Monday Morning Update 5/7/12

From Artie: “Re: Allscripts. The big event is the end of this quarter. If the company doesn’t show large improvement, it will be all she wrote.”

From The PACS Designer: “Re: better heart health. TPD is all for improving one’s heart health, and a tool that can help others do so is THUMPr. It’s an interactive tool to help you learn how to take better care of your heart by using Aspirin, Blood pressure control, Cholesterol management, and Smoking cessation (ABCS).”

Listening: Hospitality, happy, jangling, female-led 60s-feeling pop from Brooklyn. Their first video stars the actress who played Maeby Fünke in Arrested Development.

Respondents to my last poll chose CERN for their imaginary $100K investment even after the recent inadvertent discounting of Allscripts shares. New poll to your right, as requested by a reader: which political party’s beliefs most closely match your own? (“most closely” being the key word since it’s not much of a poll if everybody writes a lengthy position statement).

Thanks to the following sponsors, new and renewing, that supported HIStalk, HIStalk Practice, and HIStalk Mobile in April.

Epic EVP Carl Dvorak send me a nice e-mail asking if I could figure out why HIStalk wasn’t accessible from Epic’s campus. Lots of employees were asking, apparently. It wasn’t Epic’s fault: last Friday’s Allscripts news and my mention of two Epic wins in the UK caused a flood of Epic readers to visit HIStalk. So many, in fact, that my hosting company’s firewall suspected a denial-of-service attack and blocking incoming traffic from Epic’s IP addresses. That’s been fixed. Now I’m wondering if the report that Allscripts had blocked HIStalk access from the Raleigh office was the same issue, since certainly their employees would have been equally curious about that day’s news.

The bond rating agency of Dartmouth-Hitchcock (NH), noting the health system’s weak operating performance, blames two factors: reduced state funding and the cost of implementing Epic.

HIMSS Analytics names 17 of the 23 hospitals owned by Banner Health (AZ) as EMRAM Stage 7. They use Cerner, I believe.

Long-time HIStalk reader Tim Dodson, senior analyst with Children’s Medical Center (TX), died last week.

The Nashville Medical Trade Center names six new tenants, including software vendors Informatics Corporation of America and The SSI Group. They’ll be next door to big tenant HIMSS on the top floor.

Vince’s HIS-tory this week deals with  big drops in a company’s stock price..

Document management system vendor BlueWare will move its corporate headquarters and 190 jobs from Cadillac, MI to Melbourne, FL.

Imprivata is assigned a patent for a rules-based method of authenticating a computer via biometrics without using the security functions of the underlying operating system.

E-mail Mr. H.

News 5/4/12

Top News

The US Congress asks Accretive Health CEO Mary Tolan to provide the company’s hospital customer list, employee policies, and past complaints, citing its concerns about violations of HIPAA, EMTALA, and the Fair Debt Collection Practices Act. Above is a snip from the letter. AH shares dropped 3% Thursday and another 2% in extended trading, having given up 58% in the past four weeks.

Reader Comments

From Calorie Counter:  “Re: Cinnabon and nurses. Cinnabon is giving nurses free rolls (730 calories, 24 grams of fat) in honor National Nurses Week. Maybe hospitals should ban Cinnabon consumption.” Yeah, well, I wish hospitals good luck with enforcing that. Here’s another brilliant marketing idea: maybe CVS should consider honoring nurses by giving them a free pack of cigarettes.

From HIPAA Police: “Re: passwords. A nurse in IMCU was complaining to me about having to remember too many passwords. She then showed me the back of the badge to illustrate just how bad it is and let me take this photo.” In case you can’t make it out, her badge notes the passwords for several different systems, including Pyxis, pharmacy, and e-mail. I am sure that HIPAA Police does not work at the only hospital that can’t afford an SSO solution, so how do others manage multiple passwords? Bigger badges?

From Sweet Tea: “Re: size of the healthcare IT market. One commercial company’s estimate is $40 billion per year, close to your estimate of three times Vince’s $12 billion revenue number for the largest companies.”

From Stock Analyst: “Re: size of the healthcare IT market. Our company thinks it’s around $32 billion in size, of which $9 billion is hospitals.” Thanks for that information.

From J-Lo: “Re: Stage 2 comments. I seem to recall that with the Stage 1 NPRM, you could see the comments everybody else submitted. Is that not the case with Stage 2?”

From Nasty Parts: “Re: Allscripts. If things to continue to go bad for Glen Tullman, he can always focus on his other company. How many people know that Glenn is the CEO of another company?” At least 20,000+, assuming HIStalk’s readers paid attention when I mentioned it a couple of times in the past. People are always sending me stuff that I’ve already run, though, so maybe they’re trained by newspapers to assume that small stories aren’t important and are skimming HIStalk posts just a bit too fast. Here, I could describe World War III in one paragraph while using twice that space to rave about some weird band I like.

From Moe: “Re: Trinity Health. The group of hospitals in Columbus, OH (Mt. Carmel) brings 10,000 users live on Cerner big bang , including revenue cycle, clinicals, lab, and more.” Nice. If you have any pictures, send them over. Who doesn’t love command center pics?

HIStalk Announcements and Requests

This week’s highlights from HIStalk Practice: electronic medication reminders may improve adherence in the short term, but long term effectiveness remains unclear. More than 40% of all primary care providers are enrolled in RECs, including 50,000 in practices with fewer than 10 physicians. CareCloud CEO Albert Santalo wins Miami’s Technology Entrepenueur of the Year award. Dr. Gregg muses on odds and ends, inluding a shift in HIT discussions beyond Meaningful Use and the end of service for a few clinical informatics professionals. If you’re not a regular HIStalk Practice reader, what are you waiting for? And if you are one of the thousands of readers stopping by each month, many thanks!

A few folks always seem to be getting Inga and me confused, sending her information intended for me. Just to clarify: we don’t tag straight news items with who wrote them – we both do. If Inga adds her opinion, answers a question directly, or otherwise writes something in a way that might not be clear who’s talking, I put the little red icon in front of that item (as above). Otherwise, it’s me (Mr. H) you’re reading. I was tagging my items with a blue icon, but that was a bunch of unnecessary blue icons given that it’s just the two of us (other than Dr. Jayne, who has her own clearly marked section).

A pet peeve: confusing one-word adjectives with two-word nouns and adverbs. Example: Walmart may have everyday low prices, but you will see them in the story every day (not everyday.) You may have a backyard swimming pool, but it’s not in your backyard.

Acquisitions, Funding, Business, and Stock

MedAssets reports Q1 numbers: revenue up 15%, EPS $0.00 vs. -$0.28, with the company pointing to costs involved in its Broadlane acquisition in November 2010, but still beating estimates on both revenue and earnings. Non-GAAP earnings were $0.24 vs. $0.17.

The Advisory Board Company announces a 2-for-1 stock split following the release of its Q4 numbers: revenue up 33%, EPS $0.46 vs. $0.30.

Amcom Software acquires the IMCO-STAT CTRM product from IMCO Technologies that will allow traceable delivery of critical lab test results to the ordering physician by paging, PCs, tablets, and smart phones.

Facebook’s upcoming IPO will raise about $11 billion based on Thursday’s announced price range, valuing the former dorm room project at up to $100 billion.

Two law firms file class action lawsuits against Allscripts, charging the company and its officers with intentionally hiding failed integration efforts, missing its revenue and earnings guidance, and misrepresenting its post-merger prospects after it acquired Eclipsys. All routine and rarely meaningful, of course, guaranteed to happen when any company’s stock drops unexpectedly.

Sales

HHS contracts with Archimedes, Inc. to develop a modeling and simulation software platform for clinical scenarios, health interventions, and disease conditions.

Samaritan Regional Health System (OH) enters into a multi-year contract with CareTech Solutions for comprehensive IT services.

Radiology Associates of Fox Valley (WI) selects McKesson Revenue Management Solutions for its 33-physician practice.

Shands HealthCare will use the Rothman Index to monitor patient status and to conduct research at its Gainesville and Jacksonville campuses. I interviewed co-founder Michael Rothman 18 months ago for insight into how the software works.

People

Medecision names Katherine Schneider MD (AtlantiCare) as chief medical officer.

Former Eclipsys CFO Bob Colletti joins academic credentials exchange vendor Parchment as CFO.

MIT Sloan CIO Symposium chooses four finalists for its CIO innovation award based on four criteria: trusted advisor, business leader, strong communicator, and proven manager. Among the finalists is Catherine Bruno, VP/CIO of Eastern Maine Healthcare. Healthcare CIOs on the speaker list for the May 22 event include James Noga (Partners HealthCare), Chuck Podesta (Fletcher Allen Health Care), and Sue Schade (Brigham and Women’s Hospital.)

DuPage Medical Group (IL) names Krishna Ramachandran as chief information and transformation officer, where he will lead the 330-physician group’s Value Driven Health Care initiative. I note that he’s a member of the HIStalk Fan Club on LinkedIn, so special congratulations to him (it’s fun to read down the list of 2,408 members – since most folks have photos, it’s like an HIT yearbook.)

Announcements and Implementations

Mercy Health System (PA)  activates its Meditech EHR across its four hospitals and 44 physician offices.

Phoebe Putney Memorial Hospital (GA) goes live on McKesson CPOE on May 15.

Newark-Wayne Hospital (NY) goes live on Epic as part of Rochester General Health System’s $65 million EHR initiative.

JPS Healthcare (TX) will go live on its $110 million Epic system this Saturday, the seventh Metroplex-based health system to do so.

Practice Fusion launches an API that allows any laboratory to connect directly to its EMR and send lab results using standard HL7 data files.

Gartner names Kony Solutions a Visionary in its report on mobile application development platforms. The company also announces that it supports the BlackBerry 10 platform.

CE Broker announces the EverCheck paperless system for automatically verifying professional licenses for credentialing, including sending alerts about licensure status changes and maintaining an archive of all licensure changes for Joint Commission review. The price is $0.45 per employee per month.

Vassar Brothers Medical Center (NY) credits technology it had just installed with saving the life of a firefighter who had a heart attack during a fire. His EKG, taken immediately in the ambulance, was sent to cardiologists at the hospital, allowing them to hit a door-to-balloon time of 18 minutes, a third of the standard. The technology they use is AirStrip Cardiology (remote EKG viewing), GE Healthcare’s MUSE Cardiology (EKG storage), and Physio-Control’s LIFENET (EKG sharing between emergency medical services and hospitals).

The Johns Hopkins Hospital opens its new Sheikh Zayed Tower and The Charlotte R. Bloomberg Children’s Center using the Versus Advantages RTLS to support asset tracking, fleet management, nurse call automation, and food cart tracking. New York Mayor Mike Bloomberg donated $120 million of the $1.1 billion construction cost of the two towers.

MediServe announces a Web-based solution for private practice therapy providers. The Attigo system includes billing, documentation, scheduling, and practice management.

Government and Politics

During this week’s HIT Policy Committee meeting, members discussed whether licensed professionals and scribes should be allowed to enter data into EHRs on behalf of physicians under the Stage 2 MU program. The proposed rule would require physicians to use their own user IDs when accessing the system, also holding them responsible for approving information entered on their behalf by anyone else. Several committee members raised concerns that the doctor won’t benefit from clinical decision support otherwise since most systems provide their guidance during order entry.

Also from the HIT Policy Committee meeting: CMS reports that more than $5 billion in Medicare and Medicaid MU incentive payments have been made to 93,650 EPs and hospitals through the end of April.

Representative Renee Ellmers (R-NC), chair of a House subcommittee on health technology (also a nurse and the wife of a surgeon), asks CMS to exempt from MU requirements those physicians in small practices and those close to retirement.

Other

The US again outspends other industrialized countries on healthcare with mixed results. At $8,000 per person, well above the next-highest Norway and Switzerland at $5,000, survival rates for breast and colorectal cancer were the highest, but death rates for asthma and diabetes-related amputations were also the highest. The report blames US costs on expensive drugs, medical services, and technology such as MRIs and CT scans, with a high obesity rate also adding to the total.

In Canada, the Hospital Employees’ Union publicly criticizes the outsourcing of 130 hospital medical transcriptionist jobs, saying the result will be less secure, of lower quality, and increasingly expensive. The hospital executive in charge of HIM says they’re already outsourcing half their transcription to the same group without problems, no information is stored on transcriptionist PCs, and per-minute rates are the same as they were in 2006 and will save $3 million of the $14 million annual transcription budget. Part of the appeal was the chance to move to a system that has better speech recognition capabilities.

Also in Canada, Nova Scotia’s Department of Health and Wellness and Canada Health Infoway announce an expansion of their peer support program for users of the Nightingale ambulatory EMR.

McKesson Automation’s building in Cranberry Township, PA was evacuated Tuesday evening after a female employee reported hearing a bomb. Police gave the OK to return when they concluded that the woman was hallucinating after experiencing an adverse reaction to an unnamed medication.

Bloomberg BusinessWeek profiles eClinical Works CEO Girish Kumar Navani and the company’s involvement with health projects in New York City. The company’s annual revenue was reported as $250 million.

Sunday night’s finale of The Amazing Race pits Epic employee Rachel Brown and her husband, Major Dave Brown, against three other couples. The winners will get $1 million.

In Ireland, three NUI Maynooth students win the Irish finals of the Microsoft’s Imagine cup for developing docTek, which allows patients with chronic illnesses to record symptoms for online review by their doctors. They will compete in the global finals this July in Sydney, Australia.

A UK doctor is investigated after sending an 18-day-old baby home with what was later determined to be myocarditis, which killed the baby the next day. The parents say that during the examination, the doctor looked up the baby’s meds on the computer and suggested giving him Tylenol, but he never left his chair to actually look at his patient.

Sponsor Updates

• Benefis Health System (MT) signs an agreement with MedAssets to use its Spend and Clinical Resource Management Solutions and initiate use of MedAssets GPO and other cost containment services.
• Angleton Danbury Medical Center (TX) creates a paperless registration system for its Meditech system using forms software from Access.
• DrFirst announces that 6,000 pharmacies can now accept electronically transmitted prescriptions for controlled substances using EPCS Gold.
• GetWellNetwork recognizes ten hospitals for Excellence in Interactive Patient Care during its GetConnected 2012 conference.
• The Advisory Board honors Virginia Hospital Center (VA), Alegent Health (NE), and Monmouth Medical Center (NJ) with 2012 Crimson Physician Partnership Awards for improving the quality of care they provide while documenting more than $13.2 million in aggregate savings.
• MEDecision introduces its new brand and highlights the evolving healthcare market during this week’s 2012 Client Forum.
• A Detroit business publication profiles the growth and focus of JEMS Technology, which has seen one-year growth of 100% for its encrypted remote video solutions for healthcare.
• Culbert Healthcare Solutions promotes Tina Sarantos to manager of consulting services for the company’s GE and Allscripts practices.

EPtalk by Dr. Jayne

CMS keeps sending me e-mails about ICD-10. For whatever reason, I thought this header was really funny given the recent delay. I’m personally worried that the 60-day comment period for the Stage 2 Meaningful Use NPRM is almost over and I haven’t gotten my personal comments finished yet. You can submit yours via the MU specific comments page. Although my organization has submitted its own official comments, I’m encouraging every physician, provider, and patient I know to comment as well.

CMS also issues a final rule on the use of the National Provider Identifier (NPI) on Medicaid and Medicare enrollment and claims documents. I can’t imagine that anyone out there practicing doesn’t have an NPI after all this time, but if you don’t, you have 60 days until the rule takes effect.

A Circulation article documents improvements in blood pressure control among US veterans. Over 10 years of data from the VA Health Data Repository was analyzed. Authors credit performance measurements in the EHR as contributing to the improvements.

Medical Economics advises providers how to respond to negative reviews on physician rating sites. Common complaints from a patient group profiled in the article include long wait times, lack of communication about delays, not being informed about test results, and failure to return phone calls promptly. Among the tips:

• Don’t respond to negative reviews. Ask the site to remove unfair information.
• As your patients to review you since most give positive reviews.
• Conduct your own surveys to let patients feel heard.
• Start a blog or practice website to help control your online presence

For women physicians tethered to their practices via smart phone, JoeyBra provides a solution that lets you avoid those pesky purses, totes, and satchels. Right now, it’s only available in leopard print. Personally I think an iPhone is a little bulky to be storing in my bra, but to each his (or her) own. Even with the leopard print, I don’t see Inga lining up to purchase one either.

Remembering an Industry Leader and Friend
By Daniel S. Herman

John Cornelius Wade, former CIO at Saint Luke’s in Kansas City, former chair of the HIMSS Board of Directors, colleague, and a close friend of mine, passed away on Saturday.

He was ill for the past several months. I spoke with his wife Cheri Thursday evening, and to John on his birthday a couple of weeks ago. He was in great spirits and was talking shop.

I first met John in Chicago in 1987 when we served on the First Illinois HFMA chapter IS Committee when I was with KPMG/Peat Marwick and he was CIO at Northwestern Memorial.  We were reacquainted by a colleague at FCG in the spring of 1993 shortly after he took the CIO position at Saint Luke’s.

John was a loyal person who was tenacious in everything he pursued. He would drive from Kansas City to Boston all night to see family. He did home repair himself, refusing to call a handyman despite his wife’s objections (until he fell off a ladder and dislocated his shoulder).

His loyalty was expressed in many ways across business and personal situations. He was an authoritarian leader when it came to running the IS shop, and was often opinionated when interacting with his customers throughout the health system.

In 1993, John took over a data processing (DP) shop from an interim management team from Andersen Consulting. He was swift to make leadership changes inside the IS organization, also changing how the department served its customers. He redefined the IT strategy; enhanced governance, project prioritization and executive ownership of technology-enabled IT initiatives; and established service level metrics by which he measured and demonstrated accountability. Saint Luke’s went on to become one of the first healthcare organizations to win the coveted Malcolm Baldrige Quality Award and the Missouri Quality Award almost 10 years ago.

When John retired from Saint Luke’s in 2008, the health system’s IT group was (and still is) considered one of the most effective and well-run healthcare provider IT functions in the country. It has been recognized for its outstanding IT governance structure.

John accomplished much in his 71 years and touched many people. I’ve learned a lot from him personally and professionally during our 25-year friendship. His memory will be in my heart for eternity.

Information about John, including photos and information about funeral and memorial services, is available here. Please take a moment to read the many memories and tributes from his friends and industry colleagues and add your own.

Daniel S. Herman is founder and managing principal of Aspen Advisors.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 5/2/12

Top News

Castlight Health raises $100 million in Series D funding, raising its total to $181 million. The San Francisco company offers online tools to help consumers choose providers, evaluate cost and quality, and understand their healthcare benefits. Above is a TV news report about the company.

Reader Comments

From Reckless Speculator CIO: “Re: Allscripts. Glen will appoint someone from HealthCor to the board to placate them and save his Teflon self. I think he said after the Misys merger, ‘Given the choice to control the boardroom or executive suite, always choose the executive suite.’” I tweeted Monday that big Allscripts shareholder HealthCor Management is urging the company’s board to replace Glen Tullman as CEO or put the company up for sale, saying his 13-year record of underperformance is not acceptable, particularly with the HITECH tailwind and high returns to shareholders of the company’s competitors (Cerner and athenahealth were named). They point out the company’s strengths, such as Sunrise and EPSi.

From Customer CIO: “Re: Allscripts. Stock prices don’t mean much to us as a customer, but I would like to know what the company disagreement was about. Perhaps over resources for its clinical products vs. a new inpatient revenue cycle product.”

From EMRwatcher: “Re: Allscripts. Glen wants to engineer a buyout of the company. He’ll probably get fired first, but that will make it easier for him to spend time getting the cash together.”

From MDRX Files: “Re: Allscripts. They should be well positioned for the shift of focus to the ambulatory world with clinical integration and accountable care. Epic is benefitting from their solid vision and impeccable execution, but the door is open for Allscripts to raise the bar as the only company designed to deliver on the future. Everybody else has inpatient baggage that will slow them down. I hope Allscripts takes advantage of the stock plunge to go for it. The software side of the industry needs fresh thinking. Some companies will become commoditized as data an information prevail as strategic and they’re so entrenched in their transaction processing history that they can’t fathom any other world. Epic has the advantage of not being publicly traded and not required to deliver quarterly numbers, but maybe an Allscripts shakeup was what was needed to invigorate them to take a bolder view of the future.”  

From Global Travelin Babe: “Re: Allscripts CEO debacle. I have no idea if it has any merit, but I heard they’re going after a few brand name, reputable CEOs to get their mojo back. Two names mentioned were Ivo Nelson from Healthlink and John Glaser of Siemens.” That sounded pretty off the wall, but I asked both Ivo and John since I like to get answers when I can. They say, not surprisingly, that they have not been approached and wouldn’t be interested.

From Kermit: “Re: healthcare IT from a doctor’s point of view. This is a monthly show for the Mass Medical Society, produced at a local cable access station where I volunteer. Given my links to health IT, I suggested this topic.”

From Vince Ciotti: “Re: Susan’s inquiry about the size of the healthcare IT market. The top 13 vendors had $12 billion in revenue in 2011, so I’d guess the total market is at least twice that with all the niche players and consulting firms.” Above are Vince’s numbers.

From Dragon Man: “Re: Mike Mardini. The founder and CEO of Commissure, the radiology speech recognition company acquired by Nuance in 2007, is leaving. He was also the founder and CEO of Talk Technology, acquired by Agfa in 2001.” Unverified. No change in his LinkedIn profile so far.

From HIPPA Hound: “Re: Raleigh newspaper’s series on hospital profits and low levels of charity care. Not new since it was reported last week, but it has struck a few nerves.” Politicians (including the ever-present Sen. Chuck Grassley, who will no doubt write a scathing letter of inquiry that yields nothing) get worked up about about the ongoing series, which I’m sure is exactly what the newspaper planned. Every newspaper follows the same formula when trying to goose dying circulation: (a) write a huge and endlessly publicized series on some hot button topic, with or without solid facts and objectivity; (b) refer to their own series in some high-and-mighty editorials; (c) prod everyday people enough times about the topic du jour until they get enough outraged quotes to yield let another article; and (d) pester people in power about their articles until somebody finally at least pretends to share their outrage and makes vague promises about coming down hard on the villains. That’s about as good as it’s going to get from the dead tree folks whose readers avoid making eye contact with the politics and world news sections as they make a beeline for the sports page and comics.

From Kaiser Roll: “Re: Kaiser Permanente’s innovation award winners. Here’s the list.” Some of the technology winners:

• Knowledge Builder, which provides a way to import clinical algorithms into a rules engine to identify appropriate treatment conditions that are likely to occur, such as kidney stones
• OpQ, an operational dashboard that extracts information from the data warehouse and Epic Chronicles database every 10 minutes to allow outpatient managers to oversee staff assignments and patient flow.
• Specimen Transfer and Tracking (STAT), a chain of custody tracking system for specimens that would replace paper logs.
• Ambulance on the Information Superhighway, an inter-facility transportation clinical documentation tool.
• Nurse Advice Chat, an online chat function for the nurse advice center.
• Matching Clinical-Facility Data, tools to integrate various information sources to determine whether the physical environment, such as patient room characteristics, affect patient outcomes.
• Hospital Capacity Grid, a one-screen view of activity and capacity across a 21-hospital region.
• BirdDog, which sends lab results to the mobile devices of ED clinicians.
  

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor nVoq. The privately held Boulder, CO company offers the SayIt speech recognition solution, exclusively endorsed by the AHA with vocabulary support for over 35 medical specialties. The SaaS-based SayIt is being rolled out in both ambulatory and inpatient healthcare settings, where users gain productivity within minutes as they dictate SOAP notes and other text directly into their EMR with no integration required, even using voice commands to navigate through their templates and operate other applications. SayIt is delivered as a low-cost Internet subscription, so users can use it at work, at home, or on the road. The company is interested in expanding its service delivery network and welcomes inquiries to VP/GM Debbi Gillotti. Thanks to nVoq for supporting HIStalk.

Here’s a video I found of Microsoft’s Bill Crounse MD talking about nVoq.

Acquisitions, Funding, Business, and Stock

Allscripts expands its stock repurchase program to $400 million from the $200 million that was approved a year ago.

Kansas City, MO startup Cognovant raises $500K in a seed round to launch its first product, the PocketHealth personal health record. The basic version will be a free App Store download, with paid upgrades available for versions that handle more complex needs and allow use by multiple family members. The founders are Joe Ketcherside MD and Stan Pestotnik RPh,  who were executives at TheraDoc before it was acquired by Hospira.

McKesson announces Q4 results: revenue up 10%, EPS $2.09 vs. $1.62, beating expectations on both. Technology Solutions revenue was down 2% and profit was down 20%. John Hammergren said in the conference call that several Horizon Clinicals customers have committed to moving to Paragon and conversions have begun. He also said that while EMRs are important, customer success will be driven more by performance management, analytics, care coordination, and payor capabilities, and that RelayHealth is well positioned for the MU Stage 2 emphasis on connectivity.

Sales

Perry County General Hospital (MS) selects RazorInsights’ ONE-Electronic Health Record for its 22-bed critical access hospital.

Southwest Medical Center (KS) contracts for Summit Healthcare’s Provider Exchange for integration with physician offices.

West Tennessee Bone & Joint Clinic selects SRS EHR for its 11 providers.

Fletcher Allen Health Care (VT) will use the CapSite hospital purchasing database, which gives subscribers access to research studies and thousands of real-life contracts, proposals, and RFP responses covering healthcare IT, imaging equipment, professional services, and medical devices from 1,400 vendors.

Somerset Medical Center (NJ) signs a renewal agreement for secure e-mail services from Zix.

Perinatal Quality Collaborative of North Carolina will implement a wireless clinical support system from San Diego-based startup Cognitive Medical Systems.

People

The Allscripts board of directors elects Dennis Chookaszian as its chair. He was previously chairman and CEO of retirement advice site mPower and had retired in 1999 as chairman and CEO of insurance company CNA. He’s been on the board since September 2010.

New Jersey Hospital Association’s Healthcare Business Solutions affiliate appoints Michael Guerriero (MedAssets, Eclipsys) VP of business development.

Telemedicine provider Virtual Radiologic names former US Oncology COO George Morgan as CEO. He replaces Rob Kill.

Vocera Communications subsidiary ExperiaHealth names Elizabeth Boehm (Forrester Research – above) director of patient experience collaborative and Christine Henningsgaard (Accretive Health) national practice leader.

Elsevier promotes Hajo Oltmanns to president of its CPM Resource Center.

Deaths

Joanne Wood, SVP of client services of Meditech and president and COO of LSS Data Systems, died Sunday, April 29. She was 58.

John Wade, former VP/CIO of Saint Luke’s Health System and former HIMSS board chair, passed away Saturday, April 28. He was 71.

Rick Brown, founder of the UCLA Center for Health Policy Research, died April 20 at 70.

Announcements and Implementations

Bon Secours Mary Immaculate Hospital (VA) goes live on Epic as part of Bon Secours Health System’s $200 million EHR initiative.

Lifepoint Informatics introduces CPOE Connect, a plug-in solution that allows vendors and commercial labs to offer seamless lab order entry using existing EHRs.

Preceptor Consulting, which offers go-live support and clinical training for EHR implementations, is supporting the implementation of the Cerner IView charting flowsheet at all campuses of Emory Healthcare.

In Canada, The Collingwood General & Marine Hospital goes live with PatientOrderSets.com.

Government and Politics

The American Hospital Association tells CMS that most hospitals will not be able to meet proposed Stage 2 Meaningful Use requirements, warning that, “many of the proposals put regulatory requirements ahead of actual experience with these technologies – an approach that will likely have unintended consequences."

Meanwhile, CHIME urges the government to give providers more time to prepare for Stage 2. Among its specific recommendations: a 90-day EHR report period for the first payment year in Stage 2.

The General Accountability Office (GAO) recommends that CMS verify provider requirements band collect more information before paying out EHR incentives.

Technology

MedAptus selects problem search technology from Intelligent Medical Objects for its Professional Charge Capture solution, which will allow clinicians quick access to diagnoses when completing charge documentation using ICD-10.

Wyse Technology integrates Imprivata OnSign into its thin and zero clients, offering No Click Access for Citrix and VMware View that supports roaming between locations with badge validation.

Valued Relationships Inc. signs with AT&T to provide remote patient monitoring services for VRI’s nurse-staffed telemonitoring center. The service will capture information from wireless health devices in the home, such as scales and blood pressure cuffs, and issues triage alerts to the monitoring center when appropriate.

More information on the technologies used by Max Healthcare, the first two hospitals in India to earn Stage 6 EMRAM recognition from HIMSS. They include WorldVistA EHR (a free offshoot of the VA’s VistA), the open source Mirth integration engine, and a homegrown hospital information system. Dell Services manages its IT operations, including the EHR implementation, running all IT infrastructure into a private multi-protocol label switching cloud hosted at a remote data center.

In the UK, Blackpool Teaching Hospitals NHS Foundation Trust rolls out 900 Samsung Galaxy Tab tablets to clinicians in a deal with Vodafone.

A Massachusetts psychologist creates  what she says is the first evidence-based treatment app for obsessive compulsive disorder. Live OCD Free costs $79.99.

Other

KLAS reports that half of providers anticipate buying or replacing a business intelligence solution in the next three years. In alphabetical order, the top five most considered BI vendors are IBM, McKesson, Oracle, QlikTech, and SAP.

A Weird News Andy wannabe sends this story about man with a toothache who made a poor choice of dentists: the girlfriend he had just dumped. She sedated him and removed all 32 of his teeth, saying she had tried to remain professional, but couldn’t help thinking “What a b—–d” as he was unconscious before her. Most of us gals have had that feeling once or twice.

The real Weird News Andy wonders who will update EHR med lists if the FDA allows drugs for hypertension, diabetes, infections, migraines, asthma, and allergies to be sold without a prescription, possibly justifying that practice by requiring pharmacist counseling.

Here’s a fun SNL parody video that T-System created as an opening to its user group meeting. It has a lot of details that are worth a rewind, for instance at the 1:30 mark, where development VP Bill Hall is stereotypically sucking down what appears to be a Red Bull.

In the UK, North Bristol NHS Trust admits to a huge budget overrun in its second try at a successful Cerner rollout after problems with the first. Most of the extra money was spent on additional support people.

The Dr. Oz Show partners with Temple University Health System and Practice Fusion to run a May 19 “15-Minute Physical” event in Philadelphia, where 1,000 people will be screened and the resulting analytics report presented to the city by the end of the day.

Facebook urges its users to post their organ donor status. Self-proclaimed pundits crow that Facebook is naïve in thinking that sticking a “donate” label on your profile provides legal consent, but they’re missing the point: the idea is to use social networking to encourage people to sign up with state registries. Your Facebook profile will outlive you, so your organs might as well follow its lead.

Sponsor Updates

• Cumberland Consulting Group promotes Saman Pourkermani to executive consultant.
• Merge Healthcare releases its Merge Honeycomb Archive archiving application.
• Beacon Partners is named by Boston Business Journal as one of the region’s fastest-growing companies.
• Baptist Health System (AL), INOVA Health System (VA), and Park Nicollet Health Services (MN) select  LRS software for secure document delivery from their Epic footprints.
• T-System outlines its pending response to the proposed MU Stage 2 rule to ensure it addresses the needs of EDs.
• Olmsted Medical Center (MN) extends its partnership with MED3OOO through 2017.
• Teletracking hosts a free networking lunch May 11 in Baltimore featuring Kevin Capatch, director of supply chain technology and process engineering for Geisinger Health System.
• Intelligent InSites joins the Cisco Developer Network in the wireless / mobility category.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 4/30/12

From Bignurse: “Re: [vendor name omitted.] An absolute disaster in our state. No customer support is available. Lawsuits are being prepared. Meanwhile, patient care is at risk from systems that are crashing. I feel badly for laid-off employees, but every more alarming is customers facing the specter of systems going down forever. They need help!” I’ve left off the vendor’s name to offer a suggestion. Hopefully someone has complained formally to the vendor from at least one of those sites. Send me a copy of that document and I’ll run it here with any company response. That’s not only more fair to the company, but more useful to readers who really don’t know what’s going on.

From Susan: “Re: overall size of the healthcare IT market. Any estimates of total money spent annually by hospitals or clinics?” Maybe someone knows the answer to this question, which sounds like something Epic would ask on its famous employment test.

HITECH’s impact on patient outcomes has been modest, respondents seem to be saying. New poll to your right: if you had $100K to invest in the stock of one healthcare IT vendor, which would you choose?

Listening: the fresh and very well produced first album of Electric Guest, some LA kids cranking out a delightfully catchy mix of pop, soul, and electronic dance music that would be great for driving as long as you can control your in-seat gyrating better than I can. The low bass notes of the opening song are so strong out of my PC’s subwoofer that my Diet Coke with Lime can is vibrating across my desk like the quarterback in a 1970s electric football game. I’ve played the CD three times in a row, which is unusual for me.

Vince’s HIS-tory this time around covers the history of an innovative but trouble-prone input device that required creating an intentionally poor user interface to hide its design flaws: the typewriter.

The Minneapolis-St. Paul newspaper finds that two executives of Fairview Health Services, which is taking heat for allowing Accretive Health to strong-arm its patients into paying for ED and other medical services upfront, have connections to the company. The son of Fairview’s CEO is an Accretive employee, while the son of its physician group CEO is also an Accretive employee and helped it implement aggressive collection policies. In addition, the physician group CEO was found to be a shareholder in Accretive. The fallout from Tuesday’s national press about the tactics was dramatic: by Friday, Fairview had severed all relationships with Accretive. In addition, Fairview’s board held an emergency meeting from which its CEO was excluded, but he apparently emerged with the organization’s support. The biggest question is whether it was legal for Fairview to give Accretive full access to its patient records for collection purposes. Nearly overlooked in all the debate is that Ascension Health was Accretive’s original customer and owns a sizeable chunk of the company. Accretive’s market cap after its 61% share price drop (!!) over the past month is $919 million, with Ascension Health’s equity worth $72 million.

Nuance closes on its acquisition of medical transcription vendor Transcend Services.

The local business journal covers the recent Epic go-live at 206-bed Greenwich Hospital (CT), part of Yale New Haven Health System. The hospital spent $25 million ($121K per bed), according to the article, which gives the entire system’s cost as $250 million.

Yale New Haven is also mentioned as using the SAMI system from local startup MyCare, LLC, a product described as having capabilities for EMR searching, alerting, a rules engine, and analytics.

Harvard Business School healthcare expert Regina Herzlinger says accountable care organizations and patient-centered medical homes will go down in flames just like the 1990s capitated HMOs that preceded them, with the key problems being (a) inefficient EMRs, (b) awkward team culture, and (c) challenges in developing public health insurance exchanges. Instead, she advocates a focused factory model, where instead of providers taking on whatever problems cross their doorstep, they focus on particular health conditions, such as diabetes. She’s written such books as Market Driven Health Care and Who Killed Health Care? She blames today’s healthcare mess on hospitals consolidating to eliminate competition, bureaucratic insurance companies with wildly overpaid CEOs, and federal government meddling.

Weird News Andy’s joke: How do you make a Phillips screwdriver? Mix vodka with milk of magnesia (cue rim shot). That’s to celebrate this story, in which a Kentucky woman is suing her dentist, claiming she needed abdominal surgery to remove a screwdriver he dropped down her throat while repairing her dentures.

E-mail Mr. H.

Allscripts

From Stock Boy: “Re: Allscripts. This was a when, not an if. HCIT rollups never work. The coup could have gone either way – one vote and it could have been Tullman’s blood running through the Merchandise Mart. Investors are also afraid that another shoe will drop, like whether Lee Shapiro survives or even wants to. Clients have been angry – I’ve heard that Tullman is personally banned from several high-profile Eclipsys sites. The timing of Davis’s resignation could not be worse, and naming his new firm would have eliminated one piece of missing information. Investors hate uncertainty, so the stock is likely dead money for six months. They will be doing a ‘sum of parts’ valuation. Maybe a private equity leveraged buyout would work, but it would be tough. Allscripts is in third or fourth place, but it’s still a big market, and if I invested in this sector, I’d be a buyer of MDRX. Glen is a talented CEO and can sell water to a drowning man. He’s one of the most aggressive and competitive, but within an ethical framework, I’d be disinclined to bet against him.”

From MDRX Mole Army Private: “Re: Allscripts. HIStalk access is being blocked at the Raleigh office. Good thing I have a smart phone!” Unverified and pointless in any case since I’m pretty sure employees have a variety of ways to access an unfiltered Internet on their own.

Allscripts shares closed at $10.30 on Friday, down 36% on 20 times normal trading volume as Nasdaq’s second-biggest percentage loser for the day. Market cap dropped over a billion dollars, and Glen Tullman’s wallet was $5 million lighter at dinner than it was at breakfast. Not to mention that Glen’s frequent verbal sparring partner Jonathan Bush’s athenahealth now has a bigger market cap than Allscripts ($2.61 billion vs. $1.96 billion).

My reaction to Friday’s events:

• During the investor conference call, Glen’s performance hit extremes of negativity and optimism at a time when he desperately needed to inspire confidence as the last man standing. He went into graphic, pathological detail about all of the company’s significant problems. When asked tough questions by the analysts on the earnings call, however, he trotted out unconvincing cheery optimism that those problems would be quick to solve. That’s when he actually answered what was asked instead of reciting unrelated positive factoids about Agile development methodology. If I were grading his performance, I’d go with a C minus (with demerits to whoever should have been coaching him better, not just during the call, but in overall transparency given that last quarter’s conference call was rosy.) It just seemed to lack conviction, glossed over the apparent gravity of the situation, and seemed to be scripted into trying to convince everybody that these issues all came up in one quarter and would require just one quarter to fix.
• I was surprised that MDRX shares didn’t regain some of their losses by end of day Friday, especially since Nasdaq closed up for the day. Stocks often regain huge opening losses after the bad news is digested, the company’s fundamentals are re-examined, and overreaction seems likely in hindsight. in this case, the initial negative reaction stood for the most part and the dead cat didn’t bounce much.
• The biggest problem Allscripts now has isn’t the sales organization or the loss of board members, but rather the now-public record of executive upheaval and share meltdown. Hospital CIOs look first at the KLAS ratings and client roster when evaluating a vendor, but hospital CFOs go straight to the stock pages, and what they’ll find there may cause them to unholster their veto stamp. I’ve been in the room several times when that exact event occurred with other companies.
• Allscripts is raising consulting prices, pushing harder for customers to buy more of those services, and being more aggressive in cross-selling. Sometimes those tactics provide a bottom line boost, sometimes they just annoy prospects into inflating the company’s “nickel and dime” KLAS scores or even push them to choose another vendor.
• If you were a hospital swimming against the populist tide and considering Sunrise instead of Millennium or Epic, you might question whether the dismissal of all of the former Eclipsys board members and the disagreement over the company’s direction was a signal that Sunrise isn’t the company’s focus. I didn’t get that impression at all from the conference call since Sunrise was most of the conversation, but some might make that inference (and you can bet competing salespeople will be making sure their mutual prospects consider it.)
• The company has good opportunity to make its board stronger with some non-Eclipsys people. The former board members of Eclipsys were hardly a model of success, mostly known for approving questionable and ultimately failed acquisitions and finally finding a willing buyer for the company after years of shopping it around with no takers. Maybe they wanted to stick with the old Eclipsys ways, or perhaps Allscripts felt misled by what it found after it bought the company.
• Glen has said repeatedly that integration between the company’s ambulatory and inpatient EMRs would be basically a slam dunk that would send Epic fleeing for cover. Now the word is that, according to the customers who were supposed to benefit from that integration, Allscripts failed. That seems to indicate that nobody was actually talking to those customers (a massive mistake when you’ve got North Shore-LIJ to keep happy no matter what it takes.) Meanwhile, the Epic train keeps rolling over everything in its path, and all of this news just gives it a little bit more steam that it doesn’t need.
• Glen may think that losing John Gomez wasn’t a big deal, but it seems that most of the challenges Glen listed were related to development – high costs, poor delivery, and an apparently stripped down Sunrise integration plan that clearly fell short of expectations. Glen is a big-picture salesman, so every time he talks we hear about how smoothly the integration will happen, how easy it will be to juggle a barnyard full of EMRs and keep them all current with regulatory changes, and how well Sunrise can compete with Epic because Epic is 30 years old and not an “open” system like Sunrise (one might suspect that his definition of that term is anything but technical.) It’s going to take more than a company full of Glens to make that happen, no matter how you reorganize the sales force.
• The company had outsourced some of its technology work, sending some programming to India and turning over hosting management to third parties. Given that it apparently didn’t develop good integration specs for Sunrise, what does that leave as its core competency?
• The drop in share price sets the clock back three years, before HITECH and the Eclipsys acquisition. In fact, share price is less today than at the company’s 1999 IPO ($10.30 vs. $16.00).
• It will be interesting to see if the vultures swoop in to buy now-cheap shares to the point they can force the company to put itself up for sale, hoping to make a quick buck on the flip. That would be the worst possible outcome for everybody except the money-lenders.
• The same day that Allscripts was trying (and mostly failing) to ease concerns about its debacle, Cerner put up huge numbers and Epic was announced as having beaten both companies in a pivotal two-trust selection process in the UK. Not only did Allscripts lose absolute ground, it lost even more relative ground against its most significant inpatient competition that many feel was already insurmountable.
• No matter what explanations are provided, the casual observer might conclude that Glen staged a coup that cost the company four board members and its CFO at the worst possible time. Those boardroom discussions must have been particularly acrimonious given that the parties involved, all of whom hold Allscripts stock, were willing to torch the share price and possibly damage the company irreparably by going public with their spat.
• Was Jim Cramer a genius for urging investors to get out of Allscripts and into Cerner a month ago, or a fool for shamelessly pitching it and fawning over Glen Tullman for the four years prior to that? Had you bought and sold when he suggested, you would have made around 30% over 3.5 years, whereas buying Cerner upfront instead would have more than tripled your money over the same period.
• The biggest unknown: could a different CEO or ownership improve the situation? Eclipsys wasn’t selling much of anything before the acquisition; there’s little hope that Sunrise can do anything more than catch the occasional crumb dropped by Epic or Cerner; the company doesn’t have very much non-US business; it offers too many legacy EMRs that will require significant ongoing investment and face ever-stiffer competition on price; the market is rapidly changing as providers chase the ACO and population management dream (rightly or wrongly; and the HITECH tailwinds have died down considerably.
• As a counterpoint, Allscripts remains a large and profitable company; company fundamentals will make it attractive again once the embarrassment wears off and things settle down; its practices are apparently entirely honest and ethical; Glen Tullman proved himself a stock market and finance master in wresting control from the clueless overlords at Misys; he gets to pick his own loyal board members to replace the dearly departed and apparently less-loyal members; and the industry sector may be changing but it’s not going to go away. Long-timers will remember at least a couple of times that Cerner shares tanked on similar news, only to come roaring back.
• Expectations are now lowered and the gloves can come off. All the bad news is out there and already priced into the stock’s current (low) value, so now’s the time to make all the tough decisions that nobody wants to make when a company is riding high. Write down all the bad investments, retire badly aging products, fire the underperformers, show some competitive fire and frankness instead of Teflon Barbie-like reassurances that the sky isn’t falling when it clearly is, and decide exactly what it is that Allscripts wants to be when it grows up other than a collection of mismatched businesses that got thrown together primarily because they were struggling individually.

Here’s the five-year share performance of Allscripts (blue), the Nasdaq (green), and Cerner (red). A $10,000 investment in May 2007 would be worth $28,700 today (Cerner), $11,980 (Nasdaq index), and $4,350 (Allscripts).

I interviewed Glen Tullman and Phil Pead about the Allscripts-Eclipsys merger the day before it was announced, asking them to give me the criteria to judge their performance two years afterward (September 2012). Here’s what Phil Pead said:

From a shareholder perspective, I would like to see you grow the top line and prove your earnings per share leverage over that period. If I was a client, I would grade you by the integration between the product solutions to make this a great experience for their hospital and ambulatory environments so that the two came together. If you were looking at it from the employees, I would want to say that the next few years will be some of the most exciting with all the new opportunities they have to plan.

If you’re an Allscripts customer, tell me what all this news means to you. Please use your real name and employer with the confidence that I will absolutely not allow you to be identified in any way, but I need to be sure I’m getting legitimate information and not an Allscripts competitor trying to pile on (it happens). I’ve heard from investors and employees, but the real unknown is what Allscripts customers think about what’s happening.

HIStalk Innovator Showcase – Health Nuts Media

Company Name: Health Nuts Media
Address: 949 Concha St., Altadena, CA 91003
Web Address: www.healthnutsmedia.com
Telephone: 818.802.5222
Year Founded: 2010
FTEs: 6

Elevator Pitch

Health Nuts Media is attacking one of the primary causes of skyrocketing healthcare costs, poor health literacy, with a complete platform of easy-to-use assessment tools and a full suite of consumer-friendly educational resources, including animation, games and apps.

Business and Product Summary

Low health literacy costs the U.S. health system up to $236B annually and leads to higher health care utilization, problems understanding instructions and taking medications, inappropriate self medication, and reduced life expectancy. Costs are four times higher for individuals with low health literacy than for those with proficient health literacy. Only 12% of Americans have proficient health literacy, and that number has not changed over the last 40 years. 

Health Nuts Media will dramatically improve the health literacy of Americans by providing easy-to-use online assessment tools and a suite of consumer-friendly educational resources. These include easy-to-understand animated videos for both adults and kids in multiple languages. We deliver technology in a software-as-a-service model with a wide range of customization options from hospital rooms to medical homes improving healthcare literacy one patient at a time. Our clients are managed care organizations, hospitals, doctors, schools, government agencies, accountable care organizations, disease management companies, insurers, and consumers. 

Target Customer

Managed care organizations, hospitals, physicians, health educators, schools.

Customer Problem Solved

Low health literacy leads to dramatically higher costs and poorer outcomes. Health Nuts Media increases health literacy through consumer-friendly assessment tools and easy-to-understand educational resources.

Competitors

KidsHealth, Krames Staywell, Milner-Fenwick.

Advantages Over Competitors

Health Nuts Media produces health education content that is more engaging and more interactive than other offerings in the marketplace. Our Emmy Award-winning production team delivers highly engaging, branded experiences that create true market differentiation for our clients.

Fast Facts

• Complete suite of health literacy assessment and education tools with a unique combination of quality health education, premium animation, and enjoyable storytelling
• Emmy Award-winning production team
• Kids Education Advisory Panel (KEAP) enhances our child-friendly focus
• Diverse medical expert review panel – doctors, nurses, health educators, homeschooling parents
• Customization and made-to-order content creation services available

Pitch Video

Customer Interview (a physician who runs a pediatric medical content site)

What Health Nuts products and services do you use and what difference have they made?

As a content provider for primary care practices for the past 10 years, I’ve seen a lot of medical content come my way. The animated information from Health Nuts Media is fresh, engaging, creative, and effective. We have chosen to add it to our library of medical content to distribute to many of the websites that we host and service.

How would you describe your experience in working with Health Nuts?

Tim Jones of Health Nuts Media is passionate about bringing the message of Good Health to all children. I admire his vision. He will teach many children about the importance of caring for their own bodies.

How would you complete this sentence: "I would recommend talking to Health Nuts as a potential customer if you are …"

A children’s hospital, a pediatrician or family physician, or an advocate for kids.

An Interview with Tim Jones, CEO, Health Nuts Media

Medical people seem to be challenged to provide patient education that’s both understandable and engaging. What problem does that cause and how do you turn that into a compelling return on investment for your product?

Some of the studies that we’ve seen show that low health literacy costs up to $236 billion every year, if we’re just talking about dollars and cents. Our basic thesis is people don’t want to be sick, they don’t not want to follow their doctor’s instructions or not take the medication they’re told to take. There’s just a basic misunderstanding, where individuals will overestimate their ability to understand and healthcare professionals and clinicians will overestimate what people did understand by saying, “Well, they didn’t ask any questions, so I assume they understood everything.” Therein lies this big black hole of information.

What we’re trying to do is bridge that gap and make non-written forms of communication available so that those with health literacy or innumeracy problems can understand what it is that they’re supposed to do.

Do you think the expectations have changed with online video services like YouTube and video-friendly devices like the iPad?

Absolutely. One of our advisors, Dr. Pion, is an OB-GYN doc who just turned 80 years old last summer. I don’t think any of these things are necessarily like, “Oh my gosh, we never thought of this in the ’60s or the ‘70s.” We’re just at this point in time where it’s actually possible with our technology now that even 10 years ago really didn’t exist. There was not real way to reach the masses the way that we have the ability to do today.

You have a standard library of resources. What are some of your more popular titles or topics?

Diabetes is by far the most popular. Asthma has also been very popular with us –  we know there are nine million kids in the U.S. with asthma that are dealing with it. But we also do a lot of things like gastroenteritis and vaccinations and broken bones. A lot of the topics that we deal with are common with pediatrics.

You do custom work. What kind of things have people asked for?

We’ve done breast cancer. We just finished a series on clinical research in both English and Spanish. Some of our clients like our library, but they have their own corporate mascot or brand identity, so we’ve taken their characters and wrapped them around our content as well.

When you draw the box around what you do versus what you might want to do down the road, where do you see things going? Right now you focus primarily on pediatrics. Do you see a different focus or moving into games or anything like that?

Absolutely. Every age demographic here and all around the world responds to this. Gaming is so important to our long-term objectives. We realize that it’s very popular format. It’s a great way to get information out to people without pounding them over the head with, “This is education.” We know that it works.

There’s lots of research that shows that gaming and gamification can work and deliver better clinical outcomes. That’s definitely part of the path. We see storytelling and gaming fitting together very well.

How do you make a business case that your videos are not only good for patient outcomes, but are something that customers should invest in?

We know that someone with low health literacy will end up costing something like four times more than those with proficient health literacy. Take away all the outcomes and the lower life expectancy, but if you’re just looking at a business case to say those folks that don’t understand what it is that you need to have them understand, those folks that don’t understand how to take their medication properly, how to follow your instruction will cost you four times more than those who do understand.

When you look at it in those terms and understand that that is a cost of hundreds of billions of dollars to the healthcare system every year, it’s fairly easy to make a business case to those healthcare organizations that mare managing large populations of patients, especially under a capitated basis where there’s a fixed fee or accountable care organization. It makes a pretty simple bottom line case for return on investment.

Prior to that when providers were paid for episodes and not outcomes, the only business model would have been to get drug or insurance companies to pay for your videos. The change to managing health must give you more organizations to sell to.

It does, right. We believe at the end of the day that individuals are very concerned. Nobody wants to be sick. Ideally education happens at the hospital, at the doctor’s office, at the clinic, but we also realize that when a parent has a child that’s sick and they want that information, more often than not they’re going to the Internet. They’re trying to find good resources.

For instance, we know in research that for every day a child has an asthma attack and has to miss a day of school, that will cost those parents an average of $172 per day. We know that in the average poorly controlled case of asthma, they will miss somewhere between 12 and 18 days of school per year. The real cost, not even the medication cost, not even the long-term cost on academic achievement in lifelong earnings, but just that simple mom or dad has to miss a day of work to take care of that child, it makes a pretty compelling case even at a consumer level that good information is worthwhile and will end up saving them money and help them to be more healthy.

What do you hope to gain from the exposure?

I really think we’ve got a great idea. We’ve got a great company. We’re fairly new and not a lot of people know about us yet. We also say that we like to collaborate. We like to be part of larger systems. My sense is there are so many people out there who are working in the technology space and the HIT space that really don’t know about us and they think of ways that we fit into their systems that we haven’t even thought of yet.

To me, that’s what becomes very exciting. We know where we’ve started and where we’re going and where we’re headed. We don’t ultimately know where we’ll end up. I think some of this exposure could start conversations, could start relationships that take us to places that we haven’t even yet imagined.

Allscripts Shares Open Down 42%, Epic Wins UK Deals

Allscripts shares opened Friday morning down 42% after yesterday’s financial and organizational announcements. My notes on the news and yesterday afternoon’s conference call are here.

In news from the UK, Cambridge University Hospitals and Papsworth Hospital NHS Foundation Trusts name Epic and HP as their preferred EHR vendor and are expected to sign a 10-year contract in June. Cerner and Allscripts were on the short list.

News 4/27/12

Top News

Allscripts turns in its Q1 report: revenue up 9%, EPS $0.03 vs. $0.07. Bookings were down 8% and the company has revised its full-year earnings forecast to $0.74-$0.80 per share vs. previous guidance of $1.06-$1.10. CEO Glen Tullman’s reasons for the numbers: lower sales, unfavorable sales mix, high development costs, Sunrise sales delays as cautious prospects wait for the promised integration, and a reorganization of the sales force. Also announced:

• CFO Bill Davis has resigned effective May 18
• Phil Pead has been fired as chairman of the board
• Directors Catherine Burzik, Eugene Fife, and Edward Kangas, all of whom had ties to Eclipsys and who were apparently loyal to Pead, have resigned in protest over the company’s direction and leadership

Shares are dropping precipitously in extended trading following the announcement after Thursday’s market close, down 45% as I write this. That would wipe out nearly $1.5 billion of shareholder value if the price holds when the market opens Friday morning. The transcript of the earnings call should be interesting when it’s posted shortly. If you work in Allscripts sales and haven’t found your job to be challenging enough, this should do it. My question: how will flagship customer North Shore-LIJ react to the news?

Update: the conference call transcript hasn’t been posted yet, but audio is posted here. Notes I took, including my reactions:

• Glen’s list of what went wrong includes just about everything.
• He talks quite a bit about Sunrise successes, but doesn’t say too much about the ambulatory products.
• Bill Davis is leaving to take a non-healthcare job. He was on the call and presented the financial results. He says he isn’t leaving because of anything to do with Allscripts.
• Bill said neither the inpatient or ambulatory businesses performed up to expectations.
• How many of the clients who are waiting on the much-touted integration to occur will just give up and buy something else, especially after reading about this latest company turmoil?
• Stay away from courthouses today – they will be crowded with lawyers filing class action investor lawsuits today, I expect, since that always happens when share prices drop on unexpected company news.
• “Unfavorable revenue mix” – does that mean that the only thing selling is MyWay?
• They mention high non-capitalizable development costs – does that mean bug fixes rather than planned enhancements and integration projects?
• They mention the high cost of attending HIMSS, which isn’t surprising if you saw their monstrous booth village in the exhibit hall.
• The company will spend $190 million this year to improve software integration and user experience. Glen says prospects are withholding their decisions until some of these projects are finished.
• The integration between Sunrise and the ambulatory products met the technical specs, but clients weren’t impressed. The beta of the re-do attempt will start in 50 days.
• Sunrise 6.0 will add high availability and Sunrise Financial Manager will include ACO capability and ICD-10 support.
• Glen said there’s work to be done on the client experience, and 400 employees have been hired to support that effort.
• The company is investing in its hosting capability and adding a new data center in the next 90 days.
• Getting rid of Phil Pead will cost $2 million (or at least as I interpreted).
• Glen said he’d never in his career had a quarter as tough as this one.

The Q&A ran on for more then 45 minutes and was predictably ugly.

• The first question was basically, “Why weren’t you fired instead of the board?” Glen’s answer: it was a bad quarter, but boards take a longer-term view. The follow-up: our numbers don’t match anything you’ve said, so why should we believe you? Glen’s answer: we’re making progress even though our Sunrise integration flopped.
• Question: who’s the chairman now and how do you give confidence to investors given that a third of your board just quit saying they had no confidence in you? Glen’s answer: the board will name a chairman soon and will add new members. Clients evaluate companies on their products, not their board members. We’ve changed our development methodology from Waterfall to Agile.
• Question: why aren’t the surviving board members on the call and will they have a vote of confidence? Glen’s answer: they’ve voted their confidence by remaining on the board.
• Question: I’ve never seen that much board turnover due to bad bookings. What really caused the turnover? Glen’s answer: merged companies often have a different vision about the direction of the combined entities and you can look at who quit to figure out the issue (all the Eclipsys people, in other words).
• Question: you implied at HIMSS that integration wasn’t all that important, but now you’re saying that prospects are not buying because your integration effort wasn’t good enough. Glen’s answer: it matters to a segment and customers waiting for 1.0 found it disappointing. Some problems due to sales execution, some customers waiting on the 1.5 version of the integration, some due to accounting changes.
• Question: how do you get clients to stick with you when the window isn’t all that wide? Glen’s answer: we have 350 new clients this quarter and three Sunrise signings. Some waited and that’s what impacted sales. First time that our close rate dropped. The new sales team is the best we’ve had.
• Question: all the Eclipsys people have left the board, but you said earlier that all the growth was centered around the Eclipsys products. What’s the difference in direction? Answer: we still have many Eclipsys employees and good products. There’s no change in strategy.
• Question: have you been approached to be acquired and maybe the board members left because you turned it down? Glen’s answer: no.
• Question: who will certify the first quarter’s 10Q? Answer: Bill Davis.
• Question: you said customer attrition is low. Is that current or predicted? The data looks like you’re having problems in the market. Glen’s answer: no big bump in attrition. We’re the beneficiary of our competitors having attrition problems, but everybody is struggling to compete with Epic (as I interpret it, anyway).
• Question: your stock’s going to be hammered and your credibility is shot, so why should Allscripts remain a public company? Glen’s answer: I wouldn’t speculate on that. The stock has fluctuated between $89 and $1 over the years and we just keep pushing forward.
• Question: where was the underperformance in the acute care area? Bill Davis’s answer: some Sunrise deals didn’t materialize and EPSi analytics fell surprisingly short given prior performance.
• Question: what’s the sales force stability? Glen’s answer: very good. We have some open territories. We lost only one significant salesperson and they became a CEO of another company, which indicates the quality of people we have.
• Question: where is Bill going? Bill’s answer: that will become public knowledge in a couple of weeks, but it’s a private company not in healthcare IT.
• Question: the numbers look like sales numbers on the Allscripts side are going down. Is the problem Allscripts or Eclipsys or both? Bill’s answer: it’s both.
• Question: how can you turn this around? Glen’s answer: we’ve released software timelines and there’s a vibrant market. We have the right sales structure and product deliverables, so I don’t think we’re talking about a lengthy process. We’re betting on this for the next 10 years.
• Question: will there be any other management changes? Glen’s answer: no.
• Question: a year ago at HIMSS you said that you didn’t need a single database and that service oriented architecture would do. Has that changed? Glen’s answer: yes. Epic (he didn’t actually name them) talks a lot about single database, but their customers use EPSi and other products and with genomics and other advances, you’ll always need more than one database. 93% of healthcare organizations can’t afford to rip and replace with Epic (he named them this time) and our open platform makes more sense. Some people have Enterprise and Sunrise — that’s a limited but important universe and our 1.0 release was technically acceptable but customers said it wasn’t exactly what they wanted, while 1.5 will offer that.

Glen mentioned on the call that the company has opportunities in England, but it was announced Friday morning that both Cambridge University and Papsworth have chosen Epic over Allscripts and Cerner.

Reader Comments

From Shaken The Tree: “Re: Allscripts. Time will tell, but news is MDRX is in big trouble — big financial losses, CFO resigning, COB resigning, and no one is sure what or why the CEO is safe. If this rumor pans out, it will really just be an Epic vs. Cerner market. Then again, isn’t it already?” I’ve been getting regular and entirely credible rumor reports about the company’s problems over several weeks that turned out to be almost eerily accurate, but I either didn’t run them or did so without naming the company since I’m not comfortable putting out rumors on publicly traded companies (I picture me as Charlie Sheen’s Bud Fox being hauled off bawling in handcuffs, a la Wall Street.) This anonymous Rumor Report came in at noon Wednesday, which would have given me almost two full trading days to short-sell MDRX shares had I been so inclined. I’m poorer for my inaction, but at least I’ll sleep soundly.

From Nasty Parts: “Re: Allscripts. There was a Tuesday evening board meeting where they attempted to fire Glen Tullman. He survived on a 5-4 vote. As a result, Phil Pead (above) will be leaving the board.” I don’t think TV stock picker Jim Cramer necessarily saw this coming, but he flipped his recommendation at a great time.

From Lumpy Rutherford: “Re: Allscripts. Rumor we heard was that the board tried to fire Tullman but he held on. Dissenting board members, including the chairman, resigned on the spot. Bill Davis (above) was the sacrificial lamb and was let go also.” The wheels have fallen off at least temporarily, but Glen is still driving after winning the Allscripts vs. Eclipsys arm-wrestling match with Phil Pead (shades of the “tank over the cliff” scene from Indiana Jones and the Last Crusade). So much for Glen’s insistence about the ease of integrating Eclipsys and Allscripts products just because they both run on Microsoft technology – prospects apparently aren’t buying it (literally). I like Sunrise, but Eclipsys was a disaster, with recurring self-inflicted wounds from management gaffes and overpaying for acquisitions in a desperate and failed attempt to be a player. I don’t see any way that Allscripts will ever get back the $1.2 billion it paid for the company, which everybody knew was vulnerable to losing its few big Sunrise clients to Epic and Cerner due to lack of an integrated ambulatory solution and a narrow product line. I take no pleasure in this news – we need more strong competitors in the inpatient clinical systems market and headlines like this usually send the risk-averse CFOs of hospital prospects fleeing to the HIT billionaires.

From Dismayed ExECLP: “Re: Allscripts. So all Eclipsys board members are out, Glen’s new CFO Bill Davis leaves, numbers are terrible for last quarter and the year looking forward, and Glen survives? He is destroying shareholder value, client relationships, and what had been a highly motivated workforce on both the Allscripts and Eclipsys teams pre-merger. This is worse than what Pam did at McKesson.” Certainly Allscripts suffers more from their HIT-related challenges since they don’t have a hugely profitable cash cow of drug sales to fall back on. Maybe Allscripts should rehire Newt for the EHR Stimulus Tour Part II: he’s tanned, rested, and ready.

HIStalk Announcements and Requests

Highlights from this week’s HIStalk Practice include: a federal agency fails to update its list of medically underserved communities, leading Medicare to overpay physicians millions of dollars in bonuses. More physicians could and would participate in the MU program if their EHRs provided the required functionality. Physician compensation fell in 2011. Medicare and Medicaid paid EPs $1.4 billion in MU incentives through the end of March. A Louisiana woman steals over $700,000 from her plastic surgeon employer. You know the drill: visit HIStalk Practice; sign up for the e-mail updates; bask in the knowledge that you are smarter than the guy in the next cubicle or corner office.

I am amused and touched that so many readers have sent e-mails asking if I am OK given my recent mentions of doctor office visits. Thanks for the concerns and be assured I have nothing life-threatening. I have an injury that is annoying and that has created a particularly nasty side effect: it’s hindering my ability to take full advantage of all my fashionable shoes. 

A reader suggests this as a gift for Inga: a custom bobblehead that turns photos into a 3D image of a person’s head. Cute and apropos, although maybe not $200 worth.

My Time Capsule editorial last week challenged anybody to prove that healthcare IT improves outcomes and costs. TeleTracking responded on their blog with what they say is proof. I’ll defer to your assessment – were they successful?

On the Jobs Board: Director Project Management, Implementation Project Manager, Epic Certified Builders, Senior Business Development Executive. On Healthcare IT Jobs: Cerner Orders iVew Consultant, Healthcare Services Systems Analyst III, PACS Application Coordinator II.

I always feel like a failure when I see people around me lost in an iPhone Zone while ignoring everyone around them, happily absorbed with their make-believe Internet friends in their self-imposed Cone of Silence. Was I not adequately scintillating to draw their limited attention away from the electronic lure that is infinitely more time-wasting than the “vast wasteland” of 1960s TV? Have I failed to meet their need for human interaction, forcing them to flee for the comfort of the electronic equivalent of a blow-up doll? And yet I seek such illusory validation myself, measured by the number of people who (a) sign up for my e-mail updates;  (b) Friend/Like/Connect frenetically with Inga, Dr. Jayne, and me, secure in the knowledge that we reciprocate unconditionally; (c) peruse and uncontrollably click those gloriously non-animated ads to your left because my sponsors offer such an interesting variety of valuable products and services that you really can’t stop yourself; (d) send me rumors, news, and other goodies that I can use here to appear smarter and hipper, at least to people who don’t actually know me; and (e) use the Resource Center and Consulting RFI Blaster since you would be indirectly helping the less fortunate (the grateful offshore programmers to whom I paid a pittance to develop those). You may have noticed that I’m using Twitter slightly more to prove that I’m just as pedantic as the tweet-happy crowd, so you may get some early glimpses of HIStalk stuff there if I’m in the mood. Lastly, I would ordinarily say that having a 2,400-member HIStalk Fan Club on LinkedIn is the ultimate manifestation of narcissism, but unlike some of my fellow HIT netizens, I didn’t start my own fan club, so I’m just a guest there as you could be, courtesy of Dann. That is all, other than the obvious: it means a lot to me that you read what I write.

Acquisitions, Funding, Business, and Stock

Cerner announces Q1 results: revenue up 30%, EPS $0.51 vs. $0.37, beating consensus estimates on both. The company raised guidance to yearly earnings of $2.25-$2.32 on revenue of $2.6 billion.

Athenahealth announces Q1 numbers: revenue up 38%, EPS $0.07 vs. $0.09 (unchanged in non-GAAP reporting, beating expectations).

CPSI’s Q1 numbers: revenue up 10.2%, EPS $0.51 vs. $0.49.

Quality Systems, the parent company of NextGen, acquires Matrix Management Solutions, a NextGen reseller that provides RCM, implementation, and support services. Quality Systems says the acquisition will “enable NextGen Practice Solutions to expand its footprint among private and hospital-based physicians and groups by leveraging Matrix’s RCM expertise.”

Emdeon completes the repricing of its existing senior secured credit facilities and borrows $80 million of additional term loans for general corporate purposes, including potential acquisitions.

McKesson will pay $190 million to settle yet another lawsuit over its average wholesale price debacle of a few years ago. I don’t have the numbers in front of me, but I would guess they’ve paid out nearly $2 billion over that mess.

Sales

Siemens Healthcare signs a global radiation oncology partnership agreement with Varian Medical Systems, displacing Varian incumbent GE Healthcare. Siemens also announces four Soarian revenue cycle sales: MD Anderson (TX – a 10-year agreement for Soarian financials); North-Shore LIJ (NY – a six-year extension for Soarian financials and adding Soarian physician revenue management and scheduling to the faculty practice plan); Shepherd Center (GA – a five-year extension to migrate to Soarian clinicals and financials); and Baton Rouge Medical Center (LA – a 10-year extension to install Soarian Enterprise Revenue Cycle).

Iowa Health System expands its relationship with MediRevv to include use of its Revenue Integrity Service.

The VA awards Harris Corporation an $80 million, eight-month contract to support the VA’s migration to 5010.

People

MEDecision names Ellen Donahue-Dalton EVP/chief marketing officer. She was previously with GTECH Corporation.

HealthTrio promotes Dominic Wallen to president and COO.

Announcements and Implementations

Beacon communities Quality Health Network (CO) and HealthBridge (OH) announce an agreement that allows QHN to access HealthBridge’s data analytics and BI tools.

Montgomery County Memorial Hospital (IA) goes live on NTT DATA’s EDIS solution. The hospital is a user of the company’s Optimum solutions.

Orthopaedic & Spine Center (VA) expands its use of White Plume solutions with the addition of AccelaMOBILE, White Plume’s mobile charge capture app.

OTTR Chronic Care Solutions announces OTRRbmt, a pediatric bone marrow stem cell transplant patient management system.

The New York eHealth Collaborative, the NYC Investment Fund, and the NYS Department of Health launch the New York Digital Health Accelerator, a program to promote HIT initiatives in New York state. It will offer up to $300,000 and mentoring to 12 early- and growth-stage companies that are developing technology solutions for care coordination, patient engagement, analytics, and message alerts, primarily products that could benefit the state’s Medicaid program redesign. The initial investment of $4.2 million is expected to create up to 1,500 jobs over five years and to attract up to $200 million in venture capital investment to graduating companies. Mentoring will be provided by 18 provider organizations, including New York-Presbyterian Hospital, North Shore-LIJ Health System, NYU Langone Medical Center, Maimonides Medical Center, and Community Healthcare Network.

Moffitt Cancer Center (FL) goes live with a clinical trials recruitment and personalized medicine application, built on Oracle tools, that it says will allow it to more closely connect patient care information and research results to improve clinical decision support tools.

Max Healthcare becomes the first hospital in India to reach HIMSS Analytics EMRAM Stage 6.

Government and Politics

CMS awards CPA firm Figliozzi and Co. a three-year, $3 million contract to audit payments and compliance with the EHR incentive program.

VA CIO Roger Baker says the first VA-DoD integrated EHR sites will go live two years ahead of schedule in 2014. He also announced that the VA is testing an iPad EHR app in a 1,000-clinician pilot. 

Pentagon researchers are exploring the use of computer-based simulated therapists to conduct therapy sessions with service members, with the system using motion sensing and a webcam to detect signs of post-traumatic stress disorder. The video above is of a similar DoD project that was intended for service members to use in their homes, but without the symptom detection hardware. Thanks to Guy for the link.

Technology

The US Patent and Trademark Office issues a patent to DR Systems for technology related to automated selection and forwarding of medical data to secondary locations, such as EMRs.

Other

Weird News Andy ponders whether anyone’s up for a third-hand kidney. Surgeons at Northwestern Memorial Hospital (IL) transplant the same kidney twice in two weeks in two different patients when the first recipient’s existing disease renders it useless to him. The donor was the first patient’s sister, who was disappointed that her kidney didn’t help her brother but happy that at least someone benefited from it. And being on a transplant roll, WNA also finds this story bizarre: the father and grandmother of a two-year-old boy are arrested for kidnapping him as his family sits by the phone waiting for the call saying the boy – #1 on the heart transplant list – needs to be rushed to the hospital to receive a donor heart.

One more gem from WNA. The Utah Department of Health, alerting 273,000 people of a Medicaid data breach that exposed their Social Security numbers by sending an unsigned letter advising them to call a hotline number, gets complaints about the first question scam-wary people are asked when they call: what’s your Social Security number?

Cincinnati Children’s Hospital (OH) announces an $180 million addition that will bring its total research space to 1.4 million square feet, which will make it the largest pediatric research facility in the country.

Pennsylvania’s State Health Department finds that two patients at St. Luke’s Hospital were dangerously overdosed on IV meds because nurses incorrectly programmed their IV pumps at 10 times the ordered rate. At least it wasn’t erroneously programmed PCA pumps this time, which the state said was the cause of three patient overdoses at the same hospital a few months ago.

Sponsor Updates

• Cisco honors World Wide Technology with six awards at its annual partner summit. 
• MEDSEEK recognizes five customers with eHealth Excellence Awards at its 2012 eHealth Client Congress. 
• Boston Business Journal names eClinicalWorks to its Pacesetters Powerhouse Elite in recognition of its 148% growth over four years.
• TripleTree names Awarepoint and Optum as finalists for its 2012 TripleTree iAwards for Wireless Health.
• CynergisTek will feature its HIPAA Audit Readiness Solution Portfolio at this weekend’s 16th Annual HCCA Compliance Institute in Vegas.
• Billian’s HealthDATA adds home health agencies and nursing home financials to its market coverage for subscribers.
• Aventura partners with Choice Solutions to provide one-click access to patient data.
• Gartner names MedVentive as a 2012 “Cool Vendor in Healthcare Providers” for providing innovative and potentially transformative solutions for healthcare delivery organizations.
• EBSCO Publishing adds continuing education modules for PT/OT/ST to its Rehabilitation Reference Center that’s used by rehabilitation clinicians at the point of care.
• Capsule posts the next video in its Connected Consultant series intended to educate clinicians and IT people about medical device integration, this one on hardware.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 4/25/12

Top News

Cerner breaks ground on its $160 million Kansas City, KS campus, which will eventually house 4,000 employees. The first tower is projected to open mid-year 2013 and will serve 1,000 employees, including about 800 new hires.

Reader Comments

From THB: “Re: Accretive Health. Wanted to hire me with this exact thing under the guise of implementing an ACO-type process (do you want us to put the kidney stones back in?)” The State of Minnesota goes after Accretive Health for its actions on behalf of its hospital customers, including placing its employees in the ED to demand payment before services are rendered and for using information in hospital charts to try to collect overdue bills. I’m uncomfortable with the tone of the entire article, which seems to suggest that (a) hospitals should be passive in their efforts to convince patients to pay for services rendered, asking them nicely and infrequently if they wouldn’t mind setting their debts at some point if it’s not too much trouble; (b) it’s unethical to ask ED patients to make payments for previous visits before seeing them again, when in fact many of those patients show up for non-emergent conditions anyway and treat it more like a physician office visit; and (c) hospitals are being shady when they allow Accretive employees to work in its departments, even though full hospital departments like dietary and housekeeping are outsourced all the time.

Why isn’t the state upset about a national healthcare system based on ridiculously inflated charges that are favorably discounted to big insurance companies but not to patients without insurance, or with patients who incur healthcare services with no intention to pay for them even when they are financially able to do so? Hospitals and Accretive are doing exactly what you would expect given the goofy rules of the game – hospitals are often huge and hugely profitable non-profits (intentional oxymoron) with multi-million dollar executives who are wired to maximize the bottom line. The system was changed years ago to eliminate the charity and tax-supported models and instead requires hospitals to be run like a business. The shades of gray about which services are mandatory, who can and can’t afford to pay, and how aggressive the bill collectors are allowed to be just detracts from the central issue – hospitals are doing nothing illegal, just selectively distasteful to those who think healthcare isn’t a business when it clearly and intentionally is, rightly or wrongly.

From Banishing Bob: “Re: North Carolina hospitals. Subject of a scathing investigative series by the Raleigh newspaper.” The five part-series, called “Prognosis: Profits — Hospitals Prosper at Patient’s Expense” is an extension of the argument above – behavior that’s unsavory, but legal and, according to the hospitals named, necessary. North Carolina’s non-profit hospitals – which pay no income, property, or sales taxes — are banking annual profits of up to $500 million, erecting massively expensive Taj Mahospitals, paying their executives handsomely (25 in the state make over $1 million), strong-arming patients who can’t or won’t pay their bills, and sitting on multi-billion dollar reserves in a couple of cases. All in the name of sustainability and giving the locals the care they deserve, the executives say. Most of the 25 non-profit hospital executives in the million dollar club work for Novant or Carolinas HealthCare. Carolinas HealthCare paid its CEO $4.2 million, the COO $2.5 million, the CFO $1.8 million, and has EVPs making nearly $2 million. Novant’s chief clinical, medical, and administrative officers each made over $1.5 million and its general counsel was paid $1.2 million. On the IT side, Novant paid its CMIO $801K and its CIO $770K. I don’t know about Carolinas HealthCare since their federal 990 form isn’t readily available for whatever reason (I assume because they’d rather it not be). Excessive? You decide.

From Oblate Spheroid: “Re: Bill O’Connor. Gone from Zynx. What’s going on there?” Unverified. Bill’s LinkedIn profile says he’s still there. He is (or was, depending) the SVP of marketing, joining the company nine months ago.

From Beeper King: “Re: beepers. Because there is no guarantee of message delivery with cellular communications, pagers will be with us for a long time to come. How often have you received a cellular text message a day late? The cellular community will need to be pressured to make this change. However, given the small portion of their market that healthcare segment makes up, this probably isn’t likely to happen soon.” The beeper discussion is fascinating. Somehow every other industry makes do without beepers for their critical, real-time communications. The only time I felt secure in knowing whether my message was received (and opened) was in the old days of the two-way RIM pager, precursor to the BlackBerry. Even now, there’s no perfect system – secure, cheap, usable in all geographic areas, and with verifiable delivery.

From Suggestion Box: “Re: interviews. You should interview health system CEOs about IT-related topics such as Meaningful Use and ACOs.” I really like that idea. If anyone can hook me up, I’m happy to do it. I’ve tried George Halvorson of Kaiser a couple of times with no luck, but just about any big-hospital CEO would be fun.

From The PACS Designer: “Re: cloud collaboration. An application that has been adopted for collaboration by over 120,000 businesses is Box. Box offers secure, scalable content-sharing that both users and IT love. The app pioneers a new level of content management security, with role-based access controls, 99.9% uptime guarantee, and data encryption using 256-bit SSL." A one-user, 5 GB personal account is free, although so is the long-delayed, just-announced Google Drive.

From Frank Poggio: “Re: Medicare payments. CMS proposes a payment update for acute-care hospitals that it projects will increase operating payments by about 0.9% in 2013. Well, let’s see — that would mean if you did not meet Stage 1 MU, that would be a penalty of 0.3%. In a 250-bed facility, that would be maybe a $100k loss. Is it worth slamming in an EMR? I doubt it. Oh, by the way the docs got 0%, so one-third of zero equals zero penalty.”

From Daniel Barchi: “Re: Yale New Haven Health System. Greenwich Hospital went live big bang on Epic for all financial and clinical applications this past Saturday. Greenwich is the first of the three hospitals to go-live and it joins 36 physician practices from Yale Medical Group, Northeast Medical Group, and private community physicians who have been live on Epic since October. I could not be more proud of our local Epic team and the staff and leadership of Greenwich Hospital. We have also been really well supported by a talented team from Epic. I have been through many go-lives and the preparation and hard work of all of these teams made this about as smooth as a hospital go-live can go. The attached picture shows Greenwich Hospital President and CEO Frank Corvino throwing the switch at a go-live ceremony the first day.” Thanks for the report. Daniel is CIO of the Yale health system and the medical school.

HIStalk Announcements and Requests

Welcome to new HIStalk and HIStalk Practice Platinum Sponsor simplifyMD. The Atlanta-based company offers The Digital Chart Room, which includes medical-grade document management, auto-indexing of scanned documents, a template generator, the Productivity Pilot task organizer, and a personal health record. It eliminates the limitations of paper-based charts (one-person access, lost files, high labor costs), avoids the risks of EMR implementation (physician workflow interruption, expense, lack of ROI), and allows practices to increase their volume to offset higher costs and reduced payment. The company’s talking points are fast and friendly customer support, affordability, easy implementation, and elimination of customer exposure to technical obsolescence. Customers choose between a fully hosted cloud-based solution or a local cloud (a local server that allows uninterrupted operation if Internet access is lost, but with access from anywhere). It’s one monthly price ($395) for everything and the customer can just stop using it with no additional charges if they find that it doesn’t pay for itself. Check out their ROI calculator here. Thanks to simplifyMD for supporting HIStalk and HIStalk Practice.

Acquisitions, Funding, Business, and Stock

Streamline Health reports Q4 results: revenue $4.5 million vs. $4.9 million, EPS $0.00 vs. -$0.19.

Standard Register announces Q1 revenue of $157.6 million, which includes $57 million from its iMedConsent (dba Dialog Medical) division and other HIT solutions. The company notes that sales of clinical documents and administrative forms fell 12% from the previous year due to customers implementing EMRs.

Healthways acquires Ascentia Health Care Solutions, a provider of population health management technology to support physician-directed population health initiatives.

HealthStream announces Q1 numbers: revenue up 28%, EPS $0.05 vs. $0.07, beating revenue estimates but missing consensus earnings estimates of $0.06. Shares made Nasdaq’s biggest percentage losers list for the day, down 10%.

Apple beats all Q2 expectations with revenue up 59% and EPS $12.30 vs. $6.40. The company sold 35 million iPhones that accounted for 58% of its revenue. It sold 11.8 million iPads, more than double the year-ago number even though the newest model was available for only the last month of the quarter. Mac sales were up 7% to four million, while iPod sold 15% less than the year-ago figure.

Sales

DR Systems announces seven new PACS contracts totaling more than $3.7 million.

The 90-physician Allied Pediatrics (NY) selects Isabel Healthcare’s diagnosis decision support technology, which will be integrated with Allied’s GE Centricity EMR.

The VA extends its contract with Authentidate for home telehealth devices and services for at least one more year with three one-year extension options. 

Indian River Medical Center (FL) selects RelayHealth to provide HIE and PRN technologies.

The Saskatchewan Surgical Initiative announces that it will expand the implementation of Surgical Information System technologies into new hospitals.

Duke University Health System will implement iSirona’s device connectivity solution.

Cuyuna Regional Medical Center (MN) chooses PatientKeeper’s clinical applications to create a virtual EMR from the hospital’s Meditech inpatient and Allscripts outpatient systems.

People

Poudre Valley Medical Group CEO Russell Branzell joins GetWellNetwork’s board of directors. He was formerly CIO of Poudre Valley Health Systems and the president and CEO of that organization’s for-profit IT company.

Communications consulting firm WCG hires Rob Cronin, the former head of corporate communications for SureScripts, as practice leader of healthcare technology and transformation.

AMIA President and CEO Kevin Fickenscher MD is named chairman of the newly created healthcare advisory board of Intelligent InSites.

Lt. Col. Danny J. Morton (on the right above) is named as the Army’s MC4 battlefield EMR product manager, replacing Lt. Col. William E. Geesey in a ceremony at Fort Detrick, MD.

Announcements and Implementations

Open source provider Medsphere Systems joins the Open Source Electronic Health Record Agent community, which focuses on establishing a code repository for the VA’s VistA EHR.

Mount Sinai Medical Center (NY) implements Perminova EP to manage the scheduling, workflow, documentation, and billing processes for cardiac electrophysiology procedures.

Phreesia adds an electronic version of the M-CHAT autism screening tool for toddlers to its patient check-in system.

The Health Information Trust Alliance (HITRUST) establishes the Cybersecurity Incident Response and Coordination Center to provide alerts and information-sharing related to healthcare cybersecurity threats.

EHR Doctors announces that its CCD Generator is being used by Ministry Health Care to create an ONC-ATCB certified Continuity of Care Document from its multiple EHR systems.

TigerText announces a new version of its secure text messaging application, with University of Louisville as its first higher education customer.

In Canada, doctors at Ottawa’s Queensway Carleton Hospital say they like what they’re seeing in the pilot project for a discharge information system developed by TELUS Health. PCPs automatically get electronic copies of the records of their patients who are seen in the hospital’s ED, replacing the paper records that took two weeks to deliver.

Other

I don’t watch much TV (American Idol excluded) but I was glad to see that Epic employee Rachel Brown is still a contender in The Amazing Race. Rachel and her Army helicopter husband Dave are one of four remaining couples in the running to win a $1 million grand prize. If the Browns win, I am sure that Judy will be happy to offer investment advice.

A KLAS report says almost half of inpatient providers plan to purchase a computer-assisted coding solution within the next two years, according to KLAS, mostly because of ICD-10. The most recognized vendors are 3M, OptumInsight, and Dolbey.

Epic beats IBM in the StarCraft II Championship, earning $5,000 for its charity of choice, Doctors Without Borders. The motto of the 12-0 team, captained by JDUB, is “Need Medical Attention?”

A New Zealand doctor is reprimanded for failing to tell a patient about an abnormal blood test result. The doctor said he hit the wrong key on the keyboard, but a public health commission said he should have used other software to remind him about the result.

Sponsor Updates

• GetWellNetwork customer Celebration Health and its CEO, Monica Reed MD, will host all 350+ attendees on its campus to kick off GetWellNetwork’s user group meeting in Orlando next week.
• CynergisTek partners with the law firm of Davis Wright Tremaine to create the HIPAA Audit Readiness and Response Solution Portfolio for OCR audit compliance.
• NextGate announces the release of MatchMetrix v8 and NextGate Registries for Healthcare for accurate identity matching and health information exchange.
• Cuyuna Regional Medical Center (MN) selects PatientKeeper technology to aggregate data from the MEDITECH system used by the hospital and the  ambulatory care offices’ Allscripts system.
• Meritas Health Corporation (MO) selects eClinicalWorks EMR for its 72 employed physicians.
• Lakeside Orthopedics (NE) chooses the SRS EHR for its five physicians.
• eClinicalWorks opens a Chicago office to provide a central US presence. The city will host eCW’s user group meeting April 28-29.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Thomson Reuters Will Sell Healthcare Unit to Veritas Capital

Thomson Reuters announced this morning that it has entered into an agreement to sell its healthcare unit to Veritas Capital for $1.25 billion in cash. The company offers analytics services, clinical decision support, an HIE solution, and the Micromedex drug information reference.

Robert McKeon, chairman of Veritas Capital, was quoted as saying, “The Healthcare business of Thomson Reuters is the preeminent healthcare analytics company in the industry today. The acquisition will provide us with a unique and exciting opportunity to add a truly outstanding business and world-class management team to our portfolio and we look forward to building upon our experience in the healthcare analytics market. We look forward to welcoming the business and its talented employees, including its talented management team led by Mike Boswood, into the Veritas family.”

Monday Morning Update 4/23/12

From Radar Love: “Re: Todd Cozzens. Leaving Optum after the company’s Picis acquisition in 2010 and his role change to running its Accountable Care Solutions business.” Verified. Todd confirms that he’s moving to Sequoia Capital this week, although he will continue to service in an advisory role with Optum. Sequoia is a legendary Silicon Valley VC investor that was Apple’s first backer and a player in household names like Oracle, Google, LinkedIn, and YouTube. I checked the company’s site and they have healthcare IT investments as well, most of which are in fact HIStalk sponsors even though I hadn’t previously noticed the connection (AirStrip, Healthcare Quality Catalyst, and ZirMed). At Sequoia, Todd will work with some of its portfolio companies as a board member and mentor, as well as a deal scout. Todd and I have penciled in time for a chat once he’s gotten his feet wet there since I’m interested in their view of the healthcare IT world. Trivia I learned from checking Wikipedia: the company estimates that 19% of Nasdaq’s value is made up of companies Sequoia funded. Todd’s HIStalk history is almost as long as mine – he was my second interview way back in 2005 (everybody was turning me down back then as a waste of time and Todd had to pull rank on his marketing people, who were appalled at the idea) and as one of HIStalk’s first sponsors.

From Recovering Physician: “Re: Lynn Vogel, MD Anderson Cancer Center. He has left. No word on whether he has accepted a new CIO role.” I received this over the weekend and wasn’t able to check with Lynn, but his LinkedIn profile sees to indicate that his employment at MDA ended this month. I’m sure I’ll have an update, possibly by Monday. UPDATE: Lynn confirms that he has stepped down, but isn’t quite ready to announce what he’s doing next.

Respondents were almost evenly split on the subject of hospitals choosing not to hire people who smoke or who are overweight. New poll to your right: how has HITECH affected patient outcomes?

Listening: reader-recommended Of Monsters and Men, super-catchy and creative alt-folk (think Mumford & Sons) from some cheery young folks from Iceland. Lead singer Nanna Bryndís Hilmarsdóttir sounds a bit like Dolores O’Riordan of The Cranberries, right down to the enchanting lilt in her accent when she sings. They’re so cute and fun that not only do you want to give them a group hug and carry them around in a handbag like a Shih Tzu, they may end up being Iceland’s ABBA. Their small US tour starts in May, and if they only sound half as good as they did recorded all-acoustic live in their living room, they’re going to kill.

An item that’s been on my to-do list forever is to enlist volunteers for what I’m grandly calling the HIStalk Advisory Board. What that means: I will e-mail you every 1-2 months with just 3-4 questions about what’s going on in your world – interesting product issues or needs, rumors heard, important issues I’m not writing about, etc. You do a quick reply and let me know what’s up, which will help me keep focus on what’s important to readers. I will not spam you, identify you in any way, or otherwise bug you. If you work for a hospital, clinic, or physician practice and can spare a couple of minutes every few weeks to help me out, plop your information here and accept my thanks. I may sweeten the pot with random prize drawings or something like that if it works out.

Welcome to new HIStalk Platinum Sponsor OTTR Chronic Care Solutions. I just ran my interview with CEO Lou Halperin, in which you may notice that I was fascinated with the company’s focus on transplant centers since I know next to nothing about transplants (I also learned that the company pronounces its name as “otter,” so there you go.) OTTR is the dominant player in supporting the clinical and administrative software needs of solid organ transplant centers, which as Lou points out are really like ACOs in that they’re paid a flat fee for their services, they follow patients indefinitely, and they need to assemble clinical information from a variety of providers and care venues to make clinical decisions. With new investment and leadership (not to mention a name change for the former HKS Medical Information Systems), OTTR is widening its sphere of influence into logical adjacent sectors such as bone marrow transplant and ventricular assist devices. The company has over 70 customers, manages 300,000 patients, supports 250 interfaces, and offers 24×7 technical support. They just announced that Porter Adventist is implementing its system in a cloud environment integrated with CORHIO, with employees using iPads to track patients, manage donor calls, make rounds, and to complete the forms that CMS requires. Thanks to OTTR Chronic Care Solutions for supporting what I do here.

Vitalize is celebrating its tenth year with a Disneyworld event. Founders Mary Pat Fralick (left) and Danny Arnold (right), along with Employee #3 Wendy Kadner (middle), were surprised with a cool-looking cake. The mouse ears brought back bad memories of my work trips involving MCO, the worst airport in the world for business travelers. Inbound planes were always crammed full of obnoxious kids jacked up on sugar and Mickey Mouse adrenaline, bouncing off the cabin walls with minimal supervision from their vacation-dreamy parents, any of whom might at any given moment be wearing those ears to demonstrate their temporary free-spirited insouciance. Outbound, they clogged up MCO security lines with inexpert procedure (what, we have to take our shoes off and put our carry-on bags through the metal detector?) and an abundance of backpacks and souvenir crap, but at least were quiet, newly morose at the prospect of leaving their corporately crafted fantasy land and heading back to reality.  

Weird News Andy finds it ironic that pathologist blames the death of a New Zealand woman on her two-gallon-per-day Coca Cola habit despite the company’s historical use of ad slogans that suggest Coke makes you healthy and happy (“Coke adds life, “Life tastes good,” “The Coke side of life,” and “Life begins here.”)

Boston Children’s Hospital releases its iPhone/Android app, which include wayfinding, a physician directory, appointment setting, and a patient portal with access to the patient’s medical records. 

Liverpool Heart and Chest Hospital chooses Allscripts Sunrise, the company’s first sale to a UK trust. Two other trusts choose this week from finalists Allscripts, Cerner, and Epic. The company hasn’t confirmed, no doubt saving the news for its May 7 earnings announcement.

A project manager of South Carolina’s HHS is arrested for downloading the personal information of 228,000 Medicaid recipients. He won’t say what he planned to do with the information, which involves a fourth of the state’s Medicaid population. He got caught only because of his poor work performance reviews. The incident has become a political football as the Republican Party was quick to point out that he is (or was in the past – accounts vary) a member of the Democratic Party’s county executive committee. Screen captures of the Democratic Party’s site show that his name was quick removed after his arrest. All of that is irrelevant unless he was planning to use the information for campaign purposes.

University of Arkansas for Medical Sciences announces that the information of 7,000 patients was improperly handled when a physician e-mailed a worksheet of patients to an non-employee analyst for billing purposes.

I’m both encouraged and puzzled that the embarrassing alpha pagers we use in healthcare are such a hot topic all of a sudden. Coincidentally, I watched one of the great “Beeper King” episodes of 30 Rock last night, where Dennis tries to convince Jack that technology is cyclical and beepers will eventually stage a comeback over cell phones (best lines, both from Jack: “Gosh, I hope you got a picture of that with a camera on your beeper.” and “I’m expecting a call from 1983.”) John from EMR and HIPAA sent info on docBeat, a new iPhone app in beta that provides two telephone numbers on one device, voice to text, secure text messaging (including future dating for non-urgent messages), and a directory service. I’m sure there are other products as well, and I’ll defer to Travis of HIStalk Mobile, who is checking them out. The main problem I see is poor cell coverage inside hospitals, where somehow crappy technical dinosaurs like pagers seem to work more reliably (or at least more predictably). The issue of user-to-user critical messaging is becoming important, not only because pagers are dying, but because so is BlackBerry and its BBM capability.

GE Healthcare announces Q1 numbers: revenue up 5%, net income up 10% to $585 million. Overall, GE reported revenue that was down 8% and EPS of $0.34 vs. $0.33 excluding one-time costs.

Microsoft’s Q4 numbers: revenue up 6%, EPS $0.60 vs. $0.61. Windows revenue was up a little despite flat or declining PC sales, as were sales to businesses, but Windows Phone didn’t do much and MSFT’s videogame-related sales dropped 16%.

Vince has a fascinating personal story to tell about his days at MedTake in this week’s HIS-tory. Like he says in it, it’s vendor insider stuff that should be interesting to providers they’re trying to sell to.

I’m trying to decide if the weekly review I’ve done the last couple of Mondays is worth the couple of hours it takes me to write it. I’m not feeling ambitious at the moment, so I’m going to take a break from it. I have a lot of great ideas if I ever quit my hospital job, but in the mean time, I’m finding it really hard to keep all of life’s plates spinning.

E-mail Mr. H.

News 4/20/12

Top News

Cerner CEO Neal Patterson makes the cover of Forbes in a piece called Obamacare Billionaires. It’s generally positive given the awkward situation that it’s a right-wing magazine covering a fellow rich guy making big bucks from left-wing healthcare policies. There were some fun background facts I hadn’t heard:

• Neal was moved up to first grade in his boondocks school because otherwise there would have been only one male student in the class
• The three founders came up with the idea of starting Cerner while studying at a picnic table for the CPA exam as Arthur Anderson employees
• The word “cerner” is Spanish, meaning “sift”
• The magazine says Neal is worth $1 billion, although SEC filings show him directly holding less than half that amount in the form of CERN shares
• The infamous “tick, tock” e-mail is of course mentioned (you just know that, as with Jim Morrison’s grave, former Cerner associates will be spray-painting it on his tombstone for decades after Neal has checked out)
• The reporter saw the fancy Vision Center demos of Millennium, then observed firsthand the “klutzy” (I assume they meant “clunky” since “klutzy” usually describes people, not objects) real-life version running at Truman Medical Center, although the hospital still said mostly good things about it

Here’s a snip from the article:

Cerner’s new offerings, on display at its gleaming headquarters with a heavy dose of skilled salesmanship, have the whiff of the future. The company is giving hospitals, for free, software to help predict which patients will get deadly, hard-to-treat blood infections. A new type of patient record is quickly and automatically searchable, even if the data go back decades. A fictional case study shows how a heart attack patient could be cared for in this new system, starting with wireless monitors that he’s wearing when his heart rate speeds up; through a visit with a nurse who talks to specialists using an iPad and FaceTime; to improved versions of the bar-code-reading devices at Truman.

Like in real life, Epic and Judy Faulkner are everywhere Neal turns, even within the current edition of Forbes. She gets a piece called Judy Faulkner: Health Care’s Low-Key Billionaire. There’s not too much new there for those of us who already know the Epic story – as usual, Judy declined to be interviewed – but it’s a fun read. One interesting factoid: when Forbes estimated her net worth at $1.7 billion, she denied to them that she has reached the billionaire club, with her spokesperson saying that Judy owns less than 40% of Epic’s shares (although as could be the case with Neal’s money, there are many ways to make that statement honestly while still being misleading, such as not counting shares held in family trusts or other ownership that’s indirect but controlling). The hardest fact to believe: Judy is 68 years old, which is about 15-20 years more than she seems to be. There’s an intriguing mention about Kaiser Permanente’s insistence that it be given equity in Epic as a condition of signing the contract for its $4 billion HealthConnect project, to which Judy provided a two-letter reply: “NO.”

A sample of the article:

Beneath the rock star antics on view strictly for customers, Faulkner is not eager to telegraph her newfound wealth and power. She turned down our request for an interview. “She doesn’t want the spotlight on her,” explains her spokesperson. Interviews with people who know Faulkner paint a picture of a forceful, yet modest woman. Leonard Mattioli, an Epic board member, recalls chiding Faulkner for driving an old Volvo. “I told her next time you buy a car, take a man with you,” says Mattioli, the founder of American, a midwestern retailer of appliances and electronics. A few years later, Mattioli introduced his fiancée to Faulkner. She proceeded to pepper her with questions Epic typically asks prospective employees: “How many square yards of astroturf are there in the U.S.? Which person, dead or alive, would you most like to have lunch with?” Turning to a bewildered Mattioli, she said “next time you take a wife, take a woman with you [for advice].”

Both articles are interesting primarily because the average Forbes reader has probably never heard of Patterson or Faulkner, much less been aware that healthcare IT has created a couple of billionaires (well, the articles didn’t really make a convincing case that either is a billionaire, but I think we can agree they’re doing pretty well considering they sell almost entirely to non-profit organizations). I wonder if some big wheels in stagnant industry sectors won’t suddenly develop a healthy curiosity (no pun intended) about what healthcare IT is all about now that they’ve seen dollar signs?

Reader Comments

From TheRock: “Medicaid MU programs. Have any states begun issuing 2012 payments for eligible hospitals?” I’m not sure. CMS issued a statement this week announcing that Louisiana’s Medicaid EHR incentive program was the first to issue payments for “Eligible Professionals.” Meanwhile, the Louisiana Department of Health and Hospitals says they are the first state in the nation to issue (any) payments for the second phase of the Medicaid EHR incentive program. Readers?

HIStalk Announcements and Requests

HIStalk Practice highlights from the last week: Emdeon CEO George Lazenby will lead Nashville’s IT Recruitment Task Force. MGMA opens registration for its 2012 conference in San Antonio. Why physicians ignore alerts in their EMRs. Hayes Management Consulting’s Rob Drewniak offers tips for successful change management in healthcare. Sign up for e-mail updates while checking out the news; it ensures you stay in the know and makes me feel loved.  Thanks for reading.

More tales from my recent medical office visits. I wasn’t too surprised that the specialist’s office used paper charts, but I was shocked when they asked me to sign an insurance form so they could mail the claim to the carrier. Maybe I am out of touch with reality, but I thought 99.9% of practices file electronically. I might note that the claim was only for the professional fee and I assume the facility (part of a large, for-profit hospital chain) has more sophisticated technology in place. Now that I think about it, I see a great opportunity for the healthcare system to offer some technology subsidies to their providers.

Here’s one of those uncomfortable IT office moments. You get a new manager (or a new employee to manage), someone you’ve ignored in many previous close encounters in the elevator, restroom, or hall because they’re just some faceless person you don’t really know and don’t care to know. Once the org chart umbilical cord has been attached, however, it becomes obligatory to be their BFF with each chance encounter in making small talk and calling them with gusto by the name that you just learned.

On the Jobs Board: Implementation Project Manager, Director of Marketing, HL7 Business Analyst. On Healthcare IT Jobs: PACS Application Coordinator II, Cerner Orders iView Consultant, Soarian Financials.

Acquisitions, Funding, Business, and Stock

Mediware closes its $2.2 million acquisition of Cyto Management System, an oncology management system, from Holland-based Cobbler ICT Services BV.

Sales

ProMedica (OH) selects athenahealth’s athenaCollector and Anodyne Business Intelligence Services for its 400-physician network.

The National Institutes of Health awards a sole source contract to Carestream Health for its Vue RIS.

Porter Adventist Hospital (CO) signs an agreement with OTTR Chronic Care Solutions to deploy its Transplant Care Platform.

People

CareCloud hires Brad Blakey (NextGen) as VP of sales.

Trinity Mother Frances Hospitals and Clinics (TX) names Jeffrey Pearson (Bon Secours Health System) VP and CIO.

Holon appoints Dyanne Tiller (Bottomline Technologies) its quality assurance and release manager.

Announcements and Implementations

Community Health Network (IN) says it will have its $120 million Epic system in place by November.

NovoPath announces that its anatomic pathology system, which is certified as an EHR Module, can now download pathology patient reports to iOS and Android devices.

Cerner will collaborate with Advocate Health Care to develop a solution that integrates Advocate’s administrative and electronic health information to create predictive models for health outcomes.

CareFusion and Cerner announce the release of a bidirectional solution connecting the CareFusion Alaris infusion pump system with Cerner Millennium EHR. The offering is already in place at Oklahoma Heart Hospital.

Intelligent InSites releases its InSites Connect RTLS mobility solution as an iPhone app.

Other

Hospitals recognized on Thomson Reuters’ 100 Top US Hospitals in 2009 or 2010 had more advanced levels of EHR adoption, according to HIMSS Analytics.

The CEO of Yuma Regional Medical Center (AZ), which goes live on Epic on May 1, says the organization has been experiencing staff changes — including layoffs — as a result of improved procedures and technology. The implementation has affected 33 core employees and 45 adult acute care positions.

And in still more Epic press, its undefeated newcomer StarCraft II team faces IBM in the After Hours Gaming League grand finals this Saturday. Good luck, guys (am I safe in assuming that the electronic warriors are all male, and also likely to have no conflicts with a Saturday night game?)

Emory Healthcare (GA) announces that 10 old computer disks containing information of 315,000 patients are missing, either misplaced or stolen from the unlocked cabinet in which they were stored (it’s in a locked office, though.) Unlike most breaches, Emory didn’t do anything eye-rollingly wrong, and in fact their response seems thoughtful and thorough.

The University of Ottawa Heart Institute posts an RFP for a mobile clinical communications system, specifically nurse hand-held devices that contain a physician directory.

A Louisiana doctor is sentenced to six years in prison for possession of child pornography. He was the medical director of Intra-Op Monitoring Services, whose doctors monitor neuro surgeries in remote hospitals. The company previously admitted that it billed for services that weren’t performed, sometimes not even bothering to make a connection to the remote site or having technicians using the doctor’s logon to make it look as though the monitoring occurred.

Weird News Andy, noting this cash-strapped hospital in Canada that asks patients to do their own laundry on cash-only machines, ponders the likelihood of a coin-operated MRI.

Sponsor Updates

• Account exec Brady Taylor of electronic forms and workflow automation vendor Access drops by Tucson Medical Center to present an iPad to Rita Cartwright, senior business systems analyst. She was an HIStalk Booth Crawl winner at the HIMSS conference in Las Vegas.
• PatientKeeper and Geonetric partner to offer integration of Geonetric’s Patient Portal and PatientKeeper’s Physician Portal.
• The Academy of Managed Care Pharmacy presents First Databank VP Tom Bizzaro with its The Grassroots Advocacy Award.
• Beacon Partners offers a new white paper, Accelerating the Development and Adoption of Affiliate EHR Programs
• Versus hosts an April 24 Webinar featuring Memorial Miramar’s integration of RTLS with Epic.
• Lifepoint Informatics announces its participation at next week’s CLMA ThinkLab ’12 conference in Atlanta.
• Norton Healthcare (KY) contracts with CSI Healthcare IT for 85 go-live resources for their Epic activation.
• The University of Waterloo will award NextJ Systems founder William Tatham an honorary doctorate during its spring convocation ceremonies.
• MedAssets announces the general availability of its Collections Management solution.
• maxIT Healthcare profiles Stanly Regional Medical Center (NC), which successfully deployed EHR and RCM with assistance from maxIT.
• Minnesota Eye Consultants selects the NextGen Ambulatory EHR for its 22 providers.

EPtalk by Dr. Jayne

Thomson Reuters releases its annual “100 Top Hospitals” report, which purports to recognize the best US hospitals. Measures include organizational performance, operational efficiency, and financial stability.

The HIMSS13 call for proposals is open now through May 30. I don’t know about you, but I’m thinking about skipping HIMSS next year and just showing up for HIStalkapalooza. My health system refused to pay for my trip this year, feeling that it’s just not valuable for the cost. I’m sure budgets won’t rebound this year. Who else out there thinks it’s getting a bit pricey?

An article in the Journal of the American Medical Informatics Association looks at the use of health information exchanges in the emergency department environment. Researchers (including Dr. Jayne’s secret crush #3, Dr. Mark Frisse of Vanderbilt) found that HIE access was associated with cost savings and reduction of admissions.

American Medical News ran this piece on EHR alert fatigue. I know several of the people quoted in the article and found it interesting that it really only references inpatient systems. Personally, I’ve found ambulatory systems to be much more annoying with alert fatigue that hospital-based CPOE systems, although more likely to allow individual providers to adjust the level of alerts they receive. I still struggle with physicians who want to turn alerts off completely, which is a bit frightening.

This doesn’t really have anything to do with health information technology, but I found it fascinating. I’ve long been a fan of Lechuguilla Cave, located in New Mexico’s Carlsbad Caverns National Park. Researchers studying bacteria which have never come into contact with humans have identified strains which are resistant to antimicrobial agents. All were resistant to at least one antibiotic and some were resistant to at least 14. Another good reason to continue to fight antibiotic resistance, because obviously bugs are built to survive.

I had the opportunity to hang out this week with some true in the trenches “IT guys” and was reminded what a fun bunch they can be. Most of them have accepted me into the tribe and no longer hold the fact that I’m a physician against me. Words that describe these guys and gals: brilliant, dedicated, straight shooters, funny, detail-oriented, and occasionally downright hilarious. One of them owes me, though, for almost making me spit red wine all over the place, so he’d better be on the lookout. I’m going to find a way to pay him back, mark my words. Thank you for standing guard over my systems 24/7 and for alerting me when administrators and other bean-counting individuals cause trouble. I’ve got your back. And I promise if one of you ever accidentally activates the Halon system again and shuts down the entire health system’s network, I’ll still be your friend.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 4/18/12

Top News

Verizon Chairman and CEO Lowell McAdam, addressing the World Health Care Congress on Tuesday, outlines the challenges to US healthcare delivery and announces a relationship with NantWorks to create the Cancer Knowledge Action Network that will give physicians access to best practice treatment protocols. NantWorks is owned by billionaire Patrick Soon-Shiong. Excerpts from the transcript:

It’s now been almost three years since Congress authorized $27 B to fund the transition of electronic medical records, and in that time we’ve seen a tremendous amount of innovation across the whole health care marketplace. The CDC reports that 57 percent of America’s physicians have now adopted electronic medical records … Yet for all of this innovation, technology has yet to truly transform health care as it has other sectors of the economy. Doctors report that their productivity actually goes down, not up, when technology is introduced because of incompatible systems and frustrating interfaces. The amount of digitized medical information is rising exponentially, but systems still can’t talk to each other easily, in part because of the licensing and security issues unique to this industry … And maybe the most surprising thing in an anywhere-anytime age is that patients don’t have the seamless connection to their health care systems that technology affords them in every other facet of their lives … In order to realize the full disruptive potential of technology, we need holistic approaches to solve these fundamental issues and deliver next-generation health-care experiences to consumers … The World Health Organization has just published a report on the fantastic potential for using these wireless networks to deliver m- and e-health care solutions to the world’s population. They note that, while there are lots of small-scale m-health experiments going on, no one has really solved the security, interoperability and standardization problems that are getting in the way of delivering these vital services in a system-wide, worldwide basis in a secure and interconnected way. At Verizon we think it’s time to scale up.

Reader Comments

From Beth: “Re: AHIMA ICD-10 Summit. Pat Brooks, a senior technical advisor with AHIMA, just finished presenting. All indications is that 10/1/14 is go for ICD-10 implementation. Most important so far: CMS will continue the partial freeze on updating ICD-9 and ICD-10 codes until one year after ICD-10 implementation. They’ll go back to regular, annual code updates on 10/1/15.” More details on the partial code freeze here.

From Kevin: “Re: HIPAA fine. I found this blatant disregard for privacy shocking, but then I thought of all the other minor displays I’ve seen that are HIPAA violations.” Phoenix Cardiac Surgery (AZ) pays $100,000 to settle an Office for Civil Rights HIPAA investigation. The practice was posting its appointments publicly on an Internet-based calendar.

From Aspiring Philosopher: “Re KLAS and Epic. I notice a lot of, ‘they are the best of a bad lot’ commentary. That proposes an unspoken implication that paper records are superior and the inefficiencies of paper record keeping of today can be overlooked and are preferred over new technologies that are intended to improve safety and communication across practitioners. If the most money is spent developing the idealized products and we cannot get something better than ‘bad’ I don’t know where that will ultimately leave us. Thoughts?” The most important point: the naysayers aren’t the people using these systems and, in fact, usually aren’t providers at all, just preachy sideline watchers. That would be like not buying a car because a handful of people who don’t own one keep harping about how inferior they are to walking. If the feeling was widespread, you would see providers going back to paper in droves and that is just not happening – that’s the strongest of rebuttals to the “paper is better” argument. I even take KLAS reports with a big grain of salt because you just don’t know if their interviews with a particular provider really reflect the big-picture attitude there about a product. Taking the MBA viewpoint, vendors will match their effort vs. reward curves, and if customers keep buying (or keep paying maintenance fees), you’ll never see products get a lot better — think Detroit rustbuckets pre-Japanese imports. Also, much of what is labeled as product failure is user failure – providers who don’t really want to standardize or change or don’t have the skill to manage the process well – non-IT precedents are ample. The bottom line: there are only a dozen or so full-line hospital system vendors out there and all have successful and unsuccessful users, which indicates that there’s more to the equation than just which product is “better.” I’ve advocated in the past that user organizations should undergo the same subjective assessment before being allowed to implement patient-impacting technologies such as CPOE.

From Portnoy: “Re: Epic. They are working with the open source GT.M database to allow them to offer a free alternative to the expensive Cache’ so that smaller hospitals can afford to implement Epic.” Unverified, but it makes sense. Everybody (including me) obsesses with Epic’s success and Judy’s net worth, but it of all the money that has been made from companies with roots going back to Meditech in the 1960s, InterSystems may be on the leaderboard. Every time Epic makes another big sale, InterSystems sells a ton of per-user Cache’ licenses and collects yearly maintenance fees on every one of them forever. My information is dated, but when I last bought them for my hospital employer, seats were $1,000, as I recall, and the maintenance percentage was pretty steep.

From EHR Warrior: “Re: [vendor name omitted]. The certified EMR is next to dead. You talked to them awhile back and they just BS’ed you. Now they have sold off their IP to a mail drop in Texas. Nothing wrong about failure, but to stiff employees, creditors, and users with lies is hopefully unacceptable, even in this climate.” I’m leaving this as unverified for now since I haven’t been able to confirm. If anyone recognizes the company being described and has verifiable information, let me know.

HIStalk Announcements and Requests

Last week I mentioned visiting the doctor and being geeked with my brush with technology. Alas, when I went for a follow-up appointment yesterday, my physician said she needed to fax my records over to a specialist. I had a momentary flashback to my neon yellow track suit and Jennifer Anniston haircut.

I ran an unverified rumor from Senor Ortega on Monday about a company he claims has ceased operations. I declined to name the subject of the rumor until I gave them a chance to respond to my inquiry. I haven’t heard anything back from Allocade, so the rumor is still unverified. That’s all I know. If the company wants to provide a response, I’ll run it.

Acquisitions, Funding, Business, and Stock

Humedica raises $10 million in a new round of funding, bringing its total VC investment to $63 million.

Sales

The board of directors of 37-bed Palm Drive Hospital (CA) will vote on the purchase new EMR and financial system within the next month. The hospital was set to approve a $3.8 million McKesson solution last month, but deferred the vote to determine if McKesson could interface its financial product with a clinical-only system designed by one of the hospital’s physicians. I admit it: I felt genuine pain for the McKesson rep who was thrown this last minute curve ball.

The Air Force awards LongView CIO Group a five-year, $985 million contract to provide management and professional support services to the Air Force Medical Service.

The urgent care franchise Doctors Express selects DocuTAP’s EMR and PM software for all its new urgent care centers and most of its existing facilities.

People

AsquareM Healthcare Consulting co-founders and managing partners Timothy Ogonoski and Victor Arnold have joined Huron Healthcare as managing directors.

Mental health research and technology non-profit Centerstone Research Institute promotes COO Tom Doub PhD to CEO.

Healthcare software usability firm PointClear names Justin Neece (above) as VP of corporate development and Jerry Hill as director of operations, technology practice.

Tom Stampiglia, formerly CEO of Medical Present Value, is named CEO of revenue cycle vendor Origin Healthcare Solutions.

Announcements and Implementations

Dell announces that its Clinical Service Desk is working with Mount Sinai Hospital (NY) to implement Epic.

Datalink deploys a $3 million unified virtual data center infrastructure for Cook County Health and Hospital Systems (IL) and two dozen of its facilities.

The American College of Surgeons and the CDC collaborate to use standardized quality measures and HIT resources to track, report, and prevent surgical site infections and other adverse outcomes.

North Hills Hospital (TX) implements VeinViewer, a computer-powered, hemoglobin-sensing instrument that projects the patient’s vein images on their skin, giving nurses a high probability of starting an IV on the first stick. It’s apparently been around for some time.

Innovation and Research

One of the winners of Penn’s Wharton Venture Award is 1Docway, an online doctor’s office in which patients can schedule appointments and connect to secure video chat with their physician.

Express Scripts is implementing ScreenRx, predictive software it developed that uses 400 factors to identify patients most likely to skip prescription refills so they can be contacted in advance. That must be an odd conversation to have.

Other

From KLAS: urgent care organizations are searching for EMRs to better manage their growth. Technologies under consideration includes ambulatory EMRs, ED solutions, and best-of-breed urgent care EMRs.

Memorial Healthcare System (FL) fires two employees who are suspected of accessing the names, dates of birth, and Social Security numbers of 9,500 patients with the intention of filing fraudulent tax returns.

Because it’s tax day, it seems appropriate to mention the thief who stole the identities of 56 patients at the Long Island Head Injury Association. The former manager used the personal information to file false tax returns and pocket the refunds.

A Mayo Clinic doctor develops a real-time ED dashboard that he says cuts patient ED stays by 30-60 minutes. A Mayo spokesperson says that on one occasion, it warned physicians that the patient they were discharging was having a heart attack. A consulting firm has licensed it to use with Microsoft Amalga.

Where was this service post-HIStalkapalooza? An enterprising Las Vegas anesthesiologist launches Hangover Heaven, a converted 45-foot tour bus that serves up a hangover cure called “Salvation.” For $200, patients can hop on the bus and be infused with two bags of saline mixed with vitamins, ketorolac (an anti-inflammatory), and Zofran (for nausea.) I think even Mr. H would allow him himself to be over-served so he could be treated by the medical assistant “wearing a white, sexy nurse costume with white fishnet stockings and white knee-high boots.”

Weird News Andy likes this story, in which a surgeon with a MIT engineering degree restores a woman’s ability to speak using concepts he learned from studying jet engines. The woman’s vocal cords were destroyed 35 years ago in a car accident, after which she noticed when calling her parents for help that, “I sounded like Linda Blair in The Exorcist.” The engineer-surgeon rebuilt her larynx using muscle from other parts of her body, allowing her to speak. She concludes, “My husband probably thought he had it made … a woman who couldn’t talk.”

Strange: a 52-year-old UC Irvine Medical school physician and professor sues Johnny Depp, claiming that his bodyguards forcefully took her iPhone from her and then had her handcuffed by security at an Iggy and the Stooges concert as she took her assigned seat in the VIP area where Depp was sitting. She says she suffered extensive injuries that caused pain, insomnia, numbness, depression, insomnia, post-traumatic stress disorder, nightmares, and phobias that have left her unable to work.

Odd lawsuit: a 28-year-old South Dakota prisoner sues the hospital that circumcised him at birth, saying he just realized that he’s had the procedure. He wants $1,000 and surgery to have his foreskin put back.

Sponsor Updates

• Awarepoint CEO Jay Deady is featured in a podcast discussing hospitals’ substantial gains using RTLS solutions.
• Thomson Reuters releases its 100 Top Hospitals study.
• Hayes Management Consulting announces that its revenue cycle business has tripled from March 2011 to March 2012.
• Greenway Medical provides an update on the 2012 PQRS incentive pathways and qualifications.
• eClinicalWorks recognizes several customers for achieving NCQA Level 3 Physician Practice Connections PCMH status.
• Santa Rosa Consulting offers an explanation of the the CMS readmission reduction program timeline and penalties.
• AT&T mHealth introduces the WellDoc DiabetesManager application, which aids in disease management and cost control. 
• MaxIT Healthcare ranks No. 5 in Indy’s Top Workplaces for 2012.
• CynergisTek CEO Mac McMillan discusses security and privacy solutions at several upcoming April events.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 4/16/12

From ZZtop: “Re: Meditech ambulatory. Meditech is developing an ambulatory product written in part with M-AT (focus) and M-AT WebServer (unreleased and a SAAS application). It will be available in 2013 starting at the 6.1X product line as they are merging P/BR and B/AR into one application. The design is very un-Meditech with horizontal tabs. Looks a bit Epic-ish.” Unverified.

From Epic Dude: “Re: Nuance. Apparently sunsetting their RadPort imaging decision support service.” Unverified.

From Senor Ortega: “Re: [company name omitted]. Ceased operations on Monday, April 9 and will declare bankruptcy next week, according to an e-mail sent by a member of their board of directors.” Unverified, so I’ve left the company name out for now. I e-mailed and asked them to confirm or deny and will re-run with their name if they don’t respond.

From Dr. Beeper: “Re: Henry Ford Health System. They spent $150 million to replace the 25-year-old McKesson MIMS product starting in 2006, bringing in CSC, RelWare, and Siemens to develop Care Plus Next Generation (the intellectual property is still owned by HFHS and RelWare.) That product did not have revenue cycle capabilities and it captured, normalized, and stored data from over 150 interfaces. HFHS needed to replace 150 individual solutions with a single, unified record with full RCM, inpatient, and ambulatory. That’s why they are spending $300 million on Epic.” Above is a March 2011 quote from the HFHS’s president and COO, talking to the local TV station upon Care Plus Next Generation’s go-live. Eight months later, HFHS was finalizing its contract with Epic to replace the whole thing.

From Epic Envy: “Re: Epic. I get it, Epic is the best of a bad lot. They’ve copied the Meditech business model and have executed it well. But does anyone really believe their KLAS scores aren’t ‘engineered?’ Ask who is KLAS’s biggest paying customer while reading KLAS’ users comments. Ask yourself what effect their ‘good maintenance’ contract incentive has on muting malcontents. Finally, allow your mind to wonder why they don’t foster the use of social media customer dialogue. I am envious, indeed but not naive.” Point A, not effective – just because they’re a KLAS customer doesn’t automatically mean they get to fudge the numbers and I don’t think they control the results any more than other vendors who encourage certain customers to participate. Point B, effective, but I think there’s another factor that automatically quiets down any complainers – who wants go to public with gripes after you’ve just spend hundreds of millions of dollars on Epic? (the hospital’s board would not appreciate public second guessing after approving a decision of that magnitude and the messenger would undoubtedly be shot). Point C, not effective – customers can talk among themselves all they want and I haven’t heard any say that Epic’s giant user group meeting is full of bitter complaining like I’ve seen at similar events held by Epic’s competitors. Point B wins – nobody buys a Rolls Royce and then whines about crappy gas mileage or expensive oil changes because it would just make them look stupid for buying it in the first place. Compounded by the fact that Epic seems to be pretty open with its customers, so there’s not a lot to be gained by airing dirty laundry to a bunch of sideline-watchers, especially when the company is privately held and thus not too worried about negative publicity that might otherwise get shareholder attention.

From Deep Throat: “Re: Thomson Reuters Healthcare Division. Any news about who has purchased it?” I haven’t heard anything, but maybe someone has and will share.

From The PACS Designer: “Re: Windows 8.  Microsoft has released a consumer preview for Windows 8. The new version has vast changes from previous versions and will take some time to get used to if you are in the market for a new system.  In many respects, it appears that Microsoft is trying to challenge Apple’s iPhone/iPad user interface to create some marketing buzz amongst consumers.” Microsoft couldn’t possibly do like everyone else and post the intro video on YouTube or something that might involve a competitor – they had to run it in the non-shareable, proprietary Silverlight format. Luckily someone smarter than the Microsoft marketing folks (why wouldn’t you use a competitor’s free service to pitch your product?) posted an intro video to YouTube where someone might actually see it, which I’m including above. We’ll see on Win 8. Given the radical changes, I’m not convinced it won’t follow the “every other release sucks” pattern like Vista before it and Windows ME before that.

HIStalk readers apparently aren’t all that interested in the JOBS act and aren’t that optimistic that it will spur startup growth and create jobs. New poll to your right, from recent headlines: should hospitals decline to hire overweight people or smokers? The poll accepts comments, so feel free to argue your position.

My Time Capsule editorial this time around: Rogue IT Shops: Provide Rules, but Leave Them There. A flash of the goods: “As soon as IT gets in trouble or tries to hide staff shortages like a balding man’s comb-over, it’s all hands on deck to save the tanking projects, meaning those previously dedicated departmental resources will be yanked to put out some new fire, often self inflicted by poor planning.”

I periodically need to vent about a pet peeve, so here’s one: a character-based GUI is not the same as a DOS application. If you hear someone refer to Meditech Magic or a mainframe app as “DOS-based,” stop listening because they just revealed a startling lack of even basic IT knowledge. I’m also lately irked when I read, “I had a couple drinks …” or something like that where somehow the author feels the “of” separator is superfluous, which to me sounds like someone who’s talking after more than just two drinks.

FirstHealth of the Carolinas CIO Dave Dillehunt left an excellent comment he left on Travis’s HIStalk Mobile post on pagers that hits a point I’ve been trying to tell people about: one-way pager coverage sucks and is getting worse once you get even a few miles away from a reasonably sized city, just like cell phones of the 1990s. They work fine on a hospital campus, but not well for folks covering call from home or traveling even locally. Not to mention that if you aren’t in range when the page goes through – unlike a cell phone – there’s no notice to the sender or voice mail for the recipient since alpha paging is incredibly unintelligent technology. For example, above is a USA Mobility coverage map for Tennessee. They may well have statewide coverage, but only if you’re in the blue areas (which look to be maybe 10% of the geographic area), so if you’re on weekend call, the electronic leash is pretty short. There may be a way for the commonly used Amcom paging system to detect failed delivery or to allow users to forward to a cell number to have the page converted to an SMS text message, but I haven’t figured it out if so. Anyway, here’s what Dave had to say:

Because traditional paging technology is dying, and customers are leaving in favor of their smart phone texting apps, the industry is now milking what revenues they have left and are no longer repairing or replacing damaged and failing paging towers and equipment. As a result, paging coverage is rapidly deteriorating. This is now causing more people to abandon that technology, further worsening the problem. While cellular coverage is sketchy as well, technologies that send out through both cellular and wi-fi are a good start and probably provide better coverage than the current (worsening) paging coverage. Our physicians (and others) are now demanding something other than paging (beeper) systems. Personally, I predict that paging will be gone within 36 months.

Beaumont Health System (MI) promotes Subra Sripada to EVP/chief administrative & information officer. He was previously SVP/CIO.

The Healthcare IT Week in Review

1. Utah: Do These Breaches Make My Butt Look Big?

Facts and Background

European hackers penetrate a Utah Medicaid claims server, downloading files covering nearly a million individuals and stealing the Social Security numbers of more than 250,000 of them.

Opinion

Hackers can get into anything stored online given the proper motivation and resources. Breaches happen all the time. This just happened to be a very large one and the state  government just happened to be very wrong in its initial assessment of the extent of the breach.

Musings

• Of all the things you could profitably hack, why would you want to steal the identities of welfare recipients? Possible answer: health records are often complete and therefore a convenient package for stealing someone’s identify.
• An IT technician’s weak password was identified as being cracked to gain access. That illustrates two points: (a) trying to compose and remember a bunch of complex passwords means most people won’t do it, and (b) at least this was a refreshing way to hack since most PHI exposures are due to inappropriate server security settings rather than old-school password cracks.
• The more other industries beef up their information security because they can and must, the more healthcare becomes the target of choice because security is primitive compared to that used by banks and retailers. Not to mention that healthcare records may include valuable data elements these days, such as bank account and credit card information.
• Utah had better be glad it’s not two states west since California’s breach penalty would have triggered an automatic penalty of $800 million.
• The state is now warning consumers that scammers may take advantage of the situation by calling people up randomly, telling them their information may have been compromised, and asking them to provide personal information (like their SSN) to find out.
• Adequate security is probably an unreasonable target when possession of just a couple of numbers (SSN, insurance ID, date of birth, etc.) is presumed to be positive identification to receive expensive benefits.

2. DoD’s EMR, Out-Of-Control Psychiatrists Prescribing Blamed for Addicted Marines 

Facts and Background

Poor EMR medication functionality is partly to blame for high rates of abuse of both prescribed and illicit drugs in a program for wounded Marines, according to the Defense Department’s inspector general. Also blamed is overprescribing of addictive drugs, particularly by psychiatrists.

Opinion

It may well be that the multi-billion dollar AHTLA EMR can’t bring in data from community pharmacies or the VA to help prescribers identify overmedicated patients. However, that would put it right on par with the systems used by non-military doctors.

Musings

• For identifying patients who may have an addiction problem, why can’t the government ignore prescribing records and instead look at pharmacy dispensing records? The only ways the problem can be identified in the private sector are by doctor shopper databases and examination of claims records (which won’t work if drug-seeking patients get smart and pay cash).
• While illegally obtained drugs are mentioned in the report, the emphasis seems to be on those prescribed from a sound doctor-patient relationship. In other words, the real problem is the doctors doing the prescribing, who in the absence of other motivation must think they’re doing the right thing clinically (i.e, it’s an education problem).
• The problem here is the same as it is in private medicine: doctors are pressured by patients to overprescribe, use of addictive drugs is often anything but evidence based, and any crackdown means chronic pain patients with a legitimate need for aggressive pain therapy will suffer from under-medication.

3. 3M Acquires CodeRyte

Facts and Background

3M announced last week that it acquired CodeRyte, which offers medical coding tools based on extracting information from free text using natural language processing. 3M was already using CodeRyte’s technology in some of its offerings.

Opinion

CodeRyte had put together some attention-grabbing bullet points: 250 customers, heavy penetration into deep pockets academic medical centers, 3M’s reliance on its products, and a potential ICD-10 play. If you’re going to make yourself attractive to a potential acquisition partner, it’s nice when your attributes make a deep pockets partner the logical choice.

Musings

• CodeRyte’s #1 philosophy, according to its corporate overview, was to “stay private as long as possible to allow the technology to become ubiquitous rather than a benefit to a small subset of health care through one vendor’s client base.” I translate that to mean, “3M, you’d better bring a wheelbarrow full of money if you want to get our attention.” Which I assume was the case.
• The company had brought over some former Cerner execs: Glenn Tobin as COO and Don Trigg as chief revenue officer.
• CodeRyte’s board of directors had five members other than CEO Andy Kapit. Every one of them was from a different venture capital firm with investment in the company. Surely the company’s financial ambitions were obvious.
• 3M has a steady cash cow in coding solutions and it has made few obvious acquisitions or investments in that market. This move seems preordained.
• The integration of CodeRyte’s product into 3M’s was not all that great, at least according to folks I talked to. Now 3M loses both its barrier and its excuse.
• 3M and Nuance announced just over a year ago a deal to deliver computer-assisted physician documentation and coding solutions from speech recognition. I don’t know if 3M’s contribution of the coding technology relied on CodeRyte to take the Nuance-converted dictation text and apply NLP to it, but that seems reasonable.
• CodeRyte’s technology was developed by linguistics professor Philip Resnick PhD, who still advises the company.

News 4/13/12

Top News

The Defense Department’s inspector general finds that drug abuse among Marines in the Wounded Warrior Battalion at Camp Lejeune, NC is hard to detect because of shortcomings in its CHCS and AHLTA EMRs. Prescription information from the VA and civilian doctors are not visible in AHLTA. An Army doctor said AHLTA’s medication module is “a mess,” saying that it’s so bad that doctors just free-text in the patient’s medication list, especially after the most recent update that added interfaces to civilian pharmacies and the VA. The battalion also wanted to implement the EMMA medication dispensing system used by the Army at Fort Bragg, but the Navy nixed that idea over concerns that it might not be HIPAA compliant.

Reader Comments

From X-Ray Gun: “Re: Philips. In December, decided to discontinue their RIS product, XIRIS in NA. They have also decided to discontinue their Digital Dictation and VR solution.” Unverified. They live on at least as artifacts on the company’s webpage.

From WildcatWell: “Re: requirement to have health insurance like car insurance. Will it flood my TV with endless commercials such as we see now from Allstate, GEICO, et al? It’ll be worse than political season! But, imagine: ‘15 minutes on HIStalk could save you $15K or more on life insurance.’ Send me a royalty! Keep up the good work.” I would need to dress Inga up in all white with red lipstick like that loopy Flo chick from the Progressive commercials, which are indeed ubiquitous. I’m more of a fan of the Allstate ones since they feature Dennis Haysbert, best known for playing Pedro Cerrano, the Jobu-worshipping outfielder in Major League, one of the best movies ever.

From Recent Interviewee: “Re: interview. I’ve been answering very nice e-mails since the HIStalk interview ran. Congratulations on such a great service you provide to the industry. Everyone reads it.” Thanks. I do quite a few interviews and always let the interviewee know upfront that the result is usually quite a few reach-outs from folks who’ve lost touch over the years. I don’t think they generally believe it until it happens. Healthcare IT really is a small world and most of the players just move around in it without ever straying far.

From Gesundheit: “Re: Henry Ford Health System. The $100 million MIMS system was built in the 1980s, when there were no good vendor offerings. It lasted over 20 years – not bad in today’s environment. However, adding $300 million for Epic is insanity or some lack of governance process or client acceptance. I’d like to see the fact finding on this one.”

From Ixnay: “Re: Meditech. Heard they’re ditching LSS to create their own ambulatory product.” Unverified. That rumor has been going around for at least a year and they’ve bought the remainder of LSS in the mean time. I don’t know if it’s a competitive offering, but the rumors would suggest that at least some folks think it isn’t. Most inpatient vendors still have a weak ambulatory albatross hanging around their necks, not surprising for systems whose underpinnings go back decades when nobody in hospitals cared what physician practices did.

From Jonathan Grau: “Re: International Congress on Nursing Informatics. The meeting is one of the most important activities of the International Medical Informatics Association -Nursing Informatics Special Interest Group (IMIA/NI-SIG) and is held every third year to promote all aspects of nursing and health informatics globally. We expect over 800 in Montreal, June 23-27.” I don’t usually give free plugs since I don’t want to open the floodgates, but I’m feeling uncharacteristically generous. Jonathan is with AMIA. Attendees can hang around afterward and catch the Montreal jazz festival, with performers that include Norah Jones, BB King, Ben Harper, George Thorogood and the Destroyers, James Taylor, Liza Minelli, Seal, Stanley Clarke, old favorite Van der Graaf Generator, and an interesting group whose 1970s LPs populate part of my collection, Tangerine Dream. They put me to sleep every time with their all-instrumental space music that sounds like Pink Floyd taking an on-stage break, but I like the name and covers.

HIStalk Announcements and Requests

Catch up on your HIStalk Practice reading so you have the full scoop on these posts: PCMHs improve quality and reduce costs in New Jersey. CareCloud CEO Albert Santalo joins President Obama during the signing of the JOBS bill. AMA names HP its preferred provider for technology products. Dr. Gregg sends out an RFP for an EHR – and stirs some good discussion from readers. I am a firm believer that you can never be too rich, too thin, or have too many HIStalk Practice e-mail subscribers, so please either send money or diet tips or sign up for the e-mail notifications. Thanks for reading.

Listening: the brand new first album from Alabama Shakes, Joplin-esque (or is it Otis Redding?) Southern soul from Athens, AL, just in time for summer. Singer Brittany Howard, 23 years old, belts it out and leaves it all on the stage. Killer Led Zep cover here.

Travis is on fire over on HIStalk Mobile, with one excellent, meaty post after another. His latest: Pagers – There’s an App For That, which arrives at thought-provoking conclusions about the situations when hospitals can and can’t do like drug dealers did in the 1990s in dumping the typewriter of the communications world, alpha pagers, which surely have no market left other than in healthcare.

On the Jobs Board: HL7 Business Analyst, Director of Marketing, Director of Business Development. On Healthcare IT Jobs: PACS Application Coordinator II, McKesson Paragon Consultants, Cerner Go-Live Project Manager.

It’s a strange, strange world we live in, Master Jack. Reality TV that’s anything but real, rampant Facebook narcissism, crumbling economies, and celebrities whose IQs and morality levels compete like golfers shooting for the lowest score. One thing you can count on, though – like Big Ben or Old Faithful, I will be predictably spooning with my PC to bring you news, rumors, and Cerrano photos almost every day of the week just like I’ve been doing for nine (!!) years. How might one harvest this rich outpouring of prosaic potpourri, you might ask? Simple – just click the Subscribe to Updates link at the upper right of the page to get into the exclusive club of industry movers and shakers who read HIStalk but probably won’t admit it publicly, putting it right up there with pr0n in the guilty pleasure category. Should  you wish to take our relationship to a deeper level, may I suggest: (a) electronically bond with Inga, Dr. Jayne, and me on social not-working sites like Facebook and LinkedIn, where rejection is impossible because we accept connections from everyone; (b) send me rumors and secrets; (c) pay homage to the companies that pay the bills by perusing the Resource Center and the plethora of newly animation-free ads to your left, replacing heartfelt applause with mouse clicks to see what they all actually do; (d) if you are a provider seeking consulting help, broadcast your RFI to several companies in seconds via the RFI Blaster; (e) tell someone you know about HIStalk since they won’t hear about it otherwise; and (f) bow your head humbly as I strap on the Honorary Reflector Thingy in knighting you with gratitude as my tireless confidante and defender. Thanks for reading.

Acquisitions, Funding, Business, and Stock

Emdeon reports Q4 revenue of $284 million, up 3% from a year ago. Net loss for the quarter was $71 million compared to the previous year’s net income of $15 million. Emdeon, which went private last year, says the loss was “primarily due to costs and expenses, including increased interest expense.” The company also announces its intention to re-price its existing senior secured credit facilities to take advantage of current market rates and borrow $60 million of additional term loans for general corporate purposes, including potential acquisitions.

McKesson shares rose 4% to a 52-week high Thursday on news that its $4 billion per year drug supply contract with the VA will be extended for up to eight more years.

I recently interviewed Brian Phelps, the ED doc who co-founded iPad-based system vendor Montrue Technologies, whose Sparrow ED product won the Nuance’s Mobile Clinical Voice Challenge that I judged a couple of months ago. The company learned Wednesday that it had won the $160,000 Southern Oregon Angel Investment prize. It had already received $200,000 in angel investor money at a similar conference and some pretty nice prizes from Nuance.

CPSI will move some of its Mobile, AL operations to Fairhope, saying it has run out of room.

Sales

The State of Minnesota selects Hielix, Inc. to develop a statewide HIE.

Bayfront Health System (FL) signs an agreement with Unibased Systems Architecture to deploy its surgery management and physician order management solutions across more than 20 operating rooms.

Blue Mountain Hospital (UT) chooses clinical and financial solutions from Prognosis. 

Orion Health wins the HIE contract for North Texas Accountable Healthcare Partnership. Also announced: former T-System VP Joe Lastinger was named CEO of the HIE.

Franciscan Alliance selects iSirona’s enterprise device connectivity solution to integrate medical devices with Epic in its 14 hospitals.

Care Logistics sells something that sounds kind of software related to Catholic Healthcare East, but I can’t figure out what it is from this sly hint: “This comprehensive approach combines an organizational commitment to efficiency, systemwide process reengineering and enterprise logistics software to help hospitals achieve reliable and predictive operational performance in the areas of throughput, quality and patient experience.” Their site is similarly vague, but is clogged up with enormous blocks of dense text sure to send all but the most determined visitors fleeing.

People

Post acute care IT provider American HealthTech names David Houghton (Advocat) as COO.

Hospice and homecare IT provider CareAnyware names Ray DeArmitt (CellTrak Technologies, Allscripts Homecare) as sales VP.

Quest Diagnostics appoints former Philips Healthcare CEO Stephen H. Rusckowski president and CEO immediately after his resignation from Philips. He replaces Surya N. Mohapatra, who will join the company’s board.

Philips Healthcare promotes Deborah DiSanzo to CEO. She was previously CEO of Patient Care and Clinical Informatics for the company.

MediClick names Scott Pettingell (GHX) VP of the company’s new consulting services business.

The Healthcare Financial Management Association appoints Joseph J. Fifer its president and CEO, succeeding the retiring Richard L. Clarke. He most recently was VP of hospital finance at Spectrum Health.

Announcements and Implementations

The Hawaii REC names Curas its preferred eClinicalWorks vendor.

The Carolina eHealth Alliance (SC) announces that 11 Charleston area emergency departments are now connected to its HIE.

NexJ partners with Beth Israel Deaconess Medical Center (MA) to digitize the health system’s Passport to TRUST program and make it available through NexJ’s Connected Wellness Platform.

The New York Times profiles remote monitoring system vendor AirStrip Technologies in its list of companies it says are pushing healthcare transformation. Also on the list: Avado (Web-based forms and health status tracking); ClickCare (secure physician communication for consultations); ZocDoc (making physician appointments); and Telcare (cloud-based glucose meter data sharing).

Yuma Regional Medical Center (AZ) will go live May 1 on its $73 million Epic system.

Government and Politics

CMS Innovation Center picks seven states to pilot the Comprehensive Primary Care Initiative, which aims to strengthen coordination and collaboration between private and public healthcare payers to improve primary care.

Other

The athenahealth folks sent over this video entitled It Sucks to Be Me, which highlights why it’s not easy being a physician, nurse, administrator, and patient. OK, so it’s mildly cheesy like an overwrought, applause-milking truck show Broadway musical on opening night in Omaha  (check out the drummer’s cowbell and wood block work – think Waiting for Guffman), but you’ve got to love athenahealth for its out-of-the-box marketing.

Several members of the Medicare Payment Advisory Commission (MedPAC) express concern that federal incentives may not cover the true cost of implementing an EHR. Some specific worries are that Stage 1 requirements are set too high and some required elements are too expensive to implement and offer questionable value.

Allscripts CEO Glen Tullman writes a Forbes piece on how consumer technology can be used in healthcare. He mentions FaceTime, Kinect, and FitBit. He included a video from Madonna Hospital showing some futuristic ideas that I was going to run here, but I noticed it’s a couple of years old and I would hope they’ve come up with new stuff since then.

This seems like a bad idea: an Indiana hospital implements a Web-based incident management system, intended for use during tornadoes and other natural disasters during which Internet connectivity is often lost.

A laid-off IT security administrator at Waterbury Hospital (CT) is arrested for hacking into the hospital’s computer system hours after he was marched out, using his boss’s own e-mail account to send him threatening messages.

A newspaper’s investigation finds that five electrophysiologists – cardiologists with the Ohio State University Wexner Medical Center were each paid a $1.3 million bonus in 2011, raising their one-year pay to $2 million each. The only employee at the state university to earn more was the basketball coach.

Sponsor Updates

• EHRtv posts its HIMSS 2012 interview with T-System CEO Sunny Sanyal.
• Macadamian assists in the design of Elsevier’s Mosby’s Certified Nurse Exam Prep smart phone app and its development for the iPhone, iPod Touch, and iPad. 
• HealthMEDX provides an update on its HIPAA 5010 readiness preparations.
• Allscripts President Lee Shapiro participated this week in a TechNexus panel discussion on the changing face of technology in healthcare.
• A white paper from Care360 discusses the positive impact of technology on the quality of patient care.
• NextGen will integrate Entrada’s clinical documentation technology with its PM/EHR.
• GE Healthcare launches Centricity EDI Services 5.4,which includes support for HIPAA 5010 and stronger analytics.
• Beacon Partners expands its ICD-10 Assessment Service with the addition of an ICD-10 translator and business intelligence application from McGladrey.

EPtalk by Dr. Jayne

The Colorado Regional Health Information Organization (CORHIO) releases a report on integrating behavioral health information through health information exchanges. Although agreeing that information on mental illness is a vital part of the overall data influencing the health of a patient, a role-based tiered consent structure was recommended. Surprisingly, the roles weren’t based on physician vs. nurse vs. checkout clerk but rather the specialty of physicians involved. For example, participants in community focus groups felt that specialists such as OB/GYN or dermatology had less need to know information than did hospital-based physicians. Being a primary care doc at heart, I think any time you start excluding classes of providers (especially when drugs to treat mental health have a number of potential interactions and contraindications) it’s a detriment to patient safety. Who will be liable when harm occurs because a physician was denied information that would have made a difference? Needless to say, I’m not a fan of pick-and-choose consent policies.

CMS has compiled individual quality and resource reports for physicians in Iowa, Kansas, Missouri, and Nebraska. Practices have been e-mailed a link to the reports, but only 3,300 of 23,730 reports have been accessed. I reached out to at least 10 physicians in these states and none of them knew anything about it. My guess is the e-mails either went to spam folders or are sitting in some administrator’s inbox.

I’m a reasonably diligent reader of the Federal Register but somehow I missed this item. The Drug Enforcement Administration is increasing physician fees for the privilege of prescribing controlled substances by nearly 33% – from $551 to $731. This allows us the privilege of having drug-seekers hassle us for meds and increases scrutiny of our practice patterns (not to mention an increase in medical liability insurance premiums.) It seems like what the feds provide in MU funding just slowly erodes to other areas.

I’m a little behind on my reading, so I laughed when I came across this article about the recent Utah Medicaid data breach reported to affect 24,000 patients. As of today, the number is closer to 900,000.

One of the folks I’ve found on Twitter has turned out to be one of my new favorite bloggers. Skeptical Scalpel is written by a surgeon with considerable (40+ years) experience in the field. Worth a view, especially if you have a clinical background. And if you aren’t clinical, it may provide some good conversation-starters to help you bond with physicians who are generally ticked off at the world when all you’re trying to do is fix their laptops.

I enjoy reader correspondence and always like to try to share information when I can. Recently a reader asked, “I am looking for a good hospital BYOD policy for physicians. We’re enabling physician use of iPads and similar devices to connect to our clinical systems and I am in need of a policy that covers their use. Have you come across a good one yet? If so, can you share it?” Being from a strictly “don’t touch my network” hospital, I don’t have personal experience with the thrill of being able to actually use my own device on the network. I do however have much experience hooking to the patient access network so I can use the forbidden Twitter and Facebook. I also have experience carrying both my own smart phone and a hospital-issue BlackBerry, which really makes me look goofy at times. Can anyone help a fellow reader? E-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 4/11/12

Top News

HHS proposes a one-year delay for ICD-10 compliance, pushing the deadline to October 1, 2014 and giving providers and other covered entities more time to prepare and test their systems with the new code sets. HHS also issues a rule requiring all health insurance plans be numerically tagged with a unique health plan identifier, which it says would save providers and health plans up to $4.6 billion over the next ten years.

Reader Comments

From What Next?: “Re: Epic starting their own consulting business. Anyone heard that rumor? They’re supposedly trying to hire back former employees to provide supplemental staffing for application build and design, credentialed training, and go-live support. They would price this as part of the license cost under ‘enhancement implementation services.’” Unverified.

From Baldp8: “Re: Medicare reimbursement break-even in hospitals. How will this impact the IT capital and operating budgets? More spending to automate costs out or less spending to get to a number?”

From Lovin’ Sunshine: “Re: McKesson Practice Partner. Heard that Mel Coovert is no longer with the company, making us consultant folks wonder if Practice Partner is headed the way of Horizon Clinicals. Makes us go ‘hmmmm’ being right in the middle of an implementation.” Melissa Coovert left the company last month, according to her LinkedIn profile. That’s all I know.

HIStalk Announcements and Requests

I had a brush with technology at the doctor’s office this week. I had a minor procedure a couple weeks ago and the incision area has not healed well. Yesterday I decided I should have my doctor check it out, but she had taken the day off.  I saw one of her partners instead, who asked me to compare the site with its appearance a week ago. That’s when I whipped out my iPhone and showed him a picture I had taken. He then made his assessment (I’m getting better) and I went on my way. It’s the little things that get me geeked.

The folks at Imprivata sent over this brilliant item from their April newsletter.

Acquisitions, Funding, Business, and Stock

Cerner CEO Neal Patterson earned $5.6 million last year, a 10% boost over 2010. Compensation included a salary of $1.025 million, $1.6 million in cash incentives, and stock options valued at $2.8 million on the date they were granted. He also received $122,412 in “other compensation” that included $110,000 for his private use of the corporate aircraft, plus contributions to his 401(K), insurance plans, and private security systems.

Sales

Mercy selects Merge Healthcare’s iConnect VNA as its image archive solution for more than 200 facilities across the Midwest.

The 200-member IPA of Nassau/Suffolk Counties (NY) selects Greenway’s PrimeSUITE EHR/PM solution.

FirstHealth of the Carolinas selects Thomson Reuters’ Integration Discovery, powered by CareEvolution, to provide clinical interoperability across its system.

People

Cardinal Health names Donald M. Casey, Jr. CEO of its medical products and services business. He was previously CEO of the West Wireless Health Institute.

John D. Bennett MD, FACC, FACP, president of CDPHP, joins the board of New York eHealth Collaborative.

David O’Hara, COO of Microsoft Advertising, joins the board of Intelligent Insites.

Announcements and Implementations

The Hawaii HIE goes live on messaging and referrals using the Medicity platform.

Elsevier launches ClinicalKey, an online collection of clinical resources covering every medical and surgical specialty and including over 700 textbooks and 400 medical journals.

Capsule Tech releases the first of a series of videos called Connected Consultants intended to educate clinicians and IT staff about medical device integration. The first one is pretty funny.

UnitedHealthcare donates $700,000 to the California Telehealth Network to expand telemedicine training and support rural and medically underserved clinics and hospitals in California.

Government and Politics

CMS announces that 27 ACOs have entered into agreements to participate in the Shared Savings Program beginning April 1, 2012 and has selected five organizations for inclusion in its Advanced Payment ACO model. CMS is considering an additional 50 applicants for the Advance Payment program beginning July 1st.

CMS publishes a full set of proposed Clinical Quality Measures for 2014 as part of the proposed Stage 2 EHR rule.

Other

I loved this headline and yes, it prompted me to read the article. The Washington Post article discusses a letter recently published in the British Medical Journal, which highlighted the amount of data entered incorrectly into the UK’s medical system.

A class-action lawsuit is filed against St. Joseph Health System (CA), which in 2011 accidentally released information on 31,800 patients. At the time of the breach, personal and medical information stored in unencrypted electronic reports were searchable online. The suit seeks $31.8 million, following California’s mandatory damages of $1,000 per affected individual.

Weird News Andy spotted this major breach news. An IT tech’s weak server password allows European hackers to penetrate a Utah Department of Health Medicaid claims server, where they download thousands of files covering nearly 900,000 individuals, of which 280,000 have their Social Security numbers stolen. Here’s an interesting quote from RSA’s CISO:

Why do we continue to see these large aggregate databases? Why should hackers be able to steal 10 million credit card numbers or 700,000 personal records at once? We need to think about distributing that information so that when networks do get penetrated, we’re not looking an all-or-nothing situation.

WNA also likes this story about the geriatric ED at Mount Sinai Hospital (NY), of which there are several dozen nationally. He’s a bit creeped out by the dome in the photo, saying it reminds him of Edward G. Robinson in Soylent Green.

A state audit of SUNY Downstate Medical Center finds that only 10 of its 200 departments are using the $2 million purchasing system it implemented over a four-year period.

A Time article says that cash-strapped universities, following the lead of for-profit schools, are cranking out high-margin professional certificate programs that are attractive to mid-career students who don’t need financial aid or whose employers reimburse them. Healthcare technology management was mentioned. Experts question the quality and the career value to students.

HealthPrize Technologies, which encourages medication adherence through online games and rewards, brings on new staff to support what it says is major growth. Founder and CEO Tom Kottler’s first startup was revenue cycle vendor MedAptus.

The CEO of Sony, which just announced a $6.4 billion loss for the year, says the company may get into the medical products business.

Jack Tramiel, who bought a typewriter repair shop and turned it into Commodore, the company whose early computers (VIC-20, PET, Commodore 64) helped make home computing popular, died this week at 83.

The CEO of Henry Ford Health System (MI), reporting a 64% decrease in net income to $22 million, calls the past two years “transition years” as the organization spent $300 million on Epic less than a year after going live on its $100 million homegrown system.

Four former executives of iSoft, including former chairman Patrick Cryne, will be tried in the UK, charged with making intentionally misleading statements to inflate the company’s financial position.

An attorney and former employee of the Austin, TX-based Cancer Connection volunteer program sues her former employer for wrongful termination, saying the organization ignored her strong warnings that it needed to implement HIPAA training and to stop giving volunteer-prepared baked goods to cancer patients. One of the organization’s founders and board members, known as “the brownie lady,” told her the baked goods policy would not be changed.

Sponsor Updates

• In Turkey, Emsey Hospital implements iMDsoft’s MetaVision in its ICU.
• Culicchia Neurological Clinic (LA) selects SRS EHR and Patient Portal for its 17 providers.
• MEDecision announces details of its Client Forum 2012 conference May 1-4 in Philadelphia.
• Liaison Technologies completes all milestones required as part of a $30 million investment from Merck’s Global Health Innovation Fund.
• Kony Solutions appoints Harold Goldberg (Merced Systems) its chief marketing officer.
• Raymond Gruby MD, FACS, chief medical officer at Intelligent InSites, will present a session on RTLS in medicine at this week’s meeting of the SD/ND chapters of the American College of Surgeons.
• MEDSEEK and Microsoft co-host an April 12 Webinar explaining why healthcare reform strategies will fail without patient engagement.
• Kareo launches a Resource Center that includes webinars, white papers, and educational videos.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

3M Acquires CodeRyte

3M announced this morning that it has acquired CodeRyte, which offers natural language processing and computer-assisted coding tools. 3M has offered CodeRyte’s computer assisted coding products to its own customers since 2009.

CodeRyte offerings include Health System Coding (natural language processing and coding workflows); CodeAssist (automated coding using extracted text from physician documentation); CodeComplete (outsourced coding services); and DataScout (analytics using information extracted from both structured and unstructured records.)

3M Health Information Systems VP/GM Jon Lindekugel was quote as saying in the announcement, “This acquisition allows us to apply CodeRyte’s leading edge NLP technology to our new 3M 360 Encompass System. We believe CodeRyte’s powerful NLP engine combined with 3M’s deep expertise in coding, reimbursement and patient classification will foster further innovation in the application of NLP.”

CodeRyte’s 130 Bethesda, MD-based employees serve 250 customers, which the company says represents 85% of academic medical centers that use computer-assisted coding.

Monday Morning Update 4/9/12

From N2InformaticsRN: “Re: UCI Medical Center. Developed a program to bring staff nurses into the field of nursing informatics in support of their EMR implementation. It uses ONC’s Health IT Workforce Curriculum as its core.” Above is the video explaining the program.  

From El Pescador: “Re: HITECH incentives. I don’t disagree with you often, but I do this time. We are one of the systems that is going to get a ‘windfall’ in MU money without significant investment. Where I take issue with your response is that when the looming reductions in reimbursement are taken into account – surprise – it’s almost dollar for dollar. Zero sum game for our organization. Perhaps others don’t find themselves in the same boat. Enjoy your website immensely … best source of info in the industry.” I think my point is still valid. CMS may indeed take your money elsewhere, but that was not related to your unrestricted HITECH “grant.” Without it you would be in the hole rather than even. It’s like winning $2,000 on a scratch-off lottery ticket but blowing your car’s transmission at a repair cost of $2,000 on the way to cash it in. You still won the lottery, and the repair was going to cost you $2,000 in any case. WildcatWell’s original question was: is it fraud when providers use a free EHR to earn HITECH money? Answer: no, there is no requirement to spend anything to earn an MU check. Most providers will indeed spend money (and sweat) to earn their payout, but that’s between them and their vendor … Uncle Sam doesn’t care when he writes the check.

From WildcatWell: “Re: Jason Dufner. Would a Masters win bolster his sponsor’s footing? Doubt it. At Augusta, a Greenway label comes across like a landscaping company. Wasted marketing dollars.” Above is an Associated Press photo of him after the second round with the Greenway logo on his shirt. Like NASCAR drivers and football coaches, life is good when you get big paychecks just for wearing logo apparel in public. I don’t know how you’d calculate the ROI on wearing a PM/EMR logo in front of a golfing audience, but I assume there’s leverage opportunities with prospects who enjoy watching someone else play golf.

From Fish: “Re: Epic’s 2006 ambulatory sale to Capital Health in Edmonton, Alberta. Whatever happened to it?” Beats me. Readers?

Imprivata provided a response to 1Sign’s unverified rumor about Dell having discussions with the company about an acquisition. Here it is: “Not true.”

Our judicial handicappers expect the Supreme Court to strike down just the insurance part of the Affordable Care Act, with equal minorities saying it will be all or none. New poll to your right: how much impact will the JOBS Act have on healthcare IT startups and innovation?

In case you don’t know what the JOBS Act is, here’s a CliffsNotes version. The JOBS Act, signed into law last week, makes it easier for small business startups to raise investment capital. Anybody can offer the general public shares in their venture, which was previously illegal (investors had to be accredited, i.e. wealthy and vetted, before being allowed to buy their way in.) The new law lets anyone invest and allows early-stage and tiny companies to solicit investors, even via Web-based “crowdfunding.” On the downside, amateur investors are on their own to perform due diligence, some shaky companies are now going to be free to pitch to investors, and lawyers will probably make a fortune as would-be CEOs and their unsophisticated investors butt heads. The hope is that small businesses can grow faster with easier access to unrestricted capital, allowing them to hire employees earlier than they would have otherwise.

An article in Clinical Pharmacology & Therapeutics called Electronic Health Records: The New Vehicle for Drug Labeling, Safety, and Efficacy by Ed Fotsch MD, CEO of PDR Network, proposes that services like those offered by his company could increase safety and decrease liability by delivering up-to-date drug labeling, REMS, and adverse event reporting right to individual provider EMRs. It finds from its own database that 25% of brand name drugs have clinically significant changes in their professional labeling each year, meaning that paper-based literature used to make clinical decisions is often obsolete. The problem: most EHRs don’t have the capability to electronically receive these alerts and confirm receipt. The article also says that EHRs could be used to file adverse drug event reports with the FDA and improve patient adherence.

Note: I come home straight from work on Tuesdays and Thursdays and jump right in to spend an unbroken 4-5 hours writing HIStalk and I’m up pre-dawn the next day to go to work. Therefore, I will rarely be able to reply to any Tuesday or Thursday e-mail until the next evening at the earliest. Re-sending the e-mail doesn’t do anything except clog my inbox even further. I always catch up, but it takes time.

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

Law firms are using California’s Confidential Medical Information Act of 1981 to file profitable class action lawsuits against providers, who are required by that law to pay $1,000 for each person whose information is exposed. The article says McKesson lobbied to have the damages clause removed retroactively about a year ago, but failed. Courts will need to decide whether the law is appropriate since when it was written in 1981, breaches were both rare and small, but today a single breach could result in millions of dollars in payments, which the lawyers find irresistible. 

E-mail Mr. H.

The Healthcare IT Week in Review

1. Newt’s Think Tank Tanks

Facts and Background

The Gingrich Group LLC, doing business as the Center for Health Transformation, filed for Chapter 7 liquidation after struggling to maintain relevance once founder and former Congressman Newt Gingrich resigned last spring to run for the presidency. The for-profit group offered its strategic services to healthcare companies whose products and services addressed Gingrich’s big ideas themes, including healthcare IT. The company had pulled in $55 million by charging companies such as Blue Cross Blue Shield, Allscripts, HealthTrio, and VISICU up to $200K per year to gain access to Gingrich and his contacts.

Opinion

CHT was not illegal, just distasteful. It’s satisfying that it went down in flames, but unfortunately Pilot Newt had already done a DB Cooper and bailed out with the money. It’s too bad that the smoking wreckage still had employees who lost their livelihoods because Newt decided to run an unsuccessful political campaign, not to mention surprising that he didn’t just end his presidential run and go back to the one thing he’s been really successful at — selling his influence. It’s too bad that he presumably had at least some hand in  getting the $19 billion HITECH package inserted into the stimulus bill.

Musings

• CHT was like William Shatner signing autographs at Star Trek conventions. If you wanted Newt’s attention, it was going to cost you.
• Unlike Shatner, CHT claims it wouldn’t accept money from anyone whose agendas didn’t align with Newt’s, but offered no proof that Newt’s rich man’s club had standards that exceeded passing a mandatory checkbook inspection.
• Newt’s loyalties were apparently available even when for issues that would not typically enjoy widespread Republican support, such as pushing federally subsidized EMRs and mandatory health insurance.
• One of CHT’s most controversial clients was Freddie Mac, which paid CHT $1.6 million to advise it on potentially troublesome new Congressional regulation. He claimed he was hired as a historian, which probably encouraged historians everywhere to offer their services as a slight discount. Freddie Mac’s bailout will cost taxpayers up to $360 billion.
• Newt was adamant that CHT did no lobbying, which was critical to preserve his presidential run. That’s probably legally correct, but the average citizen would find it hard to believe that paying a former Speaker of the House to make introductions to his political pals and and to pitch client offerings in Washington isn’t pretty much the same thing.
• In a fit of stimulus schizophrenia, Newt called the stimulus package a “big politician, big bureaucracy, pork-laden bill” that should be stopped, but lauded the HITECH part of it that benefitted his clients as “a key part of the stimulus package.”
• After the stimulus bill passed, CHT set up regional meetings called the “EHR Stimulus Tour” with Allscripts and Microsoft, urging doctors to implement EHRs to get their taxpayer payouts.
• While running CHT, Newt kept popping up like Where’s Waldo at Washington events and even on the Capitol floor, but his former colleagues never questioned why he was entitled to have that access. Some said later they didn’t realize CHT was a for-profit organization, assuming from its name that it was a non-profit think tank with purely altruistic interests.

2. CSC: Pardon the $30 Billion UK Black Hole –What US Healthcare Needs is Lorenzo

Facts and Background

Government consulting CSC, a key player in the massive NPfIT failure in the UK, says it will use the lessons learned there to launch its Lorenzo product in the US.

Opinion

Choose your site visits carefully.

Musings

• CSC bought iSoft a year ago when that company, which was also the key supplier in CSC’s NPfIT contract, was about to go belly up after huge losses and government financial investigations.
• iSoft had a long record of missing its NPfIT dates, although it was an awkward arrangement between CSC as the contractor and iSoft as its most important provider.
• Once NPfIT was shut down, individual trusts could decide whether they still wanted the previously mandated Lorenzo. Many didn’t.
• When the UK government talked about the money that could be saved shutting down NPfIT, CSC said it would sue the government since it had spent $1.5 billion trying to get Lorenzo running in England and was planning to make an extra $3 billion for the planned one-year extension.
• The company’s UK problems triggered layoffs and investor lawsuits.
• CSC joins every other NPfIT contractor and supplier in nearly going under after winning what seemed like a windfall NPfIT business, but accepting such hardball contract terms that they couldn’t deliver.
• CSC named former Misys PLC CEO Mike Lawrie as president and CEO in February.
• Shares are worth half what they were five years ago.
• A key CSC healthcare acquisition was First Consulting Group in 2007 for $365 million.
• Much of the reason US vendors such as Cerner have struggled in the UK is because of localization issues, trying to get software designed around US healthcare processes to work elsewhere. Lorenzo will have the same challenge in reverse here.
• All that said, it will be fun to see if Lorenzo is competitive with the usual suspects (Cerner, Meditech, Epic, etc.) and whether CSC will offer a wide range of department and financial systems instead of just clinical systems. The market could use another choice.

3. Data Entry Error Kills Baby, Costs Hospital $8 Million

Facts and Background

Advocate Lutheran General Hospital (IL), which admitted that a pharmacy technician’s IV machine data entry error in 2010 killed a baby, settled the family’s lawsuit for $8.25 million last week.

Opinion

Many hospitals have electronic interfaces that connect their pharmacy system to their IV manufacturing systems. Why didn’t Advocate? Hospital system vendors often consider such interoperability only begrudgingly since there’s no benefit to them other than keeping clients happy, so it would be interesting to know whether that option was available.

Musings

• IV room automation is perhaps the least-understood, yet most patient-impacting technology a hospital owns. The final product is a clear solution that may or may not contain the intended contents in their correct amounts, and mistakes are often deadly and undetectable.
• IV compounder data entry errors are not uncommon, just not commonly reported and not always fatal. Any time you have people keying highly critical numbers into a machine there’s a good chance that they will eventually mess up. Allowing this work to be performed by unlicensed personnel is not a good idea, but the reality is that anyone – licensed or not – could have made the same mistake.
• IT departments are usually at least slightly involved in IV compounders because they require a server, but often they stop there and assume the pharmacy department knows what it’s doing.
• Potentially life-saving alerts on the compounder were turned off, but activated after the fatality.
• A lab tech sealed the baby’s fate by assuming that his high serum sodium level was a mistake, rather than what it really was – the last chance to catch the IV error before it was too late.
• Some clueless critics blamed CPOE for this error. That had nothing to do with it – the order was entered correctly by the prescriber and the pharmacist in the CPOE and pharmacy systems, respectively. It was the sometimes forgotten but most important step of actually preparing the ordered dose for the patient where things went horribly wrong.
• CIO lesson learned: don’t assume the world revolves around big-iron IT systems. Go to the sharp end of the stick (on the nursing stations, ED, and particularly high-acuity areas like the OR and ICU) and see what gets put into patients. Then track it backward to see where it comes from. Technology could be increasing the chance of mistakes, or it could offer opportunities to reduce them. Serious patient drug harm is rarely caused by drug ordering (which is where IT systems focus), sometimes caused by drug preparation, and often caused by drug administration.