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.

News 6/8/12

Top News

Microsoft and GE Healthcare complete the formation of Caradigm, their 50-50 joint venture that will be led be CEO Michael Simpson from GE Healthcare. Lauren Salata (Care Innovations) joins as CFO an Michael Willingham (Philips Healthcare) assumes the role of quality assurance and regulatory affairs executive.

Reader Comments

From LesserEvils: “Re: what uninsured un/under-employed do. They have several choices. They can wait until they are really sick and visit an ED, which just makes the cost of care even higher. Or they can become self pay, which in many cases translates to no pay, which we all end up paying for in some way. Or, they file for bankruptcy. Something like 60% of personal bankruptcies are due to the un/underinsured being unable to pay medical expenses.”

From Paul: “Re: Cerner. Featured in Investor’s Business Daily. Feels like an optimistic PR announcement, but I see solid stability with their hosted offering and decent improvements on the ambulatory side.” IBD quotes analysts who like the fact that Cerner shares have done well lately, bucking past experience in which any one HIT vendor that reported bad results (like Allscripts) dragged the whole sector down. They also like Cerner’s chances to offset eventually declining EHR sales with revenue from medication dispensing cabinets, medical devices, and outsourcing services. It says that although Epic wins most of the high-profile hospital deals, Cerner’s win rate has improved in the last couple of years.

From AcuVedder: “Re: patient right to access and correct their health information. The Office for Civil Rights posts a video explaining patient rights.” I don’t know if it will help or hurt hospital foot-dragging (long delays and high per-page costs involved with giving patients copies of their own records), but at least the video sends a signal that the government sides with patients, in theory anyway. If it’s so time-consuming and expensive to give patients a copy of their records, imagine the disarray that must be involved with providers trying to access and use those same records for treating those patients during their stay. Or at least that’s how I would see it as a patient. Imagine a garage that isn’t able to provide estimates, sells services ordered by third-party mechanics over which it has limited control, and expects customers to just pay their bills afterward with no explanation of what was done or how their car should be driven or serviced in the future.

From Izzie: “Re: Accretive Health. Are hospitals more or less likely to hire them as their RCM vendor since their dispute with the Minnesota attorney general?” I would expect that’s the case since nobody wants bad press, but let’s ask their customers and prospects: have the headlines changed your plans involving Accretive? How? Tell me. I’ll keep you anonymous.

From Nurse Informaticist: “Re: help! I work for one of the big vendors that thinks a nurse is a nurse. They have no idea what my specialty certification in informatics is or what it means. How about a shout-out for the fact that nurses specialize and have expert knowledge to contribute to system design? Long time, die hard fan!” I’m not an expert on ANCC certification, but I recall that it requires passing a test and clocking a bunch of hours working in any kind of informatics role. Vendors may see that as more of an indication of interest rather than of specific, value-added skills since anybody can call themselves an informatics nurse and lots of nurses make their living doing informatics-like work  (training, consulting, support, etc.) with no higher education or certification at all, just applied informatics experience (which is often true of other professionals as well.) Then there’s the Epic model, where they’d rather have impressionable, cooperative (read: young) licensed people who have recent frontline care delivery experience and no IT connection. Finally, some vendors have a warped view of the provider food chain in thinking that physicians can intelligently speak for nurses, therapists, pharmacists, etc. and don’t seek other clinical expertise. I’ll poll HIStalk’s readers again: are nurses with informatics education and/or certification adequately involved in system design and implementation by your organization? Why or why not?

From Not Very Innovative: “Re: CMS’s $10 billion Center for Medicare and Medicaid Innovation program. In a WSJ editorial, Steven Greer MD says Congress should dismantle it since it’s a poorly conceived, politically motivated system that is unlikely to deliver innovation or ROI.” He should know – he was chairman of its grant review program, concluding from his experience that it is “nothing but a pork program that diverts untouchable Medicare entitlement funds to political cronies in key states.” The first millions went to a Chicago group run by the President’s golfing buddy and a program that eventually subcontracted the work out to IHI, formerly run by Don Berwick, who was running CMS at the time. He concludes, “The newly created CMMI is nothing but a stealth stimulus plan to help job creation and politicians’ careers, just like the extremely ineffective ARRA ‘stimulus plan’ was in 2009. The ARRA did nothing to reduce unemployment, and neither will the much smaller CMMI.” It probably doesn’t help Dr. Greer’s credibility that he is a UFO contactee who has accused the government of an alien cover-up, not that there’s anything wrong with that.

HIStalk Announcements and Requests

Life got in the way of mentioning HIStalk Practice highlights last week, so here are a few don’t-miss items from the last two weeks: Dr. Gregg discusses intriguing new bedside monitoring technology from Blnk Medical Technologies. David Wellons muses on the next generation of healthcare informatics. Over the last decade, more widespread use of EHRs has contributed to a 17% increase in the use of the two highest-level codes for established office visits. Consumer Reports adds ratings for Massachusetts primary care providers. eClinicalWorks treats employees to ice cream in exchange for donations to the troops. I have resigned myself to the fact that I will never catch Mr. H in terms of the number of LinkedIn connections, Facebook friends, or Twitter followers. The only thing that keeps me from falling into a deep depression is seeing lots of visits to HIStalk Practice and new sign ups for the e-mail updates. Thanks for your support, which is far more effective than therapy.

Acquisitions, Funding, Business, and Stock

Streamline Health reports Q1 results: revenue up 31%. EPS $0.05 vs. –$0.03.

Stanley Healthcare Solutions, a division of Stanley Black & Decker, acquires RTLS provider AeroScout. We reported that rumor on May 18.

Veritas Capital completes its $1.25 billion purchase of the Thomson Reuters Healthcare business, which will be known as Truven Health Analytics. You may recall that Veritas sold government healthcare IT contractor Vangent to General Dynamics for $960 million last August, making a 240% profit on its investment.

Ringadoc receives $750K in an angel-led seed round, with the participation of Practice Fusion CEO Ryan Howard and LA-based technology incubator Curious Minds. The company offers virtual visits from its physicians at a cost of $89.99 per year and $29.99 per call, with three free calls per year. Fast Company just profiled Ringadoc, saying that it’s operating out of Practice Fusion’s San Francisco offices and using its EMR. The company says it has 1,600 registered users and will soon launch a service that will allow physicians to use its technology in their practices.

Allscripts creates an incentive program based on earnings-per-share performance for 10 of its executives, but CEO Glen Tullman was not be included for unstated reasons. The company also amends the employment agreements of Glen Tullman, Lee Shapiro, Diane Adams, and Laurie McGraw to require that they resign within 10 days of a change in company control to earn their cash payment for not being retained.

Discharge planning and readmissions software vendor CareInSync gets $1.6 million in Series A funding from HealthTech Capital. Above is a video of staff from Marin General Hospital talking about their use of the company’s Carebook transitions software.

Athenahealth launches a “More Disruption Please” program that will sponsor hack-a-thons, invest in startups, and open up the athenahealth platform via APIs.

An Israel business publication cites sources claiming that iMDsoft is talking to a private equity fund about an $80 million sale of the company. I didn’t realize that its three founders also founded population management systems vendor CareKey (sold to TriZetto for $60 million in 2005), and two of the three also founded consumer telehealth systems vendor American Well.

People

Consultant Karlene Kerfoot, PhD RN joins API Healthcare as VP of nursing.

Lifespan (RI) names Ian Hyatt (GTECH) VP/CTO.

ZeOmega appoints Christopher Mathews MD (Community Health Network) SVP/CMO and adds Anne Wilkins (Healthways) and Anna Haghgoole (Sandbox Industries) to its board.

Santa Rosa Consulting names Patrik Vagenius (Dell Services) as EVP of sales and marketing.

Larry Stofko, formerly SVP/CIO of St. Joseph Health System (CA), has been promoted to EVP of the system’s Innovation Institute, which will design, develop, and commercialize potential solutions; create and manage a venture fund; and convert delivery opportunities into business units.

CareCloud appoints Joseph P. Sawyer (American Well) as VP of marketing.

MediRevv names Holly Krueger (CureIS Healthcare) as director of sales.

Acuo Technologies hires Barry Gutwillig (Virtual Radiologic) as senior director of business development.

Vocera appoints Steven Soderberg (Force10 Networks) as CIO.

Orange Regional Medical Center (NY) hires Sujatha Ramanathan (Pain Centers of American) as its director of ambulatory EHRs.

Announcements and Implementations

NY eHealth Collaborative announces that three RHIOs and three HIE vendors will participate in the state’s HIE.

RadNet, an operator of 232 outpatient imaging centers, implements eRAD’s RIS, PACS, and report generation solution.

The Advisory Board Company launches its 2012 Patient Engagement Blue Button Challenge to encourage the creation of apps for improving care by sharing health data. The prize is $25,000 and submissions are due August 6.

The EntryPoint module of PatientOrderSets.com earns ONC-ATCB certification.

MyHealthDIRECT wins ONC’s discharge follow-up appointment challenge, earning the company $5,000 and the opportunity to run a pilot project.

A team from IOSTREAM wins another ONC challenge, this one for creating the MedDAERS portal that providers and consumers could use to report adverse events and other problems with medical devices.

EXTENSION announces the release of Version 3.0 of its clinical alerting system.

Anthem Blue Cross and Blue Shield in Colorado announces that providers can access Availity’s Health Information Network to verify eligibility, submit claims, and review clinical histories and care alerts.

Government and Politics

HHS posts recorded streaming video of the Health Datapalooza plenary sessions. For celebrity watchers, Jon Bon Jovi goes on at the 1:43:00 mark of the Tuesday morning video. He muffs some lines when reading the script, but then ditches it and speaks really well. He mentions his “pay what you can afford” JBJ Soul Kitchen restaurant in Red Bank, NJ and his corralling of Aneesh Chopra outside a White House men’s room to talk about apps that can find available shelter beds and medical providers in real time.

The Congressional Budget Office says that if lawmakers do what they usually do to address budget problems (i.e., make them worse), healthcare entitlement spending will in 25 years make up 10% of GDP, pushing the country’s red ink to 200% of GDP.

The House passes a bill that would repeal PPACA’s medical device tax that is intended to subsidize the cost of providing insurance coverage to 30 million new people. The bill isn’t likely to pass a Senate vote and the President says he will probably veto it anyway. Device manufacturers will pay 2.3% of gross sales starting in January, and several of them have already announced layoff plans to offset the new expense.

The Federal Trade Commission files charges against electronic payments and collections vendor Checknet, whose customers include healthcare providers, for leaking consumer data. Checknet’s COO installed file-sharing software on his computer, exposing the health insurance and medical information of 3,800 patients to anyone using the same peer-to-peer software.

A proposed Michigan law would create a Peace of Mind Registry, an online database where patients can record their advance directives for review by providers.

Other

If you are a vendor looking for a cool trade show give-away, here is something better than a tee shirt, stress ball, or even a warm chocolate chip cookie. Pong Research announces a $120 iPad case that not only provides protection, but boosts the iPad’s 4G reception up to 10x, the Wi-Fi reception up to 9x, and range by 2x. Plus, it reduces exposure to electromagnetic radiation. The trinket bar has been raised.

Harvard Professor Latanya Sweeney PhD announces theDataMap, a crowdsourcing project to map the flow of personal data in the US. She says her early attempts to document the ever-increasing flow of patient information into more and more corporate hands elicited gasps every time she showed the graphic.

Two of New York City’s biggest health systems, NYU Langone Medical Center and Continuum Health Partners, announce plans to merge into a super-system that would cover the most affluent Manhattan neighborhoods and flank Mount Sinai Medical Center. The reaction of Princeton health economist Uwe Reinhardt: “Economists have for some time now worried about the ceaseless consolidation on the supply side of the health care market, facing a much more splintered payment side with less market power … So a hospital can literally tell an insurer you either take our prices or you take a walk, and that’s what’s happening. Both sides always justify that, not on the basis of crude market power — we want more market power to get better prices — they always find some kind of high national purpose.”

Rapping 10-year-old twins star in a hand hygiene video for caregivers that was developed by All Children’s Hospital (FL), where one of the twins had been a patient. The video won an award from an infection control group. Now I can’t get “scrub-a-dub-dub” out of my head. 

Mostly unrelated except for a medical clinic mention: the best graduation speech in history, even better than the one Steve Jobs gave at Stanford. The message to rich kid high school graduates: you’re not that special – we all are.

HealthLevel Script Object Notation, an open source HIE standard based on JavaScript Object Notation, seeks board members to steer what it says will be the most widely used HIE standard in the world. Nominations are due June 30.

An Oklahoma doctor asks in The Atlantic, Are Computers Getting Between You and Your Doctor? He says doctors are starting at computers instead of listening to and touching patients, are copying/pasting medical information without adding any value, and are forced to ignore the patient and click screen after screen to justify their payment. He concludes, “On my best days in practice, it seems as though all of my patients are savvy, engaged, and connected: e-patients. On the bad days, I feel like an overcompensated data entry clerk.” Check out the hideous stock photo used to illustrate the article (since nobody reads anything unless there are pictures, even unrelated ones): the monitor looks like it was made in around 1997, there’s a keyboard but no mouse, and the office furnishings look a lot more like a lab in Bulgaria than a US doctor’s office.

A doctor’s former receptionist is arrested in Connecticut for using the practice’s computer system to create narcotics prescriptions for herself.

iPhone/iPad EMR vendor Drchrono adds the ability for practices to process patient payments using the Square credit card reader. Square just announced that its reader will be sold at Walgreens and Staples stores or can be ordered at no cost from its site, with swipe card transactions charged at 2.75%.

A PwC report concludes that patients want mobile health to provide convenience or save them money, while doctors have less interest unless it can improve care, ease patient access, or reduce in administrative time. The report also predicts that change-resistant providers will slow mHealth adoption as everybody tries to protect their own turf, with the best chances for adoption being developing countries, and that the entitlement attitude of patients means that vendors need to appeal to payers.

eHealth Saskatchewan finds a computer problem that prevented diagnostic imaging results for about 100 patients from being faxed to their doctors for several weeks.

A group of high-profile healthcare CEOs and the Institute of Medicine develop a 10-point checklist of actions that can reduce costs and improve care. Among them: program hard stops into the CPOE system for duplicate lab test orders, requiring the prescriber to call the lab to override the block.

An editorial in the local paper by Mark Herzog, president and CEO of Holy Family Hospital (WI), talks up the hospital’s EMR. He goofs in his description of the one specific benefit by saying that in bar code medication verification, nurses “scan prescription bottles.” I would hope isn’t the case because only clueless hospitals dispense medications in bottles instead of unit dose packages, but I figure he dumbed it down for the lay folks.

Weird News Andy says clinicians must have had a flaccid response to this patient. He’s suing a Yale-New Haven Hospital emergency facility, claiming that staff watched a baseball game on TV instead of treating his priapism.

Sponsor Updates

• Black Book Market Research ranks Certify Data Systems third out of 20 private core HIE system vendors.
• HealthMEDX’s Bridgette Leonard offers advice on auditing EHRs to reduce readmissions.
• The California Health Information Partnership and Services Organization awards Family Health Care Network of Visalia (CA) $573,750 to advance its use of MED3OOO’s EHR.
• CTG Health Solutions releases CTGTALK 4.0, which allows users to manage the application via mobile devices or PCs.
• Nuesoft announces that its NueMD Android EMR app will be available this summer.
• RelayHealth launches RelayAnalytics Pulse, a comparative analytics solution for hospitals and health systems.
• Practice Fusion releases a 10,000-record HIPAA-compliant dataset and launches a data challenge to solve public health issues
• Western Kentucky Orthopaedic & Neurosurgical Associates selects SRS EHR for its 11 physicians.

EPtalk  by Dr. Jayne

The HIMSS Virtual Conference & Expo began this week. Keynote speakers included MedVirginia CEO Michael Matthews and political commentator Jonathan Alter.

When I’m teaching students and residents, I often challenge them to use non-medical search engines such as Google in addition to “traditional” platforms for finding medical information. A recent study in the Journal of Medical Internet Research found that identical searches performed using multiple search engines will produce different results. Since two-thirds of physicians and an even greater number of patients use standard Internet search engines to find medical information, the doctrine of caveat emptor becomes increasingly relevant.

In follow up to my piece on goat farming, a reader shared this story about a pediatrician’s frozen yogurt shops along the Jersey Shore. I know a lot of primary care physicians who have left medicine (or who have gone part time) and can’t help but think that if the pay were better the impending primary shortage would look different.

I wrote last month about medical schools compressing coursework for students choosing primary care careers. The American Board of Family Medicine, the Association of Family Medicine Residency Directors, and TransforMED are now working in cahoots to expand family practice residency training to four years. I don’t disagree that it will provide additional educational opportunities to trainees, but extending training (which translates to lost lifetime income for family docs) to an already-depressed specialty isn’t going to help recruit new family docs.

CMS keeps e-mailing me with reminders that Version 5010 Enforcement is almost here. The discretion period ends June 20, 2012 and practices that are still experiencing issues should work with clearinghouses and payers to resolve any problems. I’ve asked my trusted source Bianca Biller to provide a summary of her 5010 experience, but it appears she’s so busy fighting fires that she hasn’t had time to write.

Travis from HIStalk Mobile shared a link on Twitter that discussed whether so-called “sunshine laws” really work. These laws require drug and device manufacturers to disclose payments to physicians. I don’t see drug reps any more, but recently encountered this with a medical device manufacturer rep who wanted my NPI and state license number before buying me a drink. Since I’d already authorized purchase of tens of thousands of dollars in hardware, I didn’t think one Cosmopolitan celebrating the closing of the deal was going to cause an ethical lapse. Although I know my state license number from memory, I was particularly glad that my OCD had led me to store my NPI in the contacts section of my phone.

Speaking of phones, MSN reports that nearly 20% of smart phone users are sexting or otherwise sharing explicit photos or text messages. The most common age groups are men aged 18-34 and women aged 35-44. The report states, “only 3 percent of American adults who are smart phone owners say their biggest concern about losing their phone is that their inappropriate pictures or text messages could be exposed… this number is shockingly low when you consider that 69 percent of smartphone owners have lost their phone.” Grammatical issues aside, I find the quote surprising. If I ever lose my phone, I hope the finder is titillated by the sassy acronyms found within: CCHIT, ONC, HIPAA, EDI, PCMH, and HL7.

Have tantalizing news? Let me know on Twitter @JayneHIStalkMD, on Facebook, or if you’re old-school, e-mail me.

Health Datapalooza from the Eyes of an Entrepreneur
By Dan Wilson

Our company, Moxe Health, was invited by HHS to attend the Health Datapalooza (HDI Forum) because of a product we designed during the Milwaukee BuildHealth Hack-a-thon seven weeks ago. Triage.me was our response to a challenge posed by Aurora Health Care: "Reduce the number of ED visits for non-emergent care in Milwaukee County."

I first learned about the Datapalooza listening to Todd Park’s presentation at the HIMSS conference. We had no idea we were going to be participating until a month ago. Talking with other folks around the event, our experience wasn’t unique. In a sense, Datapalooza is a large-scale agile conference. Hosted by the government. For healthcare. It’s pretty wild.

The last conference I went to was HIMSS. The Datapalooza is definitively not HIMSS.

As an exhibitor, we had the same amount of space as IBM, Aetna, and SAS. Specifically, an 8×8 booth, with nothing allowed to hang overhead and no swag over $10. It was refreshingly low key. Also, startups didn’t pay for their own booth (thanks, HHS!) That’s Mark and me in the Moxe / triage.me booth. We were among the first to set up on Monday. Really nice convention space.

This is the closest you’ll see to the government holding a startup event. They pulled it off, and a lot of respect is due to the folks at HHS and the ONC. Todd Park deservedly gets a lot of the attention, with some folks (HHS Secretary Kathleen Sebelius) even referring to it as the "Todd Park Roadshow." But the event was much bigger than that, and it’s clear there’s a lot of momentum propelling it event forward.

As further evidence of the underlying focus on innovation, one of the most anticipated sessions was held in a side room to make sure the Wednesday afternoon app demos could be simulcast online. While two youngbloods from Wisconsin (and the other code-a-thon winners) were presenting their product on the main stage being simulcast across the nation, Atul Gawande and Farzad Mostashari were facilitating an ACO breakout in a relatively small, overheated room with spotty Internet connectivity. We’re not sure if this was by design or by accident, but the it reinforced the statement that the only thing bigger than the technologists innovating things at the HDI was Bon Jovi (who aside from his noble work for the homeless, also innovated the technological wonder that is "Living on a Prayer.")

Even the ACO event panelists were made up of a number of small, yet terribly innovative companies. One example I learned about was Forward Health Group, a 20-employee company that’s coming up with awesome ways to connect and visualize data. They’re now working with the Guideline Advantage program, which is a collaboration of the American Heart Associate, American Cancer Society, and the American Diabetes Association.

From our standpoint, the event was a huge success. As a young company, we gained incredible insight and valuable contacts from ONC, HHS, and private enterprise leadership. I’m excited to see where the Datapalooza goes next, and I’ll be doing everything I can to stay involved.

Random Musings

@Farzad_ONC Humble apologies, sir! Truly, I did think…no bowtie…aaarghh. But that apron…oh dear.

— Forward Health Group (@ForwardHealthGp) June 6, 2012

• The bow tie is in vogue around the ONC.
• The new Healthdata.gov site launched. I spoke with one of the guys who helped program it. His take is that structurally, the site is a step forward and a good foundation for releasing better data. He also felt that the currently available data/APIs weren’t much changed and there’s still a ton of work required to make sure the data being opened up is both valuable and usable.
• Kathleen Sebelius mentioned that another 150 ACO organizations are slated to start in July.
• VC investment is up 60% in the HIT sector since 2009.
• From Kathleen S.: a recent diabetes study showed patients cared for by a doctor using an EHR had a 600% better chance of receiving the right care.
• I think Bill Frist summed up the focus of the conference well: "The goal is to turn data into discovery."

Dan Wilson is CEO and Mark Olechesky is CTO of MOX eHealth, LLC.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 6/6/12

Top News

An article in The Economist covers the programming that powers medical devices such as smart IV pumps and pacemakers, proprietary systems that the FDA has the power to examine but rarely does even though the programming can be sloppy, error-filled, or vulnerable to hacking. Penn researchers are working with the FDA on an open source alternative that would bypass uncooperative manufacturers, hoping to prevent more bugs and turn fixes around more quickly. Similar projects at other universities address open source CT and PET machines and surgical robots. The article also mentions $10 million NIH-funded The Medical Device Plug-and-Play Interoperability Program and the more ambitious Medical Device Co-Ordination Framework of Kansas State University, which is developing a core set of downloadable, open source apps that could be pieced together to create medical devices.

Reader Comments

From Defiant: “Re: the University of Missouri billing fraud story. The dean of the med school is also the former chair of the Department of Radiology. He was the key influencer in having the Cerner RadNet application uninstalled six months after installation some six years ago. The Feds would be wise to plan an extended stay at this place.” Unverified. The health system announced that Dean Robert Churchill MD will retire after news of the federal investigation broke.

From Who CaresFX: “Re: Carefx. Looks like Chairman and CEO Andy Hurd has left for greener pastures. I heard they were doing a RIF, but the CEO? His profile has been removed from the site.” He has indeed been expunged from the site, but that’s because he left to become CEO of Epocrates in March. Harris bought the 250-employee Carefx just over a year ago for $155 million, expressing interest in its interoperability business .

Acquisitions, Funding, Business, and Stock

Awarepoint raises $14 million in funding, including the first investment of the Heritage Healthcare Innovation Fund, which is backed by several health systems and vendors.

Data analytics vendor MedAssurant changes its name to Inovalon.

Sales

Winter Haven Hospital (FL) will implement Amcom Mobile Connect for encrypted smart phone communications.

The VA awards Harris Corporation a two-year, $19 million contract to create a wireless network infrastructure for 26 medical centers.

People

Physician learning network QuantiaMD appoints Beth Israel Deaconess Medical Center CIO John Halamka, MD to its board.

Harry R. Jacobson MD, former vice chancellor for health affairs at Vanderbilt University Medical Center, joins ICA’s board.

M*Modal hires Jonathan A. Handler MD (Microsoft, MedStar Health) as the company’s first CMIO.

WebMD names former Pfizer executive Cavan M. Redmond CEO and a member of the company’s board. He replaces Wayne Gattinella, who resigned in January following a failed attempt to sell the company.

RF Technologies hires Ken Sandifer (GE Healthcare) as SVP of service and operations.

Anthelio Chairman and CEO Richard Garnick resigns in what the company describes as “an amiable and mutually agreed upon process.” Chief strategy and innovation officer Rick Kneipper will serve as interim CEO until a permanent CEO is hired.

Medsphere Systems names Lily S. Chang (Advent Software) as CTO.

Shareable Ink names Keith Slater (Henry Schein Medical) as VP of client services.

Mediware SVP/COO John Damgaard resigns effective September 7, when he will join an unnamed private company as president.

Halfpenny Technologies appoints Brian Muck (Vitera) as EVP of sales and marketing.

Plastic surgeon Howard Krein MD PhD, Organized Wisdom’s CMO, makes non-HIT headlines for his marriage last weekend to Ashley Biden, daughter of VP Joe Biden. I loved his unofficial bio, published in an independent Jewish newsletter:

Dr. Krein, 45, is quite the catch. He is double board certified in otolaryngology and plastic surgery and has a PhD in cell and developmental biology. He is an assistant professor at Thomas Jefferson University as well as maintaining a busy medical practice. Krein, who is a Cherry Hill, N.J. native, also serves as chief medical officer of Organized Wisdom, a company founded by his brother to provide digital solutions to medical professionals. Most importantly, he is a mensch.

A 21-year old Chicago man becomes the youngest student ever awarded an MD (as well as a PhD in molecular genetics and cell biology) by the University of Chicago. Sho Yano began reading at age 2, was writing and composing music at age 3, and earned his undergraduate degree from Loyola at 12. He’ll begin his residency in pediatric neurology. When I was 21, my biggest accomplishment was winning the Quarters tournament in my dorm. 

Announcements and Implementations

The DoD extends Authorization to Operate certification to Mediware, paving the way for the implementation of Mediware’s HCLL Transfusion software to 68 MHS sites worldwide.

PDR Network announces that 18 EHR vendors have signed agreements to deliver its drug and safety information to their users.

Release of information vendor MRO Corp. announces availability of its patient portal solution, ROI Online.

Government and Politics

CMS reports that Medicare and Medicaid EHR programs have paid hospitals and EPs over $5 billion in incentives through the end of April.

ONC extends the public comment period for the Nationwide Health Information Network Condition – Conditions for Trusted Exchange until June 29.

Even CEOs and politicians wish they were rock stars, and you can see why given Jon Bon Jovi’s draw with the ladies at Tuesday’s opening sessions of the sold-out Health Datapalooza in DC (the photo is from the IOM.) The live streaming was of really good quality, so I watched Todd Park speak for a short time before I had to get back to work. HHS Secretary Kathleen Sebelius will speak Wednesday morning, with former Senate Majority Bill Frist later in the morning and other speakers and demos in between.

Innovation and Research

Children’s Healthcare of Atlanta and Georgia Tech form a $20 million research partnership that will develop pediatric technologies, including medical devices and healthcare software.

Technology

Matt Grob, senior director of enterprise IT planning at The Mount Sinai Medical Center (NY), says he was inspired by recent HIStalk and HIStalk Mobile articles on pagers to write this mHIMSS blog posting that works in a mention of Caddyshack’s Dr. Beeper and the drug dealer/doctor pager connection in adjacent paragraphs.  

Other

The Consumer Federation of America says CSC’s Colossus evaluation software, used by insurance companies to classify bodily injuries in auto and homeowner insurance claims, intentionally downgrades injuries and saves the insurers 20% over the evaluation of human adjusters. The group claims the software can be used with other applications that reduce “usual and customary” medical costs. The above description is from CSC’s site.

The company that operates Walmart’s retail medical clinics is piloting in-store telemedicine-based video consultations.

Consumer Reports will publish ratings of Massachusetts physicians  in copies of next month’s issue that are distributed to that state.

In Greece, the diabetes association claims that diabetics are at risk because pharmacists have cut off credit to the country’s largest healthcare fund, which owes them $670 million. The health ministry says it can’t pay its debts without more bailouts, leaving patients without the 75% medication subsidy it provides.

A Norwegian foreign exchange student rushed to a California hospital after a rattlesnake bite is billed $144,000, almost all of that the cost of antivenin. The patient, who notes that the same services would be free in Norway, expects insurance to cover most of the costs. Yesterday I opened a bill for recent medical expenses and nearly cried reading the astronomical amount due in the “patient responsible” column. Not to get political, but what do the uninsured and un/underemployed do?   

Weird News Andy finds this story to be a mash-up of recent HIStalk ones involving heroic Army nurses and surgeons removing explosives from patients. A helicopter crew of four New Mexico National Guardsmen volunteers to medevac 20-year-old Marine Lance Corporal Winder Perez from the site of a Taliban attack in Afghanistan despite the presence of a live, foot-long rocket-propelled grenade lodged in his leg. They work on the patient in flight, exposing themselves not only to the possibility that the RPG would explode in their faces, but also that it might ignite the helicopter’s 300-gallon jet fuel tank just 18 inches away. They bring their patient safely to a field hospital 65 miles away, where a Navy lieutenant commander nurse and an Army staff sergeant, wearing full combat gear and flak jackets, remove the explosive so the medical teams can get to work. The patient is recovering at Walter Reed. As WNA says, “May God bless these brave people.”

Bizarre: a 31-year-old police officer dies during a sex threesome that doesn’t include his wife. His family sues the cardiologist he had seen the week before for chest pain for medical malpractice, claiming the doctor didn’t advise the man to avoid physical activity. His stress test appointment had been scheduled for the day after he died. The jury awards the family $3 million.

Sponsor Updates

• nVoq will exhibit at the 11th International Congress on Nursing Informatics this month in Montreal.
• DIVURGENT employees raise $5,000 for Miami Children’s Hospital Miracle Network.
• EMC presents World Wide Technology with its Velocity National Partner of the Year Award.
• Macadamian Technologies’ Matt Hately, VP of product Strategy and innovation, will participate in a panel discussion on mHealth opportunities during next month’s 9th Annual Healthcare Unbound Conference in San Francisco.
• Billian’s HealthDATA presents EHR saturation by physician specialty based on CMS’ latest attestation reports.
• PROFIT Magazine names NexJ Systems Canada’s fastest-growing company.
• Christi Clinic (IL) selects eClinicalWorks EHR solution suite for its 150 providers.
• The Advisory Board Company highlights best practices and new technology supporting ACOs at this week’s Health Datapalooza in Washington, DC.
• An Allscripts-sponsored study finds that C-level executives have an positive attitude about value-based purchasing and its impending takeover of traditional fee-for-service reimbursement.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 6/4/12

From Roger Collins: “Re: JAMIA article on dictating into the EMR. The authors measured ‘quality of care’ by looking at discrete quality measures in the EMR. By definition, clinicians who dictate their documentation aren’t using templates and would not have double-documented by checking off boxes. The study didn’t look at the transcribed dictation notes, so they had no way to know whether those clinicians even met the quality metrics, much less that they provided lower-quality care.” It appeared to me that the study looked only at whether the documentation was complete (tobacco use recorded, blood pressure taken, etc.) rather than patient outcomes, so I was suspicious about its conclusion that “physicians who dictated their notes appeared to have a worse quality of care than physicians who used structured EHR documentation.” But it does raise an interesting question: if we agree that transcribed dictation provides a richer narrative, then in our fanaticism to distill every encounter into a set of predefined checkboxes that will be used to measure quality, determine payment, and drive Meaningful Use payments, how are those checkboxes going to be populated without losing their original context? We’re reaching an electronic decision point: as a clinician, would you rather assess a patient based on the verbatim thoughts of your peers or a bunch of lists and graphs? And if the answer is that we need both, how do we make that happen? Your comments are welcome.

From CT Scan Moneyball: “Re: healthcare price disparities. One way to fix this is a fixed fee schedule like they have in Japan as described in this article, but it probably can’t happen here in our poisonous political climate. A bonus is controlling cost – Japan’s spending on health went from 7.7% to 8.5% of the gross domestic product over eight years, compared to an increase from 13.7% to 16.4% in the US.” 

From SmallTown CIO: “Re: MUSE 2012. The crew from MUSE have done a great job again with a well-organized conference. As a long-time attendee, it is a little strange seeing a younger crowd – some of the usual suspects I haven’t run into. However, at the same time it is great to see the up-and-comers that will keep MUSE and Meditech strong. The vendor exhibits have been good with some new faces. Forward Advantage, Iatric, and Dimensional Insight are among a few that have a bigger presence. Forward Advantage held a great party at House of Blues – definitely an extracurricular event highlight. The thing I appreciate more than anything at MUSE is the vendor exhibits aren’t ostentatious, which fits very well with the customer base of Meditech (we are all driven by cost effectiveness). It is great to see Meditech have a presence at the conference in terms of presentations. My hope is that next year they have a presence in the vendor exhibit area as well, where we can catch up on the latest software changes. All in all, it has been a good conference and I tip my hat to Alan Sherbinin and crew – nice job!" Thanks for the report.

From THB: “Re: Epic. Going down the path toward NHS implementation – they’ve posted a job to help prepare their product for the UK. Anyone know where I can find workflow documents for NHS hospitals?” I found the listing above. People thought Epic was kidding when they talked about world domination. They weren’t.

From Cyber Spy: “Re: hacking. Medical IT is highly vulnerable.” This article covers the development of Zero Day exploits. A former NSA hacker shows how randomly changing file data at the byte level will eventually cause a system to crash, and once that happens, he can often figure out why to discover a previously undocumented exploit. It mentions the secret Stuxnet cyberattack on an Iran (the White House financially admitted last week that it was a US-Israel creation and it got out of control) and that the Pentagon now considers cyberspace to be a theater of war. I seem to remember that at least one UK hospital was hit by a Stuxnet-caused outage, so if so, that means the US government may have caused patient harm in England.

From No Bull: “Re: sex in the road. Doctors could not get to their patients. Thank heavens for mobile medical devices.” A busy highway in Pennsylvania is closed for hours due to a bull-and-cow hookup, or as one state trooper described the scene, “They’re having relations in the road.”

From Wheeler and Dealer: “Re: deals between Congress and pharma. There other others between Congress, HIMSS, and IT vendors.” The House Energy and Commerce Oversight and Investigations Subcommittee (made up of 14 Republicans and nine Democrats by my count) reports on what it calls Closed-Door Obamacare Negotiations. It says the White House struck a PPACA deal with the Pharmaceutical Research and Manufacturers of America, committing to protect the drug companies from price controls, government-run prescription insurance, and new drug importation policies in return for $80 billion in payment cuts. The deal came together quickly when the Obama administration was getting beat up over PPACA the week of June 18, 2009, and was desperate to announce something positive before the Sunday political talk shows. I actually read this as pro-Obama: he told the drug companies that if they didn’t play, he was going to call them out as foot-dragging and hit their profits via mandatory rebates and the elimination of tax-deductible direct-to-consumer advertising. The gist of the findings is that Obama conducted closed-door meetings with drug companies after being critical of such practices as a candidate.

From The PACS Designer: “Re: World IPv6 Day. This coming Wednesday, we’ll see the launch of the next Internet upgrade to IPv6, promoted as World IPv6 Day. The upgrade has become necessary since the supply of available IPv4 addresses has been exhausted. The challenge for IT departments will be testing IPv6 on all browsers and servers for compatibility with existing applications and security issues.” You can follow along on Twitter.

Listening: Fitz and the Tantrums, LA indie kids who sound eerily like a really good 1965 Detroit soul band, right down to the growling organ. They are amazing in this live video, especially the female lead singer, and were the subject of an episode of the excellent Live from Daryl’s House, where they did a better-than-the-original cover of “Sara Smiles.” On tour now, appearing in Houston, Birmingham, Greenville, Manchester, Charleston, and Raleigh this week.

Being blessed as I am with heightened perception of the obvious, I believe I see some agreement (95%) that hospitals should be able to provide a bill that the average patient can understand. New poll to your right: does the average hospital CIO encourage innovation or stifle it?

HMS customers meeting last week at its Nashville office: Millie Schinn (Hamilton General), Diane Sherrill (Medical Arts), Rob Malone (Houston Orthopedic), HMS Chief Medical Officer Frank Newlands, Cindy Jandreau (Northern Maine), and Angie Waller (McDonough).

The weekly employee e-mail from Kaiser Permanente CEO George Halvorson says KP has once again mined its HealthConnect database to discover a new treatment, as reported in the journal Neurology. In reviewing the records of nearly 13,000 ischemic stroke patients spanning seven years, it found that starting cholesterol-reducing statin drugs as soon as possible cuts the death rate by nearly half and raises the chances of the patient going home instead of to a nursing home by 20%. And if the patient was already taking statins at the time of their stroke, simply continuing the drug during their hospitalization dropped the death rate to 5% (if the drug was stopped, deaths jumped to 23%). As George concludes, “We are the only people in healthcare who have done that analysis. Our stroke researchers have done truly great work. This finding has the potential to save many lives. Every stroke treatment program on the planet Earth can and should either start to give or continue to give cholesterol-lowering statins to their stroke patients.” KP has already changed its stroke order sets to start statins on Day 1 as the default.

In less-cheery Kaiser news, its Oakland hospital gets hit with a $75K Department of Health fine for a 2010 incident in which nurses ignored a telemetry patient’s tachycardia alarms, including warnings that the alarm itself was about to shut down due to a low battery. The patient was found unresponsive and was resuscitated, but died afterward. The nurse says he didn’t call the doctor as instructed for the tachycardia because the patient seemed OK, and ignored the low battery warnings because he was too busy.

I curse the name McAfee regularly when Scan32 and MCShield suck the life out of my hospital laptop, especially during the once-weekly antivirus scan that assures a solid several hours of hourglass when I’m trying to work. Now I can humanize that annoyance with this story of founder John McAfee, who at 66 is living on the run in the jungle. Forty-plus police officers in Belize (specifically the Gang Suppression Unit) raid his guarded estate, kill his dog, and rouse him from the bed he is sharing with his 17-year-old girlfriend, charging him with running an illegal antibiotics factory and possessing unregistered weapons. He claims he declined to bribe a local official and the drug companies don’t want competition from the topical antiseptic and female Viagra that he’s developing, so they hired the police as muscle to claim he was operating a meth lab. A fascinating 2010 profile is here – the man’s clearly both a genius and a total wack job. I think we can agree that he looks great for 66, although perving around with a 17-year-old might be a bit much even in a country where it’s legal at 16. 

In the UK, Brighton and Sussex University Hospitals NHS Trust is fined $500,000 when hard drives containing the medical information of patients were sold on eBay. The hospital is upset about the size of the fine, says it can’t afford to pay it, and is appealing. It hired a subcontractor to erase 1,000 hard drives, but he listed 250 of them on eBay without the hospital’s knowledge.

This could be a hint of things to come (or a 1990s flashback). Three fired HCA doctors in Florida publicly criticize the chain for hiring huge waves of physicians to prepare for an ACO environment, then dumping those whose practices were not profitable. They also say the company doesn’t have the infrastructure to support the practices it’s buying. One doctor who left said that HCA was sloppy in controlling costs, paying multiples of what he paid in private practice for everything from business cards to transcription services. My experience is similar: hospitals in general are inefficient, bureaucratic, loaded with VPs of inconsistent talent and motivation, and the worst possible partner for a small business. I’ve sat in those meetings when docs complained and once they were gone, we mostly talked about how to marginalize them. Some physicians are fine with working for a huge corporation under their rules (like academic medical center docs), but the free spirit types hate every minute of it. Like any other business, entrepreneurs enjoy selling their businesses to big companies for a big one-time payday, but don’t usually last long with them as employees afterward.

New Hanover Regional Medical Center (NC) was set to go live Saturday with Epic. Their cost was given as $56 million.

The University of Missouri School of Medicine fires two radiologists and announces that its dean will retire following the announcement that the health system is the subject of a federal Medicare fraud investigation. The school says it believes that the radiologists, one of whom was the chair of the department of radiology at the time, billed for work performed by medical residents without reviewing their work. The MU radiology department says it will modify its software to prevent future occurrences and says it will pay for having the images of any concerned patients re-read, either by the health system or by an outside radiologist of the patient’s choosing.

I’d like to see Vince’s HIS-tory series continue. I know the best way to make that happen: send him fun anecdotes, old articles, or “where are they now” updates that will get him enthused to keep it going. He’s specifically looking for anyone who can facilitate connections to the folks who started companies back in the 1970s and 1980s so he can get their first-person stories, which would be very cool.

A Texas urologist and his practice manager wife are charged with healthcare fraud, with federal prosecutors saying the doctor submitted at least $1.5 million in fraudulent benefit claims since 2003. His claims indicated that he treated as many as 117 patients in a single day, sometimes billed for more hours than exist in a day, and billed for services provided by office personnel while he was traveling in Iran. The couple was indicted in 2010 for funneling $1.8 million to Iran for investments claimed to be charitable contributions, using a charity run by their daughter.

The Lexington, KY newspaper covers a non-profit mental health board whose for-profit subsidiary, run by the board’s retired CEO, sells scheduling, billing, and payroll software to other state-funded regional boards. It also notes that the retired CEO is married to the current CEO and continues to be paid as a consultant, while their son-in-law is the organization’s IT director.

Weird News Andy says the bomb squad and ED “cheated Darwin” again by removing unexploded fireworks from a man’s chest. He was apparently setting off illegal fireworks from a hand-held mortar to celebrate Memorial Day when “a firework intended for the sky penetrated his chest.” The hospital had to call the bomb squad to remove the pyrotechnic before they could operate. The last reports I saw said the patient is in critical condition with massive chest trauma.

E-mail Mr. H.

Allscripts Caves to Proxy Fight, Nominates HealthCor’s Board Candidates

Allscripts announced this morning that it will nominate a three-member board slate to settle a lawsuit and proxy fight brought by key shareholder HealthCor Partners. HealthCor previously called publicly for the replacement of Allscripts CEO Glen Tullman, sued the company over its plan to nominate its own candidates to replace four board members who quit in April in a management dispute, and had obtained an expedited review of its arguments in a hearing that was scheduled for June 14, the day before the Allscripts shareholder meeting.

The director nominees are:

• Stuart Bascomb, founder of Express Scripts and chairman and CEO of QualSight, which offers managed care refractive surgery
• David Stevens, former chairman and CEO of specialty pharmacy vendor Accredo Health Group
• Randy Thurman, founder of Viasys Healthcare and former CEO of Corning Life Sciences and Rhone-Poulenc Pharmaceuticals

Tullman said in the announcement, “We welcome the addition of Stuart, David, and Randy and believe they will bring new perspectives and additional industry experience to our board. Taken together with the recent additions of Paul Black and Robert Cindrich, the Company will have added five, high-quality, independent directors in just the past few weeks. We believe this is a positive outcome for Allscripts and its stockholders and we look forward to working collaboratively as we continue to implement our strategic initiatives and make the important and necessary investments to deliver a connected community of health for our clients and build value for all of our stockholders.”

HealthCor co-founder Arthur Cohen said, “We are pleased to have reached this amicable resolution with Allscripts, which we believe will serve the best interests of all stockholders. We continue to believe that Allscripts has great products, strong capabilities and a unique installed base of customers. Furthermore, we are confident that Stuart, David, and Randy will make strong additions to the Board, and will work hard to represent all stockholders and assist the Company in seizing the tremendous market opportunity before it.”

News 6/1/12

Top News

A study finds that physician practices using EMRs did no better (in fact, did a bit worse) in delivering diabetes care. It wasn’t a very large study, it was narrowly focused, it didn’t take into account such important variables as insurance or patient demographics, quality of EMR use wasn’t considered (the survey just asked whether the practice “owned” an EMR), and it used old data (the baseline assessment was from 2004 and the follow-up was in 2006.) I don’t take it to mean much, to be honest, but I’m sure it will be widely (mis)quoted with headlines that don’t reflect the data. The full text article is here.

Reader Comments

From Master of Tweets: “Re: Aneesh Chopra tweet chat sponsored by HIMSS and the magazine they publish. He mentioned HIStalk, but their magazine removed that from their transcript.” Above is the former US CTO’s answer when asked what he reads to stay current on health IT trends, That tweet does indeed not appear in the magazine’s transcript (which means it’s not really a transcript since they edited stuff out.) My favorite question he was asked: "Many ‘experts’ in health IT have never used let alone implemented an EHR – how do we get stories of success out?" I’ve learned to tolerate the writing and tweeting of HIT-naïve reporters, academics, etc. when they stick to repackaging the news, but I don’t recognize their credentials to be armchair quarterbacking to CIOs, doctors, government folks, or vendors. You need street cred like Inga when she threw down by fearlessly by asking Farzad Mostashari, “When was the last time you used an EHR?” with both her question and his answer (after his initial shock) raising their respective levels of professional credibility.

From Maxwell Smarts MD: “Re: Cerner. Their silence is deafening giving their central role in the HealthSMART program, now declared a total failure.” The Victoria, Australia government finally puts HealthSMART out of its misery due to the ubiquitous dynamic duo of cost overruns and implementation delays. I’ve been reporting regularly on HealthSMART, launched in 2006 with an estimated cost of $318 million, but now dead after blowing through $557 million with only 40% of the sites live several years after the expected completion date. Millennium was the key component and Cerner struggled to localize it according to critics there, but the government apparently also contributed its expected share of incompetence. Maybe there’s a shining example out there somewhere of government bureaucrats and politicians hunkering down in the mud with big contractors and Wall Street-driven vendors to deliver a successful IT project on time and on budget, but I can’t think of even one.

From Killjoy: “Re: Harris Corporation. Looks like they are purging many of the CareFx positions after their acquisition last year. I heard 40 or so were let go Wednesday.” Unverified.

From Secretive: “Re: Accretive Health. Its SVP apologizes while being grilled by Sen. Al Franken’s committee.” It was a conditional apology – the SVP says that while some patients may have been offended, the company operated within legal and industry guidelines, also pointing out that it fired the employee whose widely quoted e-mail called patients “deadbeats” and “stupid.” More interesting to me was that according to Minnesota Attorney General Lori Swanson, Accretive customer North Memorial Medical Center turned patient information over to Accretive without having a business associate agreement in place, but created one later and back-dated it. That hospital’s data was exposed when a laptop was stolen from an Accretive employee’s car.

From @Cascadia: “Re: NHS. They are shutting down the PHR, but they are clearly emphasizing patient portals according to their just-released Department of Health strategy.” They are indeed. The PHR, in addition to being a big-time flop, wasn’t really necessary to give patients access to their own information. The story of vendor-offered PHRs is pretty much like that of mullets, Zamfir’s pan flute, and the Big Mouth Billy Bass – they’re an unpleasant memory of an unfortunately popular fad that nobody admits to having embraced.

HIStalk Announcements and Requests

On HIStalk Mobile, Dr. Travis posits a great question: why aren’t we hospitals involving inpatients and their families in their care by giving them their own meds lists? They could not only learn by following along with their copy of the MAR, but would also undoubtedly catch a bunch of medication errors. You would think that despite potential embarrassment, hospitals would appreciate being given a chance to avoid making a medication mistake. Why wait until right before discharge to suddenly start dumping information on the patient for take-home use?

HIStalk stats for May: 116,203 visits (the second-busiest month ever, barely behind the HIMSS month of February 2012) and 219,070 page views (beating the all-time record from last month by 20%). Year over year, visits are up 42% and page views are up 98%. Very nice for a month that’s usually the beginning of the summer doldrums. I don’t really follow the numbers, but some readers e-mail me if I don’t mention them. I work the same whether it’s a bunch of readers or not many. Which reminds me as I’m writing this: HIStalk turns nine years old on Sunday, meaning I can’t even remember what it was like having only one full-time job.

I don’t have any reports from the MUSE meeting. Yours is welcome.

On the Jobs Board: Service Delivery Manager, Cerner and Epic Resources. On Healthcare IT Jobs: Programmer Analyst II, Cerner Go-Live Project Manager, Network Engineer II.

It doesn’t take much to make Inga, Dr. Jayne, and me happy. Just your reading HIStalk pretty much does it. If you’re an overachiever, you can (a) sign up for the spam-proof e-mail updates; (b) check out the searchable, browsable sponsor Resource Center; (c) use the Consulting RFI Blaster to painlessly get proposals for your consulting needs; (d) connect with us on LinkedIn, Facebook, Twitter, and all those trendy sites since we approve all requests to join our fairly large network; (e) support our sponsors by perusing their ads and clicking on those that tickle your fancy; and (f) keep the news, rumors, photos, etc. coming since we are not omniscient – we get a lot of help from readers. Of which you are by definition one, and we appreciate that.

Acquisitions, Funding, Business, and Stock

MED3OOO announces its acquisition of St. Louis-based KASS-MSO, an 80-employee provider of medical practice services.

RTLS vendor Versus Technology announces Q2 results: revenue up 89%, net income $198,000 vs. –$405,000.

SAIC reports Q1 numbers: revenue up 4%, EPS $0.35 vs. $0.36. The company said its Vitalize Consulting Solutions acquisition increased revenue, but its Military Health System revenue was down.

Sales

Greater Houston Healthconnect (TX) selects Medicity’s HIE solutions to connect more than 130 hospitals and 14,000 physicians.

Catholic Health East purchases NetSafe business continuance and downtime protection software for its 15 hospitals.

Covenant Health (TN) selects InfoSystems to provide data center virtualization and optimization infrastructure.

NextGate and CSC announce plans to integrate the NextGate Multi-Language Enterprise MPI with several iSOFT applications.

Caverna Memorial Hospital (KY) selects clinical and financial solutions from Healthcare Management Systems.

People

Robin Settle, former leader of PricewaterhouseCoopers’ HIT leadership team, joins Kurt Salmon’s HIT practice.

CORHIO announces that its policy director Liza Fox-Wylie has been selected to become Colorado’s State HIT director.

RCM provider Medical Business Resources appoints Thomas D. Sidebottom (Oracle) its CTO.

N-of-One, a provider of personalized diagnostic and treatment strategies for oncology patients, names Christine Cournoyer , former president and COO of Picis, as CEO.

Vitera Healthcare Solutions appoints Steven Holmquist (MedPlus/Cerner/HBOC) VP of sales.

Apollo Health Street brings on three sales professionals with healthcare IT experience: Andrew Finck, Greg Williams, and Anil Kumar.

Announcements and Implementations

Maine’s HIE announces the pilot of the nation’s first statewide medical imaging archive, which will include data from 56 radiology imaging centers, require about 200TB of storage, and be hosted by Dell.

UPMC deploys AeroScout’s Healthcare Visibility Solutions to automate temperature monitoring at its St. Margaret Hospital and will roll out temperature monitoring and asset tracking across most of its US hospitals.

DPR, a provider of imaging informatics for the radiology industry, will embed M*Modal Fluency Direct technology into its CaseReader structured reporting software solution.

St. Michael’s Hospital in Toronto implements Amcom Software’s Mobile Connect solution to send encrypted messages to staff on their iPhone, iPad, and BlackBerry devices.

Madison Memorial Hospital (ID) goes live on PatientKeeper CPOE and Medication Reconciliation.

Gateway EDI announces that it has signed its 100,000th client and expanded its client base by 19% over the last year.

Government and Politics

Last chance: nominations are due June 11 for open slots on the HIT Policy and Standards Committees.

Other

An article called That CT Scan Costs How Much? in the new Consumer Reports covers wide variation in healthcare charges, even for patients who are careful to use in-network providers. The price of an in-network colonoscopy in one city ranged from $840 at a freestanding practice to $4,481 in a big academic medical center. In another example, a woman with new Cigna insurance was treated in the ED for back pain and the hospital told her she owned $6,500 of the $14,600 bill that included a $9,000 CT scan. The hospital told her they’d take $3,000 cash if she paid immediately, which she did, only to find afterward that other Cigna providers offered CT scans for $318. Other stories: a woman with high-deductible insurance couldn’t find any lab that could tell her what her two routine tests would cost; a patient went to an out-of-network neurosurgeon for a risky procedure and was charged $592,000 by the surgeon vs. the $112,000 the insurance company would pay as usual and customary; and a woman who carefully chose an in-network surgeon still got stuck with a $10,000 bill from the hospital’s out-of-network anesthesiologist.

Feather River Hospital (CA) will shut down its 12-employee medical transcription department and outsource the work, saying the government’s push for EMR usage will reduce its need for transcription services. Said one of the transcriptionists, “I think they are going to find that they still need us. I don’t think computers are going to cut it.” That’s what stenographers said.

The 3,700-physician Hill Physicians Medical Group (CA) posts its financial results publicly: $481 million in revenue and $11.6 million in profit, even after spending $7 million last year on an EMR. The full report mentions specific applications they use: RelayHealth, Ascender, and NextGen.

A specimen control clerk at Mount Sinai Hospital (FL) is arrested on identity theft charges after police found credit cards and hospital computer printouts that were later traced back to her.

National Coordinator Farzad Mostashari will deliver the opening keynote for the 2nd International Summit on the Future of Health Privacy, held in Washington DC June 6-7. Registration is free to either attend in person or to view via streaming Webcast. The agenda is here.

An Abu Dhabi publication profiles Cerner nurse executive Deirdre Stewart and the state of healthcare IT in the Middle East. It says UAE spending on healthcare IT will rise from $3.1 billion to $4.7 billion this year, with quality (“the latest technology from reputed companies”) rather than price driving product selection.

The government of South Australia provides $186 million to fund three health IT projects: a patient administration system, a pathology information system, and a medical image storage system.

Weird News Andy predicts that June 21 will be a long day for patients in the UK. Unionized doctors there vote to go on strike for a day for the first time since 1975. The docs are mad about government plans to push back their retirement age from 60 to 62 and to make them contribute more towards their pensions. In the example given, a doctor making $185K today could retire at 60 with an annual pension of $74K, with one Member of Parliament (who’s also a doctor) saying, “The public will simply not understand why doctors have called for strike action over pensions that private sector workers and many other frontline NHS workers can only dream of.”

A money-losing hospital in Canada that installed a Tim Horton’s coffee shop expecting to make the same $300K annual profit that similar outlets rake in instead finds itself losing $260K per year. The CEO of the health authority explains: “We charge you a buck-ninety-four for that large coffee, but we insist that the staff who are pouring the coffee are Eastern Health staff, and they get paid $28 an hour.” The health authority says it will turn the location over to a private operator that isn’t saddled with its generous compensation practices.

Sponsor Updates

• Memorial Medical Center of West Michigan selects Wolters Kluwer Health’s ProVation Order Sets as its electronic order sets solution.
• Frost & Sullivan awards Imprivata its 2012 North American Customer Value Enhancement Award for accelerating EMR adoption with its single sign-on solution.
• Hayes Management Consulting announces that its MDaudit software provides an E&M bell curve reporting module to help organizations identify providers who are consistently coding higher than their peers.
• A local newspaper interviews Kareo sales director Jason McDonald, who shares how his experience as a Marine has transferred to his civilian career.
• The Advisory Board Company posts a case study that details how St. Joseph’s Hospital (TX) launched a four-hospital clinical integration network in just six months.
• Premier Bone & Joint Centers (WY) selects SRS EHR for its 12 locations and 10 physicians.
• CTG Health Solutions hosts a Webinar on healthcare security issues.
• Health and Social Care Northern Ireland selects Orion Health to provide a clinical portal-based Electronic Care Record.
• Sentara Healthcare discusses how Capsule Tech’s DataCaptor solution helped it connect more than 1,800 medical devices from over 1,000 patient beds. 
• Healthmark Regional Medical Center (FL), Millford Memorial Hospital (UT), Beaver Valley Hospital (UT), and Kit Carson Memorial Hospital (CO) select Prognosis HIS Enterprise Clinical and Financial systems.

EPtalk by Dr. Jayne

NCQA offers a seminar on Improving Organizational Performance to be held July 11 in Washington, DC. Speakers will discuss overcoming obstacles and barriers as well as implementing effective quality interventions. ONC will be providing faculty support as well. The fee is a bit steep, though – $795 unless you register prior to June 13 for the early bird discount.

George Washington University’s Hirsh Health Law and Policy Program has launched Health Information & the Law as a guide to federal and state laws on the access, use, release, and publication of health information. Information is grouped by topic and an analysis section also features articles and issues briefs by GW authors.

A colleague from residency recently introduced me to Quackwatch, which describes itself as “your guide to quackery, health fraud, and intelligent decisions,” which got my attention. Although some of the articles are older, there were many interesting reads. The kinds of scams described never go out of style, unfortunately.

If you build it they will come. Or not. A recent report shows that less than a third of eligible physicians reported quality data to CMS for 2010. Although 125,000 physicians received a bonus, 50,000 attempted and failed. Physicians who don’t report in 2013 will be assessed a noncompliance penalty starting in 2015, although it’s relatively small at 1.5%. I don’t blame paper-based physicians who have small Medicare panels for concluding that reporting may be more trouble than it is worth. On the other side, for most providers with reasonable EHR technology, you’re just throwing away money if you’re not reporting.

CMS will host a National Provider call on June 7 for Eligible Professionals to learn about registration and attestation for the Medicare/Medicaid incentive programs. There are quite a few providers out there who still have only minimal knowledge of the programs. Since this is the last year that providers can start and still earn the full incentive, it’s a good starting point for providers who need to catch up. If you’re a provider who didn’t report, why not? Do you plan to report in 2013?

A thoughtful reader sent an article to Mr. H “for Inga and Dr. Jayne on their never-ending quest.” It was a review of Rachelle Bergstein’s book, Women From the Ankle Down: The Story of Shoes and How They Define Us. It’s been added to my Amazon wish list (ahem, to certain men in my life who may be shopping for a soon-to-be arriving birthday) and I’ll be sure to read it prior to the next HIStalkapalooza so I can provide more informed commentary on the shoe competition. In the mean time, I learned a great factoid from the review: Salvatore Ferragamo invented the cork-soled wedge after taking human anatomy classes at USC. Who would have guessed?

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 5/30/12

Top News

In the UK, NHS says it will shut down its HealthSpace personal health record by March 2013. The Department of Health director says the system attracted few users, which he says is because, “It is too difficult to make an account. It is too difficult to log on. It is just too difficult.” A 2010 report commissioned by the government said it was failing for the reasons that government-run software projects usually fail: poor project oversight, lack of ability to define standard datasets, poorly defined consent practices, and contractors looking out for their own interests. I found this comment fascinating and relevant to other clinical IT system deployments:

The fortunes of the SCR and HealthSpace programmes appeared to turn partly on the philosophical question “Where is the wisdom we have lost in knowledge?”. Many though not all senior stakeholders in CFH, the professions and the IT industry viewed knowledge as stable and discrete data items which could be extracted from their context, placed on the SCR and transmitted to new people and contexts while retaining meaning. An alternative perspective holds that much knowledge is tied to particular people, organisations, experiences and practices and is difficult if not impossible to extract from its context or the people who know it.

Reader Comments

From Period Piece: “Re: hospital pricing article. Cash is king.” The LA Times covers the seldom-discussed topic of hospitals offering lower prices to cash-paying patients. Its lead example is a hairdresser who pays $700 per month for medical insurance and who was charged $6,707 for a CT scan, of which her share after insurance was $2,336, but had she just written the hospital a check, she would have paid only $1,054. Another hospital lists the same test at $4,423, the Blue Cross Blue Shield negotiated price is $2,400, and the cash price is $250. Says the patient, “I was really upset that I got charged so much and Blue Shield allowed that. You expect them to work harder for you and negotiate a better deal … it kills me that I’m paying that much in premiums and it’s better to pay cash out of my own pocket.” In yet another example, a doctor ordering blood work for his patient found that the hospital charges $782, the insurance company billed the patient for $415, but the patient’s cash price would have been $95. Like everything related to hospital charges, there’s even a catch to paying cash: you have to lie upfront in saying that you don’t have insurance since hospitals won’t give the cash discount otherwise since they don’t allow price cherry-picking, although they may offer a cash discount on the insurance company’s negotiated price. The hospital’s Robin Hood-like explanation: insured patients have to pay more to cover the underpayment of Medicare and charity care. The hairdresser is suing Blue Shield and seeking class action status, but the insurance company says it doesn’t guarantee that providers won’t undercut its negotiated prices for cash-paying patients (in other words, they’re making a fortune on administrative skim and premium-raising and thus have no incentive to worry about what their customers are paying providers.) Here’s the thing about medical insurance: both patients and providers would be better off without it other than for its coverage of catastrophic events, which of course is what it was supposed to be in the first place until it morphed into the borderline socialist “health insurance” that used to pay for everything, but now pays less and less even as medical costs increase and patient rebel at the idea of being responsible for their own healthcare expenses.

From Pico D’Gallo: “Re: Duke. Their cost for implementing Epic was announced at $700 million over seven  years, surely a record.” Verified, at least the $700 million part — I found a link here.

HIStalk Announcements and Requests

Based on the success of the HIStalk Advisory Panel, we want to add a separate HIStalk Practice Advisory Panel for practicing physicians and others working in the ambulatory space. Every month or so we’ll e-mail 3-4 questions pertaining to product issues or needs, cool technology that you might be using in your practice, and other issues affecting physician offices. If you have a few minutes every so often to participate, please drop me an e-mail. Many thanks!

Thanks to HealthCare Anytime, joining HIStalk as a Platinum Sponsor. The San Diego-based company offers a cloud-based patient self-service portal (online bill pay, recurring payments, once-time payments by telephone, appointments, pre-registration, secure messaging, refills, and PHR) that gets providers paid faster and makes their operation more efficient. Of course, patients like it too – who wouldn’t, compared to playing time-wasting telephone tag and jotting down indecipherable notes about balances and appointments? The portal helps providers meet two key Meaningful Use Stage 2 requirements: allowing patients to view/download their information and actually exchanging secure messages with at least 10% of them. The company has been around since 2000 and is run by Steve Click (founder and former CEO of Dairyland, now Healthland) and Brady Click (CEO of Intelligent Health Systems and founder of HealthCare Anytime.) The company is at MUSE in Orlando this week if you’d care to drop by Booth 207 to say hello. Tell them you saw them mentioned on HIStalk – sponsors love that tangible manifestation of their support. Thanks to HealthCare Anytime for supporting HIStalk.

I trolled YouTube to see if there were any videos about HealthCare Anytime and, what do you know, here’s a just-posted two-minute overview of their patient portal. I’m usually not that lucky, mostly because not all companies have caught on to the marketing value of posting videos on YouTube or Vimeo.

I can’t believe I’m saying this, but I’m getting kind of excited about Windows 8. I’m hoping it’s an easy and cheap upgrade, but the “cheap” part is negotiable with me – I don’t mind paying for an OS that’s more stable and functional (but I wouldn’t use Internet Explorer even if you paid me.) History has shown a predictable “every other Windows release sucks” pattern going back to Windows for Workgroups, so I’ll believe Microsoft has regained its long-lost relevancy and reputation for innovation if they can break that pattern. If not, Steve Ballmer needs to be fired immediately and I may go with a Mac since the Win 8 team appears to have stolen liberally from the Mac OS anyway. I’m interested in the announcements from WWDC (Apple’s developer conference, probably the most-watched conference in the world) in a couple of weeks, the first without Steve Jobs.

Acquisitions, Funding, Business, and Stock

In the UK, McKesson hires a lobbying company to help it earn IT business following the demise of the government’s NPfIT project. McKesson, which wasn’t a successful bidder in that project, can now sell directly to individual hospital trusts.

Sales

The National Institutes of Health awards Evolvent Technologies a 10-year contract to provide IT services and solutions for the NIH IT Acquisition and Assessment Center. The contract’s ceiling value is $20 billion.

Australia’s Austin Health and the Center for Ambulatory Surgery (NY) select ProVation by Wolters Kluwer Health for GI coding and documentation.

In the UK, Surrey and Sussex Healthcare NHS Trust votes to not only stick with the NPfIT-provider Cerner Millennium, but to extend its contract and add on the RadNet radiology information system. The trust is also seeking a PACS.

David Miller, vice chancellor and CIO of University of Arkansas for Medical Sciences, tells me that the organization has approved an $87 million Epic implementation. They expect to save $10 million per year in clinical improvements and $2 million in reduced software maintenance costs. Upgrading existing systems to meet Meaningful Use requirements would have cost $24-30 million.

LongView International Technology solutions wins a $300 million Military Health System contract to develop proof-of-concept applications that may have something to do with the joint DoD-VA EMR (the announcement doesn’t really say). The company also recently won part of another $20 billion contract. The five-year-old company was started by a retired Navy officer with an MS in hospital administration who had been assigned to the Secretary of Defense to manage a $20 billion appropriation (hopefully not the same one his company won.)

People

Imprivata names Mark Clark (Hitachi Data Systems) as VP of international sales, based in London.

Andrew Terry is named VP of software engineering at electrophysiology lab software vendor Perminova. He was previously with Sotera Wireless.

Announcements and Implementations

Krames StayWell makes its library of discharge instructions available to Meditech customers.

The HealthBridge HIE (OH) announces the go-live of its ED Admit Alert System, which lets physicians know when their patient visits the ED or is admitted.

MediServe announces that its MediLink for Outpatients solution will support recent changes to therapy caps for hospital-based outpatient therapy services.

The White House invites Iatric Systems to participate in the June 4 Patient Access Summit, where it will be one of 25 invited participants. Facilitating the event will be US CTO Todd Park, National Coordinator Farzad Mostashari, and VA CTO Peter Levin.

Image sharing network vendor lifeIMAGE anounces release of programming APIs that will allow software developers to enable image sharing directly from their applications. The announcement cites an unnamed academic medical center’s use of the API to send images from access management systems to Epic and to allow its employees to populate WebMD’s PHR with their images. I interviewed President and CEO Hamid Tabatabaie awhile back and learned a lot about the state of image sharing.

Government and Politics

Former US CIO Vivek Kundra, now with Salesforce.com, takes a shot at the IT establishment, which he says is stifling innovation. “There are these evil CIOs that everyone hates because they’re the ones that tell you ‘you can’t bring technology to your workplace.’ They represent the greatest threat not just to innovation, but also to citizens getting the services they want.”

Under fire: the Affordable Care Act’s 2.3% excise tax on the gross sales of medical devices, set to kick in next year but facing increasing Congressional resistance. At least if you believe the WSJ article, which seems to be partisan in the Republican direction (read the article comments for fun).

Innovation and Research

The CareFusion Foundation awards a $329K grant to the Healthcare Technology Safety Institute to study smart IV pump errors. Brigham and Women’s will coordinate the efforts of 10 hospitals in observing smart pump use to find problems, then identify possible solutions. The institute is part of the biomed-intensive, non-profit Association for the Advancement of Medical Instrumentation, which has worked with FDA on issues related to IV pump safety.

Technology

Epic authorizes implementations of its EHR on Intel x86 servers running open-source Linux, virtualized to VMware. Previously Epic ran exclusively on AIX and UNIX servers. This should make Epic a bit less expensive and perhaps more attractive to smaller facilities, though hardware is a minor part of the Epic implementation budget. Awhile back we ran a rumor that Epic was looking at the open source equivalent to Cache, so this might be a signal that they are looking for less proprietary and less expensive ways to run their systems.

Cisco kills off its Cius tablet for businesses less than two years after it was launched, born back when the original iPad wasn’t all that robust and businesses were expected to buy enterprise-grade tablets instead of succumbing to pressure from their employees to be allowed to  bring in their own far cooler tablets. It’s bad enough to be trying to move non-Apple tablets, but you are toast if yours is more expensive besides (the Cius was $700).

Other

South Shore Hospital (MA) will pay $750,000 to settle charges related to a 2010 data breach that compromised the personal data of 800,000 people. The hospital contracted with Archive Data Solutions to erase and resell 473 data tapes, but failed to encrypt the data and didn’t tell the vendor that the tapes contained PHI. The vendor shipped the tapes to a subcontractor to do the work and two of the three boxes were lost.

A UK doctor accused of killing two elderly patients by ordering tenfold overdoses of morphine is acquitted of manslaughter. He admitted that he made a mistake in prescribing the drugs while he was reading e-mail and checking online cricket scores.

Also in the UK, a hospital launches an urgent investigation after a patient complains that an exam light wasn’t working when the doctor was trying to stop her post-delivery bleeding, leading him to order the nurse to hold up his iPhone so he could work from its light. Says the patient, “Then the doctor and nurse had a bit of an altercation when the light went off, as she didn’t know how to do the finger swish thing to keep turning it on, and he… felt she wasn’t listening to his instructions.”

Weird News Andy says this took guts, but he urges police to add practicing surgery without a license to the charges. Police responding to the home of a New Jersey man who was threatening to harm himself with a 12-inch kitchen knife find him barricaded in his room, and when they kick the door down, the man stabs himself repeatedly in the abdomen and throws skin and parts of his intestines at the officers. The man, who has a history of psychiatric problems, is hospitalized in critical condition.

Sponsor Updates

• AT&T Health sponsors a June 5 Webinar discussing the creation of an enterprise image management strategy in the cloud. 
• Bloomberg Businessweek profiles Digital Prospectors Corp.
• Capsule will showcase its device integration solution a this week’s International MUSE 2012 Conference.
• Newfoundland and Labrador Centre for Health Information selects Orion Health to provide framework for its providence-wide interoperable EHR.
• SCI opens registration for its Client Innovation Summit 2012, to be held October 21-24 at Chateau Élan in Braselton, GA.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 5/28/12

Memorial Day is not just a three-day weekend — it’s the one day set aside each year to honor those who have died in military service. Go to the beach, picnic, or have a cookout, but please take a moment to honor the memory of those who gave up all of those things to die thousands miles from home while serving their country (and are dying still today.) Most of us will never experience or even understand their sacrifice, but the least we can do is take a few minutes from our year-round comfortable existence to honor it.

E-mail Mr. H.

News 5/25/12

Top News

The FCC votes 5-0 to approve allow wireless patient monitoring systems such as those being developed by GE Healthcare and Philips to share a frequency spectrum that was previously used exclusively for aircraft testing. Hospitals using the new systems will be able to monitor patients anywhere in their buildings without connecting them to hard-wired instruments and limiting them to specific areas such as ICUs. In-home patient monitoring via Medical Body Area Network devices will also be supported, so that body-worn sensors can communicate wirelessly with an in-home station that will send data to a hospital or other provider.

Reader Comments

From Raydonia: “Re: downtime of Transcend Systems/Nuance on 5/21. They are paying full-time transcriptionists the princely sum of $60 for the day of downtime. As of this writing Tuesday, we are down again. It’s a big deal. At-home workers don’t have the rights that on-site workers have. Any questions and you’re told, ‘Be glad you have a job.’” Unverified. I’m probably the last person you’d want to have soothing you since I’m not usually too sympathetic to career-related gripes. If you don’t like the job and have better prospects, you should take the better job. If you don’t have better prospects, then I agree with the company – the market is telling you something and you should be glad you’re working since lots of people aren’t. In this economy, knowledge workers and those with skills that are in high demand but limited supply are going to be treated very well, but the rest will be have to reset their expectations since the threat of automation or offshoring is always there (hello, HP layoffs). I don’t mean to be a downer, but our parents and schools are feeding us the “dream big and do whatever makes you happy and you’ll be rich and famous” story that doesn’t usually match reality unless you’re freakishly smart, cunning, connected, hard working, or lucky. I think that’s one reason the unemployment rate isn’t going down much – people are holding out for yesterday’s comfortable, high-paying jobs that are gone for good for many of them. In your case, I concur that being paid a “salary” based on piecework seems odd, but if that’s the work arrangement you signed up for, then I guess being paid just the base amount for days you can’t work is consistent, even though it sucks when it’s not your fault that there’s no work to do (kind of like minimum wage restaurant servers who would starve without tips). Hopefully they’ve got their systems back to normal since I’m sure your hospital customers are as anxious as you are to reconnect. 

From Pop Top: “Re: HL7. They are encouraging vendors to put the ‘Care Connected by HL7’ logo on their splash screens. Do you think any vendors will do this?” I don’t know why they would. Users are the ones who see the splash screen and they don’t care about HL7. Other than giving HL7 free advertising, I don’t see the benefit. And not to be overly critical since I’m probably the worst at aesthetic design (as readers who are always complaining about the HIStalk format can attest), but the logo looks kind of cheesy to me – harsh and badly proportioned wth an unpleasant 3D chiseled effect. Not to mention that the HL7 part of it, even though it’s their regular logo, is hard on the eyes. White on black looks like a DOS screen.

From Annie: “Re: Cerner. Consulting SVP David Sides resigned last week.” Unverified. His bio is still up and his LinkedIn profile says he’s still there.

HIStalk Announcements and Requests

Some nuggets you might have missed this week from HIStalk Practice: former Medic and A4 CEO John McConnell shares insights on HIT startups, Meaningful Use, Allscripts, and more. Dr. Gregg discusses the data-drenched world of HIT and the need for tools to keep things simple. A glitch leads to the rejection of 450,000 Humana claims sent through the Availity clearinghouse. Is the direct primary care model just a new name for concierge medicine? My take on banning smart phone pics in doctors’ offices (hint: good luck with enforcement.) A physician seeks opinions on drchrono. ONC promotes device integration for ophthalmologists. What do these news bits, interview, and opinion pieces have in common? None can be found on HIStalk, meaning you best pop over to HIStalk Practice to ensure you remain in the know. While there, click on a sponsor ad or three and educate yourself on some cool offerings. And don’t forget to sign up for the e-mail updates. As always, thanks for reading.  

Listening: brand new from Slash, excellent guitar-heavy rip-it-up rock that’s loaded with licks reminiscent of the best of the 1970s and early 1980s: Deep Purple, AC/DC, Whitesnake, and of course Guns N’ Roses. Nobody’s making straight-ahead hard rock these days, especially the kind that sounds like a real band instead of one guy and a laptop. It doesn’t exactly break new ground, but it’s going to be killer at summer gigs like Rocklahoma this weekend. And I can’t help cheering for Black Sabbath, together on stage again (minus drummer Bill Ward over money issues) after a seven-year hiatus and Tony Iommi’s lymphoma, opening their Birmingham, UK show last week with 1971’s amazing Into the Void.

Dr. Rick is back from the NIST-ONC EMR usability meeting. I asked if anybody recognized him since I work in an anonymous vacuum and always wonder what that’s like. He said a few folks did, including Farzad Mostashari. Rick will be providing a meeting recap after he gets caught up on his ophthalmology work.

On Healthcare IT Jobs: Application Analyst II, Assistant Director IT-Medicine, Hospital Software Analyst II, System Architect, Cerner Testing Project Manager.

Welcome to new HIStalk Platinum Sponsor Clinithink. Healthcare solution vendors use the company’s cloud-based CLiX natural language processing engine to turn free text medical notes into fully coded structured data (ICD-9, ICD-10, SNOMED CT) that payers, providers, and analytics companies can use to improve quality, increase revenue, and meet reporting and regulatory requirements. Structured data entry via check boxes and drop-downs makes like easier for the computer, but the richness of the patient encounter is often locked away in the detailed narrative of those providing the care. CLiX converts that data to information for everything from capturing Meaningful Use measurements to providing doctors with smart search capability for research that understands “bronchial hyperreactivity” as being related to “asthma.” Thanks to Clinithink for supporting HIStalk.

Here’s an overview I found of Clinithink’s CLiX on YouTube. It shows the user’s narrative popping up SNOMED CT codes.

Acquisitions, Funding, Business, and Stock

Kony Solutions closes on a $15 million third round of funding, led by Insight Venture Partners.

Healthcare payment network InstaMed secures $14 million in new capital.

Shares of Scotland-based charge master systems vendor Craneware drop by 15% after analysts speculate that its US customers might be chasing Meaningful Use money rather than buying its financial software, at least until next year. The company indicated in January that the situation was exactly that, but predicted a quick reversal of the trend. Other analysts agree with that earlier assessment, saying demand is already recovering.

Compuware reports Q4 numbers: revenue up 21%, EPS $0.12 vs. $0.16. Its Covisint subsidiary, which offers HIE and cloud-based services for healthcare, had annual revenue of $74 million, up 34%.

Nashville Medical Trade Center signs its biggest tenant so far, the RFID in Healthcare Consortium trade group. It will use part of its 80,000 square feet for The Intelligent Hospital, the hospital replica you saw in the downstairs exhibit hall at HIMSS in Las Vegas earlier this year (it was doing big business each time I checked). HIMSS will have 25,000 square feet in the building, which has 1.5 million square feet.

University of Maryland spins off Analytical Informatics, Inc., which will offer radiology dashboards and eventually expand into BI and quality tools that cross systems. 

Philips shares drop after its CEO warns that the European debt crisis may hurt imaging sales there.

Sales

Kosair Children’s Hospital (KY) selects Amcom Software’s clinical alerting middleware and smart phone communication solutions, planning to integrate it with their GE Healthcare Telligence nurse call system, GetWellNetwork interactive patient care system, and Cisco wireless IP phones and smart phones.

Omnicell closes on its previously announced acquisition of MTS Medication Technologies, a provider of medication adherence packaging systems.

Tri-State Gastroenterology Associates (KY) selects eMerge | ENDOTM for procedure documentation and workflow for its endoscopy center.

Lakeland Healthcare Group (IL) selects Merge Healthcare’s complete radiology cloud solution.

Indiana Orthopaedic Hospital selects the anesthesia information management system from Surgical Information Systems.

People

Former WellPoint VP Ryan Miller joins Availity as SVP of strategy and corporate development.

Todd Helmink (Allscripts) has joined The LDM Group as VP of strategic partnerships.

Greater Houston Healthconnect, a regional health information network, names Philip Beckett PhD (Baylor College of Medicine, RosettaMed) as CTO.

Announcements and Implementations

The US Olympic Committee announces that GE’s continued sponsorship will include the use of Centricity to manage the care of the 700 athletes participating in the London 2012 Olympic Games.

Iatric Systems and Order Optimizer announce the availability of an evidenced-based order set platform for Meditech Magic using Iatric Systems’ OrderEase solution.

MED3OOO announces the general availability of InteGreat EHR V6.5, which includes Quippe technology from Medicomp Systems.

RelayHealth and Greenway Medical complete a development agreement to exchange data between hospitals and ambulatory clinics.

Healthwise wins a Center for Plain Language award for its course on coronary artery disease. The non-profit company’s course combines easily understood content that is personalized by user type (recent coronary event, someone whose symptoms have subsided, etc.) Healthwise has previously won similar awards for its arthritis and low back pain materials.

Government and Politics

Representatives Michael Burgess MD (R-TX) and Gene Green (D-TX) introduce legislation that would require states to require hospitals to disclose information on charges for certain inpatient and outpatient services and to require insurance companies to provide enrollees a statement of estimated out-of-pocket costs for healthcare services.

US CTO Todd Park, writing on The White House Blog, announces the Presidential Innovation Fellows program. He’s looking for 15 innovators to spend 6-12 months in DC starting in July to work on one of five projects:

• Open Data Initiatives (entrepreneurial use of government data for societal benefit, including but not limited to healthcare)
• Blue Button for America (consumer downloading of their own health information)
• MyGov (access to government information)
• RFP-EZ (development of a platform to make it easier for the government to buy technology from startups)
• The 20% Campaign (move US aid payments from cash to electronic payments)

Innovation and Research

Three students at a Ugandan university win a prize for their smart phone-powered fetal monitoring system, which analyzes fetal sounds and produces a plain-English description that midwives and birth attendants can understand. The device costs at least 80% less than an ultrasound machine.

A study finds that OptumRX’s text message prescription reminder program improved medication adherence, with 85% of patients taking their at-home oral meds correctly vs. 77% without the reminders.

Technology

Cerner is looking pretty smart for buying up 65,000 IP addresses from bankrupt Borders for $12 each. The IPv6 kickoff is in a couple of weeks, but the transition is expected to take up to 10 years, meaning Cerner hedged its bets in being able to run in dual stack mode with the additional old addresses.

Other

The main Delaware newspaper covers the Delaware Health Information Network, which it says has enrolled 92% of the state’s providers. The front page story’s key figure is Christiana Care Health System CIO and DHIN Chair Randy Gaboriault, who had a recent positive experience with the value of shared medical information during a heart attack scare. He says his mother was not as fortunate – she died a couple of months ago after being treated by an unconnected hospital that did not have her history available, which he is convinced led to her unfortunate outcome.

Fairview Health Services (MN) fires CEO Mark Eustis, presumably after being embarrassed by never-ending press caused by the heavy-handed patient debt collection tactics allegedly employed by Accretive Health, which he brought in. Of course he also could have been fired had Fairview lost a ton of money by not collecting aggressively enough, so there’s that fine line thing.

As already reported here thanks to a tip from reader Gran Cru, Partners HealthCare (MA) takes a $110 million write-down on its soon-to-be dumped Siemens financial system, dropping its Q2 net income to $5 million vs. last year’s $71 million. As also reported here, bringing in Epic will cost another $600-700 million.

A scrub nurse at a Washington urology practice sues Robert Weissman MD, claiming that he threw an intra-operative tantrum that included cursing at her, throwing instruments, and finally intentionally stabbing her in the finger with a needle that he had just withdrawn from a patient’s scrotum.

Weird News Andy finds this story to be weird and wonderful. A Baltimore area high school freshman develops a 3-cent paper sensor that can detect cancer by indicating high levels of a particular protein, making it cheap enough to use in routine screening. Over 200 researchers he asked to help him test his invention turned him down, but now he’s working with a Johns Hopkins researcher, he has won $75,000 in the Intel International Science Fair (above), he has patented his device, and a San Diego biotech firm has offered to help him perform the FDA-required clinical trials.

WNA also likes this spooky security camera video from the ED of St. John’s Mercy Hospital in Joplin, MO as it was being hit by a tornado a year ago.

Dr. Jayne wants to play Weird News Andy in finding this obituary of a “crazy woman” characterized by her family as “De Facto empress of the hell she lived in.” I almost ran out of fingers trying to tally her former / present, living/dead husbands, not to mention her “friends at the Lakeside Trailer Park.” The family also noted that among the folks who will miss her most are Anheuser-Busch, Philip Morris, and the Ohio State Lottery. Her loved ones concluded with some sound advice: “Everyone dies, but not everyone lives. Mom lived. She lived hard, but she lived full. So, ‘Don’t cry because it’s over….. Smile because it happened!’ Light your smoke and raise your glass and remember the last thing she said to you that made you laugh so hard you thought you were going to wet yourself; but this time don’t hold back. Because she never did. “

I was startled to see this pop up on my LinkedIn page.

The executor of the estate of a 102-year-old heiress says everybody robbed her blind before she died, convincing her to give them extravagant gifts. Her daytime nurse got $31 million, the night nurse was given $1.1 million, her two doctors got $3.1 million, and Beth Israel Medical Center got a $6 million Manet painting for allowing her to live in the hospital for years even though she was healthy. Her attorney says she gave the gifts because she was generous (and he got only $60,000).

Sponsor Updates

• Practice Fusion announces the availability of customizable endocrinology templates.
• Cooper Green Mercy Hospital (AL) goes live on Stockell’s InsightCS Revenue Cycle Inofrmation Management system, including patient access and patient accounting.
• TELUS Health Solutions and Orange partner to develop remote monitoring solutions for chronic disease patients.
• Allscripts releases a white paper by CMOs Doug Gentile MD and Toby Samos MD that explores insights from ACO pioneers.
• Lifepoint Informatics is sponsoring G2 Intelligence’s Laboratory Outreach Conference June 6-8 in Las Vegas.
• The Advisory Board Company’s Crimson team will lead two breakout sessions at the 3rd Annual Health Datapalooza June 5-6 in Washington, DC.
• CareTech Solutions announces that its clients Barnes-Jewish Hospital (MO), Touro Infirmary (LA), and Wheaton Franciscan Healthcare (WI) have won 2012 Aster Awards for their websites.

Dr. Sam 5/23/12

On the Other Side of the Quality Chasm

The acceleration of the movement toward electronic health record (EHR) implementation and adoption begun by the Institute of Medicine reports of the late 1990s and fueled by the American Reinvestment and Recovery Act of 2009 has propelled us away from the paper environment at a rate that would undoubtedly not have been present in their absence. It is now possible to conceive of a time when the majority of our healthcare institutions and professionals function entirely in an electronic environment.

Now that the other side of the quality chasm is in sight, it is worthwhile to consider what it may be like when we land there, and prepare for a vastly different environment.

A significant body of evidence has been building over the last decade reflecting medical errors that may occur because of electronic medical records. Examples include default acceptance of all orders in an order set when some may not be applicable to a specific patient, or an inaccurate weight entered manually for a newborn but used to automatically calculate medication doses. Any implementation should include attention to proactively averting such errors by responsible quality control processes.

The practice of medicine in real time and enhanced capabilities for granular auditing bring the considerable exposure to medical liability to the forefront. Standards of expectation should be established for reasonable response times to alerts, e-mails and data generated and delivered in real time. Clear policies, consistent with state law, should be established to define exactly what compromises a legal electronic medical record, what information must be produced in the event of litigation, and consideration of consistency in patient care considerations in implementing new features and functions. (Is a different level of care being delivered to a subsection of patients within a hospital if a new feature or function goes live on one service and not another?)

It will be very long time before most hospitals and practices cease to work in a part paper, part electronic environment, but the common goal is to eliminate as much paper as possible. It is therefore highly probable, if not certain, that a generation of clinicians will eventually evolve who have never worked on paper.

It is also certain that hospitals and practices will experience both planned and unplanned system down time. Downtime policies specify circumstances where documentation and order entry must revert to paper, but do not generally address the possibility that clinicians may not know how to work on paper. As part of disaster planning and down time policy determination, policies should be in place for clinicians to be trained at regular intervals in the use of order forms, progress notes, history and physical notes, medical administration forms, etc. that may be called to use in a disaster environment or system down time. After a few years using fully implemented EHRs, they may simply not know how to use paper.

Similarly, ward clerks, pharmacists, lab technicians, and other support personnel must know how to carry out their responsibilities on paper, and must periodically be retrained.

Paradoxically, we may have to be certifying people to work on paper in the future.

Several years ago, I began to consider the vulnerability of our massively growing medical databases. Even though security measures, redundancy, and backup processes are in place, much of the firewall technology is "off the shelf," which simply means to me that someone sitting in a distant country can find a way through it. Most hospital security and background checks on IT personnel consist of credit reports and other forms of superficial investigation, but are rarely in-depth security evaluations.

In spite of painful mass casualty attacks and natural disasters that we have experienced (the Oklahoma bombing, September 11, Hurricane Katrina), our emergency rooms remain woefully unprepared to handle a massive number of injured people or able to sustain care for a large population of injured individuals for anything other than a very short time. If one considers the potential chaos that could ensue from a combined mass casualty episode combined with an intentional attack on the same regions’ medical databases, the importance of this consideration becomes obvious. Organizations such as HITRUST are bringing the importance of protecting our databases to light. As we move further toward the universal use of EHRs, hospitals and database specialists will need to devote more time, energy and money to protecting our healthcare databases.

I have recently been an active participant in the debate over physician-patient communication by e-mail. The greater issue goes far beyond this particular debate. While the mechanics of physician-patient interactions may be brought into the 21st century by reduction to the 1s and 0s of the binary world, the art of medicine cannot be.

If one has ever engaged in online dating, cyber political debate, or an e-mail argument, they will appreciate that much is lost in the absence of face-to-face interaction. Things are said that would never be said when an immediate reaction can be anticipated with someone who is physically present in real time and not in an untouchable, invisible virtual space. In an electronic environment, as much attention needs to be paid to taking care of the emotions and reactions of patients as is paid to the convenience of the communication vehicle in use. This lesson must not be lost for the upcoming generation of texting / Facebooking / Twittering clinicians. Those of us with grey hair have a teaching responsibility in this arena

Let’s not cross a quality chasm and create an empathy chasm.

Samuel R. Bierstock, MD, BSEE is the founder and president of Champions in Healthcare, LLC, a strategic consulting firm specializing in clinical information system implementation and healthcare IT business strategies.

News 5/23/12

Top News

HealthCor, which owns 5% of Allscripts, launches a proxy fight for control of the company by suing Allscripts over its nomination process for board members. HealthCor says the resignation of three of the company’s nine directors last month, all of whom had ties to Eclipsys before Allscripts acquired that company, left the Eclipsys product lines unprotected “from the continuing failures of execution of [Glen] Tullman,” whose ouster it had previously demanded. HealthCor wants the June 15 Allscripts annual meeting postponed to give it time to nominate its own candidates for the three open board seats, saying Allscripts should not have put forth its own slate of prospective new board members without giving shareholders the same opportunity. HealthCor is also criticizing Tullman’s $7.2 million compensation in 2011, saying he makes more than the CEOs of competitors whose stock is going up instead of down.

Reader Comments

From BoltUpright: “Re: Shantanu Paul. Interesting that he left Allscripts to head up product development at Vitera. He was a major player in the overall integration strategy at Allscripts. Not sure if his departure is motivated by a desire to jump ship because they weren’t listening to him, or if he’s being pushed out as a scapegoat for the integration problems they are having.” Vitera announced Paul’s appointment as SVP of product development here.

From White Lightning: “Re: Dan Michelson, chief marketing officer of Allscripts. Leaving the company.” Unverified, but a purported internal company e-mail sent my way says he’s leaving to become CEO of a private software company after 12 years with Allscripts. He won’t be replaced, according to the e-mail.

From Reverse Transcriptionase: “Re: Transcend. The servers of the former Transcend Systems transcription company that Nuance acquired have been down for days.” E-mails forwarded to me refer to a major system issue that was caused by failed storage devices. The last e-mail I saw, from Monday, said that they were still down and were typing and faxing stat reports, preop H&P, and radiology reports. I tried the Transcend Services Web site on Monday evening and it was down, but it’s working now, so I assume the problem has been resolved. Anybody can have systems fail and I give them credit for communicating thoroughly, although I’d be interested to hear what customers did in the interim.

From Casual Hospital Administrator: “Re: famous highly wired hospital. Patients appear to have been harmed.” The family of a former post-bypass ICU patient of UPMC Shadyside (PA) sues the hospital, claiming the 68-year-old man was somehow not attached to monitors when he died. Documents apparently verify that the patient was not being monitored for a 16-minute period, saying only that “mistakes were made.”

From Don Diego: “Re: HIStalk Advisory Panel. I’m an avid reader and also impressed with the insight, but the post on what Allscripts should do to fix things is absolutely amazing. Way to go, HIStalk.” I appreciate the involvement of the 79 panel members (now 94) who have volunteered to offer their opinions on topics I’ll e-mail them every few weeks. Most of them are CIOs, CMIOs, and practicing doctors, with a few vendor executives added to the mix. They can provide their honest thoughts knowing that even though I won’t identify them in any way, they’re still not potentially untrustworthy anonymous commenters (like Allscripts competitors, for example) since I know who they are. I’ll take suggestions on what I should ask them in the next round of crowdsourcing. In the mean time, I’ll be listing a few companies they mentioned in response to my question about any cool, small companies they’re working with – stay tuned later in the week.

From CDiff: “Re: Chicago CEO pay. The Chicago Tribune set up a Web page so you can do your own sleuthing on any aspect of compensation. Allscripts and Accretive did not bubble up, the the Trib’s lead story was about Debra Cafaro of healthcare real estate investment trust Ventas, who made $18.5 million. As you know, we have no method to compensate you for all you do; you remain the very definition of priceless.” Healthcare well represented on the list: drug maker Abbott ($24 million), supplies vendor Baxter ($14 million), supplies vendor Hospira ($12 million), and drug store operator Walgreen ($12 million) on the first page alone. Glen is on the list at $7.2 million and Mary Tolan of Accretive lags the well-enriched executive pack at $1.6 million.

From Carriage Bolt: “Re: Cerner single revenue cycle product. I’ve heard Adventist Health West is helping them develop a clinic and physician revenue cycle module.” Unverified.

HIStalk Announcements and Requests

Here’s a tip for companies who go to the trouble to issue press releases about their new hires. Include a link to a hi-res photo and insist that the person create a LinkedIn profile that includes a head shot (and not a thumbnail-sized one – a professionally made full-size headshot since LinkedIn automatically creates the thumbnail). You would be surprised at how many press releases I get about folks who have no apparent photographic presence on the Web, or who use a blurry, small, or amateurish snapshot as their LinkedIn photo. I’m less likely to run those announcements. Another gripe is PR companies that e-mail me a press release that hasn’t been posted anywhere else (including the company’s own site), so I don’t have anything to link to. Or, that send Word documents instead of pasting the text into the body of the e-mail or attaching a PDF – I practice safe text, meaning I’m not opening your Word doc unless I know where it’s been.

Acquisitions, Funding, Business, and Stock

Apple’s iPad in Business page features HCA’s use of AirStrip, Epocrates, PatientKeeper, Heart Pro, and other apps I didn’t recognize.

Here are iPad screen shots of Nova’s $17.99 Heart Pro, developed with Stanford University School of Medicine as a patient teaching tool. Very cool.

Sales

Iowa Primary Care Association selects Ignis Systems to integrate lab orders and results for 15 community health centers running Centricity EMR.

San Jacinto Methodist Hospital (TX) chooses PerfectServe for clinical communications.

People

Former Optum/Axolotl VP Anand Shroff joins Health Fidelity, Inc. as chief technology and product officer.

Nate Ungerott joins Health Care DataWorks as VP of sales. He was previously with Accuvant.

Investor Sue Siegel is named CEO of GE’s healthyimagination, which is spending billions on healthcare innovation and bringing healthcare IT to rural and underserved areas. She replaces Mike Barber, who has moved to VP/GM of molecular imaging at GE Healthcare.

Teresa Jamison is named VP of customer operations of SciQuest. She was previously with Allscripts.

Announcements and Implementations

Oregon’s statewide HIE implements Harris Corporation’s CareAccord platform and Direct Secure Messaging system.

Anthem Healthcare Intelligence, a provider of healthcare BI solutions and services,  rebrands as Agilum Healthcare Intelligence.

The 319-bed Cooper Green Mercy Hospital (AL) implements Medsphere’s OpenVista EHR and Stockell Healthcare’s Insight CS financial and accounting solution, replacing Meditech. The hospital says it will receive considerably more HITECH money than its five-year costs.

CBORD will offer Horizon Software International’s point-of-sale system that allows cafeterias to handle meal plans, payroll deduction, and gift cards to provide “the best total return on investment for healthcare food service operations.” Pretty cool, but I wish hospitals cared enough about their cafeterias to stop outsourcing them to companies like Aramark or Sodexo, who are given free rein to coldly enforce margin-preserving policies that would drive a real restaurant out of business within days: pre-portioned freezer-to-grease prisoner food from Sysco (the potato peeler has left the building), wildly overpriced drinks with no free refills, and weighing plates so that a modest portion of waterlogged spaghetti with canned sauce ends up costing $8. Nobody cooks, everybody scowls defiantly (especially the cashiers), and they all clear out by mid-evening, leaving the captive audience of off-hours employees and visitors with only the vending machines as a shining example of wellness. The best, cheapest, and most nutritional food that’s anywhere close is usually the hot dog cart out front or the caterers who bring in real food for the executive meetings.

Government and Politics

The VA refines its VistA strategy at the Open Source Think Tank, planning to spend up to $5 billion to tap the open source community and the private sector to advance VistA. Among its significant challenges is the Military Health System, which likes the fat cat contractor approach that turned its own AHLTA EMR into a $10 billion flop. The generals claim they’re leading the military-industrial complex charge, trying hard to win some EMR hearts and minds. In the mean time, the VA and DoD announce that they won’t roll out their integrated EHR until 2017. The excellent NextGov got a copy of the presentation outlining the problems. The only sure thing is that it will be late, over budget, and politicized.

Innovation and Research

A Brigham and Women’s study finds that doctors who dictate their notes instead of using templates or typing free text have lower quality of care, as evidenced by standard quality measures. The authors postulate that doctors who use a keyboard instead of a microphone pay more attention to on-screen discrete data elements and clinical decision support messages.

Technology

Bloomberg profiles Jintronix, a company I’ve mentioned that’s building technology around Microsoft Kinect that helps home rehab patients do their exercises correctly.

Mentioned in the above article is potential Kinect competitor Leap, a $70 iPod-size Minority Report-type pre-order USB peripheral that the company says will be 200 times more accurate than “a game system that roughly maps your hand movements,” able to distinguish individual fingers and track movements down to 1/100th of a millimeter. Assuming it’s not bogus, which seems to be a topic of discussion.

Other

In the UK, NHS announces an initiative to provide patients with online access to their medical records by 2015.

Bond ratings firm Fitch Ratings surveys its client hospitals about capital spending and finds that they consider IT investments to be the most important, ranking much higher than capital spending to increase capacity and align with physicians. The company was surprised to find that hospitals don’t expect the Patient Protection and Affordable Care Act to have significant influence on their capital spending plans regardless of the Supreme Court’s ruling.

Boston Children’s Hospital announces that an employee at a conference in Buenos Aires, Argentina lost an unencrypted laptop containing information on over 2,000 patients as an e-mail attachment. Somehow until trying to track this down I didn’t realize that Boston Children’s Hospital is one facility of Children’s Hospital Boston (if I’m correctly deciphering the seemingly contradictory logos and names on their site).

One of those lame problem-solver type news crews investigates a woman’s 10-hour ED wait, quoting the ED doc’s two mitigating issues: a new EMR system (Cerner from Trinity Health, I believe) and the need to treat sicker patients first.

HIStalk reader Alexander Scarlat MD’s book, Electronic Health Record: A Systems Analysis of the Medications Domain, is now available on Amazon. This is not one of those easy-to-skim books that seem to get published without any real purpose – it is hardcore into the medication domain (prescribing, drug concepts, dispensing, MAR, user interface, etc.) Alex was kind enough to send me an autographed copy since I reviewed a pre-press chapter and provided a quote for the back cover:

… encompasses high-value, high-volume therapeutic transactions of indescribable complexity that touch nearly every licensed professional in a hospital, enrobing drug ordering, dispensing, and administration in sophisticated layers of clinical decision support, caregiver work lists, and back-end charging and continuum of care functions. I am pleased that the topic merits its own formal review and analysis in Dr. Scarlat’s book. I found the user interface chapter immediately useful – in fact, I’m hoping the vendors of my own hospital’s systems take its recommendations to heart.

Weird News Andy is all up in our grill with , which he subtitles, “A Brush with Death.” Doctors investigating a man’s suspected appendicitis instead find that his intestine is pierced by a nail-like object later identified to be a bristle from his metal grill cleaning brush, which had become embedded in the steak he ate.

Sponsor Updates

• Greenway Medical and NextGen will participate in a patient data exchange demonstration during the ONC’s 2012 Direct Demonstration Showcase in Washington, DC May 31.
• Healthcare Informatics releases its annual list of top 100 vendors based on revenues from HIT products and services. HIStalk sponsors earning a spot of the list include: 3M Health Information Systems, API Healthcare, Allscripts, Beacon Partners, Capario, CareTech Solutions, Cumberland Consulting Group, eClinicalWorks, GE Healthcare, Greenway Medical, Health Data Specialists, HealthStream, Iatric Systems, Impact Advisors, Lawson Software, maxIT Healthcare, MED3OOO, MEDSEEK, McKesson, MedAssets, Merge Healthcare, NTT Data (formerly Keane), NextGen, Nuance, Optum, Orion Health, Passport Health Communications, SCI Solutions, Sunquest Information Systems, Surgical Information Systems, T-System, TELUS Health Solutions, TeleTracking Technologies, The Advisory Board Company, Vitera Healthcare Solutions, Vocera Communications, and ZirMed.
• ICA and AlliedHIE launch a national health information exchange to identify technology and communications issues within healthcare organizations.
• Michael O’Neil, founder and CEO of GetWellNetwork, gave a patient engagement presentation at Cleveland Clinic’s Patient Experience Summit on Tuesday.
• Hayes Management Consulting reports that eight of the top ten US hospitals listed on US News and World Report’s Honor Roll use MDaudit.
• The hospital authority for Memorial Hospital and Manor (GA) approves a consulting engagement with Vitalize Consulting for the implementation and training of hospital’s eMAR/BMV project.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 5/21/12

From Determinant: “Re: Cerner. Have you heard of them trying to sell ProFit patient accounting for both hospitals and practices? Looks like Cerner wants to complete head to head with Epic by offering one combined solution set for hospital, professional, and physician clinic billing.” I haven’t heard that. Anyone?

From The PACS Designer: “Re: Samsung Slate. One of the drawbacks of the iPad when it comes to viewing healthcare legacy apps is its small size. This hampers the effort to move these apps to a tablet display. Samsung has released a tablet called Slate with a 11.6 inch form factor, which should make the legacy app transition effort easier.” Samsung seems to be leading the “bigger than Apple is better since we can’t beat them otherwise” charge with its 3×6” Galaxy smart phone (or “smablet”) and now the 11.6” Slate. You’re going to look like a tool yapping into the bigger-than-your-hand Galaxy that covers the whole side of your head like Gordon Gekko’s 1987-era cell phone in Wall Street (which in turn looked like a Vietnam War walkie talkie), so I suggest budgeting for a headset and to arrange tailoring services for pocket expansion. The Slate will basically be the size of the entry level MacBook Air screen without the keyboard, meaning you’re back to a laptop size again other than the touch screen and a lot more money. Wasn’t portability the whole point of these devices? All of this makes me think that Windows 8 could be a really big deal since it seems that everybody wants some features of iOS (apps, touch, crisp display) but doesn’t care too much otherwise, and Win 8 will of course run on cheaper commodity hardware.

From Real Doll: “Re: former Cerner COO Paul Black on the board of Allscripts. The other new board member is from UPMC, which has close Cerner ties. Could be a merger in the works.” Unverified. I suppose anything is possible and Cerner isn’t all that strong on the ambulatory side, but that would be an ugly marriage.

Listening: Material Issue, a Chicago-based guitar-heavy power pop trio from the mid-80s. The frontman-founder killed himself in 1996, but the band left behind some great music. I also looked back to my February 13 post as Van Halen started their tour, when I said, “Check out their tour, but I’d be cautious about buying tickets for anything after the Boston show since tours seem to bring out the squabbling between the Van Halen brothers and whoever their lead singer is at the moment (Roth, Hagar, Cherone, lather, rinse, repeat) and the whole thing could go down in flames (think The Eagles without the concert-dollar greed that makes them pretend to get along.)” Sure enough, the band has postponed the remainder of their tour, although I missed the date — the Boston show was March 11 and it lasted a few weeks longer than that.

It’s OK to ask ED patients with non-emergent problems to pay before treating them, say 82% of respondents. New poll to your right, from the next story down: will Cerner and Epic be the only hospital information system survivors?

Cerner CEO Neal Patterson says at Cerner’s shareholder meeting that the company could be pulling in $10 billion per year in revenue by 2020, almost five times today’s total. He also says he’ll probably retire before then. When asked about the complexity of meeting provider technology needs, he said Cerner and Epic might be the only companies left standing. The “and Epic” part is not very Neal-like, so maybe he’s already mellowing on his way to the rocking chair.

Long-term care provider Deseret Health Group chooses HealthMEDX Vision to manage patient records across its 20 locations.

On HIStalk Practice, Inga interviews John McConnell, who sold more than $1 billion worth of companies that weren’t Eclipsys (Medic and A4) to what is now Allscripts.

Eight physician groups in the Kingsport, TN area start the OnePartner HIE, which will use the Siemens MobileMD platform.

The Twin Cities paper profiles the use of SafetyPad by Hennepin County paramedics. The tablet app, developed by Open Inc., receives 911 information, records vital signs, provides checklists, and notifies the ED that the patient is inbound. The hospital’s server receives a copy of the chart, looks for trends that may signal an epidemic, and bills insurance companies quicker than on paper (10 days vs. 90).

Here’s your weekly dose of HIS-tory, in which Vince talks about product names.

The FCC will vote this week on allocating a chunk of the wireless spectrum to Medical Body Area Networks, in which wearable patient sensors would communicate wirelessly to a local base station to send information back to physicians. FCC Chairman Julius Genachowski lauded the technology, citing examples such as remote EKGs, smart pill boxes, and diabetes management devices, also pointing out that half of hospital inpatients aren’t monitored and could potentially be with MBANs. If the rules are approved to reallocate the spectrum formerly used by commercial test pilots, the US would be the first country in the world with a dedicated spectrum for MBANs. He specifically mentioned that GE and Philips are working on the technology.

The results of Dr. Oz’s 15-minute physical on 1,000 Philadelphians using Practice Fusion’s free EMR: 43% were obese, another 29% were overweight (meaning a total of 72% weighed more than they should), 43% had high blood pressure, and 40% had pre-diabetes. Two patients were found to have significant problems (blood chemistry, hypertension) and were admitted to the hospital. Practice Fusion compared the data from its records on 40 million patients to conclude that more of those 1,000 patients were hypertensive than in several other large cities. The article says the Dr. Oz show chose Practice Fusion over several other EMRs that were considered, including Epic and drchrono.

Reading Hospital (PA) reports that a now-fired employee exposed the medical information of 12 patients by printing their billing information and using it in a training class.

A Department of Homeland Security bulletin warns that connecting medical devices to wireless networks is risky, and organizations that do it need to implement a really good security program. They mention the VA’s use of virtual LANs with access control lists as one way to keep unauthorized users out. A problem is that more devices are using commercial operating systems rather than custom-developed embedded ones, meaning they are more susceptible to malware.

A team of electrical engineering students from Portland State University wins Cornell Cup USA Presented by Intel for its prescription drug identification device, which provides near-instantaneous identification of tablets and capsules from their image. The students came to the university through the Intel Vietnam Scholars Program, in which interns from the Intel’s Ho Chi Minh City factory study engineering at Portland State.

In Australia, the government of Victoria finally kills off the HealthSMART project that was to have provided hospitals with software from Cerner, iSoft (now CSC), and InterSystems. The initial $318 million budget had run up a $557 million tab before funding was ended. Only four health services are live today of the 10 the government had promised would be running by 2007. Most folks blame mismanagement and poor planning rather than the vendors.

The Chicago business paper reports that Merge Healthcare Chairman Michael Ferro and companies he’s invested in have earned $9.3 million in side deals from Merge. Only four of the 11 related-party transactions were reviewed by independent directors. Shares have dropped 61% in the last couple of months.

The former assistant dean of Temple University’s medical school, along with the university, will pay more than $1 million to settle Medicare fraud charges in which $4.5 million in plastic surgery work was billed to Medicare but performed by unsupervised medical residents. The doctor is serving a seven-year term in federal prison for 150 counts of fraud.

The Tucson newspaper recognizes Sunquest Information Systems interface programmer Kenny Wickert, who throws annual  cookouts at work to collect co-worker donations for a Tucson child protection organization. Each event raises around $5,000. Says Kenny, who has worked for Sunquest for 21 years, “I see people dropping 20 and 30 bucks in the jar for a burger … We grew up just dirt-poor, and she always made it work with what we had. It’s kind of fair that I give back now that I can.” The award was given by Ben’s Bells, a kindness recognition program started by the mother of two-year-old Ben, who died when a respiratory infection caused his airway to swell shut while he was playing.

I lauded HealthNovation President and CEO Mike Mosquito at HIMSS in Las Vegas after observing his sartorial splendor, explaining as I asked to take his photo that Inga would be impressed with his truly sharp-looking outfit. Here’s a shot of him taken by Jennifer Dennard at last week’s Georgia HIMSS golf tournament, pulling off a great look despite what might appear to a highly questionable choice of trousers even in the “go to hell pants” world of golf clothing (I’m thinking Rodney Dangerfield’s Al Czervik in Caddyshack). I found by searching that I ran a photo of Mike from the same tournament last year, in which he was equally resplendent. I should get him to take a pic of his closet contents.

The event funded $2,000 scholarships for Ana Alston (Georgia Health Sciences University), Tiffany Formby (Georgia Tech), Laura Griggs (College of CoastalGeorgia), Lars Moen (Georgia State), and Laura Sims (Georgia Tech).

E-mail Mr. H.

News 5/18/12

Top News

Big Meaningful Use news: 3M, as part of its deal with the VA and DoD to help create a shared electronic medical records system, makes its Healthcare Data Dictionary available to all providers, payors, and vendors anywhere in the world for free. The dictionary translates to and from standard terminologies such as LOINC, RxNorm, ICD-9, ICD-10, and SNOMED CT, allowing disparate systems to communicate via concepts that support semantic interoperability. Check out the company’s white paper on the dictionary. You may recall that the feds licensed SNOMED for the entire country a few years back, making it free. This announcement may be even more important for interoperability, although I don’t see much buzz about it for some reason.

Reader Comments

From HIT Cynic: “Re: Cal eConnect. Looks like another state HIE bites the dust.” Not exactly. California’s HHS announces that it will move oversight of the state’s ONC-supported HIE program from Cal eConnect to the Institute for Population Health Improvement, which is part of UC Davis Health System. IPHI’s director is Ken Kizer MD, renowned for whipping the VA into shape in the mid-1990s.

From Wise Guy: “Re: new Allscripts board member Judge Cindrich. He’s a major consigliere to UPMC CEO Romoff, whose former right-hand man Phil Green is also on the Allscripts board.” I assume their UPMC connection is a coincidence. It’s a sure bet that they are Glen-friendly, though. I’ll be interested to see this quarter’s announcements and results since it’s pretty much go-time, one way or the other.

From Grand Cru: “Re: Partners HealthCare. They are all in with Epic. A catalyst was the Siemens rev cycle project, which needed a significant cash infusion over and above the existing budget. They were supposed to have all hospitals live by now and only one is (barely). This got the board’s attention since they were already looking for a clinical solution. I heard the write-off will be around $100 million on top of the cost of moving to Epic. Yikes! Siemens had an entire floor of one of the Partners office buildings, with employees who had moved their families and been there for years. Within two hours of Siemens getting the Epic decision, the floor was empty – they were told to move out ASAP.” Unverified. But in the mean time, Partners goes public with its plan to spend $600 million on Epic, which I’ve heard from several folks is a soup to nuts implementation, not just clinicals. I either didn’t know or forgot that former National Coordinator David Blumenthal MD has a Partners position – chief health information and innovation officer, according to the article.

From Dr. Gregg: “Re: health literacy. I was on a focus group call for the AHRQ-sponsored Center for the Advancement of Health IT concerning health literacy, which you mentioned on April 6. We were asked how to best get the word out about their health literacy guide and someone suggested popular HIT blog sites. Someone said, ‘Great idea, like HIStalk’ and it sounded as though everyone the call enthusiastically agreed. The moderator concurred with gusto that many of their focus group participants had come by via HIStalk.” I’ll try not to get all soapboxy, but I’ve been an obnoxious advocate of readability for many years. Everybody’s talking about software usability, but we medical people are even more deficient in content usability – the words we speak and write for patients are poorly thought out, full of jargon, and way beyond their level of comprehension. It’s hard – I once researched and wrote 100 or so patient education handouts (conditions, meds, treatments) and got the readability down to around 6th grade level, but it took a lot of careful wordsmithing and translating. This AHRQ publication contains most of my secrets, including a super-handy checklist at the end. I wish someone could convince the medical journals to break the self-sustaining cycle by eliminating their snotty, third-person dry recounts of studies in their articles – providers learn absolutely everything wrong about how write, resulting in articles that no human being can possibly understand even with the fivefold increase in time it takes to try to pry apart the dense, lifeless, code-worded verbiage to extract the tiny bit of useful information. I guarantee I could summarize a stack of medical journals in a couple of easily-read pages and you wouldn’t miss anything important. Anyway, the AHRQ pub is good whether you’re a readability beginner or just need a refresher. It’s a free download and, as you might expect, it’s easy to read.

From Radar Love: “Re: InfoLogix. It’s hard to believe the company, which largely failed in the RTLS market, is owned by Stanley Black and Decker and is acquiring AeroScout. They have maybe two installs that I can recall.” A rumor posted by a business publication in Israel (where AeroScout was founded) says Stanley Black and Decker will acquire AeroScout for $200-250 million via its healthcare division (meaning InfoLogix). InfoLogix lists quite a few customer testimonials on their site (Baylor, Tucson Medical Center, Albert Einstein, Swedish, etc.) so either your two installs number is incorrect or there’s something going on with the testimonials.

From Dennis “Doc” Gross: “Re: Captain Donna Rowe and National Nurses Week. I will always be grateful to Capt. Donna Rowe. She was the triage nurse the night our Dustoff helicopter went down bringing in a scout dog injured by shrapnel. We flew out of Dong Tam in the Mekong Delta  and were bringing  the dog to the Army’s veterinary hospital in Saigon. Our tail rotor blew out and all I remember was a big bang and then the helicopter did six 360s and we dropped into the trees from about 400 feet. I woke up the next day in the 3rd Field. A few years back, I was in contact with Capt. Rowe by e-mail. She and all of the nurses that served in Vietnam will always have my respect. They are special people and did a thankless job with compassion and professionalism. Many of my buddies and other soldiers owe their lives to these wonderful nurses. May God bless them.”

HIStalk Announcements and Requests

Highlights from this week’s HIStalk Practice: MGA-ACMPE asks HHS for a six-month deadline extension for submitting e-prescribing exemption requests. Vitera CEO Matthew Hawkins says his company will add up to 100 employees and spend $25 million on new technology. The AMA asks CMS to push the ICD-10 deadline to October 1, 2015. CureMD, Practice Fusion, and athenahealth take the top spots in KLAS’s review of SaaS ambulatory EMRs. Aaron Berdofe explores the definition of health informatics. Julie McGovern of Practice Wise offers advice for providers investing in IT hardware and services. Thanks for reading!

Constantine Davides felt pangs of responsibility to update his healthcare IT vendor family tree with your suggestions, so here’s the new version he did. I was thinking about it today. With consumer application software, companies buy each other and usually just keep selling the same software with no new claims. Purchasers continue to be happy since they have no new expectations and already got what they thought they would get. In healthcare, companies try to convince prospects that the mess of thrown-together unrelated products have become seamlessly integrated and synergistically improved just because the marketing people said so, happy to take the customer’s money even though they are sure to be disappointed in the futures they bought but may not receive. If you are industrious, you could plot number of acquisitions against KLAS scores and see if there’s a relationship.

On the Jobs Board: Business Development Executive, Director Solution Sales EPSi, Clinical Pharmacist.

Inga, Dr. Jayne, and I aren’t as smart as that $20 billion brat Zuckerberg. Instead of inventing Facebook (aka the OS for Farmville), we toil anonymously on HIStalk, trying to inform our healthcare IT audience while we actually work in healthcare IT (a novel concept). We’re on the non-profit side of the house, which means that a few muckety-mucks at the top of our org charts make millions, but down at our pagers-and-cubicles level, the perks are few and far between. You can, however, provide us with an emotional payday without spending a cent. Sign up for the spam-free e-mail updates by clicking the Subscribe to Updates link at the top of the right column (or by clicking here). Bond with us on all of the social not-working sites, or join Dann’s “no dues, no benefits” HIStalk Fan Club on LinkedIn as 2,460 cool people have done (check the list … impressive.) Choose a color and click each sponsor ad to your left that uses it, possibly finding an interesting offering purely by chance. Play with the searchable Resource Guide and give the Consulting RFI Blaster a try if you need consulting help. Send me news and rumors. I’m sure you can think of other ways to stroke our fragile egos, but I’ll leave that up to you. Reading HIStalk is the best way, of course, as is using your beguiling charm to get others to do the same. Thanks for hanging out with us.

Acquisitions, Funding, Business, and Stock

DICOM Grid, which offers a SaaS platform for medical imaging applications, closes a $5 million financing round. The company also announces sales to Frederick Memorial Hospital (MD), Ella Health (PA), and Texas Medical Center.

Emdeon reports Q1 results: revenue up 5.4%; net loss of $17.3 million versus a profit of $7.3 million a year ago. The company attributes the loss to the cost of taking the company private last year when PE firm Blackstone Group purchased the company for $3 billion.

Measurement technology vendor Agilent will acquire Denmark-based cancer diagnostic company Dako for $2.2 billion.

Sales

Catholic Health Initiatives signs a 10-year agreement with Tenet Healthcare subsidiary Conifer Health Solutions to manage revenue cycle services at CHI’s 56 hospitals. The agreement calls for CHI’s revenue cycle employees to transition to CHI and for CHI to receive a minority position in Conifer.

People

Healthcare RCM provider Adreima names Bob Wilhelm (TriZetto, Cerner) CEO. Former CEO Connie Perez is moved to the position of president.

Paul Black (Genstar Capital and former Cerner COO) is appointed to the board of Allscripts. Also named is Robert Cindrich (UPMC). All directors will stand for re-election at the June 15 shareholder meeting.

iSirona promotes Philip Sawa to VP of sales.

Medicomp Systems promotes Dan Gainer from senior software engineer to CTO.

CynergisTek hires Neil Buckley (Partners Healthcare) as VP of technology solutions, Eric Nelson (Secure Privacy Solutions) as a contributing principal, and Arnold “Van” Zimmerman as a contributing principal.

Announcements and Implementations

Bon Secours Charity Health System (NY) chooses MediRevv to provide A/R management for its three hospitals.

Wolters Kluwer Health will integrate its ProVation Order Sets with Meditech Client/Server and Magic version 5.64.

Government and Politics

Here’s a dynamic Farzad Mostashari from ONC, effectively explaining Meaningful Use in five minutes to an oddly boisterous audience.

Other

The body refrigerator at the Oklahoma Medical Examiner’s Office breaks down, requiring 28 bodies to be moved to refrigerated trucks just as the state legislature debates funding of a new building for the office. Coincidence or leverage?

Sponsor Updates

• GetWellNetwork will offer CBORD’s room service offering in its interactive patient care solution.
• The Ontario Ministry of Health and Long-Term Care signs a two-year contract extension with TELUS Health Solutions for its Health Network System.
• MEDecision hosts more than 150 customers at its client forum.
• T-System is selected as a finalist for Red Herring’s Top 100 Americas Award, which honors the most promising private technology ventures.
• DrFirst recognizes 10 of its client hospitals for being named to the Thomson Reuters list of Top 100 Hospitals.
• New York eHealth Collaborative will honor Jeffrey Immelt, chairman and CEO of GE, and Samual Palmisano, chairman of IBM, at its 2012 gala in October.
• Allscripts and dbMotion will host a June 12 seminar discussing the connecting of healthcare communities.
• Beacon Partners offers new Webinars on MU Stage 2, project management, and Epic Community Connect.
• A Billian-sponsored Webinar presents results of a post-implementation EMR perception study.

EPtalk by Dr. Jayne

Inga already mentioned this on HIStalk Practice, but I have to put my two cents in. The AMA recently sent a letter to HHS Acting Administrator Marilyn Tavenner, requesting an additional delay of ICD-10 until at least  October 1, 2015 citing “inadequately aligned” federal programs. Although I don’t disagree about the number of competing initiatives, this sort of feels like a child trying to renegotiate bedtime. They already extended it once, and since we’ve known about this for years, many of us just want to be done with it.

Speaking of HIStalk Practice, I really enjoyed the Practice Wise piece that Inga published earlier this week. Topics like proactive network support and asset management are often overlooked by small practices (and frankly some large ones) who later are surprised by their importance when something goes wrong.

Many physicians are worried about the loss of privacy (for both physicians and patients) resulting from the boom in social media. Cyberstalking is certainly easier when someone has an online presence, but I didn’t realize how many physicians have been impacted by old-fashioned stalking. A recent report presented at the American Psychiatric Association annual meeting notes that more than 20% of surveyed physicians said they have been stalked by a current or former patient at some point. Having been on the receiving end of stalking a few times, this is worrisome.

Recently I’ve seen an uptick in the number of spam e-mails I receive. One today asked me if I’m the person responsible for adding content to a particular HIStalk page from 2008. This was clearly not from an HIStalk reader based on other things in the e-mail, so off to the trash can it went. Of course I couldn’t avoid going to see what the topics of the day were and I wasn’t disappointed: bad decisions at Allscripts led the news.

I’ve heard the phrase Goat Rodeo used to describe various IT projects, but I’m wondering if we’re going to have to retire it from the lexicon? Apparently it’s also the title of a recent album by acclaimed cellist Yo-Yo Ma. Speaking of goats, I enjoyed reading a recent blurb about a New York emergency doc who found happiness on a goat farm. In the midst of a go-live right now, I agree that career alternative is starting to sound awfully appealing.

Speaking of go-lives, I wanted to share a hilarious email I received last week in response to my piece on EHR upgrade training. I was lamenting the difficulty of finding the training room. This reader earns the coveted “Laugh of the Day” award:

Don’t blame IT for lack of signage to your training room. I’ve gone around and around with facilities on this. They won’t put up permanent signs because not that many people need to know this information on a regular basis. TJC and the fire marshal prohibit 8 1/2 x 11 paper signs. I’m not sure how many people are killed annually by these things spontaneously combusting.

In the same spirit, some top pieces of advice from this go-live:

• When your implementation team recommends you reduce your schedule, they’re not kidding.
• When they asked you six months ago to start cleaning up your illegible paper problem lists and medication histories to make go-live easier, they weren’t kidding then either.
• Don’t be afraid to ask questions – we won’t laugh at you (at least not to your face – at happy hour, however, it’s another story.)
• Please, for the love of all things, let your support staff support you.
• If you’re going to drink from the secret bottle of bourbon you keep in your desk, the least you can do is share.

Have a favorite piece of go-live advice? E-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Quality Systems Acquires The Poseidon Group

Quality Systems, Inc. announced this morning that it has acquired The Poseidon Group, an Atlanta-based emergency department information systems vendor. Quality Systems will integrate the Navigator PC and NavigatorWeb EDIS modules into its NextGen Inpatient Solutions small hospital product line.

NextGen Healthcare Inpatient Solutions EVP Steve Puckett was quoted as saying, “This acquisition provides our clients additional value by extending our hospital suite portfolio of advanced solutions to the Emergency Department. This product along with our surgical services suite will help support our rapid growth upward into the community hospital market.”

The acquisition closed May 1. Terms were not disclosed.

News 5/16/12

Top News

Accretive Health sends a detailed response to Senator Al Franken, who is investigating the company’s hospital collection practices. The company says its primary purpose is to help patients by making sure they use the benefits to which they are entitled, also adding that the company follows HFMA guidelines, including making it clear that services won’t be withheld for financial reasons. Accretive says it complies with all federal laws, including HIPAA, and that all but one of its missing laptops was encrypted and that one was because a now-fired employee messed up. The company also hires a boatload of influential guns-for-hire former politicians to polish its tarnished reputation: former HHS Secretaries Mike Leavitt and Donna Shalala, former Senate majority leaders Tom Daschle and Bill Frist, and former CMS administrator Mark McClellan. Newt Gingrich on Line 1?

Reader Comments

From MT Hammer: “Re: Transcend Services (now Nuance). Medical transcriptionists file a class action lawsuit against the company for labor law violations.” The 13 named transcriptionists claim that Transcend violated federal labor laws by paying them per line of text transcribed or edited but not for related activities such as looking up information, thereby dropping their compensation below the $7.25 federal minimum wage. I’m surprised that Transcend hired them as work-from-home employees instead of independent contractors, but maybe the company provides more direction than would be expected for a contractor.

From David Stock-Man: “Re: Quality Systems/NextGen. Anyone have thoughts on the company missing its numbers and shares getting crushed?” QSII announced preliminary Q4 results last Thursday, with expected revenue for the quarter of $107-111 million and EPS $0.24-0.27, blaming revenue recognition delays for missing expectations and issuing guidance down for the fiscal year. FY2013 guidance calls for revenue and earnings growth of up to 25%. Some folks on the stock message boards are crying foul, saying that pro traders were taking huge put positions in the shares right before the announcement, suggesting the possibility that word leaked out (without having any proof, of course.) Shares that were trading in the $45 range just a handful of weeks ago are down to $30. Above is a one-year graph of QSII (blue) and the Nasdaq (red). Shares have a long track record of steady growth, are now priced relatively cheaply, and the company’s margins are good, so if you’re feeling confident that this is just a bump in the road, you get to buy shares at a discount (and if you’re wrong, you get to lose even more money). All I know is that quite a few of the old-school EMR vendors seem to be failing to meet lofty expectations lately despite billions of taxpayer dollars being spent to help them sell product, so if not now, when?

HIStalk Announcements and Requests

Thanks very much to the 68 readers who donated to support the four young daughters of Epic analyst and long-time HIStalk reader Tim Dodson of Children’s Medical Center (TX), who passed away recently at 34. Including the three of us who matched $250 in contributions dollar for dollar, our total contribution was $5,495, which I’ve deposited to the fund set up by Tim’s wife Wendy for the girls, flagging it with a note saying it came from Tim’s fellow HIStalk readers. I covered the credit card fees, so every dollar you donated went directly to support the children. Those of us who chipped in know that it could have been us who died young and unexpectedly, leaving a family deprived of not only their loved one, but of their primary breadwinner as well. You did good.

Acquisitions, Funding, Business, and Stock

The Trizetto Group announces that its subsidiary Gateway EDI has acquired NHXS, a provider of contract compliance and point-of-service adjudication workflow automation. Gateway will incorporate NHXS’s capabilities into its EDI and RCM offerings.

Wolters Kluwer sells its prescription data business to PE firm Symphony Technology Group.

Simplee, which offers free online medical expense management tools for consumers, raises $6 million in a Series A funding round.

Sales

Unity Health System (NY) selects Phytel’s Atmosphere platform as part of its infrastructure for population health management.

Cape Cod Healthcare (MA) chooses Courion Suite for user access management for its Siemens Soarian system, scheduled for a December go-live.

Stewart Webster Hospital (GA), a 25-bed critical access hospital, selects the ONE EHR from RazorInsights.

The State of Arizona contracts with Mosaica Partners for consulting help in updating strategic and operations plans for the state’s HIE.

Orange Coast Memorial Medical Center (CA) selects PerfectServe’s clinical communication platform.

Hartford Hospital (CT) will deploy OTTR’s transplant system, including the recently announced OTTRvad module for ventricular assist device patients.

Norton Sound Health Corporation (AK) will deploy ambulatory and inpatient solutions from NextGen.

Chesapeake Regional Medical Center (VA) contracts with ICA Informatics to develop an HIE for its integrated delivery network.

Boston Medical Center (MA) signs a five-year license agreement with Streamline Health for use of its business intelligence and analytics solutions in 19 physician group practices, while Bronx-Lebanon Hospital Center (NY) extends its licensing agreement with Streamline Health for five years.

North Texas Accountable Healthcare Partnership (TX) selects Orion Health’s HIE solution to connect its 12,000 physicians.

Advocate Health Care (IL) selects Merge Healthcare’s cardiac imaging and informatics solution. Merge also announces that 12 radiology and orthopaedic practices have selected its EHR products.

Aetna selects Kony Solutions’ KonyOne Platform for its mobile health app.

People

The Massachusetts eHealth Institute names Laurance Stuntz (NaviNet, CSC Healthcare) as director.

e-MDs hires former CO-REC director Robyn Leone as director of public policy and government initiatives.

M*Modal brings on Kathryn Twiddy (Quintiles, Misys) as chief legal officer.

Blair Butterfield (GE Healthcare IT) joins VitalHealth Software as president of its North American division.

Announcements and Implementations

Rockford Memorial Hospital (IL) goes live next spring on the health system’s $40 million Epic system. Rockford’s physician group has been live since last year.

SoutheastHEALTH and Missouri Delta Medical Center join forces to build and manage a $3.5 million networking and data storage center for their organizations and other medical providers. Both hospitals will also install a $12 million Siemens Soarian system over the next year.

Austin Diagnostic Clinic (TX) goes lives on PatientKeeper Charge Capture for its 120 physicians.

Aetna Pharmacy Management offers its members new services based on their prescription claims data: (a) switching to once-per-day meds when appropriate; (b) recommending trying a less expensive single component of a combination drug; (c) flagging prescription that have been taken longer than recommended; (d) sending prescribers a letter for daily doses that exceed that listed in product labeling; and (e) identifying cases where a new prescription may indicate that a previous one caused side effects.

Medical billing and financial management vendor Fi-Med Management says it will expand its services and add 145 new jobs in the Milwaukee area. It says its new software can help hospitals identify over- and under-charging and avoid audits.

Other

Allscripts will train and hire 40 City College of Chicago graduates, whose salaries will be paid by the City of Chicago for their first six months.

Cerner customer The Hospital de Denia achieves HIMSS Analytics Europe Stage 7, the first Spanish hospital and the second in Europe to do so.

A Northwestern Memorial Hospital (IL) employee is charged with identity theft after a police search of her home, triggered by her use of several credit cards to pay her water bill, uncovers the credit card numbers, birth dates, and Social Security numbers of more than 50 patients.

Last weekend I had the chance to snuggle with a relative’s new baby, which reminded me of this recent article. Laptop magazine compiled a list of 15 current technologies that newborns will never see, including wired home Internet, Windowed operating systems, hard drives, the mouse, desktop computers, and fax machines. If I had written the article, I would have put an asterisk by a few of them (desktops, fax machines) and added, “Not applicable to healthcare because providers are resistant to change.”

Sponsor Updates

• Surgical Information Systems recognizes five hospital systems with 2012 SIS Perioperative Leadership Awards, among them Holy Spirit Hospital (PA – above.)
• Certify Data Systems ranks as a tier one enterprise HIE vendor in the Chilmark 2012 HIE Market Report.
• CynergisTek expands its portfolio of offerings to include the HIPAA Surveyor Solution Series and the HIPAA Audit Readiness Solution Portfolio.
• AHA Solutions and GetWellNetwork host a Webinar featuring Texas Children’s Hospital and its interactive patient care RFP process.
• PatientKeeper awards Ashe Memorial Hospital (NC) its customer innovation award.
• EHRConsultant’s AIMSConsultant division provides advice on choosing the right anesthesia information management system.
• Informatica releases its Informatica 9.5 platform, designed to maximize customers’ return on big data.
• BridgeHead Software will sponsor The Big Event social gathering at the 2012 MUSE International Conference May 29-June 1.
• Computerworld honors Lehigh Valley Network (PA) with its 2012 Laureate award and NASCAR Teamwork award for its innovative use of DigitalShare, T-System’s ED patient documentation system that’s based on Shareable Ink technology.
• Barrington Orthopedic Specialists (IL) selects NextGen’s EHR, PM, portal, and other solutions for its 15-physician practice.
• College Park Family Care Center (KS) selects eClinicalWorks EHR for its 91 providers.
• Emerson Hospital (MA) integrates Access Intelligent Forms Suite with its Meditech Magic system.
• Kareo upgrades its billing system clients to a new release, which includes enhanced claim scrubbing capabilities.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.