News 9/19/12

Top News

Massachusetts Eye and Ear Infirmary and its physician group will pay HHS $1.5 million to settle potential HIPAA violations following the theft of an unencrypted laptop containing electronic PHI of patients and research subjects.

Reader Comments

From Honky Cat: “Re: Waiting in line at Apple. Don’t wait in line for your iPhone upgrade. Go to this link and pre-order your phone. They will ship it to you in two to three weeks. Surely you can wait that long for it.” I considered setting my alarm to be one of the first people to go online last Friday and place an order. Instead, I slept in and waited until 6:00 am to get online. By that time Apple had stopped taking orders to reserve the iPhone 5s for pick up at the local Apple store, so I’ll wait for mine to be delivered in a couple of weeks. Apple, by the way, sold two million iPhone 5s in the first 24 hours of pre-orders, more than double the previous record set in 2011.

From The PACS Designer: “Re: mobile image viewing. TPD congratulates Aycan Medical Systems for being one of the first to gain FDA approval for its Aycan Mobile for the iPad. Now that the FDA is involved with mobile solutions, we’ll see more teleradiology mobile solution approvals for other vendors.“

From Steve: “Re: QuadraMed. To be sold in the next 7-10 days.” Unverified.

From Pointer: “Re: EHRs. A vendor-agnostic viewpoint on how they don’t change the cost curve.” It may be vendor-agnostic, but this particular article is a clearly labeled opinion piece written by authors who have been historically negative toward EMRs, EMR vendors, and government. They are entitled to their opinions, but recognize them as such despite the bait-and-switch newspaper headline trumpeting “A Major Glitch.” Their editorial conclusion is accurate, though – most studies have failed to prove that EMRs save money (I haven’t seen any studies that convinced me that paper records save money or improve outcomes either, of course.) That’s not to say they don’t, only that it’s tough to prove since nothing in healthcare stays unchanged long enough to get a baseline. It’s also true that expecting technology alone to create savings without changing incentives is unreasonable. I agree with the authors that blowing taxpayer billions to get providers to buy software they weren’t willing to spend their own money on was illogical, but no amount of Monday morning quarterbacking will bring that cash back or cause providers to toss their EMRs out the nearest window. It’s time to move on, realize that healthcare IT is here to stay, and constructively make it better instead of hand-wringing. Like everything else, the industry has 10% cheerleaders, 10% naysayers, and 80% rational people who don’t need the self-proclaimed experts on either end of the spectrum to tell them what to think or do. If you’re a provider, choose EMR or paper as you desire, do something innovative with it that improves outcomes and reduces costs, and then write your own article. That’s the one I’d rather read.

From Looking Deeper: “Re: patient portals and self-scheduling. I install patient portals for a living, including scheduling. There really aren’t technical challenges any more. Providing convenient, immediate online scheduling is a solved problem even in healthcare, especially in primary care. The problem is in people’s heads. Whenever online scheduling comes up, physicians and clinic staff will tell you that their patients can’t possibly handle it – they’ll schedule the wrong kind of visit (office visit vs. physical) or create some other vague problem. I dutifully inform them that online scheduling is working fine in clinics and practices across the nation. ‘Other clinics find that their patients can handle this,’ I always say. They usually say, ‘Not our patients.’ Interestingly, clinics serving less-affluent areas and the indigent tend to be more in favor of such patient-centric services. ‘Our patients are an especially incompetent group’ is a pretty negative view to hold of the people you’re trying to care for. If we could just get past this attitude, pretty much all primary care visits could be scheduled online. In the rare case where something needs to change, the clinic can call or e-mail the patient and reschedule, but that’s less than 5 percent of appointments scheduled online. Specialty and procedure visits are a different beast and need some careful analysis before they are opened up to online scheduling, but online scheduling for primary care is a solved problem.”

HIStalk Announcements and Requests

I have newfound respect for anyone working with insurance companies to secure payments. I had mentioned a few months ago that I had a minor medical procedure that resulted in some complications, lots of doctor office visits, and about 20 different medical claims. I was lucky enough to have both primary and secondary coverage in place since the claims were in the thousands. I also thought I was lucky because both policies were from the same very big insurance company. Unfortunately, the insurance company has spent the last four months trying to decide internally which policy should be primary, and so far no claims coordination has occurred. After several weeks of hour-long phone calls, yesterday I finally turned “not nice” and demanded to speak to a supervisor. I explained that I didn’t give a (expletive) which policy was primary or secondary, it was all one insurance company, and the (expletive) claims needed to be paid. I actually believe the claims will finally be processed correctly. The moral of this story is that if you work in a hospital or practice, take a moment to say thanks to your billing and collection staff. And bring them chocolate on a regular basis.

I don’t know about you, but I’ve been busy turning off all my Facebook and Twitter connections to folks who keep preaching politics. Has anybody ever convinced someone to change their political beliefs by proudly posting a Facebook link to the latest nut-job partisan article? Actually, they sometimes almost convince me to vote the other way out of annoyance.

Thanks to Healthcare Quality Catalyst supporting HIStalk as a Platinum Sponsor. The Salt Lake City company offers a practical clinical data warehouse solution that combine technology and clinical improvement methodologies to improve care. The information needed to answer a clinical improvement question is scattered in most hospitals (satisfaction surveys, Epic Clarity transactions, and lab and prescription information, for example) and HQC puts it together in its Adaptive Data Warehouse and subject-specific data marts (such as women and newborns) to support continuous, evidence-based care improvements. HQC offers more than just the tools, supplying clinical improvement methodologies such as role definitions and process templates to create effective improvement teams. If you’ve been around the industry for some time, you surely know some of their folks: Todd Cozzens, Larry Grandia, Dale Sanders, Bruce Turkstra, and David Burton, MD were some of those I immediately recognized. I interviewed co-founder and CIO Steve Barlow a year ago and got a good background on the company. Thanks to Healthcare Quality Catalyst for supporting HIStalk.

I naturally cruised over to YouTube and found this video that introduces Healthcare Quality Catalyst better than I did.

Acquisitions, Funding, Business, and Stock

PE firm ABRY Partners makes a “significant” investment in SourceMedical Solutions, a provider of software and services for ASCs and rehab centers.

In England, a company that commercializes university research invests in an Oxford spinoff whose software that can monitor pulse, respiration, and oxygen saturation using only a webcam.

Also in England, eHealth Insider reports that CSC will stop selling iSoft GP systems to NHS markets, in which it has 582 practice customers. CSC denies the report.

Vipaar, which sells surgery proctoring software based on technology developed at the University of Alabama at Birmingham medical school, raises half of its $1.2 million funding goal.

Sales

Community Medical Center (NE) selects BridgeHead Software’s Healthcare Data Management Solution for backup and archiving.

CommUnity Care (TX) will deploy NextGen RCM Services throughout its 22 clinics.

Pemiscot Memorial Health Systems will expand its deployment of Prognosis Health Information System by implementing its financial system and its laboratory information system powered by Orchard.

Community Hospital Grand Junction (CO) chooses the perioperative system of Surgical Information Systems.

People

Zotec Partners hires Kristy Floyd (American Society of Anesthesiologists) as director of anesthesia business development.

The Medical College of Wisconsin appoints David C. Hotchkiss (University of Texas Health Science Center) VP/CIO.

Healthland names Patrick Spangler (Epocrates) CFO.

Douglas Billian, founder of Billian Publishing, died September 15 at 84.

Announcements and Implementations

HIMSS Analytics recognizes Fort HealthCare (WI) with its Stage 7 Award for EMR adoption.

Providence Medford Medical Center and Asante Rogue Regional Medical Center (OR) will complete their hospital and clinic implementations of Epic in April.

Nuance will purchase Ditech Networks, a provider of voice technologies and voice-to-text services, for $22.5 million.

AMA releases the 2013 CPT code set, which goes into effect for claims filed as of January 1, 2013.

Certify Data Systems announces the general availability of its HealthLogix HIE platform, which it says is the first to deliver an aggregated patient view from all community health encounters regardless of EHR.

Cincinnati Children’s Hospital Medical Center (OH) implements Passport Health’s PatientSimple and Smart Statement online billing solutions.

eClinicalWorks launches its $10 million open, secure collaboration platform that works with any EHR or even paper-based practices. The NHIN Direct-compatible network allows members to transmit electronic referrals and patient records with attachments.

Government and Politics

ONC posts the second wave of draft test procedures for the 2014 Edition EHR certification criteria.

I don’t think Farzad ever followed through on his promise to name the EMR vendors who took his #VDTnow pledge to allow patients to view, download, and transmit their medical information. Claudia Williams of ONC tweeted her list, which I assume is complete: Allscripts, NextGen, AlereWellogic, Intellicure, eClinicalWorks, Greenway, SOAPware, athenahealth, Azzly, and Cerner. Conspicuously but not surprisingly missing is Epic, which doesn’t even have a Twitter account as far as I know. Maybe they already offer the capability as some have suggested, but if so, all they had to do was tweet out their already-met pledge. Judy’s on ONC’s Health IT Policy Committee, after all.

Innovation and Research

The National Library of Medicine awards The Ohio State University College of Medicine’s Department of Biomedical Informatics $1.3 million to develop a system that uses EHRs to identify potential patients for clinical trials.

Other

Wider use of EHRs over the last decade may be contributing to a growing up-coding trend that has added $11 billion to healthcare costs. Physicians argue the higher codes are justified because care of seniors has become more complex and technology allows them to code more accurately. Critics say the findings suggest billing abuse and fraud. I I were still selling EMRs, I’d be handing this study to doctors and touting it as proof that technology is helping physicians bill and be paid for the actual care provided. Meanwhile, naysayers like Mr. H will probably dig deeper and suggest objections to such hasty conclusions.

Hell hath no fury: a Washington dermatologist wins a $600,000 settlement and a rare apology from state health officials who had investigated him for drug abuse and medical fraud. An anonymous tipster had reported that the doctor was falsifying drug records, using cocaine, and running in-office orgies among his staff, patients, and prostitutes. In a separate lawsuit, the doctor was award more than $100,000 from his former wife, who turned out to be the anonymous tipster who had filed the complaint late in the couple’s bitter divorce proceedings.

The folks from Arizona Associated Surgeons sent over their video for the Western Users Group meeting at ACE (the Allscripts user meeting) last month.

Want to rub elbows with sexy celebrities on your hospital employer’s dime? CHIME’s Fall CIO Forum will feature Olympic beach volleyball gold medalists Misty May-Treanor and Kerri Walsh Jennings, mostly known for leaping around nearly naked in prime time reminiscent of the much-beloved “Girls on Trampolines” segment of The Man Show except with smaller bikinis. Misty and Kerri (or was that Misti and Kerry?) will discuss Meaningful Use Stage 2 and … no, wait, they’ll pose with star-struck CIOs, sign autographs, and collect a big non-amateur payday courtesy of patients who pay $5 for an aspirin.

A group of 30+ physicians labeling themselves as “Doccupy” complain to Contra Costa, CA county supervisors about the $45 million implementation of Epic at its hospitals. They said 10 percent of ED patients are leaving without seeing a doctor, a number that increased after the hospital’s July 1 go-live as the average time in the ED increased from three hours to four. Patient loads were cut in half to prepare for the implementation, but the doctors claim that several of their peers still quit because of stress, saying, “We were not ready for Epic and Epic was not ready for us.” An ED physician going off shift said she still had documentation to complete for 16 patients, adding, “It’s going to implode.” Some doctors spoke up about the advantages of Epic, and all agreed that it’s important to have an integrated electronic record. Detention facility nurses had complained about Epic to the supervisors last month.

The Cure JM Foundation (juvenile myositis) is in the running for a $250K research grant that will go to the charity with the highest number of Facebook votes. Information and voting links are here. Several HIT folks I’ve heard from have children with JM and I’m sure they would appreciate your vote.

Patients storm Charlton Memorial Hospital (GA) after a contracted collection company incorrectly manipulates the hospital-provided data file, sending patients collection notices for bills they don’t owe.

Of the seven highest-earning non-profit CEOs in the country, four run hospitals, according to the Chronicle of Philanthropy. I think they’ve missed a few since I’ve seen several hospital tax forms with CEO salaries above these figures.

Bloomberg Businessweek profiles Terry Ragon, founder of the Boston-based InterSystems, which sells the Cache’ database that runs Epic, Meditech, and quite a few other MUMPS-based healthcare systems. The article calls Ragon a “Hidden Software Billionaire,” estimating the value of the company he directly owns at $2 billion.

Here’s a fun coincidence. Dave Miller, vice chancellor and CIO of the University of Arkansas for Medical Sciences, sent over the above video of him doing a nice cover of “Mustang Sally” at Epic’s UGM (his wife had the camera 90 degrees off kilter for a few seconds, but his singing was fine). The day they got back home, he impulsively bought some raffle tickets from a charity fundraiser. He won the prize, which was made in 1967, the same year Wilson Pickett released “Mustang Sally” on an album – a classic Ford Mustang.

Sponsor Updates

• SuccessEHR grows its RCM services business 92 percent over the last year.
• First Databank hosts its 2012 FDB Customer Seminar this week in San Diego.
• T-System offers Webinars this week on  improving ED throughput.
• Melanie Pita JD, EVP of product management at Prognosis Health Information Systems, presented a session on EHRs and Meaningful Use at the Georgia Rural Health Association conference this week at Callaway Gardens.
• TeraRecon is exhibiting its advanced visualization solutions for medical imaging this week at CIRSE 2012 in Lisbon, Portugal.
• Michigan Health Connect HIE and Greenway Medical will provide data exchange between Greenway’s PrimeSUITE customers and hospitals on the Michigan Health Connect platform.   
• MedPlus offers a three-part Webinar series hosted by Steven Waldren, MD, director of the AAFP’s Center for Health IT.
• White Plume releases a white paper discussing practical considerations to minimize losses while migrating to ICD-10.
• ChartWise Medical Systems unveils its ChartWise:CDI software at this month’s AHIMA convention in Chicago.
• Orion Health opens an office in Singapore for development and technical support employees.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 9/17/12

From Another View: “Re: your Time Capsule editorial. You have missed a competitor to Epic … Sunrise/Eclipsys. Ring any bells? Long Island Jewish has it installed as well as others and it is well received. Is the price tag of Epic is going to bankrupt medicine? I really think Sunrise could very well be the Apple product that beat the giant Microsoft. Any thoughts?” Read more closely: I specifically mentioned (twice, in fact) Cerner, Eclipsys, and McKesson as Epic’s big-hospital competitors. That was true when I wrote the article in 2007, but I would expect that Allscripts/Eclipsys and McKesson have faded since then in terms of big-hospital customer count. Epic’s huge number of wins since 2007 were replacements, meaning their gain was somebody else’s loss. No, I don’t think that Allscripts (or any other vendor, at the moment) can compete with Epic in the large-hospital inpatient clinical systems market. Reasons: (a) incomplete integration; (b) narrower product line; (c) lower customer satisfaction; (d) lack of momentum; (e) hospital consolidations favoring existing Epic customers; and (f) trying to disrupt the status quo with one hand firmly planted in Wall Street’s lap. It’s not the end of the world for Allscripts – 80% hospitals aren’t candidates for Epic but need a lower-priced, pre-packaged, hosted product, meaning the biggest companies to beat are Meditech, McKesson, Cerner, and Siemens. Struggling to compete against Epic in big-hospital accounts hasn’t hurt Cerner, which doesn’t bag a lot of fresh Millennium wins over Epic but still has turned its assets into a $12 billion company. If you want to score Epic vs. Allscripts without emotion or subjectivity, it’s easy – just watch the number of new sales, the total number of beds and EPs covered, and KLAS scores.

From Music Lover: “Re: Epic UGM. You missed it, Mr. H! Some cool end users rocked the house Monday night. Anyone have pics or YouTube?” I only found the video of the opening session above, which is a clever riff on a horrible Journey song (was that redundant?) that reminds of me when Mrs. HIStalk dragged me to grit my teeth through the traveling Broadway version of “Rock of Ages” (who would have guessed that disco would be more fondly remembered than 80s hair bands?) By user group standards, though, it is darned cool. From the end of the video, it appears next year’s theme will be, predictably, Deep Space (the new 14,300-seat Deep Space auditorium pictured above will be open then.)

Listening: new from The Avett Brothers from Concord, NC, who have matured from frantic newgrass revivalists into something like an indie, rootsy Beatles with banjos. Long-term fans will have to decide whether the de-emphasis on hillbilly picking and grinning is inevitable maturity or perhaps overly slick production by hit-maker Rick Rubin. The new album is more accessible and probably less embarrassing to crank up in a vehicle that isn’t a pickup truck.

I was making an appointment for my annual PCP visit last week. After navigating through the annoying phone tree, waiting on hold, and negotiating with the scheduler for a convenient appointment time, the phone connection dropped on their end. My call-back went right to the “we’re too busy to talk to you now” message, so I figured I’d just try another day. The next day, I got an e-mail confirmation for a date/time I had declined, so it must have gone through as we were changing it. I noticed an unobtrusive link in the e-mail to “click here to cancel or reschedule” and darned if it didn’t work – I clicked, it gave me available days/times on the screen, I clicked on a convenient date/time, and I was all set. It actually felt like 2001 instead of 1980 in using Expedia to book a flight instead of wasting everybody’s time by calling a travel agent for an inefficient and entirely unnecessary telephone conversation. It’s not exactly cutting edge, but very few businesses let you schedule appointments online (restaurants being one exception, and that’s only because of OpenTable). Scheduling an appointment is a lot different than buying a product online, so the usual snarky Amazon references don’t apply.

Forbes chose the wrong company as the most innovative in healthcare, according to readers who said it’s actually Epic (had Forbes included non-publicly traded companies, of course). Cerner wasn’t too far off the mark, though. New poll to your right: have you ever requested and reviewed your electronic medical information from your PCP? The poll accepts comments if you’d care to elaborate on your experience. I didn’t even bother asking about hospital records since I know what a nightmare that can be.

Allow me to introduce new HIStalk Platinum Sponsor ChartWise Medical Systems. The Rhode Island-based company describes ChartWise:CDI as a Computer-Assisted Clinical Documentation Improvement solution that improves the accuracy and speed of documentation. it guides physicians to high-quality and complete documentation, using its built-in intelligence to analyze labs, meds, and procedures to suggest diagnoses and complications that may not have been correctly coded. Easily retrievable, auditable, and AHIMA-compliant query templates ensure compliance and consistency for internal QA and external auditors, with physician communication automatically initiated and documented by e-mail. Customers can reduce staff and physician training, ensure continuity when key team members leave, and get real-time metrics for their CDI programs. It’s offered by a subscription-based license, online training is free, and ICD-10 is built in and carries no upgrade fee. Customers can use it their way, regardless of whether documentation is on paper or EMR and with or without the participation of physicians. Half of Medicare paybacks are due to erroneous or incomplete documentation and you know the RAC auditors are out there digging since they’re paid a percentage of recovered dollars. The company was founded by Jon Elion MD, who also developed the Heartlab imaging software that was acquired by Agfa in 2005. Thanks to ChartWise for supporting HIStalk.

CapSite releases its new HIE report. It shows a big jump in hospital HIE participation in the past year (from 30% to 50%), with 71% of respondents planning to invest in new HIE technologies in the next two years. Surprisingly, two-thirds of respondents chose their primary HIE vendor because the company was an extension of their core hospital system (Epic was the most-named HIE vendor, so that gives you an idea). That probably reflects the uptick in private HIEs.

A hospital in England uses Skype for video teleconsultations with ADHD and Asperger syndrome  patients.

The flagship product of Detroit-based startup SchedFull manages an online waiting list for physician practices that allows them to fill appointments opened up when patients cancel, alerting the standby patient by e-mail or SMS if an opening matches their expressed preferences. The product is in beta.

Twenty-three employers participated in a jobs fair that was held last week in the new Sheik Zayed Tower at The Johns Hopkins Hospital, hoping to hire healthcare IT and informatics graduates from Johns Hopkins University, George Washington University, and University of Maryland University College (surely the strangest and most multiply-redundant college name ever, which they cheerfully admit and explain here). The event was held in the Chevy Chase Conference Center, which I assume is named after the nearby municipality rather than the embarrassingly unfunny comedian who did in fact have a Hollywood theater named after him for six weeks in 1993, which is all it took for his horrible late night TV show to flatline.

The Dallas-Fort Worth TV station covers the technology used in a new Texas Health Alliance hospital.

The local paper covers the use of shared medical appointments by Reliant Medical Group (MA), in which 90-minute visits are scheduled with groups of patients suffering from the same chronic health issues. Patients have the option to request one-on-one doctor time during the visit if they feel the need, but three-quarters of them like the group appointments. That’s an interesting approach to maximizing the use of resources while providing peer support for patients, which is probably far more effective than the usual online groups. All that’s missing is a financial incentive for consuming fewer resources, which is of course a healthcare problem not limited to how patients schedule their visits.

Raul Recarey is named executive director of the Illinois HIE in his third HIE leadership role in less than three years, having been named COO of the West Virginia Health Information Network in November 2009 and CEO of Missouri Health Connection in March 2011.

Indian River Medical Center (FL) will implement centralized appointment scheduling using McKesson’s Paragon Resource Scheduling, which issues printable appointment itineraries and procedure instructions. After the May go-live, the hospital will implement patient self-scheduling.

A hospital in Scotland is found by NHS to be cancelling 12% of its outpatient appointments due to problems with its new computer system. The hospital cancelled 105,000 outpatient appointments and 7,500 inpatient appoints in a 15-month period.

The author of an upcoming book says that children’s hospitals are banking huge cash surpluses and paying eye-popping executive salaries despite their non-profit status and ongoing solicitation for donations, which he says threatens their non-profit status, government subsidies, and community reputations.

California’s attorney general sends out subpoenas to several big health systems (Scripps, Sharp, Sutter, and others) in launching an antitrust investigation to determine whether consolidation among hospitals and physician groups is increasing healthcare costs through increased pricing power over payers.

A nurse working for an Atlanta-area anesthesia service is released to rehab after being charged with driving the wrong way on a highway and causing several vehicles to crash, injuring six people. She is alleged to have stolen propofol from Gwinnett Medical Center and starting an IV on herself to administer it in her car right before the accidents.

Vince tells the story of Compucare and QuadraMed this week, going right to the source in somehow connecting with Dynamic Control co-founder David Pomerance, who then introduced him to Ron Aprahamian, whose fascinating story is that he bought all of Compucare’s stock for $50,000 as a 29-year-old, struck a deal with Meditech, took Compucare public for $40 million, took leadership roles at Superior and First Consulting Group as those companies were acquired … well, just check Vince’s slides because it’s too amazing for me to summarize. I’m glad Vince shared Ron’s story because even though I knew his name, I had no idea how much influence he had on so many major industry players. We would never have heard these stories if it weren’t for Vince, who seems to be the only person willing to work hard to preserve our industry’s history. If you can help him with stories, photos, or connections to folks he should talk to, give him a shout.

E-mail Mr. H.

News 9/14/12

Top News

Mediware will be acquired by PE firm Thoma Bravo LLC for $195 million, the company announced Wednesday. The $22 per share cash offer represents a 40% premium over Tuesday’s closing price.

Reader Comments

From Shades of Green: “Re: RECs and EPs. You point out that only 17,144 EPs have demonstrated Meaningful Use through the REC program. I did a little digging and found that total grants for RECs to date (which does include some funding for rural hospitals) is $706 million. That comes to $41,181 for each of the 17,144 EPs demonstrating Meaningful Use.”

From N2InformaticsRN: “Re: MappyHealth. You mentioned a few weeks back our entry into the HHS NowTrending 2012 Challenge. I have an update – we won! Not bad for two nurse informaticists and a computer science student.” Social Health Insights LLC’s free application mines real-time tweets via Twitter’s open APIs to serve as an surveillance system for emerging health issues. The challenge, which drew 33 entries, was created by HHS after it observed that social media trends can be correlated to disease outbreak. The team is Brian Norris, Charles Boicey, and Mark Silverberg. I’m sure they are keeping their fingers crossed that their app doesn’t get hosed as Twitter continues to reduce the functionality and terms of service of its APIs in hopes of monetizing tweets instead of allowing others to build applications around them. Several small companies whose only products were Twitter add-ons have already gone belly up when their data hose went dry.

From The PACS Designer: “Re: iPhone 5. Faster, thinner, 4” display, and iOS 6. Apple is prepared to meet Q4 demand by preparing suppliers to ship as many as 50 million of them in the quarter.” The only Apple products I own are an iPad and a Nano, but I still watch blow-by-blow live-blogging of every Apple announcement, which is an indication of how dramatic Apple makes their unveilings (not to mention how well they keep those huge, world-impacting announcements a secret, which is truly amazing to me). I can’t think of any reason I should care given that I’m not in the market for new Apple products, but I still do. I’m not convinced that the iPhone 5 is better than some of the Samsung or other Android phones (many of the new iPhone features have been on Android for a long time, leading some analysts to openly ridicule Apple for under-delivering), but I can safely predict that the fanboys will be camping out at the Apple store next Thursday night (what recession?) I read the other day that Apple’s iPhone sales volume alone is bigger than all of Microsoft.

From Arnold: “Re: KLAS report on Epic consulting firms. They just posted an update saying one firm has been removed because KLAS mistakenly gave them credit for another company’s survey. How shoddy, and it isn’t the first time we’ve seen this kind of mistake.” I blurred the company’s name on the KLAS announcement since it’s a good news/bad news thing – in removing some other company’s negative survey, this company’s score went up, but then it didn’t have enough surveys, so KLAS removed it completely from the updated report.

From Blue Dog: “Re: Allscripts Enterprise EHR. Heard CHS in Oklahoma City had a great implementation and they are re-looking at using it in other markets. They had a huge contractor downsizing and had postponed or shifted to athenaclinicals in many markets.” Unverified.  

HIStalk Announcements and Requests

This week’s HIStalk Practice highlights include an example of “EMR garbage.” Opinions on why specialists may seek MU incentives less often than primary care providers. Healthcare expenditures fall when patients have more access to office-based care after hours. An internal medicine physician grades his EHR. More feedback from the HIStalk Practice Advisory Panel on the ACA’s potential impact on patient volumes. Culbert Healthcare Solutions VP Jeff Wasserman offers strategies to help independent practices enjoy the financial benefits of quality-based care. Thanks for reading.

Despite the inconvenience of the new adapter, I am ready to take advantage of the $199 option to upgrade my iPhone 4 to the 5. The fast-draining battery has always been my biggest gripe with the iPhone, so longer battery life is the most appealing new feature. A bigger display will also be nice and I am envisioning all the cool panoramic photos I’ll be able to take at the upcoming MGMA meeting. I’ll be one of the geeks standing in line at the Apple store on September 21.

I was waiting for the elevator at work today with the “going up” button lit. As I stood patiently, some guy charged around me and gave the already-lit button several quick jabs. Do you suppose he thinks there’s an algorithm built in that gives preference to the number of times the button is pushed, does he harbor suspicions that elevator lights are rigged, or is he just an impatient jerk who assumes I’m not capable of pushing the button correctly?

Acquisitions, Funding, Business, and Stock

Streamline Health reports Q2 results: revenue up 22%, EPS –$0.04 vs. $0.00.

MRO Corp. acquires the assets of Florida Medical Records Services, a provider of release of information services.

Athenahealth signs a definitive agreement to acquire Healthcare Data Services, a provider of healthcare data analysis and population health management solutions for payers and providers.

Nightingale Informatix secures $2.75 million in Series B funding.

In England, mental health EHR vendor Strand Technology is acquired by Advanced Computer Software Group for $3 million.

Sales

Community Hospital Anderson will use Summit Healthcare’s Express Connect and Provider Exchange technology  for internal and bi-directional integration with its Meditech system.

Cherry County Hospital (NE) chooses Access Intelligent Forms Suite for electronic forms management as it migrates to Meditech 6.0.

The Federal Economic Development Agency will use the Connected Wellness Platform of NexJ Systems for its Connected Health and Wellness Project.

Fort Drum Regional Health Planning Organization (NY) selects Wellcentive to provide disease registry, case management, and predictive analytics.

Anne Arundel Medical Center (MD) chooses Medseek’s ecoSmart Patient Precisioning CRM solution for patient engagement and education.

Key-Whitman Eye Center (TX) selects Versus Advantages RTLS to track patient progression and staff workflows.

HealthEast Care System (MN) chooses Humedica for its ACO and PCMH initiatives.

People

Lance Fusacchia (Webmedx) joins Shareable Ink as CFO.

CHIME awards its State Advocacy Award to Texas Health Resources SVP/CIO Ed Marx.

Tom Penno (Indiana HIE) joins NoMoreClipboard as VP of channel management.

SuccessEHS promotes Lori Junkins and Elizabeth Featheringill Pharo to VP and Elizabeth Pitman to general counsel.

Jim Speros, who led the VA’s innovation prize contests and promoted its use of Blue Button, died September 3 at 59.

John Cox, former CIO at the Hospital for Special Surgery (NY), died September 12.

Announcements and Implementations

HIMSS names Hawai’i Pacific Health the winner of the 2012 Enterprise HIMSS Davies Award of Excellence.

In the UK, Moorfields Eye Hospital NHS Foundation Trust adds three modules to OpenEyes, its self-developed, open source patient management system. The new modules include surgical notes, discharge letters, and prescriptions.

Government and Politics

HHS announces $983,100 in grants to support improved healthcare access and coordination for veterans living in rural areas using telehealth and health information exchanges.

HHS Secretary Kathleen Sebelius admits to violating the Hatch Act, a federal law that restricts the political activity by government employees. Sebelius called for the re-election of President Obama at a February speech to a gay rights group. Sebelius has apologized and the Democratic National Committee has reimbursed the government for the cost of her trip.

ONC’s blog urges nurses to request a copy of their own electronic health record, verify the accuracy of its contents, and sign an online pledge. I suspect few of us in healthcare IT have requested electronic copies of our information, so I will post this as a challenge of my own to all readers. Request a copy of your EHR information and let me know how the process went – how convoluted the request process was, how long it took, and how accurate and complete your information was. I’ll run anything you send me. Somehow I think that, like almost everything related to healthcare, it doesn’t work nearly as well as patients have a right to expect. It’s not exactly Golden Rule territory.

ONC releases its educational security training game for medical practices. I played it and it’s pretty cool.

Medicare says it won’t pay providers based on copied-and-pasted patient notes.

Other

Beth Israel Deaconess Medical Center is named the #1 company in the InformationWeek 500 list of the most innovative users of business technology. Other healthcare organizations in the top 50 include Quintiles (#6), Sparrow Health System (#16), Premier Inc. (#30), Miami Children’s Hospital (#31), RadNet (#32), McKesson (#34), Intermountain Healthcare (#48), Kindred Healthcare (#48), and Sharp HealthCare (#50).

CareCloud will establish a Massachusetts office to take advantage of the region’s technical talent.

I said in January when US CTO Aneesh Chopra resigned that I expected him to run for lieutenant governor of Virginia, but instead he went back his previous employer, The Advisory Board Company. I should have paid more attention to the election calendar: the election is in 2013 and he has announced as a Democratic candidate for that office.

A Financial Times article called “Healthcare: Cyber wards” covers Silicon Valley companies trying to break into healthcare. It doesn’t contain anything all that interesting, but it does quote an entrepreneur who says VCs are still wary of investing in companies because of long healthcare sales cycles and their previous experience with products that were never perfected.

University of Minnesota Medical Center, Fairview violated patient protection and EMTALA laws by its aggressive collections tactics overseen by Accretive Health, a federal investigation finds. Fairview says they “continue to learn from this experience.” Shares in Accretive were down 11% Thursday on the news, by far the biggest percentage loser on the NYSE. The company had already paid a $2.5 million fine and agreed to cease operations in Minnesota. Shares owned by founder and CEO Mary Tolan  are still worth $108 million.

Weird News Andy is convinced that being real smart doesn’t preclude being real stupid. Richard Keller MD, a pediatric endocrinologist and Harvard Medical School instructor (WNA summarizes as “a vile human being,” at least assuming he’s found guilty), is arrested when a package containing 50 DVDs of child pornography is delivered to his attention at Phillips Academy, where he was medical director until last year. He might be one of few people whose life goes directly into the toilet because he forgot to update his shipping address or perhaps had the misfortune of back-ordered porn.

Markle Foundation puts out a video promoting the consumer use of Blue Button.

The computer hacker / brain tumor patient in Italy who cracked the proprietary formats of his electronic medical records so he could post them publicly to seek help has updated his site with the ideas he has received so far. It’s getting interesting – he’s about to publish a tutorial explaining the quirks he found with DICOM images and he’s putting out some rather eloquent ideas about health and technology:

The definition of "diseases" is "reserved" to doctors. Often using words which we don’t understand and, most important of all, touching only a part of the human condition, which is made from body, but also of spirit and sociality. The DICOM format is open, yes, but in a very "peculiar" condition of openness: it is like the openness of the words which they use to tell you about your health condition, and with which they describe and actuate their version of the "cure": you can’t understand it, you can’t reuse it, you can’t combine it with other possibilities. It is thought for "experts" and "professionals" (of one single type), leaving little space for other possibilities for expression and socialization … Maybe we could start to think about an "open" world in this sense, too, not dedicated to "professionals" and "procedures", but also to human beings.

Sponsor Updates

• Vonlay created a Web page featuring live tweets and photos from the Epic UGM this week.
• PDR Network announces that its flagship service meets Meaningful Use Stage 2 requirements in delivering real-time FDA drug safety alerts and product program information at the point of prescribing.
• More than 50 employees from the Burlington, VT office of Allscripts will take part in a Habitat for Humanity build this week.
• Amerinet makes McKesson’s pharmacy automation solutions available to its 3,000 hospital members.
• Intelligent InSites integrates its RTLS with Haldor’s ORLocate surgical instrument tagging to offer a surgical instrument management and tracking solution.
• Lifepoint Informatics announces its Silver Level sponsorship of next month’s Pathology Informatics 2012 conference in Chicago.
• LDM will provide consumer medication information from Polyglot Systems in its point-of-care messaging solutions.
• HIStalk sponsors Allscripts, NTT Data (formerly Keane Inc.), and World Wide Technology earn spots on the annual InformationWeek 500 list of innovative business technology users .
• Forbes cites Greenway as being “ahead of the pack” in delivering information exchange and interoperability between its PrimeSUITE and the EHRs of other vendors.
• Orion Health will incorporate images from Agfa’s clinical imaging platform into its clinical portal.
• DrFirst and Meditech will demonstrate their combined solutions during a series of Webinars in September and October.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Tweets and Photos from Epic UGM 9/12/12

They have the best swag! #epic #ugm2012 #newbie

— Michael Lamb (@lambatwork) September 10, 2012

Barry Bershow from Cedars-Sinai (Lake Wobegon West) where all the men, women, children, and Epic progress notes are good looking. #UGM2012

— Jorge Scheirer (@infomedoc) September 10, 2012

I’d like to thank google maps for the ability to see in real time that traffic at Epic Lane is already backed up to exit 77 #ugm2012

— K Wroblewski (@kdwroble4) September 11, 2012

#UGM2012 stats: 7900 customer attendees, 3400 gallons of coffee

— borborygmi (@nickgenes) September 11, 2012

Epic CEO Judy Faulkner on rock theme for #UGM2012: says “hey Jude” has particular meaning for #healthIT “take a sad song and make it better”

— borborygmi (@nickgenes) September 11, 2012

Only 1.2% of US hospitals are at top HIMSS stage for #EHR integration — and 3/4 of those hospitals are at Epic’s #UGM2012

— borborygmi (@nickgenes) September 11, 2012

CEO Judy Faulkner says Epic is installed in over half of US academic medical centers #UGM2012

— borborygmi (@nickgenes) September 11, 2012

47% of Epic expenses are R&D. Moving into long term care, home care. Faulkner wants her programmers to have individual offices #UGM2012

— borborygmi (@nickgenes) September 11, 2012

Epic CEO Judy Faulkner: too few physicians on meaningful use committees, and their input is lost on way from ONC to CMS #UGM2012

— borborygmi (@nickgenes) September 11, 2012

Next big things for Epic seem to revolve around mobile apps on your phones and tablets. #UGM2012

— Sarah Nelson (@Sarah_at_Vonlay) September 11, 2012

#UGM2012 physician slicer dicer: from evidence based practice to practice based evidence. Cool!

— Arjen Noordzij (@dokter_no) September 11, 2012

Especially excited about Epic planned release of patient centered product for pts in hospital. Very cool for pt engagement#UGM2012

— Luis Saldana (@lsaldanamd) September 11, 2012

Great riff on ICD-9 and ICD-10 in relation to Spinal Tap and going to 11. "It’s one version higher. So it has to be better." #UGM2012

— Sarah Nelson (@Sarah_at_Vonlay) September 11, 2012

RT @gruntdoc: #EPIC #EPICUGM 14K here, about 7.4K are clients, rest Epic staff; 10 countries rep’s. #UGM2012

— Luis Saldana (@lsaldanamd) September 11, 2012

#UGM2012 Wouldn’t it be great: the UGM2013 app with your schedule notifying when to go and showing how to get there?

— Arjen Noordzij (@dokter_no) September 11, 2012

After day 1 at #ugm2012 I am exhausted, but #Epic has been fantastic, need to take notes on guest services!

— Autumn (@rhodes_aut) September 12, 2012

In upcoming Epic release, patients will be able to log into myChart and download their records to a PDF #UGM2012

— Robert S. Miller, MD (@rsm2800) September 12, 2012

#ugm2012 300/500 of the Epic hospitals are using barcode med administration. Very good for patient safety!

— GruntDoc (@gruntdoc) September 12, 2012

Good job Epic – lots of cool new features. Loving the emphasis on analytics! @epicugm #UGM2012

— Krishna Ramachandran (@krishna_gr) September 12, 2012

#ugm2012 good news, Epic is going to have an opt-in for benchmarking across Epic hospital systems. Terrific!

— GruntDoc (@gruntdoc) September 12, 2012

Beacon oncology updates: therapeutic substitutions 4 antiemetics 4 drug shortages; breast ca survivorship plans; better analytics #UGM2012

— Robert S. Miller, MD (@rsm2800) September 12, 2012

Epic will use protocols from #DirectProject to push information to outside EHRs #UGM2012

— Robert S. Miller, MD (@rsm2800) September 12, 2012

Mobile payments to be built into Epic myChart. Can also sign up via mobile for paperless statements #UGM2012

— Robert S. Miller, MD (@rsm2800) September 12, 2012

#ugm2012 Need this Cogito data model! It is a data warehouse that compiles Epic and non epic data in one place to help reporting.

— GruntDoc (@gruntdoc) September 12, 2012

#UGM2012 #Carl Dvorak did it! His childhood dream came true: live on stage with a guitar.

— Arjen Noordzij (@dokter_no) September 12, 2012

#ugm2012 surreal seeing software planned for release in 2 years, that we won’t get for at least three. Like hearing about the cool1/2

— GruntDoc (@gruntdoc) September 12, 2012

Fun idea to improve clinical note quality: ‘Like’ button on peer’s progress notes! #UGM2012

— K Wroblewski (@kdwroble4) September 12, 2012

Was intently watching #UGM2012 tweets and Apple anncmt live blogging. Neither affects me, but I felt temporarily cool.

— histalk (@histalk) September 12, 2012

News 9/12/12

Top News

ONC publishes a Health IT Dashboard that includes six views and 250 custom dashboards for states, ONC programs, and grantees. It includes charts, maps, and downloadable tables pertaining to EHR adoption, REC programs, and HIT workforce training. An interesting statistic: of the 143,890 EPs enrolled in RECs, only 17,144 (12%) have demonstrated MU. Also surprising: only 39% of acute care hospitals were using even a basic EHR by the end of 2011.

Reader Comments

From David: “Re: Dr. Jayne’s comment on ‘educational session’ put on for members of Congress. As someone who used to put these on, these are simply a forum for making a lobbying pitch to lawmakers and Congressional staff under the guise of education. The ‘education’ is to get lawmakers to vote in the interests of the event’s corporate sponsors.” Sponsors listed include HIMSS, Ingenix, Allscripts, BCBSA, and a bunch of other companies, government contractors, and member organizations. It was the Washington schmoozing and complete surrender to its Diamond members that largely turned me against HIMSS as an organization that represents me as a non-profit hospital employee and dues-paying member instead of a piece of meat offered up for ogling by its conference exhibitors. I would rather see HIMSS split into two groups, one for providers only (like it almost was before the current regime got dollar signs in their eyes) and the other being the vendor trade association that HIMSS denies being despite ample similarities.

From Dell-lightful: “Re: Dell Services layoff. It’s true. I’ve spoken to two senior salespeople in the healthcare vertical who were laid off in recent weeks. One of them said the action was called Operation Savings Storm. He e-mailed me a picture of him shaking hands and smiling with Michael Dell. I suppose that only Michael is smiling now since his labor cost just went down, good for his quarterly report.”

From Eileen Dover: “Re: Lahey Clinic. Scrapping their Allscripts implementation and going big with Epic. You probably already knew that.” I ran reader rumors to that effect in June, but got no response from the CIO when I asked about the “unified architecture” the rumor said they were pursuing (which means they’re planning to buy Epic nine times out of ten). Their original strategy involved using Orion Health to serve up scanned PDFs of inpatient records and using Allscripts on the outpatient side, which doesn’t sound like much of a strategy at all given Meaningful Use requirements and changing care models. I’ll leave this as Unverified since I’m missing the standard confirmation: the posting of a ton of Epic jobs on their site.

From SubDude: “Re: athenahealth. Saw this poster on the green line of the Boston T.”

From Empty Handed: “Re: Encore Health Resources. In talks to be acquired by Dell.” I asked the Encore folks a few weeks back and they said this rumor isn’t true. I believe them, but I also noted from experience with other companies being acquired that you always get that same answer even when it really is true, with an apology later for being less than truthful out of necessity. All I can say is that I’ve heard the rumor from anonymous readers twice now, the company denies it, and I have nothing to back it up.

From Debunker: “Re: the EMR cost study you mentioned. There are also significant issues with how the HIMSS Analytics data collection is performed when you look under the covers at the raw data.” That’s a good point. Everybody trying to do these lazy database-matching “studies” assumes that those databases have perfect information, which I’m sure they do not.

From Neal: “Re: Glen Tullman compensation by Allscripts. Thanks for keeping an eye on the mega-earnings of the vendor CEOs. However, it’s fair to note their value is not reflected solely by share price. Tullman grew Allscripts from a niche ambulatory vendor to a near-competitor with Cerner if not yet Epic across virtually every segment of the market. It’s too early to tell if he’ll be successful, but they will be a serious competitor if they can integrate their myriad solutions. He has one year, two tops, to deliver or face the boot from his new board.” Glen did a masterful job of wresting control of the company from Misys and then buying Eclipsys. The mistakes he’s made from my cheap seats view: (a) paying too much for Eclipsys, which nobody else seemed to want; (b) declaring mission accomplished with Sunrise integration almost immediately after the acquisition, backing up that statement with questionable comments that having two unrelated systems both running on Microsoft-powered servers meant they could just start happily interoperating once the ink dried on the sales collateral; (c) trying to pass off Allscripts as a serious competitor to Epic; and (d) escaping an ugly board power struggle and then caving in to a proxy fight that gave a dissident shareholder board seats. You are right that Wall Street encourages actions that boost share price for all the wrong reasons, often at the cost of long-term possibilities, like when Cerner stock took a beating in the late 1990s as they dared spend research dollars to build Millennium instead of booking big earnings per share. Allscripts needs to deliver technically before the competition (both inpatient and ambulatory) pushes it permanently into the mid-majors. If you’re a customer, you’re better off with Glen in charge than selling off to private equity investors, who would have a field day retiring products, selling off divisions piecemeal, and milking services revenue to juice the bottom line to enable a quick flip. We’re already down to basically three vendors for big hospitals (Epic, Cerner, and Allscripts plus a bit of Meditech in the mix). I don’t see Allscripts gaining much inpatient ground given its few announced sales to mostly small hospitals, which is the same problem Eclipsys had despite an arguably superior product, but I hope they keep it competitive. I should have also mentioned that despite seemingly generous compensation, this particular bonus plan announcement actually represented a pay cut for Glen.

HIStalk Announcements and Requests

Say hello to LDM Group, supporting HIStalk as a Platinum Sponsor. The St. Louis-based company offers behavior-changing prescription management programs. Specifically, its patented process improves patient compliance and outcomes by connecting patients with their prescribers and pharmacists. The company’s electronically targeted ScriptGuide messaging (print, e-mail, SMS) helps build tighter provider-patient relationships and helps meet Meaningful Use and ACO requirements for customized patient education and engagement. LDM Group’s network of providers, EMR/EHR vendors, and sponsors of educational material (pharma, payers, health plans, and PBMs) help patients become better educated about their healthcare via personalized messaging from their trusted providers right at the point of service. The company’s case studies show that medication adherence increases up to 16% for specific disease categories, potentially avoiding expensive interventions due to non-compliance. Thanks to LDM Group for supporting HIStalk.

Epic’s UGM is underway. Your report, photos, etc. are welcome since we are not in attendance. So many conferences, so little time.

Acquisitions, Funding, Business, and Stock

Mediware completes its acquisition of the assets of Strategic Healthcare Group, a provider of blood management consulting, education, and informatics solutions. Mediware also reports Q4 results: revenue up 4%, EPS $0.29 vs. $0.25.

Elsevier acquires ExitCare, LLC, an enterprise-wide solution for patient education and discharge instructions.

Sales

Rush University Medical Center (IL) selects MethodCare’s Charge Recovery Solution to optimize charge capture.

The University of Colorado Hospital will implement Infor Lawson Healthcare’s financial, supply chain management, and human capital applications.

Coordinated Health (PA/NJ) selects Allscripts Sunrise Clinical Manager. Their hospitals are Coordinated Health Allentown Hospital (22 beds) and Coordinated Health Bethlehem Hospital (20 beds).

Cancer Treatment Centers of America chooses QlikView to replace its existing business intelligence software, using its analytic capabilities to find opportunities for improvement and planning its future use to predict which therapy options will work best for a given patient.

People

Clarity Health names Bill Bunker (Vertafore Agency Markets) as CEO, taking over for founding CEO and newly appointed executive chairman Peter Gelpi.

The GAO appoints Christopher Boone, director of outpatient quality and HIT for the American Heart Association, to fill a vacant patient advocate seat on the HIT Policy Committee

Announcements and Implementations

West Virginia University Healthcare installs the Patient Safety Net incident reporting system from Datix and UHC.

HIMSS Analytics recognizes Hennepin County Medical Center (MN) and Truman Medical Center (MO) with its Stage 7 award for EMR adoption.

Franciscan Alliance goes live with iSirona’s device connectivity solution at multiple facilities.

In Southeast Texas, CHRISTUS Health, Texas Children’s Hospital, UTMB Galveston, and Legacy Community Health Services sign up with Greater Houston Healthconnect to exchange patient information.

Medecision’s care management solution is added to the Availity network to support post-discharge planning and coordination.

Government and Politics

ONC posts draft test procedures and test data files for the 2014 Edition EHR certification criteria.

HHS Secretary Kathleen Sebelius announces that the public can vote for their favorite innovation among finalists in the HHSinnovates Program, which is designed to recognize innovative projects developed by HHS employees to solve healthcare challenges. Public voting is open until September 14.

Allscripts CEO Glen Tullman pens a Forbes opinion piece extolling the accomplishments of his friend President Barack Obama, also saying great things about his stimulus bill, particularly the HITECH part that benefited Allscripts immeasurably. He concludes, “Now what he needs is one more term to finish the job.

Technology

AirStrip Technologies is awarded a patent for its technology and process for delivering physiologic monitoring data to smartphones, tablets, and other devices.

A 17-year-old invents an inexpensive and portable EKG that collects heart rhythm data via Bluetooth and sends it to a remote physician.

An orthopedic surgeon uses an iPod Touch in knee replacement surgeries, saying it allows more precise placement of the artificial knee and thus reduces complications and provides a greater range of motion.

Weight loss company Diet Doc offers its customers weight loss consultations with physicians at its 30 locations via Skype. The (female) CEO cites the “growing possibilities that telehealth has” in decided to replace its telephone-based consultations with video in managing its human chorionic gonadotropin diet plans. They’re probably the only telehealth-using provider featuring a Star magazine cover of Kim Kardashian with the CEO’s unsolicited opinion that “comfort foods added a few pounds to her frame” but that she has thankfully “slimmed down to snag a man.” The FDA doesn’t have anything good to say about HCG diets and has banned non-prescription sales. It requires prescription HCG products to be labeled with a warning that there’s no proof that they work.

Other

Two University of Miami Hospital employees are accused of selling the information of thousands of patients they obtained from registration face sheets over 22 months. The university’s medical school reported the theft of a pathologist’s briefcase earlier this year that contained an unencrypted flash drive with six years’ worth of patient medical record data.

A computer hacker in Italy with brain cancer, desperate for second opinions, cracks the proprietary format of his electronic medical records, converts them to an open format, and shares them on his Web site. Two doctors responded in the first 24 hours to what the patient is calling “My Open Source Cure.” He invites doctors, hackers, musicians, or anyone who can help to review his information and e-mail him their “cure,” which he will post on his site. If you’d like to help out, you will need someone who can read Italian to translate the scanned records.

The former hospital equipment designer who in 1982 designed the first laptop computer, the GRiD Compass, has died. Bill Moggridge was 69.

In the UK, Fujitsu is reportedly blacklisted from being awarded any government services contracts after previous failures, notably its work on the failed NPfIT project.

A Chicago-area health department says EMR implementation temporarily reduced the walk-in patient capacity of its clinics by half right after go-live last week. At a two-physician clinic whose appointments are booked out for months, one patient said the line that snaked around the corner looked like “a Depression-era soup line.”

Weird News Andy says an interdiction might be placed on the future work of this surgeon, who is being sued by a patient whose lawsuit claims his cancerous penis was amputated without his consent.

Sponsor Updates

• HTMS, an Emdeon company, and Managed Care Executive Group launch the fourth annual Industry Pulse Survey to identify issues and concerns important to healthcare payers.
• Pivot Point and NextGate collaborate to offer identity management, credentialing, and RCM enhancement solutions to HIEs, ACOs, and health systems.
• Orion Health posts the agenda for its October Healthcare Collaborative in Colorado.
• Imprivata demonstrates its secure no-click access at Epic’s annual UG meeting and offers a white paper on optimizing Epic clinical workflow.
• Awarepoint adds VT Group as a VAR for its aware360 RTLS suite.
• MED3OOO announces the keynote speakers and agenda for its October National Healthcare Leadership Conference in St. Thomas, USVI.
• Greenway recognizes Pediatric Associates (WA), Premier Family Physicians (TX), and Medical Park Orthopaedic and Sports Medicine Clinic (AR) for their innovative use of Greenway solutions to improve care delivery.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 9/10/12

From Lickety: “Re: percentage of EPs/EHs achieving MU Stage 1. Does anyone know the percentage of all EPs/EHs to get a feel for where the country is in total?”

From Candy Albicans: “Re: Allscripts. Considering selling its profitable MyWay division to SYNNex, a reseller that has purchased 1 million licenses.” Unverified.

From Eric the Well-Read: “Re: your posts. I’m pretty sure I see another site that you’re writing for under a different name. True?” False. I barely have enough hours in the day to write HIStalk. I suppose I could attempt to pimp myself out in several ways (writing elsewhere being one) and use the proceeds to quit my hospital job, but I like things the way they are, which is they way they’ve been for the past nine years. That represents either high satisfaction or low ambition (probably the latter).

From Mrs. Beasley: “Re: EMR implementations led by hospital business units. This seems to be more common, especially with Epic. I’m curious to hear whether anyone else thinks the role of the CIO is changing because of this. I’m in the middle of one and wondering whether after the install, it will be business as usual for IT.” I’ll expand your original thought a bit for the benefit of the many CIOs whose hospitals are implementing Epic: if your hospital has been live on Epic for more than a year, how did your IT budget, staffing, priorities, consulting budget, staff training costs, and personal responsibilities change? I bet I’m not the only one curious about what happens in the Epic afterlife.

President Obama would win a close race if the election were held today and my poll respondents were the only voters. New poll to your right: which of the five listed inpatient clinical systems vendors offer the most innovative products? I’m asking since Cerner was just named by Forbes as one of the top 10 innovative companies overall, but I’m skeptical about how the magazine arrived at that conclusion since they didn’t actually say. And note that there’s no “none of the above option” since it’s unnecessary based on the question being asked.

Thanks to the following sponsors, new and renewing, that supported HIStalk, HIStalk Practice, and HIStalk Mobile in August (click a logo for more information):

Listening: new from Katatonia, brooding Swedish progressive metal that is admirably devoid of the characteristics of suckier bands that drive many potential fans away: grunting, screaming, excessive tempo, and a wall of impenetrable noise. Good vocals, minor key melodies, and fine musicianship.

Hey, EHR vendors! tweet a pledge to do View/ Download/Transmit in 2012. Will shout out on Monday. #ONCPledge #VDTnow #HealthIT4U

— Farzad Mostashari (@Farzad_ONC) September 7, 2012

I’m impressed with how openly Farzad Mostashari uses Twitter. Granted the bar was set low by his deadpan predecessors, who probably would have been happy to turn the ONC Twitter account over to a federally contracted, chirpy, 23-year-old marketing ghostwriter with a blissfully empty head, but he’s out there tweeting away with original thoughts at all hours. Here’s a brilliant throw-down he posted Friday afternoon: which vendors are willing to publicly promise that they will roll out View / Download / Transmit capability for patients by the end of 2012? He says he’ll post the names Monday, with takers so far being eClinicalWorks, athenahealth, SOAPware, and Greenway. What say you Epic, Practice Fusion, NextGen, Cerner, McKesson, SRS, Allscripts, and GE? Farzad wants to know whether you own cattle or just big hats.

Speaking of ONC, they decide not to proceed with their intended regulation of NHIN’s “conditions for trusted exchange.” Reason: regulation might slow things down, which is just about the last thing that HIEs need.

The board of Allscripts approves a $1.9 million 2012 incentive for CEO Glen Tullman. His total compensation in 2011 was $7.2 million. Above is the two-year MDRX share price (blue) compared to Cerner (green), athenahealth (red), and the Nasdaq (brown). Had you invested $10,000 in each two years ago, the value of your holdings today would be worth $6,257, $22,854, $32,844, and $14,025, respectively.

Orchestrate Healthcare names former Dean Health Systems IT VP Jerry Roberts as VP of its Epic practice.

Olympic Medical Center (WA) will spend $7.6 million to get Providence Health and Services to implement Epic for its hospital and clinics over the next year. They expect to get $7 million in HITECH money in return. Annual support fees will run around $750K. The CEO says they’re getting a tremendous deal, especially given that Epic will replace five systems. “I think our current systems really don’t help us take care of our patients the way they should. I think Epic is the best system available.”

Nuance announces its 2012 Understanding Healthcare Challenge, offering prizes to the top three developers to describe how they would integrate Nuance’s clinical language software into their products. Entries are due October 5.

Crain’s Chicago Business found 10 Illinois physicians who are making at least $1 million per year from Medicaid, with four of them being pathologists (as with most businesses, those higher on the supervisory food chain did better than those doing the actual work). Leading the pack: the head of pathology at safety net hospital Sinai Health System (also their CMO), who pocketed $5.9 million in a three-year period. The second-highest was a urologist who raked in $5 million while being investigated for questionable billing. The third was the medical director of Planned Parenthood of Illinois, who just agreed to a $367K settlement for overbilling. She made $3.9 million in just over one year of the study period before being cut off because of the billing investigation.

Vince finishes up his HIS-tory of Keane with the stories of First Coast Systems and Source Data Systems. As always, he welcomes your contributions about vendors of yesteryear.

A reader sent over an article from the HIMSS cheerleader rag, knowing I wouldn’t have seen it since I don’t read free healthcare IT magazines (they’re mostly just re-worded press releases). The article proclaims, “It’s confirmed. Electronic medical records can indeed yield marked savings for hospitals.” Just to be a contrarian, I dug up the original article to see what they were gushing about (other than everything that’s pro-vendor).

As I expected to find, this is another example of the pitfalls of outsourcing your conclusions to non-experts armed with the dual motivations of (a) not biting the hand that feeds them, and (b) drawing in readers with sexy headlines that the article doesn’t support. I think the work of the study authors was OK, but hardly conclusive or even convincing.

What the paper actually says is that EMRs have provided “mixed performance,” i.e. the paper isn’t suggesting predictive value. The authors tried to prove (unsuccessfully, in my opinion) that the driver of whether hospitals save money as a by-product if implementing an EMR is the availability of local technical expertise, which just doesn’t make a bit of sense given that (a) technical resource availability doesn’t have much impact on cost since it’s a tiny portion of overall hospital cost, and (b) hospitals use remote and/or contracted technical resources all the time, making geographic location only marginally relevant.  

My reactions:

• The study is just a paper, so it hasn’t gone through peer review or acceptance. I would hardly say it “confirms” anything.
• This was yet another drawing room study where someone just mashed up conveniently available but questionably relevant data, in this case the HIMSS Analytics database, the Medicare Cost Report, and the AHA Hospital Survey.
• The databases were current only through 2008, so this is four-year-old information that predates almost every significant EHR event.
• The study’s main finding is that the average hospital that implemented an EMR during the 12-year period saw no improvement in efficiency, and in fact, saw their costs go up after adoption (“quite high,” the article says). I notice that didn’t make the magazine’s headline.
• Hospitals located in areas with a lot of IT talent saw costs go down 4% from previous IT cost (those adopting basic EMRs) and no change (those adopting advanced EMRs).
• Hospitals in low-talent areas increased their costs 2-3% with EMR adoption.
• I didn’t really understand how they considered hospital ownership, which is a good predictor of both IT utilization and overall cost structure. Or for that matter, separating hospitals that outsource IT functions from those that don’t.
• I don’t think most hospitals buying an EMR in the early 2000s expected or even wanted to reduce costs, so I don’t really see the value of finding out whether they did.
• The idea that the likelihood of a given hospital reducing its costs by implementing an EMR is based solely on how many programmers live in its area does not pass any sniff test I can envision.
• The article’s abstract contains the real conclusion: “Adoption of EMR is generally associated with a slight increase in costs. We argue that this average masks important differences over time, across locations, and across hospitals.”
• The thrust of the article can be inferred from its title, “The Trillion Dollar Conundrum: Complementarities and Health Information Technology.” It is actually, to a certain extent, debunking the questionable conclusions of CMS and the Cerner-funded RAND study in proclaiming that EMR adoption will reduce healthcare spending. The article says EMR cost savings will be “mixed” until technical resources are more widely available. That doesn’t really sound like the upbeat conclusion the magazine trumpeted.
• As always, even if you buy the study’s methodology, it at best identifies a slight correlation rather than causation. I would not attempt to predict the impact of a $200 million Epic install in a large academic medical center to generalized, old information of mostly small hospitals (which as a percentage, is most of them).
• Implementing an EMR to save money is an iffy proposition at best, not to mention that maybe patient outcomes should be the stronger consideration.

My conclusion is that it’s not a bad study, just not all that conclusive and certainly not worth detailed coverage in an industry magazine. I lost interest in further analysis at this point since it was time to have a beer and watch some college football. If you didn’t, feel free to elaborate further.

E-mail Mr. H.

News 9/7/12

Top News

Merge Healthcare’s board hires an investment bank to seek strategic alternatives for the company that could include a merger or outright sale. Merge, which has lost money for six straight quarters, has seen its share price drop 40% on the year, although shares were up 10% Thursday on the announcement. Above is the one-year share price compared to the S&P 500 (green) and Cerner (red).

Reader Comments

From Acorn: “Re: emergency power off switch. An engineer fell onto ours today.” Been there. We had just moved into a new data center at my previous employer and the entire data center was going dark a couple of times per day. We couldn’t figure it out, but suspected a construction mistake. The UPS wasn’t kicking on and the standby generator wasn’t coming up, so all systems were going down hard, creating a nightmare of system outage and recovery downtime (we’re talking every server, connection, telephone system, etc. spanning several hospitals). We eventually figured out the problem: the big, red emergency power-off switch was right beside the exit door where the old data center’s “press here to open door” button was located. Employees were smacking it by habit as they exited, and then sheepishly running for the hills without telling anybody when the data center suddenly went dark and quiet. We put a $1 plastic cover over the switch and that was the end of the problem.

From Sadie: “Re: Merge Healthcare. Three weeks after an RIF in France and one week after a 56-person RIF in the US, Merge announces plans to sell the company. I hate to say that I called this months ago.”

From MindYourOwnBusiness: “Re: UPMC. They’re in the hospital (and EMR) business, not the law enforcement business.” A patient who says she contracted hepatitis C from syringes infected by a drug-using radiology tech at UPMC sues the hospital and two of its staffing agencies. The lawsuit says UPMC caught the tech in the act of stealing fentanyl from the OR and told his contract employer to stop sending him to work there, but didn’t notify anyone else. The tech then worked at eight more hospitals, spreading hepatitis C to at least 30 cardiac cath patients and possibly hundreds or thousands. I’ve negotiated the “resignations” of a couple of hospital employees for known or strongly suspected drug theft over the years, and as irresponsible as it sounds, begrudgingly let them walk away without a resume blemish. The reason: the hospital’s legal counsel said that unless we had an airtight case against them (which is almost impossible to obtain) and ran them through a couple of cycles of optional drug rehab at our expense, they would probably sue us immediately for even insinuating to a potential employer that their records were anything but impeccable. In this case, the tech wasn’t even a UPMC employee. Nobody is bothering to sue the actual criminal, of course, given his unattractively shallow pockets.

From Curious: “Re: Dell. Heard they’ve cut a large number of experienced senior people from their outsourcing group.” Unverified.

HIStalk Announcements and Requests

HIStalk Practice highlights from the last week include: MGMA urges CMS to remove duplicate e-prescribing requirements in the MU and PQRS programs. Physicians express concerns about the impact of the ICD-10 transition on finances and practice operation. GenX physicians want a life outside of work, rely heavily on EMRs and smartphone apps, and like sharing the load with other doctors. Dr. Gregg has a geeky moment about Scanadu. The HIStalk Practice Physician Advisory Panel provides insights on patient volumes and the impact of EMRs and other technologies and the anticipated impact of the Affordable Care Act, with the possibly surprising finding that many of them won’t increase their patient volumes or workload even if it means higher incomes. Thanks for reading.

On the Jobs Board: Cerner and Epic Resources, Inside Sales Manager, Services Implementation Consultant.

Travis’s post on HIStalk Mobile, What I Learned about Health IT in Medical School, seems to be popular based on who’s linking to it or tweeting it (including some high-profile folks). Sign up for his updates and you’ll get the viewpoints of somebody who’s both a doc and an mHealth expert.

If Inga, Dr. Jayne, and I were running for office, we would kiss babies, try to appear humble by wearing carefully casual costumes to our scripted photo ops, and make a lot of promises we know we can’t keep. We aren’t, so the only vote we seek is one of approval, which you may cast by (a) connecting with us on the usual social not-working sites (and thus enlarge your own network significantly); (b) signing up for spam-free e-mail updates; (c) sending us news, anonymous rumors, and anything else that might amuse us; (d) enjoying the company as we do of our much-appreciated sponsors, whose click-worthy electronic greetings you see entirely coincidentally on this page (they look a bit like ads); (e) peering into the Resource Center, which contains more detailed sponsor information; and (f) telling others that you are shocked by the irresponsible and objectionable material you see here since nothing draws Internet page views like bad behavior. We thank you for reading, and if you were in the room with us, there’s a good chance Inga and Dr. Jayne would plant a kiss on each of your cheeks simultaneously.

Acquisitions, Funding, Business, and Stock

Registerpatient.com, which offers a Web-based patient registration and scheduling system for $50 per provider per month, raises $1.1 million towards a $4.1 million target.

Pamlico Capital acquires home health technology provider HEALTHCAREfirst from fellow PE firm The Riverside Company.

Vocera Communications announces a public offering of 4.5 million shares of common stock.

MobileHelp, a provider of mobile emergency response technology for personal use, acquires Halo Monitoring, a developer of home monitoring products.

Harris Corp. is investigating potential violations of US anti-bribery laws by its Carefx China division, whose employees were found to have provided gifts and payments to prospects and customers. Healthcare executives in government-run healthcare facilities in Europe and Asia are considered foreign government officials by the Justice Department and SEC.

Physician networking site Doximity secures $17 million in series B financing led by Morgenthaler Ventures, bringing its total funding to $27 million.

Sales

Intermountain Healthcare (UT) chooses Accelarad’s medical imaging solution for its 22 hospitals and 185 clinics.

Medical Center of the Rockies (CO) selects ProVation from Wolters Kluwer for GI documentation and coding.

People

Healthcare Quality Catalyst names Todd Cozzens (Optum) to its board. Todd got in touch to say that the company is building data warehouses and Subject Area Marts on top of Epic and incorporating quality and workflow principles developed at Intermountain into more of an industry quality engineering type capability. He’s been around healthcare for a long time and has a nice viewpoint from his work at Sequoia Capital, so when he says it’s the next big thing, it just may be. I interviewed Steve Barlow, CIO and co-founder, a year ago.

Intelligent InSites appoints Margaret Laub (Policy Studies, Inc.) president, CEO, and board member. Interim Doug Burgum will become executive chairman of the board.

Ivo Nelson (Encore Health Resources) is announced as a financial partner of Health Care DataWorks, where he has served as a board member.

Announcements and Implementations

HIMSS Analytics recognizes the University of Iowa Hospitals and Clinics with its Stage 7 award for EMR adoption.

Caverna Memorial Hospital (KY) and Palestine Regional Medical Center (TX) go live on their HMS information systems.

OB-GYN PM/EMR vendor digiChart will integrate Dialog Health’s text message patient reminder system into its product.

Oregon Community Health Information Network will provide Epic to 10 public health centers in King County for $500K per year.

Government and Politics

CMS reports that through the end of July, 128,000 EPs and 3,624 hospitals have collected almost $6.6 billion in MU incentives from Medicare and Medicaid.

A BMJ editorial by two professors says that, based on their fields of behavioral economics and social psychology, pay-for-performance probably won’t deliver the expected results. Their reasons: (a) risk adjustment methods are inconsistent; (b) the system can be gamed by upcoding; (c) process-based indicators are poor proxies for quality of care; (d) social characteristics of patients can make good doctors look bad; (e) overly detailed criteria may encourage just checking off the boxes instead of really taking care of the patient; and (f) doctors may stop exhibiting empathy and pride in their work since nobody’s paying them for those qualities.

A new report from the Institute of Medicine says that the US healthcare system wastes 30% of its cost, or $750 billion, on unneeded care, administrative overhead, and fraud. It says that if other industries worked like healthcare, an ATM transaction would take a full day, laborers building a house would each use different plans without talking to each other, stores wouldn’t post prices, car warranties would not be offered, and airline pilots would make up their own pre-flight check list if they felt like following one at all. Many of their potential solutions for creating a continuously learning healthcare system involve technology.

Other

Surescripts will connect Epic’s Care Everywhere interoperability framework to its network, allowing Epic users to exchange patient-specific information with other providers regardless of their technology platform.

Forbes puts Cerner in good company as one of the 10 most innovative companies in America, citing it as #8 because “its servers handle 150 million healthcare transactions a day.”

Florida’s HIE adds Broward Health, Health First, Martin Health System, Mt. Sinai Medical Center, and Tampa Bay Regional HIE to its clinical exchange network.

Bill Clinton was such a good president (especially when graded on the 25-year curve) that the man formerly known as Slick Willie has completed his ascent to Elder Statesman/Rock Star, capped by his ad-libbing convention speech this week (how many people were like me and thought, “Why can’t we vote for him?”) and the announcement that he will deliver the Wednesday afternoon keynote at the HIMSS conference in New Orleans in March. HIMSS didn’t mention Hillarycare or his Monica Lewinski-driven impeachment, which I find myself being OK with since his relatively benign scumbaggery was eclipsed by his results in office. He could easily be elected president again, I expect, were it not for the anti-FDR 22nd Amendment that limits him to the two terms he already served. I don’t know what HIMSS is paying for his hour or so at the podium, but his rumored rate is in the $400K neighborhood. Also announced on the post-election, politics-heavy HIMSS keynote schedule: James Carville and Karl Rove, which I would find more interesting as a boxing match.

An ACO formed by Blue Shield of California and Dignity Health (the former Catholic Healthcare West) saved $37 million in projected costs over two years for the CalPERS state retirement program, with most of the improvement due to shorter hospital says and fewer readmissions.

Temple Community Hospital (CA) notifies 600 patients that their information was contained on a computer that was stolen from a locked office in the radiology department. The hospital says it will upgrade its security, presumably meaning it is belatedly considering encryption.

Lucile Packard Children’s Hospital (CA) announces a 150-bed, $1.2 billion expansion ($8 million per bed, $2,300 per square foot).

The San Franciso Jewish newspaper profiles David Jacobs, who started kidney paired donor-matching software company Silverstone Solutions within a month after his own kidney transplant in 2004. He expects to add several large hospital groups as customers in the next few weeks.

The feel-good Weird News Andy, temporarily changing his e-mail signature to Wonderful News Andy, likes stories about surgeons who help others (“a cut above,” he calls them). Two Salt Lake City surgeons win awards for their combined 100+ foreign medical trips, taken at their own expense to treat individual patients and educate physicians. WNA’s carriage turns back into a pumpkin with what he calls, “Doctors – The Flip Side,” as he reads the story of a patient undergoing surgery in a Swedish hospital whose anesthesiologist decides to knock off for lunch at the stroke of noon even though he’s the only anesthesiologist working. The patient crashes an hour later, employees can’t reach the anesthesiologist, and in the confusion someone turns off the respirator of the patient, who dies weeks later of brain damage.

Ministry Health Care (WI) tentatively agrees to join Ascension Health. Ministry’s stats: $2.2 billion annual revenue, 12,000 employees, 15 hospitals, and 46 clinics.

Self-proclaimed “EMR geek” Rob Lamberts, MD lists 10 ways EMRs could be made better. Ones I particularly liked: (a) require all visits to have a simple summary entered; (b) since the patient is often the “interface” between EMRs anyway, allow them to pull up their own records and show them to their new doctor; (c) maintain one comprehensive patient calendar that can be shared among providers; (d) let the patient manage the information they provide, such as family history, meds list, and social history; and (e) make patient records searchable.

Sponsor Updates

• A letter to the editor of SIIM by Brad Levin of Visage Imaging offers suggestions on how the organization can decrease radiology technology commoditization by offering crowdsourced innovation theaters, product showdowns, and demonstration of extreme use cases.
• Trustwave introduces security education services to help organizations protect against security risks and compliance missteps.
• Jay Deady, president and CEO of Awarepoint, discusses RTLS technology in an interview.
• MED3OOO announces that its customer PriMed (CT) will participate as an ACO in the CMS Shared Savings Program.
• SimplifyMD will offer Capario’s EDI platform to its customers.
• 21st Century Health selects Sandlot Solutions as a profiled business.
• MedHOK’s 360ACO solution is NCQA certified for P4P, HEDIS, and disease-management performance measures.
• NextGate begins operations at a new corporate office in Monrovia, CA.
• Divurgent hosts The After Party September 12 after Epic’s UGM.
• Wellsoft demonstrates its EDIS at next week’s 2012 ENA Scientific Assembly in San Diego.
• T-System issues a call for presentations for its April linkED emergency care conference.

EPtalk by Dr. Jayne

I’ve spent a lot of time the last several weeks digesting everything there is to read about Stage 2 Meaningful Use. My eyes are glazed over and my brain has become addled. To help providers make sense of it all, CMS has released some tables comparing Stage 1 and Stage 2 Objectives and Measures. I’ve found them helpful, although I wish their page breaks made a bit more sense and didn’t chop a single row into multiple pages.

Mr. H wrote Monday of the Epic vs. McKesson patent appeal. For those readers who enjoy shoes as much as Inga and I do, here’s a bit of patent news. The 2nd US Circuit Court of Appeals reversed a lower court decision, with the outcome that Christian Louboutin was entitled to trademark protection of its well-recognized red soles, but only on contrasting shoes. Competitor Yves Saint Laurent is still allowed to make red soles, provided they are attached to red shoes.

A Medscape article reveals results from a survey on physician EHR preferences. Although nearly two-thirds of users were happy, that means there are a lot of unhappy users out there. Other interesting (but not surprising) tidbits: many physicians are unaware of whether their systems are hosted vs. locally installed, the magnitude of maintenance or installation costs, or what happens in the back office.

CMIO magazine has renamed itself Clinical Innovation + Technology, citing a recognition of “the ever-growing convergence of the IT and technology management teams within the provider setting.” I’m pretty sure that at most places the IT and technology management teams were already intermingled. I think it would have made more sense to say that the IT and clinical management teams were converging. For those hospitals that are still in denial about the need for a CMIO in the first place, it’s probably validating.

A recent study demonstrated that men who consumed chocolate reduced their likelihood of stroke by 17%. It’s not entirely proven how chocolate provides health benefits, but dark chocolate in particular is thought to have anti-inflammatory properties. Maybe I should try some medicinal cocoa instead of ibuprofen after my next workout.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 9/5/12

Top News

HL7 will make its standards and other intellectual property available to all healthcare stakeholders at no charge by the first quarter of 2013. The company says it hopes to increase private and governmental use by eliminating licensing fees, thereby improving care and reducing costs.

Reader Comments

From Mandrake: “Re: NuPhysicia. I’m looking for information from healthcare systems that have worked with them, but I’m not having any success and I see they haven’t been mentioned on HIStalk even though they’ve been around for several years.” I couldn’t find anything either, but I snooped around and found that the company – which has offices in Houston, Brazil, and Malaysia – shares its Houston address with medical staffing company eCareGroup and is apparently the same operation even though they never actually say so (NuPhysicia also offers telemedicine services under the name InPlace Medical Solutions). NuPhysicia is selling a commercialized version of telemedicine software developed at UTMB, best known for its use in prisons, but also used in retail clinics and on oil drilling rigs.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Vonlay. Given their location in the epicenter of Madison, WI, you might cleverly guess that Vonlay is an Epic consulting firm and a successful one at that, with 30 clients in more than 20 states. It deploys some of the industry’s best EHR consultants individually or on teams, working at your site when you need them there or via Vonlay’s Remote Services program, which offers big savings to its customers. If your Epic go-live is impending or completed, Vonlay’s remote experts can help work down your open tickets, pitch in on applying upgrades and SUs, and help you phase out more expensive on-site consulting services. The company also provides application mentorship and management-level strategy consulting on how to design, build, and roll out EHR projects, including technical assistance with system builds, Cache programming, interfaces, Web services, and portals. You’ll be in their neighborhood if you’re going to next week’s Epic UGM, so keep an eye out for their folks. Thanks to Vonlay for supporting HIStalk.

Here’s a fun Vonlay video I found, Attack of the Issues List.

Acquisitions, Funding, Business, and Stock

Net Health Systems, which offers an EHR for wound care, acquires competitor Wound Care Strategies.

Data analytics startup Predilytics raises $6 million in its first round of VC funding.

Sales

Geisinger Health System (PA) selects TeleTracking’s RTLS technology to track mobile medical equipment at two of its six hospitals.

Saint Vincent Health System (PA) contracts with onFocus Healthcare for its enterprise performance management software.

St. Vincent Hospital (WI) will implement Merge Healthcare’s complete cardiology solution across its enterprise.

Rex Healthcare (NC) will use Passport’s eCare NEXT solution for eligibility checking, demographic verification, precertification, and estimation of patient payment.

People

Virtual Radiologic names John Way (UnitedHealth Group) CFO.

John Gomez of JGo Labs is interviewed at Apple’s WWDC.

Announcements and Implementations

South Lyon Medical Center (NV) will complete transition to CPSI’s clinical applications by the end of the year. 

Government and Politics

The VA says that over one million patients have registered to download their health information via Blue Button.

The FDA issues a warning letter to Merge Healthcare, saying the company isn’t manufacturing its blood pressure monitoring kiosks within FDA’s guidelines.

Other

Picis, Epic, and GE own the largest share of the anesthesia information system market, according to KLAS. The survey found that customer satisfaction is highest when AIMS purchasing decisions are handled cooperatively between the hospital and OR/anesthesia department rather than either entity making the decision alone.

ZirMed will undertake a $5.1 million expansion project that is expected to create 85 jobs over the next two years at its Louisville, KY headquarters. The state is offering $2 million in incentives for up to 10 years.

Apple announces a September 12 event that is likely to include its announcement of the iPhone 5 (note the shadow in the picture. )

Scotland-based Craneware says demand for its hospital revenue products has returned to high levels after a slow first half caused by US hospitals focusing on EHRs.

The government of China will invest $63 billion in its healthcare system over the next seven years, with part of the money going toward creation of an electronic health information network.

Technology investor and Sun Microsystems co-founder Vinod Khosla says computers will eventually replace 80% of doctors because computers are cheaper, more accurate, and objective, while healthcare is “witchcraft … based on tradition.” He also says that it will take outsiders to fix healthcare rather than those working within it. He has a knack for throwing out outrageous sound bites that earn him exposure, such as saying that hybrid cars offer no environmental advantage – they just make their owners feel better about themselves.

Highly regarded UCSF physician Bob Wachter, MD (chief of medicine, invented the term “hospitalist,” author) says UCSF’s new Epic system generates an impressive-looking progress note from fragments of manually entered information, but the “monkeys and typewriters” approach not only violates the legendary teachings of SOAP note inventor Larry Weed MD (in the 1971 video above that everybody who designs physician documentation systems should study regularly), it’s not as useful as the old fashioned written note. However, he also offers a solution: ditch the use of Epic’s Smart Text and offer a “Big Picture” field where physicians are encouraged to tell the patient’s story as of that moment (although he wonders whether natural language processing will make that unnecessary at some point). Wachter describes the current state as:

Why did Epic and our UCSF IT gurus structure things this way? The primary virtue is that this charting-by-problem approach allows the patient to be followed longitudinally, since one can track problems such as “hypertension” or “ovarian cancer” over years, seeing how they have been managed and observing the response to therapy. It isn’t a bad conceit, and it probably makes tons of sense when described in a fishbone diagram on an informatics seminar whiteboard. But the effect I witnessed on patient care and education was less positive. When I was on clinical service in July and read the notes written by our interns and residents, I often had no idea whether the patient was getting better or worse, whether our plan was or was not working, whether we need to rethink our whole approach or stay the course. In other words, I couldn’t figure out what was going on with the patient.

Small software vendor QueueVision says the Tampa VA hospital is refusing to pay for its medication tracking software despite using it since 2006. The company says the purchase was approved by the hospital’s pharmacy administration, but the VA won’t cough up the $214K it owes. Says a partner in the company, “We were suckers. They took us. I figured the veterans were so happy, the staff was so happy, everybody loved it. So we thought they would pay. We never fathomed that they would lie to us.”

In England, small blood-tracking systems vendor MSoft eSolutions is expanding after winning eight of eight RFPs last year. Its Bloodhound system provides positive ID of employees and patients throughout the blood transfusion process.

I liked this Facebook article by disgraced investor / interesting author Henry Blodget, in which he says publicly traded companies destroy their own value by trying to appease impatient investors and venture capitalists. He explains why nobody should be surprised at the fall in Facebook’s share price (May IPO price $38, Tuesday’s closing price $17.73) given the clear message that CEO Mark Zuckerberg has sent all along that he’s focusing on the customer experience and long-term value as Amazon has always done rather than next quarter’s share price. A snip of Blodget’s paraphrasing of a section of Zuckerberg’s pre-IPO shareholder letter:

Let me remind you that I own 57% of the voting stock of Facebook, which means I have complete control over it. I organized the company this way many years ago, with the very deliberate intention of maintaining complete control over it. I did this so I wouldn’t get overruled and canned by venture capitalists, a fate that unfortunately befalls many entrepreneurs. I also did it so in the event that we ever had to go public—which we unfortunately have to do now—I would never have to pay attention to whiny short-term public shareholders. Those whiny short-term public shareholders have destroyed many great companies by making management obsess about absurd near-term financial targets … Maximizing near-term profits" often means under-investing in future innovation, customers, and employees. And although it sometimes temporarily boosts stock prices, it often guts companies and clobbers their value over the long haul.

The Florida teenager accused of impersonating a PA and practicing medicine without a license is found guilty by a Florida jury and could go to prison for up to 10 years.

Sponsor Updates

• Aetna will offer eviti’s oncology decision support tool on its Medicity iNexx platform.
• The Surgical Information Systems anesthesia information management system earns the highest client satisfaction scores in KLAS’s anesthesia specialty report.
• MED3OOO CMO Paul McLeod, MD discusses the challenges of controlling ER visits in a blog post.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 9/3/12

From HITEsq: “Re: McKesson. Won its appeal against Epic for patent infringement. The Federal Circuit, en banc (i.e., before all the court of appeals judges), overturned existing law to find in favor of McKesson. The case is remanded to the lower court to decide if Epic really does infringe.” It’s a complex issue, and since I covered it when McKesson lost the original appeal in April 2011, I’ll recap from there. McKesson said Epic’s MyChart violates a McKesson patent for a method of placing visit-specific patient information on a Web page so that patients can schedule appointments and request prescription refills. The original  “joint infringement” decision (about which the three-judge panel argued a lot) was that Epic wasn’t liable since it doesn’t directly offer those capabilities, but rather allows individual patients to request MyChart access subject to the approval of their physician. Since no single party violated McKesson’s patent, the original court said Epic wasn’t liable. Legal experts are troubled with this latest decision, which appears to make “inducing infringement” actionable even if no infringement has been proven. All of this is way over the heads of mere non-lawyer mortals like myself who can’t resist snickering while repeating phrases from the document like “joint tort feasor” in humorous voices because it’s just so weird and funny, so if any legal beagles wish to expound pro bono, here is your electronic lectern.

Patent on personally controlled health record with notation of source/ authority (filed 3 yrs ago) HT @craigjoseph patft.uspto.gov/netacgi/nph-Pa…”

— Farzad Mostashari (@Farzad_ONC) August 31, 2012

From Lex Luther  Van Dam: “Re: Epic’s patent for a patient-controlled, patient-generated health record. This is bizarre. Much of this was already on the market when the patent was filed, so either Epic didn’t know or forged ahead anyway, and either is not good. Epic has seemed indifferent to patients controlling their own information, to the point that they don’t even talk about Lucy, their own PHR solution, and they certainly don’t cooperate with anyone else offering a PHR solution.” My guess is that this patent either covered Lucy when it was first being developed or was simply a legal stake in the ground to prevent further legal incidents like the McKesson one above. I also don’t know that Epic’s customers, being turf-protecting and somewhat patient-paternalistic academic medical centers, have a heartfelt interest in empowering their patients via PHRs from Epic or anyone else. Or for that matter, avoiding the “walled gardens” between proprietary EMRs that Farzad was railing against given that Epic-to-Epic direct data exchange has displaced the interest in a vendor-neutral exchange in some areas where most of the major players run Epic.

From MU Nick: “Re: worksheet. Has anyone created a worksheet for MU2 for the EP and EH requirements (as opposed to a PDF?)” If you’ve put something together and are willing to share, let me know.

From DanburyWhaler: “Re: Western Connecticut Health Network. Hired Steve Laskarzewski, Waterbury’s former CIO, as clinical applications director. Looks like they’re grooming him for the top spot when Kathy DeMatteo steps down later this year.” Steve’s LinkedIn profile says he started in June. He’s one of the 2,716 members of the HIStalk Fan Club that reader Dann started years ago, so he gets a shout out.

From Douglas: “Re: Mr. HIStalk. Why do you use that name?” I needed an e-mail address when I started HIStalk back in 2003, and being in a minimally creative mood at that moment, the best I could come up with was mr_histalk (the name HIStalk itself was equally lame, with the HIS standing for Hospital Information System, which was in vogue at the time). I had zero readers and minimal expectation of gaining any, so I didn’t give it much thought. I don’t recall having actually called myself that at any point, but readers did over time, and then Inga at some point shortened it to Mr. H. It feels odd since I have never even once referred to myself as Mr. Anything in real life since I’m not too impressed with titles in general. My latest pet peeve: family members of dead doctors who stick “Dr.” in the title of their obituary listing instead of just their name like everybody else does, apparently hoping that like Egyptian boy kings, their most valued earthly possession will carry over into the afterlife. Putting “MD” after your name is perfectly fine on your office door, as is “Doctor” in front of your name is for professional encounters. A doctor who is so deficient in self-esteem as to demand the use of those titles in social situations when nobody else is calling themselves Mr. or Ms. is, in my opinion and experience, an arrogant ass. Lots of people earn doctorates, many of them requiring more education than a medical degree, and yet it’s most often an MD (or, in the case of male MDs, their wife) who insists on cramming their title down everybody’s throat at the auto repair place or at school meetings (my theory: that’s why hospital administrators enjoy putting physicians in their place). So, to complete my circular logic, the Mr. HIStalk thing is not indicative of a superiority complex since if anything, my tendency is the opposite.

It’s Labor Day, so I am appropriately laboring (in the non-obstetrical sense). I hope your holiday is – or was, depending on when you’re reading – delightful.

We are collectively fatigued with the endless Meaningful Use palavering, apparently, as 46% of respondents say they are indifferent to release of the Stage 2 rules. Of those who cared, reaction was split between positive and negative. New poll to your right: if the presidential election were being held today, who would you vote for? An online issues quiz says that I’m exactly evenly split between the two major candidates with a 63% alignment with my beliefs for each, but both are far dwarfed by my 91% match with Libertarian candidate Gary Johnson, who I’d never heard of until I took the quiz. That leaves the same options I had in the last presidential election: vote for either of two candidates that I would dread seeing take office or vote for one I’d like to see win who doesn’t have a chance.

Surescripts acquires Kryptiq, of which it previously owned a 21% share. Surescripts uses Kryptiq’s secure messaging technology for its network. Other healthcare IT vendors are also among its customers (GE Healthcare and Vitera), and its other offerings include clinical messaging, a patient portal, and electronic prescribing. Kryptiq announced earlier this year that its revenue grew 60% and its user count exceeded 40,000.

Cambridge Health Alliance chooses EDCO’s Solcom electronic document management system for managing historical paper records and paper documents originating outside of CHA. It will integrate that information with its Meditech and Epic systems to eliminate the file room and hybrid record environment.

Joint Township District Memorial Hospital (OH) chooses the Optimum general accounting suite from NTT Data. The company also announces that its NetSolutions Point-of-Care clinical and billing system for long-term care facilities will now send care data toAssured Proactive Analytics to optimize payment.

A Wells Fargo Securities report sent over by a couple of readers says that hospital users of Meditech, Cerner, and CPSI lead the pack in total number of Meaningful Use attestations through June 30. On the ambulatory EHR side, it’s Epic, Allscripts, and eClinical Works, although Epic would drop to third if it didn’t have 10,000 Kaiser doctors of its 15,000 attestations. Of new attestations, it’s Cerner and CPSI leading for hospitals (those same two vendors also led in the overall percentage of client base attesting) and athenahealth and Practice Fusion for EPs. A reader, however, notes that the numbers suggest that Epic has 650 hospital customers, which seems awfully high, so there’s always the question of what’s behind the data.

CoCentrix hires Clayton Ramsey (Elsevier) as SVP of delivery.

I chose this graphic in mentioning the new KLAS evaluation of Meaningful Use consulting firms a few days ago and regretted it the next day when I had more time to ruminate on it. I’m unhappy with how KLAS presented the graphic since they committed the cardinal sin of not setting the Y-axis of the graph to zero. That’s usually a red flag indicating that someone is trying to make an overly dramatic point that their data points don’t support. In this case, the actual range of consulting firm “money’s worth” scores was 7.1 to 8.8, which are pretty good numbers within a fairly narrow spread. The KLAS graph only shows the range of 7.0 to 9.0, making it appear that huge gaps separate the firms, which is absolutely not the case. This doesn’t give me a lot of confidence that the behind-the-scenes work at KLAS is statistically rigorous, a often-made but never-answered charge. I would also question whether this graphic means anything at all considering that the Y-axis is customer-reported value, while the X-axis is “relative cost per resource,” whatever that means. Should we infer that a company with a high per-resource cost can’t be worth it no matter how satisfied their customers are? My main gripes with KLAS (and the Most Wired surveys and HIMSS Analytics and so on ) is their tendency to take a modest amount of data and over-extend it to lofty conclusions using a black box that nobody’s allowed to peer into. I like what they do, but as we healthcare types say, “In God we trust – everybody else bring data.”

Among the speakers at this past weekend’s health IT conference in Hyderabad, India were Lee Shapiro (Allscripts president) and Marc Probst (Intermountain Healthcare CIO).

TeraRecon launches its iNtuition Review, iNtuition Enterprise Medical Viewer, and iNtuition SHARE at the AOCR/RANZCR radiology conference in Sydney, Australia. The products provide multi-modality review and the capability to distribute images throughout the enterprise via a browser-based viewer.

Cancer Care Group (IN) announces that medical information of 55,000 patients and the organization’s own employees was exposed when server backups were stolen from an employee’s locked car. The announcement leads off with, “Patient confidentiality is a top priority,” which is apparently now a bit closer to the truth since they’re suddenly considering encrypting backups and mobile devices. It’s an immutable rule that nobody encrypts anything until they are publicly embarrassed for not having done so, and then they can’t jump on board fast enough.

Novant Health (NC) rolls out a screensaver featuring former UNC star Michael Jordan to remind employees of its zero-tolerance handwashing program, launched in 2005 after three premature babies died in one of its hospitals from MRSA infection. The source was tracked back to staff who hadn’t washed their hands, which Novant found was common with a compliance rate of only 49%. They’re at 98% now.

In Australia, a hospital CEO sues a nurse who he says disparaged him in her Facebook comments that were brought on by a labor dispute. One of her comments: “We don’t take kindly to misinformation by well-paid fat cats who only visit the hospital wards for photo opportunities.”

Surgeon and best-selling author Atul Gawande, one of the most visible and respected people in healthcare, apparently is sold on the use of analytics but  isn’t a fan of using technology in his own practice. Some snips from a recent interview:

• I do use the iPad here and there, but it’s not readily part of the way I can manage the clinic. I would have to put in a lot of effort for me to make it actually useful in my clinic. For example, I need to be able to switch between radiology scans and past records … I haven’t found a better way than paper, honestly. I can flip between screens on my iPad, but it’s too slow and distracting, and it doesn’t let me talk to the patient.
• I think that information technology is a tool in that, but fundamentally you’re talking about making teams that can go from being disconnected cowboys in care to pit crews that actually work together toward solving a problem.
• I worry the most about a disconnect between the people who have to use the information and technology and tools, and the people who make them. We see this in the consumer world. Fundamentally, there is not a single [health] application that is remotely like my iPod, which is instantly usable … In many of the companies that have some of the dominant systems out there, I don’t see signs that that’s necessarily going to get any better.
• The reason [data analytics] works well for the police is not just because you have a bunch of data geeks who are poking at the data and finding interesting things. It’s because they’re paired with people who are responsible for responding to crime, and above all, reducing crime … That’s what’s been missing in health care. We have not married the people who have the data with people who feel responsible for achieving better results at lower costs.
• Timeliness, I think, is one of the under-recognized but fundamentally powerful aspects because we sometimes over prioritize the comprehensiveness of data and then it’s a year old, which doesn’t make it all that useful. Having data that tells you something that happened this week, that’s transformative.

More on Keane’s HIS-tory this week from Vince.

E-mail Mr. H.

News 8/31/12

Top News

SAIC announces Q2 results: revenue up 8%, EPS $0.32 vs. $0.32, beating expectations on revenue and meeting on earnings. The company announced plans to split itself into two independent, publicly traded companies, one offering technical services and the other delivering solutions. Healthcare will be part of the solutions business. Shares are up 10% in after hours trading. SAIC acquired Vitalize Consulting Solutions in August 2011 and maxIT Healthcare in August 2012.

Reader Comments

From Klinger: “Re: Epic support. I always heard it was second to none, but what I’m getting is lacking. Have other people noticed, or is it just the TSs that I have?”

From Palmetto Jack: “Re: Palmetto Health. Not an affiliate of USC.” Thanks for the correction. Wikipedia says Palmetto Health Richland is affiliated with University of South Carolina and Palmetto Health’s graduate medical education page says the USC School of Medicine is a “partner and close affiliate,” so it’s one kind of affiliate but not another. I don’t really claim to know the difference.

From Honey Badger: “Re: Cerner. Heard a rumor that they will switch to Greenway’s ambulatory clinic EHR product.” Unverified.

HIStalk Announcements and Requests

This week’s top picks from HIStalk Practice: Consumer Reports publishes ratings on over 500 Minnesota practices. Practice administrators at large groups see a rise in median compensation, while their small practice peers experience a decline. AMA urges CMS to delay the move to ICD-10 by at least two years. Is HealthTap’s model viable in the long term? Physicians give high scores to Amazing Charts, Epic, and the VA’s ambulatory EMR. Practice Wise CEO Julie McGovern advises practices to avoid tackling other projects in the midst of an EMR implementation. We don’t have a Like button for our posts, so the next best thing is to sign up for the e-mail updates on HIStalk Practice. Thanks for reading.

Listening: new from Dispatch, their first new material since disbanding in 2002. The indie band hoped to draw 10,000 people to its free final concert in its home town of Boston in 2004, but instead became record-holders as the largest independent music concert in history when 166,000 fans came to say goodbye. The band’s mostly Northeastern tour starts in three weeks.

Welcome to new HIStalk Platinum Sponsor Health IT Quality Solutions, a certification program offered by Quest Diagnostics to vendors of ambulatory EHR products that support Quest’s DEX lab orders and results network. The program’s goal is to maximize lab data quality and enhance interoperability for the 500,000 patients per day that use Quest’s testing services. Three certification tiers are available based on solution capabilities, implementation processes, and participation in mutually beneficial activities. The entire program is free for vendors who qualify, with benefits that include customer satisfaction, solution visibility, faster interface approval, and priority access to Quest’s IT staff. Download a brochure and take a look at the several vendors that have already earned certification. Thanks to Quest Diagnostics and Health IT Quality Solutions for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Greenway announces Q4 results: revenue up 24%, EPS $0.07 vs. –$1.09, missing on earnings expectations. The company also projected lower than expected earnings for FY2013. Shares fell 7.1% on the announcement, making GWAY the biggest percentage loser of the day on the New York Stock Exchange. Shares priced at $10 in its February IPO are at $15.27.

Sales

The 300-provider Cornerstone Health Care (NC) selects MedAptus Pro Charge Capture solution for coding and billing.

People

HealthTech Holdings hires Stan Gilbreath (Allscripts) as VP of client services for its HMS and Medhost divisions and Eric Anderton (Jackson Key Practice Solutions) as VP of new account sales for HMS.

Joe Miccio (maxIT Healthcare) joins Divurgent as client services VP.

In Canada, Nancy Martin-Ronson RN, who joined Peterborough Regional Health Centre three months ago as CIO, will also take on the role of chief nursing officer.

Arkansas Governor Mike Beebe names Ancil Lea, executive director of HITArkansas, as coordinator for the Arkansas Office of Health Information Technology.

Announcements and Implementations

The Karmanos Cancer Institute (MI) implements Versus Advantages RTLS in once of its clinics to monitor patient location, track throughput, and manage workflow.

McKesson will offer NovoPath’s anatomic pathology solution to its LIS customers.

Craneware earns CMS’s Electronic Submission of Medical Documentation certification, allowing it to offer customers the ability to electronically submit medical records to review contractors.

Government and Politics

ONC names CCHIT, the Drummond Group, ICSA Labs, InfoGard Laboratories, and Orion Register as certification bodies under the Stage 2 certification program.

Farzad Mostashari says that ONC will not allow EHR vendors to drag their feet in supporting data exchange with competing EHRs.

Other

KLAS names its top-rated Meaningful Use consulting firms in three categories: Impact Advisors (enterprise implementation leadership and advisory); Cumberland Consulting (team implementation leadership and advisory); and Navin, Haffty, & Associates (team implementation leadership and staffing). Of the 51 firms identified, more than half achieved satisfaction scores of 89 or above out of 100.

SCI Solutions announces record growth for the first six months of 2012, with 82 hospitals choosing its solutions for care coordination, referral management, and scheduling.

Queens Health Network (NY) honors Congressman Joe Crowley for supporting ARRA, which will pay the hospitals and clinics of New York City Health and Hospitals Corporation up to $200 million.

Madison Memorial Hospital (ID) unblocks access to Facebook from its wireless network after patient complaints. One employee said it was “stupid” that as a patient, she couldn’t post photos of her newborn baby on Facebook. A newspaper reader was more rational: “What an inconvenience when we have to go to a hospital and we can’t get on Facebook. I guess most of us in this day and age feel entitled to more than that what we get.”

Real estate sources say that Meditech is finalizing a deal to acquire 200,000 square feet of office space in Foxborough, MA. The company abandoned plans for a Freetown, MA campus earlier this year after running into a mountain of red tape triggered by the discovery of native American artifacts on the property.

Epic not only submitted MU Stage 2 comments to ONC, it even helpfully distributed them to their customers so they could submit the same comments under their own names. David Clunie noticed this and lists the hospitals who sent in the boilerplate, including University of Miami, which submitted the same comments five times without noticing the “Remove Before Submitting” headline that prefaced Epic’s explanation of why its customers should share its opinions with Uncle Sam.

In Kenya, the country’s hospital insurance fund won’t issue insurance to a man who claims to be 128 years old because its computer system can’t handle birth years before 1890. His family says they don’t appreciate the implication that he should be dead, and until the issue is sorted out, he’s relying on the insurance of his youthful wife of 89.

Odd: a 29-year-old man sues the maker of the sexual enhancement supplement VirilisPro, claiming that the ensuing sex with his partner in a Scottish Inn damaged his manhood to the point that blood was squirting out onto the walls. A physician expert says the man’s story is “the most absurd thing I have heard of in my life,” explaining that men often arrive embarrassed in the ED with damaged sex organs and make up elaborate stories to explain their predicament. He says, “The most common one told is they walked into an ironing board.”

Sponsor Updates

• Billian offers its fellow HIStalk sponsors discounts on first-time purchases of its programs for vendors, including the HealthDATA database and prospecting portal and Porter Research market analysis.
• NextGen will integrate the TRUEresult blood glucose monitoring system from Nipro Diagnostics into NextGen Ambulatory EHR.
• Velocity Data Centers hosts an open house at its Ann Arbor, MI facility on October 25.
• T-System offers two September 5t webinars on attesting to MU with T SystemEV.
• HealthStream expands its suite of products with the addition of NurseCompetency’s exams and skills checklists.
• Cumberland Consulting Group promotes Christopher Miller to principal and Jennifer Vesole to executive consultant.
• Emdeon expands its Clinical Exchange solution to include e-prescription routing, lab orders and results exchange, care alerts, medication history, and clinical messaging.
• Worldwide Clinical Trials selects Merge Healthcare’s eClinical OS solution for data capture, processing, and reporting on clinical trials.
• ICSA Labs hosts two September webinars to help EHR technology developers understand the 2014 Edition certification criteria and testing requirements.
• A CareTech Solutions white paper offers customer insights on achieving Meaningful Use Stage 1 for the 82% of hospitals that haven’t completed it yet.
• Kareo updates its website and branding to reflect its commitment to small practices and billing services.
• TeleTracking invites hospitals to visit its new Enteprise Solution Center in Raleigh, NC to try its capacity management solutions hands on without the time challenges of a site visit.
• An informatica blog post covers Hadoop and big data.

EPtalk by Dr. Jayne

I often wonder how Mr. HIStalk does it all, balancing his day job with his HIStalk duties. He’s done an amazing job for just short of a decade, so when I run across a bit of writer’s block, I know I have no reason to complain.

The last few days have been bereft of ideas. Maybe it’s the weather (I hope all of you in storm-tossed areas are safe) or maybe it’s just the end-of-summer doldrums. I was particularly pleased, though, when an idea squeezed its way into my mind this morning (pun intended, keep reading).

Why All the IT in the World Will Not Fix Health Care

Like many women, I go every year for a certain radiologic screening test. This year’s adventure was a prime example of why technology is not necessarily the answer. There was a fair amount of hassle in my attempts to complete this testing, and it largely revolved around people failing to look at the monitors right in front of them.

First, I had to schedule. As in previous years, I scheduled over the phone. I have my films done at an independent imaging facility, which is funny being the CMIO of a pretty good-sized hospital. Frankly, despite all the HIPAA training, I don’t trust the hospital staff to not discuss employees who are patients. The imaging center also charges half the amount the hospital does, which makes sense with my insurance coverage limits. Plus, I don’t want to have to disrobe for people who I might have to later “counsel” about their bad EHR habits.

The first annoyance was when I was asked (after the staffer pulled up my account) whether I’d been there before. I chalked it up to someone just following a script without thinking about what they were asking. Knowing the billing and scheduling system they use, she should have been able to see the date of my last visit on the patient information screen.

Due to family history, I’m being screened at an age much younger than the standard recommendation. Because of this, I know exactly what my insurer will and will not cover. Luckily, I have a “pseudo health savings account” type of coverage which allows me a lump sum (no pun intended) for preventive services. I can use it as I see fit — exams, labs, tests, etc. — as long as they’re preventive in nature.

The staffer proceeded to argue with me about needing a physician order for the screening test, citing, “Your insurance won’t cover it without an order.” Being a doc (and a savvy patient), I know what they cover and how they cover it. I reminded the scheduler that I’ve never needed an order in the past (especially since my state allows women to have screening mammograms without an order).

She was insistent, so off I went to call a physician. I was tempted to just write my own order, but that would have been too sassy even for me. I just shook my head at the barriers to care that were being placed in front of a paying patient with a valid medical need.

Even though I regularly drink martinis and hang out with my personal physician, I didn’t want to abuse our friendship with something so clearly silly, so I called the office. They unfortunately are pretty early in their EHR transformation and do not yet have a patient portal (which would have been ideal for something like this – e-mail the request, get the order electronically, and be done with it). I survived phone tree hell and reached a nurse (they didn’t have a choice for “Press 3 if you need an order that you don’t really need, but it’s totally not urgent, requires no clinical skill, and you’re embarrassed to even have to ask for it.”) Luckily it was a nurse I know, who laughed with me and agreed to mail the order.

It was with my order in hand that I dutifully arrived 15 minutes early this morning. No one asked for it. After a few minutes of deliberation (while filling out the same information on a paper clipboard that I fill out every year), I decided to proffer the order. The receptionist handed it back to me kindly, telling me they already have my physician’s information on file and don’t need orders for screening tests.

For the actual testing, the imaging center has an excellent facility, caring staff, and “on demand” results, which is another key reason I go there. Who wants to wait to get results in the mail (or even from a patient portal) if you can get them directly from the radiologist while you wait? Especially for cancer-related screenings. If it’s not normal, I want to know right away, so I value the service they provide.

The technician didn’t bother to look at my record, instead asking me if this was my first screening, and if not, how many films have I had and where were they done. At this point, I was ready for a mint julep or perhaps some smelling salts.

Fortunately, the radiologist did take the time to look at the previous films and determine there was no change (which was good, because sometimes I have to have additional views and was spared that particular fun) and came in to chat. He knows I work for Big Hospital and usually has something funny to say about my not using their radiology department. I in turn tease him about the candy-colored kiosks from Merge Healthcare that I tried to get them to purchase a few years ago to spice up their lobby.

I decided to gently broach the details of my experience and my concerns about barriers introduced that might have been important to less-savvy patients. He’s an owner of the facility, so he has a significant interest in the amount of money spent on technology. He seemed genuinely frustrated that employees are using old paper-based processes rather than new ones supported by the technology at hand.

He pulled up my record and showed me that I am clearly flagged as high risk, an existing patient, and as a VIP (although apparently my VIP status is funny to his partners since I’m an exec at the competitor — it seems I’m not the only one.) He plans to address the workflow at the weekly staff meeting, which I appreciate.

Still, as a physician, patient, and payer (aren’t we all payers these days?) I find it striking how difficult it is to achieve ideal healthcare. In my dream world, patients are only asked information once (unless they’re asked to validate their existing information) and the staff uses the information at their fingertips to provide high-quality, expedited care. Even in a facility with a very favorable payer mix, well-paid staff who don’t appear overworked, engaged owners and managers, and a huge IT budget, they’re still part of the healthcare problem, and technology just isn’t going to fix it. Until we start addressing process, procedure, and performance, we’re just throwing money and technology at the problem.

On a lighter (but still feminine) note, an old friend of mine made my week by sending an article about the new Bic pens “for Her.” Of course, I had to go to the actual Amazon UK website and read the reviews for myself. In the words of one of yesterday’s reviewers, “If they made Bic for Her keyboards, I could write this so much easier! Darn my silly lady hands …”

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 8/29/12

Top News

Johns Hopkins will use a newly received $8.9 million grant to improve coordination in the ICU. Peter Pronovost MD, PhD, who leads the Johns Hopkins Armstrong Institute for Patient Safety and Quality, says he’ll be looking for ways to integrate new technologies into ICUs that he says “look the same as they did 30 years ago.” Part of that effort will be to develop software that allows medical devices to communicate with each other and with the EMR. The money comes from the Gordon and Betty Moore Foundation as part of a 10-year, $500 million Patient Care Program that was announced this week. Gordon Moore is the 83-year-old founder of Intel who in 1965 postulated Moore’s Law, which says that the power of computing circuitry doubles every two years.

Reader Comments

From Marketing Gal: “Re: HIMSS. Would you suggest participating in the Exhibitor Spotlight for a product launch?” Vendor readers, feel free to weigh in on whether the Exhibitor Spotlight would be a good way to make a big splash amidst a sea of 1,000 vendors trying to make big splashes. It costs $950 for corporate members.

From Lost in the Woods” “Re: Patient portals. Do you have any idea how and what vendors charge, especially those for practices?” I think it would make sense to just ask them, but readers, please leave a comment if you can help.

From Former MCK Employee: “Re: Practice Partner Seattle office. Developers and QA are leaving as MCK shifts its focus to the new SaaS application.” Unverified.

From Crook County Doctor: “Re: U Chicago Medical Center. Several days of Citrix logon misidentification troubles affecting all physicians. The help desk recording warns doctors to beware when logging on to Epic.” Unverified.

From The PACS Designer: “Re: ONC. Wimps out on image sharing. TPD is disappointed and angry that ONC has allowed vendors to intimidate the comment group when it comes to image sharing among practitioners. The overall comments were positive about the subject, but the powerful had the upper hand and made sure that image sharing was excluded from the next phase of Meaningful Use. David Clunie, a highly respected blogger on DICOM, did some sleuthing and points the finger at the Good Enuff participants. I can see why they wouldn’t want the image sharing, as it would reduce the need for more imaging at the next treatment facility and lower their chances to sell more imaging equipment.”

HIStalk Announcements and Requests

Here’s the latest musical production of The American College of Medical Informatimusicology, “Gimme My DaM Data,” featuring HIT notables Ross Martin MD (founder and HIStalkapalooza Elvis tribute artist), Harry Greenspun MD, e-Patient Dave, Todd Park, and “a cast of dozens.”

HIStalk sponsors with executives on Modern Healthcare’s 2012 100 Most Influential People in Healthcare list include Aetna (Mark Bertolini), McKesson (John Hammergren), and MedAssets (John Bardis).

This isn’t a pitch, just a recap. A relative saddled me with selling her 16 GB AT&T iPhone 4 after she upgraded, and it became obvious that messing around with Craigslist and eBay scammers and fools was going to be a big waste of my time. I ran across TriPhonia. Their online form took a few seconds to complete and I got an instant e-mail offer of $175 for my stated condition of “excellent.” They shipped a prepaid Fedex mailer and e-mailed a couple of days later saying it had a few scratches and wasn’t quite “excellent,” but said they’d still offer $158. I accepted, and within about two minutes I had the balance in my Amazon account. Maybe I could have held out for a few extra dollars elsewhere, but it was well worth it to just sell it and move on, plus they guarantee they’ll wipe the phone clean before reselling it. Do your own due diligence (almost all of the similar services have terrible reviews), but it might be worth a look.

Acquisitions, Funding, Business, and Stock

WellPoint Chairman and CEO Angela Braly resigns over criticism that the company is underperforming. Above is the five-year stock price chart for WellPoint, which was voted by hospital executives last week as the worst insurance company in the country.

Dell signs a deal to provide computer kiosks for SoloHealth, whose interactive healthcare kiosks provide free health screenings from retail locations. CoinStar (aka Redbox) and WellPoint are investors.

Sales

Lexington Medical Center (SC) selects Patient Access and Payment Certainty solutions from Passport Health Communications to integrate with Epic.

Erie County Medical Center (NY) contracts for Omnicell’s G4 automated medical management system.

OCHIN will deploy Caradigm’s Amalga solution.

People

TeleTracking Technologies promotes Mike Gallup from VP/COO to president/COO.

Business intelligence vendor Agilum Healthcare hires Winnie Fritz (Carondelet St. Mary’s Hospital)  to lead its healthcare performance improvement consulting service.

Caradigm names Rich Berner (Cerner) SVP of client services and support.

Announcements and Implementations

Memorial Health Systems (FL) nears completion of its two-year, $150 million Cerner implementation.

HealthHIE Nevada goes live on eHealth Image Exchange, allowing HIE participants to share diagnostic quality images.

The Pennsylvania eHealth Collaborative awards grants of $1.5 million each to four organizations to promote regional and statewide electronic information exchange.

Implementation draws to a close at two Missoula, MT, hospitals: St. Patrick Hospital (above) will go live in January on Epic, while Community Medical Center is on target for a November live with Cerner. Each hospital’s ambulatory clinics have begun their migrations (St. Patrick to Epic and Community to NextGen).

St. Mark’s Medical Center (TX) replaces Meditech with McKesson Paragon.

Virtua (NJ) initiates CPOE across four hospitals using Siemens Soarian.

PerfectServe launches a new version of its clinical communications app for iPhone and Android.

OnShift announces new acuity-based staffing capabilities for its long-term care scheduling and shift management software.

Government and Politics

HHS launches a competition for developers to create apps for reducing cancer among women of color. The top three developers will split $100,000 in prize money.

Here’s a Meaningful Use Stage 2 overview by Justin Barnes of Greenway.

Innovation and Research

IBM expects to market its Watson computer beyond healthcare to consumer uses, with plans to turn it into a Siri-like voice-activated analytics tool. IBM says the next version will work on tablets and smart phones, but they’re still working to add functionality such as speech recognition and the ability to understand images. Apparently IBM’s vision of its value for patients doesn’t necessarily include the participation of physicians – according to its VP of innovation, it will eventually so good at answering patient questions and making diagnoses that “you don’t need any intermediary.”

Other

Most healthcare providers still can’t justify the expense of infection control systems, though new incentive programs may spur adoption, according to a KLAS report. The market is dominated by best-of-breed solutions, with CareFusion taking top scores in product training and ease of use. Hospira led in interface capabilities and mandated reporting.

Allstate Insurance Company sues a Florida rehab hospital that it claims falsified medical records to bill it for $7.6 million in unnecessary medical services. Allstate says the hospital markets heavily in Michigan, which does not cap no-fault auto insurance payouts. The state is also investigating the hospital for alleged patient abuse.

A man reviewing the contents of a storage unit he bought at auction finds human brains, hearts, and lungs preserved in soda cups and plastic food containers. The unit was once used by a former Florida medical examiner who had been fired in 2003 for not completing autopsy reports.

Sponsor Updates

• AT&T CMIO Geeta Nayyar discusses early successes and high participant engagement rates in AT&T’s DiabetesManager pilot.
• SimplifyMD adds billing software provider Healthpac as a reseller for its EHR.
• Greenway will offer Isabel Healthcare’s medical diagnosis tool with its PrimeSUITE EHR.
• ICA’s chief marketing officer John Tempesco speaks at this week’s AlliedHIE-sponsored workshop on Direct healthcare communication.
• The Pittsburgh Technology Council includes TeleTracking Technologies as a finalist for its Tech 50 Awards in the tech titan category.
• iSirona is named the 82nd fastest growing company in America in the Inc. 500.
• The Achievers names Impact Advisors to its list of 50 Most Engaged Workplaces.
• AirStrip Technologies incorporates a real-time Meaningful Use tracker in its mHealth platform.
• Imprivata customers share best practices in workflow, securing patient data, and enhancing patient care during this week’s VMworld 2012.
• UpToDate by Wolters Kluwer Health adds psychiatry as its 20th specialty. The company also announces a partnership with the Altos Group to develop a sepsis mortality reduction program.
• IDC MarketScape ranks Medicity as a leader of packaged HIE solutions.  
• Billians adds 7,400 hospital social media links to its Portal healthcare sales and marketing database.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

A 2012 Campaign Primer 8/28/12

Campaign 2012 arrives at a formal down select today with supplier presentations in Tampa and Charlotte over the next two weeks. Like most selections, people involved are bemoaning the available options and questioning who designed the process in the first place.

The current preference gap is razor thin. The Real Clear Politics number, a blended average of major nonpartisan polls, has President Obama at 47% and former Massachusetts Governor Romney at 45.5%. It remains — for all the Fear, Uncertainty, and Doubt of the last several months — well within the margin of error.

Of course, as we were reminded in Campaign 2000, the popular vote doesn’t determine the President. The Electoral College does. And despite all the noise this summer, it too is a largely unchanged landscape since June.

The dirty Election 2012 secret is that 40 or so states are largely irrelevant, residing squarely in one camp or the other. Only about nine states, as of now, are being heavily contested: Florida, North Carolina, Virginia, New Hampshire, Ohio, Iowa, Colorado, Nevada, and now Wisconsin. And if you live in one of these states, you are being bombarded with micro-targeted messaging almost to the point of affliction. “Hello 9-1-1. It’s me again.”

The expansion of what the pros call the “map within the map” to include Wisconsin is a function of native son Paul Ryan joining the GOP ticket earlier this month. At 42, Congressman Ryan is the third youngest vice presidential nominee in the post-WW II period. He is, both sides agree, a serious policy thinker. He also brings a detailed plan, Path to Prosperity, to the national conversation.

The healthcare provisions within the Ryan policy sketch have of late been a focal point of the nightly shouting matches on cable news. Brookings Institute’s Henry Aaron and Robert Resischauer may have originated the term “premium support.”* Senator Ron Wyden (D-OR) may have embraced it last December. But Romney and Ryan now own it as the campaigns fight for seniors in Florida, Iowa, and rust belt states like Ohio.

The aggressiveness of the debate is a reminder that the modern presidential campaign sadly does not lend itself to deep educative efforts, particularly in the last 90 days. As the former DNC Chair Howard Dean said last Sunday, “I have always told people that campaigns are not for educating” and much of the last several weeks validates that near term view.

Romney and Ryan, of course, know how the game is played. And thus as we start the Republican National Convention this morning, the U.S. economy will be front and center. Q2 GDP (advanced) was middling at just 1.5%. Median household income has had its worst 10-year stretch since the Great Depression. U-3 unemployment remains above 8%. It is a tough narrative for any incumbent, even for the personally well-liked Barack Obama.

These Hurricane Isaac-quality headwinds, in turn, all but ensure a close race through November 6. For believers in Surowiecki’s Wisdom of Crowds, the online betting market Intrade currently favors Obama to win by 57.3% to 42%. That collective sentiment feels qualitatively right, with the caveat that even a week can be an eternity in modern politics.

Beyond the electoral outcome, it also is worth asking the larger question: what realistically can be accomplished in the coming Congress? The down ballot House and Senate terrain looks poised to deliver two closely divided chambers, including a U.S. Senate where Joe Biden or Paul Ryan may well cast the tie-breaking vote. Absent a fiscal crisis, and in the wake of an ugly campaign, it may make the current Congress look comparatively productive.

It will be a tough environment for either man. Selection is, of course, always easier than the change management required to make something work. And while some surely will bemoan the process, the blame in a democracy actually has to begin with us.

*Premium support, in simple terms, would provide Medicare recipients with an annual payment from the federal government to enroll in the health plan of their choice. It is a serious policy idea that has champions and critics alike. A primer can be found here. Beyond that, we will leave the debate around approach to the myriad sites focused on health policy and politics.

Donald Trigg, along with his long history in healthcare IT, spent a decade in the public policy space, including his work on the 2000 Bush for President campaign in Austin, Texas.

Monday Morning Update 8/27/12

From Siemens Surfer Dude: “Re: Mark Zielazinski, CIO of Alameda County Medical Center. An e-mail was distributed to ACMC staff last week saying he’s leaving with no details. They’re in the middle of an Invision to Soarian implementation scheduled for go-live on CPOE this fall.” Verified. Mark says he’s moving on to Marin General Hospital to rejoin his old El Camino Hospital boss Lee Domanico, who is now CEO at MGH. They’re building a replacement hospital and Mark will have some related additional responsibilities beyond IT, telecomm, HIM, and biomed. As far as ACMC goes, Mark says the Siemens / NextGen rollout is going fine and ACMC is getting its ARRA money. Both organizations will make announcements about his new job sometime this week.

We would expect that an EHR technology developer could satisfy § 170.523(k)(1)(iii) by disclosing: 1) the type(s) of additional cost; and 2) to what the cost is attributed. In reference to the first example above, an EHR technology might state that “an additional ongoing fee may apply to implement XYZ online patient service.” In situations where the same types of cost apply to different services, listing each as part of one sentence would be acceptable, such as “a one-time fee is required to establish interfaces for reporting to immunization registries, cancer registries, and public health agencies.

From Frank Poggio: “Re: MU Stage 2 zinger. Buried back on Page 405 is a real ditty, Price Transparency. Looks like in spite of all the flaming comments ONC received from vendors on the draft of this idea, they are moving ahead with it. ONC backed off requiring vendors to publish a specific price list, but now mandates that they list out all component, install, training, interface, third party and other costs. At this rate, I predict in Stage 3 they will ask for the numbers. Also, in the new certification rules, ONC estimates that it will cost vendors $195 million. If you take the 816 vendors certified under Stage 1 and then reduce the $195 million by ONC’s $60 million annual budget, that means each vendor will spend $165,000 to revise and certify their software for Stage 2. Who will eventually pay, and would that money be better spent elsewhere?”

From Sagacity: “Re: MU Stage 2. For the pleasure of your readers, the bookmarked and cross-linked versions of the Stage 2 and Certification Criteria rules. Save to the same folder with the original names and the cross-linking will work.” Thanks for that.

From Luminosity: “Re: authors. You should get more people to write instead of just giving space to a few guest authors.” Everybody is welcome to submit Readers Write articles as long as they meet my requirements for length, quality, and non-promotional topics. Being invited as an ongoing contributor to HIStalk is another matter – I’m not desperate for content, so I would expect folks to be way better than average. Regulars like Ed Marx, Dr. Rick, and others have an interesting and credible perspective, state it well, are entertaining as well as informative, and are diligent enough to keep it up month after month. Writing is like teaching – everybody thinks they could do it perfectly because really talented folks make it look easy. Anyone who thinks they have the right stuff and can send me a sample article along with ideas for their ongoing series and we’ll see where it goes. That’s the limiting factor on whose articles you’ll see here, not my unwillingness to give someone else a platform.

Welcome to new HIStalk Platinum Sponsor Sandlot Solutions. The Fort Worth, TX company, which is uniquely jointly owned by Santa Rosa Consulting and North Texas Specialty Physicians (NTSP), offers a platform that turns data into information. NTSP is a pioneer ACO (one of only 32, also named one of eight ACOs to watch including its use of Sandlot Solutions by Information Week) with 2.5 million patients. They know how to connect providers with critical information. Sandlot Solutions offers a next generation HIE and analytics system that uses low-cost cloud computing to connect physicians across all care settings and practice locations to improve care and reduce costs. The underlying products include Connect (HIE and master patient index); Dimensions (data warehouse); Metrix (analytics); and Care Manager (caregiver workflow driven by near real-time clinical and claims data). If you’re in the market for HIE software, check their no-nonsense evaluation checklist. The company’s leadership team has some familiar names, including that of our own “From the Investor’s Chair” Ben Rooks as an advisor. Thanks to Sandlot Solutions for supporting my work.

Now that I’ve talked about Sandlot Solutions, let’s have a short demo (which I found by cruising YouTube).

Allscripts says its systems are open, but 70% of poll respondents say really aren’t, at least by their definition of the term (the thoughtful comments are worth reading). New poll to your right: is your reaction to the announcement of the Meaningful Use Stage 2 rules positive, negative, or indifferent? Once you’ve voted, click on the Comments link in the survey box (or click here) and explain your opinion.

From that last poll, a comment by Limber Lob was particularly thoughtful given his obvious knowledge of several vendor EMR products:

Whether Allscripts is "open" centers on the definition of the term "open." "Open" conjures up notions of "open source" or at least multiple read/write APIs for a system, but it also reminds us of the important related concept of "extensible systems." An extensible software system is one that can be "extended" by someone other than the original developer AND in the programming language in which the system was written. It isn’t widely realized that three of the four successful long-lived integrated EHRs (with single patient database) are extensible by this definition. The VA VistA’s programming Standards & Conventions (SACs) allowed the extension of VistA over the years by VA sites nationwide, with — for example — the Puget Sound VA developing VistA’s Provider Order Entry (POE) system, and the Topeka VA writing VistA’s Bar Code Medication Administration (BCMA) module. VistA’s extensibility under the VA’s Decentralized Hospital Computer Program (DHCP) of the 1980s and 1990s is a principal reason why VistA now has more than 100 major sub-systems and an estimated 125,000 function points. Cerner’s EHR can be extended using Cerner Command Language (CCL), which is a proprietary "scripting language" in which as much as a quarter of the Cerner EHR’s logic is written. Many Cerner sites employ multiple CCL programmers, and books on CCL are available from Amazon. And perhaps surprising to many, Epic’s EHR is also extensible by Epic customers, as Epic makes source code and documentation available so that customer organizations can develop name-spaced code and data structures that extend Epic’s functionality in a manner similar to Epic’s customizations of their system for their clients. Epic encourages customers to use the other mechanisms for enhancing the functionality of the Epic EHR, but they also support what they term "free range programmers" in their customers’ organizations. Meditech, the fourth of the long-lived integrated EHR systems, has a closed code base. Finally, Allscripts’ supports extension of their Sunrise environment using a package called ObjectsPlus that has a reputation for being hard to use, and requires highly skilled and expensive programmers — which makes it an impractical proposition for many Sunrise customers.

I must have received half a dozen breathless “Breaking News” e-mails at work Friday screaming that HHS had delayed ICD-10 implementation until 2014. I’m not sure why this news was earth-shattering given that HHS itself proposed the extension in early April. Were the rags expecting some other outcome, or did they just forget that this is old news?

Here’s a new book on healthcare business intelligence. The folks involved sent me a Kindle copy, but I haven’t had time for more than a quick skim so far. Amazon has the Look Inside! feature turned on, so you can peruse the table of contents and quite a few sample pages. The author is Laura B. Madsen, who works for BI vendor Lancet Software.

In England, Lewisham Healthcare NHS Trust chooses Cerner Millennium for electronic patient records, its first UK win since it jointly bid to Royal Berkshire along with UPMC in 2009. InterSystems and Cambio were the other finalists and iSoft is the incumbent.

Also in England, Buckinghamshire Healthcare NHS Trust  admits that a software problem prevented the parents of some children from receiving their follow-up vaccination notices. The trust took over the vaccination program a year ago, but some parents were sent multiple reminder letters while others received none. A trust spokesperson said other customers of the unnamed software may also have been affected.

In another item from England, the county of Herefordshire, trying to determine why only 3% of its residents received an invitation to be checked for serious disease vs. the 20% target set by the government, find that a software problem may be responsible. A doctor tells them that the screening software only works with the Google Chrome browser, while the county-side medical system is not compatible with Chrome, forcing doctors to print out their entries and then re-enter them manually on two dedicated computers.

The Meaningful Use Stage 2 Webinar offered by NeHC and ONC on Friday filled up quickly. They’ve added sessions for Tuesday and Thursday at 12 noon Eastern, or you can view Friday’s recorded session or download the slides.

Researchers working with data from hospitalized HIV patient create a predictive model to estimate the chances of readmission within 30 days and death, using only EMR information from the first two days of their admission.

Keynote speakers at New York eHealth Collaborative’s October 15-16 conference at Pier Sixty in New York City: David Brailer, chairman of Health Evolution Partners, and Stephen Dubner, author of Freakonomics. Several dozen other speakers will grace the lectern. Receiving career achievement awards in health IT at the event’s gala will be Jeff Immelt of GE and Sam Palmisano of IBM. General registration is $395, licensed healthcare professionals and government employees get a $195 rate, and students get in for $100. The gala runs an extra $750. Rooms at the Hilton New York Fashion District are $319. HIStalk sponsors who are sponsoring this event include Optum, Emdeon, NextGen, and Nuance.

Tom Carson, founder and former president CEO of MD-IT until January of this year, is named CEO of Axion Health, which sells employee and occupational health software.

ZirMed names Kenneth Willman (WellPoint) as VP of payer solutions and strategy.

The University of Toledo Medical Center announced last week that it had temporarily suspended its live donor program and suspended two nurses after unspecified human error forced surgeons to abort a planned transplant while both patients (a male donor and his sister, who was the intended recipient) were in the OR. The university provided more information Saturday: the human error was that a nurse put the donor’s kidney in the trash, ruining it.

Doctors in Ontario complain in a town hall meeting about changes in their fee codes, intended to reduce costs by $340 million but making it impossible for physicians to bill for certain services. An interventional cardiologist says doctors are now paid only $2.50 for reviewing an ECG, with the rationale being that computers are doing all the work, leading her to say, “I’d like to think I’m better than a computer. I feel disrespected and disillusioned.”

Vince takes a short HIS-tory break to memorialize industry long-timer Dick Schopp, who died earlier this month.

E-mail Mr. H.

News 8/24/12

Top News

#meaningfuluse Can’t guarantee perfection, some hard choices made. But I promise- no arbitrary decisions, no unconsidered comments.

— Farzad Mostashari (@Farzad_ONC) August 23, 2012

Meaningful Use Stage 2 regulations are approved.

National eHealth Collaborative will present a free Webinar Friday afternoon, August 24, from 1:00 to 2:30 p.m. Eastern time called How to Play by the (Final) Rules: An Overview of Meaningful Use State 2 and the Standards and Certification Criteria Final Rules. CMS and ONC presenters will go over the rule and answer questions.

Reader Comments

From Limber Lob: “Re: Massachusetts healthcare law. Note the quote by Governor Dev Patrick.” In summarizing the bill that he says will save the state $200 billion over 15 years, Patrick said, “We are ushering in the end of the fee-for-service care system in Massachusetts in favor of better care at lower cost.”

From Concerned in Texas: “Re: Epic. I work for a Epic hospital and haven’t signed any kind of agreement. I’ve heard from two sources that if my hospital wants to block another hospital from hiring me, my hospital can call Epic and they’ll tell the other hospital not to hire me. Is that true?” Recent discussion on that topic here brought out lots of folks with firsthand experience, so I’ll defer to them.

From Kara: “Re: managing population health and overall analytics. I would love to know who is having tangible, positive ROI-type success in this area. Not a vendor white paper, but real-world experience measuring financial impact done by someone who would be willing to talk about it.” I told Kara that the payment model isn’t very far along to have allowed anybody to demonstrate ROI on managing population health, but that’s probably a hospital-centric answer that doesn’t include other kinds of programs. She would really appreciate your comment if you can help.

HIStalk Announcements and Requests

Do the dog days of summer leave you wishing for cool reading material? If so, here are a few HIStalk Practice highlights from the last week: physicians are more likely to suffer job burnout than other professionals. Happtique introduces prescribe-able apps. Epocrates offers its Essentials reference product free to medical students. The number of retail clinic visits increased fourfold between 2007 and 2009. Student loan repayment is the top source of stress for physicians. Attorney Jessica Shenfield offers advice for physicians to stay HIPAA compliant in the age of mobile devices. Dr. Gregg shares the “gray lining” of the cloud. While you’re catching up on your HIStalk Practice news, click on a few sponsor ads and see if there are any ambulatory HIT goods or services that might make your life more complete. Thanks for reading.

I don’t like being scooped, so I was pleased to put a reader’s rumor that Inga forwarded to me on Twitter early Thursday morning saying that Meaningful Use Stage 2 would hit the Federal Register Thursday afternoon (which it obviously did). I tweet only stuff I think is important, so you won’t get bombarded following @histalk, but you might share my scoopage on occasion.  While you’re in that interoperating mood, you might as well follow Inga too, and follow that with a LinkedIn and Facebook chaser of connecting with any or all of our various personas since we are free with our Internet love. We don’t really solicit sponsors or hold their hands if they’re considering it, so marvel at how many of them have exhibited the resourcefulness to become one anyway and perhaps click on their ads to your left in a primitive form of the Like button. You can dig around in more detail in the Resource Center, and if you want to summon offers of consulting help while sitting regally on your throne and beaming benevolently at your hushed minions, simply fill out the Consulting RFI in maybe 60 seconds and dispatch it to several willing providers with one click of your royal scepter and wait for your e-mail to light up. You have surely noted that HIStalk is a contact sport – we minimize the usual pontificating and self-indulgent journalism and give readers the floor whenever they’ll take it – so feel free if not morally obligated to send us your news, rumors, and anything we would find interesting. It’s delightful having you as a reader.

On the Jobs Board: Services Implementation Project Manager, Account Executive Northeast, Services Implementation Consultant.

Welcome to new HIStalk Gold Sponsor Velocity Data Centers. The Chelsea, MI company offers economical, quick-to-build modularly constructed data centers installed on site. They’re bulletproof, hurricane tested, suitable for any climate, and less expensive than building from scratch or using valuable hospital square footage for data center space. If you’re worried about cloud security or service levels, you can build your own private cloud instead of renting someone else’s. if you’re struggling with technology expansion, obsolete disaster recovery capabilities, or need space for big data storage or research computing, you can get the data center capability you need for less money and time. Thanks to Velocity Data Centers for supporting HIStalk.

I found this really cool time-lapse YouTube video of a Velocity Data Center being built in 90 days.

Acquisitions, Funding, Business, and Stock

Two of the Quality Systems directors who were nominated by dissident board member Ahmed Hussein in a proxy fight have been elected, along with seven of the company’s eight nominees. Names have not yet been released pending certification of the results. The company also announced that Scott Decker, president of its NextGen subsidiary, has resigned effective September 7 to take another job with an unnamed healthcare IT vendor that the company says is not a Quality Systems competitor. QSII shares dropped another 4.5% Thursday to $17.39, above their 52-week low of $15.04, but down 66% from their 52-week high of $50.70.

Data analysis tools vendor Apixio raises $5.8 million of its $7.8 million goal from at least 10 private investors.

Michael Kluger, an Allscripts board member since 1994, resigns because of what the 8-K form says is, “His desire to spend time on his professional responsibilities.”

Roper Industries completes its previously announced $1.4 billion acquisition of Sunquest.

HP reports the biggest loss in its 73-year history, writing down a mind-boggling $8 billion of its $13 billion acquisition of Electronic Data Systems from GM in 2008 (GM had bought it from Ross Perot for $2.5 billion in 1984). Excluding one-time charges, the company’s revenue dropped 5% and earnings declined by 13% as its PC, printer, and notebook sales all dropped by double-digit figures. CEO Meg Whitman says she’s confident of a turnaround, but analysts are looking warily at the company’s $30 billion debt load. Above is the five-year HP share price (blue) compared to Microsoft (green) and the S&P 500 (red). Shares are at $17.64 after dropping more than 8% Thursday on the news, 41% off their 52-week high of $30.00.

Sales

Union General Hospital (LA) selects the Healthcare Management Systems EHR and EDIS.

Walgreens will deploy its WellHealth EHR, built on Greenway’s PrimeSuite, to 8,000 locations, allowing pharmacy employees to view the immunization and health testing history of patients.

EHealth Saskatchewan awards SAIC Canada a three-year, $16 million contract to provide implementation and maintenance technology services in support of the province’s EHR.

West Virginia Health Information Network launches its statewide HIE, with Truven Health Analytics (the former healthcare business of Thomson Reuters) as its technology provider.

Mountain States Health Alliance selects the Siemens perioperative management solution by Surgical Information Systems for its 13 hospitals in Tennessee and Virginia.

Franciscan Alliance (IN, IL) selects Merge Healthcare’s iConnect imaging solution. Children’s Hospital & Research Center (CA) also contracts with Merge for its iConnect Access and Share solutions.

Rochester General Health System (NY) selects Wolters Kluwer’s ProVation Order Sets powered by UpToDate Decision Support for its eight affiliate hospitals.

People

The University of Michigan Health System names long-time Brigham and Women’s Hospital CIO Sue Schade as its new CIO, effective November 1.

Physician networking site QuantiaMD appoints Mike Coyne (Verisk Health) as president.

Hayes Management Consulting names Shawn DeWane (Emdat) as EVP of business development.

Cumberland Consulting Group names Jeffrey Sturman (Memorial Healthcare System) as partner.

Announcements and Implementations

Hospitalist management company Cogent HMG will extend its use of athenahealth’s athenaCollector.

The University of South Carolina School of Medicine completes its implementation of Cerner Ambulatory EHR for 143 providers and 1,200 users. Affiliate Palmetto Health will bring another 153 providers live over the next 13 weeks.

The local paper mentions that Providence Medford Medical Center (OR) has implemented a Modified Early Warning System that scores vital signs entered into the EMR and pages the charge nurse if the score indicates possible problems. The article doesn’t give specifics, but it may be Caradigm Amalga that they’re using.

Government and Politics

CMS selects 500 primary care practices across seven regions to participate in the Comprehensive Primary Care initiative, which will pay primary care practices a care management fee of $20 per month per beneficiary to support enhanced coordinated services on behalf of Medicare FFS beneficiaries.

Open health and VistA advocate Matt McCall was honored Thursday by the White House as a Presidential Innovation Fellow. He’s working on the Blue Button initiative, the HealthME PHR, and formerly the VA’s OSEHRA VistA community.

In England, the Department of Health is reportedly pursuing the replacement of Cerner Millennium for its Choose and Book scheduling system, hoping to eliminate its dependency on commercial software products to reduce costs. It hopes to own the intellectual property outright.

The US Army creates an open encounters report for its MC4 battlefield EMR in Afghanistan using a Business Objects query that finds open encounters that are more than three days old. The weekly reports, along with toughened policies, reduced open encounters by 72% in the first month, which it says will allow better care because encounters not closed per policy by the original physician were being cleaned up afterward by someone else.

Other

Greenway has put out a summary of the Meaningful Use Stage 2 rules for EPs.

Microsoft unveils a new company logo, its first in 25 years. According to the company, the font is Segoe, while the symbol conveys the company’s diverse product portfolio. The video is running 3,530 likes to 670 dislikes so far. Personally, I like it.

Epic is awarded a patent for, “A system for facilitating patient ownership of his or her medical data through the use of third-party health repositories that preserves the maximum information content of the medical records by displaying information relevant to the authority of the medical data as reflected by its source and types of modification as it has moved between institutions, as well as the data itself. In this way, improved use of this data is made possible.”

United Memorial Medical Center (NY) eliminates five transcriptionist jobs, blaming its financial losses and electronic medical record as good reasons to outsource the function. Two of them complained to the local paper, saying it “added insult to injury” that Intivia, the company chosen to take over the function, offshores some work to India.

In Malaysia, the University of Malaya Specialist Centre is developing clinical and imaging systems for its new campus that will scale up from the current 100 concurrent users to 4,000. The CIO estimates that 80% of Malaysian hospitals are still paper-based and the remainder keep their electronic information in silos. He’s using VMware products to virtualize servers and desktops, including thin-client touchscreens for the OR that have washable mice and keyboards. He says desktop PCs are “irrelevant” with triple the three-year cost of a terminal, plus they support the “bring your own device” movement. The hospital is spending 4% of its annual revenue on IT.

Dan Mandy from Winthrop Resources tells me that CMS has changed its rules that previously required critical access hospitals to purchase hardware to be eligible for the Meaningful Use incentive. CMS apparently announced in July that a capital lease will meet the “purchase” requirement.

An Arkansas nursing home installs a telemedicine station that allows residents to be evaluated by a physician quickly instead of in several weeks. They’re using a digital stethoscope and cameras, while the vendor (IntegrateMD) will also offer wireless stethoscopes and iPad access.

The city of Alpharetta, Georgia forms a commission to attract and retain technology companies, hoping to brand itself as the “Technology City of the South.” The commission’s members include executives representing several companies that sell healthcare technology.

Grady Hospital in Atlanta suspects that a a married couple holding senior financial positions (payroll director and budget director) stole $500,000 from the hospital. They had been laid off and then sued the hospital for discrimination.

A fired account representative of a Chicago-area psychiatric hospital admits that she stole copies of patient files and used the information to send harassing letters to the hospital’s patients, which the police said included “vulgar comments, references to confidential medical information and psychiatric treatment received by these patients.” She also threatened to expose the information to the friends and families of the patients.

The State of Missouri will provide $4.6 million in incentives to Sporting Innovations, which will hire 120 people and spend $20 million renovating a Kansas City, MO building for building smartphone sports apps. The company is an offshoot of Kansas City’s professional soccer team, which has as two of its five owners Neal Patterson and Cliff Illig of Cerner. The soccer team famously chose Kansas City, KS for its stadium and a new Cerner complex after Kansas outbid Missouri with $230 million in “border wars” incentives. Illig says Sporting Innovations will deliver the same technology improvements to sports as Cerner has done for hospitals, allowing fans to view multiple video feeds of sports events and to scan QR codes on stadium seats to order team apparel. According to Illig, “What we see in sports is similar to health care. You have stadiums with 30 different technologies that don’t talk to each other. This will enhance the fan experience and be a platform for innovation.”

Strange: a male porn star named Mr. Marcus admits that he convinced a medical testing service to omit the positive result of his syphilis test, which he calls “the Scarlet Letter,” so he could continue working. The company denies his claim, saying their software does not allow employees to omit specific test results. Nine cases of syphilis have been documented in investigating an outbreak, with one trade group urging a temporary national moratorium on the production of adult films until all performers have been tested. I was highly entertained by the performer testimonials (especially their hilarious phony names) on the testing company’s site, including one enthusiastic Ms. Bailey Brooks, who said, “I have such a hectic life between kids, college, and travelling to shoot that I LOVE TTS!!!”

Hospital district officials checking up on complaints about taxpayer-funded 269-bed Salinas Valley Memorial Hospital (CA), best known for the $5 million retirement package it gave to its CEO last year followed by extensive layoffs and losses, say they have no problem with the hospital’s interim CEO turning in $4,000 in receipts from “Airport Town Car” since his contract guarantees him a car service. The driver providing the service: his daughter. They’re also happy to pay his commuting expenses from Seattle, his rounds of golf, and the candy bars he buys at the airport.

Sponsor Updates

• Attendees at the all-employee annual meeting of Ignis Systems on August 9-10 pitched in at the Oregon Food Bank, repackaging two tons of bulk pasta for distribution to families in need.
• Santa Rosa Consulting reviews the 2012 impact of the CMS hospital readmission reduction program in a blog post.
• The State of Florida awards iSirona $530,000 in grant and tax incentives to create jobs in the Bay County, FL area.
• Greenway Medical VP Justin Barnes reflects on the eight-year journey to accountable care in a blog post.
• Wolters Kluwer Health’s Sentri7 Patient Surveillance software earns high marks in two recent KLAS reports.
• Intelligent InSites offers a free August 29 webinar titled How to Better Manage Consumable Medical Assets with RTLS/RFID Solutions.
• Medicomp Systems CEO Dave Lareau discusses the need to make clinical data usable in order to enhance patient outcomes in a guest article.
• Nearly 200 volunteers from GE Healthcare helped prepare Milwaukee-area school buildings for the new school year on Wednesday.
• eClinicalWorks expands its Westborough, MA headquarters with the purchase of a 61,000-square-foot building in the same complex.
• Medical billing technology vendor Healthpac will offer products and services from simplifyMD to its customers.

Inga’s Quick Skim of Meaningful Use State 2

Inga came up with this after a quick skim of the rule as published. She and many others will be poring over the rule in more detail, so please leave a comment (as will Inga) with anything interesting you find.

• A special three-month reporting period rather than one year of reporting for providers attesting to either Stage 1 or 2 in 2014.
• A delay in the Stage 2 timeline probably is the most important to EPs. In the Stage 1 final rule, CMS established that any provider who first attested to Stage 1 criteria in 2011 would begin using Stage 2 criteria in 2013. This final rule delays the onset of those Stage 2 criteria until 2014, “Which we believe provides the needed time for vendors to develop certified EHR technology [CEHRT].”
• For 2014 only, providers that are beyond the first year of demonstrating MU will have a three-month quarter reporting period to allow up to nine additional months to upgrade certified EHR technology to the 2014 edition.
• Nearly all of the Stage 1 core and menu objectives included in the proposed rule are being finalized for Stage 2.
• Adds “outpatient lab reporting” to the menu for hospitals and “recording clinical notes” as a menu objective for both EP and hospitals.
• There will be 20 measures for EPs (17 core and 3 of 6 menu) and 19 measures for eligible hospitals and CAHs (16 core and 3 of 6 menu).
• New core measure for EPs: use of secure electronic messaging to communicate with patients on relevant health information.
• New core measure for EH/CAH: automatic tracking of medications from order to administration using assistive technologies in conjunction with an eMAR.
• Ability to use a batch reporting process for MU, which will allow groups to submit attestation information for all of their individual EPs in one file.
• CMS is requiring providers to send a summary of care record for 50% of its patients rather than more than 65%.
• Providers electronically transmit a summary of care for more than 10% of transitions of care and referrals, but eliminated the requirement that the summary of care be electronically sent to a provider with no organizational or vendor affiliation.
• Lab reporting for hospitals as a menu objective.
• EPs who can demonstrate that they fund the acquisitions, implementation, and maintenance of CEHRT, including supporting hardware and interfaces needed for MU, without reimbursement from an eligible hospital or CAH —and use such CEHRT at a hospital, in lieu of using the hospital’s CEHRT—can be determined non-hospital based and receive an incentive payment. Determination will be made through an application process.
• EPs must report on nine out of 64 total clinical quality measures (CQMs).
• Eligible hospitals and CAHs must report on 16 out of 29 total CQMs.
• All providers must select CQMs from at least three of the six key health care policy domains from the HHS’ National Quality Strategy: Patient and Family Engagement, Patient Safety, Care Coordination, Population and Public Health, Efficient Use of Healthcare Resources, Clinical Processes and Effectiveness.
• Beginning in 2014, all Medicare providers that are beyond the first year of demonstrating MU must electronically report their CQM data to CMS.
• Added four categories of exceptions for EPs to avoid Medicare pay adjustments: in a geographic area without sufficient Internet access; new EPs; unforeseen circumstances, such as a natural disaster; and, specialist/provider type, such as those that lack direct patient contact of follow-up needs with patients.
• Made 12 additional children’s hospitals eligible to participate in Medicaid incentive program, despite not having a CMS certification number since they don’t bill Medicare.

EPtalk by Dr. Jayne

The Food and Drug Administration approves the Ingestion Event Marker, or so called “smart pill,” for marketing as a medical device. The sensor is embedded in a pill and is activated by contact with fluid in the stomach. A signal is sent to a wearable water-resistant patch that wirelessly transmits the data to a smart phone or computer. Manufacturer Proteus Digital Health Inc. will begin direct-to-consumer marketing in the United Kingdom with the sensor embedded in a placebo taken at the same time as the patient’s regular medication. The company hopes to gain FDA approval to embed it in therapeutic medications by 2014.

The Archives of Internal Medicine publishes a study that not surprisingly shows that burnout is more common among physicians than other types of workers in the US. Frontline specialties such as internal medicine, family medicine, and emergency medicine are at greatest risk. I’d be interested to see how healthcare IT workers fared on the same screening instrument.

HIStalk reader Evan Steele blogs about the “arduous task” of having hundreds of EHR vendors each programming more than 100 clinical quality measures. Software companies are spending their time jumping through hoops rather than advancing usability and innovation.

Hi tech, low tech: Dallas County declares an emergency with the recent outbreak of West Nile virus. Aerial spraying crews are deploying synthetic pyrethroids (chrysanthemum extract) to combat mosquitoes. If you’re going to be outside at dusk, it’s not a bad idea to break out the insect repellent.

Weird but true: Molecular geneticists translate an entire book into 55,000 strands of DNA, then convert it back to text. Researchers propose that “a device the size of your thumb could store as much information as the whole Internet.” The text used in the project was a book on genomic engineering. There are several other fun facts in the article, including discussion of sequencing Disney’s most annoying song, “It’s a Small World,” into a micro-organism.

Weird News Andy wannabe: This wasn’t from him, but it’s worthy of his name. The FDA recalls surgical bone putty that can ignite during surgery.

Medicare announces the completion of updates to its website. The list of accomplishments includes better design, increased compatibility with smart phones, and improved access to key parts of the site.

I had the privilege of hanging out with one of my favorite CMIOs as he was passing through town this week, and I’m especially pleased that he noticed my shoes. That’s the mark of a true Renaissance man, if you ask me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CMS Releases EHR Incentive Program Stage 2 Rule

CMS publishes its 672-page Stage 2 Final rule in the Federal Register. A statement from HHS Secretary Kathleen Sebelius also notes:

• Stage 2 will begin as early as 2014. No providers will be required to follow the Stage 2 requirements outlined before 2014.
• The announced requirements include certification criteria for the certification of EHR technology.
• The certification program has been modified to cut red tape and make the certification process more efficient.
• Current “2011 Edition Certified EHR Technology” can be used until 2014.

News 8/22/12

Top News

MModal becomes a wholly-owned subsidiary of Legend Parent Inc., an affiliate of JP Morgan’s One Equity Partners, following the completion of Legend’s tender offer for all of MModal’s outstanding shares.

Reader Comments

From PCP Doc: “Re: specialists. In my community, 40-50% of specialists are practicing primary care because there are too many of them. It makes coordination of care more difficult. One patient sees a cardiologist for blood pressure and another who had breast cancer two years ago sees an oncologist, radiation oncologist, surgeon, OB-GYN along with her primary care doc just to get a breast exam, mammogram, and CBC. Specialists have said they’ll do primary care if the pay goes up, but they’re a bit rusty at it.” I suppose that’s the downside of luring the procedure docs back into primary care – many of them have never done it and more than a few are probably going to be lousy at it because of personality type or lack of interest. Can you imagine retooling a cardiac surgeon into a pediatrician?

From Leopold: “Re: hospital software lineage. I’m looking for the link posted earlier this year showing vendor consolidation.” Constantine Davides of JMP Securities created the HIT family tree for HIStalk readers (parenteral alert: it’s full of HIT incest that spans decades.) I think he’s sorry he opened this particular can of worms since it was pain to create and then update with reader-suggested additions.

From Scott: “Re: Tableau data visualization free trial. Altosoft also offers a free download, but with no registration required. Clients include Cleveland Clinic, Geisinger, Memorial Sloan-Kettering, Yale, etc. We have pre-built dashboards for AP, CP, radiology, leadership, charge nurse, etc.” Scott’s from Altosoft.

From Oh the Humanity: “Re: PlatinumMD. I heard they’re calling practices with a ‘courtesy call’ from the ‘Stimulus Recovery Department’ and asking to have the doctor call them back about ‘the doctor’s reimbursement checks that come from CMS.’ I can only imagine how they respond once they find out that the company is a MU consultant and not the government calling to reclaim their stimulus dollars.” Unverified, but their site does have a page called Stimulus Center.

From Nicole: “Re: hospitals forced to share records. Two New York hospitals were told by the state that their certificate of need requests for construction would be approved only if they join a RHIO.” Nicole sent the article over, which is available by registration only on the Crain’s site. The Department of Health’s Public Health and Health Planning Council told Hospital for Special Surgery and Memorial Sloan-Kettering that their construction projects (valued at $859,000 and $339 million, respectively) would be approved only if they agreed to join a RHIO, observing that they are the only two hospitals in New York County that haven’t already done so. Council member Jeffrey Kraut said, “The time has come to make all CON applications join,” and when another member said their reasons might be financial, Kraut shot back, “You mean Sloan-Kettering is too poor?”

HIStalk Announcements and Requests

Listening: Pentagram, after watching a documentary on Netflix about their singer’s 44-year drug addiction and the band’s recent comeback attempt after years of self-inflicted lack of commercial success and endless membership changes. I’ve played this magnificent song, recorded during a 1976 basement practice session on a cheap reel-to-reel recorder, least 100 times in the last three days because it sends chills up my spine (it really kicks in at 1:50). Pentagram is like a mix of 70s heavy metal bands from my vinyl collection that you’ve probably never heard of, like Captain Beyond, Sir Lord Baltimore, and UFO. I may get a Pentagram tee shirt as my tribute to non-conformist failure in the presence of ample talent.

Acquisitions, Funding, Business, and Stock

The Outsource Group, an RCM provider for hospitals, acquires XAM/MAX, a provider of self-pay collection and insurance follow-up services.

Behavioral software vendor Netsmart Technologies, whose CEO is former Cerner COO Mike Valentine, acquires Behavioral Pathway Systems, which sells behavioral provider benchmarking services.

Sales

Arkansas Heart Hospital signs a 10-year, $10 million agreement with Siemens to implement Soarian clinicals, financials, pharmacy, and med administration check. Siemens Financial Services division financed $4.8 million of the purchase.

Jordan Hospital (MA) selects Mediware’s Insight Performance Management software for monitoring enterprise performance programs.

Trinitas Regional Medical Center (NJ) chooses Hyland Software’s OnBase enterprise content management to integrate with its Allscripts Sunrise EMR.

University of Iowa Hospitals and Clinics chooses Voalte’s iPhone-based communications system for use throughout its facilities.

People

Home health software provider Procura appoints Rebecca MacKinnon VP of US sales. She was the founder of BeyondNow Technologies, which was acquired by Cerner in 2003.

PracticeMax, a provider of practice management services, announces the retirement of Rick White as president and the promotion of Patrick Lukacs (above) from VP of software services to VP of operations.

Press Ganey Associates names David Costello, PhD (SCIOinspire) chief analytics officer.

Consumer health engagement firm Silverlink Communications names Adam A. Hameed (Emdeon) chief revenue officer and Paul G. Fitzgerald (ITA Software) CFO.

Natalie Sensabaugh (Picis/OptumInsight) joins PerfectServe as a clinical advisor.

Elsevier/MEDai names Peter Edelstein, MD (Adventist Health System) as chief medical officer and Gerald Osband, MD (Trizetto Group) as director of product strategy.

UNC Health Care System (NC) promotes Donald Spencer, MD to VP/CMIO.

Announcements and Implementations

HealthBridge and the Greater Dayton Area HIN announce the launch of secure, electronic transmission of immunization data from two primary care practices to the Ohio Department of Health.

Arnot Health (NY) joins the Rochester RHIO.

Healthcare Quality Catalyst says its data warehouse solutions sales increased by 1,100% in the first half of 2012 vs. 2011.

Microsoft announces release of an iPhone app for its HealthVault personal health record, which also includes a list of compatible apps such as iTriage and CareCoach.

Government and Politics

The Department of Defense and the VA eliminate an RFP requirement that proposed pharmacy systems for their combined EHR use First DataBank’s drug database.

HHS awards $48.8 million in grants to bolster epidemiology, laboratory, and health information systems in state health departments to help states fight the spread of infectious diseases.

ONC’s Consumer eHealth Program announces a contest for a mobile app that mashes up an individual’s Blue Button personal health data with open public health data to promote better personal health and lower costs. The top entry wins $45,000.

In England, the Department of Health and the trade department will encourage hospitals to open clinics abroad under the NHS brand to bring in additional revenue. They want to model their services after Mayo and Hopkins in providing services in India and China under the direction of Healthcare UK, an oversight board that has already been created.

Innovation and Research

In the UK, Birmingham Children’s Hospital is testing car-monitoring software that was developed for McLaren’s Formula 1 racing team. Input from 130 sensors provide 750 million data points during a race (fuel use, temperature, and tire wear) and the hospital is using it to monitor the vital signs of its pediatric patients. Says a PICU doctor, “Formula 1 engineers do lots of real-time monitoring during races and look at performance and modeling to see when they should change tires and have pit stops. They’re predicting, essentially, which we don’t tend to do in healthcare. Although we can see what is happening at the bedside, we can’t see trends over time.”

Sotera Wireless receives 510(k) clearance for its ViSi Mobile wireless vital signs monitoring system, whose body-worn sensors use hospital WiFi to allow monitoring to continue as the patient is ambulating or being transported. The company says the device’s output can be sent to an EMR.

Other

Hospital leaders rank WellPoint the worst health plan in the country, with BlueCross finishing last based on payment rates.

A former Florida Hospital Celebration ED employee is arrested following accusations that he sold the information of 700,000 auto accident patients to chiropractors and attorneys.

Sunquest held its annual executive summit on August 6 as the kickoff of its user group meeting, with presenters that included CIOs Dave Pecoraro of Exempla Healthcare and Allana Cummings of Northeast Georgia Health System along with Steve Lieber, CEO of HIMSS.

An article in The New York Times describes the secretive use of e-score, a “digital ranking of American society” that’s calculated as people cruise the Web. The CEO of eBureau says his product can predict whether a given person is likely to be a good or bad prospect in less than a second, scoring 20 million people a month and selling the names to interested companies. A spinoff uses similar information to decide which online ads to display. Clients send lists of sales leads they’ve bought, then eBureau extrapolates and adds details from other databases to generate up to 50,000 variables per person, which it then grades against similar factors for existing customers. Sounds harmless enough until they start selling scores to insurance companies or employers.

MD Anderson (TX) notifies 2,200 patients that their information was compromised when a trainee lost an unencrypted thumb drive on the employee shuttle bus. The feel-good part of the notice says they’re working at device encryption and have purchased encrypted thumb drives, probably hoping that nobody will remember that an unencrypted laptop was stolen in April that contained information on another 30,000 patients.

The State of California sues a plastic surgeon (who also apparently graduated from law school) for using strong-armed collection tactics on ED patients whose insurance doesn’t cover the full amount of her bill. She has sued more than 50 patients, taken out liens on their homes, and damaged their credit ratings, the state says. Her attorney admits that she is “very persistent” in her collections effort, but says she’s entitled to be paid. Other attorneys say so called “balance billing” isn’t common the ED because the patient doesn’t really have a choice about who to see, plus California law specifically requires doctors to settle their payment disputes with the insurance company and not the patient. Her lawyer has an answer for that, too: the patients were stable in the ED, so these weren’t emergency situations.

And administrative director at Maine Medical Center sues his employer, claiming they fired him for speaking out against the tradition of taking sports medicine residents attending an out-of-state conference to strip clubs. He says the hospital retaliated by moving his office to the attic of an old building that has bats. The hospital says he wasn’t very professional in raising his concerns, piping up at a department leadership meeting and addressing a physician in attendance, “So, what do you want to tell us about the lap dances at your conferences?”

Strange: a hospital in Israel recognizes clowns as members of the healthcare team, with up to 20% of surgeries featuring pre-op clowns to reduce tension and thus the amount of anesthesia required. A study found that in vitro fertilization success rates increased from 20% to 36% if the patient received a pre-procedure visit from a clown dressed as a bumbling chef. An American doctor says it probably won’t work here since a lot of us find clowns annoying.

Sponsor Updates

• Billian sponsored last week’s Lekotek of Georgia Run 4 Kids that benefits special needs children, with its team receiving a bronze medal for participation in the four-mile run.
• Virginia Physicians selects eClinicalWorks EHR for its 58 providers across eight locations.
• Visage Imaging announces GA of an upgrade of its Visage 7 Enterprise Imaging Platform with enhancements that include lesion tracking, drag-and-drop support, single-click attachment of non-DICOM images, and integration with Nuance PowerScribe 360.
• Capario launches an integrated patient pay solution in partnership with TransFirst that facilitates the collection of patient payments, including co-pays, deductibles, and balances after insurance has paid.
• CommVault announces the integration of Nimble Store CS-Series with CommVault Simpana snapshot management software as part of the IntelliSnap – Connect Program.
• Kony Solutions acquires Sky Technologies of Melbourne Australia to expand its global enterprise mobility market.
• Prognosis Health Information Systems sponsors a Webcast featuring National Rural Health Resource Center CIO Joe Wivoda discussing EHR for rural health leaders.
• The Nashville Area Chamber of Commerce names Cumberland Consulting Group, Emdeon, HealthStream, and Shareable Ink among the finalists for its second annual NEXT Awards.
• dbMotion and Allscripts host a webinar on preparing for accountable care.
• Anesthesia Business Consultants partners with Surgical Information Systems to integrate data captured in SIS’s AIMS with ABC’s anesthesia billing tools.
• Inc. names the following HIStalk sponsors to its list of 5000 Fastest Growing companies:  Beacon Partners, Culbert Healthcare Solutions, eClinicalWorks, Enovate, ESD, etransmedia Technology, GetWellNetwork, Greenway Medical, Hayes Management Consulting, Healthcare Growth Partners, Iatric Systems, Impact Advisors, Ingenious Med, Intellect Resources, iSirona, Kareo, maxIT Healthcare, MED3OOO, MEDSEEK, Virtelligence, and Vocera.
• A Wolters Kluwer Health Survey finds that a third of Americans have experienced a medical mistake, with two-thirds of them  firsthand or from a third party. The majority of respondents expect new technologies to reduce errors.
• CPU Medical Management, a division of MED3OOO, announces a vendor partnership with eBridge to offer a combined PM and document imaging solution.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 8/20/12

From The PACS Designer: “Re: data visualization. The concept is booming outside of healthcare. One of the beneficiaries is Tableau Software. They have free trial software for anyone in the healthcare field to try if they want to get an idea of what can be accomplished with it.” I’ve played around with it a couple of times over the years courtesy of their free trial offer. Both times I thought it was pretty cool initially, but I quickly ran out of stuff to try and lost interest. I probably would have kept working with it had there been specific, short examples or pre-loaded demonstrations of why it’s better than Excel 2010’s pivot tables or Analysis ToolPak, which can do quite a bit and don’t cost $999 for the personal version. Tableau gets a lot of love out there, so I assume it works well once you figure out what you’re doing and starting throwing more complex data at it.

From EHRbitrator: “Re: EHRevent. The EHR event reporting system has been showing an ‘under construction’ message. What’s going on with it?” I asked Ed Fotsch MD, CEO of PDR Network, the company that donates the resources to run EHRevent (PDR hosts the service, but it’s managed by the non-profit iHealth Alliance). Ed says that since EHRevent was launched, the Institute of Medicine report called for a national approach to health IT safety, which would have required EHRevent to expand dramatically. PDR Network and the iHealth Alliance decided to suspend the service pending a decision by the federal government on IOM’s recommendation. I interviewed Ed about EHRevent and other topics in November 2010.

Nearly two-thirds of poll respondents say that Meditech’s market position has worsened in the past year. New poll to your right: Allscripts is emphasizing its “open systems” message. By your definition, would you characterize the systems it sells as open? Once you’ve voted, show your work by clicking the Comments link on the poll and explain what your definition of “open” actually is.

Inga and I read tons of press releases and often roll our eyes at how badly done they are (which usually means the alleged news won’t see the light of day on HIStalk or probably anywhere else). Instead of just making fun of the PR atrocities, we’ve put together a list of 25 tips for doing them right. We’ll be sending it out to our sponsors, who no doubt will rise to the top of the press release heap after heeding unconventional advice from hack pseudo-journalists like ourselves.

Listening: The Bamboos, big-band soul from Australia (“funk from the deep southern hemisphere”). That’s when I can tear myself away from the purely angelic First Aid Kit, which is harder after I found this video that I’ve watched in amazement about 20 times. I’m listening to it solo in the house as I write this Saturday morning, having taken Mrs. HIStalk to the local farmer’s market for some summer tomatoes, a vegan barbeque hand pie that I ate right there in the parking lot, and a blueberry-cardamom goat cheese cake for later. She’s off for the facial and massage that I arranged and I’ll meet her for lunch (barbeque may or may not be involved), followed by my usual exercise routine, more work, and one of the Sierra Nevada Summerfest Lagers that I tried a couple of weeks ago and bought today. Maybe it gets better than that in your world, but not in mine, except maybe when college football starts in a couple of weeks.

Quality Systems Inc. held its shareholder meeting Thursday, but says the results of the board member election won’t be available until this week. In other words, we don’t know yet whether dissident shareholder Ahmed Hussein was able to wrest control of the company via his proxy campaign (although rumor has it that he lost and demanded an independent recount, which is why it’s taking so long, but that’s unverified). Hussein’s previous attempts failed, but that was before QSII shares took a beating and he added former QSI President Pat Cline to his slate of director nominees. Shares have rebounded to $19 after touching off the $16 range three weeks ago, which would be fantastic news had they not been in the mid-40s when the ugly slide started in April.

Stan Nelson, founder and chairman of Scottsdale Institute and former CEO of some major Midwestern health systems, died earlier this month at 85. The guestbook is here.

Dick Schopp, a 50-year healthcare IT veteran, died August 16 at 75. He had worked for McAuto and HIS, Inc. and also founded Healthcare Computing Strategies. He was a principal with HIS Professionals, LLC. He is survived by his wife Pat, five children, 27 grandchildren, and seven great-grandchildren. Vince Ciotti let me know and says he’ll have a salute to Dick in his next HIS-tory.

The VA awards a $4.5 million, one-year contract with four optional years to Ray Group International to restructure the MUMPS code of one module of VistA as well as its application layer, making it more modular. That’s the same company that got a $4.9 million contract in June to develop the VA’s OSEHRA project to make VistA an open source, community supported application. I’m impressed with CEO Ronald Ray: a Marine and Green Beret battalion commander for 21 years, three tours in Vietnam as a platoon leader, recipient of the Medal of Honor, a White House Fellow, and assistant VA secretary. He did something in Ia Drang Valley in 1966 that I thought only happened in movies: as he was getting his legs shot up by machine gun fire, he flung his body onto a live grenade to protect his comrades.

An article by two Yale economists says women would be better off financially to become physician assistants instead of doctors. Reason: women in medicine work fewer hours than their male counterparts, so their correspondingly reduced earnings don’t readily cover the high cost of medical school. If you didn’t buy the “an increased supply of doctors creates its own demand and therefore increases healthcare costs” argument, you might suggest that healthcare reform dictate a faster and cheaper pathway to becoming a primary care physician. You know the financial dynamics in play, however: universities love healthcare professions programs because they can charge huge tuition (knowing that students can get loans easier with expectations of eventual high incomes) and every healthcare profession is fiercely protective of its own, doing all it can (like any other business) to raise the barrier to entry to keep cheap newcomers out. On the other hand, it’s sad to see how many students take up one of those valuable spots and then either never practice medicine or gravitate to one of the high-paying specialties that does little to improve population health.

Several companies named as best to work for by Consulting magazine offer healthcare IT services. I don’t know all of them, but those I know as primarily serving healthcare are Impact Advisors, Aspen Advisors, and Cumberland Consulting.

West Virginia University Hospitals-East goes live on Epic.

ED management company Emergency Physicians Medical Group will implement a digital dashboard from Emergency Medicine Business Intelligence for its 44 hospital customers to improve ED turnaround time. Scott Richards, one of the two principals of EMBI, used to be an IT director at UAB Health System.

Consumer health expense management software vendor Patientco gets $3.75 million in funding. It offers patient-friendly bills, multiple bill payment methods, and secure patient-to-provider messaging for asking questions about a bill. They register using a secure code printed on their statement. 

Fidelity National Information Services sells its healthcare payments and claims business to a private equity firm for $335 million.

A University of Florida study finds that patients with three or more chronic conditions are only half as likely to receive treatment for depression if their doctor uses electronic medical records. The researchers speculate it’s because EMRs reduce the time doctors spend with patients or perhaps the EMR directs their attention to purely physical issues.

I’m always fascinated that this happens all the time in India when relatives suspect hospitals or doctors of substandard care of their loved one. Family members go on a rampage after the death of a hospitalized teenager, destroying hospital computers, breaking windows, and attacking police officers. Eighteen family members were detained and eight police officers were injured, two of them requiring hospitalization.

A former VA hospital employee who won a $1 million lottery prize in January of last year buys a scratch-off ticket, but gives it to a beggar in the convenience store. It turns out to be a winner worth $260K. She protests to the lottery commission, saying the man pressured her and she intended to give him money instead, but surveillance camera footage and interviews show she gave him the ticket voluntarily. Despite the million dollars she won, the woman claims she’s broke because of medical bills and her unpaid leave from the VA. She’s writing a book about her life.

Strange: a nurse performs her own fecal transplant to cure her chronic diarrhea, using her husband’s feces, a blender, and a turkey baster. She told the reporter that she kept the blender, so I’d suggest passing if she offers you a Margarita.

Vince’s HIS-tory this time is about INFOSTAT. If you’re watching on NBC, mute your TV now for a spoiler: “They were acquired by Keane in 1995.”

Sponsor Updates

• Assisting Lee Memorial Hospital (FL) its its just-mentioned Epic go-live was HCI (Healthcare Clinical Informatics).
• Elumin Healthcare Solutions has expanded its LinkedIn page to keep its consulting customers and associates up to date on the company’s activities.
• Visage Imaging offers an online white paper (no registration required) called It’s Your Image: Top 15 Reasons to Consider an Enterprise Imaging Viewer.

E-mail Mr. H.