Monday Morning Update 11/19/12

From Documented: “Re: Cerner Content360. Does this represent somewhat of a minor strategic shift for Cerner, or is just a re-branded aggregation of existing document imaging solutions (such as Cerner ProVision Document Imaging)? When I worked at Cerner (a few years ago), it was practically a cultural taboo to suggest the need for document imaging (especially clinically, as in meds ordering) because it stood in philosophical contradiction to CPOE and its closed-loop meds process. Anyway, I was just curious if any Cerner clients or other wise luminaries among the HIStalk audience knew much about it.”

From The PACS Designer: “Re: healthcare and Windows 8. In a past HIStalk post I covered Microsoft’s Healthcare in Silverlight software. Now, with the release of Windows 8, we get to see Microsoft Flexible Workstyle for Health utilizing Sharepoint for rounding and other data viewing. Partners HealthCare has an interesting case study demo that could generate an 80 percent reduction in desktop image management efforts.”

From HITEsq: “Re: Epic. Appears ready to file for review of the McKesson case. They filed an extension for their writ (i.e., the document where they asked the Supreme Court to take the case). Nothing is a sure thing, but my guess is this has a really good shot at being accepted. The Federal Circuit was really fractured and went in an unexpected direction. The Supreme Court is good at addressing these things.” This is the years-long legal battle over whether MyChart violates a McKesson patient portal patent. The appeals court’s decision in September troubled some legal experts who are uncomfortable with its interpretation that companies (Epic in this case) can be held accountable for “inducing infringement” even when the infringement itself hasn’t been proven.

From MT Hammer: “Re: MModal. Word on the street is that they have acquired transcription provider MxSecure. No official announcement.”

From Shhh: “Re: Epic. They must have finally chosen a new CFO – the job listing is gone from all the career sites.” I was slightly aware that Anita Pramoda was the company’s CFO, but I see from her LinkedIn profile that she moved on this year as a co-founder of California-based TangramCare (I guess she didn’t have to sit out a year). I can find next to nothing about that company except that it’s some sort of technology-enabled homecare provider. From a LA Craigslist job posting, she’s taken some Epic principles out West: the “do good” motto, the hiring of “brilliant people,” and the need for candidates to state their GPA in their application. The “who are we?” section says, “Healthcare today is conducted like a horribly inaccurate Markov chain. That is, each piece of healthcare is siloed from one another, at all times with incomplete information. None of pieces the mesh well, the left hand doesn’t know what the right hand is doing/has done. This results in inefficiency, inaccuracy and unbearable patient experiences. We wake up every morning working to solve this problem, make healthcare more affordable, and save lives.” Jim Sweeney, founder of Caremark, Bridge Medical, and CardioNet, is involved and talks about the company in the video above. He has an interesting point: hospitals were created to make it convenient for physicians to see patients, but being aggregated with other sick people isn’t so great for the patients.

Half of my survey respondents are indifferent to CHIME, while the remainder are equally split in seeing the organization as positive or negative. New poll to your right: which annual conferences do you routinely attend? Check all that apply and feel free to leave a comment.

Here’s new Spotify playlist of some odds and ends that might give you some new music ideas. On it: Toad the Wet Sprocket, Broken Bells, Veruca Salt, Neon Trees, and quite a few more. If you like country music, computer-generated dance tunes, classical, or jazz, you’re out of luck since I don’t listen to those.

Speaking of music, a reader sent a link to the early 1980s company promotion album You Respond to Everyone But Me: Songs for the EMT, which seems to be the only album dedicated to EMS. Stream some of the very well done country/bluegrass tunes and see if you agree with me that it’s way better than you would expect. I’m desk-drumming to #11 – EMS Express.

ONC publishes the Request for Comments for Meaningful Use Stage 3. The comment period will open this week on Regulations.gov and will end on January 14.

The Advisory Board Company’s e-mail policies are featured in an article about companies that encourage (or mandate) employees to stop checking e-mails after hours. CEO Robert Musslewhite, saying that “e-mail has gone too far and that is now impeding productivity,” also issued guidelines that include summarizing the topic in the subject line, limiting the number of recipients, and considering the use of instant messaging instead. The company imposed an e-mail moratorium over Labor Day weekend.

Lucile Packard Children’s Hospital (CA) provides iPads loaded with kid-friendly apps in all nine of its pediatric ED rooms. The unit’s director says that “one iPad is worth 10 milligrams of morphine.” Parents can also check e-mail and FaceTime with hospital specialists, guest services employees, and interpreters.

The Columbus, OH newspaper writes about Ohio hospitals that use EHR information to tailor their marketing campaigns to specific patient populations. At least one system (OhioHealth) admits that it screens out lower-income patients in mailings encouraging patients to schedule health maintenance visits.

CVPH Medical Center (NY) lays off 17 employees after losing $400,000 in September, but says the cuts would have been a lot more severe had it not banked $3.2 million in Meaningful Use money that was counted as revenue. 

A series of Greenway surveys finds that:

• 76 percent of practices either aren’t sure about participating in an ACO or have decided they won’t participate, while 50 percent of hospitals say they have no ACO plans
• 16 percent of practices will stop taking Medicare and Medicaid patients if payments are reduced
• 39 percent of hospital CIOs say technology has improved the efficiency of their organizations
• 45 percent of patients say they would change doctors if they’re kept waiting too long
• Seven percent of patients say technology gets in the way of their interaction with their doctor vs. the 56 percent that believe it helps the physician improve their care
• Patients view paper and electronic-based systems as equally safe and secure
• More than half of consumer respondents believe it’s the government’s job to improve the healthcare system, with hospitals and physicians a distant second and third place respectively

From the Investor Day transcript from the CEO of Quest Diagnostics, parent of MedPlus (ChartMaxx, Care360 EHR):

…We are redirecting our EHR Information Systems business. We believe that business needs to be focused on helping Diagnostic Information Services. We believe there is an opportunity for that business to complement enterprise EMR strategies that companies like Cerner and Epic and that McKesson have, and we need to participate in helping them with them and be with them when they present their strategy to integrated delivery networks in hospital systems. And therefore, we’re focusing the plan in the business around that segment in the marketplace and having a proactive program to work with the enterprise EMR companies going forward.

The $5.99 BabyDoze smartphone app plays Doppler-recorded mother’s womb sounds that the company says are 98 percent effective in calming crying babies. Its author recorded his wife’s uterine sounds in 1985 with the help of hospital staff, selling the original version as an audio tape.

A study finds that goofing off at work every now and then may improve work performance. Top-performing subjects in a four-hour simulation session of piloting military drones were found to have been distracted 30 percent of the time by their smartphones, having a snack, or reading something nearby.

Vince and Mrs. Vince have been re-honeymooning in Europe, so he compares how technology has changed in the 40 intervening years. He has returned and his regularly scheduled HIT programming will do likewise next week.

Sponsor Updates

• Jardogs recently attended the University of Iowa’s Engineering Career Fair. That’s recruiter Nicole Baer meeting with a student above. The company offers FollowMyHealth patient access solutions that include the Universal Health Record and patient kiosk.
• Intelligent Medical Objects releases its IMO Terminology Browser for Android smartphones.
• We missed a sponsor who made the Inc 5000 in our list last week. Toledo-based ESD, which you may remember as the force behind HIStalkapalooza in Las Vegas earlier this year, was recognized for its three-year revenue growth of 172 percent.
• Award-winning IT staffing firm Digital Prospectors is raising funds for Hurricane Sandy victims. The company will match donations and chip in $5 for each Facebook share and $1 for each Facebook like.
• An article by Emily Ruffing of Lifepoint Informatics describes ways that laboratory information systems can be integrated with EMRs.
• Nordic Consulting, the KLAS-ranked #1 Epic service provider and the largest Epic-only consulting practice in the country, publishes a guide for Epic-certified consultants interested in joining the Madison, WI-based company.
• SayIt Clinical Notepad from nVoq,  a cloud-based iPad speech-to-text app that allows users to capture quick patient notes on the go for later addition to the EMR, is available on iTunes.
• Liaison Technologies, the Atlanta-based cloud integration and data management leader, is recognized by the Deloitte Technology Fast 500 as one of the fastest growing companies in North America.
• Bottomline Technologies recently held its Healthcare Customer Insights Exchange in Sausalito, CA with its experts and customers providing insight about mobile technologies, process automation, payment solutions, and advanced forms management. The company offers a case study of Alamance Regional Medical Center’s move to a Logical Ink-powered tablet-based patient registration solution.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

HITlaw 11/16/12

Exit Shmexit

When healthcare provider entities merge, whether physician practices or hospitals, there is usually a misalignment of technology. It is not typical that the merging entities operate the same vendor systems, which means that ultimately one vendor is out and the other gains a new (merged) customer.

Here is a real-world example recently brought to my attention. Physician Practice A merges with (larger) Physician Practice B, which basically means Practice B bought out Practice A. The two practices use different EMR products and Practice B dictates that its current EMR technology will remain the standard. Practice A will have to transfer its operations to the other vendor’s EMR technology. Not surprising and not a big deal, many are thinking as they read this, because practices convert to different systems all the time.

However, the vendor being replaced at Practice A is not playing nicely and refuses to provide the EMR data in a format that satisfies the technical requirements for conversion. Setting aside the fact that Practice A will have serious record retention issues, they will be unable to access historical patient records (unless they continue to pay for support or subscription to keep the old system, a very unnecessary cost) and will have to start from scratch in the new system. Really?

One would think that bad PR would be enough to persuade the ousted vendor to provide the practice data ready for conversion, but we have seen enough strange stories about sore losers recently to unfortunately have to consider this possibility and behavior.

About the title of this posting – Exit Shmexit? Every software contract should have a section devoted to data rights and extraction at termination. Frequently labeled in conversation as “Exit Procedure” or “Exit Strategy,” this type of language is absolutely essential. I take the tone I do because it is clear that unfortunately many practices, and to a lesser extent, some hospitals, do not take the time to carefully review and negotiate the terms and conditions under which they are investing in technology.

Evident in my HITlaw postings is the emphasis on the critical need to review and negotiate your software agreements. “Exit Shmexit” is my personal rebuke to those that consider vendor license agreements as merely “paperwork” and hurriedly review and sign what is put in front of them. Inclusion of a few sentences in Practice A’s EMR license would have prevented the present angst and difficulty for that entity.

Although not as pertinent to hospitals due to the size and expense of the technology investment (and corresponding recognition and cooperation by vendors), I am made increasingly aware of instances where physician practices are courted, quoted, and commanded. The first two everyone knows. Commanded refers to the attitude of some vendors at the contract stage. Sign here. We don’t negotiate.

Editorial comments now aside, here is the help.

To repeat, every software contract should have a section devoted to data rights and extraction at termination.

Critical inclusions that should be in the software license:

• As between vendor and customer, all data entered into the software database is the property of the customer. This is my nod to the notion that medical records are truly the property of the patient, but that is a topic for another day. The point here is that the customer owns all the data, not the vendor, and the vendor must recognize this.
• Transition must be accommodated. Upon termination of the software contract for whatever reason, all data must be immediately made available to the customer. This is to be provided without question in industry standard format and at no additional cost. This is part of the price of doing business and I have no problem advising my healthcare technology company clients that this must be done.
• The vendor must also agree to provide the data, for an additional cost if necessary, in whatever format is required by the replacement vendor, with a reasonableness factor included regarding technical feasibility.

Dust off your existing EMR license agreement or review the proposed agreements in front of you for that new EMR, PACS system, or HIS as the case may be. No exit procedure? For existing relationships, think about this before you sign with the new vendor. Go back to the existing vendor and address the issue. Far better to do so when there is still a working relationship than after you have told the vendor they will be replaced. For prospective business relationships, get agreement from the vendor as described above (as well as many other important considerations).

Going back to my editorial comments, any customer presented with a contract and the statement that “we do not negotiate” should politely show the salesperson the door. There will be another one from another vendor ready and willing to discuss your needs and listen to your contractual concerns.

This is not to say that vendors must negotiate all terms and conditions as requested by the customer prospect. Vendors are completely within their right to protect their business and intellectual property, limit their liability, and keep sacred the things most important to them. However, to place a contract in front of a prospect with the message “take it or leave it” is not good for business. Unless of course the agreement is written so fairly that it considers not only the company’s interests but also the interests of its customers in equal measures. That would be very rare.

Repeated many times in my HITlaw postings is the advice that contract review, at least for major terms and conditions, is a critical part of the vendor selection process. Do not select a vendor and then look at the contract. When you have the search down to a select few vendors, review the contracts in front of you. Look for the smoldering sections that need attention. Recognize the absence of sections of vital importance for your protection during and after the business relationship.

In the example above, the absence of a “data rights at termination” section should be immediately brought to the vendor’s attention. If the vendor provides language suitable for your protection, keep them in the game. If they refuse where others cooperate, take them off the list.

Please see my quick tips for an EMR Contract, as well as my paper Selection and Negotiation of EMR Contracts for Providers. Hopefully my general insight and advice will help avoid problem situations such as the one involving unfortunate Practice A.

Previous HITlaw postings were fairly infrequent and arose only when I found a seriously weighty topic. Look forward to more frequent postings on important issues in shorter format. E-mail me with questions and suggestions for future HITlaw writings, whether provider side or vendor side.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA. You may contact him at wfo@otoolelawgroup.com and follow him on Twitter @OTooleLawHIT.

News 11/16/12

Top News

Sixty-nine percent of US primary care physicians report using EHRs, up from 46 percent in 2009, while about a third of doctors say their patients have the ability to e-mail the practice and have online tools to request appointments, referrals, and prescription refills. The study of 10 “high-income” countries also finds that despite health reform initiatives, a high percentage of physicians in all countries complain of untimely access to information from hospitals and specialists.

Reader Comments

From Mango Mel: “Re: UNC. As you mentioned, they are going Epic.” I heard that rumor again today from an excellent source. If it’s true, that gives Epic all of the big hospitals in the Triangle area of North Carolina, which is almost all of the beds there now that they’ve recently added Duke and the just-announced WakeMed. Other NC users of Epic are New Hanover, Vidant, and Novant.

From The SFTreat: “Re: GE Healthcare layoffs. True – a number of staff from the Seattle office are gone.” We’ve run several rumors suggesting that the layoffs were going to happen Wednesday. A Boston article says the company confirmed that 10 percent of its Vermont workforce has been let go, but the company declined to give specifics. Our GE contact said that fewer than 50 employees were impacted and no office closures or product retirements were involved. According to the official response:

“In fact, GE HCIT is maintaining its focus on the needs of integrated care delivery, and in conjunction with our strategy, we are making choices to redeploy some portions of our resources and capital into new areas of product and service innovation. While these types of decisions are never easy in the near term, we are confident that they are necessary to meet the current and future needs of our customers.”

From Candace: “Re: research and think tank institutions for healthcare technology. What do you think of IDC Health Insights? Can you recommend other research centers? I’m a recent college graduate doing a research project.” I don’t have any experience with any of them, so I’ll open the floor to readers willing to help. Don’t they sound like swell places to work, though, just sprawling back at your desk thinking in a swanky office park?

From DeanInsider: ”Re: rumor of doctor resignations. Not the case. Dean is pleased to have become an Accountable Care Organization and has always put patients first.” I assumed that was the case, but several hospitals have announced layoffs they’re blaming on PPACA. The latest: Wake Forest Baptist Medical Center, which will eliminate 950 positions. A local professor there says hospitals must plan for at least one year of lower payments, reductions in federal grants, and the high cost of EHRs.

HIStalk Announcements and Requests

nice “@ingahistalk: Bowtie Confidential 11/10/12: Tweet Accountable Care Act and its Effects on the Board of Directors bit.ly/S9bQkV”

— Farzad Mostashari (@Farzad_ONC) November 11, 2012

HIStalk Practice highlights from the last week include: MGMA members give Medicare the highest marks among seven top payers. The country will be short 52,000 family physicians by 2025. An 87-year-old doctor who charges $5 an office visit says he didn’t select his profession for the money. Physicians must participate in PQRS in 2013 to avoid 2015 penalties. A list of the worst passwords for 2012. Rob Drewniak of Hayes Management Consulting discusses the need to educate board members on the ACA and its implications for their organization. Dr. Mostashari, by the way, gave Rob’s post a thumbs up. If Dr. Mostashari is reading HIStalk Practice and you aren’t, maybe it’s time to consider what you’re missing. Thanks for reading.

We ran a link to the draft Meaningful Use Stage 3 rules earlier this week, but just to be clear, this is a draft document not yet available for public comment even though its title is “HITPC Stage 3 Request for Comment.” You’re seeing it as it came from the Policy Committee.

Inga’s been a good girl this year, so here’s her Christmas list for your consideration: (a) sign up for spam-free e-mail updates to HIStalk, HIStalk Practice, and HIStalk Mobile; (b) friend, like, and connect with us on all the social not-working sites; (c) send us news and rumors; (d) review and impulsively click some of the much-appreciated sponsor ads to your left, search and navigate to their details in the Resource Center, and send your consulting RFI viral with the RFI Blaster; (e) tell other folks you read our sites because when it comes to our marketing channels, you’re all we have; and (f) give yourself one of those wrapping-your-arms-around-yourself hugs and pretend it’s Inga since it will take her awhile to get to each reader personally. I’m just happy reading down the list of 2,850 impressive folks who have signed up for Dann’s HIStalk Fan Club and thinking how cool that is. That’s the first place I look when considering somebody’s request for an HIStalk-related favor.

On the Jobs Board: Workflow Automation Project Manager, Technical Trainer, Product Analyst, User Interface Engineer.

The most common grammatical crutches I have to edit out of the interview transcripts I run, sometimes in truly startling numbers: (a) “really”; (b) “sort of”; and (c) starting sentences with “so” like someone telling a bar stool yarn. I was at a doctor’s presentation today and counted the number of times she said “sort of” and was up to 79 in the first 30 minutes before I tired of the exercise. I’m not annoyed, just sorry that the power of what she was saying was needlessly diluted by subconscious speech tics.

Acquisitions, Funding, Business, and Stock

CACI will acquire Emergint Technologies, a provider of HIT services and analytics solutions.

WellStar Health System pays $20,000 for the trade name, trademark, and other assets of the bankrupt Center for Health Transformation, the for-profit healthcare think tank founded by Newt Gingrich. WellStar intends to convert it to an independent, nonprofit collaborative of 20 non-competing health systems in the Southeast, focusing on sharing ways to improve quality and reduce costs. 

Salt Lake City-based Remedy Informatics gets a $6 million investment from Merck. The registry and research informatics company is headed by Gary Kennedy, so I assume it’s related to the former RemedyMD. I interviewed him in early 2007 and was pretty impressed, although the hospital-type database products seem to have been de-emphasized in favor of the life sciences ones.

Sales

WakeMed Health & Hospitals (NC) will invest $100 million over five years to implement Epic.

The DoD and VA award Document Storage Systems an EHR integration subcontract.

Oakwood Healthcare (MI) renews its multi-year IT outsourcing contract with CareTech Solutions for $120 million.

People

Harry Jacobson, MD, former vice chancellor for health affairs at Vanderbilt and CEO of Vanderbilt University Medical Center, joins digiChart as chairman, replacing G. William Bates, MD, who was recently named chairman emeritus.

Net Health systems, a provider of IT systems for wound care, hires Kelley J. Schudy (Allscripts) as VP of sales.

Announcements and Implementations

The National Basketball Association will use Cerner’s HealtheAthlete health management platform for all of its teams.

The LSU Interim Hospital and 11 clinics are live on the Greater New Orleans HIE, which will connect to the state-wide Louisiana HIE by the end of the year.

The Pennsylvania eHealth Collaborative signs up 3,449 providers for DIRECT messaging, exceeding the federal government’s goal of 1,000.

Lakeland Regional Medical Center (FL) goes live on Cerner clinical applications with implementation assistance from Healthcare Clinical Informatics.

Elsevier announces the launch of Health Care: The Journal of Delivery Science and Innovation. It will focus on applied healthcare IT and health reform. Founders and co-editors are Amol Navathe, MD, PhD (Brigham and Women’s, Harvard Medical School, Wharton School) and Sachin Jain, MD, MBA (Boston VA, Harvard Medical School, and Merck).

North Mississippi Health Services (MS) wins a Baldrige Award. 

Innovation and Research

Got a flair for design and patient-friendly medical information? ONC and VA are running a Health Design Challenge for creative types who can make CCD/Blue Button information easier for patients to understand. Three prizes are offered in each of four categories (Best Overall Design, Best Medical/Problem History Section, Best Medication Section, and Best Lab Summaries) ranging from $1,000 to $16,000. The deadline is November 30.

Other

A CapSite study finds that almost one-third of hospitals plan to invest in patient flow solutions within the next two years. Leading vendors include TeleTracking, McKesson, Epic, and Meditech, while the vendors most often being considered are listed in the graphic above.

Speaking of CapSite, a HIMSS webinar this Friday afternoon will cover “The CapSite Acquisition and What It Means to You.”

Bill Hersh provides an update on the clinical informatics subspecialty for physicians. Details are being worked out about the grandfathering and initial exam process, but Bill says the first candidates will sit for their test in October 2013.

Allscripts responded to our reader’s question about whether MyWay users will be released from their contracts if they decline the company’s offer of a free upgrade to Professional.

“Allscripts is providing a free upgrade, and the contract does not allow for cancellation of current leases. Allscripts is dedicated to working with our clients to help them succeed, and we believe the upgrade provides the right benefit for the long term.”

Weird News Andy says this never happens to him while listening to NPR. A former Doctor of the Year ED doc faces a long list of charges after hitting several cars in a parking lot while allegedly under the influence of drugs and alcohol with NPR cranked up loud in her Outback. She says her accelerator got stuck on her way to Whole Foods to buy a Thanksgiving turkey, but police found pills and prescriptions she had written for herself.

WNA labels this story “Hello Terry Schiavo.” Scientists performing a functional MRI on a man who has been in a vegetative state for 10 years find brain wave patterns that suggest he is answering the questions they’re ask him. The scientists believe the patient is aware of who and where he is.

Sponsor Updates

• Leslie Kelly Hall, SVP for policy at Healthwise, joins a panel discussion on patient engagement framework at next week’s National eHealth Collaborative Webinar.
• Visage Imaging will demo its Visage 7 processing technology, including work-in-process capabilities, at this month’s RSNA meeting.
• Merge Healthcare will unveil its mobile and Internet platform for patients during RSNA.
• Greater Baltimore Medical Center (MD) reports a reduction in paper output and waste since deploying Access Intelligent Forms Suite and Wacom STU-500 signature tablets.
• TeraRecon previews a pay-as-you-go option for use of its iNtuition advanced visualization tools by physicians who perform aortic repair procedures.
• Kareo offers tips for increasing practice revenue in its November newsletter.
• The Canadian Health Informatics Association awards TELUS Health Solutions its Corporate Citizenship Award for achievements in health and technology to improve patient outcomes.
• McKesson will combine its Episode Management software with the Prometheus Payment model to support large-scale bundled payment programs.
• DrFirst will embed Halfpenny Technologies’ Integrated Technology Framework for CPOE and results delivery within its Rcopia e-prescribing platform.
• White Plume Technologies’ Laura DeBusk and MED3OOO’s Cindy Cain will discuss the impact of ICD-10 on operations, compliance programs, and cash flow in a November 29 Webinar.
• Aprima will integrate Alpha II claim scrubbing technology into its EHR and PM solutions.
• HIStalk sponsors earning a spot on the 2012 Inc. 5000 List of America’s Fastest Growing Companies include Beacon Partners, Culbert Healthcare, Cumberland Consulting, Digital Prospectors, eClinicalWorks, Enovate IT, Etransmedia Technology, Greenway, GetWellNetwork, Hayes Management Consulting, Kareo, Iatric Systems, Impact Advisors, Ingenious Med, iSirona, maxIT Healthcare, MED3OOO, MEDSEEK, Passport Health, Virtelligence, and Vocera.
• HIStalk sponsors included on Deloitte’s 2012 Technology Fast 500 ranking include Etransmedia Technology, Greenway Medical, MModal, MedAssets, NexJ Systems, and Vocera.
• Sandlot Solutions unveils the final results of eHealth Initiative’s 2012 Annual Survey of HIE Initiatives.

EPtalk by Dr. Jayne

The American Academy of Family Physicians releases a summary of the 2013 Medicare Physician Fee Schedule. Increases will only occur if Congress takes its annual action to block the reduction that is scheduled for January 1.

AAFP also publishes (subscription only) its 2012 EHR User Satisfaction Survey. Of 3,088 viable responses (as in previous years, several hundred responses were excluded because respondents said they did not use EHR or didn’t identify their systems) 31 vendors account for 92 percent of the systems. The highest counts (over 200 responses) were reported with Allscripts, Centricity, eClinicalWorks, Epic, and NextGen. As someone who has been documenting with EHRs for more than a decade, I find some of their survey questions suspect. For example, “This EHR helps me see more patients per day (or go home earlier) than I could with paper charts.” They certainly didn’t control for the dramatic increase in federal, regulatory, and payer scut work that has added to the bottom line of my work hours. Even if I was on paper, I’d be seeing fewer patients and going home later just for that reason.

The authors recognize that “practice size is independently related to satisfaction,” noting that except for a few systems, the majority of “large practice” vendors fall towards the bottom and “small practice” vendors hit near the top of satisfaction scores. The cutoff for vendor inclusion was 13 responses, so there is question on whether they are statistically significant. Some of the highest ranking systems are relatively untenable in enterprise environments, so I feel for administrators whose physicians will be marching into the office with the article in hand, demanding that Cerner be de-installed in favor of Praxis, SOAPware, or my favorite: Point and Click EHR.

Another doomsday prediction finds that we’ll need 52,000 more family physicians by the year 2025. I can almost guarantee that if you figure out how to pay them what a cardiologist makes, you’ll get them.

A good friend sent me a link to the “Jane and the Doctor” YouTube video. It’s an oldie but a goodie if you haven’t seen it. For those of you in the implementation trenches, know that you are not alone and there are many others of us who hear the same tired complaining from physicians all day long.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 11/14/12

Top News

ONC releases the draft of the proposed Stage 3 Meaningful Use rule.

Reader Comments

From Minnie Mouse: “Re: NextGen User Group meeting. Over 4,400 attendees have descended on five Disney resorts in Orlando.” The NextGen folks sent over a few pics and we are running a Twitter feed box with meeting updates. The company honored the winners of its innovation awards Monday evening, which included the Flemington, NJ-based Hunterdon Healthcare Partners (above) as Grand Champion. Attendees tweeted positive comments about the food, the presenters, and the enhancements being previewed.

From SideWays: “MyWay contract. Will Allscripts let MyWay users out of their contract if they choose not to migrate to Allscripts Professional?" We’ve asked Allscripts for clarification.

From Peter Potamus: “Re: Allscripts. John Gomez has been consulted by some PE companies asking for guidance and insight into MDRX, and possibly the idea of his returning as CEO. He is getting tremendous pressure to step up, take the helm, and reinvent the company as he did during his early tenure at Eclipsys. I wish he would take it on, but so far he has been resistant. In the Sunrise XA days, he galvanized the client base, rallied the employees, and delivered all he said he would, inventing the App Store, Helios, Objects Plus, and much more.” I’m going to keep my response guarded since Allscripts is publicly traded. I have reason to believe that one or more of the PE companies with an interest in bidding for Allscripts may have approached John for advice that may or may not have included discussion of a possible role if the acquisition moves forward. That’s hardly surprising – if I were a PE guy, l would be calling up departed executives such as John, Jay Deady, Phil Pead, Bill Davis, and maybe even John McConnell for an arm’s length opinion about what they think needs to change to make the company successful. They could also read the advice of the HIStalk Advisory Panel. Or yours, if you’d care to leave a comment – I have a lot of readers who are VCs, equities analysts, etc. so make me proud by showing them how insightful you are.

From Stock Doctor: “Re: cartoon. Thought this was amusing.” I like it.

From Country Lane: “Re: Geisinger. I’ve heard rumors that they will release a commercial product aimed at the ACO market.” Geisinger Consulting Group offers software-related services, but I don’t know if the health system is selling software directly. It doesn’t seem like their core competency, but that doesn’t mean they aren’t doing it.

From G.E. Smith and the SNL Band: “Re: GE Healthcare IT. Layoffs coming, the third large one this year. The Centricity Business line is rumored to be heavily impacted again. Software development for various imaging product lines will likely also be cut. Tragic for employees, unfortunate for customers. In any competitive industry, failure to innovate=death. In this case, GE Healthcare has chosen assisted suicide at the hands of Epic and other more agile competitors.” Unverified.

From Fly on a Wall: “Re: GE Healthcare IT. Rumor has it they’re dumping people (layoffs Wednesday) and capital to prepare for a potential acquisition of a large healthcare IT company that McKesson was rumored to be acquiring last week.” Unverified. The subjects of the McKesson rumor that appeared here were athenahealth and Greenway. Monday’s stock market action gave no hints that ATHN is in play (shares were down in a down market), but GWAY shares rose 2 percent on no news other than a management overview. That’s interesting, but probably means nothing.

From HITEsq: “Re: American Hospital Association. They’re very litigious, with dueling complaints filed in federal court with SSI Group. SSI Group seeks declaratory judgment that the UB-04 codes are not valid copyrights or that any protection ‘is extremely thin.’ AHA filed suit against SSI Group for copyright infringement.”

From Karl Marx Brothers: “Re: ONC. It would seem like a good time to look at the return on investment of ONC. In 2009, this office had a budget of $67 million. I am told that in FY 2012 the budget was over $2 billion. While I understand some increase was needed, this seems excessive in a time where a balanced budget is becoming increasingly important. Do we really need masses of beltway bandit consultants working on HIE interoperability issues, such as communicating lab results, that were solved 10 or more years ago?” According to FY2013 budget documents from February 2012 (the only documents I found), ONC requested 191 FTEs and $66.3 million for 2013, up $5 million from 2012.

From EpicBuzz: “Re: HCA. One HCA hospital went live on Epic earlier this year and now Epic is quietly assembling an implementation team to begin rolling out more facilities. Can they be successful with this huge win? As a former Epic employee, they already seemed stretched to meet customer needs – I was working 70+ hour weeks when I left. This large of a commitment will be a test of their strength for sure.” HCA hasn’t confirmed plans for further Epic rollouts beyond the pilot, or at least the several HCA people I asked said they didn’t know anything about it. Epic is the only vendor that has demonstrated an ability to rapidly ramp up without apparently loss of quality, but HCA has a couple of hundred hospitals and that would indeed provide the ultimate test of turning thousands of brand new liberal arts grads into healthcare IT experts via a short company training program. I don’t think the already-stretched Epic-certified talent bank can even begin to handle a multi-year HCA rollout if it happens, so that probably means a salary war to lure people over. That might throw some disarray into Epic’s carefully managed centralized contractual control over people seeking new opportunities without a waiting period. I don’t have enough fingers to count the percentage of US patient volume that Epic will have if indeed it does land the HCA whale. 

Photo: Michael Henninger/Post-Gazette

From Grizzled Veteran: “Re: UPMC. How is this possible?” UPMC reports Q1 revenue of $2.5 billion, up $39 million, but the real eye-opener is its $300 million net revenue swing from –$120 million a year ago to $180 million. Kaiser Permanente also turned in good quarterly numbers, with $12.7 billion in revenue vs. $11.9 billion and operating income of $561 million vs. $320 million. KP’s net non-operating income got a huge pop from investments, swinging from a $365 million loss last year to a positive $242 million in Q3.

From MadisonHIT: “Re: Dean in Madison. I’ve heard indirectly that they are laying people off and blaming Obamacare because 100 doctors are leaving because ACA doesn’t let them place patients first. Supposedly this is a nationwide occurrence since the election. Anyone hearing anything similar?” I haven’t heard that, but I’m all ears.

HIStalk Announcements and Requests

I’m running “Morning Headlines” early each weekday on HIStalk, a quick summary of the handful of most important news items you should know about. You won’t get an e-mail blast – just go right to the site. If you’re in a hurry or need a quick smartphone HIT news check while eating breakfast at your hotel, this is the place.

Acquisitions, Funding, Business, and Stock

A Reuters report quotes unnamed sources who say that three private equity companies placed bids last Friday to acquire Allscripts: Carlyle Group, Blackstone Group, and TPG Capital. The sources said that Allscripts is asking for a premium to the current share price and a deal isn’t guaranteed for that reason. It also said that Bain Capital declined to bid because of unreasonable price expectations and company management turmoil. Shares closed Tuesday at $12.32.

EarlySense Ltd., a maker of patient monitoring sensors, completes a $15 million Series E financing round.

Emdeon reports Q3 loss of $15.2 million, which represents a 341 percent decline over a year ago. Revenue was up 5.3 percent to $297 million. Emdeon attributes the loss to increased interest expenses and costs associated with the company’s acquisition by Blackstone a year ago.

InterSystems opens an office in Riyadh, Saudi Arabia to support its TrakCare EMR system.

QualComm Life announces availability of its cloud-based health device connectivity solution in Europe.

Sales

Lake Health (OH) selects Accelarad’s SeeMyRadiology.com imaging management and storage solution.

Orlando Health contracts with Phytel for its Atmosphere population management suite, including the Outreach, Insight, Coordinate, and Transition products.

Erie County Medical Center (NY) selects Merge Healthcare’s iConnect Enterprise Archive and iConnect Access for real-time access to images and information from Meditech.

Medina Regional Hospital (TX), Red River Regional Hospital (TX), Ward Memorial Hospital (TX), and First Street Hospital (TX) choose Healthland Centriq, adding to the company’s total of more than 70 rural Texas hospital customers.

Central Washington Hospital (WA) selects patient privacy monitoring tools from FairWarning.

People

Zynx Health announces that President and CEO Scott Weingarten, MD (left) has resigned to return to Cedars-Sinai Health System. He will be replaced by First Databank President Greg Dorn, MD (right), who will run both of the Hearst organizations.

Awarepoint names Vanguard Health Systems Vice Chairman Keith B. Pitts to its board of directors.

Apprio names H. Allen Dobbs, MD (HHS) CMIO.

Announcements and Implementations

McKesson renames Horizon Surgical Manager to McKesson Surgical Manager to convey that the product is not specifically tied to the Horizon product line.

FDA issues Cerner 510(k) pre-market clearance for its Cerner FetaLink+ mobile fetal monitoring solution for the iPad and iPhone.

Piedmont Healthcare and WellStar Health System (GA) create the Georgia Health Collaborative, a partnership which includes 10 hospitals and over 700 physicians. The organizations will remain independent, but will partner to share best practices and create innovations and cost reductions through economies of scale.

Intelerad will offer Nuance’s PowerScribe 360 voice-enabled reporting radiology system to customers of its imaging solutions.

Galaxy Health Network will offer its 400,000-member physician network iMedicor’s SocialHIE, a NHIN Direct-powered secure messaging service that the company calls “the social network for healthcare professionals.”

Steward Health Care System (MA) expands its use of Craneware’s Chargemaster Corporate Toolkit and InSight Audit across 10 hospitals.

Over 1,000 physicians across 422 practices have joined Michigan Health Connect and are using Medicity’s iNexx Referrals app.

The Upper Peninsula HIE goes live on ICA’s CareAlign CareExchange interoperability platform.

An article in the Sarasota newspaper profiles Voalte, including its $6 million in recent funding, the planned tripling of its headcount and physical space, and hints of major new sales in 2013. It says the smartphone hospital communications system vendor is doing $10 million in business annually. Sarasota Memorial Hospital nurses are sending 600,000 text messages and 6,000 telephone calls through the system each month.

Visage Imaging’s mobile viewing app has been enhanced to support the iPhone 5/iOS 6. It’s available in the Apple App Store.

Government and Politics

HHS announces the first class of the HHS External Innovation Fellows, who will spend the next six to 12 months building systems and infrastructure to solve such issues as the acceleration of clinical quality measures for the Affordable Care Act, building technology to withstand natural disasters, and devising electronic tracking and transport systems for the national transplant system. 

Innovation and Research

A Detroit TV station covers research commercialization at University of Michigan, including a profile of real-time patient monitoring software vendor AlertWatch. AlertWatch, used by UM Hospitals and awaiting FDA marketing approval, was developed by a UM doctor who also invented the pulse oximeter.

Other

The president of New York’s public hospital system says it will cost more than $300 million to repair damages from Hurricane Sandy. Full restoration of the hard-hit Coney Island and Bellevue Hospitals will take two to three months.

Here’s a time lapse video of the audience filing in for Monday’s opening session at NextGen UGM 2012 in Orlando.

London-based Future Lab Group launches the FlipPad, a medical grade, ruggedized case for the iPad that’s being piloted in several NHS hospitals.

Bart Harmon MD, chief medical officer for Harris Healthcare Solutions and former Military Health System CMIO, writes a Forbes Veterans Day editorial on the use of healthcare IT to deliver care “both in the field and when they return home.”

In Greece, several hospitals lose their connection to the outside world when protesting students break into the data center and disable servers.

Employees and patients of Cincinnati Children’s Hospital create a video dubbed to Flo Rida’s “Good Feeling.”

Steve Sinofsky, the president of Microsoft’s Windows division and one-time CEO heir apparent, is leaving the company just a few weeks after the launch of Windows 8.

Guaranteed doctor blood pressure raiser: Lawsuit Settlement Funding Company hires a marketing company to help it find medical malpractice victims. The company offers malpractice plaintiffs quick-approve loans of up to $250,000 as an advance against their potential court winnings.

The son of a woman who died after knee surgery at a Massachusetts hospital files a HIPAA complaint, saying that rounding students visited her room without the family’s permission. He also tries to file homicide charges against the hospital and doctors, but police said it’s a civil matter. The son’s song tribute to Fenway Park is played before Red Sox home games, while his mother starred in the song’s video along with William Shatner just before she died.

One Medical expands to Boston, offering concierge medicine for $199 per year whose consumer-friendly experience includes online appointments and e-mail contact with physicians. Unlike most organizations of that type, they accept insurance.

A Chinese man sues his former wife after she gives birth to an “incredibly ugly baby.” He initially accused the mother of having an affair since the baby did not resemble either of them, but later found that his wife’s beauty was due to the $100,000 in plastic surgery she had prior to their marriage. The judge ordered the woman to pay her ex $120,000 for tricking him into marrying her. I hope she hits up the plastic surgeon for a loan in exchange for all the free publicity.

Sponsor Updates

• Transplant solutions vendor OTTR Chronic Care Solutions exhibited at last week’s National Marrow Donor Program conference in Minneapolis. That’s Joy Nock above.
• Five care management solutions providers featured in a recent market report use consumer health education tools from Healthwise.
• Versus offers a Webinar  that highlights the use of Versus RTLS by Northwest Michigan Surgery Center.
• MedHOK enhances its care management, quality, and compliance system by incorporating HTML5.
• Informatica introduces Cloud Winter 2013, which includes enhancements in master data management and end-user integration.
• Prognosis Health Information Systems will integrate Health Language’s provider-friendly terminology and Language Engine into its EHR suite.
• Frost & Sullivan recognizes Humedica for its innovative approach to clinical data analytics and the value it provides to clients.
• Emdeon exhibits its Edge payment solution suite and offers educational sessions during this week’s National Health Care Anti-Fraud Association conference in Anaheim, CA.
• T-System’s VP of Revenue Cycle Management Compliance Greer Contreras discusses the value of relevant clinical documentation to ensure proper reimbursement in a guest article. 
• UK HealthCare (KY) licenses Vendor Selection, Systems Implementation, and Program Management Methodologies from Fulcrum Methods.
• Merge Healthcare updates its Merge Eye Care PACS to support video and the DICOM OPT standard.
• The Nashville Chamber of Commerce and Entrepreneur Center recognizes Cumberland Consulting and Emdeon with 2012 NEXT awards for their significant growth in revenue and employees.
• BridgeHead Software’s file archiving data and storage management systems for PACS is successfully tested by Fujifilm.
• The Huntzinger Management Group streamlines its services offering to include RCM offerings from both its Advisory Services and Managed Services segments.
• CareTech Solutions introduces CareWorks, an out-of-the-box content management system for smaller hospitals.
• Brad Levin and Malte Westerhoff, PhD of Visage Imaging were featured in an Imaging Biz article called “The High-performance, High Speed Enterprise Viewer.”
• Worcester Business Journal awards eClinicalWorks top honors for its employee rewards and recognition.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 11/12/12

From Winston Zeddemore: “Re: EHR incentive program. Purely from the perspective of economic stimulus, by any measure, the EHR incentive program is a complete failure. After nearly four years since the bill was signed, they’ve paid out only a third ($8.36B) of the $25B set aside for EHR adoption.” Thanks to our recalcitrant and justifiably skeptical doctors for finally forcing government to stop making it rain like a defensive back in a strip club. Economically, we now know that EMRs are even a tougher sell than we thought – thousands of dollars in bribes still isn’t enough to convince doctors to spend more of the one resource they have (time) to benefit everybody but themselves. However, it’s fairly early in HITECH and the money is flowing freely now, so eventual success aside, your argument holds true – HITECH as a quick-jolt stimulus program hasn’t worked out, but for a positive reason — its intended recipients were held to high standards before the taxpayer-written checks were mailed out. That’s another good thing  – the biggest concern about a stimulus-funded EHR program was that it would move too fast, causing doctor headaches and possibly harming patients along the way because of shoddy implementations of historically poor-selling products as everybody elbowed their way to the feed trough. As distasteful as HITECH is to many (me included), it’s working better than many other ARRA-funded boondoggles.

From Geek Chic: “Re: open source code for integration. Have any of your readers used an open source engine for HL7?” Leave a comment if you can help our inquisitor. Readers have mentioned using the Mirth engine in the past.

From The PACS Designer: “Re: RIS-teria. TPD has coined a new name for problems surrounding radiology information systems. While a RIS does a reasonable job of scheduling patients for studies, it is less efficient in dealing with the subsequent information flow. With the increased demand for better information to improve efficiencies, the RIS is lagging behind other systems due to the lack of adequate application programming interfaces (APIs). RIS-teria results from department managements quarreling on where to place new API’s, and who is going to provide the necessary funding. One solution is to do an upgrade to a RIS/PACS from the same vendor who can provide the necessary API software to communicate with other systems.” 

From RIP_IDX: “Re: GE Healthcare. Significant layoffs coming to GE Healthcare in Burlington this week (probably Wednesday). Not sure if it is going to be limited to just the BTV office or across GE-HCIT. Rumor is Centricity Business will be hit hard. Haven’t heard if imaging (also based in Burlington) will be impacted. In a completely coincidental move, employees have been reminded of the corporate policy prohibiting them from talking to the media.” Unverified and hopefully untrue. We’re getting close to that Thanksgiving to New Year’s period where companies show their hand as desperate, cold, and clueless by sending employees packing during the holidays.

From MaxIT Numbers: “Re: MaxIT. Bought by SAIC for $473 million. Last quarter’s revenues were $52 million, or $208 million analyzed. That’s a buyout multiple of 2.3 times yearly revenue. How many consulting firms saw this number and are considering selling? Does this multiple seem off to anyone besides me? They must be generating huge margins at the expense of their customers.”

Two-thirds of respondents believe that patient empowerment and mobile apps can will change the healthcare system. New poll to your right, requested by a reader: what’s your general opinion of the College of Healthcare Information Management Executives (CHIME)?

Here’s my latest Spotify playlist in case you’re interested exploring new music (although some of the “new” music is actually old but little appreciated). Examples of what’s on it: Metric, Chevelle, Hammers of Misfortune, Fitz and the Tantrums, The Czars, Curved Air, Marmalade, Hole, and After Forever. It spans more than 40 years and several genres, connected only by the thin thread of my common appreciation.

Some nuggets from the Allscripts earnings call Thursday:

• Glen Tullman said drastically reduced earnings were caused by prospects delaying decisions because of the rumors that Allscripts was trying to sell itself, and also because of clients were waiting for new product releases. Ambulatory sales were hurt by the acquisition rumors and MyWay announcement. Professional services revenue slipped due to fewer sales and upgrades, but maintenance revenue increased. He repeatedly referred to the sales-impacting issues as “noise.”
• The company had one new Sunrise sale in the quarter. The buyer was a three-hospital, 214-bed system.
• Reaction to the MyWay announcement was “pretty positive.” Glen declined to give the MyWay customer count, but said it’s in the thousands.
• Glen: “You’ve got some old systems out there that are harder to connect and harder to upgrade, and you’ve got a slew of new technologies starting to hit the market. That’s when whole sectors change. I think that’s our opportunity.”
• Allscripts hasn’t seen lengthening sales cycles in ambulatory as other companies have said they’re experiencing.
• The company expects “the vast majority” of MyWay users to move to Professional by the October 13, 2013 signup deadline.
• Glen: “I think this is a big focus for us whether it be analytics, whether it be care coordination, whether it be interoperability, connectivity, and mobility. All of those will absorb a higher and higher percentage of our R&D budget, which continues to grow. And we think that we will have significant advantage. Some of our competitors are locked into architectures that don’t allow for the kind of innovation that we can bring. And with our open ecosystem that we’re creating, with all the third parties starting to develop on that platform, we think we can extend significant competitive advantage as those folks developed for us.”

A survey of “digital health entrepreneurs” by venture capital firm InterWest finds that the top three barriers to healthcare innovation are reimbursement (27 percent), government (19 percent), and Epic and Cerner (14 percent). The heel-nippers may pout that well-established and successful vendors won’t voluntarily move out of their way, but they’re also envious: companies they wish they had founded include AirStrip, Castlight, ZocDoc, Epic, and Google. The graphic above is their prediction of which of their brethren will be the next to go public.

A wood products company becomes the first business in Maine to use telemedicine in the workplace, offering its diabetic employees video consultations with the co-director of the diabetes center at Tufts Medical Center. The program gives employees access to specialists who aren’t available in the company’s rural location and eliminates the high co-pays that most employees couldn’t afford.

Massachusetts-based hospital drug supplier Ameridose, a sister company to the compounding pharmacy whose products have been linked to a national outbreak of fungal meningitis, lays off its 800 employees as the FDA reviews the company’s sterility practices. The director of the Massachusetts Board of Pharmacy has been fired for failing to investigate a sterility complaint against the compounding pharmacy. It’s an interesting juxtaposition of headlines on Ameridose’s site (above).

Nashville-based Dalcom Communications Systems, which sells a wireless patient communication and nurse alarm system, renames itself to Amplion Clinical Communications after raising $3.75 million in financing to expand sales.

Sen. Orrin Hatch (R-UT) raises concerns with HHS Secretary Kathleen Sebelius that Quality Software Services, Inc., which was awarded a contract worth up to $145 million to create an eligibility system for the federal health insurance exchange, has since been acquired by Optum, part of UnitedHealth Group. QSSI’s annual sales were $13 million before the deal. The federal official overseeing implementation of the health insurance exchanges resigned in June to take an Optum EVP job.

Release of information vendor HealthPort merges with competitor Discovery Health Records Solutions. The Atlanta-area companies will operate under the HealthPort name. HealthPort sold its IT-related businesses, which included the former Noteworthy Medical Systems, to Germany’s CompuGROUP for $24 million in November 2010.

Sponsor Updates

• A four-part series by Karen Baker, MHS of the nonprofit Healthwise celebrates National Health Literacy Month with a discussion about how to engage patients in healthcare decisions. The organization took a team of 18 of its content producers to a scriptwriting camp led by an advertising copywriter, an actor, and a filmmaker to encourage them to break the rules in developing material that not only supports evidence-based medicine and behavioral change theory, but in a way that gets patients involved using plain language and taking the patient’s point of view. According to Healthwise Founder and CEO Don Kemper, “Medical gobbledygook robs people of their autonomy. Without understanding, they have no real say in their care. Plain language gives them back their say.”
• Besler Consulting will exhibit at HFMA’s Region 9 conference in New Orleans this week, demonstrating its cloud-based BVerified solutions for transfer DRG, IME, excluded provider screening, and revenue integrity auditing.
• CSI Healthcare IT revamps its job portal, which lists its several dozen open positions (direct hire, consultant, and contract to hire) for candidates with expertise in Cerner, Epic, McKesson, and Meditech.
• An interesting blog post by Henry Sabia of Software Testing Solutions on the changing no-man’s land between the EHR and laboratory information system: “It seemed to me the consensus was that ‘LIS’ won’t be about one system doing everything. Thought leadership sees it as a spectrum of systems working together. Ironically, GenLab and Microbiology functions may leave the typical LIS applications to become part of the general EMR, but Blood Bank and Anatomic Path will most likely fall under the ‘specialty’ category and will require standalone systems. Seems to me that we will always have separate systems, but a game of Red Rover is happening with some of our functionality. The EMR/CPOE has called GenLab and Micro over. Will be interesting to see if/how they make it to the other side. Regardless of where GenLab and Micro may live, the need for functional and volume testing will be more demanding than ever. EHRs, EMRs, interfaces, and data integration are here to stay. Add new acronyms like LOINC and HIE, and the picture only increases in complexity.”
• Velocity Data Centers President Steve Jacobs offers four concerns about healthcare IT moving to the cloud: data security, service levels, performance, and energy efficiency.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 11/9/12

Top News

Allscripts reports Q3 results: revenue down 1 percent, EPS $0.23 vs. $0.24 excluding special items, missing consensus revenue estimates by 4 percent but beating adjusted EPS estimates by a penny. Earnings were down by more than 50 percent on asset write-downs and slipping margins. CEO Glen Tullman confirms earlier reports that the company is evaluating strategic alternatives, adding that the company will not comment further on the issue and will not issue financial guidance for the next quarter.

Reader Comments

From Curious in Cleveland: “Re: Lyman Sornberger, executive director of revenue cycle management at Cleveland Clinic. Two confidential informants confirm that he’s out – any idea why? I’m a loyal reader and ex-Epic. Judy had me scared stiff to report anything to any blog, so this is a real thrill for me even if you don’t publish it.” Unverified. We’ll see if anyone confirms. I get basically no reports from anyone at Epic, so you’re not alone there.

From Coyote: “Re: McKesson. Half verified – they will acquire Greenway and athenahealth.” Unverified and unlikely given that those are two publicly traded vendors of competing systems with market caps totaling more than $2.5 billion. However, experience has taught me to at least mention even bizarre rumors just in case they happen to come true. If this rumor is accurate, it would easily be the most bizarre. Color me even more skeptical than usual.

HIStalk Announcements and Requests

This week’s HIStalk Practice highlights include: CMS adds a couple of new hardship exemptions for the e-prescribing rule. As more hospitals buy physician practices, facility fees for routine office visits are expected to increase Medicare spending $2 billion a year by 2020. The number of physicians in independent practices is predicted to drop to 36 percent by 2013. Occasional HIStalk  contributor Lyle Berkowitz, MD earns a spot on the list of Top 25 Clinical Informaticists. The most commonly deferred Stage 1 menu objectives by EPs include providing patients with a summary of care at transitions, using EHRs for reminders, and reporting data to public health agencies. NYeHC Executive Director David Whitlinger provides an overview of his organization and its initiatives. Stop by HIStalk Practice to get the latest ambulatory HIT updates, and while you are there, check out a few of our sponsor offerings and sign up for e-mail notifications. Thanks for reading.

On HIStalk Mobile, the talented and knowledgeable Lt. Dan is putting up several news items each day, while Dr. Travis has written an immediately popular post called Where I Would Invest. We don’t want to overload your inbox with the news posts, so you’ll get notification only of Travis’s longer posts if you sign up for updates. Thanks to HIStalk Mobile’s sponsors: 3M, Access, AT&T, Imprivata, Kony Solutions, Truven Health Analytics, Vocera, and White Plume.

Welcome to new HIStalk Platinum Sponsor Clinovations. The advisory practice of the DC-based company targets ambulatory and inpatient provider organizations, non-profits, and federal and state government. Their expertise includes patient safety, quality, and all phases of electronic medical records implementation. I mentioned Pitt County Memorial as one of the North Carolina academic medical centers running Epic and I’ve learned two things about that since yesterday: (a) Clinovations provided go-live support, EMR optimization, and physician engagement services for their implementation; and (b) the hospital changed its name earlier this year to Vidant Medical Center, with the 10-hospital system now going by the name of Vidant Health. I first connected with Clinovations a few weeks ago when I interviewed CEO Trenor Williams, MD, recommended to me by Travis from HIStalk Mobile, who knows him. More than half of the company’s 100 employees are clinicians, Trenor told me. In fact, read the interview to get a feel for how the company works (hint: they’re big on upfront optimization planning, wringing value from EMR implementation, and using data to improve care delivery). Thanks to Clinovations for supporting my work.

On the Jobs Board: Systems Engineer, Epic and Cerner Resources, Senior Certified Epic Analyst, Senior Quality Engineer. HIStalk Platinum Sponsors post their jobs for free, while everybody else watches enviously because they aren’t allowed to post jobs there at all.

It’s unfortunately unfashionable to divert one’s attention from self-absorbed activities to take a moment to think about members of our military, living and dead, whose sacrifices (ranging from modest to ultimate) provide us with the illusion that the world is full of caring people who wish us no harm. Sunday is Veterans Day, the eleventh day of the eleventh month that is set aside to honor every man and woman who has served this country in uniform. It’s a real shame that most cities don’t bother to have Veterans Day parades any more, but chances are you know a veteran or will see someone in uniform this weekend who would be grateful for nothing more than a nod and a “thanks for your service” instead. If you served, thank you. If not, thank them.

Acquisitions, Funding, Business, and Stock

Cerner will acquire Anasazi Software, Inc., a provider of behavioral health technology.

Accretive Health’s Q3 numbers: revenue up 2 percent, EPS $0.03 vs. $0.07. They signed some new revenue cycle management deals despite being run out of Minnesota for harassing ED patients to pay up. Amusing: their AR days jumped from 48 to 56 due to “delayed payments from a few customers.” They must not have strong-armed their own customers like they did those of their hospital clients, although they did take “action relative to the resources that were local in the market and focused on the clients in those areas,” i.e. fired their Minnesota employees once the company got the boot from there.

A Reuters article says that Merge Healthcare has attracted the interest of at least five private equity firms as it contemplates taking itself private. Named as suitors Thoma Bravo LLC, GTCR LLC, Welsh Carson Anderson & Stowe, Francisco Partners, and Avista Capital partners. Sources say the company hopes to have offers by today (Friday).

For-profit hospital operator Vanguard Health Systems announces that it will consolidate its IT operations in San Antonio. They will move to the Inner City Reinvestment/Infill Policy zone, which sounds great for corporate tax credits but lousy for night shift computer operators.

Sales

SAIC subsidiaries maxIT Healthcare and VCS close a combined $102 million in contracts from several North American hospital and clinics.

Summit Radiology Associates (NJ) selects Merge Healthcare’s radiology suite.

The DoD awards Evolvent Technologies a $20.5 million contract to build additional coding, database uses, and mobile applications into AHLTA-Theater.

People

Lakeland Regional Health System (FL) names J. Scott Swygert, MD chief quality officer and CMIO.

Vermont Information Technology Leaders appoints John K. Evans (Strategic Alliance Advisors dba s2a) president and CEO of its statewide HIE.

Announcements and Implementations

Wellmont Health System (TN) will begin file building for its Epic implementation in January and will phase its go-live throughout 2014.

The 17-provider Reedsburg Physicians Group (WI) goes live next week on GE Centricity EMR.

Park Nicollet Health Services (MN) goes live with Levi, Ray & Shoup’s VPSX software solution for document and printer management.

RamSoft will integrate MModal’s Speech Understanding technology into its PowerServer RIS/PACS, PACS, and Tele Plus Systems.

Government and Politics

CMS releases updated reference grids for Stage 1 and 2 MU requirements, including details on how MU objectives align with EHR certification criteria.

HRSA (Health Resources and Service Administration) offers a November 16 Webinar called Patient Charting and Documentation in an Electronic Health Record for Nurses and Allied Health Professionals, with presenters that include practicing nurses.

El Camino Hospital (CA) considers a legal challenge after voters narrowly pass Measure M, which will limit the pay of its executives to twice the governor’s annual salary, or around $350K. CEO Tomi Ryba, CFO Michael King, and CMO Eric Pifer, MD would all see major pay cuts if the legality of the measure is upheld. Meanwhile, an SEIU-UHW union steward admits that the union proposed the measure only because hospital officials declined to meet with its leadership in last year’s labor negotiation in which the union was unhappy that its members were no longer being offered free healthcare (that perk has since been reinstated).

Innovation and Research

A study published in the Journal of General Internal Medicine finds that clinical decision support tools in EHRs can help reduce the inappropriate use of antibiotics for acute respiratory infections.

Chicago startup MetisMD offers radiology second opinions for $75 (report review) to $250 (MRI, CT, PET, mammography, nuclear medicine, echocardiograms). Patients get a copy of their study, upload it to the company, and get a written report and a conversation with the radiologist within 1-2 days.

Technology

We are going from fee-for-service to not-quite-fee-for-service, in a pretty broad way, where you are paying fixed amounts for cases. Hospitals don’t know how to deal with that. The profit now will come from being efficient instead of being prolific. So they will need tools and programs and analytics to help them make that transition. The other area is the whole “retailization” of insurance. There is a huge, fundamental shift in the business, as individuals are driven more and more to buy their insurance from exchanges. Insurance companies don’t sell that way. They don’t have good brands from a consumer-satisfaction standpoint; in fact they have some of the worst brands in the world. So organizations that work on consumer brands are coming into the marketplace.

Motorola Solutions rolls out the HC1 Headset Computer, a self-contained wearable computer with a boom-mounted viewer that simulates a full-sized monitor, a two-way headset, and the ability to respond to voice or head-movement commands. It came out too late for making a fashion statement at AMIA.

Other

Aprima announces that it has settled the lawsuit brought against it by Allscripts, which had claimed that the wording of Aprima’s advertised “MyWay Rescue Upgrade Program” violated state and federal laws. Aprima agreed to changed its advertising, but will continue to market its product to users of the Allscripts MyWay EHR. Allscripts previously announced that MyWay will not be upgraded to handle ICD-10 or Meaningful Use Stage 2, but customers will be offered a free conversion to its Professional product.

Athenahealth Chairman, CEO, and President Jonathan Bush appeared  on CNBC Thursday morning in a discussion about healthcare reform.

You’re going to get more rules and innovation anyway when the healthcare costs are going up faster than GDP. Everyone is going to force some innovation. In this next stretch, it will come from the government … Medicare first and the commercial health plans are falling nervously behind the tank that is Medicare … If you’re a buyer of healthcare, an employer or consumer, you’re going to see two things. You’re going to see some markets where hospitals rally around and buy up doctors. We’ve seen half the doctors in the country become employed in the last three years in preparation for this. And then jack up commercial rates and say, “I got this huge group of Medicaid rates coming in, I’m going to jack up” … we saw this in Massachusetts, the first state that did this. Commercial rates went up 50 percent for the same coverage over a five-year period just for the commercial side … The hospitals bought all the doctors and said, “You can’t have any of us unless you go up.” There will be others who figure out how to get cheaper. They’ll get more efficient. They won’t need to raise rates. And then the third group will be the ones who go bust … they’re supposed to go bust. Please, no bailouts for the hospitals that go bust.

Here’s a new video on the Texas approach to a statewide HIE that involves 12 local HIEs.

Heisman winner runner-up and Indianapolis Colts rookie quarterback Andrew Luck signs his first big endorsement deal … with Riley Hospital for Children.

A new study finds that doctors, like most people, are subconsciously biased against the two-thirds of Americans who are overweight. If you’re obese, your best bet for compassion is to find a fat female doctor, the study results suggest.

FDA urges that providers writing prescriptions write neatly, minimize the use of abbreviations, and consider using e-prescribing instead. The practitioners being addressed are veterinarians.

This is nuts: genital injuries send 16,000 men and women to the ER each year.

Bizarre: a California couple lose a real estate fraud lawsuit when the husband, the director of pathology and clinical laboratories of Community Regional Medical Centers, admits that he faked the death of his wife, a former National Raisin Queen. The purchaser of their horse ranch, an anesthesiologist, says the couple faked her death to increase the value of their property to $2.3 million. The wife, a former waitress, changed her name from Genevieve Sanders to Genevieve Marie de Montremare and claimed to be a physician and French-born royalty. Their transgressions will cost them $1.55 million.

Sponsor Updates

• API Healthcare CEO J.P. Fingado offers insight on how the results of the presidential election will affect the healthcare workforce.
• Prognosis maintains its 100 percent success rate among its eligible clients achieving and attesting for MU.
• GetWellNetwork launches Transformative Health, an online publication covering the intersection of patient engagement and technology.
• 3M hosts a Webinar on the critical need to start ICD-10 education now.
• White Plume offers advice on creating interoperability in preparation for the ICD-10 deadline in a blog post.
• The IT director and a senior systems analyst from Henry Mayo Newhall Hospital will lead a November 14 Webinar on their use of solutions from Access to create a paperless admissions and bedside consent system, send completed forms automatically to their Meditech system, and maintain electronic registration and clinical activities when the hospital system is down.
• Shareable Ink hosts a Webinar on preparing anesthesiologists to qualify for MU.
• An article by T-System VP Greer Contreras highlights the need for physicians to describe their thought process when documenting to help prevent denial of payment.
  Bottomline Technologies publishes a case study that highlights Alamance Regional Medical Center (NC) and the efficiencies it has gained since implementing the Logical Ink e-form solution.
• The Canadian Health Informatics Society honors Orion Health and eHealth Saskatchewan as Project Implementation Team of the Year for the successful integration of Orion Health’s Clinical Portal with four eHealth Saskatchewan applications.
• Liaison Healthcare’s Gary Palgon, VP of healthcare solutions, discusses cloud-based solutions for big data during this week’s 12th Annual BMS IT Symposium in Princeton, NJ.
• Robin Mitchell, MD (WA) shares how her practice has improved patient care by leveraging EMR support services from INHS in a company profile.
• Ingenious Med becomes one of the most downloaded apps for Android.
• SAIC subsidiaries maxIT Healthcare and Vitalize Consulting Solutions will exhibit at the NextGen User Group Meeting next week.
• Fulcrum Methods recognizes new Meaningful Use-EP Tracker users, including Duke  Private Diagnostic Clinics (NC), Greenville Hospital System (SC), Lucile Packard Children’s Hospital at Stanford (CA), Physicians Medical Group of Santa Cruz County (CA), and University Hospitals-Cleveland (OH).
• IT staffing company Digital Prospectors Corp ranks #9 on “Top 100 Private Companies for 2012” by Business NH Magazine.
• Besler Consulting will participate in the HFMA Region 9 conference in New Orleans November 11-13.
• Carl C. Jaekel of Santa Rosa Consulting offers five ingredients for successful ICD-10 activation in the company’s team blog.
• Jason Fortin, a senior advisor with Impact Advisors, weighs in on meeting Stage 2 menu objectives.
• MModal’s chief scientist Juergen Fritsch discusses ways for healthcare organizations to obtain a holistic view of patients’ health in an article published in the Allscripts Newsletter.
• The latest version of Imprivata’s OneSign technology includes Fade to Look walk-away security for shared workstations, No Click Access for Citrix XenApp, and support for Epic 2012.
• Florida State University student Bill Blough takes first place and a $1,500 prize in iSirona’s e Code-A-Thon competition.
• Bottomline Technologies hostted a November 8 Healthcare Customer Insights Exchange to foster collaboration between healthcare organizations using its technology.
• Wellcentive highlights Borgess Health (MI) and its use of Wellcentive’s Advanced Outcomes Manager solution for population health management and clinical analytics. 

EPtalk  by Dr. Jayne

I worked double shifts in the emergency department this week as a result of another physician defection. In case there’s any question, I can attest to the fact that the front-line physician shortage is very real, especially if patients are on Medicaid or are uninsured. Out of an entire day’s work, only two patients actually belonged in the ED – a child with a laceration and an adult with a fully dislocated finger. There were multiple patients there for medication refills, work notes, and plenty of malingering.

I think stationing a Boy Scout with a first aid kit outside the door of the hospital would have not only have provided great cost savings, but also also would have helped patients learn that many of their conditions could be treated at home with basic first aid training and a little common sense. Until we figure out how to educate patients on these things, we will continue to have unnecessary ED visits.

Other countries seem to do a better job with this. A friend who lives in Germany keeps telling me about the baby nurse that comes to her home to do basic parenting and health education (how to handle fever, why babies are fussy, what to do when your child falls and hits his/her head, etc.) Having something like that here would be fabulous. However, that would require what many interpret as government intrusion and it would certainly require government funding, so I don’t see it happening here anytime soon.

Here are some pearls of wisdom from last night’s adventure:

• Influenza season is here. If your child has a fever, doping them up on Tylenol and sending them to daycare to infect everyone else is a bad idea.
• When your child shoves something in her ear, do not try to get it out with a cotton swab. You will jam it in further. What I could have removed quickly and painlessly has now become a procedure that requires us to sedate your child and quadruple your hospital bill. And BTW, please do not call an ambulance for this.
• Pain in a wrist you broke 10 years ago is not an emergency condition. I will screen you and send you home.
• Asking me to diagnose a rash that is no longer present is just silly.
• When you’re a homeless guy who just wants a warm place to hang out and a sandwich, it’s best not to strip naked and sexually harass the nurses and physician. We will call security. But if you keep your clothes on, we’ll board you for a little while.

I did have some downtime in the wee hours of the morning and tried to keep up on the massive stream of social media and correspondence that was flowing my way. One of my Tweeps mentioned that BlackBerry 10 looks “promising.” Unfortunately, the hospital firewall blocked my attempts to read the article. but I did find a blurb on YouTube. Anyone seen it and have good intel? It sounds like it has a slick camera feature that lets you go back in time to modify faces when someone blinks.

Inga’s not-so-secret admirer Dr. Lyle Berkowitz makes Modern Healthcare’s list of Top 25 Clinical Informaticists. Of all the honorees, he’s got one of the best-looking head shots. Being an anonymous blogger, I know I will never make the list, but it’s fun to see lots of HIStalk friends on it.

I ran across another first-hand account of the evacuation of NYU Medical Center, this time from a medical student. It depicts situations which would make great scenarios for your next disaster preparedness drill.

There have been lots of good tweets coming from attendees of the AMIA 2012 Annual Symposium. Lots of thoughtful ponderings on “real” interoperability and what data elements really need to be tracked across disparate care settings. Not a lot of photos, though. If you were there and have some good ones to share or general thoughts about the meeting, feel free to send them along.

Speaking of meetings, the NextGen Annual Users Group Meeting starts Sunday in Orlando. Hope to see some good pics and tweets from readers who are enjoying the warm weather and getting in some quality time with The Mouse.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 11/7/12

Top News

ECRI Institute’s “2013 Top 10 Health Technology Hazards” report includes several patient issues that are IT-related or potentially IT-solvable: alarm hazards (#1); IV infusion pump errors (#2); data mismatches in clinical IT systems (#4); interoperability failures between IT systems and medical devices (#5); and caregiver distractions due to mobile devices (#9). The nonprofit organization’s report, which contains good assessment tools and recommendations, is available as an immediate and free download with registration.

Reader Comments

From Ron Strachan: “Re: Community Health Network in Indianapolis. I’m happy to report that we’re live on the final wave of Epic sites. Community is an Enterprise customer and now has four hospitals and over 200 sites of care live on EpicCare. The install started in April 2011.” Congratulations to the team there and to the CIO, which happens to be Ron. Epic “waves” of ambulatory go-lives within an organization are like an army’s push into enemy territory – cause for concern beforehand, but worth celebrating after the careful planning pays off.

From Karl: “Re: for Inga and Dr. Jayne. Beware … you are about to lose substantial time and money too.” The Pinterest page is shoe porn for the ladies, or possibly for cash-eager healthcare providers who specialize in treating the foot and leg damage that some of the more bizarre models surely cause. But as they say, it’s better to look good than to feel good.

From Tarheel Ingenue: “Re: UNC Health Care. Named Epic vendor of choice on Friday.” Unverified, but hardly surprising given that not only is Epic getting just about every big-hospital deal, they have several of UNC’s academic hospital neighbors as customers (Duke, Wake Forest Baptist, Pitt County in Greenville, and probably others I’m forgetting.)

From JB: “Re: soft drinks. Mayor Bloomberg isn’t the only one banning the sale of sugary drinks.” Children’s Mercy of Kansas City, MO will stop the sale of all sugar-containing drinks on January 1, including sugar-loaded faux healthy fruit juices. The hospital cafeteria emphasizes healthier food choices, encourages purchase of fruits and vegetables, and plans to trash their deep fryers by 2015. They will also switch all IVs from dextrose to normal saline starting in 2015 (OK, I made that part up). This is an admirable step in trying to lead by example. Outsourced food service departments of hospitals are big-time nutritional offenders in serving whatever is easy and cheap, although in their defense they’re selling what people unfortunately want. It would be interesting to see how many overweight people suck down sugary drinks regularly, which are surely the least-satisfying calories you can take in. Put your finger a third of the way up the side of a soda can – that’s how far the 140 calories’ worth of sugar would pile up if you removed the colored water.

HIStalk Announcements and Requests

I plan to get comfy on the couch tonight in front of the TV to watch the election returns. Hopefully by the week’s end I can unhide a few of my more politically passionate Facebook friends whose various posts have raised my blood pressure in recent weeks. I’ll then be happy to ignore all politics for awhile – at least until Bill Clinton keynotes at HIMSS.

We like reading tweets from conferences, so we’re offering sponsors a free tweet box from their annual user meetings. The one from Imprivata’s HealthCon is running to your right.

Speaking of meetings, AMIA’s seems to be going well judging from the tweets. Your report is welcome since we aren’t there.

Acquisitions, Funding, Business, and Stock

NexJ pays $5.5 million to acquire Broadstreet Data Solutions, a provider of data management, analytics, and mobile solutions.

Shareholders of Streamline Health Solutions vote to convert $5.7 million in convertible notes to preferred stock in order to reduce company debt and reduce interest expense.

Hearst Corporation, whose holdings include Zynx Health and First Databank, will acquire Milliman Care Guidelines LLC, a provider of evidence-based clinical healthcare databases.

Tenet Healthcare subsidiary Conifer Health Solutions, which provides business process management services to 500 hospitals, acquires Dell’s revenue cycle management business for hospitals and healthcare systems.

Vocera reports Q3 results: revenue up 27 percent, EPS $0.07 vs. -$0.25, beating estimates on both and raising earnings guidance.

As we reported earlier, McKesson announces that it will acquire Emendo Ltd., the New Zealand-based vendor of the CapPlan hospital capacity planning solution. Its customers are in New Zealand, Australia, the UK, and Canada, with some US hospitals signed since it began marketing here through partners in 2010.

Sales

Legacy Health (OR) contracts with Explorys for its platform and enterprise performance management applications to power Legacy’s PCMH and ACO initiatives.

Altru Health System (ND) selects Perceptive Software’s content and process management solutions to complement its Epic patient registration, HIM, and patient finance processes.

Baptist Health (AR) chooses the Patient Access Intelligence and Revenue Cycle Intelligence solutions from MedeAnalytics.

First Choice Health Centers (CT) signs with eClinicalWorks for its six-location community health center organization.

Coosa Valley Medical Center (AL) selects Merge Healthcare’s iConnect Enterprise Clinical platform, including Merge PACS, iConnect Access, and iConnect Enterprise Archive.

HomeTown Health buys McKesson’s CareEnhance-Review Manager Enterprise technology to increase the accuracy and efficiency of medical necessity review and documentation among its network of rural hospitals and providers.

People

Kaiser Permanente promotes President and COO Bernard Tyson to chairman and CEO, replacing the retiring George Halvorson.

Stuart Nelson, MD (US National Library of Medicine) joins Apelon as chief innovation officer.

The TriZetto Group hires Jeffrey Rose, MD (Ascension Health) as CMIO.

The Georgia CIO Leadership Association names Emory Healthcare CIO Dee Cantrell its CIO of the Year.

Tony Fonze, CIO of Carondelet Health Network (AZ), is named president and CEO of Carondelet’s St. Joseph’s Hospital of Tucson.

Announcements and Implementations

NYU College of Nursing and Rubbermaid Medical Solutions combine resources to develop and enhance clinical technology solutions for nursing education that will  include scholarship programs, telemedicine projects, and educational initiatives.

The executive director of HealtheConnections reports that about 1.2 million people in central and northern New York are now connected to its HIE.

First Databank releases the ICD-10 code set within its FDB MedKnowledge clinical decision support drug knowledge.

nVoq and Mi-Corporation will collaborate to deliver voice-enabled versions of commonly used templates for the home health and long-term care industries and will develop additional voice-enabled e-Forms for other healthcare settings.

One of my Advisory Panel members mentioned using Vendormate to review the financials and sanction record of prospective vendors. The healthcare-specific company recently announced Medzo, an online service that matches the needs of buyers with seller offerings, potentially eliminating the RFI process. Vendormate’s network covers 70,000 companies, 660,000 provider-vendor relationships, and 48,000 users. Hospitals get free access and vendors get a free basic listing in Medzo.

Government and Politics

A Masachusetts law went into effect this week that prohibits employers from requiring nurses to work overtime.

Innovation and Research

A Rand Corporation study finds that physicians with fewer than 10 years of experience account for 13.2 percent higher overall costs than physicians with 40 or more years of experience.

Other

GE Healthcare issues a field safety notice to physicians warning of a potential defect in its Centricity PACS imaging systems that could result in the loss of images when sending exams from one Centricity PACS to another.

Eleven vendors own 80 percent of the HIE market, according to a new KLAS report. Epic, ICA, and Siemens MobileMD earned the top scores for overall connectivity and satisfaction, though scores for all HIE vendors except Cerner have declined over the past year.

Social workers in British Columbia are startled when their computers display the home page of the US Department of Homeland Security and an entry form labeled “Co-Conspirator.” Their new, problem-plagued software was modified from Homeland Security’s system by a contractor at a cost of $194 million and counting. The government shut down an $89 million student information system last year after giving up that its problems could be fixed.

Strange: a doctor tells a British couple who aren’t having any luck conceiving that the problem might be the husband’s laptop, which he props in his lap for several hours each evening to use Facebook. Three months after the husband starts using a table instead of his lap, his wife becomes pregnant.

Sponsor Updates

• The Sandy Relief Drive of SRS generated almost $5,000 in employee donations, which the company then matched in purchasing supplies for affected employees. The balance of the money will be donated to the Red Cross and Governor Christie’s Relief Fund.
• GetWellNetwork completes its 350th interface in US hospitals.
• CHMB (CA) partners with Ingenious Med to expand its RCM service offerings to hospitalists.
• Intelligent InSites announces that its software platform integrates with the ultra wide band RTLS from PLUS Location Systems.
• iSirona offers a $1,500 prize to the winners of a Code-A-Thon programming challenge at Florida State University.
• ICSA Labs calls for qualified EHR technology developers of both complete EHRs and EHR modules to participate in a pilot program for the 2014 Edition certification criteria.
• Orion Health CEO Ian McCrae discusses the growth of his company and its approach to software integration in a video interview.
• Imprivata is ranked 26th in the medium company category of 2012 Top Places to Work in Massachusetts.
• eClinicalWorks receives full NCQA certification as a CAHPS PCMH survey vendor to conduct NCQA HEDIS surveys.
• Philips SpeechMike Premium earns a perfect score of six dragons on Nuance Communication’s recording accuracy test for assessing compatibility with the latest version of Dragon Naturally Speaking.
• Dawn Mitchell and Kathy Krypel of Aspen Advisors will co-present break-out sessions at next week’s HIMSS Midwest Fall Technology Conference in Des Moines, IA.
• Eye Health Services (MA) selects SRS EHR for its 21 providers and 11 locations.
• Quality IT Partners sponsored the 13th Annual Scott Hamilton CARES Initiative Gala and hosted a patient from the Cleveland Clinic Taussig Cancer Institute last week.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

McKesson To Acquire NZ-Based Emendo

Mckesson announced this afternoon that it will acquire Emendo Ltd., the New Zealand-based vendor of the CapPlan hospital capacity planning solution. Its customers are in New Zealand, Australia, the UK, and Canada, with some US hospitals signed since it began marketing here through partners in 2010.

Guest Article: Hurricane Sandy Report from a Disaster Recovery Firm

Note: I offered to run an article from a disaster recovery vendor because I thought their perspective on Hurricane Sandy would be interesting. This is not an endorsement of that company, but I appreciate their article.

Extreme power outages and widespread flooding may wind up making Superstorm Sandy the second most expensive storm in US history, according to the forecasting firm Eqecat. Losses from the storm could total up to $50 billion, and according to Moody Analytics, an estimated $30 billion will come from physical storm damage split evenly among households, businesses, and public infrastructure. The remaining loss comes from lost business activity.

In addition to the financial challenges, several hospitals, nursing homes, and assisted living facilities failed a fundamental test of preparedness during Superstorm Sandy: they lost power. Their backup generators failed or proved inadequate, forcing thousands of patients to evacuate. Doctors, nurses, and medical practitioners were unable to access electronic health records and communication lines were down with no backup plan in place to redirect or re-establish phone lines.

Days after the storm, many businesses were up and running despite infrastructure failures because of disaster recovery and business continuity plans provided by Agility Recovery. Agility Recovery, a former division of General Electric that has been rescuing businesses impacted by disasters for over 23 years, offers a disaster recovery solution endorsed by the American Hospital Association.

In the aftermath of Sandy, Agility is responding to over 1,300 businesses, including several healthcare organizations. Agility is currently delivering assets to 95 businesses. Another 1,210 businesses are on alert, meaning Agility is pulling down assets, waiting for the go-ahead from the business to ship them.

The main Sandy-related response activities include:

• Power loss. The company has shipped out generators to dozens of members and provided electricians to connect the generators and fuel to keep them running.
• Downed phone lines. We have conducted over a dozen telephone and voice mail redirects so businesses can continue to communicate with employees and clients.
• Computer or server failure. Agility has shipped out computers and servers to several clients who have experienced damage to their existing technology or need extra technology for employees working from alternate locations.
• Structural damage. We have completed several full office recoveries, shipping out a mobile office, a generator to power the office, satellite to establish phone and Internet connectivity, phones, computers, servers, printers and faxes, desks, and chairs.

Although significant gains have been made in healthcare industry with regards to preparedness post 9/11, Georges Benjamin, executive director of the American Public Health Association, warns that austerity budgeting threatens these gains. “People presume that we have greater capacity than we have. When we get the big ones, we throw everything at it. We need to make sure we have the same capacity on the shelf at all times,” Benjamin continued, "I remain worried about the infrastructure.”

Most Common Recovery Plan Vulnerabilities

• Access to generators in the absence of a predefined relationship.
• Failure of backup generators due to poor location or lack of testing.
• Access to generator fuel.
• Establishing communications, as employees and clients left in the lurch as they receive busy signals.
• Incomplete planning for alternate facilities, where those locations are either impacted by the same disaster or have inadequate technology.
• Inadequate business insurance coverage. Of the estimated $50 billion in Hurricane Sandy damage, $10-20 billion is predicted to be insured losses.

Having a flexible and executable plan that accounts for many eventualities is critical to resuming operations following a disaster. Of course, revenue is an issue. A healthcare industry study found that one in 20 hospitals is unprepared for power disruptions, and a power outage may result in more than $1 million in lost revenue and other costs. Another study of a 16-hour power failure in New York in 2003 found that of 120 hospitals impacted, one was forced into bankruptcy and 10 others suffered significant revenue loss.

But more importantly beyond revenue is the need to provide high quality, continuous patient care. Patient safety is always the biggest concern hospitals and healthcare organizations face. Following the high-profile failure of several hospitals hit by Sandy, it is time for everyone to take another look at their disaster response and recovery plans.

Bob Boyd is CEO of Agility Recovery of Charlotte, NC.

Humana Acquires Certify Data Systems

Health insurer Humana Inc. announced this morning that it has acquired HIE technology vendor Certify Data Systems. The San Jose, CA company, which offers the HealthLogix HIE platform, will operate as a subsidiary of Humana.

Humana VP/CIO Brian LeClaire was quoted in the announcement as saying, “Humana remains focused on leveraging the power of technology to provide a more coordinated patient experience for our members that will enable quality, affordable health care. With the health information exchange platform from Certify we can move closer to creating a virtual integrated delivery health care system that can help us deliver this value-added, simplistic [sic] experience to our members.”

Terms of the transaction were not disclosed.

I interviewed Certify CEO Marc Willard in February 2012. He reported at that time that the company had 70 health system customers.

Monday Morning Update 11/5/12

From The PACS Designer: “Re: iPad Mini. TPD told you about the iPad Mini awhile ago, but didn’’t expect its arrival until early next year. Now that it’s here, you will see a rapid deployment in the healthcare field. Healthcare IT departments need to be on alert as the expansion of iPad mini users will could quickly overload already busy networks.”  

From Japandroid: “Re: MMRGlobal. I spent 30 minutes reading their press releases after your item and was floored. They crank out what seems like one per day, like the one mentioning that they shipped 25 more PHR licenses to a reseller (congratulations!) Check out their YouTube video – the company’s spokesperson is a former Playboy model, soft porn movie star, TV producer, and the trophy wife of company founder Robert Lorsch, who has a long list of business and philanthropic accomplishments.” Looks aside, Kira Reed is polished and engaging in the video, although not enough to make PHRs interesting (she says PHRs are “exploding,” which I would agree by my definition of “exploding.”) Vendors: is anybody planning to reward the company’s patent trolling by licensing its EHR-related intellectual property, which will be celebrating its one-week birthday in just a few days?

From Epic Pawn: “Re: Epic. The contract they sent me for the privilege of consulting with one of their clients will require me to end my HIT career!” Interesting points:

• Apparently a hospital can’t hire a consultant to help with Epic until that person signs a lengthy contract with Epic.
• If the consultant develops any kind of enhancement to Epic software and doesn’t sign over the rights to the hospital, the enhancement is automatically owned by Epic.
• You are obligated to report anyone you know who has accessed anything related to Epic without authorization, even if you didn’t have anything to do with their access.
• You can’t hire or contract with a former Epic employee until they’ve sat out a one-year waiting period.
• You can hire an Epic customer’s project team employee only if you don’t assign them any Epic-related work for two years, and they are considered to be a project team employee until three months after go-live.
• Your employees can’t perform any activities that compete with Epic – design, sales, consulting — for two years after they leave your employment.
• You agree that Epic is a third-party beneficiary of the agreement your employees must sign, which gives Epic a right to enforce the agreement even though those people don’t work for Epic.
• You agree that any legal actions will be heard in Wisconsin courts.
• I’m sure there’s more, but it’s a long read and I’m getting numb.

From Lambrusco: “Re: Allscripts. I think they’ll get a private equity deal announced by the earnings announcement on Thursday. Otherwise, they will have to put out an ‘exploring strategic alternatives’ addendum to the announcement if they miss on revenue or earnings (which is likely) to cushion any fall. Worse than allowing word of the PE deal to leak out was the MyWay announcement, which clued every potential PE buyer to dig more closely into attrition rates, which are sure to rise. They could have waited a month or two before putting a bullet in MyWay. The company is incredibly inefficient and the CEO was given carte blanche by the board to do M&A himself to buy his way out of trouble after avoiding tough product decisions in 2008 and 2010, so the cash flow and margins are probably understated and the PE guys can put in a management team that can execute. This week will be interesting.” Indeed it will.

From Coolmaker: “Re: vaccine refrigeration. They can make a zeer pot refrigerator that only requires water to function.” That might be an interesting project – a couple of flower pots and some sand and you can make a rudimentary refrigerator, although I don’t know if it will get cool enough to keep vaccines.

From Tarheel Ingenue: “Re: UNC Health Care CIO. Leaving.” Verified, apparently, based on an internal e-mail sent my way. Rose Ann Laureto, who’s been on the North Carolina job just a year, is moving to Promedica as CIO of the 11-hospital system that’s closer to her original home.

It’s pretty much all KLAS when providers use paid information sources to evaluate vendors according to my poll, although Gartner and “none of the above” had minimally respectable showings. New poll to your right: how much will patient empowerment and mobile apps change the healthcare system? After you’ve voted, click the Comments link on the poll to try to sway the undecided voters.

Instead of doing a “Listening” recommendation, Lt. Dan of HIStalk Mobile and I put together a Spotify playlist with some new and old stuff we’ve been following (our musical tastes overlap quite a bit). Spotify offers high-quality free streaming, so download it and you can play through the 39 tracks and three hours. Examples: new Neil Young, Wild Belle, Seapony, and older stuff from Frank Black, the BellRays, Public Enemy, and Operator. Feel free to create your own playlist and send me the link – if I like it, I’ll run it. If anyone seems to care, I’ll put out a new playlist every week or two, maybe focusing on specific genres.

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

A colonoscopy is not only an unpleasant procedure — a fact the voice failed to mention — but an expensive one. Hospitals don’t list their prices — no, that would make way too much sense — but independent cost-comparison websites suggest you can count on paying an average of $2,025 for a colonoscopy in St. Louis. The anesthesiologist will bill you separately. Why? Because he can. The facility may bill you separately. Why? Because it can. Also, if the colonoscopy actually finds a polyp or some other anomaly, it becomes a “diagnostic” procedure and not a “screening” procedure and it will cost you more. Why? Because it can. That $2,025 price applies if you have insurance. The voice was happy to suggest a colonoscopy because (a) voices don’t have colons to be scoped and (b) the insurance company would rather pay its share of the discounted price of the procedure than pay out hundreds of thousands of dollars for colon cancer treatment. Insurance companies have many faults, but stupidity is not one of them.

California state HIE overseer UC Davis releases HIE Ready, a buyer’s guide for providers interested in the interoperability capabilities of EHRs they are considering. It’s mostly a set of technical specs and an invitation for companies to participate.

Former shareholders of critical test reporting system vendor Vocada file suit against Nuance, which acquired the company and its Veriphy product in 2007, claiming Nuance has failed to make $7 million in earned payments. The shareholders say an arbitration panel has already unanimously ruled that Nuance fraudulently induced Vocada’s board and shareholders to agree to an acquisition whose terms included $20 million in cash or stock for shareholders, $4 million in cash or stock for employee retention and management bonuses, and $21 million in earnout consideration contingent on three-year revenue targets. An earlier Nuance SEC filing states that the financial targets were not met.

Is the iPad mini the killer form factor for medical professionals? #iPadmini #Epocrates

— Epocrates (@Epocrates) October 23, 2012

An Epocrates survey finds that one in three physicians plan to buy an iPad mini since it fits into a lab coat pocket.

The Raleigh, NC newspaper covers local EHR efforts. Tidbits:

• A local doctor who took the Allscripts MyWay plunge two years ago is not happy that it won’t be further enhanced. “We bought what we bought thinking it was a stable company and it was their newest package. You spend all this time transitioning to a program, and they come back and say, ‘Sorry guys, we’re not going to do this after Jan. 1.’” Allscripts has 1,200 employees in Raleigh, the home of the former Misys that it acquired.
• About 50 percent of NC doctors surveyed said EHRs haven’t improved care or aren’t worth the cost.
• WakeMed will spend $100 million on its EHR, while Duke’s Epic implementation will cost $500-700 million and will earn $50 million in HITECH incentive payments. UNC will choose a vendor this month to replace several hundred applications.

News 11/2/12

Top News

AHA and four hospital systems file suit against HHS, claiming Medicare isn’t paying for reasonable and necessary care as required by the Medicare Act. The issue: Recovery Audit Contractors are second-guessing physicians long after an inpatient stay, claiming that patients should have been treated as outpatients and demanding that payment be returned. The RAC gets a nice bounty for denying the hospital’s payment, the hospital gets next to nothing.

Reader Comments

From Lee Shapiro’s Shoe Lifts: “Re: Allscripts General Counsel Jackie Studer. Has she left? Her pic and bio are gone.” She’s gone, sources tell me. Unrelated to her departure, the company announces results next week, and I have this feeling that they’re trying hard to get a PE deal ready to announce before then for reasons you might speculate.

From Michael: “Re: RazorInsights. Thanks for the mention. I wanted to confirm our customer attestation numbers – 83 percent have achieved Stage 1 Meaningful Use as of today and several outstanding filings are being finished up by clients.”

From Bucket Head: “Re: Sandy. We have about 50 clients in private practices on the East Coast without power and/or Internet. In our world, the big deal for them was finding a safe home for vaccines. If you have $50K (or more!) of stock in your fridge, it’s not like the milk. A couple of our customers will be without power for five to 10 days at least, so we’re expecting to turn on virtual servers in our offices for them to access. We have three or four customers on the Jersey shore from whom we’ve heard nothing and haven’t returned a call, text, or e-mail.”

From Evan Steele: “Re: Temporary command center, post-Sandy. We are settled into our ‘MCC’ (Marriott Control Center) and everyone not at the MCC is working virtually from home, a friend or relative’s house, or office with Internet access. We have 42 servers (physical and virtual) in a co-location facility, so everything is available and every SRS’er with an Internet connection has access. We are doing a great job keeping pace with support requests considering our less than ideal circumstances.” Evan, who is CEO of the Montvale, NJ-based SRS, reports that his company’s headquarters remains without power. Access to remote servers and a cloud-based phone system has enabled staff to continue working, either from a local Marriott hotel conference room or from home. Thumbs up to technology and adaptability.

From Millerbarber: “Re: Infinitt. The NJ-based PACS vendor has been down for two days.” Unverified.

From Lead Sinker: “Re: NYU. Servers are down, basically underwater. We have an enormous go-live scheduled for 12/2 – not sure how this will affect that date.”

From Capo Crusader: “Re: NYU Langone admitting that its generator was old and poorly located. I hope everyone is OK, but I smell lawsuits with this admission. With all that has been written about Katrina, how can a hospital this size not be better prepared?” The hospital says it spent millions of dollars after Hurricane Irene on backup power improvements that included a flood-resistant pump house, sealed fuel tanks, and rooftop generators, but they apparently overlooked the fact that the electronic system driving it is located in the basement that flooded. At least the staff behaved admirably: four NICU respirator babies were carried down a nine-flight stairwell in the dark while a nurse manually bagged them to keep them breathing as volunteers and medical students lit their way with flashlights.

From Ex-McK: “Re: McKesson. Moral compass broken at the top. We highlight to the company that employees are breaking the law to ensure that the bottom line is met, renting ambulances to ensure we can sneak our profits through.” A purported e-mail from McKesson Chairman and CEO John Hammergren lauds employees of one of the company’s distribution centers for renting ambulances to make deliveries to New York, which prohibited non-emergency vehicles from using bridges.

HIStalk Announcements and Requests

Wondering what you may have missed on HIStalk Practice over the last week? Highlights: an AHIMA-published article suggests that cloud-based computing and smart mobile platforms are making ambulatory EHRs more affordable and attractive to physicians. CMS names 24 qualified vendors for the 2013 PQRS program year. Digichart’s founder and CEO assumes title of chairman emeritus. An Impact Advisors consultant provides recommendations to measure EHR success. NYeC Executive Director David Whitlinger gives an overview of his organization, its goals, and current success. Dr. Gregg (and his dog) fantasize what the world would be like if HIT had started with a grand plan. All I have to say is that if you aren’t reading HIStalk Practice, your HIT news world is incomplete. Thanks for reading.

We have a new contributor on HIStalk Mobile who I’m calling Lt. Dan since he (like me) works full time in the industry and probably wouldn’t find his employer to be receptive to the idea of his writing potentially controversial material under his own name. Lt. Dan is and industry pro who will be posting several news items each day, adding to the excellent analysis and commentary from Dr. Travis. We’ll also be revamping the site’s design shortly with a more modern look, and most likely renaming it to indicate broader coverage than I originally anticipated (we’re now writing about telehealth, startups, consumer health, and social media). In addition to the expanded coverage, Travis will be on the ground at the mHealth Summit December 3-5 in the DC area, of which HIStalk Mobile is a media partner, so you can expect lots of information from there. How you can get involved with HIStalk Mobile: subscribe to the spam-free e-mail updates, follow our tweets, write a guest post, and tell us who we should interview. Most of all, read HIStalk Mobile and participate by sending us interesting news and rumors.

Speaking of HIStalk Mobile, thanks to new Founding Sponsor Imprivata, which offers Cortext, an easy-to-use mobile app that replaces outdated texting and paging with HIPAA-compliant messaging for smartphones (Android and iOS) and PCs. Imprivata now supports both HIStalk and HIStalk Mobile at the highest levels that I had available, which I appreciate.

On the Jobs Board: Senior Certified Epic Analyst, Healthcare Analyst – Security Tester, Community Health Center Sales Executive, System Software Engineer.

A lot of readers dropped by in October, in fact more than in any month in the almost 10 years HIStalk has been around, for reasons unknown: HIStalk had 130,254 visitors and 241,599 page views.

The weather’s cooling down, leading to the bane of the cubicle dweller: where are you supposed to hang your coat?

Acquisitions, Funding, Business, and Stock

Merge Healthcare announces Q2 results: revenue up five percent, EPS $0.01 vs. $0.06 a year ago, missing analyst estimates by $0.02.

Carestream Health acquires Genesis Digital Imaging, a developer of software for diagnostic imaging systems.

Meditech’s Q3 numbers: revenue up 7.8 percent, net income up 4.6 percent.

Greenway announces Q1 results: revenue up 28 percent, EPS $0.00.

Sales

Intermountain Healthcare (ID) selects SA Ignite’s MU Assistant for EP Meaningful Use automate attestation of EPs using Intermountain’s proprietary EHR.

Medical Mutual of Ohio chooses the mobile application development platform and Mobile Health Plan application from Kony Solutions to provide members with account management, access to physicians, electronic ID cards, and claims information.

Health Fidelity will use the terminology solution of Intelligent Medical Objects in its Reveal natural language processing service for extracting data from unstructured medical narrative information. IMO will use Reveal for its solutions.

Alameda County Medical Center (CA) engages MedAssets to oversee several cost reduction projects involving physician preference items, supply and services sourcing, and workforce management.

People

Cerner appoints Justin Whatling, MBBS (BT Health) senior director of strategic consulting for its European advisory practice.

The US Chamber of Commerce names Peter Tippett, MD, CMO of Verizon and VP of its incubator, as the recipient of its first Leadership in Health Care Award for his efforts to advance health HIT innovation.

As a reader leaked to us a couple weeks ago, Pulse Systems co-founders and brothers Basil and Alif Hourani resign their posts as CEO and CTO, respectively. CFO Jeff Burton takes over as president and CEO. The French technology company Cegedim purchased the company two years ago for $61 million.

PerfectServe names Cary Smith (Allscripts) as VP of sales for the western region.

Avalere Health names Protima Advani (The Advisory Board Company) as VP of its healthcare networks practice.

CHIME President and CEO Rich Correll will move to a COO role with the organization, saying CHIME’s board worked with him to develop an operational management role required by its growth. They’re seeking an experienced CIO to replace Correll as “ambassador to the industry.”

Announcements and Implementations

UPMC expands its telemedicine services to rural hospitals.

Sparrow Hospital (MI) rolls out Epic’s MyChart for patient use on mobile devices.

Wellcentive announces the release of Proactive Data Quality, which allows healthcare organizations using its population health management system to detect data delivery and mapping issues.

Siemens Healthcare expands its relationship with TIBCO Software, which provides the business process management technology used by Soarian. Siemens says it will use TIBCO’s next-generation technology to provide Soarian customers with on-the-fly analysis of current and historical data to allow them to become what TIBCO calls the Event-Enabled Enterprise.

Brown & Tolan Physicians (CA), a Medicare Pioneer ACO, goes live with Humedica’s MinedShare analytics platform.

UK sensor vendor Toumaz starts the first US pilot of its disposable, continuous wireless vital signs sensor at St. John’s Health Center (CA). Patients in any location can be monitored with the Sensium system, eliminating the need for them to be kept immobile in the ICU.

In Michigan, Beaumont Health System and Henry Ford Health System announced months ago that they expected to merge in some fashion. They’ve signed the papers to start discussions on the merger details, which would create an organization with $6.4 billion in annual revenue and 42,000 employees. Both use Epic.

MMRGlobal, which always puts out bizarre press releases that make it sound like a big company instead of a minimally known PHR vendor, decides that lawsuits pay better than trying to sell a personal health record. The company was awarded a vague patent for a method of giving patients access to their electronic medical records. That was on Wednesday. By Thursday, the company was sending threatening letters to hundreds of EHR vendors, demanding that they start paying licensing fees.

Innovation and Research

MIT researchers develop a system for disambiguating the senses of words used in physicians’ freeform notes in EHRs. The researchers say their method, which identifies relationships between words while also drawing correlations between words and syntax, is 75 percent accurate and thus markedly better than previous methods.

A study in Ireland finds that 40 percent of handwritten ICU orders contain an error, although “error” was loosely defined to include missing pager numbers and illegible signatures. Articles like this always alarm laypeople who can’t distinguish between “preventing an error” vs. “preventing patient harm.” It’s like saying that 99 percent of drivers make at least one error per day while intentionally not mentioning that most of those are of no consequence whatsoever and are thus not worth a prevention effort.

Technology

Researchers from the engineering and media arts schools of Drexel University design the Belly Band, which contains an antenna that allows remote monitoring of pregnant patients. The band, which does not require batteries or electricity, transmits radio signals to indicate changes in the shape of the uterus and can be picked up with an ultrasound. Maybe once they complete work on all the functional aspects Dr. Jayne and I can advise on the fashion design.

Other

The National Health Information Sharing and Analysis Center (NH-ISAC) activates a 24/7 emergency response system to support healthcare critical infrastructure protection, mitigation, response, and recovery. The response system is intended to address situational awareness, facilitate information system, and provide incident response support.

Lake Health (OH) performs a routine EMR audit and subsequently fires several employees for inappropriately accessing a patient’s health information.

Cleveland Clinic and GE Healthcare join 25 companies that have committed to lease space at Cleveland Medical Mart, raising the building’s committed tenancy to 50,000 of its 95,000 leasable square feet.

Exeter Hospital (NH) is denied a court order that would have prevented the state HHS from accessing the hospital’s electronic medical records as part of an investigation into a hepatitis C outbreak. The hospital argued that such access would violate state and federal laws, but the court said the state proved its need to review the records and has proven it will do so in a professional manner. The cause of the outbreak is suspected to be a contract radiology technician who is accused of stealing fentanyl syringes and replacing them with ones contaminated with his blood. After being fired from UPMC for exactly that offense, he went on to work in 10 hospitals, including Exeter, since UPMC didn’t report him for fear of not being able to prove he did it even though they had caught him red-handed.

Bellevue Hospital Center (NY) evacuated about 500 patients Wednesday after fuel pumps for its backup generators failed. Despite pumping out 17 million gallons of water, the basement remained covered in two and a half feet of water.

British Medical Journal institutes a new policy that require researchers and drug companies who submit drug clinical trials articles to make all patient-specific data used in the study available to individual researchers on request. Drug companies are notorious for shining the most favorable light possible on questionable data, so this change will allow independent researchers to double-check their conclusions. BMJ hopes other journals follow suit.

Weird News Andy captions this article as “Starving for Cash.” Two-thirds of NHS hospitals in the UK have earned bonuses for following the Liverpool Care Pathway, which can require them to stop providing food and water to terminally ill patients. The Department of Health says the protocol ensures that dying patients are treated with dignity, while opponents say the practice is “euthanasia by the back door” that is sometimes employed without involving the patient’s doctor or family.

Sponsor Updates

• Allscripts CMO Toby Samo, MD discusses improving public health with EHRs in a blog post.
• East Bay Eye Specialists (CA) will implement the SRS EHR.
• ICSA Labs seeks qualified candidates to help pilot test the test procedures and test tools for the 2014 Edition Certification.
• Greater Baltimore Medical Center (MD) creates a paperless admission and consent process using Access e-Signature and signature tablets.
• Huron Consulting Group releases a case study that highlights how it helped the University of Arizona Health Network improve its RCM operations.
• OTTR Chronic Care Solutions will participate in the National Marrow Donor Program Council Meeting next week in Minneapolis.
• The Nashville Technology Council recognizes Passport Health Communications as Technology Company of the Year for 2012.
• MedVentive hosts a November 15 Webinar on critical technology needed to support ACOs.
• Intelligent InSites will host the InSites Build 2012 conference on November 14-15 in Fargo, ND. Speakers include President and CEO Margaret Laub and AMIA President Kevin Fickenscher, MD,

EPtalk by Dr. Jayne

The HIMSS/AMDIS Physician Community issues a call for posters for the 3rd annual Physicians’ IT Symposium to be held Sunday, March 3, 2013 at HIMSS in New Orleans. The deadline is November 30. Selected presenters must also submit a 5-7 page technical paper after the conference.

CMS offers a second chance to physicians who missed the June 30 deadline to file for a Medicare ePrescribing hardship exemption to avoid the 2013 penalty. They will now have until January 31, 2013.

I’m always having issues with Medicare patients who don’t want their insurance information on lab requisitions and other key paperwork because CMS still uses the Social Security number as its patient identifier. CMS is seeking provider input on new Medicare ID cards that would remove the SSN to reduce the risk of identity theft. Its survey will be available until November 7.

Nashville-based Entrada raises $1M in new equity. Its products, which integrate with a variety of EHR platforms, allow dictation into the EHR through synchronization to the appointment list. I heard some buzz at MGMA that they also have a fax-related product, but I haven’t seen it yet (hint, hint).

Physician Edward Pullen MD shares his frustration with the Washington State Electronic Death Registry System.

Dr. Travis from HIStalk Mobile shared this story about Walmart boosting domestic medical tourism. As of the New Year, its employees will have access to heart and spine surgeries at health systems like Cleveland Clinic, Geisinger Medical Center, Mayo Clinic, and others. Additional companies that are negotiating bundled rates for employees include Boeing Co., PepsiCo, Lowe’s Companies, and HCR ManorCare. Personally I’d like my employer to negotiate a deal here.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 10/31/12

Top News

From Velveteen Rabbit: “Re: NYU Langone and Sandy. My cousin is a neuro fellow at NYU Langone. Was in the middle of surgery when all power flickers and then goes out. Closed via flashlight and then patient was transferred to another hospital.” Sounds like an episode of MASH. A backup generator failed at the height of the hurricane, forcing NYU Langone Medical Center to evacuate at least 215 patients to other hospitals. Other facilities forced with forced evacuations include Coney Island Hospital (NY) and Palisades Medical Center (NJ). Numerous hospitals relied on backup generators and many facilities reverted to paper systems when EHR access was lost. Billionaire and Home Depot co-founder Kenneth Langone was an inpatient in the hospital bearing his name (courtesy of his $200 million gift) at the time and had to be evacuated with everybody else. A board member says the hospital knew its generators were old and poorly located; they’re planning to spend $3 billion to upgrade the facility.

Reader Comments

From Halsey A. Fredrick: “Re: Allscripts. The Mountain Lakes data center attempted and failed to move to generator power Monday evening. Approximately 50 Sunrise customers were down for at least seven hours, including those hosted at the company’s other data center in New Jersey. Some reportedly came back up overnight, some were still down as of Tuesday morning.” Unverified, but HAF forwarded a purported company e-mail update indicating that power was being restored. As any of us who have run IT during a weather disaster can vouch, backup generators work maybe 50 percent of the time, and that’s assuming you’ve been diligent to test the cutover regularly and have stockpiled an adequate supply of diesel fuel.

From Inspired but Concerned: “Re: Connected Health Symposium in Boston last week. I listened to great speakers and met people with truly great ideas, but few will address the elephants not in the room (i.e., Epic and Cerner). Conferences focusing on eHealth and connected health have a grassroots feel of empowering patients and consumers, but I rarely see big vendors participating unless it’s incognito to get new ideas. Providers are increasingly becoming part of IDNs and ACOs that use those large vendors and their non-open, non-easily integrated systems. Will consumer-based healthcare IT and their innovators suffer against these big vendors and providers?” My cynicism is predictable, but I’ve always said that these conferences and their self-selecting, charged-up evangelists are buying the illusion that patient empowerment is increasing when it’s really not. Few examples exist where customers have convinced big businesses to change their ways, especially when those changes threaten their profits, and I can’t think of even one where it happened when those customers had little buying power discretion and in fact aren’t even paying with their own money. It’s going to take a lot more than some feel-good conferences attended by the same familiar faces and featuring demos of the latest cool app to change healthcare, if in fact it can be changed at all. Healthcare reform may end up making it worse, as the massive consolidation it has triggered means a lot more physicians are now just another cog in a faceless corporate wheel whose bargaining power just went up several notches through market-dominating mergers (Partners Healthcare, which puts on the conference you attended, is a good example of using size and brand name to command high prices). In that regard, their choice of IT systems is way down on my list of concerns.

From BK: “Re: hospice-specific EMRs. What’s a good source of information? Most seem to be focused on the in-home aspect and we’re a 50-bed inpatient unit not affiliated with any major hospital or health system.” I know the names of a few companies that offer hospice EMRs but I’m not familiar with any of them, so I’ll ask readers to jump in.

Acquisitions, Funding, Business, and Stock

Online physician communication platform vendor QuantiaMD closes a $12 million expansion round.

Hospice and home health software provider Homecare Homebase lands a $75 million senior secured credit facility to refinance debt and fund a dividend payment to shareholders.

Deloitte Consulting acquires Recombinant Data Corp., a provider of data warehousing and clinical intelligence solutions.

CommVault Systems reports Q2 results: revenue up 21 percent, EPS $0.29 vs. $0.17.

McKesson announces Q2 numbers: revenue up

Relexion Health, developer of interactive software that uses Microsoft’s Kinect system to help physical therapy patients, raises $4.25 million in seed funding.

McKesson says in its earnings conference call that Technology Solutions had flat revenue in Q2, but performed a bit better than expected. The MedVentive acquisition provides a technology asset that will bring other McKesson products together to manage populations, the company says, while its MED3OOO acquisition will allow the company to add capabilities to its market-leading revenue cycle management business. CEO John Hammergren hinted that McKesson might work with athenahealth given that a third recent McKesson acquisition, PSS World Medical, sells athenahealth’s products and appears to still hold some portion of the $96 million worth of ATHN IPO shares (at today’s price) that it acquired in 2007 and partially sold in 2008-2009. Hammergren also said that McKesson has experienced some attrition of its Horizon customers who declined to migrate to Paragon because of functionality shortfalls, but the company is on track to deliver the ambulatory capabilities Paragon users need.

Sales

The American Association of Endocrine Surgeons selects ArborMetrix to provide clinical performance analytics for its national clinical outcomes registry.

The hospital board of governors for Fulton County Hospital (MO) approves a $1 million contract for Healthland’s EMR.

Eastern Connecticut Health Network signs a multi-year agreement with MedAssets for its RCM solutions and process improvement consulting services. Also contracting with MedAssets is Sharp HealthCare, which will implement its Spend and Clinical Resource Management solutions, including group purchasing services.

Mountain States Health Alliance (TN) selects Streamline Health Solutions and its OpportunityAnyWare solution for business analytics and automated workflow.

Resurgens Orthopaedics (GA) chooses Merge Honeycomb as its patient image archiving and long-term disaster recovery solution.

The Ohio State University Wexner Medical Center chooses lifeIMAGE for medical imaging sharing.

People

InTouch Health, an acute care telemedicine provider, elects Siemens Healthcare exec John Glaser to its board.

AirStrip Technologies adds Todd Cozzens (Sequoia Capital, Picis) and Keith Pitts (Vanguard Health Systems) to its board, with Cozzens named as chairman.

CommVault Systems promotes Brian Carolan to VP/CFO. He replaces Louis Meceli, who was named SVP of finance.

The Dallas Business Journal names T-System CFO Steven J. Armond as CFO of the Year in the technology segment.

SPi Healthcare appoints Brian Mitchell (GE Healthcare) as SVP of sales.

Announcements and Implementations

The Asian Centre for Liver Diseases & Transplantation announces an agreement with UPMC to develop a transplant center in Singapore. The facilities already share medical and technological expertise, including telemedicine and EMR.

Saint Agnes Medical Center (CA) goes live on Cerner.

Document Storage Systems and GetWellNetwork bring two VA hospitals live on GetWellNetwork’s interactive patient system integrated with the VA’s VistA.

IBM partners with the Cleveland Clinic (OH) to enhance the medical knowledge of its Watson supercomputer.

Government and Politics

The Indian Health Service is building a PHR populated with data from existing IHS clinical, administrative, and billing systems.

CMS publishes the final 2014 clinical quality measures for MU reporting.

AHRQ will conduct a 14-month, $800,000 observational study at six Vanderbilt University Medical Center clinics to look at how EHRs affect workflow at various phases of implementation. The work might have had more applicability had AHRQ chosen a more typical site than Vanderbilt, which developed its own ambulatory care model and EHR.

Wells Fargo Securities has updated its list of hospital EHR attestations by vendor. Small-hospital vendors CPSI and Healthland, along with Cerner, top the list of attestations as a percentage of customers. Trailing the pack are GE Healthcare, QuadraMed, NextGen, and McKesson (interestingly, three of those four are publicly traded companies, and QuadraMed was too until it was taken private in 2009). Also interesting: we’ve talked recently about upstart RazorInsights and I see they’re right in mid-pack with 30 percent.

Innovation and Research

A study finds that whole-genome sequencing will cost the US healthcare system $25 billion annually by 2021 even with steadily dropping prices, with the virtual certainty that the cost of those tests and the patient demand for treatment of conditions they suggest will dwarf the relatively small savings they create from earlier treatment of a few specific conditions.

Other

Dale Sanders (SVP of Healthcare Quality Catalyst and also holding senior roles with The Advisory Board Company and Cayman Islands National Health System) develops a HIMSS EMRAM-type model for measuring a hospital’s analytics capabilities. The Healthcare Analytic Adoption Model, he says, is the key to delivering value from the country’s big EMR investments.

Robert Schwab, MD, chief quality officer for two Texas Health Resources hospitals, adds a new Meaningful Use-related verse to his “Go-Live Ballad,” recorded live at the National CXO Summit last week in Dallas.

Cerner CEO Neal Patterson and his wife celebrate his company’s record quarter by buying the $100,000 grand champion market steer at the Junior Premium Livestock Auction in Kansas City.

A Colorado hospital’s lawsuit claims that it hired WebMD Health to evaluate its wellness programs, only to find that the company used its confidential information to launch a competing service.

A Texas woman is charged with aggravated assault with a deadly weapon after striking a man in the eye with her high-heeled shoe in a fight among 17 female employees of the Hot Body strip club. The man may lose his eye; the deadly weapon’s condition is unknown.

Sponsor Updates

• Steven Waldren, MD MS, director of the AAFP Center for Health, explores the HIT environment during Care360’s Nov. 14 webinar.
• Access releases case study videos featuring employees from Texas Regional Medical Center (TX) and Henry Mayo Newhall Hospital (CA).
• Billian’s HealthDATA introduces its healthcare sales and marketing portal, which includes over 3,900 data points on more than 40,000 US healthcare facilities.
• Emdeon launches its EDGE solution to detect inaccurate healthcare claims and prevent inaccurate payments.
• TELUS Health Solutions reviews the financial and strategic implications of attestation timing for Stage 2 MU in its fall newsletter.
• The Phoenix Business Journal profiles Desert Ridge Family Practice (AZ) and its effective use of NextGen’s EHR.
• InterSystems recognizes 3M Health Information Systems with its Breakthrough Applications award for the 3M 360 Encompass system.
• Kony Solutions announces that its KonyOne mobile application development platform now supports Microsoft’s Windows 8 operating system.
• CIC Advisory launches its new website.
• T-System CEO Sunny Sanyal discusses overcoding and upcoding in the ED in a guest article in a Dallas healthcare publication.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 10/29/12

From The PACS Designer: “Re: iPod’s 11th anniversary on November 10. The four versions of iPod are Shuffle, Nano, Classic, and Touch. While primarily a storage device for music, they can be used as a storage device for other data elements. Can there be a use in healthcare for the iPod? Let’s have some discussion on the subject.” My Touch is like an iPhone without the calling capability provided you’re in WiFi range, so I would say yes. You would think that a hospital might look at the Touch as a pager replacement for nurses for in-hospital use – it’s cheap and portable, it doesn’t require a cell contract since it works on WiFi, it comes with a camera and Facetime, and it runs most iPhone apps.

From Fertile Imagination: “Re: clinical raffles. I’m speechless that providers would turn this into a contest.” A New York in vitro fertilization clinic runs a contest offering IVF free services to contestants who submit the winning emotional or entertaining essay or video explaining why they deserve the prize. One winner was notified on the day after Labor Day in a scene worthy of a Publisher’s Clearing House commercial: a doctor carrying balloons knocked on her door. Another winner earned her prize by running in a 5K race, where each registration came with one raffle entry. CDC says 1 percent of American-born babies are conceived by IVF. A Harvard Medical School ethics professor concludes, “I think it’s a good parody of the unfair system in which important medical services are only available to those who can afford them. Nevertheless, sometimes these raffles exploit the despair of couples or their misunderstanding of statistics to extract money from them.”

From HITEsq: “Re: Craneware. Being sued by the American Hospital Association for copyright infringement regarding its unlicensed use of the UB-04 codes. My personal take: none of these codes, as codes, should be the subject of copyright, especially when they are used only for functional purposes for which they were created which the AHA helpfully explains in paragraph 7. What’s more, they go on about all the work in maintaining them. Of course, in copyright law, ‘sweat of brow’ does not make something copyrightable.”

Listening: Real Estate, gentle and summery pop music featuring jangly, liquid guitars with a lot of nice vocals and instrumental work hiding behind the obvious hooks so that you can play it repeatedly without getting tired of it.

Only one survey respondent reported that his or her PCP uses Twitter for medical purposes. New poll to your right, for providers: which sources do you find valuable when evaluating vendors? Feel free to choose more than one or check “none” of you don’t find any of them useful. Your comments are welcome as well – after you vote, you’ll see a Comments link.

I’m healthy and fortunately get few chances to evaluate healthcare IT as a patient, but my annual physical last week provided an opportunity. Thinking about it afterward, I was surprised at how many positive technology elements have crept in. I had changed my appointment online a couple of times using the practice’s online portal instead of wasting time on the telephone. I pre-paid my co-pay online and printed a barcoded itinerary. I scanned that paper at the kiosk when I arrived and didn’t need to wait in line since that checked me in. My doc pulled up the EMR screen after the usual chit-chat (the practice just switched to Epic a few months ago) and noticed my weight was the lowest in the seven years I’ve been going to him, so the EMR information allowed him to reinforce that behavior effectively. He did medication reconciliation and reviewed my history over the past year while we looked at the EMR’s screen together. My one and only maintenance med (hydrochlorothiazide, since I used to have high blood pressure) went out to the pharmacy by e-prescribing. I received an e-mail this weekend saying my lab results were available on the practice’s portal, where I could review them in printable PDF format along with a reassuring note from my doc (“Wow, these all look great!”) Also on the portal was a printable visit summary for future reference. We IT types may argue incessantly about the clinical value value of technology in care delivery, but as a patient, I’m sold on the convenience factor. Not to mention that my doctor knows exactly how to use technology to support the way he practices medicine instead of allowing it to dominate either the encounter or our relationship.

I don’t know of many hospitals that developed their own clinical systems, and the cost and torrid development pace required to keep up with Meaningful Use and changing care models have led most of those to cry uncle and replace their old stuff with commercial products. Vanderbilt is apparently hanging in there according to an article in the VUMC newsletter that says they’ve made some nursing documentation enhancements to StarChart/StarPanel, VUMC’s clinical data repository that holds electronic and scanned paper patient documentation. Vandy offsets some of the expense by licensing its creations to vendors: McKesson bought WizOrders (relabeled as the marginally successful but dying Horizon Expert Orders) and Informatics Corporation of America commercialized StarChart/StarPanel.

I’ve read several articles lately about the rapidly increasing cost of the bipartisan-supported, pseudo-socialist American government in which fewer and fewer workers subsidize those who aren’t contributing (either because they can’t or because they choose not to). I don’t always agree with George Will, but his editorial on disability payments mirrors what I’ve read elsewhere. Disability payments are now going to 8.6 million people, more than half of them claiming unprovable mood disorders or back pain. The ratio of workers to those receiving government disability checks has gone from 134:1 in 1960 to 16:1 today even as the number of physically strenuous jobs dropped significantly. The healthcare connection, according to George: “The radiating corruption of this entitlement involves the collaboration of doctors and health care professionals who certify dubious disability claims. The judicial system, too, is compromised in the process of setting disability standards that enable all this.” I’ll take a broader societal view: there’s no longer any shame or embarrassment involved in cashing the many forms of automated government checks that career politicians and indifferent bureaucrats dole out like vote-seeking lollipops, so the only thing standing between unmotivated or unprepared Americans and the government food trough is ever-dwindling personal responsibility. Check the federal deficit and entitlement spending if you want to see how that’s working for us.

Cerner shares jumped 13 percent on Friday following a good earnings report. The company said in the earnings call that its clients acquired 75 hospitals in the past 18 months, potentially expanding Cerner’s customer base with minimal effort required. They also predict an “acceleration in the displacement market” (i.e. replacements of Epic) over 5-7 years as organizations look at “the horse they bet on and make a decision to go in a different direction.” Neal Patterson dropped by at the end to say that Cerner has “reinstated a boldness around here” and declared the company to be “the most significant innovator in healthcare.”

The Detroit business paper says that Henry Ford Health System may be acquiring Beaumont Health System.

Mark Clark (Poudre Valley Health Care) is named CIO of Great Plains Regional Medical Center (NE).

Quality Systems (NextGen) announces Q2 results: revenue up 8 percent, EPS $0.26 vs. $0.35, missing consensus estimates on both. Shares closed Friday at $17.19, down 3 percent and now 60 percent off from their price in April. System sales revenue was down by 15 percent, but was partially offset by implementation revenue (warning sign: reduced sales now means less implementation revenue down the road). The usual obvious reactionary steps were announced: restructure the sales organization and consolidate development efforts (always begging the equally obvious question: if it’s such a good idea, why wasn’t it done before?)  The hospital division sold to six new hospitals, but still lost money. The company will continue paying dividends to shareholders but won’t institute a share buy-back program, saying they would rather use the money to fund possible acquisitions of several companies they’re talking to (they hinted at revenue cycle, hospital products, and ACO-type service offerings). They also say that they expect many of the 462 Stage 1 EHR vendors to fail at achieving Stage 2, leading to a big replacement market. NextGen won’t issue guidance this fiscal year, citing rapidly changing market conditions and the proxy fight it recently endured.

Here’s the five-year Quality Systems share price vs. the Nasdaq in red. QSII was on a nice run, but all that’s been wiped out to the point that performance would have been just as good buying a Nasdaq index fund (“just as good” being relative – you would have done little better than break even either way).

CPSI’s Q3 numbers: revenue up 8 percent, EPS $0.63 vs. $0.54.

A Senate investigation finds that medical device manufacturer Medtronic paid millions to surgeons who put their name as authors on journal articles that were actually written by the company’s marketing team. Medtronic paid $210 million to doctors over 15 years related to its Infuse spine surgery product, including $34 million to University of Wisconsin orthopedic surgeon Thomas Zdeblick (who is himself the editor of a medical journal, Journal of Spinal Disorders & Techniques). Medtronic hired Yale University to review Infuse and his comments don’t sound nearly as pro-Medtronic as the allegedly shilled articles: “This sounds eerily familiar to many of the transgressions we’ve read about from the pharmaceutical industry. It paints a picture of a company very heavily involved in the science; marketing contaminating the science; and the medical profession and researchers being complicit. It’s no wonder the public has lost confidence in the drug and device industries.” My question, as always: Medtronic’s annual sales are $16 billion and its market cap is $42 billion, so how big of a fine would be needed to send a clear message if indeed they’re guilty? I’m thinking $5 billion and some jail time for the scumbag executives who were involved, but that’s just me. And for that matter, why not hit some of those greedy docs with some mega-fines and maybe suspend their medical licenses for producing phony medical research? This business of Uncle Sam settling out of court with mega-corporations for a financial slap on the wrist needs to stop. Medtronic paid a measly $24 million a few months ago to get DOJ off its back over paying kickbacks to doctors and $85 million to settle shareholder suits claiming it made misleading statements about Infuse.

Another argument that paying providers for quality doesn’t really work: the rate of catheter-related infections didn’t go down when Medicare stopped paying for them. That’s great news if you’re a fan of well-intentioned incompetence.

eClinicalWorks held its user group meeting this past weekend at the Gaylord National Hotel and Convention Center in the DC area, with 4,500 attendees and keynote speakers Surgeon General Regina Benjamin, MD and former eCW customer National Coordinator Farzad Mostashari, MD (who used eClinicalWorks, Epic, and NextGen when he worked for NYC’s Department of Health).

Weird News Andy must be brewing over missing this sad story, sent over by a worthy competitor. A new student nurse in Brazil accidentally kills an 80-year-old woman by somehow hooking up her IV to a cup of coffee. She explained on national TV: “As they were next to each other, anyone can get confused. I injected the coffee and I put it in the wrong place."

The Florida office of HHS’s Office of Inspector General says that thieves are stealing claims data from companies that administer Medicare claims. Scammers prefer Medicare records because CMS has balked at the effort required to change its identifier from Social Security number like everybody else has done, which allows the thieves to file fraudulent tax returns and collect refunds since IRS, like CMS, pays first and ask questions later (or never). In other words, one federal agency’s electronic data is used to create another agency’s electronic data for larcenous purposes, like interoperability for crooks. Did you ever get the feeling that government is the only organization where the more technology it uses, the more vulnerable it becomes to fraud because of poor oversight?

Athenahealth is negotiating with Harvard University for the purchase of Arsenal on the Charles, an 11-building office campus and former US Army arsenal in Watertown, MA that includes athena’s headquarters. The company seeks 1 million square feet, while the Arsenal property, estimated to cost about $200 million, has 765,000 square feet.

Vince checks in from Europe with good news about John Sacco (founder of JS Data) and sad news about Ed Meehan (Keane/NTT Data). As always, if you have memories, photos, or ephemera from healthcare IT companies of old (from before 1990 or so, let’s say) then Vince would enjoy hearing from you, especially if you have e-mail addresses or phone numbers for some of the long-lost folks who ran them.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 10/26/12

Top News

Cerner reports an 18 percent increase in Q3 revenues from a year ago, with EPS of $0.56 versus 2011’s $0.45. Net earnings grew 25 percent and the company’s $769.9 million in third quarter bookings represent an 18 percent jump over last year.

Reader Comments

  From Weird News Andy: “Re: MGMA write-ups. This is too good a post not to have a comment.” WNA is referring to one of the four updates posted to HIStalk Practice this week covering the MGMA meeting in San Antonio. If you are interested getting the scoop on the conference, check out the writeups from  Monday, Tuesday morning, Tuesday evening, and Wednesday. I covered an assortment of topics including educational sessions, exhibit hall happenings, and parties. Other publications may offer a more in-depth look at some of the specific sessions, but I bet none published a photo of mariachis with Ronald McDonald.

From Junior Birdman: “Re: MGMA. The athena rep told me that two-thirds of the demos they were doing were for current Allscripts and GE customers.” Unverified.

From Empire Statesman: “Re: Allscripts. A totally unverified rumor is that they filed the HHC protest just in case a New York-based private equity company turns out to be their buyer and can then exert local influence on HHC to change its mind. The slim hope they will prevail may also delay the market’s reaction long enough to get them sold before the decision is announced.” Unverified. Another reader’s unverified rumor is that Allscripts had a big meeting with a PE firm on Thursday.

From CIO Reader: “Re: CIOs reading HIStalk. You’ve taken a good first step in running the excellent work of Ed Marx and Bill Rieger. Perhaps include other writing from insightful and innovate CIOs and/or CMIOs?” I’m happy to do that. If you’re both interested and interesting, there’s a place for you here.

From King Biscuit: “Re: RazorInsights. I’m telling you, these guys are going to leapfrog everyone … so cool!  Best engineered software, by far.  Blows Epic and Cerner away.” Unverified, but KB is a non-anonymous expert whose name you’d instantly recognize and who has no horse in this particular race, so I respect that opinion. Some company communication I intercepted says they are #2 in KLAS (behind Epic) and #1 in the community hospitals category, with 64 hospitals in the pipeline.

From HITesq: “Re: Allscripts. You can confirm the unhappy Allscripts issue. Allscripts sued Aprima in the Northern District of Illinois.  Complaint attached. Alleges trademark infringement and unfair competition.” Allscripts demands that Aprima stop using the MyWay name in its advertising and stop insinuating that Allscripts is sunsetting the product. I’ll side with Allscripts. I’m not a lawyer like HITesq, but I assume Aprima can continue to target its advertising to MyWay customers as long as it doesn’t imply that Allscripts is forcing those customers to change and perhaps adds the common disclaimer that MyWay is an Allscripts trademark and product. Kudos, by the way, to HITesq for always finding these interesting legal nuggets from sources the rest us don’t have access to.

From AnotherOneBitesTheDust: “Re: GE. Will be sunsetting it Oracle-based Centricity product – the old Logician – after upgrading it for MU 2 next year.” Unverified. 

HIStalk Announcements and Requests

I get several e-mails each week imploring me to take advantage of the many ways I could make more money from HIStalk (recent ones: drastically raise the admittedly low sponsorship costs, rent the mailing list, make it a pay site, sell consulting services to vendors). I’ll be honest in saying that I have no plans for any of those since I do it for fun, not money, and the more it would become a real business, the less I’d like it. All I need is the satisfaction, and that’s where you come in: (a) sign up for the e-mail updates since Inga loves seeing that number increase; (b) connect with us on Facebook, Twitter, LinkedIn, and Dann’s 2,821-member HIStalk Fan Club; (c) cruise the ads of our loyal sponsors, check out their listings in the Resource Center, and shoot out your consulting RFIs to several companies at once via the RFI Blaster; (d) send us news, rumors, guest posts, or ideas of how we can help the industry and patients; and (e) tell your colleagues you read here since the only way we get new readers is via word of mouth and Google. Thank you for spending time with us.

Acquisitions, Funding, Business, and Stock

McKesson will acquire PSS World Medicine Inc. for about $2.1 billion. PSS is primarily a medical products distributor, but is also an athenahealth reseller. Analysts estimate that PSS’s athenahealth sales represent less than five percent of athena’s new customers per year.

AdvantEdge Healthcare Solutions, a provider of billing, practice management, and coding services for specialty physicians and hospitals, acquires Medrium, a Delaware-based billing and PM company.

HIT raised $194 million in VC funds from 37 deals during the third quarter, according to Mercom Capital Group.

Compuware reports fiscal year 2013 Q2 financials: revenues down 15.4 percent, net income down 53.3 percent, and EPS of $0.05 versus $0.10. Analysts were expecting $0.06/share. Compuware’s Covisint division reported a 17 percent increase in revenues from a year ago.

Sales

In Australia, Queensland Health expands its use of iMDsoft’s MetaVision ICU system by purchasing a statewide enterprise license.

University Physicians Group (NY) will implement the PatientPoint Care Coordination platform and its electronic Check-In/Check out process.

Johns Hopkins Medicine expands its relationship with MModal by rolling out its Natural Language Understanding to all facilities.

Hi-Desert Medical Center (CA) selects iDoc from CareTech Solutions for document imaging and management with Meditech’s EHR and health information management systems.

Partners Healthcare (MA) renews its contract with Omnicell for pharmacy automation.

MedVirginia signs a multi-year contract extension with Alere Wellogic, the creator of the HIE’s technology infrastructure.

The Defense Health Services Systems awards an $11 million prime contract to SAIC for support of the TRICARE Online system and expansion of Blue Button capability.

Holston Medical Group (TN/VA) selects Performance Clinical Systems and the Symphony platform for care coordination.

Queens Long Island Medical Group (NY) chooses MU Assistant from SA Ignite to automate MU reporting and enable one-click electronic attestation to CMS.

Rochester General Health System (NY) purchases Carestream Vue for Cardiology PACS.

Prime Healthcare Services (CA) selects FairWarning Patient Privacy Monitoring for privacy auditing with its Meditech system.

People

Phreesia appoints Ralph Gonzales, MD (UC San Francisco) as chief medical advisor.

Convergent Revenue Cycle Management names Mark Schanck (HBCS) SVP of sales and marketing.

David Bates, MD, the SVP for quality and safety at Brigham and Women’s Hospital, joins the EarlySense medical advisory board.

Announcements and Implementations

Family Healthcare (ND/MN) goes live with RTLS from Intelligent InSites to track patients, staff, and equipment.

Van Buren County Hospital, an affiliate of Iowa Hospital and Clinics,  goes live on Epic.

Government and Politics

OIG says in the video above that among its planned 2013 work is to “identify fraud and abuse vulnerabilities in electronic health records (EHR) systems.” I assume the HHS/OIG survey I ran earlier this week was the first step in that effort.

The VA announces plans to get its VistA system Meaningful Use certified, but says that probably won’t be completed until 2014.

CMS publishes a document containing minor corrections to the Stage 2 MU Final Rule.

Innovation and Research

KLAS finds that 70 percent of providers are using mobile devices to access clinical applications. Physicians using McKesson and Epic applications are more likely to view data on a mobile device than providers running other EMRs. Providers and healthcare organizations say their biggest concerns with mobile devices are preserving the security of patient data and managing and tracking devices.

Other

Most healthcare data breaches occur in facilities with less than 100 employees, according to a Verizon study. The majority of attacks on healthcare systems are financially motivated and target personal and payment data.

The Australian federal government terminates a $23 million contract with IBM to build the National Authentication Service for Health, citing missed deadlines and delays.

Sponsor Updates

• Informatica introduces PowerCenter Big Data Edition, which allows organizations to leverage data for advanced analytics.
• Eugene Gastroenterology Consultants (OR) selects ProVation MD for GI from Wolters Kluwer Health.
• Surgical Information Systems renews its HFMA Peer Reviewed designation for its rules-based charging product.
• Tigermed Consulting Co selects Merge eClinical’s CTMS solution to streamline clinical trial management.
• ROI is not the primary measurement used by organizations to gauge the success of their EMR systems, according to a Beacon Partners survey. The report also finds that quality management and IT departments are the ones most often responsible for EMR performance measures. Beacon also hosts a Webinar featuring a discussion of navigating unknown risk in a practice.

EPtalk by Dr. Jayne

Inga and I are back from MGMA. She is drowning in e-mails I am drowning in the sea of humanity that is a double shift in the ER. I recently started watching Doc Martin on Netflix and sometimes wish I could channel his bedside manner to those folks that think that every ER visit comes with a meal tray and a complimentary can of Sierra Mist.

Like Inga, I was underwhelmed by the lack of buzz both in the meetings and in the exhibit hall. I’m chalking it up to the fact that practices are simply beaten down. Those that have already gone to EHR have spent their available cash and are focused on optimizing what they have. It might have been a good sales opportunity for consulting groups to peddle their skills.

I only saw a handful with booths, but I did run into several consultant colleagues who were there as attendees. There were a lot of complaints about sessions being too full and one Central Business Office Director told me she was skimping on the exhibit hall to make sure she had a seat in sessions.

As you can see, Inga and I were not the only celebrities in town.

San Antonio Banderas responded to my comment about the bottles and trash I saw on the Riverwalk during my morning jog. “I have attended many conventions in San Antonio in my last career, and always referred to the Riverwalk as the Sewerwalk. And Inga said she was walking barefoot back to the hotel? Ick! Have you experienced having a snack or drink at one of the nasty riverside restaurants or bars and have the pigeons land on your table, only to shed feathers and dander all over you when you shooed them away? Ick, ick!” Luckily I haven’t had the pigeon experience, and I’m happy to relay that most of Inga’s shoeless wandering was in hotel lobbies and the occasional restaurant. As her personal physician, I do try to look after her health and welfare, offering the above cowboy-style galoshes as a potential solution.

I wanted to get a better photo of these guys and their sassy purple paisley pants, but I could never find their booth. I assume they were exhibitors rather than two friends who share a stylist. The “Cushiest Carpet” award goes to Pulse. Although they wouldn’t give Inga a pair of green sneakers, they did try to buy our love with coffee at a time when we sorely needed a pick-me-up.

We spent some time cruising the hall together. I admit that I still have to stifle a giggle every time I see my signature on the HIStalk placards. I had the chance to get to know some of our sponsors better and to hear more about the plans for the upcoming HIStalkapalooza. Let me just say it’s going to be something to remember, and based on the theme, I have the perfect wardrobe for the event.

I’m looking forward to next year’s MGMA in San Diego and hope to be joined by Bianca Biller for even better perspective. I seriously doubt, however, that I will find any pastry in the shape of California in 2013. God Bless Texas!

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 10/24/12

Top News

Pam McNutt, SVP/CIO of Methodist Health System of Dallas, tells me that she has received a detailed fraud survey from OIG that covers a lot of territory. She will send it over if the hospital’s legal department gives the OK, but in the mean time, she provided a summary of what’s on OIG’s mind:

• Computer-assisted coding
• HIPAA security practices related to access to the EHR, both remote and internal
• Numerous questions on practices and protections involving allowing patients and non-employees to access EHR data
• Seventeen questions about audit log capabilities and how audit logs are monitored
• Thirteen questions on clinician progress notes, whether cut/paste/copy is allowed, and how record changes are performed
• General HIPAA privacy compliance questions

OIG Survey

UPDATE: Thanks to another reader who provided a copy of the survey, which is specific to hospitals. I found Question #44 involving patient access to their EHR data to be the most interesting given that this is a fraud questionnaire. Not only is allowing patients to see information about them a good thing in general, they can be on the lookout for questionable billing for services on their behalf. Click here for larger, printable version of the survey from my original upload.

Reader Comments

From THB: “Re: Sherman Health in Chicago. I’ll bet a dollar to your favorite charity that they join Cadence since it’s an Epic shop.” Drop a buck into a Salvation Army kettle: Sherman chooses the other suitor, Advocate.

From Back from CHIME: “Re: HIStalk. As a long-time HIStalk follower, I think everyone should know about it for keeping current. Few of my peer group seem to. How can that gap be bridged?” Let’s crowdsource some reader ideas: what should I do to make HIStalk imperative CIO reading or make them more aware of its existence?

From Michael: “Re: EHRs in the NFL. I thought HIStalk would appreciate this.” Indeed I did. A New York Times article talks about NFL teams that use technology to maintain the health of their expensive biological assets (players). Among them: electronic medical records, concussion evaluation apps, sideline video replays so trainers and doctors can quickly figure out the source of a player’s injury, and iPads for viewing player X-rays. The league hopes to move all teams to a cloud-based EHR system soon so that prospects won’t need to be X-rayed by every team that’s considering their services. According to the SVP of medical services for the New York Giants, “Electronic medical records league wide would save a player from a lot of unnecessary radiation. All of this helps on so many levels from before the game to during the game to after the game. It all just makes it easier to help the players stay healthy.” ”

HIStalk Announcements and Requests

Inga and Dr. Jayne are having quite a time for themselves at MGMA, apparently. Inga’s posts (with lots of pictures since she’s determined to wave her iPhone 5 around at every opportunity) are up from Monday,  Tuesday, and Tuesday Part 2. Inga is #4 on the list of Twitter influencers using the #mgma12 hashtag, she told me proudly.

On the Jobs Board: Systems Implementation Engineer, Billing Services Manager, Database Administrator (Oracle).

Welcome to new HIStalk Platinum Sponsor Craneware. The company is all about revenue integrity: charge master management solutions, business intelligence, and revenue cycle management. I was startled to see its growth from the days long ago when my hospital signed up as an early adopter, and now I see that 25 percent of US hospitals are its customers for a variety of products: Chargemaster Toolkit,  Bill Analyzer, Physician Revenue Toolkit, InSight Medical Necessity, Patient Charge Estimator, Pricing Analyzer, and even more solutions for supply management, denials, audits, payment variance analysis, and a broad line of professional services. Thanks to Craneware for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Health education systems vendor HealthStream acquires provider enrollment and credentialing system vendor Sy.Med Development. Both companies are located in the Nashville area. HealthStream also announces Q3 results: revenue up 28 percent, EPS $0.08 vs. $0.08. 

Perceptive Software saw a 78 percent revenue increase in Q3, according to filings by parent company Lexmark.

Vocera shares were the biggest percentage decliner on the New York Stock Exchange Friday, down 6.7 percent. They regained 2.32 percent Tuesday amidst a big market selloff, however.

Sales

Memorial Hospital (CO) will deploy SIS Analytics across its three facilities.

Beaufort Memorial Hospital (SC) selects Wolters Kluwer Health’s ProVation Order Sets.

Vanguard Health Systems (TN) will deploy AirStrip’s complete mHealth platform throughout its 28 hospitals.

Samaritan Health Services (OR) will use Passport Health’s Patient Access and Payment Certainty solutions throughout its enterprise.

Huntington Medical Foundation (CA) selects Allscripts RCM for its 50 providers to integrate with its Allscripts EMR.

HealthEast Care System (MN) chooses the Wellcentive Advance Outcomes Manager population health management solution.

Carroll County Memorial Hospital (KY) chooses OfficeEMR from iSALUS.

Announcements and Implementations

eClinicalWorks launches an all-inclusive RCM service at MGMA that includes its PM/EHR and services for 2.9 percent of monthly revenue collections.

Vitera announces Intergy Stat, a pre-configured subscription- and cloud-based PM/EHR system for independent physicians. Also announced: Vitera Intergy Mobile, an iPad app that provides mobile providers with read-only access to Vitera Intergy v8.00.

Oncology solutions vendor Prowess will incorporate tools for e-prescribing, medication adherence, and communications from DrFirst.

Government and Politics

Northern Ireland’s health minister is attending a Boston conference to urge healthcare vendors to test their products in his country, touting its single integrated health and social care system. Among the American speakers at the EU-US eHealth Markeplace are Anand Basu (ONC), David Seltz (Massachusetts governor’s office), Dave Whitlinger (New York eHealth Collaborative), Doug Fridsma (ONC), Farzad Mostashari (ONC), Joy Pritts (ONC), Judy Murphy (ONC), Katherine Luzuriaga (UMass), Laura Raimondo (UPMC Italy), and Bill Hersh (OHSU).

The VA hasn’t made much progress on encrypting its computers since a high-profile 2006 data breach, a report investigating an anonymous tip finds. The agency bought 400,000 encryption licenses for almost $6 million, but has installed the software on only 65,000 devices. The VA’s technology office says they had compatibility problems with older computers and stopped the encryption program until the computers were upgraded. The OIG report says they don’t even know if the software meets the VA’s needs and blames poor planning and project management for the outcome.

Technology

Apple announces the slightly smaller iPad mini, pricing it surprisingly high at $329 for a Wi-Fi only model. Concerns are that it still can’t compete with the $199 Kindle Fire (subsidized by the Amazon product sales it generates) or the $199 Google Nexus (sold at cost.) It could, however, take away from sales of its $499 big brother. Also announced: yet another generation of the iPad to make the one(s) you already have obsolete, thinner MacBook Pro laptops featuring the Retina display, and upgrades to the iMac and Mac Mini. Apple shares closed down 3.26 percent.

Diagnotes wins an Indiana innovation contest for its On Call program that connects hospital staff to offsite physicians who can view medical records on their smart phones and send orders back via secure messaging. The company’s CEO is Dave Wortman, who I interviewed many years ago when he was running Mezzia,  the healthcare budgeting company he formed in 1999. It was sold to VFA in 2006.

Other

A University of Wisconsin-Madison biochemistry professor whose research involves the flowering of plants is arrested after police find that the specimens in his lab are actually marijuana. My first reaction: sounds like “Breaking Bad” since I’m watching that on Netflix.

In England, a hospital blames an unspecified technical issue in apologizing to 120 breast cancer patients whose incorrect estrogen receptor biopsy results caused them to miss potentially needed hormonal therapy. The hospital is also on shaky financial ground, saying it could run out of cash in January.

An internist’s Wall Street Journal opinion piece on electronic medical records concludes:

At first I thought EMR sounded like a good idea. Then our practice started using one … checking patients into the office is an odyssey involving scanners and the collection of demographic data—their race, their preferred language, and so much more—required by Medicare to prove that we are achieving "meaningful use" of our EMR … it seems as if this is all about taking care of the chart, as opposed to taking care of the patient … With all the data entry the electronic system requires, my laptop presents a barrier between my patient and me, both physically and metaphorically. It’s hard to be both stenographer and empathetic listener at the same time.

Life Sciences Angel Network will present a November 20 conference, “Healthcare Information Technology: Change, Outlook, and Opportunity,” at Beth Israel Medical Center in New York. Investor Esther Dyson will deliver the keynote; program panelists include representatives from Aetna, Nike, Continuum Health Partners, Castlight Health, and the FDA. Registration is $120.

Medical students from Johns Hopkins University and the University of Maryland who volunteer at Baltimore Rescue Mission develop an EMR system for the free clinic using open source software. They plan to expand it to similar organizations and connect it to Maryland’s CRISP HIE. They’ve formed an organization called Networking Health.

Here’s a music video from the recent CHIME conference. I recognize quite a few of the stars.

Sponsor Updates

• Imprivata announces the agenda of its first annual user conference in Boston.
• Gartner positions Informatica in the leaders quadrant in its 2012 Magic Quadrant for Master Data Management of Customer Data Integration report.
• GetWellNetwork experiences a 125 percent growth surge year over year as patient engagement becomes an imperative component for MU reimbursements.
• First Databank releases its enhanced drug knowledge to support interoperable medication management.
• Iatric Systems receives ONC-ATCB 2011/2012 Certification for its PtAccess V1.0.11.
• QlikView expands its mobile access with QlikView for iOS, available for the iPad.
• NextGate signs 15 new clients during its third quarter for its EMPI and Provider Registry solutions.
• Park Place International introduces its Sustaining Healthcare IT blog to assist Meditech hospitals in achieving sustainability.
• Anesthesia Healthcare Partners chooses to McKesson Revenue Management Services for 30 locations across eight states.
• AdvancedMD releases its survey results at MGMA indicating that only 26 percent of physicians feel they are in control of their finances, while more than half expect their patient load to increase because of the Affordable Care Act.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 10/22/12

From MyWay or the HyWay: “Re: Aprima. I hear that Allscripts is upset that Aprima is offering MyWay customers a free conversion to Aprima. I don’t understand the situation there.” Unverified, but that’s surely the case. Here’s some history for the industry newcomers. Misys was a train wreck in 2007, a clueless British company stuck with a bunch of badly aging practice EMRs that could not compete with newer, better, and cheaper competitors that were flooding the small practice market. Instead of developing a new product, Misys took the questionable step of paying iMedica for the source code to its EMR product in a non-exclusive agreement that allowed each company to do its own development going forward, with Misys relabeling its copy as MyWay and selling it through resellers instead of the traditional sales channel. The relationship got ugly, with all kinds of legal actions and maneuvering.

Misys then merged with Allscripts in 2008, its old HealthMatics EMR product was renamed Allscripts Professional, and iMedica changed its name to Aprima in 2009 (for a first-person historical snapshot, see my 2008 interview with Aprima CEO Michael Nissenbaum and my 2010 interview with Glen Tullman and the since-departed Phil Pead from Allscripts.)

Fast-forward to 2012: Allscripts tells customers it won’t enhance MyWay to meet ICD-10 or Meaningful Use Stage 2 requirements, but will support their continued use of their product as-is or convert them to Allscripts Professional for free. Aprima, sensing opportunity, offers those customers a similar deal to move to its product, which is a lot more like MyWay than Allscripts Professional (Aprima’s product isn’t ICD-10 or MU Stage 2 ready either, but the company has said those enhancements are on its roadmap.)

MyWay customers have four options:

1. Keep using MyWay, realizing that while Allscripts support will continue to be available, the product is moving into maintenance mode with no planned ICD-10 or Meaningful Use Stage 2 capabilities. Practices that don’t need those enhancements don’t need to make any change at all right away. Historically, however, vendors usually don’t continue to indefinitely support maintenance mode products, so this option is realistically more of a decision deferral than a long-term strategy.
2. Accept the rather generous Allscripts offer of a free conversion and no-change maintenance cost in moving to the arguably more comprehensive but also more complex Allscripts Professional. That’s a great deal on the surface, but with a caveat: even free EMR conversions to an entirely different product are painful and productivity-sapping, not to mention that the Allscripts conversion schedule is ambitious and they’ve previously struggled with even same-product upgrades (TouchWorks).
3. Convert from MyWay to Aprima at no charge. The Aprima product should look and feel more like MyWay than Allscripts Pro. The switch involves signing up with a different company, which could be good or bad depending on how you feel about Allscripts as a vendor. I don’t know if Aprima has ever done a conversion of that type, but I would suspect they haven’t.
4. Buy a competitor’s product instead of accepting a unwelcome migration to either Allscripts Pro or Aprima. That option makes sense only for a limited subset of customers given the effort and expense required for an on-your-own switch. However, kicking tires doesn’t cost anything, so some customers will probably at least explore competitive products, driving their sales reps crazy since “free” is a tough selling point to beat.

In comparing products, KLAS customer respondents score them about the same:

Aprima beats Allscripts significantly in the all-important “would you buy it again” number from real-life customers, which I consider to be the most important KLAS measure since it summarizes both the product and the company:

I’d want assurances from either vendor:

1. How much productivity will you lose during the switch?
2. Can you talk to reference sites that converted before yours? You don’t want to be the first one.
3. What information will be converted automatically? “Conversion” is not necessarily a generic term.
4. What’s the cost of any required third-party product licenses, hardware upgrades, optional maintenance costs, after-hours support availability, on site training if you think you’ll need it, etc.? Both companies suggest minimal changes, but I’d want that in writing.
5. Will they guaranteed maintenance costs with limited escalation?
6. Will they send you a sample project plan for the conversion?
7. What if something goes wrong? Every factor that’s important to your practice should be covered by a contractual promise from the vendor and a contractual penalty if they fail to meet it.

I’m a cheap-seater on this issue, so comments from Allscripts and Aprima users are welcome.

From Now Seriously: “Re: Paul Levy’s Stockholm syndrome comments about Epic. For some reason in his mind, it’s a bad thing that Epic skated to where the puck was going and got there first with string of solid installs that are successful models for the industry. His poor judgment and lack of clear thinking must have helped him achieve the title of ‘former CEO’ and his blog’s title change to ‘Not Running a Hospital.’” Paul is certainly entitled to his opinion even when it’s uncharacteristically negative, but he (and the pedantic EHR-haters that posts like this one always attract) would carry more credibility with actual experience using Epic or any other commercially available product. It’s the height of arrogance to dismiss the first-hand opinions and experiences of hundreds of hospitals and thousands of actual users of Epic or any other clinical system by writing them off as collectively deluded, like a know-it-all nosebleed-section sports fan shouting out naïve advice to a professional athlete. Paul finishes on a wild tangent in predicting that any Epic error (of which the documented incidence is apparently zero) will cause “a bunch of Congressional committees to come down on the firm like a ton of bricks.” That didn’t happen with Cerner at UPMC Children’s Hospital, the homegrown CPOE system at Cedars-Sinai, or Eclipsys at El Camino Hospital, where IT problems definitely threatened patients. Or for that matter, at Paul’s former employer BIDMC, where a multi-day network outage in 2001 that included its homegrown EMR surely exposed its patients to harm. The crux of his message seems to be that someone should stop Epic’s domination of the hospital systems market (like their competitors, maybe?) and the FDA should regulate clinical software, which always elicits passionate, conflicting opinions about whether government intervention generally improves a given situation.  

From HIPAA Girl: “Re: Blount Memorial Hospital. The Tennessee hospital’s stolen laptop contained information on 27,000 patients.” The laptop stolen from an employee’s home contained only basic demographic information. The hospital says the laptop was password protected, which usually means not encrypted.

From Virtual Virtuosity: “Re: copying and pasting of patient information in EHRs. Is Dr. Mostashari aware that this is how most EHRs work? Does HHS and ONC really expect providers to individually enter every piece of data from a clinic visit? We had a doctor join our practice from the same Kaiser office I used to work at. She had been using Epic for eight years and I asked her how she did it. She said it was initially hard, but she and most of her colleagues finally just made 20 templates and copied them for the vast majority of patients. EHRs from Epic and everybody else were designed to improve efficiency by copying and pasting. If HHS and ONC really expect providers to manually enter every piece of data from every patient visit, we’ll need double or triple the number of primary care providers to keep up with demand. That also brings up another point: as we read the rah-rah press reports about how Kaiser is a shining beacon on a hill for gathering and collecting data to improve healthcare, aren’t they just analyzing the same data constantly if their doctors are just using those 20 templates over and over? How does that reduce costs or improve efficiency?” My opinion is that providers have met every expectation as long as each patient’s EHR information is accurate. If HHS wants providers to craft innovative and individualized prose just for the sake of making every patient record pointlessly different, then they need to set a payment rate for creative writing. First they wanted discrete data, then they decided that what they really want is lots of plain text to assure them that they aren’t being defrauded since they are apparently powerless to determine otherwise. I’ve said it before: the reason that EHRs haven’t improved patient outcomes is because HHS and other payors have forced vendors to focus their development efforts on administrivia enhancements to meet needlessly complex payment requirements that have nothing to do with patients. You could develop a kick-butt EHR if you weren’t required to get bogged down in the Vietnam-like quagmire of billing documentation requirements that allows payors (Uncle Sam included) to avoid writing checks. Unfortunately, that situation is getting worse instead of better as the government insinuates itself even deeper into the practice of medicine. I bet you could design a really cool EMR for cash-only practices, except you’d have few prospects to sell it to.

From Minor Key: “Re: Michigan HIEs. Talk to providers and practices in the state and you’ll hear a different story. They’re realizing benefits now, with little jeopardy or delay in the HIE’s work toward the longer-term goal of interconnection.”

From Jock Ewing: “Re: FDA and biomedical system OS, antivirus, and software patches. This 2005 article says it’s a common ploy for vendors to tell customers that applying software patches would require re-approval by FDA. FDA has clearly said that this is not the case. The bottom line is that manufacturers are supposed to be validating patches and the only issue with getting that done is their willingness to dedicate resources to the task. It’s up to their customers to demand that they validate patches in a timely manner.”

From The PACS Designer: “Re: busy week ahead. Both Apple and Microsoft plan to introduce new hardware and software next week. First, we hear from Apple on the 23rd with the expected offering of new smaller versions of their product line, and on the 26th we will hear from Microsoft on the introduction of Windows 8. Windows 8 is the big deal of the week because it is projected to be the key operating system that will replace Windows XP, and will be used in many upgrade efforts across all of industry, academics, healthcare, and home computing. One of the first apps in healthcare space will be Pariscribe’s Windows EMR Surface (above), which should draw some interest from practitioners.”

From LaRusso: “Re: Fast Company. Several pages on healthcare IT are in the current issue.” It’s mostly the usual oversimplified geek piece on how tiny software startups you’ve never heard of are going to not only disrupt healthcare IT, but healthcare itself because they have brash founders, a few thousand dollars of VC or incubator money, and cool Web pages. I don’t recall many industries that have been disrupted by apps or websites, other than retailers outflanked by competitors who started selling first via the Web, so I’m skeptical that most of these companies will even survive, much less single-handedly transform the highly profitable, political, and parochial healthcare system into a consumer-driven and transparent industry where good defeats evil. Companies get my attention once they hit $5 million in revenue since that’s the point where the concept has been validated, initial development and scaling has been completed, the organizational culture has been defined, and skilled management has been brought in to protect the VC’s investment from the managerial whim of the inexperienced founders. That’s when companies become worth writing about, if for no other reason than the strong possibility that some old-school company will just buy them outright, making the founders as rich as they’d hoped while usually ruining what they created.

Now that I’ve been predictably curmudgeonly in dismissing wide-eyed startups and their naïve faithful who really believe that every David will inevitably rise to defeat his personal Goliath, I’ll take my own counterpoint in reminding myself that I ran a successful series of profiles awhile back called Innovator’s Showcase that introduced several companies to the more traditional side of the industry that most of us work in. I want those small companies to innovate and succeed and that was my way of trying to give them a boost, choosing those that seemed to have predictors of success. Some of them have done quite well since then from all appearances. If your healthcare IT-related company is less than five years old, has sold your offering to real customers, and brings in revenue of less than $2.5 million from selling a truly innovative product or service, e-mail me and tell me why my readers should be interested — I might include it in future posts. Those companies I’ve showcased previously include Aventura, Caristix, Health Care DataWorks, Health Nuts Media, Logical Progression, OptimizeHIT, and Trans World Health Services. There’s work for both of us to do if you’re chosen, so don’t take it lightly.

Widespread interoperability is limited because (a) technology or standards are limited, and (b) because providers have no incentive to share the data they keep. New poll to your right: does your PCP use Twitter for medically related tweets? I don’t really care so I wasn’t sure if mine did, but I’m guessing no since he doesn’t turn up in a Twitter search.

Welcome to new HIStalk Gold Sponsor HealthTronics, which offers a wide portfolio of urology-specific services (mobile lithotripsy, laser prostate treatments, cryotherapy, equipment services) that includes IT solutions such as its market-leading, urology-specific EHR used by over 2,100 providers seeing 18,000 patients daily and who have received more than $12 million in HITECH incentive payments. Its UroChartEHR and MeridianEMR were among the first EHR products to earn certification. Features include hundreds of templates and treatment plans specific to urology, pre-programmed urology terms, an easily understood user interface that requires minimal training and offers a one-screen patient encounter, PQRI, eRX, a sketch pad, device integration, built-in practice analytics and economics analysis, and remote access via iOS and the Web. HealthTronics joined Endo Health Solutions in 2010. Thanks to HealthTronics for supporting HIStalk.

Mrs. HIStalk dragged me to my once-a-year trip to the mall this weekend since I needed some new cooler weather clothes. I noticed that a Microsoft Surface kiosk is scheduled to open there shortly (in the mean time, it was serving as a place to deposit partially consumed cups of coffee and food court trash). The tablet is scheduled to ship on October 26, but pre-orders have sold out. Microsoft is getting killed as iPads have eroded sales of Windows-using PCs (Apple is the #1 PC maker in the world if you consider an iPad a PC as many consumers apparently do) and they need Surface to stop the bleeding. It comes in two versions: one that’s priced similar to the iPad running Windows RT (which has a micro-percentage of the number of apps as the iPad and a questionable apps ecosystem to compete with iTunes) and an expensive Surface Pro running Windows 8. I don’t see it making a dent in consumer iPad sales or even those of Android devices, but Microsoft’s one advantage over Apple is enterprise credibility. I would say their best chance for Surface success is that companies push off employees demanding to use iPads by offering Surface as an less-desirable but acceptable enterprise alternative. Otherwise, I expect few consumers to pony up $499 for a Surface RT tablet (not including the $100 keyboard) with they can get an iPad for the same money. If you can’t beat Apple on price, you’re screwed, because they own the customer experience.

T-System is on a roll with its funny HIT-related e-cards.

John Glaser of Siemens Healthcare wins CHIME’s lifetime achievement award. Above is a photo of the occasion taken by Ed Marx.

Also at CHIME, Ed Martinez, SVP/CIO of Miami Children’s Hospital, is awarded CHIME’s Innovator of the Year award.

A newspaper covering the highly publicized opening of the Massachusetts HIE provides a good reminder of where healthcare stands compared to other industries: “To those in fully automated industries, like banking, the state’s rollout of a new health information network last week must seem sadly behind the times … the experience can leave anyone who has ever used an Internet driven technology like Facebook or even simple email wondering just how exciting it can be to send one file electronically from one organization to another? Very exciting, say those in the health care profession.”

Athenahealth shares took a dive Friday as investors reacted to earnings that were improved, but increased less than expected following its Proxsys acquisition. ATHN closed at $73.31, down more than 8 percent to levels last seen in June. In the earnings call, Jonathan Bush blames Epic for extending the company’s sales cycles and a lowering its close rate:

They go out and sort of do some Bush Doctrine, saying, “In three years, we’re going to be live with this thing, and it’s going to slice and dice and bring world peace. You’re either going to be on it or not allowed in our hospital … you’ll be cut out of our ACO. You’re going to not be clinically integrated with us if you’re not on this thing.” … I believe that all of the banks in America may not be on one instance of one software, and yet all of us can stumble up to any cash machine we want and exchange information. It’s a ludicrous, pre-Internet idea.

El Camino Hospital (CA) provides most of the funding for a group that’s trying to defeat a November 6 ballot measure called Measure M, which would cap ECH’s executive compensation as a tax district-supported hospital. ECH’s CEO makes $700K and can earn a 30 percent bonus. The measure was proposed by the SEIU labor union, which says it’s less interested in that topic now since another bill has earned its undivided attention – one that would limit the ability of unions to raise money for political candidates.

Quite a few readers are fans of snarkmeisters The Onion and feel-good TED talks that tend to be long on inspiration but short on applicability, so here’s what happen when they meet. “I’ll be your visionary, and you do the things I come up with.”

The parents of an 8-year-old boy sue a Chicago hospital for pronouncing their son dead and taking him off life support for five hours until the patients insisted on a cardiac ultrasound that showed he was actually alive. Family members said doctors told them that the boy wasn’t actually opening and closing his eyes – it was just the medications he’d been given that made it look that way. The hospital says he really was dead, but they’re happy that his heart function returned spontaneously.

Sponsor Updates

• Medicomp hosted the two-day MEDCIN U for 32 EHR developers and vendors last week in Reston, VA, teaching attendees about integrating the company’s MEDCIN engine and Quippe into their applications. That’s Medicomp CEO Dave Lareau and Clinical Architecture CEO Charlie Harp above.
• EHR vendor Prowess will use the OrdersAnywhere CPOE product from Ignis Systems for lab orders, results, and lab integration. OrdersAnywhere has been integrated with 120 lab and radiology systems and is being used to satisfy Meaningful Use Stage 2 orders requirements.
• Quest Diagnostics announces that it has certified the first 20 EHRs under its Health IT Quality Solutions program that recognizes EHRs that share data with Quest’s clinical laboratory system. The full list is here.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.