News 7/11/12

Inga and I are on a short break for another couple of days, so I’ll keep my posts brief (and rather Spartan) so that Mrs. HIStalk doesn’t feel neglected on vacation. If I’ve missed anything important, let me know.

From UK Lurker: “Re: Epic. As Epic projects get going in the UK, is there any indication of how UK customers will be handling their project team staffing? Are they using US-based consultants who have experience with Epic? UK firms that know the NHS?"

The CEO of Baptist Memorial Health Care (TN) says he is “thrilled” to announce that the organization has signed with Epic. We reported the rumor from Jog that Epic would replace McKesson Horizon there on July 6.

Kevin Shimamato is named interim CEO of Tulare Regional Medical Center (CA). He was previously CIO at Sierra View District Hospital and says it’s a trend that hospitals are hiring CEOs with a technology background. He applied for the job through his consulting company. 

MyHealthDIRECT names board member Tom Cox (Healthways) as CEO. He replaces founder Jay Mason, who will remain with the company and continue serving on its board.

University of Virginia and GE Healthcare head off to court this week over what UVA says is the failure of the former IDX to meet hospital information system implementation milestones going back to 1999. GE Healthcare bought IDX in 2006, the hospital says GEHC didn’t resolve the issues, and it’s suing for $30 million after already moving to replace IDX with Epic. GEHC says UVA didn’t make an effort to fix its own project and still owes it money. 

Weird News Andy is glad to see that these nurse assistants have been banned from healthcare. While working on contract for the Virginia Veterans Care Center, they took four wedding rings from elderly veterans suffering from dementia and other chronic conditions, pawning them immediately for a total of $405 (their appraised value was over $4,000.) The first was found guilty, but says she took only two of the rings and claims she didn’t remove them forcibly, although at least one of the victims had bruised fingers. She could be sentenced to up to 120 years in prison. Her partner in crime (check out her photo above – would you voluntarily choose her as your caregiver?) will be tried later this month.

Sponsor Updates

• University Physicians (CO) will deploy GE’s Centricity Business solution across its hospitals and physician practices.
• Legacy Health (OR) selects ProVation Medical software by Wolters Kluwer Health for its GI lab documentation and coding at five hospitals.
• Hartford Healthcare Corporation realizes $15.3 million in financial improvements within a year of selecting MedAsets revenue cycle solutions.
• DrFirst launches an e-prescribing task force to assist New York physicians in meeting the requirements of i-STOP.
• Southwest Community Health Center (CT), an FQHC, will deploy NextGen EHR, PM and Electronic Dental Record across its 12 locations.
• InMedica, a division of IMS Research, names Merge Healthcare as the #1 vendor neutral archive provider in its recent market study.
• OrthoKC (KS) selects SRS EHR for its 10 providers.
• e-MDs congratulates its client, Princeton Healthcare Affiliated Physicians, for the successful MU attestation of all 21 eligible providers.
• Optum launches coding technology to facilitate and accelerate hospitals transitioning to ICD-10.
• NextGate highlights two wins by its partners, Orion Health and Covisint, using its EMPI and provider registry.
• New York City Health & Hospitals Corporation attests to Stage 1 MU in all 11 hospitals and met interoperability requirements by exchanging data with New York’s RHIOs using QuadraMed solutions.
• James Backstrom MD of Foundation Radiology Group and Robin Brand of The Advisory Board Company will present strategies to increase imaging referrals during a free webinar July 19.
• Memphis Obstetrics & Gynecological Association (TN) selects MED3OOO’s InteGreat EHR for its 24 providers.
• MEDSEEK partners with BrightWhistle to resell its social patient acquisition solutions.

E-mail Mr. H.

Monday Morning Update 7/9/12

From Gob Bluth II: “Re: Health Information Partnership for Tennessee (HIP TN). HIP RIP. Another HIE bites the dust.” Verified. Gob forwarded the e-mail that went out to stakeholders on Friday, along with a copy of the official announcement that will be released Monday. The three-year-old state network says officials decided to pursue a simpler strategy of using the DIRECT system as a HIP replacement. HIP TN chose Optum’s Elysium Exchange (the former Axolotl) in October 2010 and now it’s going to the Greek mythology version of Elysium, the afterlife of the chosen.

From Data Birth: “Re: Consumer Reports hospital safety rankings. I’ll wager the reason the data were inconsistent or missing is because hospitals don’t want this particular information to reach the eye of regulators or the public. You would think this would be available through Joint Commission inspections.” In my experience, the Joint is good for two things: (a) reacting to headlines by setting big-picture goals and ever-moving standards that never result in hospitals getting punished, and (b) clearing the hallways of carts and getting storage boxes away from the fire sprinklers, which happens only when their inspectors are on site. Hospitals in the past have been given a clean bill of health by Joint Commission, only to be threatened with shutdown immediately afterwards by inspectors from the state or CMS over egregious patient safety problems. I’m not casting implications on the Joint’s motivations since I’d much rather have them than not, but they’re making nice coin by not only selling inspections but also the tools and services that help hospitals pass them, and sometimes I think they struggle with the balance of being both a regulator and a vendor (like other similar organizations.) I think they see their role as more consultative than punitive, while sometimes the latter seems more appropriate.

From Max Payne UK: “Re: NHS and Epic. Epic doesn’t have a UK localised product and Cerner is installed in several Trusts. Reportedly, Cerner was cheaper than Epic. So how did Epic wind up being the winner? What consulting company or consultant advised the Trust on this decision?” Hospitals often choose Epic for non-financial reasons: perceived honesty, a near-perfect track record of going live on time, general polish on issues like training and documentation, and lack of Wall Street pressure that could shift their focus quarter by quarter. Not to mention that the big price tags mentioned for Epic projects are all-inclusive of even internal labor, which other vendors don’t include to the later discomfort of their customer. If you’ve seen the actual contracts (and I have), Epic isn’t always more expensive than arguably inferior alternatives. With regard to localization, they have over 5,000 employees and have learned from the mistakes made by others, so the have a leg up on the pioneers before them who crawled back with arrows in their backs. You bring up a good point – do organizations buy Epic because consultants recommend it, or do consultants even get involved with Epic decisions? And as one last thought, Epic (and Meditech) are big enough to command UK attention, but emerged unsullied by the NPfIT meltdown since they weren’t players, so that’s a plus for them. I would hope that those who made the Epic decision talked to the Cerner-using trusts first.

From Konrad: “Re: job stress. I often wonder if part of the fear of EMR and Obamacare is tracking of stressful of employers, like cancer centers. One place I worked actually did that for employees.” The former CEO of France Telecom is released on bail after being questioned by government officials about the suicide of more than 30 company employees in the two years just before he quit. He says the suicide rate was similar to that of non-employees and blames pressure brought on by the economy and the company’s minority shareholder (the French government), but did say he wishes he had paid attention to the warnings of doctors that the company’s massive layoffs and unreasonable performance targets were causing employee health issues.

From BitesTheDust: “Re: John Muir. Epic must have gotten another major McKesson account – this time John Muir in California. Looks like the CIO (Eric Saff) is already gone too as an executive firm looks for his replacement and prefers Epic experience.” They chose Epic awhile back, I think. I had run a rumor here (without naming the hospital) that Epic had originally declined to work with John Muir over some perceived conflict with its IT department and told the hospital’s board as such. I think this may happen more often that we know – the Epic train rolls right over the CIO during selection or implementation when Epic’s way isn’t warmly embraced by IT.

From HR Guy: “Re: stack ranking of employees. Epic does stack ranking as well, with about the same results, combined with the slow hire/quick fire mentality it’s been pretty deadly.” An article about Microsoft’s lack of agility and its fall from swaggering innovator to bean-counting market follower blames stack ranking, the practice that requires a fixed percentage of employees to be identified as great, adequate, or poor, with the great getting promotions and the poor getting shown the door. It concludes, based on Microsoft employee interviews, that everybody spent more time stabbing each others’ backs and sucking up to those who might review them instead of worrying about how Apple was beating them like a drum. Steve Ballmer gets a lot of the blame (honestly, what does Microsoft see in that guy that nobody else does?) but the damage was well underway when Bill Gates was still running the show. A former marketing manager concludes, “I see Microsoft as technology’s answer to Sears. In the 40s, 50s, and 60s, Sears had it nailed. It was top-notch, but now it’s just a barren wasteland. And that’s Microsoft. The company just isn’t cool any more.” Epic does apparently follow the same practice of quickly categorizing employees based on feedback from managers and co-workers who may barely even know them. I like the practice in theory, but as in most aspects of life and business, execution is everything.  

Welcome to new HIStalk Platinum sponsor Visage Imaging. The San Diego company is a global provider of enterprise and advanced visualization solutions that make slow, trickily deployed client-server and Web-based PACS approaches obsolete. No more reconstructions at the modality console while the radiologist twiddles his or her thumbs waiting on digital mammography or PET/CT — Visage 7 makes even the largest multi-slice datasets completely navigable in seconds via an intelligent thin-client viewer displaying server-rendered 2D, 3D, 4D, and advanced visualization imagery on a single desktop (in plain language, huge images don’t need to be pushed painfully and slowly from the hospital data center to the radiologist’s workstation – the server does the work and interpretation gets underway faster no matter where the radiologist is sitting.) Its platform enables enterprise viewing and interpretation and image enablement of EMRs, VNAs, HIEs, and RIS/PACS. You can use it on smart phones and even on Macs. Thanks to Visage Imaging for supporting HIStalk.

I headed over to YouTube to see if Visage Imaging had anything there, and lo and behold, here’s a brand new video on Visage 7 that includes some cool product video (though being a non-radiologist, anything with lots of movement and color seems cool to me).

Clearing out my “Listening” box for now: Phideaux, interesting “psychedelic progressive gothic rock” led by TV soap opera director Phideaux Xavier. Think Jethro Tull, Kansas, and Renaissance rolled into a more modern package with bigger production. It’s really good, especially coming from a guy who directs General Hospital as his day job. I’m playing it loud enough for Mrs. HIStalk to ask me what I’m listening to, though her tone suggests an interest that doesn’t necessarily involve my loading it to her Nano.

Inga and I are coincidentally both traveling this week (not together, just to be clear) so we may be occasionally tardy in our responses and terse in our writing as we take rare simultaneous vacations. Let me know if anything really important comes up this week that I might otherwise miss since I’m hoping to spend a few more hours than usual not working.

Thanks to the following sponsors, new and renewing, that supported HIStalk, HIStalk Mobile, and HIStalk Practice in June. Click a logo for more information as you ponder with me the illogicality of respected, successful companies backing a shoot-from-the-lip journalistic ne’er-do-well who nonetheless appreciates their support in forms that often extend beyond financial to personal. There hasn’t been a day in the nine years I’ve been writing HIStalk that I didn’t marvel at how cool it is to live my Mr. H alter ego even though it’s purely imaginary.

PPACA pretty much splits us as taxpayers, but we apparently like it fine as healthcare IT people. New poll to your right: which group would you target first to reduce healthcare costs? Obviously it’s a simplistic question with limited answer choices, so the poll accepts comments for your further elucidation.

A Physician’s First Watch poll on the Affordable Care Act drew similar results, with 65% of respondents (presumably mostly doctors) saying they like the Supreme Court’s decision (which presumably means they like PPACA).

CapSite releases its 2012 Laboratory Information Systems study. By the numbers, the dominant vendors are Meditech, Cerner, and Sunquest, and 81% of respondents say they won’t be replacing their system within two years. I like reading CapSite’s reports because they’re formatted as PowerPoints saved as PDFs and they get right to the point with charts. I had forgotten until I read the graphic above that Allscripts offers a LIS, which I assume is the former Sysware that it acquired in 2006. I also noticed that Epic’s Beaker is moving up the LIS ladder even though it’s not quite there yet, but probably will be by the time its newly implementing customers are ready to take another look at lab systems.

For the stats-obsessed among us (not me, but maybe Inga, and surely that one person who always e-mails me to ask), June’s readership numbers were really good given the annual summer slowdown: 102,849 visits and 191,515 page views, up a bunch from last year.

Weird News Andy finds the comments left on the Physicians’ Declaration of Independence interesting.

Here’s why e-MDs CEO Michael Stearns is  no longer with the company, as explained to its customers via e-mail. Grizzled Veteran provided that rumor last week. Founder and board chair David Winn has replaced Stearns as CEO.

This might be the first time that a hospital is acquired primarily for the value of its expected Meaningful Use payout. Cookeville Regional Medical Center (TN) will hold back $700K of its $6.7 million acquisition price for Cumberland River Hospital until that hospital gets its $4 million in Meaningful Use money. CRMC’s CEO said, “Part of the viability of this acquisition is the fact the Meaningful Use dollars are tied to it. That’s why it’s vital to have those dollars. That’s why we were adamant to have a hold-back of $700,000 so that we wouldn’t close the deal and they would stop working if they have a chunk of money held out there to comply with the purchase."

Vince continues his HIS-tory this week with HMS, having connected with co-founder Tom Givens to get a first-hand account of those heady days. I suspect many of you who are enjoying Vince’s series lived the experience first-hand in some of the 1970s-80s companies he has mentioned (and those he’ll be mentioning down the road). If so, Vince could use your old pictures and papers for future installments, but most of all, your anecdotes of what it was like back in the day.

E-mail Mr. H.

HITlaw 7/6/12

Practice Fracture and EMR Rights

Physician groups are signing up for EMR technology in a rush in order to meet eligibility deadlines for reimbursement under the HITECH Act. Unfortunately one of the key considerations in the process, the license agreement, is too often seen as a “last step” on the checklist. As I have urged in previous papers and postings, this should not be the case, as many items are overlooked in the push to acquire an EMR, implement, go live, and finally attest to Meaningful Use.

One important issue that is left unaddressed in the supermajority of licenses is transfer rights in the event of a practice split.

By split I do not mean the situation where a physician leaves a practice and the practice remains intact, because in those cases the license stays with the practice. No issue there. The departing doc takes nothing away in terms of license rights.

But when a practice splits and dissolves, what happens with the EMR license? How is data divided and protected? Who is responsible to the vendor for the security and confidentiality of the EMR system?

When licensing EMR technology (or any other type), the practice should negotiate terms for the perhaps unlikely but still possible situation of the practice breakup. The first request to the vendor should be an accommodation permitting the transfer of the license to multiple successor entities in the event of a breakup. Note that this will rarely, if ever, be without additional cost to the subsets of physicians, and many vendors have minimum provider thresholds, all of which is fair. If a vendor does not market customarily below a certain provider level, there is a reason, which is in most cases ongoing cost. They have determined the minimum sustainable level at which a product can be licensed, enhanced, and supported.

That said, the key issue here is the right to split the license should the need arise. No vendor wants to lose a client, and if the vendor can accommodate a license split, they actually increase their client base and revenue stream.

Next on the priority list would be some recognition by the vendor that in the event of a non-subscription-based license split, some accommodation will be made in terms of original license fee investment. (Quick sidebar – I exclude subscription-based systems because there is no upfront, perpetual license fee – it is simply pay as you go.)

With regard to non-subscription license fees, providers should not expect a known, predetermined allowance, as there are too many factors involved. For example, a five-provider license could be split into subsets of providers in 120 different ways, if my math skills are still up to par (5 factorial, or 5 x 4 x 3 x 2 x 1). Now do the math for a 10-provider license and you will be amazed at the number of combinations. Further, if the license is more than five or seven years old, the practice has in all likelihood taken a full depreciation on the initial investment and should keep this in mind.

I suggest that the most you could reasonably request is a statement that the vendor will make an accommodation of some type with regard to license fees, perhaps on a prorated basis allowing for depreciation and subject to the vendor’s minimum provider level. Prior implementation costs and support fees are clearly not eligible, as those services were provided and paid for. However, there may be a savings to be realized if minimal implementation and training are required by the new practices due to the familiarity with the incumbent vendor’s system. There is real incentive to the vendor to move from a single customer to multiple customers, with no sales effort, minimal implementation effort, and increased revenues, both one-time and recurring. The flip side is the customer should not expect to split a single license into multiple licenses and systems with no corresponding increase in fees, especially support fees.

Although not a pleasant topic, the practice breakup is a possibility, and having a pathway for continued use of the subject technology is important. If done up front, it means one less (or smaller) headache should the breakup occur.

Another very important issue is the data in the EMR. If a practice breaks up, what happens with the data? The first issue here is to determine what happens between the physicians with regard to their respective patients’ data. Consider record retention periods and ongoing access to records by patients or former patients. These are not issues for the vendor, and the best time for the practice to address these issues is when the EMR (or other) technology is acquired.

The associated request to the vendor should be a “transition services” accommodation. This should include the willingness to export or convert data to another vendor’s system should the practice at some point move to a different technology, obviously at a cost. Next you should discuss and investigate (before signing), the ramifications of splitting data into subsets, even if to populate new systems from the same incumbent vendor, and address those as well. Find out before implementation if there are any issues to consider regarding how the EMR or associated database should be structured.

Finally, when the practice breakup occurs, what happens with the original EMR system? The customer practice has obligations to the vendor. These must be carefully considered and fully performed. From the vendor’s point of view, it does not really matter which entity (original or successor) is responsible, but that there is an accountable entity involved. This may not be necessary if the original system is split and licensed anew to subsets of the practice, with the eventual result that there is no “old system.” However, too many times I have assisted vendor clients in situations where the provider customer expects new systems to be created with credit(s) or allowance(s) given for the original system, but then also expects to keep the original system alive and well and running in order to access historical data.

It doesn’t work that way, especially if the original practice is dissolved. The vendor needs protection. Providers should recognize that if you “want it both ways” you should expect to pay full price for the new systems, which is entirely fair. I have used the example many times that you cannot purchase a new car at a price based on trading in your old car, and then decide to keep the old car with no corresponding increase in price for the new car. Note there is also the reasonable middle ground where the old system may be accessed and “wound down,” with corresponding support fees, for a limited period of time after which the system goes away and the customer certifies this to the vendor.

When practices do not work out details ahead of time as to license and data ownership rights, the vendor gets drawn into the fray. As far as the vendor is concerned, the original licensee — the practice itself — is the holder of the license and the owner (as between vendor and customer that is) of the associated data. If you find yourself in this situation as a provider customer, develop a few options that might work between practice members and then approach the vendor.

Just keep in mind that no vendor wants to be asked to decide issues that are properly between practice members. If your EMR license agreement does not contain language permitting a partial license transfer for the benefit of practice members in the event of a practice split, you can imagine what might result. Some members might want to continue using the system and consider the license “theirs”. Others might seek to block that effort. Both might go to the vendor and ask for a ruling. For the benefit of all, I will repeat once again, address these issues up front at acquisition time.

In summary, practice groups should plan ahead when signing for new technology. Negotiate license transfer rights. Expect to pay something, but know you have established a transfer pathway. Determine between practice members what happens with the practice data if the practice breaks up. Discuss this with the vendor, address conversion of data in the license, and investigate database configuration options for implementation time. Do all this at the time the technology is acquired.

Time spent addressing important license issues at the acquisition stage helps avoid future problems, whether between practice members or the practice and the vendor.

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

News 7/6/12

Top News

Consumer Reports rates hospitals on safety in the August issue just published, with a surprising number of the big names omitted from the top. The safest hospital in the country, says CR, is Billings Clinic (MT) with a score of 72 on a 100-point scale. The worst is Sacred Heart Hospital of Chicago, which racked up a 16. At the bottom of their respective states: Central Florida Regional Hospital (FL), South Fulton Medical Center (GA), Wake Forest Baptist Medical Center (NC), Medical Center of Lewisville (TX), and Clinch Valley Medical Center (VA). However,they could only review 18% of US hospitals because of missing or inconsistent information (there’s another IT challenge if you’re up for one). Criteria were infections, readmissions, communication, CT scanning, complications, and mortality. You can bet that hospital marketing people are spinning the numbers even as we speak given that even the top-rated hospitals still scored low.

Reader Comments

From Grizzled Veteran: “Re: e-MDs. Word on the street is that President and CEO Michael Stearns is no longer with the company. He’s no longer listed on their management page.” Unverified, but his bio has indeed been expunged.

From Jog: “Re: Baptist Memorial Memphis. A buddy told me they’re leaving McKesson for Epic.” Unverified.

HIStalk Announcements and Requests

The latest goodies from HIStalk Practice: attorney Jessica Shenfeld discusses four questions every physician in private practice should ask themselves. Hayes Management Consulting’s Rob Drewniak provides advice for practices to improve internal security and protect against security and privacy threats. Lawmakers introduce legislation that would allow behavioral health providers to participate in the MU program. AMA recommendations for practices weighing HIE options. If you are are not a regular HIStalk Practice reader, what are you waiting for? And if you are, thanks for reading.

I replaced HIStalk Mobile’s comment function with a version that improves readability, allows logging in with Facebook credentials, supports easy subscribing to comment updates, and allows easy sharing of comments with social networking sites. It has other functions that I’ve turned off for now, but look it over on this post and let me know if you think I should install it on HIStalk as well. Try posting a comment, but just remember it’s like HIStalk in that incessant spamming from overseas has forced me to approve each comment, so you may not see yours immediately.

Listening: Black Bonzo, Swedish rockers that sometimes sound like 1970s hard-rocking but musically precise prog bands like Uriah Heep, Deep Purple, and Kansas with a bit of Anglagard mixed in. They’re sporting big Mellotron and Hammond organ sounds, always a plus in my book. And if you’re looking for something laid back and different but still proggy, try fellow Swedes Moon Safari.

Sales

Oak and Main Surgical Center (NJ) selects SourceMedical’s Vision OnDemand for EHR and billing.

Gilbert Hospital and Florence Hospital at Anthem (AZ) choose the Healthcare Management Systems EHR.

People

Mobile health development tools vendor Diversinet names Bret W. Jorgensen (MDVIP) chairman of the board to succeed Albert Wahbe, who is retiring as chairman but keeping his board seat.

Other

Doctors at Australia’s Gold Coast Health say their new clinical system is “totally inadequate and dangerous” because of log-in problems, delays in finding records, and lost information. A hospital spokesperson admits that the system is “very bare-bones” and “does some things particularly poorly,” but they don’t have the money to fix the problems. The hospital’s rollout was part of a $200 million Cerner project by Queensland Health, which was accused of fast-tracking its Cerner selection by intentionally wording its proposal to exclude other vendors. 

Also in Australia, a Canberra Hospital executive admits that the hospital changed dozens of ED records each day to make their publicly reported ED wait time stats look better. Auditors also found that the user accounts under which the records were altered were generic and had weak passwords that had never been changed. The auditors also noted that the iSoft system has a “feature” of not recording previous values when information is changed, making audit logs nearly worthless had the hospital checked them (which they hadn’t.)

And in yet another Australia story, the government admits that its recently launched $480 million personally controlled health record system can’t accept patient names with hyphens, requiring online registration to be taken down right after go-live. Accenture gets the black eye, not only for that, but also because the system was hacked during development because of what the government says was sloppy Accenture security practices. Other reports suggest that Accenture completed only 40% of the agreed-on work by go-live. The president of the Australian Medical Association summarized the system’s launch as “throwing a paper plane out the window at Cape Canaveral.”

A newspaper in M*Modal’s home state of Tennessee questions why the company wants to sell itself for what some analysts are calling a too-low price of $1.1 billion, saying it’s worth at least $300 million more than that and that it would be better off pursuing its growth with a financial partner rather than a new owner. Several law firms are threatening to file the usual shareholder class action lawsuits that claim the company didn’t hold out for maximal shareholder return.

In Canada, Hotel-Dieu Grace Hospital rolls out a bed control smartphone app that displays available beds, expected discharges, and the length of time ED patients have waited for a bed.

Greenville County, SC pilots software in a program to triage low-acuity 911 calls to a nurse to determine if emergency response is warranted. The chief medical officer of Greenville Hospital System says that 5% of patients use 50% of the system’s ED resources, with 61 patients accounting for 1,000 visits in one year (with one patient racking up 100) and most of them weren’t really emergencies. They cite figures saying that connecting patients to a medical home, managing their care, and helping them with transportation and prescription costs reduced the ED visits by 26% and patient days by 55%. The county says 20% of the 911 calls it gets are for non-emergency situations, but it is still required to send an ambulance at a trip cost of $280. The software they’re using isn’t named, but is used nationally in the UK.

Methodist Dallas Medical Center (TX) suspends its kidney and pancreas donor program after transplanting a donated kidney into a patient who wasn’t next in line on the recipient list. The hospital blames human error – the donor ID number wasn’t matched to the recipient.

UnitedHealthcare launches its Blue Button program, which like the original VA program will allow its 26 million insurance enrollees to view, print, and download their health information by mid-2013.

Access to medical care isn’t a problem for some: the governor of Iowa is hospitalized “out of an overabundance of caution” after choking on a carrot and vomiting it up during a ceremony.

Only in America: a New Jersey woman hit in the face by a baseball at a Little League game two years ago says the 11-year-old catcher did it intentionally when he overthrew the pitcher he was warming up in the bullpen. She’s suing him for medical costs plus pain and suffering, plus her husband has added his own damages of loss of her apparently valuable consort to raise their demand to $500K. The boy’s parents, both Little League volunteers, say they’d like to beat the charges in court, but it would cost thousands of dollars and require the young players to take the stand. The Little League national organization has refused to get involved.

Sponsor Updates

• Sunquest Information Systems hosts its annual users group conference August 6-10 in Phoenix.
• ZirMed earns full EHNAC HNAP certification.
• CSI Healthcare IT spotlights its 2011 sales leader, Bryan Richardson.
• NextGen’s parent company Quality Systems Inc. wins two Gold Stevie Awards in the 10th Annual American Business Awards.
• CPU Medical Management Systems, a division of MED3OOO, releases Version 7.01 of its MED/FM practice management and billing software.
• Consultant Cynthia Castro discusses the ease of the 5010 conversion process using Kareo’s software.
• NextGate posts a fun story highlighting the travel adventures and challenges of two of its engineers implementing NextGate EMPI in Spain. 
• Lancet joins the Informatica INFORM Channel Partner Program.
• nVoq director Derek Plansky discusses the advantages of using speech recognition with CPOE.

EPtalk by Dr. Jayne

The AMA reports that through efforts to process health insurance claims more effectively, more than $8 billion has been put back into the US healthcare system. I’m not sure where the savings has gone. The report mentions that physicians had to spend more time on prior authorizations, adding $728 million in “unnecessary administrative costs and countless hassles.” I’m betting that much of the savings went into for-profit coffers.

No surprise: a study published last month found no association between patient satisfaction and a practice’s adoption of patient-centered medical home processes. A researcher states, “It may lead to better care for the patient, but some of these things maybe turn these places into factories.” Based on anecdotal evidence from the Medicare beneficiaries in my family, I don’t disagree. Team care results in less face time with their physicians. Even though patients get better diabetic care, they don’t perceive it as having as much value as chatting directly with their physicians (even about subjects unrelated to their care).

A bill recently passed in the Pennsylvania Senate moves the Keystone State closer to its first statewide health information exchange. Governor Tom Corbett plans to sign it, setting up the Pennsylvania eHealth Partnership Authority to oversee its development. The goal is a decentralized system to connect regional private HIEs currently under construction.

Citrix offers a video promoting the ability for physicians to always be accessible “whether it’s in the middle of the night or on their day off.” Grammar issues aside, I’m not in favor of the idea that physicians need to be accessible 24×7. I see too many burned out docs on a daily basis. New technologies allow them to access charts from everywhere, making them reluctant to sign out to covering partners. Allowing people time to unplug and participate in self-care activities is essential to promoting healthy caregivers. I know the kind of decisions I make when I receive a phone call at 2 a.m. while I’m on vacation, and they’re generally not at the level I want to deliver where patients are concerned.

For ambulatory EHR developers: a recent study finds that more than 25% of American teens have sent nude photos of themselves electronically. The authors suggest that physicians who care for teens ask them about sexting practices. It’s time to think about adding some new questions to those well-child visit templates, I suppose.

Quote of the day: “Harassment is supposed to be sexy. You’re not even doing it right.” Thanks to one of my favorite consultants, I was recently introduced to Better Off Ted. For those of you who haven’t seen it, the plot revolves around the R&D department of a soulless conglomerate. In some ways it reminds me of our industry. Episodes are 21 minutes long, which is just the right length to take a break but not feel like you’re idly wasting time.

Thanks again to all the readers who sent birthday wishes on Facebook, Twitter, and e-mail. It was nice to receive them throughout the day and they helped mitigate any dread of being a year older. I’m pretty sure being a CMIO ages one more rapidly than other careers. However, I’m content knowing that with age comes wisdom (or at least the sense of having been there and done that, and knowing how much heartburn a new project will bring when you see it coming 50 yards away).

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 7/4/12

Top News

Speech recognition vendor M*Modal will be acquired by the private equity arm of JP Morgan Chase for $1.1 billion in cash, representing an 8.3% premium over Monday’s closing share price. Philips owned a 70% share of MedQuist until 2008, when it sold its shares to CBay for $200 million. The resulting MedQuist Holdings then acquired bankrupt transcription vendor Spheris in 2010, acquired M*Modal in July 2011 for $130 million, and then took that company’s name in January 2012.

Reader Comments

From HISEsq: “Re: Cerner. Sued for patent infringement by a patent troll named CeeColor, whose only claim to fame seems to be suing HIT and security companies.” CeeColor’s intellectual property, like that of other patent trolls, is vaguely described. In their case, it’s a proximity-based computer security system. I mentioned in March that the same company sued Imprivata claiming similar infringement. Googling their name turns up nothing but lawsuit filings, so one might logically assume all they have is a patent bought elsewhere and a lawyer with lots of free time available to hound companies into paying them “licensing fees.”

From Reppin’: “Re: GSK. You should run the GSK Las Vegas sales kickoff video if you can find it. That’s what’s wrong with healthcare. The big boys scream to government, ‘Get off our backs, we can regulate ourselves.’ They can’t, and a $3 billion fine is nothing to them. Executives should have been fired. They aren’t alone: Abbott, Pfizer, etc.” Drug maker GlaxoSmithKline will pay $3 billion for promoting two of its popular drugs for unapproved uses and for hiding safety information about a third drug. Its marketing tactics included sending doctors on pheasant hunting trips to Europe and paying them for speaking. GSK pushed doctors to prescribe Paxil for depression in children even though the drug was not approved by the FDA for patients under 18. GSK says it has learned its lesson, which would be remarkable given the very long list of similar problems the company has bought its way out of over years (overbilling Medicaid, charging third-world countries high prices for AIDS drugs, adulterating drugs, dodging US taxes, and hiding drug side effects.) Company profits dropped in the most recent quarter to a “disappointing” $2.1 billion, so the “huge” fine amounts to around 18 weeks’ of profit. Maybe that’s the lesson they’ve learned – settlement payouts for arguably criminal wrongdoing are just a marketing cost. If it were me, I’d go after the docs who were willing to place their patients in danger for perks – publishing their names publicly should have been a condition of the settlement. We know drug companies often lean toward scumbaggery given ample opportunity, but they didn’t take the Hippocratic Oath and represent themselves as the patient’s advocate while pimping out their prescription pads.

From Luis: “Re: GSK. Cleveland Clinic is mentioned. Did they find the drug problems with data mining out of Epic?” The original journal article was published by Steven Nissen MD, chairman of cardiovascular medicine at Cleveland Clinic and drug company critic. He did the legwork proving that Vioxx and Avandia cause problems, leading to an FDA crackdown on their use. Above is an interview in which he talks about healthcare reform and how Cleveland Clinic is different. They went live on Epic on the ambulatory side in 2000, so they may well have dug into their own data to link drugs to patient harm. Even if they didn’t, many health systems will be able to do that going forward – all they need is enough patients to make a valid sample size.

From GreenGiant: “Re: Valley Medical Center, Renton, WA. Live on Epic ambulatory on July 2.” I apparently missed the link on their main page. Its board voted in December 2010 to move from McKesson to Epic.

From HIT Guy: “Re: fat-producing foods. The Supreme Court talks about broccoli, healthcare firms punish obese workers, and Vince Ciotti talks about making certain foods expensive. Science is now saying that diets that were previously thought good for you aren’t, and the early studies were good examples of how not to do a study.” A New York Times article talks up a theory that I believe in firmly: weight isn’t as simple as calories in minus calories out, with a new study finding that it’s more about the carbs consumed than the calories. My theory is that weight problems are due to fat storage and insulin regulation (i.e., the hypoglycemic index), not just taking in more calories than are burned off. I also believe that not all exercise is created equal, and pure cardio is good but building muscle is better. You can run your butt off on the treadmill for an hour and only burn the equivalent of a candy bar, so that’s not going to work for most folks unless their body composition changes.

From James: “Re: healthcare system repair. Taiwan was a free market system like ours and became one of the best by going with a single payer, which gets the full pool of money for both healthy and sick patients, can’t cherry pick the young and healthy, negotiates prices with providers and manufacturers, and makes judgments for what to reimburse. Private payers still have a crucial role for all the stuff that the main payer doesn’t cover, like physical therapy, allied health, home care, etc.” I’m frustrated enough with the current non-system here that this alternative is sounding attractive.

From Tom: “Re: healthcare system repair. If I could change one thing, it would be to eliminate employer-based health insurance, a remnant of the World War II era. Individuals buying insurance directly from payers improves continuity of care, removes a major employer cost, incents individuals to manage their health, and reinforces the need for interoperability. It would open the floodgates on HIT innovation and use of tools such as mHealth and PHRs.” I’m becoming cynical that any solution that involves insurance is doomed. Not only because insurance companies will always find ways to make a profit from healthcare, but because healthcare insurance covers more than just catastrophic situations. Homeowner’s insurance is relatively inexpensive because you collect significant amounts only if you suffer major damage, which nobody in their right mind wants, so if we all pay a little everybody is spared from losing their home due to a tornado or fire. Imagine the cost of homeowner’s insurance if it covered every possible problem with appliances, appearance, and the lawn and business were created around collecting inflated payments for providing those services. Not only would policies be priced out of reach, services would become so expensive that you’d have to have insurance to afford them, causing prices to just keep going up to everybody’s benefit except the person needing the service. I’d like to see the concept of healthcare separated completely from the requirement of buying a third-party company’s actuarial bet that you’ll consume less of it than they charge you.

From SW: “Re: ACA. Stan Hupfeld, former president and CEO of Integris Health, wrote an excellent book summarizing the Affordable Care Act, why solutions for other countries won’t or can’t apply here, and how neither party serves us well.”

From CIO: “Re: ROI due diligence on clinical systems. My organization is spending many dozens of millions to install inpatient clinicals. We paid attention to ROI, but it was not the driving factor, and actually I am grateful for that. Proving out a hard ROI is not only a challenge, but I think it diverts attention from the real reasons an organization may want to pursue a new system. Our organization changed our IT strategy after years of integration issues from a ‘best of breed’ to ‘integrated clinical system.’ We did this prior to the guarantee of Meaningful Use funding because we felt it was the right direction for our organization and patient safety. As a part of our new system installations, we resolved a number clinical and IT data exchange issues that have improved patient safety measurably. One small example relates to interface issues with messages erroring out, requiring manual work to resolve the specific problem. On occasion this included patient allergies and other vital data. And for those of you in the industry, you know all the other examples of data exchange challenges that also impacted best of breed approaches. We could have put a price on risk / actual claims / patient harm for this and related issues, but we kept on focus on the improvements we wanted and not the dollars. And frankly with all the other challenges pressing down on hospitals, I take some pride in knowing that we have a safer environment with our new system than our prior ones. This approach may not stand up to real accounting scrutiny, but I think the real question is, ‘Are patients materially safer?’ For us, the answer is yes.” 

From Bruce Brandes: “Re: Pliny’s question about FDA regulatory oversight of mobile apps. What Pliny is describing is a clinical decision support system. FDA considers these to be at least Class 1 medical devices per their mobile medical app guidance. Where the data is processed is not important. If the input and display take place on a device, whether it’s a mobile app, web page, terminal application, hardware/software product, then the device is a medical device and subject to regulatory oversight. The determination of whether the device is considered Class 1 or 2 depends on the risk to the patient attributed to a misdiagnosis or delay in treatment. From a regulatory standpoint, class 1 and class 2 devices require the company establish and maintain the same quality management system and design and servicing controls. The only difference is Class 2 devices require premarket approval by FDA, Class 1 devices do not.” Bruce is EVP and chief strategy officer of AirStrip Technologies, which has a lot of experience working within FDA guidelines. I’ve always assumed that most of the healthcare apps out there weren’t created with the FDA in mind, but maybe I’m wrong. Feel free to chime in.

Acquisitions, Funding, Business, and Stock

HealthStream acquires Decision Critical, an Austin, TX-based provider of learning and competency management products for acute care hospitals, for $4.3 million.

Dell will purchase IT management software provider Quest Software for $2.4 billion.

Microsoft announces a $6.2 billion write-down of the $6.3 billion in cash it paid to buy online advertising company aQuantive in May 2007.

Announcements and Implementations

Catskill Regional Medical Center (NY) goes live on Epic in its two hospitals of 235 and 25 beds.

Grand Itasca Clinic and Hospital (MN) announces a partnership with Allina Health System to install Excellian, Allina’s version of Epic. Allina will provide implementation assistance and support.

The local paper highlights the T-System and NextGen implementation of White Mountain Regional Medical Center (AZ).

David Runt, CIO of Contra Costa Health Services (CA), tells me that they went live on Epic (called ccLink at their place) on July 1 enterprise-wide (hospital, clinics, and health plan.) I notice from David’s LinkedIn profile that he spent 22 years as a medical service corps officer in the US Air Force Medical Service, so I’ll throw out an Independence Day nod to David and his fellow veterans for their service.

In the UK, Cerner complains to Cambridge University Hospitals Foundation Trust that its EHR bidding process was a sham and it had already chosen Epic without regard to submitted prices. The trust says it followed the rules when it picked Epic in April.

Oracle announces its Health Sciences Network for developing and conducting clinical trials, working with Aurora Health Care and UPMC to create a cloud-based system to manage de-identified patient information from member providers. Aurora was a key player, providing its patient information in hopes of improving its work in several hundred research studies. Expected challenges include the possible unwillingness of academic medical centers to participate, the difficulty in combining information from a variety of proprietary EHR data formats, and the storage required to eventually add genomic information.

Caradigm, the Microsoft-GE Healthcare joint venture, announces that the number of active users of its identity and access management solutions (Vergence, expreSSO, and Way2Care) has increased by 50% in the past 18 months.

Government and Politics

A proposed California bill would change the Confidentiality of Medical Information Act, which allows patients to sue healthcare providers for up to $1,000 per breached medical record. AB 439 would eliminate damage awards for first offenses and in some cases for repeat offenses if the provider notifies patients whose records were exposed and takes preventive action. The bill’s sponsor is McKesson.

Innovation and Research

The for-profit technology subsidiary of Palomar Health Foundation, which operates Palomar Pomerado Health (CA), announces that AirStrip Technologies has acquired exclusive rights to its MIAA mobile EMR viewer application. I first wrote about it in February 2011 when Cisco was helping pay for its development.

DataMotion files a provisional patent for a Direct Project-based secure e-mail messaging system for patients and providers.

Other

A London Daily Mail article covers Epic Systems. It’s loaded with snark and off-topic rants, but says that not only will Epic sign a $16 million, two-trust contract, but will soon take on another two hospitals in England and most likely bag more as each trust makes their own decisions and sees the value of using Epic as a data-sharing replacement for the failed NPfIT. It describes Judy Faulkner as “a 68-year-old Harley-Davidson-riding friend of President Barack Obama” who lives in a “nice, but not palatial” house. The paper tried to pry information from someone who answered the phone at Epic and was told, “Your messages have been passed on, and if we want to get back to you, we will.” It speculates that the massive Verona campus expansion was spurred by the likelihood of Epic’s expansion in England.

Another Epic article, this one from Wisconsin, describes the company’s construction boom, with its reporters counting 12 construction cranes hovering overhead. The company expected to hire 300 more employees in June and 1,000 more for the year, bringing its total to over 6,000 (and another 750 expected next year). The Farm Campus will add another 1,000 offices, underground parking for 1,000 cars, and the 11,000-seat auditorium that looks like a UFO crashed and buried itself into cow field. The article says the new construction on the 811-acre campus is valued at around $400 million, with 1,300 construction workers on site making it the biggest construction job in the Midwest.

Orthopedic surgeon Larry Bone MD (I’m not making that up) finishes up basic training and is shipping off to Afghanistan for a three-month tour of duty as a battlefield trauma surgeon. He’s 64. The head of orthopedic surgery at the University of Buffalo wants to give back for the treatment his son received after an IED explosion in Iraq six years ago.

A JAMIA article evaluates CPOE orders that are cancelled and then immediately re-entered on a different patient, concluding that over 5,000 orders per year are being entered on the wrong patient. The proposed solution: make physicians enter the patient ID twice before allowing order entry.

In England, a 22-year-old teaching hospital cancer patient becomes delirious from dehydration and missed meds, finally dialing the equivalent of 911 to say he’s thirsty and nobody will give him water. Nurses send police away when they arrive, but the patient dies shortly afterward. His mother, who says her son was restrained, sedated, and ignored in his room the night before he died, said a nurse asked afterward, “Can I bag him up?”

Sponsor Updates

• Bottomline Technologies offers webinars on payments and cash management.
• RelayHealth shares details of its role in preparing for ICD-10.
• Liaison Healthcare Informatics will provide awareness activities in support of National Health IT Week September 10-15. Liason is also sponsoring NCHICA’s quarterly roundtable meetings for CIOs and CMOs/CMIOs.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 7/2/12

From Hellcare: “Re: ACA. Interesting reader responses. You have collected many devoted readers and contributors with varied backgrounds, experience levels, and opinions over the past few years. What about an open forum week, in addition to your regular articles, where we discuss, ‘What is wrong with the healthcare system and how do we repair it?’ Who knows, maybe we’ll do better than Congress! I don’t think that it even needs to be a dissection of the ACA, but maybe opinions from more than just C-level management that have to give the answers they have to give to save their jobs. If Ell Jeffe is right, then there is much to discuss and even better, more to learn.” I’m game. To keep it positive instead of everybody just complaining, tell me what you’d change and why. Also, operate under the assumption that we aren’t going to simply throw out today’s healthcare system, so your changes should be realistic. Anyone want to start us off?

From Pliny: “Re: mobile apps. The FDA says they are subject to its oversight if they process user input with a formula or algorithm, output a treatment recommendation, or perform a calculation that results in an index or score. That would cover any mobile app that connects to an ARRA-certified product, would it not?” Good question. I interpret it as meaning the logic is running from the mobile device itself, which wouldn’t be the case with most clinical system front ends that are just displaying data and capturing input, no different than a Citrix session. Anybody else want to chime in?

From The PACS Designer:”Re: Apple’s 7-inch iPad? With the launch of Google’s $199, 7-inch tablet called Nexus, can Apple be next with a 7-inch iPad? Earlier this year, such rumors were swirling about a mini iPad that would make a better fit in lab jacket pockets, so we may see it in 2013 at a price of around $300.”

From DrLyle: “Re: AMDIS meeting. About 300 attendees, mainly CMIOs and similar, about 50% more than last year. Some great discussions from both academics and applied informaticians, with topics such as problem list management, ACOs and population health, EMR usability, analytics, and role of the CMIO.” Presentations from the AMDIS 21st PCC Symposium are here. Above is a DrLyle photo from the meeting last week in California.

A surprising 91% of readers say hospitals and practices aren’t using sound financial principles when they decide to buy their clinical systems. New poll to your right: what’s your professional and personal reaction to the Supreme Court’s decision that Obamacare (as both parties now call it) will stand as law?

From the above poll results, here’s my challenge to CIOs of hospital that are spending $100 million or more on an inpatient clinical system. Readers are skeptical that your employer did its due diligence on return on investment. Explain to them why they are right or wrong (e-mail me a paragraph or two – I will leave you anonymous unless you indicate otherwise.) How did your organization justify the expense and what’s being measured to prove that the decision was a good one? Or if you made your investment and went live more than a year or two ago, how do the benefits you’re seeing (both financial and non-financial) compare to what you expected?

I haven’t followed the PPACA drama all that closely, but here are the healthcare IT ramifications I would expect judging from what I’ve heard here and there.

• The majority of people and companies who paid little attention to PPACA under the assumption that some or all of it would be found unconstitutional will have to scramble to catch up. Few expected it to survive unscathed, so they wasted the first couple of years after it became law in March 2010 when they could have been figuring out what it means to them.
• More people will have access to insurance, so hospitals theoretically won’t see as much self-pay and bad debt. However, they will need even more people and systems to handle all of those insurance transactions.
• A fly in the ointment, however, is that employers may decide that the penalty for not providing insurance is cheaper than actually buying it with their significant employee subsidies, so they may just drop coverage entirely and force employees into the open market via health insurance exchanges. Employees may make the same choice, especially in PPACA’s early years, when penalties for not carrying medical insurance are minimal (just a few hundred dollars per year). Real-time eligibility checking and a plan to collect patient responsibility upfront will be required for provider survival.
• States have made poor progress in developing health insurance exchanges, so they probably won’t be ready any time soon.
• Medicaid rolls will swell massively under the plan, so providers will need to watch their reimbursement rates and payor mix carefully, especially since states are already teetering financially and now have another headache to deal with.
• With 30 million newly insured citizens and a shortage of primary care providers, the pressure will be on to improve PCP efficiency (even if just to restore the time EMR usage has stolen).
• Platforms that provide the ability to schedule PCP visits against their open schedules will be in demand to even out supply and demand based on provider and location.
• Given the likelihood that PCPs will still be overloaded, I would expect more care to be delivered by extenders and telemedicine, which will change the expectation of the systems in use.
• The demand for provider information will be insatiable. The same federal government and insurance companies that require endless petabytes of questionably useful information will now want even more of it once the promise of cost reductions isn’t realized. They are even more in charge of providers now than they were previously.
• Medical device vendors can’t be happy since PPACA requires them to start paying an annual 2.3% tax on gross revenues starting in January.
• PPACA’s impact on cost will probably be to increase it. In that regard, the biggest problem has still not been addressed since the special interests would have killed the bill otherwise – the healthcare system, regardless of who’s paying, is bloated, inefficient, and run by those special interests (including the biggest special interest of all, politicians.) 

Investor reaction to the Supreme Court’s decision: shares of hospital chains and healthcare IT vendors are mostly up, insurance company shares are down. Allscripts was up 8% on the week, while Quality Systems, McKesson, and Cerner jumped around 4%, a little better than the S&P 500. Athenahealth was up, but only by 1%. Cerner’s market cap is up to $14 billion, with Neal Patterson holding $462 million worth.

Not getting your HIStalk e-mail updates? Here are two solutions: (a) sign up for them if you haven’t already (duh), and (b) add mlsend.com to your so-called whitelist of e-mails allowed to get through your spam filter (your e-mail administrator will probably need to do this). I changed the e-mail service a few weeks back, so if you aren’t getting the e-mails all of a sudden, go with option B and tell your e-mail person that mlsend.com e-mails aren’t spam.

CapSite releases its Revenue Cycle Management study, which finds that 21% of hospitals plan to replace their RCM solution in the next to years and 53% say they will upgrade what they have. Interestingly, the larger the hospital, the more likely they are to replace or upgrade their RCM. The most-desired bolt-on solution is patient insurance eligibility verification, although 400+ bed hospitals are more interested in kiosks and the most-planned purchase of all is coding solutions. I was also interested in a relatively minor stat from the extensive report – in 400+ bed hospitals that responded, the #1 registration/ADT vendor (as a proxy to overall system penetration in my mind) was Epic, followed by Siemens, Cerner, and GE. I also liked the strategic priority question above.

The non-profit Patient-Centered Outcomes Research Institute (PCORI) is hosting the National Workshop to Advance the Use of Electronic Data in Patient-Centered Outcomes Research this week in Palo Alto, CA. Assuming it’s a bit late to plan attendance in person since they just sent me the announcement, they’ll have a live webcast (July 2-3). Speakers include folks from PCORI, Stanford, UCSD, NIH, FDA, and other big organizations. I hadn’t heard of most of the speakers, but those whose names I recognize are Doug Fridsma (ONC) and Paul Tang (PAMF).

Medical image management vendor UltraLinq offers Cardiac Accreditation Accuracy, software that allows users to track their QA documentation and statistics through integration with its exam data.

The PACS Designer is updating his list of iPhone apps, so if you’ve run across any that are interesting, post a comment to tell him about them.

CTG announces four new contracts for outsourcing, business process re-engineering, IT medical management, and HIE implementation support.

A jury returns a $15 million verdict against Springhill Memorial Hospital (AL) for a 2008 incident in which a 45-year-old non-ventilated patient died after bypass surgery due to an overdose of the anesthesia drug propofol that was administered by a nurse working her first shift in the cardiac recovery unit. The nurse was found to have no documentation of training appropriate to her assignment, had no experience in working with cardiac recovery patients or propofol, and failed to call for help when the patient lapsed into an immediate coma. Afterward, the nurse changed her documentation of the patient’s vital signs and ventilator settings, then erased the IV pump’s memory and destroyed the propofol container.

Vince’s HIS-tory this week covers HMS, tracking down co-founder John Doss for a first-person account.

Wall-mounted entertainment consoles are being removed from South Australia hospital patient rooms after at least four patients are harmed by units falling off the wall. Plans to install 3,500 of the units were cancelled.

Strange: a journal article chronicles the case of a 24-year-old software engineer from India who experienced an intense headache every time he tried to watch pornography, forcing him to change his plans. The authors didn’t figure out what caused the headaches, but they successfully treated the patient by advising him to pre-medicate himself with ibuprofen and acetaminophen.

E-mail Mr. H.

News 6/29/12

Top News

 

A GAO report finds that the VA and DoD have made progress in their pilot project to integrate care at the James A. Lovell Federal Health Care Center (IL), but delays in implementing the IT component have resulted in additional costs. IT investments have already surpassed $122 million and some initiatives are almost two years behind schedule.

Reader Comments

From Convener: “HIStalk’s announcement on the Supreme Court ruling. Once again you beat Modern Healthcare and all the others, and with a more comprehensive article.” Since Mr. H is busy traveling for his hospital job, we decided in advance that I would sit by computer and TV, listen for the announcement, and send readers a quick update. The moment MSNBC said the healthcare law had been upheld, I looked for an online write-up. Above is a screen shot of what CNN posted, which obviously left me mighty confused (obviously several so-called journalists hit the “post” button for their pre-written stories after reading only the first sentence of the ruling.) Thankfully I decided CNN simply had it wrong before I blast the news incorrectly to the HIStalk universe. Boy, Mr. H would have never let me live that down.

From SummerFun: “HIStalk Practice Advisory Panel. I liked the write-up. Great questions and interesting answers.” In case you missed it, our first HIStalk Talk Practice Advisory Panel post was published earlier this week. The participants, who are primarily physicians and staff in ambulatory care practices, shared thoughts on their EMRs and discuss other technologies. It’s a fun read and a good mix of positive and negative impressions, just like real life.

From Blue Eyes: “Re: healthcare reform act. What do you think of the news and its effect on healthcare IT?” I think people have forgotten that Thursday’s ruling affirmed only the legality of creating the law, not to assess it as a good or bad idea. I’ve yet to hear anyone claim to have read and/or understood the 2,900 pages of legalese, including the politicians who voted for or against it, and it’s discouraging that even the Supremes voted pretty much along liberal / conservative lines (it’s either legal or it’s not, but you wouldn’t know that from the 5-4 opinion). I don’t know if anyone of us know what it means beyond lots of newly insured people showing up at the doors of hospitals and practices (at least when they can find a primary care provider to schedule them). I’d bet healthcare costs will continue to go up, healthcare IT will ramp up for another year or two until the Meaningful Use wad has been shot and providers go back to buying only what boosts their productivity or bottom line, and we’ll nonetheless start getting some highly useful big-picture data telling us where we stand from a population health perspective but leaving us to actually do something about it (like finding a way to get Americans to lose weight, exercise, and manage their expensive chronic conditions wisely and cost effectively). Here’s where the crowdsourcing thing works well: click the Comments link at the bottom of this post and tell me what you think. For those who have never commented, you don’t have to register first and you can give a phony name to stay anonymous. My general assessment when wearing my HIT tunnelvision goggles is that it’s a good thing. As a taxpayer, I’m not really sure.

From Watcher of the Skies: “Re: HCA. Going Epic. I was in training in Verona and someone from HCA in my class said so.” Unverified. HCA originally said they were doing a one-hospital Epic pilot to decide between it and upgrading Meditech, but nobody’s told me definitively which way they’re going.

From Robbie Douglas: “Re: McKesson. Close to making an acquisition of [company name removed], whose offerings include an ambulatory EHR and billing and management services.” I removed the company’s name since the rumor is unverified, but it sounds like a done deal. It’s a pretty big outfit. 

From Cool Runnings: “Re: Drex DeFord. Leaving Seattle to take CIO position at Steward Health in MA. Steward’s for-profit 80-hour work weeks have taken their toll on a few CIOs in a short period of time. The CEO likes to call his leadership on weekends and expects them to work as many hours as he does.” Drex has updated his LinkedIn profile to list the Steward CIO job, so I’ll call that rumor verified. I worked for a for-profit hospital chain once for a short time. It was run by the biggest scumbags in the industry given my first-hand observation of their indifference to patient care and total worship of the bottom line. I wouldn’t care to repeat the experience, but to each his own.

HIStalk Announcements and Requests

Here’s some highlights from the last week on HIStalk Practice, in addition to the above-mentioned post from our Practice Advisory Panel: the biggest challenges of running a group practice. Alleviant announces plans to open a new facility in Vermillion, NC. The Office of the Inspector General finds that EMRs from Allscripts, eClinicalWorks, and GE Healthcare were products most widely used by physicians to document E/M services. Humana is the top payer among US health insurers in athenahealth’s Payerview Rankings. Aaron Berdofe discusses the federated model in the second part of his series on healthcare infrastructure data models. It takes so little to make me happy: a glass of nice wine, a new pair of strappy sandals, or a few new subscribers to HIStalk Practice. Make me merry, if you can. And thanks for reading.

On the Jobs Page: Software Engineering Manager, Project Manager, Web User Interface Design Engineer, Senior Buyer – Third Party Labor.

Listening: Lush, underrated alt rockers from England who had a 10-year run that ended in the late 1990s when their drummer killed himself. The music is rich, sweeping, and sweet, but rocking in a wistful sort of way (some place them in the “shoegazer” genre, but I’m not sure about that). I don’t know how I missed them, but it’s not too late since it still sounds fresh today. You’ll like it if you enjoy Cocteau Twins.

Everybody’s talking about voting of one kind or another these days, so here’s an urge to visit the (electronic) polls. Register to vote by signing up for e-mail updates. Cast your vote for progress by liking, friending, and connecting with the HIStalk party (Inga, Dr. Jayne, Dr. Travis, and me) via the social media ballot boxes. Send us your tired, you poor, and your rumors and news. Show your appreciation of our supporters by checking out the sponsor ads to your left and trying out the searchable, categorized Resource Center and Consulting RFI Blaster. As Alice Cooper says, I’m your top prime cut of meat, I’m your choice, I wanna be elected – as HIT’s go-to site for news, scandalous rumors, and occasionally irrelevant amusement. Thanks for your vote to keep me in (my upstairs spare bedroom) office for another bunch of years – I won’t let you down. I’m Mr. HIStalk and I approved this message.

Acquisitions, Funding, Business, and Stock

Practice Fusion secures an additional $34 million in Series C funding led by Artis Venture. The company has raised $64 million since it launched in 2007.

Carena, which offers webcam-based provider visits and other products, completes $14 million in financing led by Catholic Health Initiatives.

People

The Digital Pathology Association appoints Sharp HealthCare CIO Bill Spooner to its board.

Employee scheduling software vendor Avantas announces the promotion of Christopher Fox from SVP of growth and innovation to CEO and Jackie Larson from VP of client services to SVP. Fox takes over for founding CEO Lorane Kinney, who is retiring.

athenahealth appoints Charles D. Baker (General Catalyst Partners) and Jacqueline B. Kosecoff, PhD (Moriah Partners/Warburg Pincus)to its board.

Announcements and Implementations

Hoag Memorial Hospital Presbyterian (CA) implements Unibased’s ForSite 2020 RMS resource management and patient access solution across all of its diagnostic imaging locations.

The Pennsylvania eHealth Collaborative announces a grant program that gives providers a free year of DIRECT messaging services for secure health information exchange.

RiverView Health (MN) will go live on Epic July 1.

Ochsner Health System (LA) will go live on Epic this week ad its health center locations.

Government and Politics

Five senators introduce a bill that would create a national standard for notifying affected individuals about information security breaches. The bill, the fourth attempt to create national requirements, would also move enforcement to the Federal Trade Commission and allow that agency to levy fines of up to $500,000.

Other

The Bethlehem Area School District (PA) joins The Children’s Care Alliance, which maintains an EMR database of student health data supplied by school districts and made accessible to area hospitals.

Meditech President and CEO Howard Messing provides the opening remarks for the 11th Annual Pappalardo Fellowships in Physics Symposium at MIT, which is obviously supported by Neal Pappalardo of Meditech. Both are MIT alumni and physics fanboys. It’s a good talk.

Highline Medical Center and Franciscan Health System (WA) announce plans to explore a strategic affiliation, partly driven by Highline’s interest in using Franciscan’s Epic system that will go live next year.

University of Texas MD Anderson Cancer Center (TX) notifies patients that a computer containing patient and research information was stolen from a physician’s home April 30. The hospital says it will step up efforts to encrypt its computers, making you wonder how an organization as smart and rich as MDACC needed negative press to finally move the needle on encryption. Here’s a gentle nudge for their fellow fence-sitters: if you don’t encrypt your portable devices, you are being inexcusably irresponsible and deserve the inevitable headlines, CIO firing, and class action lawsuits that are likely to result when the “pay me now or pay me later” time bomb you allowed to be planted finally goes off. Everybody knows that healthcare IT is stuck in a 1980s time warp, but are we seriously still waffling on encrypting PHI-containing devices?

Meanwhile, the Alaska Department of Health and Social Services agrees to pay HHS $1.7 million to settle possible HIPAA violations stemming from the,theft of a USB hard drive from an employee’s car. The Office of Civil Rights determined that the Alaskan agency had inadequate security and risk controls in place and now must take corrective action to safeguard electronic PHI.

Is that a parachute in your backpack or are you just glad to see your surgeon? Mexican doctors remove a 33-pound tumor from the back of a two-year-old, 26-pound boy.

Sponsor Updates

• ICA announces that the Central Illinois HIE is live, with four up and running.
• Kony Solutions expands support of open standards with the release of its KonyOne Platform v5.0.
• Phoenix Children’s Hospital (AZ) chooses Access Intelligent Forms Suite to integrate data among its Allscripts HIS, electronic forms, and its MedPlus ChartMaxx content management application.
• Kareo releases a free iPhone app for accessing physician schedules online.
• Ingenious Med explains how its PQRS Registry is helping healthcare facilities to avoid penalties and improve revenue.
• Medicomp Systems CEO Dave Lareau  discusses five EHR considerations for organizations preparing for ICD-10.
• Julie Corcoran, principal consultant with Hayes Management Consulting, highlights five of the major issues facing hospital revenue cycle teams.
• MyHealthDIRECT expands its partnership with Amerigroup to include Amerigroup’s Maryland provider partners and giving them access to MyHealthDIRECT’s online scheduling services.
• Wolters Kluwer Health announces that Essentia Health (MN) is the 1,000th customer to deploy its ProVation Medical software.
• BridgeHead Software releases the results of a survey finding that only 26% of worldwide HIT leaders have robust disaster recovery plans in place. 
• Centracare Health System’s St. Cloud Hospital (MN) selects Merge PACS.
• New York eHealth Collaborative says it’s the first REC to hit 1,000 providers qualifying for Meaningful Use money.

EPtalk by Dr. Jayne

Like Inga and Mr. H, I sometimes become annoyed when my day job cuts into my HIStalk time. Unfortunately, this is one of those weeks. I had taken some time off this week to make sure I would be able to immediately respond to the much-anticipated Supreme Court decision, but it has been sucked up by a couple of hospital projects that have gone off the rails. I’ll definitely be responding to the decision, whatever it may be, but just not tonight.

HIStalk reader and contributor Micky Tripathi writes about “The Dangers of Too Much Ambition in Health Information Exchange.” He warns of over-architected HIEs that try to be all things to all people at the expense of short-term wins with real value. It’s a great piece that I hope obtains wide readership.

CMS will begin enforcing the use of version 5010 HIPAA transactions next week. Although it doesn’t seem there are continued widespread issues, anecdotal reports include ongoing tales of claims difficulties.

Physicians are subject to as many as 20 different varieties of payer audits. The American Medical Association has archived a webinar that covers the who, what, where, when, and why of auditing. Anyone who wonders about the high cost of health care and declining levels of provider satisfaction should take a peek.

No surprise: An online article in the Journal of the American Medical Association discusses the higher per-patient operating costs found in clinics with higher medical home scores. Medical homes can reduce overall health care spending, but there is little incentive to incur the upfront burden if the savings isn’t passed to those doing the work.

For Inga: a chocolatier says the  Massachusetts pharmaceutical gift ban is hurting its business. Their popular corporate gift: chocolate shoes.

PremierConnect debuted this week, allowing providers and healthcare systems to access data from payers, claims, lab, billing, and other sources to monitor clinical performance and perform predictive modeling. The aggregated database includes data from more than 2,600 hospitals.

I was in Canada recently and heard quite a few public service announcements on the radio encouraging blood donors to step up and give. I haven’t heard much at home, but blood supplies in the US have reached “emergency levels,”according to the Red Cross. Summer heat and vacations typically limit donations and only 3% of people in America donate blood. If you’re looking for an air-conditioned place to spend some time over the upcoming holiday, consider taking a trip to your local blood bank. Chances are you’ll leave with a cookie and some orange juice in addition to knowing you may have just saved a life.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Supreme Court Upholds Healthcare Law

The Supreme Court rules to uphold the ACA, including the individual mandate.

News 6/27/12

Top News

ONC’s Director of Meaningful Use Joshua Seidman, PhD resigns to take a job as managing director of quality and performance improvement with Evolent, the ACO services provider spinoff of The Advisory Board Company and UPMC.

Acquisitions, Funding, Business, and Stock

Atlantic Health Solutions acquires fellow medical billing company DataSolv Services.

Sales

Lehigh Valley Health Network (PA) chooses MedAssets to provide RCM technology and consulting services, including MedAssets Charge and Reimbursement Integrity solutions and Collections Management product.

Bradley County Medical Center (AR – above), Ellis Hospital (NY), and Jamaica Hospital Medical Center (NY) sign contracts with QuadraMed for the ICD-10 compliant version of Quantim Coding and for QuadraMed’s 3-Learning and Education program.

The West Coast Regional Office of VHA and Penn State Milton S. Hershey Medical Center (PA – above) sign agreements with Avantas for the company’s healthcare enterprise labor management technology.

The VA awards Ray Group International a $4.9 million contract to support the Open Source EHR agent project, which allows developers to contribute software code for the VA/DoD integrated EHR.

The Texas Department of Information Resources (DIR) signs a contract with PatientOrderSets.com to use its solutions in public and DIR-eligible hospitals.

Summa Health System (OH) selects PatientKeeper Charge Capture software for its 300 physicians.

Lenco Diagnostic Laboratories, a New York reference lab, implements EMRHub from Lifepoint Informatics, which allows it to distribute lab data to an unlimited number and variety of EMRs through a single connection.

People

RCM provider Recondo Technology names Major General (Ret.) Elder Granger, MD (TRICARE) to its board.

GetWellNetwork appoints Beth Martinko (Avid Technology) SVP of client experience and Hugo Borda (NeighborBench) VP of enterprise architecture.

Medsphere Systems adds Mike Morotti (Validus Medical System) as VP of sales.

PerfectServe appoints George Pace (Verisk Health) RVP of sales.

Ernest & Young names The Advisory Board Company CEO Robert Musslewhite a winner in of a 2012 Entrepreneur of the Year award for the Greater Washington Region. Ernst & Young also names T-System CEO Sunny Sanyal a finalist for the 2012 Southwest Area North Entrepreneur of the Year.

Beacon Partners names Jon Mello (EMC) as EVP.

Greenway reseller iPractice Group names Monte Ruder (Integrated Healthcare Solutions) its VP of sales and adds three additional account executives. Last week iPractice announced that an undisclosed California company is investing $32 million in the company.

Announcements and Implementations

Kaiser Permanente and the Social Security Administration announce a pilot program to exchange electronic health information using the NHIN.

The Kentucky HIE, St. Elizabeth Healthcare, and HealthBridge announce their successful secure exchange of patient health information.

McPherson Hospital (KS) implements Meditech.

OTTR Chronic Care Solutions announces the arrival of its OTTR 6 release.

Merge releases its eClinical OS Platform for capturing any type of data from any source and over any modality.

Former BayCare Health System (FL) critical care nurses Cynthia Davis and Marcy Stoots form CIC Advisory, which offers strategic consulting services specializing in EMR-driven clinical process improvement. They were involved in BayCare implementations in executive roles.

Government and Politics

ONC releases a new version of its online Certified Health IT Product List that lists 1,700 EHRs and modules and includes several new features, including functionality to identify hybrid certified EHRs.

Other

Winter Haven Hospital (FL) says it has pushed backed the full implementation of its EHR system from last spring until October 1 in order complete physician training. Cerner, I believe.

KLAS takes a look at Epic consulting firms and ranks Impact Advisors highest in enterprise implementation leadership and advisory, Encore highest for team implementation leadership and advisory, and Nordic Consulting highest for staffing implementation and support. KLAS identified 45 firms with Epic consulting engagements and found that nearly every firm received good marks for consultants. Thanks to KLAS for allowing us to quote their report and include the graphic above.

The Wall Street Journal covers the failed EMR implementation of 25-bed Girard Medical Center (KS), which says it paid Cerner $1.2 million and still can’t quality for Meaningful Use money (we reported its lawsuit against Cerner back in January). The hospital claims that Cerner didn’t include quite a few items in its $2.9 million agreement, but also admits that it didn’t understand the contract it signed and relied on Cerner to tell its executives what it covered. According to the CIO of the IT department (which had only two employees when the hospital signed with Cerner), the additional costs were only $100,000 over the term of the five-year agreement, but the hospital decided to stop paying Cerner to get their attention over poor service. They did – Cerner e-mailed the hospital to say it was walking away. Based on the skimpy description in the article, I’m siding with Cerner – the hospital didn’t do its due diligence, bought way more system than it needed or could maintain, and then tried to play tough over a price discrepancy of less than 4% of the total contract value. Granted some vendors (Epic) wouldn’t have sold a deal like that knowing the chance of success was minimal, but it’s not Cerner’s job to advise the hospital as a neutral party. If someone deserves blame other than the hospital, it’s the federal government for financially baiting providers into buying systems they otherwise had been wisely avoiding as a bad fit.

The president of CVS Caremark’s MinuteClinic says its retail clinics support continuity of care by giving every patient a copy of their medical record, sending their physician a copy if the patient approves, and integrating with practices by either sending them electronic information or (for the large number of practices that don’t have an EMR) a nightly batch fax.

An article by early Epocrates executive Michelle Snyder observes that despite all the technology being thrown at physicians, they’re less productive now than 10 years ago. She urges the use of simple technologies that, like Epocrates, are easy to use and save individual doctors time – no more, no less. Examples: HealthFinch (lets doctors delegate prescription refills to staff); ImagingCloud (Webex-like medical image collaboration); and Doximity (LinkedIn-like physician referrals and consultation).

Sponsor Updates

• NextGen changes the name of its Practice Solutions Division to NextGen RCM Services. 
• Bulletin Healthcare Briefings partners with the National Association of Pediatric Nurse Practitioners to publish and electronically deliver its members-only daily electronic news briefing PNP Daily News.
• ZirMed and DoctorSites offer a free webinar entitled, “Online Marketing and Payment Secrets That can Make – or Break – your Practice.”
• Mowery Clinic (KS) selects NextGen’s EHR/PM and portal solutions for its 33 physicians.
• Imprivata scores a score of 88.4 on KLAS’s 2012 mid-term performance report.
• Emdeon announces that three of its RCM solutions have received HFMA Peer Reviewed designation.
• Allscripts reminds developers that the deadline for its Million Hearts Clinical Decision Support Challenge is July 13. The company is offering a $50,000 prize for the best publicly available app that optimizes cardiovascular disease care through clinical decision support.
• Passport Health adds its PatientTrack and PatientRisk modules to the Care Cycle Suite.

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 6/25/12

From DCollins: “Re: WatchChild. Rumored to be up for sale. That would be a huge signal to the world of HIT – why divest in times of growth?” Unverified, but even if it’s true, I don’t know if I would draw too many negative inferences about the healthcare IT market as a whole. The WatchChild OB monitoring system is owned by Hill-Rom, mostly known for selling expensive hospital beds and a few other marginally related product lines. WatchChild was supposed to be a natural extension of the company’s NaviCare nurse call system. HRC shares haven’t exactly shone lately, dropping from $48 in July 2011 to $30 now, so Hill-Rom may simply see the frenzy of M&A activity in healthcare IT as a good opportunity to sell some or all of its IT holdings to focus on core business. All of this is speculation since they’ve made no announcement that I’ve seen. Hill-Rom used to be known as Hillenbrand Industries, whose humorously complementary business was Batesville Casket Company. I’ve always wondered if they might put some of their nurse call technology in those caskets as an upgrade for those who fear being buried alive.

From TopExecIT: “Re: MRO. Overheard that it has acquired smaller release-of-information vendor Discovery Health Record Solutions.” Unverified.

From Grammar Neighborhood Watch: “Re: grammar mistakes. Thought you would enjoy this WSJ article called This Embarrasses You and I.” You are correct – I did enjoy the article, which calls out the “epidemic of grammar gaffes in the workplace” as the grammatically challenged get even sloppier as encouraged by Twitter and similar stream-of-consciousness outlets for narcissism (especially the younger folks, taught by questionable educational methods to ignore long-standing rules suggesting that maybe it’s a good idea to spell words correctly and compose sentences that the rest of us can easily follow, for the same reason that traffic laws encourage societal harmony.) Worse yet is that people actually get snippy if anyone points out their mistakes, as though being careful about language is a character flaw. The article suggests that companies have become sloppy in allowing poorly constructed writing to be blasted out publicly. It brings up an issue that is one of few that I would defend physically if necessary: the Oxford comma, omission of which is indefensibly illogical. I nearly always have to fix that when folks send items to run on HIStalk. The other is equally illogical and indefensible — sticking two spaces after every period. Unless you’re writing on a typewriter that supports only monospace fonts and thus requires the extra space to provide a visual break, placing two spaces after a period is just plain wrong.

From Kermit Randa: “Re: question about Epic and FDA regulation of transfusion systems. I think the question warrants a broader discussion around software as a regulated medical device. The FDA has classified numerous specific products that perform data and information transfer, storage, display, conversion, and similar management functions, such as a LIS or PACS. Last year, the FDA raised more questions than it resolved when it issued a new classification, the Medical Device Data System (MDDS) which it defines as hardware or software products that transfer, store, convert formats, and display medical device data. The FDA, in its commentary, made clear the definition of an MDDS is narrow. For example, an MDDS does not modify the data or modify the display of the data, does not by itself control the functions or parameters of any other medical device, and is not intended to be used for active patient monitoring. However, the FDA was not clear about whether or how they would classify software that falls on the outside edges of the MDDS definition and does not fall under one of the earlier classifications such as LIS or PACS. Furthermore, the FDA made clear that a health care facility may be directly responsible for compliance with the FDA regs for an MDDS, not just its software vendors. So as we all work to streamline clinical workflows and achieve meaningful use, the intersection between different types of information systems is raising issues about medical device compliance. More here, or click here to see which companies have registered as a manufacture of an MDDS (enter OUG in the product code search field.)” Thanks to Kermit, a long-time reader and COO of Surgical Information Systems, for providing that explanation. It seems that the climate for FDA regulation of some aspects of healthcare IT is heating up, so it’s worth watching carefully.

From Privacy Shrink: “Re: sharing patient data in Boston. I like the comparison between mental illness and Parkinson’s disease.” The article describes how Boston area hospitals handle sensitive parts of the medical record, such as psychiatric notes. Partners HealthCare says every doctor needs to see everything, so patients must request that certain information be placed off limits and Partners makes the final call. BIDMC allows psychiatrists to restrict access to the information they create. Neither system described any capability for patients to become involved in the decision. Privacy is a tough issue, but I’m siding with the patient – why can’t I decide who sees my information? The Partners approach comes across as smug and paternalistic, with the patient serving as a low-ranking, inherently unreliable player apt to gum up the disease mitigation factory works.

From The PACS Designer: “Re: Microsoft’s Phone 8. Along with the upcoming Microsoft Windows 8 release this fall, we’ll also get Windows Phone 8. It appears that Microsoft wants a piece of the enterprise business for phone improvements and has structured Phone 8 as an alternative to Bring Your Own Device (BYOD) to give IT total control of phone security enforcement within institutional walls.” Good luck with that. Microsoft’s consumer strategy seems to be to imitate whatever Apple is doing, adding in its usual missteps, poor design, and uninspired marketing. The result is predictable. There was a time when Microsoft was a near-religion among geeks and businesspeople who dismissed Apple as a bunch of hippies building products used mostly by students and temperamental artistes, but even those former Gates fanboys now worship at the Cupertino altar.

The feds should make doctors and hospitals jump through only evidence-based hoops, 93% of respondents said. New poll to your right: are hospitals and practices applying good financial analysis and ROI calculations to make EMR purchasing decisions? Obviously your yes/no vote makes you one of the silent majority or minority, but you can overcome the “silent” part by adding a comment by just clicking the comments link right below the survey’s voting button.

A hospital in Northern Ireland finds that a problem with its radiology information system caused radiologists to miss reading 17,000 images over several years. They’re reading the images now and have set up a patient hotline.

Nominations are open for HIMSS board and nominating committee positions. I know several folks who have used their HIMSS positions as a nice career springboard, so that might be the additional carrot you need to throw your hat in the ring if you have something to offer HIMSS beyond unbridled ambition.

HealthCor, the Allscripts shareholder that threatened a proxy fight until the company gave it three board seats, raises its ownership of the company from 6.1% to 7.3%. Share price has been flat since it fell off a cliff in late April following several negative announcements. The hugely important next quarterly report is scheduled for August.

HIM/IT services and outsourcing provider Anthelio (the artist formerly known as PHNS) names John Dragovits as president and COO. He was formerly EVP/CFO of Parkland Memorial Hospital and was a Cerner VP before that.

Nordic Consulting, a Madison-based, Epic-only consulting firm, is ranked #1 in staffing and implementation support in “Navigating the Sea of Epic Consulting,” a new KLAS report.

In England, several NHS trusts join together to seek a replacement for their RiO mental health EMR, expecting spend up to $470 million.

Vince has more to say about Dairyland and several related companies this week. You can help him out by reminding him of other companies he can riff about, especially if you were around in the early days prior to 1980 or so. I offer Continental Medical Systems, Megasource, Dynamic Healthcare Technology, Atwork, and Visteon/Avio as a few old-time names I’ve heard recently. In another angle of attack, has Vince missed any big personalities of that era, folks who kept turning up in one company after another? He would appreciate your ideas and contact information for the pioneers he could reminisce with.

Aetna and Inova Health System (VA) jointly form Innovation Health Plans, which will offer new HMO and PPO services. Inova’s healthcare services delivery will be supported by Aetna’s benefits administration and technology (presumably Medicity) that will allow physicians to track patient care.

London-based SwiftKey releases its on-screen tablet or phone keyboard for healthcare that claims to reduce text input time by 49% by predicting the next word to be typed. Price for this version wasn’t given since I suspect they’ll sell through hospitals and software vendors, but their non-healthcare product is $1.99, and priced appropriately given mixed reviews. Watching the guy thumbing his way through entering medical text in the video above made me nervous – doctors don’t pay enough attention to on-screen defaults and choices as it is, so I can envision some major medical errors caused by too-quick approval of the wrong word.

More Accretive Health fallout: the Treasury Department proposes regulations that would require charitable hospitals to keep their collection dogs on a leash, improving their effort to help patients qualify for financial assistance before garnishing their wages or dinging their credit scores.

An FDA report finds that software problems cause 24% of medical device recalls, also noting that the engineering teams that build medical devices are often woefully ignorant of best practices for developing and distributing software. It mentions FDA’s Functional Performance and Device Use Laboratory, which will allow the agency to test user interfaces and analyze device usability.

E-mail Mr. H.

News 6/22/12

Top News

The VA establishes a goal of conducting more than 200,000 clinic-based telemental health consultations in fiscal year 2012, offered to veterans without requiring a co-payment per VA policy that covers all videoconferencing-based encounters.

Reader Comments

From Overheard: “Re: HIT sales training. A friend tells me he just completed a sales training class led by one of the professional training and coaching organizations. His impression was that the course was developed by a ‘bunch of bitter nerds who are haters getting their kicks off telling the nice-looking popular kids that they are stupid.’” Ouch. Before begging Mr. H to hire me, I considered taking a position as a sales coach. At least in this gig I don’t think too many people call me a nerd and I can get away with telling just about anyone that they are stupid.

From Eros: “Re: Cerner and autocorrect. Have you ever tried typing ‘Cerner’ in a message on your iPhone?” It seems that Apple insists the correct word should be Cerberus, a mythological three-headed watchdog that guards the gates of Hades to prevent anyone from escaping. Perhaps Neal should invest in one for the employee parking deck.

From Printgeek: “Re: [free EMR vendor’s name omitted.] I heard its board and executive team has seen four departures. They are making good headway with physician enrollments, but actual usage is poor and eyeballs on the screen are not meeting expectations. Additionally, the model to generate revenue from data and ad sales isn’t coming close to investor expectations.” Unverified, so I’ve omitted the company’s name, not that most readers aren’t astute enough to know it instantly anyway.

HIStalk Announcements and Requests

The latest from HIStalk Practice: Medford Medical Clinic (OR – above) signs up with athenahealth. The AMA votes to evaluate ICD-11 as a possible alternative to ICD-10 for replacing ICD-9. The ONC plans to help small providers increase security on mobile devices. Offices with great EHR implementation had only slightly higher patient safety culture scores. Dr. Gregg reveals his interoperability nightmare. Give HIStalk Practice a test drive if you aren’t a regular. Thanks for reading.

Acquisitions, Funding, Business, and Stock

eMerge Health Solutions, a developer of a hands-free documentation and workflow solution for gastroenterologists, closes on $850,000 in seed funding from CincyTech and private investors.

GE Healthcare sells the assets of its Nurse Call business to Switzerland-based Ascom, which markets its own nurse call system outside of the US.

PatientKeeper raises $6.25 million from existing investors to expand professional services and support operations.

Etransmedia Technology acquires Associated Billing Services, a provider of RCM services.

T-System acquires Marina Medical Billing Service, which provides ED medical coding and billing services to 110 facilities.

Sales

Iowa Health System selects Explorys’s Enterprise Performance Management  applications to support its ACO initiatives.

O’Bleness Memorial Hospital (OH) chooses ProVation Order Sets as its electronic order set solution.

People

Former RelayHealth exec Matt Llewellyn joins BillingTree as its VP of sales for the healthcare market.

OTTR Chronic Care Solutions names Sandy DeRoberts (Carefusion) regional VP of sales.

Announcements and Implementations

Pacific Medical Centers (WA) installs Versus Advantages RTLS to track patient flow at its Totem Lake clinic.

St. Rita’s Medical Center (OH) goes live on Epic.

KLAS names Encore Health Resources the top-rated consulting firm serving Epic clients in the category of Team Implementation Leadership & Advisory.

CareFusion signs an agreement to support bi-directional connectivity between its Alaris smart IV pumps and Epic.

Kony Solutions releases a new version of its Mobile Health Plan.

In the UK, Rotherham NHS Foundation Trust begins implementation of Meditech.

The US Air Force will use SAS tools to support research and to deploy a global dashboard to improve operational and clinical decision support. An example given involves SAS Scoring Accelerator for Teradata, in which researchers can run query of 1.2 million patients to determine which 10% of those with diabetes are most likely to have an ED encounter in the next two months.

Three competing hospital systems in the Charleston, WV area (Thomas Memorial, CAMC, and St. Mary’s in Huntington) meet to discuss their use of Siemens Soarian. The article cites two examples of its use by Thomas Memorial’s CMIO Matthew Upton, one in which he entered patient orders from home before leaving for the conference and another where he followed his patient from a café in Italy using an iPad.

Government and Politics

ONC launches a pilot project to measure the effects of giving providers and pharmacies better access to drug monitoring programs in order to reduce prescription drug abuse.

CMS awards a $20.75 million Health Care Innovation Challenge grant to VHA, Inc, TransforMED, and Phytel for a three-year national project to expand the PCMH concept and test the viability of a patient-center medical neighborhood model.

Other

The Association of Regional Centers for Health Information Technology, or ARCH-IT, is formed as a national association for the country’s 62 Regional Extension Centers. I noticed, by the way, that of the 143,000 providers signed up with RECs, only 12,000 have received incentive payments. Maybe a bit more mindshare wouldn’t be a bad thing.

The Long-Term and Post-Acute HIT Collaborative issue a roadmap for HIT in nursing homes and rehab centers, focusing on care coordination with other providers, implementing quality measurement activities, and promoting technology education among LTC workers.

In New York City, merger talks between NYU Langone Medical Center and Continuum Health Partners break down after Continuum entertains a similar offer Mount Sinai Medical Center.

More Accretive Health news, all of it bad. Minnesota’s attorney general expands the suit against the collections company; Maple Grove Hospital (MN) fires the company at the request of its 25% owner, Fairview Health; and two US congressmen investigating the company’s practices say it has not replied adequately to their inquiries, failing to produce requested internal documents and ignoring their requests for a meeting.

A DrLyle blog post talks about EMR extender tools, postulating that EMRs have become somewhat stagnant infrastructure tools and that the innovation ecosystem will instead involve tools other companies build on top of their platforms.

Oracle CEO Larry Ellison buys himself a Lanai, but instead of being a tiny porch like that word would imply for most of us, it’s a 141-square-mile Hawaiian island of that name. The world’s sixth richest man will pay around $500 million cash for the purchase, which you might take a moment to enjoy vicariously the next time your hospital pays an Oracle invoice.

Weird News Andy muses about who the patient (especially for the all-important hospital billing) is in this story and others like it, in which an oral tumor was removed from an unborn child during the mother’s 17th week of pregnancy.

Sponsor Updates

• Pittsburgh Bone & Joint Surgeons (PA) selects SRS EHR and PM for its seven physicians.
• Emdeon launches Emdeon Payment Network, which combines electronic and print payment services for payers.
• TeleTracking announces a series of webinars on improving hospital operations and ROI using real-time capacity management. 
• The Minnie Pearl Cancer Foundation names Emdeon EVP/CIO Damien Creavin and Cumberland Consulting Group partner David Vreeland to its board.
• NextGen Healthcare’s Electronic Dental Record receives ONC-ATCB certification from CCHIT.
• Acusis introduces AcuMobile for the capture of patient encounters on the iPhone.
• T-System will showcase its RevCycle+ solution at next week’s HFMA’s Healthcare Finance Conference in Las Vegas.
• St. Joseph Health (CA, NM, TX) pilots AT&T Telepresence Clinic service.
• Kliniken Maria Hilf (Germany), SALK (Austria), Bakiroy Dr. Sadi Konuk Egitim va Arastima Hastanesa (Turkey), and Boston Children’s Hospital (MA) go live on iMDsoft’s MetaVision solution.
• Greenway Medical exhibits its PrimeRESEARCH solutions at next week DIA 2012 Annual Meeting in Philadelphia.

EPtalk by Dr. Jayne

I am humbled by the response to this week’s Curbside Consult. My e-mail has been overflowing with readers who know what it means to come from a farming background. Most of the themes revolve around hard work, perseverance, and living with the consequences of your decisions. There was even great story from one reader whose family ran moonshine to earn money after a tragic accident.

One reader stated she was going to post the 4-H pledge at her desk to remind her every day about striving to be better person. From the responses, it looks like there are some regional variations, but for those of you who haven’t Googled it yet, here is the 4-H Pledge:

I pledge my head to clearer thinking,
My heart to greater loyalty,
My hands to larger service,
and my health to better living,
for my club, my community, my country, and my world.

It’s kind of like the Everything I Needed to Know, I Learned in Kindergarten list, but maybe it’s something that healthcare should embrace as we slow the pace down and stick to the basics.

Another reader shared her love of trail riding and said that being on a farm is “the one place where I know I can keep all those untamed healthcare acronyms at bay for a while in favor of what my father would call honest work.”

Slightly surprising (but not really) was that nearly all of the responses were from women, several of whom cite their backgrounds as helping them make it in IT:

Being raised around country people, I was fully supported when I ventured into traditionally male roles like running a bush hog, planting, or working on engines. No one thought a thing about it – you did whatever you had aptitude for. I grew up “liberated” and was mystified by all the fuss in the 70s. How fortunate to grow up with the belief that you were only limited by the barriers you set for yourself.

Thank you again to all of you who wrote about the article. You’ve helped recharge my somewhat depleted batteries as I slog through a series of intense go-lives. And now, back to our regularly scheduled healthcare IT message.

John Halamka blogged this week about “meaningful consent” for health information exchanges. His institution is using an opt-in model where patients can choose to share or not share data originating from various institutions. There will be no clinical override or “break the glass” functionality. Although I agree generally with this patient-centric model, I’ve practiced under a similar one and found it to be less than optimal for monitoring basic patient data. When patients can choose to share some data but not all, it fragments the patient record making it very difficult to identify duplicate therapies, drug interactions, and redundant tests. Since this is the prime reason for having an HIE, it somewhat defeats the purpose.

A reader shared this write-up of the new website ChickRx whose tagline is Expert Advice to get Happy, Healthy, & Hot. The review describes it as “what would happen if WebMD met Cosmo.” Presented at a recent Rock Health Demo Day, it has some serious potential as an entertaining alternative to existing consumer-focused sites.

Both Inga and I picked up on this piece about the situation where the chief medical officer at Northwest Community Hospital was found to be lacking a medical license. A hospital administrator described needing a medical license as “irrelevant” for administrators. Although I don’t think physicians working in the tech space always need licensure, I feel it’s essential for hospital administrators. If nothing else, it shows solidarity with the physician community and gives the ability to emphasize with burdensome administrative requirements with which the rest of us have to comply. Working at a hospital yet allowing your license to lapse makes an administrator seem detached from the rest of the physicians who have to live under his or her policy decisions.

I found an interesting blog posting that discusses “cloned” EHR documentation. It’s a quick read and illustrates something providers should watch out for. In trying to avoid cloned notes, the author used different wording at each visit for the same physical findings. This resulted in an attorney trying to twist a stable disease into a progressively worsening condition. We’re damned if we do and damned if we don’t.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 6/20/12

Top News

CMS says that as of the end of May, more than 110,000 EPs and over 2,400 hospitals had been paid a combined $5.7 billion in EHR incentives from Medicare and Medicaid. That’s about 48% of all eligible hospitals and 20% of eligible Medicare and Medicaid providers.

Reader Comments

From Jenny: “Re: Catholic Health Initiatives. The group is installing Cerner, but the Tacoma-based Franciscan group received permission to install Epic in five hospitals and will go live in April 2013.” Verified.

From Pillsbury DB: “Re: Lahey Clinic. They were installing Allscripts in the ambulatory environment and had a best-of-breed approach using Orion for the inpatient setting. I’ve attached an old case study.  Instead of implementing a true EHR product, they decided to pull data using Orion into a clinical data repository. Paper-based data was scanned and indexed into PDFs which were also available using Orion portal. This worked for clinician viewing, but made it impossible to implement CPOE. They were also scanning millions of records per year requiring many FTEs to perform the function. When HITECH hit, they had no hope of meeting any stage of MU.  To compound the problem, the Allscripts implementation was about a year behind and way over budget.” Above is an extract from the Orion Health case study from last year. I guess MU did reduce the interest in EMRs based on scanned documents quite a bit.

From The PACS Designer: “Re: Microsoft’s Surface tablet. The new challenge to the iPad has arrived in the form of a tablet PC called Surface. One unique aspect of the Microsoft Surface is the keyboard in cover of the tablet. While it won’t really be any threat to the iPad, it may draw interest from PC users who are more comfortable with a traditional keyboard versus an on screen keyboard.” Microsoft has been short on innovation lately (decades), but I don’t get why they used the Surface name on a tablet when it’s already being used by their coffee table gesture thingy. And unlike Apple, Microsoft is selling futures once again since nothing’s ready to ship. They won’t get bold on the pricing because they won’t want to diminish the already iffy prospects of the Ultrabook laptops, so you’ll be able to buy a me-too tablet running probably buggy software for double the price of iPad right as businesses give in and let people bring in their own at zero expense to the enterprise. Apple started failing dismally after firing Steve Jobs and returned to prominence only after they hired him back, but Microsoft’s problem is that Bill Gates isn’t coming back.

HIStalk Announcements and Requests

I’m doing some traveling for the hospital over the next few days (to a vendor location home to a great many HIStalk readers, in fact), so given the difficulty in achieving my usual prodigious output given limited time and connectivity, Inga is handling the brunt of the HIStalk chores. I’ll chime in with whatever is interesting to me as I have time. If you’ve tried to get in touch with me, hang in there until the weekend when I can get caught up.

Acquisitions, Funding, Business, and Stock

Shareable Ink secures $5 million in series B financing from Lemhi Ventures.  As part of the deal, Lemhi Ventures’ managing partner Tony Miller will assume the role of chairman of the board.

ESO Solutions, a provider of EMR software for the EMS and fire services industries, raises $4 million from Austin Ventures.

North Bridge Growth Equity invests $30 million for a minority interest in Valence Health.

Sales

Missouri Health Connection and the NY eHealth Collaborative select the InterSystems HealthShare platform for their health information networks.

St. Luke’s Hospital (IA) chooses Amcom Software for smartphone communications and Web-based on-call scheduling.

WakeMed Health & Hospitals (NC) contracts with MobileIron to provide mobile device security and enable the organization’s BYOD program.

The Newfoundland and Labrador Centre for Health Information sign agreements with Telus Communications and Orion Health to provide technology for a province-wide integrated EHR.

Allscripts Enterprise EHR  customer Summit Medical Group (NJ) signs a long-term contract for Allscripts Managed Services.

People

Bulletin News names Nick Tabbal (Resonate Networks) VP of analytics for its Bulletin Healthcare subsidiary.

PerfectServe hires Robin Borg (Optum) as VP of human capital.

Beacon Partners names Fernando Martinez PhD as national director for enterprise assurance services. He was previously with Jackson Health System (FL).

MyHealthDIRECT adds HealthWays VP and COO Tom Cox and SSB Solutions chairman Jacque Sokolov, MD to its board of directors.

Announcements and Implementations

Geisinger Health System and Merck announce a multi-year collaboration to develop solutions that facilitate shared decision-making between patients and physicians and improve patient adherence, engagement, and care delivery.

Corniche Hospital becomes Cerner’s first client in the United Arab Emirates to achieve full closed-loop medication administration. Meanwhile, Royal Berkshire NHS Foundation Trust goes live this week on Cerner Millennium after a three-month delay.

Government and Politics

The HIT Policy Committee’s Quality Measurement Workgroup and the HIT Standards Committee’s Clinical Quality Workgroup ask for input on ways in which Stage 3 MU may advance the delivery of high-quality care in diverse care settings.

The White House recognizes 82 providers for their successful implementation of EHR at a Health IT Town Hall in Washington, DC.

HHS awards $772 million to 81 providers, tech firms, and local organizations to advance healthcare innovations that lower costs and improve quality.

VA officials tell lawmakers at a House Veteran Affairs Committee hearing that it has processed fewer than 800 benefit claims despite investing $491 million in new technology. The current backlog is 913,690, which includes 575,773 claims older than 125 days. The VA originally promised a system-wide rollout of its Veterans Benefits Management System this year, but performance issues have pushed full implementation until the end of 2013.

The Military Health System issues an RFI for a system to track lab work within its integrated EHR.

Joe Goedert writes a Health Data Management article describes pending federal legislation that could be the first steps toward regulation of healthcare IT.

Other

The US Supreme Court refuses to consider an appeal by former McKesson Chairman Charles McCall to overturn his 10-year prison sentence for scheming to inflate company revenue.

Lehigh Valley Health Network , Cedars-Sinai Health System, Kaiser Permanente, Palmetto Health, and HCA make the top 25 in Computerworld’s list of 100 Best Places to Work in IT 2012.

The local paper highlights Greenwich Hospital’s (CT) recent $30 million implementation of Epic, which replaces Meditech and will eventually connect with other Yale New Haven Health System facilities.

UnitedHealthcare tops AMA’s fifth annual National Health Insurer Report Card, which considers the insurance billing and payment accuracy of seven of the largest commercial health insurers. Error rates on paid medical claims dropped from 19.3% in 2011 to 9.5% in 2012, saving health systems $8 billion in unnecessary administrative work to reconcile errors.

New from Ross Martin MD:  The Money Machine, which he says appropriately describes your financial hamster wheel, whether it’s the usual problems or EHR adoption or whatever.

Weird News Andy admires the dry analysis of a doctor describing a 16-year-old accidentally shot through the head with a three-foot-long stainless steel fishing spear: “It’s a striking injury, something you don’t see every day … the first obstacle is to not be distracted by the obvious sensational aspect of the injury.” The spear missed most everything important in the boy’s head, doctors removed it, and he’s expected to make a near-full recovery.

WNA also finds this story interesting. A man told by a hospital that his cancer left him with just months to live, along with his wife, rack up $80,000 in debt to complete a hastily compiled bucket list, giving away $30,000 worth of goods, selling their house at a loss, cancelling their health insurance, and traveling the world. The man even takes up smoking again, figuring he has nothing to lose. He then waits to meet his maker, vowing to kill himself if the pain became unbearable even as he questions why he seems so healthy. Finally his hospice worker told them the hospital had made a mistake but didn’t tell him – he’s fine.

Sponsor Updates

• Greenway pilots integration between its PrimeSUITE EHR/PM product and Microsoft HealthVault.
• ICA Informatics exchanges direct messages and trust agents with Cerner, Max MD, Mirth, NitorGroup and Techsant Technologies at the ONC Direct Summit.
• Capsule says that within the last six months it has added or updated more than 70 devices to its device integration list.
• Johns Hopkins’ director of enterprise services discusses his hospital network’s use of Imprivata’s SSO technology.
• The NY eHealth Collaborative announces that Stephen J. Dubner and Dr. David J. Brailer will be keynote speakers at its October Digital Health Conference in NYC.
• Emdeon hosts educational presentations on cost containment challenges at this week’s America’s Health Insurance Plans Institute conference in Salt Lake City.
• Picis announces a strategic partnership with billing and PM provider Anesthesia Business Consultants.
• All Imaging Systems partners with UltraLinq Healthcare to provide cloud-based storage services to UltraLinq clients.
• Medicomp and technology partner Northrop Grumman announced Northrop’s Clinician App integrated with Medicomp’s MEDCIN engine at last week’s Government HIT conference in DC.
• The 400-physician Rees-Stealy Medical Group (CA) lowered transcription costs $800-900,000 annually (80-90%) within 10 months of adopted Nuance’s Dragon Medical voice recognition software.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Dr. Sam 6/18/12

A Key Missing Element of EHRs

Nurses play a key — if not crucial — role in successful hospital EHR implementations.

• They are the first people that frustrated physicians complain to and often have to deal with borderline or actual abusive commentary or language emanating from an angry physician.
• They are often the initial super-users who can show physicians how to navigate through specified workflows that they may not have absorbed during EHR training (if they attended training sessions at all).
• They often have to enter orders or deal with verbal orders given by a physician who cannot (or does not want to) enter orders by Computerized Provider Order Entry processes (CPOE – please note use of the term “Provider” and not “Physician,” which is the true appropriate use of the acronym CPOE.)
• They are often the first users in the go-live schedules for clinical documentation.

In spite of their key role in patient care, by tradition (in both paper and electronic worlds), their clinical notes are almost universally unread by physicians. In spite of being the caregivers who spend far more time at the bedside than any other clinicians, their notes are either ignored, or at best casually reviewed by physicians.

As a result, both the paper and electronic environments are often replete with documentation contradictions with inaccurate information entered by either the physician or the nurse, or with information that conflicts with patient status. After cataract surgery, a nurse might enter “Pupils Equally Round and Reactive to Light and Accommodation (PERRLA) when one pupil is pharmacologically dilated or constricted, or a physician might document “Patient fully ambulatory and stable” when the patient is in fact unable to get out of bed or has had fluctuating vital signs. The number of possible conflicting entries is both unlimited and endemic.

This is where standard vocabulary becomes as important as accurate clinical observations. An EHR functionality that has been lacking since the early years of clinical information system design has been the ability to cross reference nursing and physician clinical documentation notes and to generate alerts when contradictions are present. This is not only of essential importance to patient care, but to reducing vulnerability to medical liability.

Sam Bierstock, MD, BSEE is the founder of Champions in Healthcare, a widely-published author, and a popular featured speaker on issues at the forefront of the healthcare industry.

Monday Morning Update 6/18/12

From Pathological: “Re: Epic. How do they handle blood product orders (type and screen, specifically) that go to LISs? FDA requires 510(k) approval of any CPOE module that electronically touches a regulated, FDA-cleared transfusion medicine module and Epic doesn’t have that approval. What do they tell new clients?” I could use some reader help here, so please add a comment if this is your area of expertise.

From Neighbor Ned: “Re: Lahey and Allscripts. They’ve had problems and haven’t seen the post-acquisition synergies. Bruce Metz came on board as CIO and wants a ‘unified architecture,’ which sounds like Epic. Decision to come within a month.” Unverified, but from a non-anonymous second-hand source, which is the best I have since Bruce hasn’t responded to my e-mail.

Welcome to new HIStalk Platinum Sponsor Park Place International. The company offers cloud-based technologies and consulting services that give Meditech customers a stable, optimized, and sustainable reference architecture. OpSus|Live is the company’s cloud-based hosting service that provides customers with a solutions and services package tailored to their unique needs. Its OpSus|Recover cloud-based disaster recovery service offers several service level plans based on recovery point and time objectives. They can design a certified infrastructure solution for new customers, or for existing Meditech customers experiencing performance problems, their technical consultants can provide rapid remediation and intervention. Hospitals interested in storage virtualization, thin provisioning, data encryption, vendor-neutral image archiving, secure virtual desktops, single sign-on, or hybrid cloud integration can get all the help they need from a focused company whose experienced consultants offering fresh approaches. Thanks to Park Place International for supporting HIStalk.

A slight majority of respondents said that opening up government healthcare data could provide health improvement. New poll to your right, in honor of Dr. Jayne’s recent rant: should HHS (and ONC specifically) back up new provider measures of quality or Meaningful Use with evidence proving that they work to improve patient outcomes?

Listening: new from one of my favorites, Metric. I’m also enjoying the new Beach Boys album, which thankfully is (a) all of the surviving members together other than in a courtroom; (b) mostly Brian Wilson and not much Mike Love; (c) not a bunch of rehashed old demos and laurels-resting, but new music; and (d) full of amazing harmonies that sound like the 1960s, but with the wisdom and wistfulness inherent with band members now in their 70s. Live video here. How they still hit those high notes is beyond me. The final track, “Summer’s Gone,” might bring up a tear if you’re sentimental or worried that this might be their last hurrah after 52 years. The new album is #3 on Billboard’s chart, “That’s Why God Made the Radio” is their highest-charting single since 1965, and the ironically named ‘Boys have broken the record of the Beatles by having over 49 years of Top 10 records.

Michigan-based hospital users of Epic form the EHR Michigan User Group, with 150 attendees from all 11 Epic-using hospitals gathering at Beaumont Health System for their first meeting. An Epic developer gave a preview of future Epic versions, warning the group not to share details with the media or competitors, with the TV station’s summary being, “Suffice it to say the software basically tracks patients in the hospital like the screens over the patients in Star Trek’s sickbay – only you can get the information anywhere, securely, on a tablet or smart phone.” That same TV station, loathe to run a picture-free online story since nobody can read without pictures these days and the user group apparently didn’t send over a photo, lazily headed over to Wikipedia for a startlingly irrelevant screen shot of the VA’s VistA as “as an example of an electronic medical record.”

Speaking of Epic, it drives me up a wall when people insist on spelling it as EPIC for some strange reason, apparently missing the point that even though it’s a short word, it’s still not an acronym (and the fact that Epic itself clearly does not capitalize it). Confounding the issue is Mount Sinai Medical Center (NY), which is installing Epic but calling its project EPIC in a highly contrived acronym (Efficiency, Patient safety, In/outpatient communication, Care.) Given Epic’s legendary and legally enforced paranoia about its intellectual property (as in the story above that warns about loose lips), I’d be careful. 

A CareFusion site from which medical equipment firmware updates are distributed is found to be loaded with malware, triggering a Department of Homeland Security investigation. Google’s Safe Browsing program flagged several pages related to CareFusion’s ventilators as being infected with 48 separate Trojan Horse programs and two scripting exploits (the screenshot above is from when I ran it.) Kevin Fu of the Medical Device Security Center discovered the problem when downloading an update for AVEA ventilators. He reported the problem to the FDA, adding that CareFusion’s instructions advise users to just ignore the usual security warnings. Fu also points out that vendor people and hospitals have gotten lax about running updates for pacemakers or other critical medical devices from the Internet or from someone’s USB key without thinking twice about it. Homeland Security’s analysis found that some of CareFusion’s sites were running six-year-old versions of ASP.NET and IIS 6.0.

Congresswoman (and Nurse) Renee Ellmers (R-NC) sends a letter asking HHS Secretary Kathleen Sebelius if HHS has adopted recommendations from the IOM’s November report involving the safety of healthcare IT. She wants to see a plan to minimize patient safety risk, a list of HIT-related errors that have caused harm or introduced risk, and a plan for a mechanism to allow users and vendors to report HIT-related deaths. She sent Sebelius a letter in August 2011 asking for a study of healthcare IT adopt, benefits, cost effectiveness, and medical error rates.

A June 14 power outage at an Amazon Web Services data center in Virginia takes down several cloud-based businesses, including Pinterest, for up to eight hours.

This makes me cheer given that the “site errors” people complain to me about that nearly always involve bugs in Internet Explorer, the worst browser ever written, and 90% of the time it’s an old version they’re running (because hospitals are stuck in a Microsoft time warp, often standardizing on IE6 from 2001 or IE7 from 2006 paired with their 2001-vintage Windows XP). An Australian retailer slaps a surcharge on orders placed by customers using IE7 since his company spends a ton of development time “rendering the website into an antique browser.” The company says only 3% of users run IE7, but most of his Web development team’s time is spent trying to code around its abundant flaws. I’ve had to pay people several times to do the same for HIStalk “problems” that don’t exist in Chrome, Safari, Firefox, or Opera.

Vince’s topic this week is more about Dairyland, but he’s got some fascinating pricing information from a number of vendors that will shock industry noobs (a five-year total cost of ownership for a full-line financial system of $400K? Yes, please.)

Discussion at a summit organized by the Association for Pathology Informatics on June 8 addressed the push for enterprise-wide systems that creates headaches for lab managers. Bruce Friedman MD said hospital administrators and IT people don’t appreciate the complexity and criticality of what he calls T-LISF — total lab information system functionality — that includes the LIS itself, middleware, outreach support, and firmware. Consultant Dennis Winsten said he has worked with several clients whose labs were being pushed into switching to Epic’s work-in-progress Beaker LIS by the offer of a free site license, requiring the lab people to perform an assessment of whether Beaker could meet their needs. Interesting: Cerner, McKesson, SCC Soft Computer, and Sunquest had speakers or attendees at the conference, but Epic passed on its invitation. 

Steve Larsen, the federal government’s most powerful health insurance regulator responsible for consumer protection and insurance exchanges, quits to become EVP of Optum, part of insurance company UnitedHealth Group.

Strange: a nurse in a hospital in Scotland streams so much porn from his NHS-provided laptop that he drags down the entire hospital network, with noticeable problems in radiology and videoconferencing as he is enjoying “Busty Japanese Girls” and “German Lesbians, Very Hot.” Officials inspecting his office found dozens of unopened referrals for his services going back to 2004. He was fired and his RN license was revoked this week, ironically denying patients his services as a member of the addictions team.

Eric Topol MD lists five technology devices that physicians should know about:

The smartphone-powered ECG, which he used on a flight to diagnose a passenger experiencing a heart attack, resulting in an unplanned stop to rush the passenger to the hospital.

The smartphone-powered continuous blood glucose monitor.

The iRhythm patch for Holter-like monitoring of cardiac arrhythmias for up to two weeks.

The AirStrip Patient Monitoring system for remotely monitoring ICU or other critical patients.

GE Healthcare’s Vscan ultrasound device that he says has entirely replaced his use of a stethoscope for listening to a patient’s heart.

E-mail Mr. H.

News 6/15/12

Top News

NIH and the National Cancer Institute announce grants to fund development of tools that empower consumers, patients, and/or their providers. The grants, worth up to $1.15 million each, encourage developers and entrepreneurs to partner with large health systems and health-related vendors. A long list of possible tool categories is provided.

Reader Comments

From Shhh: “Re: Epic. Speculation that it will have an SaaS offering.” A Forbes article written by a healthcare strategy consultant (who also has an article about Epic in The Atlantic that I’ll cover shortly) observes that Epic’s “fundamental but hardly delightful” system (KLAS scores suggest that Epic’s customers are pretty close to delighted, but let’s not quibble) that is client-server based and doesn’t communicate well with other systems. It says Epic is OK for healthcare innovation if you think repeatable processes will do that, but otherwise not. My opinion: I don’t really agree. I don’t get the cloud fixation – large hospitals that are accustomed to running data centers and hiring DBAs not only don’t demand a cloud-based system, they often don’t even want one. There’s nothing magical about “cloud” – somebody’s running a data center somewhere, so you’re just paying them to do it instead of doing it yourself, hoping the economy of scale they enjoy offsets the profit they demand. As far as the implication of clueless Epic customers, hospitals buy systems based on the benefits they expect, and it’s silly to think that an outside observer has the information to second guess their decisions (although I would agree that hospitals are awfully breezy with their ROI figures for Epic projects running into the hundreds of millions.) Epic is just Meditech for bigger and more egotistical hospitals – integrated, tightly controlled, as technically obsolete as their competitors, and sold by non-trendy and basically honest technologists who would rather walk away from a deal than herd you into a hard-sell Vision Center or make “partnership” promises they know won’t come true. Companies should stop fixating about mounting a full frontal attack on Epic that’s sure to fail and instead innovate on building products and services for Epic’s large client base just like the companies that coexist successfully with Meditech. As far as healthcare innovation goes, don’t put your hopes on the tools of the trade – the software market would spring to life tomorrow if healthcare incentives were changed. Today’s software market, right or wrong, reflects exactly what customers demand, which in turn reflects what the market pays them to do. HITECH created a false urgency that spurred providers to buy the same old systems they could have bought with their own money and hadn’t.

Massively looking forward to working with Bryan Sivak, new CTO of HHS!!

— Todd Park (@todd_park) June 14, 2012

From Don Johnston: “Re: Bryan Sivak, chief innovation officer of the State of Maryland. He will be the new HHS CTO, taking over from Todd Park.” Verified. He was previously CTO of Washington, DC. Before that, he had founded customer service portal vendor InQuira, which was sold to Oracle last year for an unannounced price.

From Ron Mexico: “Re: Lahey Clinic. I’ve been told they are replacing Allscripts. Heard anything?” I e-mailed CIO Nelson Gagnon twice and he hasn’t responded. They have Allscripts for both inpatient and ambulatory, I believe. 

HIStalk Announcements and Requests

From HIStalk Practice this week: the AMA says Stage 2 MU requirements are too demanding for physicians. Practice Fusion CEO Ryan Howard invests in Ringadoc, a provider of virtual medical visits. A simple explanation of cloud computing from MGMA’s Rosemarie Nelson. The rise of cloud computing in healthcare and an Epic-directed dig. Aaron Berdofe weighs in on centralized repositories as a healthcare infrastructure data model. Pop over for a quick visit and don’t forget to sign up for e-mail updates. Thanks for reading.

Dr. Jayne warned me in advance that she was being “pissy” when she wrote her Curbside Consult this week, in which she laments that physicians are being pulled away from delivering care by the distraction of “pseudo-quality initiatives, MU, and demands by marketing teams that we have an online presence.” She also throws down a challenge that any new Meaningful Use or quality measures should be accompanied by evidence that they work to improve outcomes, the same standard that a drug or device would be held to. I saw lots of tweets referencing her post, and Evan Steele of SRSsoft cites Dr. Jayne in a blog post of his own that suggests that doctors are questioning the real value of chasing MU requirements.

Ed Marx updated his CIO Unplugged post this week, When the Worst is Best, with responses to your comments.

Acquisitions, Funding, Business, and Stock

Axial Exchange, which offers care transition software, acquires patient-facing mobile app vendor mRemedy from DoApp and Mayo Clinic.

Patient Safety Technologies files a patent infringement lawsuit against ClearCount Medical Solutions, claiming that company’s surgical sponge counting technology violates its intellectual property.

Microsoft will acquire Yammer, a Facebook-like application for enterprises, for around $1 billion, according to a rumor run by The Wall Street Journal.

Sales

Evangelical Community Hospital (PA) selects Allscripts Sunrise Clinical Manager for inpatient EHR. The 127-bed hospital already uses an Allscripts ambulatory EHR.

Global Healthcare Exchange selects Meddius to provide data exchange for its Implantable Device Supply Chain solution.

People

Practice Fusion hires Todd Martin (NewsRight) as SVP of business development and Sheila Ryan (CBS Interactive) as VP of people and culture.

Dan Michelson (Allscripts) is named CEO of Strata Decision Technology.

Announcements and Implementations

Home health software provider HealthWyse forms a strategic collaboration with Sutter Care and Home to enhance development of HealthWyse’s chronic care management solution.

Florence Hospital at Anthem (AZ) goes live on Stockell Healthcare’s InsightCS RCM system.

AirStrip Technologies expands its platform to provide real-time delivery of data stored in disparate EHRs to clinicians using mobile devices. Travis covers it in detail on HIStalk Mobile.

MappyHealth releases the beta of  a web app that mines Twitter data for terms that could indicate a health-related development, such as a disease outbreak.

MedAssets opens the call for exhibitors for its Technology & Innovation Forum, to be held October 9 in Dallas, TX. Companies that aren’t already covered by a MedAssets purchasing agreement will present to its clients, with high-scoring vendors earning the chance to have their products added to the company’s contract portfolio.

Secure storage sharing vendor Box says it recently added four healthcare customers, including Greenway Medical, and that its healthcare cloud adoption is up 200%. It offers a free personal account with 5 GB storage if you want to play around with it.

Other

Here’s a new cartoon from Imprivata.

More than a third of physicians participating in an athenahealth/Sermo survey say their EHR was not designed with doctors in mind, while almost 3/4 report that using an EHR distracts them from face-to-face patient interaction.

An article in The Atlantic called Is One Company About to Lock Up the Electronic Medical Records Market? (co-authored by the same consultant who co-authored the Forbes piece above) says Silicon Valley types don’t understand how Epic can be successful when it breaks all their high-tech rules: it uses no open standards and it does not open up its information for other uses, but customers buy it anyway. It concludes that what Epic offers is the opposite of innovation – the quick implementation of its own rules that hospitals haven’t had the willpower to introduce on their own. In other words, hospitals buy Epic because they don’t really know how to improve their processes and use information to improve care, so they trust Epic to do it for them. While Epic’s paternalistic rules smack of industrialization, they let hospitals quickly gain efficiency and capture data they need to make both clinical and operational decisions. On the downside, Epic forces the practice of big-hospital medicine and locks customers into its outdated technology with high costs. I would generally agree – Epic’s success means we’ll see more organizations work like the big-name academic medical centers. Epic will drive some long-overdue evolutionary changes in healthcare delivery, but it’s not going to foster revolutionary gains on a broad scale. Given the country’s high healthcare costs and modest results, incremental improvements in health may not be enough, especially given the provider-centric view that improving healthcare services delivery is the same as improving health. 

A NEJM article, Escaping the EHR Trap – The Future of Health IT, argues that healthcare needs a dynamic information infrastructure instead of putting all the eggs in the EHR basket. The authors are Ken Mandl and Zak Kohane of Harvard and Children’s Boston, the guys behind the SMART project that advocates an iPhone-like apps ecosystem for healthcare IT (I haven’t heard much about that project lately.) Among the article’s talking points:

• EHR vendors have dragged their feet in the nearly 50 years since MUMPS was invented, avoiding modular architectures that would support product extension, data sharing, and interoperability;
• The business model of vendors is to control data, which prevents clinicians from having longitudinal and population-based views;
• Google-type EHR data searches and population analytics are not easily accomplished without exporting information to neutral systems;
• The hodgepodge of hundreds of non-interoperable EHR products hasn’t helped either doctors or patients;
• Modern tools should be embraced – cloud data storage, secure communication via the Direct Project, collaboration applications to manage group tasks, and non-healthcare specific analytics tools;
• Generic rules engines and user interface development tools could be used instead of each vendor using proprietary methods;
• ONC grants are funding development of “post-EHR" products that will create innovation (like the project the authors are running, it should be noted in the interest of disclosure.)

Another article in the new NEJM is Unraveling the IT Productivity Paradox – Lessons for Health Care (don’t underestimate the significance of these two articles given that they’re running in the highly respected NEJM). It says that healthcare IT is following the path of other industries that embraced technology earlier: (a) trying to correlate IT use to productivity is iffy because metrics don’t capture true productivity and value; (b) healthcare is late to the IT party and hasn’t had time to redesign processes around it; and (c) poor software usability has historically undermined potential productivity gains. Conclusion: it’s too early in healthcare to say whether IT is worth it or not.

Here is Atul Gawande’s keynote from Health Datapalooza last week. He speaks as well as he writes – telling simple but compelling stories, speaking slowly and without obvious ego, and tying it all into a message that you didn’t necessarily see coming. He has an interesting perspective about how battlefield medical services have improved and how that might impact non-military healthcare delivery.

A reader from Catholic Health Initiatives obliged my request for more information about its $1.5 billion EHR project. The five-year project called OneCare will include electronic health records for both inpatient and outpatient, infrastructure, user access enhancements, and an HIE with portals. Its Hoover’s profile says it has 14,000 acute care beds, which would be just over $100K per bed. That’s a lot less than some hospitals pay per bed, but it’s hard to compare size and scope. They were implementing Allscripts on the outpatient side a couple of years ago, trying to get it to talk to Cerner and Meditech inpatient systems, but they seem to be posting Epic jobs lately.

A delay by University of Michigan in reporting suspected child pornography that led to the arrest of a pediatric ED resident could cost the school more than $500K. Its contract with a Chicago law firm calls for a minimum payment of $395K, with the lead attorney and a a partner billing $725 per hour, the associates at $540-595 per hour, and paralegals charging $180-280 per hour.

Weird News Andy can’t figure out why a woman would go into an empty stairwell with her abuser in this sad story. A surgeon who is also a former Special Forces weapons expert plants a tracking GPS in his former girlfriend’s car, stalks her house, and threatens to kill her more than once. He allegedly lures her into the stairwell of the hospital in which she worked, shooting her dead with a high-powered pistol. Police think he’s mentally unstable.

Strange: a nurse who stole a doctor’s iPad from the ICU lounge is caught when the device automatically connects to the hospital’s wireless network, allowing hospital security to catch him heading toward his car with the device.

Sponsor Updates

• City Hospitals Sunderland NHS Foundation Trust implements BridgeHead Software’s Healthcare Data Management archiving solution.
• CommVault is positioned in the Leaders quadrant of Gartner’s just-published report on enterprise backup and recovery software.
• eClinicalWorks releases a case study highlighting the clinical and administrative improvements realized by Block & Nation Family Medicine (FL).
• TeleTracking reports that over 80% of hospitals named in US News & World Report’s 2012 Best Hospitals use its applications.
• OptumInsight is offering Webinars for clearinghouse customers, Epic users, and GE Centricity users.
• Beacon Partners offers new white papers on HIE and organizational culture.
• Gateway EDI highlights Mid-Illinois Medical Care Association and their claims processing success.
• A MEDSEEK blog entry provides advice for overcoming physician resistance to patient portals.
• Impact Advisors has been named to the 2012 Healthcare Informatics 100 list.
• An Informatica-sponsored report reveals the vulnerability of sensitive data due to insufficient controls preventing unauthorized access.
• Wipro Mobility Solutions collaborates with Kony Solutions to offer mobile application technology and services to enterprise customers in the US, UK, Australia, and the Middle East.
• Puerto Rico Hospital Supply, Dell, and NextGen Healthcare will co-market and deliver medical technology and service to practices in Florida and the Caribbean.
• Waterbury Orthopaedic Associates (CT) selects SRS EHR for its four providers.
• Meditech collaborates with Intelligent Medical Objects to provide mapping of diagnosis and procedure terminology to billing and medical concepts.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 6/13/12

Top News

Private equity firm TPG Growth acquires critical care systems vendor iMDsoft. We reported that rumor here on June 8, along with the rumored sales price of $80 million that was not confirmed in the announcement.

Reader Comments

From SmallBiz: “Re: Accolade. Your post about Accretive Health’s chairman Michael Cline and reference to Accolade made me curious. A quick Google search shows the company on the SBA 100 list of companies that have received small business assistance. Call me crazy, but I thought SBA assistance was meant for budding entrepreneurs or bootstrappers trying to change the world, not for multi-millionaire private equity guys who want to add one more high flyer to their portfolio. The more one researches Accretive, the more one scratches their head.” Ditto the more one tries to understand how the federal government can be so free with taxpayer money while drowning us all in red ink.

From The PACS Designer: “Re: Apple’s iOS6 Preview. This fall we’ll see the arrival of Apple’s iOS 6 platform. For now, we have the iOS 6 Preview announced by Tim Cook this week. TPD particularly likes the Apple Maps, which shows cities and their skylines through Apple’s detailed  air mapping process.“ I’m not really an Apple fanboy even though I use the iPad for routine stuff (checking the weather, looking up something I’m watching on IMDB) but I admit that I intently follow live blogs of their World Wide Developer’s Conference every June. There’s just something compelling about the excitement of the unveiling and the hipness of Apple that makes me want to feel like I’m there among the geeks and crusties. The big announcements (other than Apple dumping its Google relationship for maps) involved a refresh of the laptop line (including a rare price drop on the Mac Pro) and some iOS enhancements. Boring if you were expecting a new Apple TV or the iPhone 6. It was cool, though, that everything being announced other than the new Mountain Lion OS was available for online purchase the same day (once they brought the Apple store back online later Monday.) Other than Google, the companies taking it in the shorts from Apple were Intel and its partner companies trying to sell Windows-powered Macbook Air lookalikes (aka ultrabooks) that aren’t nearly as cool for about the same price ($999), the same Apple manufacturing pricing advantage that makes it suicide to roll out an iPad competitor. Even the low-end Air now comes with all-flash storage, Thunderbolt and USB 3 connectors, and a FaceTime HD camera. For Maps, it looks like Apple has struck a deal with TomTom to turn the iPhone into a free, voice-powered GPS with real-time traffic updates driven by automatic data from individual iPhones and integration with services such as Yelp and OpenTable.

HIStalk Announcements and Requests

Maybe it’s just me, but has Facebook been dog slow lately? Are they punishing users for their unimpressive IPO by throttling back the Web server horsepower? Ditto the hourglass city for Twitter. How many billions does it take to keep the Web page coming up?

I’m speaking to the men here, but the ladies are welcome to read. I was reading a list of suggested ways to make the woman in your life happy. A common answer was to hug her from behind, kiss her cheek, and tell her she’s beautiful whether she is or not (assuming she is to you, anyway, which I hope is the case.) You and I probably have in common the fact that we haven’t done this with either Inga or Dr. Jayne even though they are clearly loved and beautiful, so here’s a list of alternatives: (a) sign up for spam-proof e-mail updates; (b) give them a virtual hug by friending, liking, and connecting via all the hipster social not-working sites; (c) send us news, rumors, photos, or anything else that is informative or entertaining; (d) intently study our sponsors via the categorized and searchable Resource Center or the gloriously non-animated ads to your left, and if you’re provider seeking consulting help, fill out a quick online form and get a bunch of responses via the Consulting RFI Blaster; (e) have patience with our sometimes terse and/or delayed responses or occasional crankiness since we work full time elsewhere, and doing all things HIStalk is an intensely enjoyable but time-sucking hobby that requires constant reallocation of hours. Do these things and the smart and sassy HIStalk ladies will virtually lean their heads on your shoulder and sigh contentedly, squeeze your bicep and insist that your workouts are buffing you up, and pretend to find your timely Caddyshack quips to be funny. Heck, I might do that myself since we appreciate all of our readers and sponsors.

Acquisitions, Funding, Business, and Stock

The Chicago business paper reports that Fidelity Investments, the largest outside investor in Merge Healthcare, has sold most of its shares, dropping its ownership from 6.7% of the company to around 1%. Shares were up 1.34% on the day, although they’re still down by more than 60% since late March.

Compuware hires an underwriter to prepare for the IPO of its Covisint business. The company hopes to raise $200 million.

Sales

Bacon County Hospital (GA) selects Summit Healthcare’s Express Connect and Provider Exchange interoperability technology for its Meditech 6.0 system.

Huntington Memorial Hospital (CA) announces a strategic collaboration with Cerner to implement its clinical and financial solutions and connect with the hospital’s information exchange.

The Orange County Partnership RHIO (CA) selects Mirth’s data exchange solutions.

Catholic Health Initiatives selects Orion Health as its HIE technology partner for its $1.5 billion EHR initiative. I’m interested to know the scope of the overall project given its cost, so help me out if you know.

Thailand-based medical tourism hospital Bumrungrad International Hospital chooses business intelligence tools from Agilum Healthcare Intelligence of Nashville, TN (known as Anthem Healthcare until a name change a few weeks ago.)

Wireless infrastructure vendor Firetide wins a contract for 4,000 centrally managed access points for a 180-hospital WLAN rollout in Korea.

Dallas County Medical Center (AR) chooses the Prognosis HIS EHR after reviewing a dozen vendors. The hospital’s CEO says a key factor was a guaranteed 120-day go-live and the 100% of customers who have received Meaningful Use money.

Federal contractor CACI International is awarded a $20 billion contract to provide IT services to the National Institutes of Health and other government agencies. The company says healthcare IT is an important growth area and that its services will provide “innovative solutions to enhance taxpayer services.”  

The Navy rejects the EMMA computerized medication dispensing system from INRange Systems because of concerns about the security of its wireless communication. They planned to pilot it, but changed their minds when it failed to earn certification and word of bad experiences from Army pilot sites got out. They also said its potential to control drug abuse among service members was overstated.

People

Steve Sarros (Spectrum Health) is named VP/CIO of Baptist Health Care (FL).

Announcements and Implementations

Agfa Healthcare selects Dell to host its medical imaging archiving services.

Precyse signs a software interface license agreement with 3M Health Information Systems to interface Precyse’s computer-assisted coding product with 3M’s Coding and Reimbursement system.

T-System introduces RevCycle+, an RCM solution for the emergency department that encompasses facility coding, physician coding and billing, and consulting.

M*Modal announces its Catalyst suite of cloud-based applications that allows extraction of data from unstructured clinical documentation (such as dictated encounter notes) that can be merged with structured EHR information. A key benefit is the ability to search all medical documents regardless of source and system while preserving context beyond simple keyword searches.

Hospira announces enhancements to its TheraDoc clinical surveillance system to support hospital antimicrobial stewardship programs, including an eMAR interface, dashboards, and alerts.

Business analytics software vendor SAS partners with the non-profit Health Care Incentives Improvement Institute to develop analytics-powered provider reimbursement models to support bundled payments and ACO shared savings models. I’m impressed with the most recent (and fun) blog post by HCI3’s executive director Francois de Brantes (formerly of GE) or his ghostwriter — Too Many KITAS can be a PITA, which applies behavioral theory to ACO-type reimbursement:

The carrot and stick approach, what Herzberg refers very cynically in his paper as the KITA method (for kick in the ass), doesn’t work very well. Instead, he suggests an exercise in minimization of toxic environmental factors. We’ve grown accustomed to thinking that incentives can be optimized, that behaviors can be finely tuned to respond to the incremental adjustment in fee schedules or bonuses. They can’t. What we must do is actively minimize misalignment of incentives – factors that lead to job dissatisfaction. If I encourage employees to seek care while penalizing physicians for delivering too much care, then I’m creating a toxic environment leading to dissatisfaction. If I put physician income at risk but only tell them after the fact what their budget was and that they blew it, then I’m creating a toxic environment leading to dissatisfaction. If we want physicians to develop and maintain an internal motivating generator (as Herzberg refers to it), we have to minimize the factors that are stopping them from achieving their potential.

Government and Politics

AHRQ produces an e-prescribing toolset for physician practices that includes a readiness assessment, sample workflows, a task table, an e-prescribing vendor assessment tool, sample project timelines, a computer skills assessment, and a flyer for patients.

Innovation and Research

A JDRF-funded study demonstrates the feasibility of an artificial pancreas for ambulatory use. Two patients were connected to an insulin pump that was controlled by a smart phone that constantly monitored their blood glucose levels and adjusted their insulin doses accordingly, allowing them to eat meals and sleep outside the hospital while maintaining near-normal blood glucose levels without medical intervention. 

An Arizona teen wins an innovation award for his enhancements to existing free software that allows people with Lou Gehrig’s disease to control a browser using their eye movements. Commercial equivalents cost $20,000, but his version costs less than $2,000 including hardware. He’s talking to some VCs about marketing it.

Other

HIMSS Analytics introduces the Ambulatory EMR Adoption Model, which will track IT adoption in more than 28,000 ambulatory facilities that are part of hospitals or hospital systems. None of the 9,247 ambulatory facilities that are providing information to HIMSS Analytics are at Stage 7 and nearly half are Stage 0 (purely paper-based.)

The Advisory Board Company’s daily briefing newsletter highlights this story, in which a researcher digging through boxes of old paper at the National Archives finds 21 pages of notes taken by the first doctor to attend to Abraham Lincoln after his shooting at Ford’s Theater. The doctor, who was also attending the play “Our American Cousin,” had earned his medical degree just six weeks before. I couldn’t help but think how uninformative the rich historical narrative would be had it been reduced to today’s codes and checkboxes.

A UK hospital admits that it believes one of its employees leaked information to a tabloid about the cystic fibrosis diagnosis of the four-month-old son of former Prime Minister Gordon Brown in 2006. The tabloid is owned by Rupert Murdoch.

In Canada, a Grey Bruce Health Services computer problem takes down the phone and computer systems of six hospitals.

Patient advocates complain that University of Iowa Foundation sent patient information to the questionable fundraising groups it hired, allowing them to enhance their mass mailings seeking donations to its hospitals by adding the signature of each patient’s doctor. The hospital says the practice is legal and everybody else does it. One of the fundraising companies raised $1.1 million for the university, but charged $1 million for doing so. The newspaper article only casually mentions an item that I consider the most troubling:

The head of the hospital’s ophthalmology department says the flow of information works both ways in that the foundation tells him which of his upcoming patients have agreed to donate money. The foundation and hospital have also agreed in writing to collaborate on “wealth screenings of patients” in order to maximize donations.

An American Medical News editorial calls Meaningful Use Stage 2 “a recipe for failure,” saying its increased number of performance measures and higher thresholds raise the chances that a practice will miss out on their HITECH check, possibly through no fault of their own (like practicing in an area where labs can’t accept electronic EHR data and patients who aren’t interested in using technology).

Inga says she hopes she has a leg up on Weird News Andy in finding this story. A Gulf of Mexico shrimper drags up a $30,000 custom-painted artificial leg from the water, saying, “I was hoping I wasn’t going to find a body with it as well.” The leg’s University of Kentucky motif allowed him to track down the owner, who says he lost it while swimming over Memorial Day. The diehard Wildcats fan wasn’t reduced to hopping on one leg in the interim: he has two more like it.

Sponsor Updates

• AirStrip Technologies and Palomar Health launch a vendor-neutral mobile platform to provide access to clinical data.
• Kony Solutions hosts a June 14 Webinar on developing an enterprise mobile strategy.
• EBSCO Publishing releases three medical e-book collections of top-rated content on its EBSCOhost electronic library collection of 300,000 e-books and audiobooks.
• The Ohio Orthopedic Center of Excellence selects eClinicalWorks EHR for its 59 providers.
• Covisint announces that DocSite is open for 2012 PQRS submission, which costs a flat $299 per provider. It also offers free webcasts and a 2102 CMS Incentives FAQ document.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 6/11/12

From Consulting Dude: “Re: Accenture. Help me out here. Stanford is kicking them out due to non-performance on their contract for outsourcing and Epic implementation and support. Partners HealthCare is supposedly hiring Accenture to implement Epic. Does the East Coast not talk to the West Coast?” Unverified, but any time you have huge academic medical centers, there’s a good chance their own bureaucracy and executive egos will cause a vendor to fail even though the situation isn’t entirely their fault.

From RTLS Experts: “Re: VA RTLS contract. They finally announced HP Enterprise Services as the winner of the $543 million contract covering 152 medical centers. There are several sensor solutions involved in this groundbreaking project, but not much has been disclosed. The RTLS Enteprise Visibility software solution tying it all together comes from Intelligent InSites out of Fargo, ND. Centrak will be used to provide location data. This breathtaking investment has stirred the Navy to release their own RTLS solicitation last week for all their facilities and the Air Force is rumored to be preparing a RTLS RFP with the same focus.” Excellent information – thank you. I haven’t seen an official announcement, but information about the award, which was announced Friday, is here. 

From Certifiable: “Re: Friday’s comment from Nurse Informaticist. If they aren’t valued by their big vendor employer, I’m recruiting for a position on my team and it doesn’t get more informatics-y than this.” Since Nurse Informaticist didn’t leave contact information, I’ll bend my no-solicitation rule and offer to forward his or her contact information to Certifiable if they’re interested enough to e-mail me.

From A CIO: “Re: Accretive. I think they’re toast in most markets. I’ve not worked anyplace where we would sign up for a service with such bad press. Sure, you can set rules of engagement, but can you afford the PR hit if things to wrong and some reporter outs you for using them after their history?” I would tend to agree. Rightly or wrongly, big organizations look for scapegoats to fire quickly to make ugly headlines go away, even though those sacrificed didn’t make the decision unilaterally and often weren’t even guilty of anything. They usually end up suing afterward. Accretive has a real challenge on its hands. Shares are down around 60% since February and the class action shareholder lawyers are circling the blood in the water. Not to mention that Accretive’s chairman J. Michael Cline lost a previous tangle with Minnesota AG Lori Swanson (above) over a consumer debt arbitration firm that she said hid its connections to the collection industry to dupe consumers, which led one of his companies to file bankruptcy and the other to shut down. In addition to Accretive, Cline is chairman of Accolade, which works “one-on-one with your employees to help them understand their health care.” It’s hard to tell from the lofty description, but it sounds like they work with big, self-insured companies to guide the health services utilization of their employees.

From The PACS Designer: “Re: more Windows 8 details. Windows 8 will come with the touch technology from mobile devices and its own anti-virus software for the first time. Also Microsoft will enhance its Windows security features and give purchasers of new PCs now and until next January a certificate to get Windows 8 for $14.99.”

Listening: Edenbridge, neo-classical operatic metal that follows the formula: soaring compositions, stunning near-classical musicality by menacing-looking Northern European dudes, and featuring an alluring female lead singer. They’re studio-quality flawless on the live video. They were recommended as being similar to my all-time favorite After Forever by Spotify, which I’m using and liking. As someone commented on a YouTube video, “For kids used to plastic dolls with Autotune on, this is what a real female singer sounds like.”

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

Three-quarters of respondents say hospital CIOs stifle innovation. If you’re a CIO stung by the results, why not e-mail me a few lines with examples of how you encourage innovation that I can run for the benefit of other CIOS, which might boost the perception scores next time around? New poll to your right: is the push to open up the government’s health-related data appropriate or overblown?

Constantine Davides of JMP Securities has updated his HCIT Consolidation Chart (aka the HIT vendor family tree). He says this will probably be the final version since untangling the HIT acquisitions hairball is an unending project. The only straight lines (no acquisitions) that I see are Epic, CPSI, Healthcare Management Systems, and eClinicalWorks.

Here’s video of Todd Park, asked by O’Reilly Media whether open data is all about the apps. Short answer: no.

A law firm files a class action suit against Emory Healthcare for losing 10 disks earlier this year when someone took them from a storage cabinet. It seeks $200 million.

Vince’s HIS-tory this time covers Dairyland. It’s good.

E-mail Mr. H.