trying to address the mass of preventive recommendations that exist, they hope to integrate the model into EHRs to prioritize guidelines on an individual basis. It’s not ready for prime time, but I’m seriously intrigued.

An app that is actually on the market, “Health through Breath – Pranayama” includes controlled breathing exercises intended to relieve tension and promote relaxation. I wish I could have beamed it to the attendees of a meeting I was in the other day because everyone was keyed up and irritable. Its topic: the cost of ICD-10 readiness.

Speaking of apps, Medical Economics releases its list of the top 10 apps physicians recommend to their patients. Four of the 10 are diabetes related, which parallels the percentage of patients I seem to be seeing.

The National Uniform Claim Committee publishes its transition timeline for the new CMS 1500 claim form. The timeline meshes with Medicare’s and proposes that payers begin accepting the new form in January 2014 with a dual-use period through April 1, 2014 when the new form is required. I may have mentioned this before but it’s worth mentioning again – I don’t know how a lot of providers keep up with this and I’ve gotten quite a few questions on it in the last few weeks.

The American Academy of Family Physicians proposes a revised Stage 2 compliance timeline for Meaningful Use. The proposal actually includes three different revisions depending on whether 2014 is your first, second, or third/fourth payment year.

It’s not just a photocopier any more. Affinity Health Plan settles with the US Department of Health and Human Services over HIPAA violations. A returned leased copies rwas later sold to the CBS television network and investigators checking the hard drive found protected health information belong to over 300,000 patients. According to the documents, Affinity didn’t include photocopier hard drives in its HIPAA risk analysis as required. Show of hands: who is pulling out their risk analysis right now to double check? The FTC’s guidance on copier hard drives is here for your reading pleasure.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

News 8/14/13

Top News

Surescripts adds 19 state HIEs and health information service providers to its national health information network, including Cerner, ICA, and Quest Diagnostics.

HIStalk Announcements and Requests

Mr. H has taken a day or two off so I am flying solo tonight. He can never rest for long so be assured he’ll be back at the keyboard later this week.

Reader Comments

From Elsie: “Re: Epic’s new campus. If I were a cow I think I’d want to live in Verona.”  Epic opens its Farm Campus, which includes a white farmhouse with a wraparound porch, a red barn with a silo, a creamery, and a John Deere tractor. The buildings, which have standard offices on the inside, will house up to 1,000 employees and include extra decorative touches that follow the farm motif. Verona city officials have estimated the value of the farm campus and Epic’s new 11,000-seat auditorium at about $400 million.

Acquisitions, Funding, Business, and Stock

Marlin Equity Partners acquires long-term care software vendor 6N Systems, which will be merged with Marlin’s portfolio company SigmaCare.

Emdeon reports Q2 adjusted earnings of $77.2 million, down 3.7 percent from a year ago. Revenues were up almost six percent to $311 million.

Endo Health Solutions subsidiary HealthTronics agrees to sell HealthTronics Laboratory Solutions, its anatomical pathology business, to Metamark Genetics as part of Endo’s announced plan to pursue strategic alternatives for HealthTronics.

Medical device maker Medtronic buys Cardiocom, a provider of telehealth and patient monitoring services, for $200 million.

CareFusion reports Q4 earnings: revenues down six percent, adjusted EPS $0.49 vs. $0.55 and in line with expectations. The company also announced a $750 million share repurchase program.

Sales

East Tennessee HIN selects DataMotion Direct as its secure messaging service.

Apria, a provider of home healthcare products and services, extends its contract with predictive analytics provider Connance.

Brazosport Regional Health System (TX) will implement MEDHOST’s EDIS.

Mercy Health System (ME) selects Allscripts RCM Services for back office processing and patient collections.

The Chain Drug Consortium renews its agreement with Emdeon to provide services through the Emdeon Clinical Exchange eRx Network.

The AHRQ awards ECRI Institute a contract to continue operating, maintaining, and enhancing the AHRQ National Guideline Clearinghouse and the National Quality Measure Clearinghouse.

PinnacleHealth System (PA) and Meridian Health System (NJ) select the SIS perioperative IT platform.

People

Impact Advisors promotes Matt Duncan and Kent Gray from principal advisors to VPs.

Conifer Health Solutions hires James C. Bohnsack (TransUnion Healthcare) as VP of acquisition strategy.

Healthcare analytics provider PTS Physicians names Penn Krause (Treatspace) CEO, replacing the retiring William Bennett.

WebMD names David Schlanger its permanent CEO following three months serving as interim CEO. The company also promoted Steven Zatz from VP of professional services to president.

US HealthCenter hires Paul A. Markham (V3 Healthcare Strategies) as chief strategy officer.

Announcements and Implementations

Cullman Regional Medical Center (AL) deploys the MedSnap ID Enterprise application, which can identify a patient’s pills from a single image and identify the name and strength of each drug. Mr. H mentioned the app several months ago and characterized it as “brilliant.”

Humana agrees to subsidize up to 85 percent of the purchase of Greenway’s PrimeSuite EHR for physicians practicing in the Humana network.

Appalachian Regional Healthcare System (NC) implements Allscripts Sunrise Clinical Manager.

Connections Counseling (WI) installs Forward Health Group’s PopulationManager for analytics.

The Kansas HIN will launch a statewide patient portal next month, which will be free to patients and based on the NoMoreClipboard PHR platform.

The Dallas Business Journal reports that Baylor Health Care System (TX) providers are electronically placing about 94,000 orders each weekday. Orders originate from multiple EHRs but integrate into Baylor’s existing EHR (Allscripts Sunrise, I believe.)

Novant Health (NC) begins implementation of its $1.1 million patient identification iris scanning system from M2SYS Technology.

Nuance Communications announces that in the last three month 100 hospitals and radiology practices, including 50 new customers, have converted to the latest PowerScribe 360 platform,

Government and Politics

The Obama administration reports that the VA backlog of disability claims is now 496,000, a 20 percent reduction since March.

The ONC selects 28 practicing providers and staff from 18 states to serve as the inaugural class of the Health IT Fellows program, which aims to “help other providers overcome challenges faster and more efficiently by sharing key lessons learned.’”

Innovation and Research

The Scripps Translational Science Institute launches Wired for Health, a clinical study to evaluate whether the integration of wireless technologies, online social networks, and medicine have a direct effect on healthcare spending. Half of the study’s 200 participants will use a mobile health device for six months to monitor blood pressure, heart rhythm, or blood glucose and will have the ability to track their conditions through a web portal or mobile device. Researchers will evaluate whether the device-wearing patients have more online interaction with their providers and more success managing their health conditions.

Technology

The FDA extends 510(k) clearance for Verizon’s Converged Health Management remote patient monitoring medical device.

LRS and Siemens Healthcare jointly develop a solution that reduces the number of Windows print servers and printer drivers that need to be defined and maintained within the Siemens Soarian platform.

Other

The Jackson Clinic (TN) reports positive results from the first year of its collaborative accountable care initiative, including better than market measures for annual eye exams and kidney disease screenings for diabetics, breast cancer screenings, and adolescent well-child visits, as well as lower total medical costs compared to the local market.

Sign of the times: The AMA announces it will shut down its print and online news magazine because of its inability to generate a profit over the last 10 years. AM News has a print circulation of about 230,000 but saw an $8.7 million decline in print display advertising last year. Pharma advertising has historically accounted for the bulk of the publication’s advertising revenue.

Only 38 percent of providers participating in an athenahealth/Epocrates survey claim they are at least somewhat confident in their practice’s ability to transition to the ICD-10 code set, while 79 percent express confidence in satisfying the requirements for Stage 2 MU.

Sponsor Updates

• Frost & Sullivan awards Kareo its 2013 North American Physician Practice Management Customer Value Enhancement Award for demonstrating excellence in implementing strategies that create value for its customers.
• Vitera Healthcare offers an August 28 Webinar to help physicians and their staff prepare for MU Stage 2.
• NextGen Healthcare will utilize Clinical Architecture’s Symedical Server for its terminology integration architecture within the NextGen Hospital Solutions suite.
• Allscripts Enterprise 11.4.1 and Professional 13.0 EHRs receive 2014 ONC HIT Certification from the Drummond Group.
• API Healthcare looks at the healthcare system trend of eliminating differential pay in order to reduce costs.
• Impact Advisors identifies three challenges in achieving MU Stage 2.
• Billian’s HealthDATA ranks MedAssets the top healthcare group purchasing organization based on the number of affiliate beds.
• Pro golfer Jason Dufner, who is sponsored by Greenway, wins the 2013 PGA Championship, his first major title since partnering with Greenway two years ago.
• Alere Analytics releases its Electronic Laboratory Reporting solution for hospital reporting of results to state health departments and to improve care coordination between lab personnel and clinicians.
• Ophthalmology EMR provider Medflow will give users access to LDM Group’s healthcare messaging programs for improved patient medication compliance.
• iSirona posts a video featuring its client services team and how it supports hospitals’ medical device integration efforts.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.