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.

News 4/6/12

Top News

From the earlier news blast: The Gingrich Group LLC, doing business as the Center for Health Transformation, has filed for Chapter 7 bankruptcy in a Georgia court. The for-profit organization, which makes up the majority of Newt Gingrich’s net worth in the form of money it owes him for his share of ownership, struggled to survive after Gingrich resigned as its chairman last year to run for the presidency. The organization listed its assets as less than $100,000, with liabilities stated as $1 million to $10 million. Several healthcare IT companies are listed among its creditors, including Cerner, Greenway, and Health Trio.

My initial reaction to CHT’s tanking:

1. So much for pretending that Center for Health Transformation was anything more than a way for Newt to sell his political influence to high-paying vendors under the guise of healthcare advocacy. The business folded almost immediately once he quit to run (badly) for the presidency.
2. How could CHT owe vendors money? Membership refunds? Or maybe the value of services not yet rendered?
3. Thanks to immediately available electronic images of the bankruptcy filing, you can learn Newt’s home address and read a list of the CHT staff members getting stiffed, like the recently hired project assistant who left her Dress Barn sales job to work there.
4. There weren’t many employees left by the time the bow slipped beneath the waves since most were apparently smart enough to have abandoned ship as soon as Captain Newt sailed off in his political life raft.
5. The most surprising aspect: why doesn’t Newt pump a few dollars into CHT to keep his seat warm since he’ll be needing a job shortly? That one seemed to have compensated him very well. Maybe political jab-taking had tainted the CHT name and his involvement to the point it was more of a liability than an asset.

Reader Comments

From 1Sign: “Re: Dell. After the Wyse acquisition, Dell is in discussion with Imprivata to complete their Mobile Clinical Computing solution. Imprivata is the last major SSO vendor not acquired and the Board is pressuring the leadership team.” Unverified.

From Rommel: “Re: shakeup coming at [vendor name deleted.] One executive gone in some manner, just the beginning. Q1 numbers are way off and the CEO is on the hot seat and may be clipped shortly.” Unverified, so I’m not comfortable naming the company. I would say the mood there probably is tense, though.

From Boston: “Re: Partners HealthCare. Enterprise-wide EMR decision has been postponed until later in the spring, probably June.” Unverified.

From K-Federal: “Re: [practice EMR vendor name deleted.] Heard from two reliable sources that it’s on the block to either Greenway or Allscripts.” Unverified, so again I’ll omit names. We snooped around a little and nobody’s talking, which may or may not mean anything. Supposedly a significant investor in the company may be selling some of its stake, but maybe there’s more to the story.  

From Loquacious: “Re: Vitera. Lee Horner is no longer listed as SVP of sales and marketing on their site. Is he still there?” His LinkedIn profile says he’s still there, although I’ve found that people often forget to keep those current when they change jobs.

From WildcatWell: “Re: HITECH incentives. If an EHR vendor offers their system as ‘free’ and a subscriber then demonstrates MU and pockets $44K, that’s not a cost-offsetting incentive, it is stealing from taxpayers. Where is the taxpayer outrage? Is anyone policing this stuff?” HITECH doesn’t require a provider to spend one penny to collect their check. Meaningful Use money is not a rebate or subsidy – it’s just free money from generous taxpayers helping subsidize some high-earning professionals and organizations. Practices or hospitals that are running systems they bought years ago get a surprise windfall, although they might have to use those systems more intensely to qualify. Enjoy that thought as you send in your tax form and as you watch the national debt rise from $16 trillion to who knows where as politicians bribe us with our own taxpayer dollars not to touch our Medicare, welfare, and social security. In the likely event that elected officials won’t suddenly grown spines, you just may get to see Greece-style fiscal meltdown and near-anarchy first hand without the pesky jet lag.

HIStalk Announcements and Requests

The latest and greatest from HIStalk Practice: CMS extends the deadline for EP Meaningful Use eligibility appeals. CareCloud’s Albert Santalo says the new JOBS bill may help his company go public sooner. E-prescribing payments jumped 83% and PQRS grew 65% between 2009 and 2010. Medical schools teach students how to stay connected with patients while using HIT. Dr. Gregg ponders whether the clinical narrative is really dying.  Julie McGovern of Practice Wise offers some great tips for successful EMR implementations and their ongoing success. None of these goodies can be found on HIStalk, so make sure you are receiving and reading your HIStalk Practice. Thanks for stopping by.

On HIStalk Mobile, Dr. Travis covers incubator Healthbox’s investor day.

Listening: Mew, brilliant, dreamy alt rock (or is it progressive?) from Denmark that’s reminiscent of Muse or Sigur Ros. If you like complex, almost orchestral music like early Genesis or Yes minus the overwrought excesses, they’ll hook you right in. Amazing stuff that you can feel smugly superior having discovered when nobody else has heard of them. And sometimes people ask what series I like on Netflix, so here’s what I’m watching at the moment: Frasier, Peep Show, and The Killing. Since I have 60 minutes of free time at most per day and that’s only if I sleep less than six hours, those will take awhile to finish.

On the Jobs Board: Soarian Clinical and Financial Go-Live Support, Epic and Cerner Resources, NextGen Go-Live Support. On Healthcare IT Jobs: Manager IS Enterprise Systems, Epic Principal Trainers, Technical Project Manager.

Acquisitions, Funding, Business, and Stock

TriZetto will build its new $40 million headquarters building in the Denver area, giving it space to house up to 750 jobs over the next five years.

CSC, trying to minimize the billions worth of damage it took from the NPfIT fiasco in England, now says it will use the knowledge it gained there to launch iSoft in the United States. A freelance journalist writing for ComputerWeekly doesn’t mince words in expressing his thoughts:

But from whence had its chutzpah come? Not only had CSC still not satisfied its NHS contract, it hadn’t even finished writing the software. Initial roll-out was due in 2007. Complete delivery was due this year. Hains told Wall Street CSC was now at last ready to roll out phase one but for a contractual settlement with the UK’s coalition government. But this was okay. Because CSC had a plan. This was not a plan for the reparation of 10 years of time and money the NHS has wasted on CSC. Nor was it a plan to recompense for the opportunity cost the NHS incurred while CSC dawdled over its clinicians’ request for better patient information. It was a plan to get its own finances in order, negotiate a firm settlement with the NHS and dazzle Wall Street with a come-back launch into what is tipped to be one of the few global growth markets: healthcare IT. Wall Street analysts privileged with the opportunity to ask Hains about this glorious transformation neglected to get his estimation of the value the British public subsidy had added to his corporation’s healthcare business in the last 10 years. British tax payers are due a share of this tremulous global growth machine, no?

Sales

Jefferson Radiology (CT) will implement TeraMedica’s Evercore Smartstore DICOM module at 11 regional imaging facilities.

Lutheran Medical Center (NY) will deploy PatientKeeper charge capture software.

People

Jean Schat, former of Curaspan Health Group, joins PerfectServe as a VP of sales.

South Dakota-based FQHC Horizon Health Care promotes Gin Wingen to director of clinical informatics.

Announcements and Implementations

The statewide ConnectVirginia HIE goes live with DIRECT messaging, free to registered providers through April 1, 2013.

Hurley Medical Center (MI) goes live on its $40 million Epic system.

Allscripts releases Wand, a native iPad app that extends functionality of its Professional and Enterprise EHR solutions.

OTTR Chronic Care Solutions launches OTTRbmt, a patient management system for bone marrow transplant centers that manage patients long term.

In Iowa, University of Iowa Health Care and Mercy Medical Center of Cedar Rapids announce plans to collaborate, including creating an Medicare ACO. UI Health Care, which has been live on Epic for more than three years, will help Mercy with its Epic implementation when it gets underway this summer. The organizations say they will use Epic to share information once Mercy is live.

Government and Politics

Members of the HIT Policy Committee express concern about several aspects of the proposed Stage 2 MU regulations. Specific issues:

• Requiring 10% of patients to receive secure electronic messages is too high.
• Public health agencies are not ready to receive electronic data.
• Communities with one dominant EHR vendor may make it difficult for providers to electronically exchange 10% of transition care summaries to other organizations on a different platform.
• Too many of the measures require EPs to collect data.

Innovation and Research

AHRQ is conducting a study about its offerings and is interested in talking to high-level professionals who either (a) develop health IT tools for patients, or (b) work for organizations that select those tools (hospitals, practices, health plans, government purchasers, etc.) They’re doing 90-minute interviews from mid-April through mid-May. Participants will be compensated for their time. If you’re interested, contact Jonathan Wald MD, MPH, director of patient-centered technologies the Center for the Advancement of Health IT for non-profit RTI International, which is working with AHRQ.

Other

A new KLAS report says that Cerner, Meditech, and Siemens are the only HIT vendors that provide their solutions to all world regions. Most purchasing activity is centered in Asia, the Middle East, and the UK. Few sites outside of North America are doing deep clinical adoption, largely due to economic and governmental challenges.

Weird News Andy wants to know if this is where we’re going. In the UK, a surgical practice drops an 83-year-old patient they had been treating for 30 years because of “green travelling issues” that make it “advisable to register at surgeries nearer to where they live.” The distance from her house to the office that raised the carbon footprint concerns: two miles. The woman thinks she was sent packing because she complained about a doctor.

Advocate Lutheran General Hospital (IL) settles for $8.25 million in a lawsuit brought against it after the death of a 40-day-old premature baby in 2010, caused by a pharmacy technician who incorrectly entered a post-op order into the IV compounder that overdosed the baby on 60 times the intended amount of sodium chloride. The hospital admitted that the compounder had the capability to issue automated warnings about potential entry errors, but they were turned off.

I’ve seen this several times recently at work. Someone who is offsite “attends” a meeting remotely by getting someone to conference them in on speakerphone. Everybody in the room forgets that person is on, and when the meeting is over, everybody walks out (more like “sprints” if the meeting was soul-sucking, as is often the case.) The person on the line, who has muted their phone in order to sleep or mow the lawn or whatever, finally pipes up, only to realize that a new group has taken over the conference room.

Adam Gale posts on KLAS’s blog about a Cerner turnaround that has moved them up the KLAS rankings from seventh to second in the past four years. He credits a new leader or two at Cerner, but I’ll offer my more cynical analysis: they didn’t have a choice unless they wanted to hand the keys to Neal’s soccer team over to Judy Faulkner, because Epic was tearing them a new one.

Sponsor Updates

• CTG Health Solutions announces an extension of its stock repurchase plan.
• Practice Fusion announces plans to add drug formulary and clinical messaging functionality to its EHR.
• Elsevier releases its 2012 spring eLearning schedule, which includes a revised ICD-10 Readiness Assessment tool.
• Premier Healthcare Alliance adds MedPlus to its ambulatory EMR software agreement portfolio.
• Kokua Kalihi Valley Comprehensive Family Services (HI), a FQHC, selects the e-MDs EHR suite for its 13 providers.
• Memorial Health System (CO) realizes a $2 million savings within three months of joining the MedAssets GPO.
• Mike Mistretta, CIO of MedCentral Health System (OH) details how his hospital’s use of SIS in the OR has provided data to control costs and improve efficiencies.
• Bill systems vendor AdvancedMD integrates its product with RaomSoft’s RIS/PACS.
• Aspen Advisors releases a case study on its work helping Akron General Health System (OH) develop an ICD-10 project management office.

EPtalk by Dr. Jayne

It’s all about the data. Studies indicating a decline in hospitalizations and deaths from pneumonia over time may not be due to better care, but rather a change in coding practices. Investigators propose that the coded diagnosis of pneumonia often took a back seat to sepsis or respiratory failure. As one who stalks the hospital floors, I know this to be true. We’ve been increasingly pushed to put more significant diagnoses first in our problem lists and discussions to indicate more complexity and support higher reimbursement. I wonder how the data would skew under the constraints of ICD-10?

It’s all about the audience. A recent study in the International Journal of Medical Informatics finds that EHR medication alerts are geared around how pharmacists think rather than prescribers – typically physicians and nurse practitioners. Alert fatigue is a constant danger and the authors recommend that alerts should leverage patient labs, balance the strengths of automation with human cognition, and support both pharmacist and non-pharmacist prescribers. My favorite of their recommendations: reduce alerts that contradict broadly accepted clinical practices. I hope this initiative succeeds, although I might be at risk for missing the lovely alerts that warn me that the diabetes medication I’m prescribing “might lower blood sugar.”

It’s all about perception. The New York Times publishes a piece about dressing for success. When subjects were told white coats they donned belonged to doctors, their attentiveness increased. When they were told the coats belonged to painters, no improvement was noted. The new phenomenon is being called enclothed cognition (the effects of clothing on cognitive processes.)

Speaking of dressing for success, one colleague shared news that her employer (a prominent health system) recently changed the dress code for physicians in response to patient satisfaction surveys. Previously recommending that neckties be avoided due to infection concerns, they have reversed course to now require them for male physicians because of a patient marketing survey that indicated that physicians with ties were viewed more favorably. Female physicians are not allowed to wear dresses without stockings or hosiery – no bare legs. I wonder what’s next – will they put nurses back in caps?

Being a patient and also a family member of patients myself, I take particular offense at one of their new rules – requiring surgeons to change into street clothes before they speak to a family after surgery. Nobody wants to be confronted with bloody scrubs (a true rarity) but I for one don’t want them wasting time changing clothes to come out and talk to me in the operating room waiting area. Just put on a cover gown or a white coat and come tell me what happened and how my loved one is doing.

Speaking of scrubs, Nurse TECH Talk launches its Most Bodacious Scrubs Contest. Entrants must join HITR and submit a picture of a bodacious scrub top to be in the running for the $100 gift card prize. I’ve got a crazy one that I’ll post just for fun if I can find it – on a transplant mission a few years ago it somehow made it into my bag because it was simply too strange to be believed. Think Nurse Chapel on the original Star Trek.

I’m happy to be surrounded by smart people and Weird News Andy is one of them, educating me on Wickard v. Filburn as the depression-era case responsible for Justice Breyer’s comments on growing wheat and its relationship to interstate commerce regulations. He also cites that decision as “a stretch worthy of Mrs. Incredible,” which made my day. Jonathan H. also commented that the home marijuana growing comment related to another precedent. Some happy Googling reveals that case to be Gonzales v. Raich.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Gingrich’s Health IT Group Files for Liquidation

The Gingrich Group LLC, doing business as the Center for Health Transformation, has filed for Chapter 7 bankruptcy in a Georgia court. The for-profit organization, which makes up the majority of Newt Gingrich’s net worth in the form of money it owes him for his share of ownership, struggled to survive after Gingrich resigned as its chairman last year to run for the presidency.

The organization listed its assets as less than $100,000, with liabilities stated as $1 million to $10 million.

Several healthcare IT companies are listed among its creditors, including Cerner, Greenway, and Health Trio.

Healthcare IT from the Investor’s Chair 4/4/12

From a recent HIStalk post:

Facts and Background 
Shares in mobile healthcare communications Vocera jumped almost 50% in their first three days of trading after Wednesday’s initial public offering, opening at $16 and closing Friday at $23.40.

Opinion 
The company either priced its shares incorrectly or intentionally undervalued them to create positive press from the price run-up. Either way, investors and not the company pocketed the $41 million price difference in the 5.9 million shares offered. Still, the company was smart enough to up the originally planned $12-14 price. A $100 million IPO yield is impressive for a company that isn’t all that widely known and that lost money in FY2011.

Sorry, Tim, not sure I totally agree with this assessment. 

With the benefit of hindsight, Vocera and its underwriters did under-price its IPO, but there’s no way to predict how a company will trade once it’s public. See my earlier post on the full mechanics of how companies go public here, but recall that the underwriters (led by JP Morgan and Piper Jaffrey in this case) had to take their best guess on how much investors would pay for Vocera stock at the time of pricing. The initial filing range is an even broader guess (albeit an informed one, based on how comparable companies are trading).

As the roadshow continued, there appeared to be more buyers than sellers (the offering was over-subscribed) so the underwriters raised the pricing range. Throughout the roadshow, JP Morgan built an “order book,” where each investor (typically mutual, pension, and hedge funds) indicated how much stock they would buy at any given price. Clearly the Vocera IPO was multiple times oversubscribed, which is the goal.

The art of pricing (and it does seem to be more art than science) is using that information to set the initial offering price. Too low and you’ve left money on the table (as VCRA apparently did). Too high and not enough funds purchase once the stock trades in the aftermarket and instead simply dump their shares rather than build a larger position. This results in the stock trading down and embarrasses and annoys all parties involved.

The trick here is balancing supply and demand precisely and in real-time and with very imperfect information (as investment funds don’t always reveal their intent, either). It’s interesting in that it’s one of the few businesses where the price of the product is directly affected by the customer to whom you sell.

That said, it’s also worth noting that underwriters have multiple incentives, and it’s not always clear who the client is in these situations. On the one hand, because they’re getting a 7% fee, they have a definite motivation to maximize the initial stock price. By pricing at $16 rather than $23.40, they missed around $3.5 million in fees.

On the other hand, any given fund can easily pay 10x that in commissions any given year, so there are those who feel that banks have an obligation to take care of their trading clients more than their underwriting clients. Suffice to say, there’s more than a little dynamic tension between different parts of the firms, but in my experience, pricing for a successful offering trumps the desire to maximize the fees for the specific deal under consideration.

As an aside, I believe the positive press effect is less the case now than during the dotcom days and not a motivator for either issuing companies or their underwriters.

One way of avoiding this phenomenon of under-pricing IPOs is by using what is known as a DutchAuction, which arguably creates the most efficient price. In 1998, an investment bank called WR Hambrecht began trying to use this method to price IPOs, calling it OpenIPO. With the notable exception of Google, it never really caught on. (I’ll try to do some research as to why for a future note, but I assume typical issuers remain risk averse and prefer the tried and mostly true IPO method.)

Because insiders rarely sell at the time of an IPO (and be careful if too many are doing so), it’s not as if management or the venture capitalists involved have a personal stake here, either. Further, in the long run, pricing the IPO with perfect accuracy just isn’t viewed as that important relative to the benefits of assuring a successful offering with a healthy balance sheet, good research sponsorship, and long term investors for the future .

Ben Rooks, founder of ST Advisors, spent ten years as an equity analyst, six years as an investment banker, and is now much happier (and adding more value) as an independent advisor to HCIT companies. He loves questions and feedback on his column. Incidentally, ST Advisors is pleased to count Vocera as a former (but not current) client.

News 4/4/12

Top News

A National eHealth Collaborative paper says that HIEs have great potential to improve care and reduce cost, but despite ONC emphasis and incentives, not a lot of value has been realized so far. Big issues remain funding, provider adoption, and difficulties connecting to the wide variety of available EMRs. They recommend focusing on patients above all else, build trust and a common vision among participants that often don’t particularly like or trust each other, ignore “one size fits all” proposals and listen to what the local community wants, and figure out how to make money once the grants run out.

Reader Comments

From Hardware Sue: “Re: Navin, Haffty & Associates. Heard that Park Place International is looking to buy them out.” Not true, NHA President John Haffty tells me. Park Place has expanded its technical offerings related to Meditech and NHA has collaborated with them on projects and will continue to do so since their work is complementary, but no acquisition-related discussions have been held or encouraged. Per John, “We have great respect for the old and new team over at Park Place, but we are committed to maintaining our independent status.” Norwell, MA-based NHA offers consulting services exclusively for Meditech customers.

From JayGlo: “Re: security testing firms. Know any that specialize in EHRs in general and Epic in particular? Who are the best white hat hackers?” I’ll defer to readers – leave a comment if you have suggestions.

From ForthePatients: “Re: Tampa Bay RHIO. Work has been dragging in the swamp for almost five years with a long list of special interests – academic medicine, lawyer, homegrown exchange vendor, and hospitals interested in connecting to their own practices. Who controls what is clearly a the crux of this one and not a focus on the patients or the community.”

Acquisitions, Funding, Business, and Stock

Santa Rosa Consulting announces that it has completed its acquisition of Nashville-based healthcare IT consulting firm InfoPartners.

Charge master vendor Craneware opens an office in Scottsdale, AZ.

Merge Healthcare shares dropped 16% on Tuesday after the company filed an SEC 8-K form indicating that a $2.75 million sale of kiosks was to higi LLC, a company founded and controlled by Merge Chairman Michael Ferro. Merge’s audit committee had cleared the sale. Merge topped the biggest percentage price decliner on Nasdaq list, shedding nearly $90 million of value for the day.

Sales

Cooper University Hospital (NJ) signs a three-year agreement with Newport Credentialing Solutions for its reporting and analytics software and back office credentialing solutions.

Southeast Michigan Beacon Community selects Covisint’s accountable care technology to aggregate regional health information.

DuPage Medical Group (IL) selects Humedica MinedShare to provide clinical benchmarking and analytics from its Epic EMR.

Einstein Healthcare Network (PA) licenses business analytics and patient financial services solutions from Streamline Health to monitor and drive revenue cycle performance in its 1,000- physician ambulatory care network.

Mount Sinai Medical Center signs with Siemens MobileMD for an HIE service agreement.

People

Cognosante names Eileen Cassidy Rivera (Vangent) as VP of marketing and communications.

Former Cigna VP of IT Marcus B. Shipley joins Trinity Health (MI) as SVP and CIO. He  replaces Paul Browne, who has been named Trinity’s SVP of integration services.

Nashville-based The Rehab Documentation Company, which sells therapy documentation systems, names Antoine Agassi as president and COO. He comes from Cogent Healthcare and was previously chair of Tennessee’s Governor’s eHealth Advisory Council and held executive roles at Spheris and WebMD Transaction Services.

Announcements and Implementations

Southeastern Med (OH) hosts a midnight ribbon cutting ceremony to officially launch its Meditech go-live.

West Calcasieu Cameron Hospital (LA) launches bedside bar code verification with McKesson’s Horizon Admin-RX.

Biggs-Gridley Memorial Hospital (CA) goes live on the Prognosis ChartAccess EHR.

Humana Cares completes installation of a 1,600 monitoring devices for a telehealth pilot project, where nurses will remotely check the vital signs daily of CHF patients in hopes of decreasing hospitalization. The project uses the Intel-GE Care Innovations Health Guide, a blood pressure monitor, and scales.

Government and Politics

A bipartisan group of House and Senate lawmakers introduces a bill proposing to link the prescription drug monitoring programs of individual states, allowing prescribers to look for patterns of prescription drug abuse across state lines.

VA CIO Roger Baker says the $4 billion joint VA/DoD EHR system could be available by 2014 and will be piloted at military installations in Hampton Roads, VA and San Antonio, TX.

The VA cancels its Software Assurance agreement with Microsoft covering its 300,000 users, giving the agency flexibility in seeking non-Microsoft alternative technologies, such as tablets and cloud-based systems.

The Coast Guard prepares to go live on its Epic-based EHR. It plans to provide mobile access via cellular network and to run cached copies of information from its vessels, which often do not have connectivity. The Coast Guard is looking for companies to provide service desk support.

Innovation and Research

A study performed in large UK teaching hospital finds that off-hours clinician response and satisfaction improved when pagers were replaced with wireless call handling and task management. Tasks were logged on a PC that sent messages to a coordinator’s tablet, who then routed the tasks via text message to on-call phones. Users liked the improvement in handoffs: task prioritization, the ability to monitor task assignment and completion, and elimination of handwritten notes.

Technology

Rochester, MN-based mobile healthcare apps vendor Preventice, partly owned by Mayo Clinic, expands into the medical device business with BodyGuardian, a diagnostic heart and respiratory monitor that patients can wear during normal activity. The company says the final product, when approved by the FDA, will be just 8×8 mm in size (about a third of an inch high and wide) and will attach like a Band-Aid for up to seven days, sending the physician a text message and EKG by Bluetooth when it detects cardiac events. The company plans to hire 15 employees and will move to new headquarters in Minneapolis.

Microsoft announces the 11 startups chosen from 500 applicants that will participate in its 2012 Kinect Accelerator. Among them are GestSure, which creates touchless interfaces for surgeons and interventional radiologists; and Jintronix, a virtual reality rehabilitation system for patients with motor control problems.

Other

The University of Arizona Medical Center will replace Allscripts and iMed with Epic at its two hospitals and outpatient centers. The project will cost $100-135 million, will require 87 full-time employees over the next three years, and will involve providing 12 hours of training to each of 6,000 employees. Four miles away, Tucson Medical Center is already running Epic, having completed its rollout in June 2010.

Partners HealthCare researchers find that the number of lab tests ordered for outpatients who were seen at both at Brigham and Women’s Hospital and Massachusetts General Hospital dropped from seven to four after implementation of an HIE that allowed previous results to be viewed by either facility. The full text article isn’t available online to non-subscribers and the usual disclaimers apply: the study sample appears to be quite small, the study data was old (1999 to 2004), and whatever correlation was implied does not prove causation. 

Despite a fall in net income from $158 million in 2010 to just $1 million in 2011, Novant Health (NC) will spend $600 to $700 million over the next four years on its Epic project. Novant expects the first of its 13 hospitals to go live by the end of 2013.

Several readers found this non-HIT story interesting enough to send over. The $4 million-per-year CEO of Pittsburgh-based insurance company Highmark is fired after an ugly love triangle fight over his 28-year-old girlfriend, who worked for him at Highmark. Kenneth Melani, 58 and married, showed up at the girlfriend’s home and refused to leave when ordered by her 48-year-old husband, resulting in criminal charges. Melani has engaged an attorney to determine whether his dismissal was legal, while the DA agreed to postpone his preliminary hearing provided he undergoes anger management counseling.

Leila Denmark MD died this past weekend in Georgia at 114 years old. She she was the world’s oldest practicing physician when she retired at 103, having begun her pediatrics practice in Atlanta in 1931.

Sponsor Updates

• Practice Fusion customers have received $22 million in EMR incentives through January, the company reports.
• Emdeon offers a free weekly webinar on Emdeon Vision for Claim Management.
• The HITR nursing technology blog is running a Bodacious Scrubs contest through April 25.
• Iowa Health System contracts with Hayes Management Consulting and Coastal Healthcare Consulting to provide legacy support services.
• MED3OOO’s IT and services divisions hosts a virtual job fair May 2. 
• Encore Health Resources names attorney Tom Luce to its board.
• ICA launches HIT Me Blog with commentary on current healthcare and HIT issues.
• Lifepoint Informatics will participate in the 2012 Executive War College on Laboratory and Pathology as a corporate benefactor. The event will take place in New Orleans May 1-2.
• Cognosante and 3M partner to provide 3M’s ICD-10 Code Translation Tool to state-sponsored health plans.
• MedHOK announces that its 360Measures V 2.55 has achieved 2012 P4P certification.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 4/2/12

From HMSUser: “Re: HMS CEO departure. The company confirms.” HIS vendor Healthcare Management Systems (HMS) confirms the rumor I ran here Friday from HMSUser: President and CEO Tom Stephenson, a 25-year company veteran, has left “to pursue some long-time interests.” According to his LinkedIn profile, he is now assistant grass cutter at Stephenson Landscaping Services LLC. Pretty darned witty if you ask me.

Survey respondents say that companies in the hospital and physician practice market will lag those that are working in interoperability and post-acute care. New poll to your right: how will the Supreme Court rule on PPACA? (no fair answering after the decision is announced.)

My Time Capsule editorial this week from the 2007 vault: Brailer’s Santa Barbara RHIO Baby Goes Down the Tubes. The expensive flop that was the Santa Barbara RHIO launched David Brailer into the first ONC job and got everybody stoked about interoperability despite not having one iota of impact on patients or providers. Some of my parchment-scribed words from way back then: “SBCCDE was a ‘big hat, no cattle’ kind of project that left two sad legacies: (a) it blew millions in grant money,  and (b) it seduced politicians and reporters into thinking they’d seen the Second Coming of CHINs, only destined for success this time. They were half right.”

Readers keep asking me to do some kind of “top stories” summary each week. I used to do that with the Brev+IT newsletter I started, in which I rattled off stream-of-consciousness cynical musings about the week’s top news, usually after I was tired from writing HIStalk for the weekend and therefore likely to blurt out just about anything to get finished. I’ll revive that practice at the bottom of this post and give it a try for a few weeks. I’ll kill it if I get bored with it, if I don’t have the time, or if nobody seems to care much one way or another. I’m not looking to create more work for myself, but I’m pathologically eager to please.

Welcome to new HIStalk Platinum Sponsor TrustHCS. The Springfield, MO company’s consulting expertise covers coding, compliance, ICD-10, and cancer registry. Vacant coder positions threaten financial performance and TrustHCS can help out with staff augmentation or full outsourcing of coding services, with every one of the company’s employees holding AHIMA and/or AAPC credentials. They can work on-site or remote, with flexible pricing to meet budget requirements. The company can help provider organizations take advantage of the ICD-10 breather by performing the assessment, analysis, and education that they might have skipped back when the implementation deadline was looming. TrustHCS works with hospitals, practices, ambulatory surgery centers, and any other provider organization that does coding, offering whatever level of support is needed to optimize the revenue cycle. The company can provide the oversight and coding compliance training needed to avoid headlines that throw the whole “bad press is better than none” concept into serious doubt. Relationship matters and experience leads at TrustHCS, whose support I gratefully acknowledge.

Weill Cornell Medical College establishes the Center for Healthcare Informatics and Policy, which will conduct HIT-related research and offer a two-year fellowship in quality and informatics. Rainu Kaushal MD, MPH, a medical informatics professor and director of pediatric quality and patient safety at New York-Presbyterian Hospital, will serve as executive director.  

A nice HIStalk Practice post by Dr. Gregg poses the question: are EMRs to blame for terse physician documentation, or are lengthy patient “stories” less common due to (a) lack of physician time, (b) wordy residents who grew up to be more concise, or (c) lack of value when documenting the same old acute conditions over and over?

Vince continues his HIS-tory this week with Part 2 on MedTake. These pieces aren’t just overly fond looks back at long-dead companies – they always contain lessons that might prevent someone from repeating the same mistakes.

HIT Application Solutions raises $2.75 million in a Series A funding round. The Exton, PA company offers the Notifi communications platform for alerts, broadcast communications, and critical test results.

San Francisco-based healthcare IT incubator Rock Health will expand to Boston in June, adding a program on the campus of Harvard Medical School.

Epic did its always entertaining April Fool’s Day page, even dropping in an Inga mention with ”The Shoe’s on the Other Foot: HIStalk’s Inga Disputes Rumor She Wore Birks to Symphony.” I like it because I did a similar HIStalk spoof years ago and referred to Epic as the Birkenstock-wearing crowd.

E-mail Mr. H.

The Healthcare IT Week in Review

1. Vocera IPO Shares Jump 50%, Meaning the Company Paid Good Money for Bad Pricing Advice

Musings

• Timing is everything when it comes to IPOs. Riding Facebook’s IPO coattails isn’t such a bad thing, at least unless Facebook stumbles.
• The company, like most hardware vendors that are anxious to avoid commoditization and increase margins and professional services income by turning themselves into software vendors (think RTLS and bed management systems), markets benefits around its “Star Trek” badge communicators that include care transition, patient transfer optimization, and patient discharge communication.
• Vocera made some key acquisitions in the past couple of years: Wallace Wireless in January 2011 (delivery of alerts to smart phones) and two White Stone Group spinoffs in November 2010 (handoff communications.)
• More acquisitions are sure to come now that the company has $94 million of IPO money in the bank and needs to feed the earnings engine. A priority will almost certainly be value-added software for nurses that can run on the company’s existing communication platform since nurses are its primary users and therefore are most likely to advocate new purchases to otherwise indifferent hospital executives.
• Chairman and CEO Bob Zollars, who joined the company in 2007, was best known as having run high-flying healthcare supply chain vendor Neoforma, and before that having executive roles at Cardinal Health and Baxter. He rode the irrational exuberance bubble hard in January of 2000, when Neoforma.com’s IPO, priced at $13 for 7 million shares, soared to $52.38 on their first day of trading. Not bad for a company with revenue of $464,000 in the previous nine months, in which the company lost $25 million but formed a complex ownership and incentive agreement with hospital buying groups VHA and UHC. Neoforma announced plans to buy Eclipsys for $2.1 billion of its stock in March 2000, but backed off two months later when its own shares dropped by 70%. He knows how Wall Street works and has a real company with strong revenue this time around.
• It’s interesting that the Vocera IPO did so well while investor interest in the HITECH-goosed side of HIT seems to be waning. But everybody likes IPOs, at least for the first few weeks before the quarterly earnings grind sets in.
• I don’t see Vocera getting into the mHealth market, but the successful IPO gives it a strong position in mobile apps for clinicians. It needs a doctor product, though, preferably one with direct impact on patient outcomes since that’s what hospitals will pay big bucks for.
  

2. Tampa Doctors, Hospitals Fight Over Which Group Will Lead Their Selfless Data Sharing Efforts

Facts and Background

A group of Tampa-area hospitals and the county medical association are pursuing independent efforts to share electronic patient information.

Opinion

Florida has quite a few active HIE/RHIO projects that haven’t made much progress, probably because competition there, particularly among large health systems, is intense. This is one of few times where the previously unstated suspicion and distrust came right out on the table, as observed by a perceptive local reporter.

Musings

• Neither group seems to be making much progress, which isn’t surprising when asking competitors to collaborate selectively with unknown benefits to each.
• Florida’s AHCA issued a four-year, $19 million contract to Harris Corp. in late 2010 to develop a statewide HIE. Two months later, Harris announced that it had acquired Carefx, which offers the Fusionfx data sharing technology for competitors that need to exchange information. The only progress I’ve heard of is the availability of a secure e-mail program for providers and limited patient look-up services among the Big Bend RHIO and a couple of health systems, but it’s only been a year. I don’t know who’s getting ONC’s HIE grant money in Florida.
• Hospitals bring most of the money and technical expertise to the table, while practices create much of the information that needs to be shared. Doctors also believe their motivations are purer than those of hospitals, which have a reputation for wanting to control anything they’re involved with for their own financial or strategic benefit. That plus the technical challenges may kill this initiative off early.
• The main benefit of interoperability comes from hospitals exchanging information with their affiliated practices, which they often undertake without going to a third-party interoperability project. Unlike in some areas, Epic does not dominate the Tampa market. That would be an interesting follow-up article for the reporter – how well do the hospitals that want to control this project interoperate with their owned or affiliated practices?

3. Post-Op Patients Love iPads So Much They Don’t Mind that their Surgeons Don’t Visit Them

Facts and Background

Henry Ford Health System implements telerounding, where post-operative patients are given iPads to communicate by video with their surgeons, who may be miles away.

Opinion

This is a really good idea since it seems cool and high tech, but basically frees surgeons of the requirement to actually make post-op rounds and makes them immediately available so that delayed actions don’t hinder the discharge pathway. But most of all because this is the first high-profile use of the iPad by patients since video projects usually involve Skype on PCs.

Musings

• Post-op patients are usually coherent and can report their own medical situation, so this is more like ambulatory telemedicine than remote ICU monitoring.
• Using iPads is a smart idea since they are portable and cheap. Installing telepresence hardware in individual patient rooms would be ridiculously expensive, and the enhanced video quality would offer no advantage when the intention is simply to chat with the patient. Observers often overlook the iPad’s price and maintenance advantage – it does a lot for $500.
• Cynics might say that a phone call would work just as well as a video call, but physicians like seeing and not just hearing.
• Once the iPads are in the hands of patients, their use could be extended to video-based patient education and self-documentation.
• Once again Apple products prove their medical value not because of more in-depth technical capabilities over PCs, but because they are easy and fast to use, especially since a lot more people know how to use iOS products like the iPhone than have Windows expertise.
• It’s easy to see how this project could be translated into home health or skilled nursing care, where it’s just not practical to have an ongoing physician presence. For that matter, a nurse could round with a single iPad as the physician participates by video.

News 3/30/12

Top News

Vocera shares gain 40% over the $16 offering price in the company’s Wednesday IPO. Shares were up another 19% Thursday to $24.91, giving VCRA a 56% jump in the company’s first two days of being publicly traded.

Reader Comments

From Max: “Re: Microsoft/Sentillion. The bloodbath is in full effect. Employees received either a 60-day notice this week or an offer to move to Caradigm. I’ve heard losses on the Amalga side were significant.” Unverified. I asked my Microsoft contact, who says that like most companies, Microsoft doesn’t comment publicly on HR-related questions.

From HMSUser: “Re: HMS CEO. ‘Resigned’ last Friday, rumor that more high-level people will be shown the door.” Unverified, but Tom Stephenson’s bio has vanished from the executive team page. HMS’s parent company, HealthTech Holdings, has been owned since 2007 by private equity firm Primus, whose other healthcare IT-related investments include InSite One, Medhost, and Passport Health Communications.

From Epic-urious: “Re: Epic leading the market and gunning for the big guys. I’ve only read a few new customer updates. Where are all of these new customers?” Just to be clear, Epic is the big guy now, so there’s nobody left to gun for in terms of penetration of patients and providers (not necessarily in  number of hospitals since it’s a lot easier to dominate the market selling to one 1,000 bed hospital than ten 100-bed ones.) The company doesn’t announce sales, so new customers come to light only casually, like at conferences with mostly large-hospital attendees, where just about everybody finds out simultaneously that they’re all implementing Epic. Another way to look at it: the lack of significant sales announcements from Epic’s competitors, who do indeed happily announce new sales when they can get them.

HIStalk Announcements and Requests

This week on HIStalk Practice: a physician being sued by his former practice resigns over “technology troubles” and “billing errors” that he claims were the caused by computer problems. CMS offers help to providers not deemed “successful electronic prescribers” in 2011. Nancy Pelosi’s connection (or lack of one) between Practice Fusion’s rapid growth and the Affordable Care Act as she cuts the ribbon at the company’s new building (above.) Brad Boyd urges providers to continue moving forward on their ICD-10 transition. In our reader survey, 85% said reading HIStalk Practice helped them perform their job better last year, so if you’re in ambulatory HIT and need performance enhancement, you should be reading.

Listening: new from The Mars Volta, complex, perfectionist progressive rockers from El Paso, TX. An Amazon reviewer said it well: they’re what Led Zeppelin would have sounded like time warped into 2050. Dead ringers for Manfred Mann’s Earth Band at the 4:10 mark of the video, but very Zeppelin-like at 5:00. And I’m reflecting on the amazing musical contributions of Earl Scruggs, who almost single-handedly gave non-hayseed credibility to both the banjo as a musical instrument and to bluegrass as a uniquely American musical genre and who died Wednesday at 88. Foggy Mountain Breakdown was the speed metal of its day and it still sounds amazing as I listen to it right now.

Acquisitions, Funding, Business, and Stock

ClearDATA Networks, which provides healthcare cloud computing services, secures funding from Norwest Venture Partners and several angel investors.

Seven-month-old hospice management software vendor Hospicelink of Birmingham, AL says it expects $50 million in sales by the end of 2012. Color me skeptical.

Ann Arbor, MI-based HIE vendor CareEvolution is expanding its 22-employee workforce to 38, expecting to hire three software developers per quarter. I notice from the company’s site that they claim a trademark on the term One Patient, One Record, which I would associate more with Epic than CareEvolution, which I’ve heard of only once when a reader said they did an impressive demo but still lost the West Virginia Health Information Network bid. UPDATE: the company clarified the newspaper article – it has 38 employees now (22 of them in Ann Arbor) and will add another 15. WVHIN did choose Thomson Reuters’ HIE Advantage, but that product actually runs CareEvolution’s HIEBus under an expanded agreement between the companies signed in February 2011, so CareEvolution is in place (and scheduled for go-live next month) even though the announced winner was Thomson Reuters.

BlackBerry maker Research in Motion reports sagging sales, a quarterly loss, and an executive housecleaning. The CEO says he won’t rule out selling the company now that he’s seen from the inside just how dire the situation is, although he’s hoping for a turnaround. The steep downward slope above is the one-year share price, down 75%.

Sales

Asante Health System (OR) selects iSirona’s medical device connectivity solution to populate patient data in its Epic system.

Memorial Hospital of Union County (OH) selects Wolters Kluwer Health’s Provation MD for its gastroenterology and pulmonology departments. In addition, Duke University Health System (NC) licenses ProVation Order Sets.

Duke University Health System (NC) selects M*Modal Speech Understanding technology to support the Epic system it’s implementing.

Two practices within the University at Buffalo School of Medicine select PatientKeeper Charge Capture, which will be integrated with UBMD’s GE Centricity Group Management PM product.

People

EMR vendor CareCloud appoints PowerReviews CEO Ken Comée to its board.

Online physician networking site Sermo names former Revolution Health president Tim Davenport CEO. He replaces founder Daniel Palestrant, who left the company in January to run Par80, a startup focused on patient referrals.

Aventura hires Brian Stern (NewsGator Technologies) as SVP of sales and marketing and Brandi Narvaez (Sentillion, Vitalize – above) as chief customer officer.

eMerge Health Solutions, a provider of voice-powered documentation systems, hires Trent McCracken as president and CEO. He was previously owner of a telecommunications software company.

Announcements and Implementations

St. Francis Hospital & Health Services (MO) will go live on Epic Saturday morning.

The Verizon Foundation donates $100,000 to launch a telemedicine pilot project at Children’s Hospital of Philadelphia. CHOP will offer community hospitals consults with its pediatric specialists.

Government and Politics

The New York eHealth Collaborative and the New York State Department of Health form the Statewide Health Information Network of New York Policy Committee, tasked with updating and creating policy measures to protect PHI while expanding the state’s ability to electronically share clinical data.

The White House announced Thursday that various government agencies will invest $200 million of taxpayer money in so-called “Big Data” R&D. A NSF/NIH project will look at large-scale health and disease databases.

It’s not healthcare related, but it’s another hugely expensive government computing foul-up: the State of California pulls the plug on a $2 billion court system that still isn’t fully rolled out 11 years after the project started. The project was originally supposed to cost $260 million, with a state audit last year finding that the massive overruns were due to poor management of contractors. An IT project failure expert said, “I am dumbstruck over the incredible waste and obvious poor planning associated with this system. This failure only adds to California’s reputation as the land of IT boondoggles”

Technology

Henry Ford Hospital (MI) implements telerounding, in which minimally invasive surgery inpatients are given an iPad to post-operatively communicate with their remotely located surgeons using the FaceTime video chat app.

Other

Weird News Andy likes this video story of a BYU nurse practitioner student whose professor, while observing her practice thyroid exams in her third week of class, happens to notice that she has a hard-to-spot tumor. The mass turned out to be highly aggressive, but she’s OK after fast-track surgery and radiation therapy. She will take a nurse practitioner job at the Thyroid Institute of Utah when she graduates this summer.

Hill-Rom joins Stryker and Zimmer in laying off hundreds of its employees to offset the cost of complying with a new medical device tax that takes effect next year. The 2.3% tax, enacted in the Affordable Care Act, is based on company revenue regardless of profitability. The industry estimates the tax will cost its members $30.5 billion and could result in the loss of up to 38,000 jobs.

Howard University Hospital (DC) notifies 34,000 patients that their health information was potentially exposed in January when a laptop was stolen from the car of a contractor who had downloaded the information in violation of hospital policy. The contractor had quit working for the hospital in December 2011, but reported the theft on January 25 of this year.

The government’s bet-the-farm idea of paying hospitals for quality didn’t move the needle on deaths or readmissions in its own demonstration project, a study published Wednesday in the New England Journal of Medicine found. The Harvard public health author says incentives are the right idea, but the metrics aren’t yet right. He also says it’s nice when processes are executed consistently, but the only thing that counts is that patients get healthier, and that didn’t seem to happen here.

It’s definitely not up to the high snark standards of The Onion, but this satirical article called Myanmar Embraces Facebook as Electronic Medical Record is kind of funny. “Whilst Facebook users can currently Add and Delete Friends, the updated site is going to allow users to Add Doctors, Nurses and other allied health professionals, who can be granted varying degrees of access to confidential medical data. ” You just know someone out there is working on this already.

I probably would find a new press release headline writer.

Here’s what HITECH has driven providers to. Physicians at Samaritan Healthcare (WA) gripe at a hospital board meeting about the hospital’s new Meditech system, which the hospital freely admits it implemented for only one reason: to get a $2.2 million HITECH check. According to one doctor, Meditech is “… time-consuming, it is frustrating, it is archaic, it’s hard to work with … It didn’t matter what we said, you were going to go ahead and implement this because there were the economic benefits being reaped by the hospital at our expense.” In response, the hospital CEO admitted that the system isn’t ideal, but says now that the money’s in the bank, Meditech is history, its replacement to be paid for by the HITECH money Meditech earned for the hospital.

Strange: two-thirds of respondents to an online poll run by the Chinese Communist Party’s newspaper choose a “smiley face” as their reaction to a story about a medical intern who was murdered by an enraged patient in a hospital, apparently because doctors are right up there with government workers in being hated for insisting on being paid bribes to do their jobs. The poll was quickly taken down. The government reported that over 5,000 medical personnel were injured by patients in 2006, the last year such statistics were published. Experts blame the anti-doctor mood to the lack of a medical malpractice system to provide compensation for errors, physician salaries that start at only $500 per month, and the fact that doctors are legally paid commissions for orders written. It was also reported that some doctors are taking kickbacks from funeral homes for promptly alerting them of the newly deceased.

Sponsor Updates

• EHRtv runs an interview with David Caldwell, EVP of HIE vendor Certify Data Systems, filmed at the HIMSS conference. We interviewed CEO Mark Willard last month.
• Salar and Transcend will participate in the Society Hospital Medicine 2012 Conference April 1-4, 2012, in San Diego, CA
• MedAssets launches its Population Health solution suite to support the industry’s transition to fee for service and accountable care.
• Greenway Medical Technologies announces the availability of PrimeMOBILE for Android and tablet devices.
• TELUS Health Solutions will license Get Real Consulting’s InstantPHRO to resell into Canada under the TELUS Personal Health Record brand.
• MEDSEEK announces that its eHealth ecoSystem V4.0 is 2011/2012 compliant and certified as an EHR Module.
• Queensway Carleton Hospital (Canada) is delivering ED records to more than 120 family doctors using TELUS Health Solutions’ CareShare technology. 
• GetWellNetwork announces its fifth annual users conference, to be held April 30 – May 2 in Orlando.

EPtalk by Dr. Jayne

All eyes are on the Supreme Court this week. Oral arguments for the cases challenging the Affordable Care Act concluded Wednesday. This has been a busy week at work so I haven’t been able to process the transcripts as quickly as I’d like. Stay tuned for my detailed reaction in Monday’s Curbside Consult. I find the whole process fascinating. It wakes up the non-medical part of my brain with the interplay of the Justices’ personalities and the complexities of legal theories of intent, severability, and judicial restraint.

The focus on PPACA overshadowed dialogue on last week’s ruling that state workers cannot sue their employer for violating a part of the Family and Medical Leave Act. A 2003 decision allows suits against state agencies for violations related to leave taken to care for family members, this decision involves leave take by employees to take care of their own health. There are already many loopholes in FMLA due to multiple court challenges over the past two decades. Additionally, states have made their own requirements and definitions, turning it into a patchwork. It’s a great example of what might happen to PPACA over the next few decades should it be allowed to stand.

My other exciting reading this week has been the recently-issued NIST protocol on EHR usability. The three-step process includes EHR application analysis, user interface expert review, and user interface validation testing. There are some interesting points in the document. Check out Appendix A, which discusses the use of human factors engineering by the Department of Defense, the Nuclear Regulatory Commission, and the Federal Aviation Administration.

It also provides questions used to evaluate an EHR’s “aesthetic and minimalist design” and “pleasurable and respectful interaction with the user,” including whether the EHR has artistic value. I never found that documenting as required by CMS (and now other payers) is particularly pleasurable, nor do I find artistic value relevant to patient care. I don’t care how ugly it is — I just want it to be easy to use and comprehensive.

AHIMA announces the Grace Award, which recognizes excellence in health information management. Nominations are open through June 30 and the award will be presented at the annual meeting in September. I give this new award a thumbs up for aesthetic and minimalist design (NIST would be proud.) It would look great on my credenza.

Wireless medical monitoring devices are highlighted in an article published yesterday. I like the idea of an edible sensor integrated into a medication that can document when it was taken, although I don’t want to receive patient information on my phone so that I can try to interpret it “all without a visit to the doctor.” Let’s take it one step further and integrate a monitoring sensor into every Girl Scout cookie produced, and if too many are consumed at a single sitting, it can send warning texts to purchasers. Having just found a stash of Thin Mints at the back of my freezer, I could definitely use the moral support.

More news: HIStalk Practice, HIStalk Mobile.

News 3/28/12

Top News

Clinical communications vendor Vocera prices shares for its Friday IPO at $16, above the originally announced range of $12-14. That price values the offering at $94 million, giving the company a market cap of around $300 million.

Reader Comments

From Midnight Son: “Re: ICD-10 implementation delay. I’m hearing rumblings that ONC is mentioning a possible two-year hold. Have you heard anything?” I haven’t, but I will listen attentively to any reader who has and who wants to share.

From Jay: “Re: Capterrra. Rates EMRs using a ‘popularity index.’” This is yet another example of coming up with information that looks impressive in eye candy form without really meaning much. Capterra decided that market share wasn’t useful because it favors more expensive solutions (not to mention that the company doesn’t have exclusive use of that data and it wouldn’t look as cool on an ever-so-trendy infographic.) They don’t like rating EMRs as “the best” since needs vary (which doesn’t stop companies that rate cars, colleges, and places to live.) Instead, they went with the lazy method of just grabbing a bunch of unrelated publicly available data and mixing it up to give a conclusion: number of customers, number of users, revenue, number of Google searches, number of Facebook and Twitter followers, and Web site popularity rankings. The end result may or may not reflect reality, but I would say this: any provider who lets a cute infographic influence their EMR choice is a fool (do you really want to change your professional workflow based on vendor Facebook likes?) However, in fairness to the company, healthcare IT purchasers do indeed often line up like docile sheep behind whatever everyone else is buying, so perhaps this reflects reality.

From Charlie Enicks: “Re: job change. I debated sending you a note before any rumor was posted — too late! I am leaving to go to Georgia Health Sciences University in Augusta, Georgia starting May 1. As you know the searches take quite awhile. Our Epic project is going well and is on schedule. My leaving for an opportunity that is on the East Coast and closer to family had nothing to do with the project. Happy to give further clarification if any questions arise. Keep up the good work!” Charlie, who is CIO at University of Mississippi Medical Center, will take over that role in Augusta. I told him it was too bad that he will just miss the Masters Tournament. He joked that he tried to get that included in his offer.

From Indigo: “Re: end-of-life decision app. Recommended by Forbes.” The Best Endings site, started by former entertainment reporter Kathy Kastner with input from healthcare professionals, guides people into living their lives optimally before dying. It includes HIT-related topics such as specifying wishes for DNR and life support. I didn’t get much from the site, but I did follow one of its links to Death 1, Medicine No Score from the Canadian Medical Association Journal, which was really good, though predictably not exactly upbeat.

HIStalk Announcements and Requests

Over on HIStalk Mobile, Travis has written an insightful post, Free isn’t Free, that has generated excellent reader response. Dr. Travis says he’s OK with having his personal information used by a free app vendor as long as he’s told upfront, although he’s uneasy with fast-growing startups who haven’t figured out a revenue model and may peddle data down the road. Cyndee has a problem with companies that sell claims data to carriers to help them dream up reasons to deny claims payment, while Margalit doesn’t like non-free apps that sell your data without your knowledge. Finally, HIT Project Mgr states that consumers should have all of their health information available without paying for it, no different than being able to check their previous Amazon orders whenever they want. Good discussion. Sign up for the e-mail updates while you’re over there if you want to keep up with excellent doctor-written news and opinion about mHealth.

Ross Martin MD, who actually has a day job (Deloitte) that doesn’t involve writing fun songs or appearing as Elvis at HIStalkapalooza, is recruiting industry folks to complete the 2012 Deloite-AMIA Health Informatics Industry Maturity Survey by April 20. They hope to conduct it each year as a benchmark about what’s going on with health informatics. I think it’s a great idea and I started the survey with enthusiasm, but I’ll be honest in admitting that I quit early – the estimated time to complete is 30 minutes and I just didn’t have it to spare.

Acquisitions, Funding, Business, and Stock

Home health software provider Kinnser Software secures $40 million in Series A financing from Insight Venture Partners.

Predixion Software will present at a New York venture summit this week, discussing its predictive analytics solutions for payors and providers. The California company claims its Readmission Insight can predict up to 86% of readmissions. I Googled and found the above video interview with the company, filmed at the HIMSS conference in Las Vegas.

Sales

Kern Medical Center (CA) selects EZ-CAP, EZ-NET, and EZ-EDI from MZI Healthcare for health benefit administration.

MD Anderson Cancer Center (TX) selects Health Language Inc.’s Language Engine to automate mapping of patient data collected in its custom-built EMR, ClinicStation.

People

EHNAC appoints Luigi Leblanc (Zane Networks) and Deborah Meisner (Emdeon) as commissioners.

Former Carefx Chairman and CEO Andrew Hurd is appointed president and CEO of Epocrates. He takes over for Peter Brandt, who will step down as interim president and CEO and assume the role of vice chairman of the board.

As rumored by reader HairClub earlier this month, Hackensack University Medical Center (NJ) hires Shafiq Rab MD as CIO. He was previously VP/CIO of Greater Hudson Valley Health System (NY).

Former CMS administrator Donald Berwick MD, MPP is named a senior fellow with the Center for American Progress, a DC-based liberal think tank with historically close White House ties.

Laurie Gehrt, former chief nursing officer of Cerner Consulting, is named SVP at B.E. Smith, where she will lead the company’s interim leadership and consulting groups.

Announcements and Implementations

Riverside Regional Medical Center (VA) implements Phytel Transition in its ED to follow up with discharged patients.

NextGen Healthcare will resell Dragon Medical speech recognition software to its ambulatory EHR clients in an agreement with Nuance.

Cone Health (NC) takes 25 affiliated physician offices live in its $120 million Epic project. Its five hospitals will go live in July.

Drug data vendor PEPID announces that it has added maximum pediatric and adult drug doses to its medication content, allowing hospitals to create overdose warning alerts.

Government and Politics

CMS reports that through the end of February, hospitals and EPs have been paid $3.9 billion as part of the EHR incentive program. That includes almost $1.2 billion to 84,005 EPs and $2.7 billion to 2,355 hospitals.

HHS awards $50,000 to the designers of THUMPr, an Web-based tool that allows users to create personal heart health profiles, as part of its One in a Million Hearts Challenge innovation program.

The Office of the Inspector General finds that Brigham and Women’s Hospital (MA) received $1.5 million in overpayments from 2008 to 2010, primarily because “the hospital did not have adequate controls to prevent incorrect billing of Medicare claims or did not fully understand the Medicare billing requirements.” The hospital’s official response notes that the organization has since implemented additional controls, performed training, and implemented a new pre-bill monitoring system and more robust claims scrubber system.

HIMSS lists the HIT-related effects if the Supreme Court finds all or part of the Patient Protection and Affordable Care Act to be unconstitutional. If the whole thing dies, with it go certain HIE provisions, ACO demonstration projects, extension of PQRI, and Center for Medicare and Medicaid Innovation. However, the court could also find that only parts of PPACA are unconstitutional (specifically the part requiring that everybody buy medical insurance) and the rest could remain intact. None of this would impact HITECH or the Medicaid EHR incentive program, both of which came from ARRA.

Contractors building the behind-schedule, 314-bed Orlando VA Hospital say the agency’s red tape and design errors could add $120 million to the original $665 million project cost. That would raise the final cost to $2.5 million per bed.

Other

A Texas newspaper picks up on the year-old policy of Citizens Medical Center (TX), which bans the hiring of employees whose body mass index exceeds 35 (about 260 pounds for a man who is six feet tall.) The policy says a prospective employee’s physique “should fit with a representational image or specific mental projection of the job of a healthcare professional.” I personally enjoy the specific mental projection of George Clooney.

SCL Health System will move its headquarters from Kansas to the Denver, Colorado area, creating 750 jobs in accounting, billing, IT, and systems services over the next four years.

Board members of the Tennessee chapter of HIMSS create their own HIT workforce initiative, pledging on behalf of their employer organizations to offer 50 internships and 500 hours of collaboration with educators and students.

The Tampa newspaper covers competing interoperability projects that are underway, one led by big hospitals and the other by big medical practices. The president of the medical association says hospitals are too profit-oriented to share data among themselves. One orthopedic surgeon who was interviewed says he doesn’t really care which group prevails – he just wants to use his two-year-old EMR to exchange records with somebody.

Medline kicks off its 2012 Pink Glove Dance competition at the AORN conference in New Orleans Monday, with 1,000 OR nurses participating in the company’s Breast Cancer Breakfast.

Sponsor Updates

• AirStrip Technologies EVP Bruce Brandes is interviewed by the Nashville Business Journal (subscription required.)
• Sam Lakkundi, VP of mobile strategies of Kony Solutions, discusses Bring Your Own Device models in a video interview.
• Regional Medical Center at Memphis selects MedAssets to provide strategic sourcing and clinical resource management services.
• CTG Health Solutions expands several of its large EMR project engagements.
• API Healthcare hosts a webinar on the importance of role-based practice in staffing.
• Regional Medical Imaging (MI) becomes Merge Healthcare’s first radiology customer to receive Meaningful Use payment.
• US Representative Nancy Pelosi participates in a ribbon-cutting ceremony at Practice Fusion, which recently moved into a new building after completing $1 million in renovations.
• T-System posts a video featuring Baptist Healthcare System (KY) and its go-live with the T SystemEV EDIS.

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 3/26/12

From Fozzie Bear: “Re: University of Mississippi CIO Charlie Enicks. Resigned just a few months before going live with Epic.” Unverified. UPDATE: verified. Charlie tells me he’ll be the new CIO at Georgia Health Sciences University in Augusta starting May 1. He says Epic is doing fine at Mississippi – he just wanted to get closer to family.

From The PACS Designer: “Re: Epic at Yale. It appears that things are going well with Epic, according to Daniel Barchi, CIO at Yale New Haven Health System, who gives us his real experience using the new Epic EMR for a recent physician visit as detailed in the Yale Medical Group News. “

I’ll be making minor changes to HIStalk over the next year based on your reader survey responses, although there won’t be too many — most respondents urged me to not try to fix what isn’t broken. First up is the search function, which I’ve just replaced with a paid Google version that’s faster and cooler. Second: readers suggested bringing on two contributors if I can find them: (a) a frontline provider-side nurse with healthcare IT insight, and (b) a stock and business expert. I’m willing if I can find that rare combination of talent, insight, and the commitment to write even when life intrudes. Some other suggested ideas (new sites, new coverage, putting on conferences, etc.) were good, but not realistic to undertake as a part-timer. They do, however, give me a fall-back position if I ever get sick of my day job and need to scratch out a living on my own. Thanks to the folks who completed the survey – it’s important to me.

Listening: new from Nada Surf, catchy indie rock that’s more upbeat than some of their earlier stuff. They sound just as good in their acoustic performances, a rarity among bands who couldn’t sing Happy Birthday to someone without Auto-Tune help and whose high-ticket shows are more karaoke than concert. They’re on tour now.

Two-thirds of respondents side with Farzad Mostashari in predicting that physicians will order fewer unnecessary imaging tests when previous results are available and new orders are guided by electronic decision support. New poll to your right, inspired by my Pam Pure interview: what target market will offer the greatest HIT opportunity in the next 5-10 years?

Emerging confused and squinting in the first light it has seen in five years is this week’s Time Capsule editorial, EMRs: Free May Not Be Cheap Enough for Physicians, in which I opine, “Imagine what they’ll think when they first encounter hospital IT types, those grudging emissaries of a department built around rigid conformance to rules, perpetual understaffing, and a vision for the common good that squelches the individuality and self-determination that doctors thrive on.”

Cooper Health System (NJ) names Jayashree Raman, formerly of Stanley Healthcare Solutions, as VP/CIO.

Mr. Ciotti turns back the HIS-tory clock  to long-forgotten bedside system vendor MedTake.

Weird News Andy is fascinated by a $100 test that could predict heart attacks weeks in advance. It detects endothelial cells that have been loosened into the bloodstream by fresh artery damage.

Cerner will break ground on its new Kansas City campus this week, planning to start moving an eventual 4,000 employees into the new offices by the end of the year as required by state-provided incentives.

CMS will conduct a free webinar overview of MU Stage 2 on Monday, March 26 at 1:00 Eastern.

CVS Caremark blames a programming error for exposing the detailed medication and condition lists of 3,500 members of Tufts Health Plan to other members by printing the wrong addresses on the envelopes.

In England, Liverpool hospitals are running a “bring your own device” pilot for tablets, installing Kaseya’s device management software on them for security. The hospitals like the idea of cheaper alternatives to desktop PCs and are considering offering an employee subsidy for tablet purchases. Says the CIO, “Refreshing all that kit every three years is becoming cost-prohibitive. People already have really cool devices, which they do bring to work. They just can’t connect them.”

E-mail Mr. H.

News 3/23/12

Top News

Thomson Reuters reportedly puts its healthcare data and analytics unit back on the market after shelving the process last year due to tough market conditions. Multiple bidders may be vying for the business, which is expected to fetch up to $1 billion.

Reader Comments

From Willy Loman: “Re: Imprivata. Being sued for patent infringement for its OneSign SSO.” I Googled and came up with a new suit brought by CeeColor Industries LLC claiming that Imprivata is infringing on its 1999 patent for proximity-based security using electronic sensors. Imprivata’s OneSign uses a webcam with optional facial recognition software to validate a user and lock their session when they walk away. I can find nothing about CeeColor Industries, which suggests that their primary business, if they have one beyond just owning a patent, at least isn’t extortion by litigation. Companies get sued all the time for reasons both valid and not, so I wouldn’t get too excited about this lawsuit just yet. I interviewed Imprivata CEO Omar Hussain a year ago and asked him about Secure Walk-Away and how the webcam aspect works. Above is a video that explains it.

From James: “Re: Roy the HIStalk King. We (Medicomp) had Roy’s HIStalkapalooza sash framed. He seems very happy about it ;)” Roy Soltoff from Medicomp was not only named HIStalk King, he also served as part of Inga’s security detail for her Quipstar competition. You can see Roy in action in the excellent HIStalkapalooza video that ESD put together (he wins at the 2:30 mark.) His beauty queen sash looks good up there on his wall and the color / black and white photo effect is cool (either that or Medicomp and its people are very drab.)  

From Roller Boy: “Re: Allscripts. Downgrades from Jim Cramer and JP Morgan have created the perfect storm. Night and weekend meetings with board and execs with talk of impending changes.” Unverified and unwarranted, I’d say, given that shares are down only 6% in the past month, although the Nasdaq was up 4% in that same period. Other brokers have stood by their recommendations and neither Cramer or Morgan said anything new – they just recited the obvious challenges the company faces in integrating and selling Sunrise after its $1.3 billion acquisition of Eclipsys, if indeed that’s such an important driver of their business. My interview with Phil Pead and Glen Tullman about the acquisition is here and worth a revisit since I asked some tough questions, like how their performance should be graded two years down the road (that date is coming up soon.) I also said this about Eclipsys when the deal was announced in June 2010:

Despite the arguably superior CPOE and clinical documentation capabilities of Sunrise, it has competed poorly against Epic and Cerner … Nearly 40% of ECLP revenue supposedly comes from about 20 big customers … Eclipsys most likely paid big money for its recent acquisitions, buying the former Medinotes/Bond practice EMR products, EPSi financial management, and Premise throughput management as it desperately sought to diversify away from its at-risk Sunrise user base. Those acquisitions didn’t seem to do much for the company’s performance … It’s late in the HITECH land grab to try to integrate companies and products in the hopes that enough hospitals are left that haven’t locked into their vendor partners to prepare for Meaningful Use. This would have been a much better deal a year ago.

From HITwatcher: “Re: system sales. A quiet year as everyone is hunkered down protecting their base while Epic continues to go after the huge brass rings. Will Partners really announce a choice of Epic by April 1? Dunno, but they will go that route, then on to HCA for the no pie-in-face lady.”

HIStalk Announcements and Requests

What you missed if you didn’t check out HIStalk Practice this week: Dr. Gregg’s recent cloud/hosted server debate. Joslin Diabetes Center (MA) offers national telehealth services. Practices adopting the PCMH model of care have higher staff morale but also higher physician burnout. EZ DERM incorporates Nuance’s medical speech capabilities into its iPad EHR. Practice Fusion offers free interfaces to 16 reference labs. While you are stopping by HIStalk Practice, take a moment to sign up for the e-mail updates because it will keep you smart and make make me feel loved.

My Internet (and cable TV) went out earlier this week, so I have resorted to tethering my laptop to my iPhone for Internet access. It’s not an ideal solution (the connection seems to drop at least once an hour) but it’s actually pretty handy. I’ve used the tethering option a bit in the past when I’ve bee in an area without free Wifi, but never before full time. I wouldn’t trade trade tethering for my high-speed cable, but it’s a surprisingly workable solution. Meanwhile, I keep wondering if no cable TV means no recordings of American Idol on the DVR.

On the Jobs Board: Release Manager, Consultant, Application Developer. On Healthcare IT Jobs: Director of Federal Health Business Development, Technical Project Manager, Health Information Systems Programmer/Analysts.

Inga, Dr. Jayne, and I are emotionally needy. We yearn for intimacy and fulfillment with our much-loved readers, but alas, our anonymity and geographic separation preclude such contact. Therefore, like a prisoner who proposes surreptitious visual stimulation from the other side of the telephone room glass or requests passionate mail in lieu of physical contact, may I suggest that you: (a) sign up for the e-mail updates; (b) engage in the mutually satisfying activity of liking, friending, and connecting via the appropriate online services in which we dwell; (c) send us news, rumors, or anything else that might serve as a fancy-tickler; (d) review and click some sponsor ads, marveling that otherwise button-down companies publicly support our unpolished journalistic style and sophomoric humor because their executives at times find as amusing and informative as a hyperactive, crude teen armed with neighborhood gossip; (e) check out the Resource Center for more sponsor information and the Consulting Engagement RFI Blaster to painlessly request consulting proposals; and (f) enjoy our fleeting moments together since one of these days when I’m no longer clacking the keyboard, you’ll be bereft of musical recommendations and HIMSS booth critiques. Thanks for reading, since without you all this typing would be pointless.

Acquisitions, Funding, Business, and Stock

On Assignment, a provider of temporary workers to IT and healthcare companies, will purchase IT staffing firm Apex Systems for $383 million in cash and $217 million in new stock.

Sales

Xerox’s IT division wins a 10-year, $1.6 billion contract to oversee claims processing for California’s Medicaid program.

WESTMED Medical Group (NY) chooses UnitedHealthcare and Optum to help it launch an ACO for its 220 physicians in Westchester County, NY.

People

The Huntzinger Management Group hires Nancy Chapman (ACS) as practice director of ICD-10 transition and RCM services. We also note that she is part of an exclusive group of 2,324 industry leaders who have joined the HIStalk Fan Club that long-time reader Dann started and maintains on LinkedIn.

LifePoint Hospitals (TN) appoints Karla Schnell (North Highland) as senior director of informatics and Paige Porter as senior director of pharmacy informatics.

National coordinator Farzad Mostashari will present the opening keynote address at the Summit on the Future of Health Privacy in Washington, DC on June 6-7, hosted by Patient Privacy Rights and Georgetown University. Security expert Ross Anderson PhD, FRS will also address the conference and Rep. Joe Barton (R-TX) will receive an award for his support of privacy and security protections in the HITECH act. Registration is free.

Announcements and Implementations

US Preventative Medicine announces an agreement to offer its wellness platform through Dossia’s Health Management System.

HIMSS names The Health Information Exchange Formation Guide, written by Laura Kolkman and Bob Brown, as its 2011 Book of the Year.

PerfectServe announces that its clinical communication applications are available for BlackBerry and Android smart phones.

iMDSoft’s MetaVision Suite for ICUs and ORs earns ONC-ATCB 2011/2012 certification.

Elsevier signs an agreement with ExitCare LLC to offer its patient education information via Elsevier’s Clinical Pharmacology electronic reference. Elsevier will also offer ExitCare licenses to its customers.

Air ambulance operator Mercy Jets implements iPad-based medical records, allowing its medical teams to monitor vital signs and to document care delivered during patient transport.

In England, Northumbria Healthcare NHS Foundation Trust goes live on NextGate’s Multi-Language EMPI for its clinical portal that links multiple systems.

Government and Politics

HHS launches a developers’ challenge to design Web-based applications that use Twitter to track health trends in real time, allowing officials to identify emerging health issues.

The FDA’s Janet Woodcock MD says the agency could do a better job of predicting the effectiveness and safety of new drugs if it were able to collect information from the field electronically rather than relying on voluntary drug company reporting.

The State of Maryland, along with the CRISP RHIO and the Abell Foundation, launches a competition to identify innovative ways to improve public health using clinical information available from Maryland’s HIE, either alone or tied into publicly available data sets (motor vehicle records, birth and death, boards of education, etc. or Maryland subsets of federal databases) Submissions can address either general public health issues or ideas related to the Million Hearts initiative to prevent heart attacks and strokes. Prizes are offered and submissions are due by April 16. If you don’t want to submit, you can vote – the first round of vetting and discussion will involve the public, who can participate right on the site.

Technology

Memorial Sloan-Kettering Cancer Center and IBM collaborate to combine the computational power of IBM Watson with MSKCC’s clinical knowledge and data to create an outcome and evidence-based decision support system.

Other

The Saginaw newspaper describes Covent HealthCare’s used of 14 locally trained scribes in the ED to interact with its Epic system while the physician focuses on the patient. Doctors say they save at least an hour for every 25 patients they see.

HIMSS clarifies that hotel rooms for exhibitors at HIMSS13 haven’t been released yet, so they aren’t showing up on the housing site. They says a “blog site” (obviously this one) said they’re full, which isn’t exactly true – a reader (two, actually) told me that rooms weren’t showing up and I said I don’t know anything about exhibitor housing since I’m a provider grunt, but I did see at least 10 hotels showing non-exhibitor availability. Like most everything else at the conference, high rollers (Diamond members) get first crack. It’s like college football programs that require a big upfront donation to earn the privilege of buying expensive football season tickets.

Epic is awarded a patent for a search method that provides a list of possible appointments that match require provider and resource criteria.

Federal agents seize documents and computers from the town hall of West New York, NJ, reportedly investigating possible insurance fraud by Mayor Felix Roque, a physician who runs a pain clinic. Campaign staffers of the mayor’s defeated political opponent admit that they provided information to federal authorities hoping to discredit him.

A highly regarded and long-established family clinic in Wisconsin becomes one of the first in the state to stop accepting Medicare, citing inadequate payments and increasing expenses that include $700K for a new EMR. Says the founder: “I love taking care of Medicare patients, but every time we treat them we have to dig into our wallets. What kind of business model is that?” The doctor’s wife says he says up until midnight at home some nights to finish up his EMR charts.

A former patient sues a just-closed eight-bed Ohio hospital, claiming the struggling facility refused to transfer him to a more capable hospital because it didn’t want to lose the revenue. The lawsuit claims that lack of prompt treatment of the man’s infection by Physician’s Choice Hospital resulted in gangrene that required surgeons to perform emergency surgery, which included removing skin from his penis. He said it hurt, of which I have little doubt.

Sponsor Updates

• T-System posts a new video showing its T SystemEV EDIS.
• Lifepoint Informatics announces that its March user conference was attended by over 40 clients, with a keynote address by Bruce Friedman MD on “The Continuous Search for Greater Lab Functionality: Best of Breed LIS versus Enterprise-Wide Solutions.”
• GE Healthcare will introduce Centricity Cardio Enterprise at next week’s 61st Meeting of the American College of Cardiology.
• TELUS Health Solutions announces the integration of HIPAAT’s privacy consent management services into its Assure EHR Integration Platform.
• API Healthcare sponsors the DAISY Foundation, which honors nurses through its DAISY Award for Extraordinary Nurses.
• MedAssets offers a case study of the $65.4 million it helped Texas Purchasing Coalition save from its supply chain.
• White Plume releases AccelaMOBILE, a free physician charge capture app for mobile devices.
• The Advisory Board Company launches its Innovations in Impact grant program designed to reward best practice-driven initiatives that articulate measurable, quantitative outcomes goals. The application deadline for the $20,000 per year grants is April 13.
• Houston Orthopedic & Spine Hospital achieves Stage 1 MU using the Healthcare Management Systems (HMS) EHR. 
• Gateway EDI earns full EHNAC Healthcare Network accreditation. Gateway also shares results of ICD-10 preparedness survey, which includes the finding that 56% of practices report are moving forward with ICD-10 preparation despite the enforcement delay.
• DrFirst congratulates 44 of its EHR partners who were awarded the Surescripts White Coat of Quality for 2011.
• Nuesoft posts a full transcript of its billing webinar series on third-party insurance billing.
• An article by Santa Rosa Consulting’s Matt Wimberley discusses the opportunity to improve a hospital’s financial outlook through participation in the MU program.
• Informatica highlights BCBS Michigan’s ICD-10 transition and Ochsner’s standardization on Informatica technologies for its HIE.    
• Recondo Technology partners with ZirMed to offer the ZPay credit card and check processing solution.

EPtalk by Dr. Jayne

Several readers were taken with my article on the caduceus vs. rod of Aesculapius debate. Several mentioned Nehushtan, the fiery serpent used by Moses to heal those who looked upon it.

CMS asks  providers who feel they have received an ePrescribing penalty in error to contact them. Impacted providers may have had their G codes stripped by billing clearinghouses or may have reported the wrong annual code. Problems with hardship exemptions may also be the culprit.

HHS’s Office of the Inspector General approves Ascension Health Alliance to form a group purchasing organization, allowing it to offer its contracting services to hospitals and health systems outside of Ascension. The 21-state Ascension, the largest Catholic healthcare organization in the US, says formation of the GPO “demonstrates our commitment to transform healthcare by 2020.”

A research letter in this week’s issue of JAMA discusses the prevalence of physicians using social media to post unprofessional content online. Surveying state medical boards, the authors found violations that included inappropriate patient communication, sexual misconduct, prescribing without a clinical relationship, and online misrepresentation of credentials.

IBM Research teams with an Italian cancer center on a new analytics platform that will personalize treatment based on pathology guidelines and past clinical outcomes as documented in hospital systems. The Clinical Genomics tool can also provide an aggregated view of patient care.

AMA Board of Trustees chair Robert M. Wah MD reflects on his recent trip to the HIMSS conference, calling it “a gathering of more than 40,000 of my closest friends and colleagues.” Dr. Wah has an interesting pedigree: Navy active duty, deputy national coordinator for health IT and founding staffer at ONC, chief medical officer at Computer Sciences Corp., and head of the Navy’s largest OB/GYN training program. He’s an interesting guy and I am glad someone with his experience is chairing the board. I hope the AMA will show real healthcare IT leadership to reverse the black eye it obtained by blocking ICD-10.

Speaking of ICD-10 codes, one of my Twitter followers keyed me in to this app available on iTunes. For $24.99 and it only one review, I think at this point I’ll take a pass.

Several readers responded to my mention of the allergist who closed his practice to join the Army as a lieutenant colonel. Rank is apparently based on experience and specialty. One reader told a great story about his own Army service, where he had to take away several service weapons from physicians who mishandled or misplaced them, including one major who left his Beretta in the PX while shopping. That’s a little different than losing your sunglasses or your keys.

A shout out to Children’s Hospital Los Angeles Medical Group, which is hosting its annual “Pediatrics in the Islands: Clinical Pearls” conference in Maui. It’s a great conference. but I think it’s time to include some health IT topics, hint hint. Perhaps a celebrity guest speaker?

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 3/21/12

Top News

Misys, whose only remaining healthcare-related product that I recall is Misys Open Source Solutions, agrees to be acquired for $2 billion by Vista Equity Partners. Competing offers are possible despite a simultaneously announced Misys profit warning after Q3 revenue slid 12%. If the deal goes through, Misys will join a family of Vista-owned companies that includes Sunquest and Vitera.

Reader Comments

From HIMSS Benefactor: “Re: HIMSS13. Almost all the decent hotels are already booked. What happened? The W French Quarter has a few rooms left at $909 per night! Too much hassle … will have to skip this one.” I just checked the HIMSS online booking site and they’re showing 13 hotels available to attendees, starting at $155. The four-star Marriott on Canal Street is $230 per night and appears available, as is the close-by Courtyard at $180. I tried several of the travel sites to see if maybe HIMSS hadn’t locked down the whole block, but all showed no rooms available. Major concerns about infrastructure readiness abounded when HIMSS last went to New Orleans in 2007 and the experience was uneven in many hotels and restaurants. Having too few or too expensive hotels would give HIMSS a black eye it doesn’t need after massive attendance in Las Vegas. Let’s hope they just haven’t released all the rooms yet since we’re nearly a full year away. Otherwise, I’m going rent a house or two for the week, bring in sleeping bags, and run a HIMSS Hostel at exorbitant nightly rates. I don’t know where I stayed last time – I only remember that it was forgettable.

From The PACS Designer: “Re: SMArt. With the release of the iPad, TPD thought it would be the right time to mention The SMArt Platform created by the Children’s Hospital Boston and Harvard Medical School. Travis Good alerted us a year ago about it and mentioned that there is $5,000 prize challenge for the winning design. The SMArt platform is envisioned to be an app store for health, with applications geared towards both patients and providers.”

From Doreen: “Re: HIMSS. You should rent one of the tiny booths for around $5,000, use the fact that you have the greatest advertising strength on earth for healthcare IT to tell people you’ll be there, have guest booth hosts like Ed Marx and Dr. Gregg, and offer giveaways.” I had to embellish the idea, of course, by suggesting that (a) I set it up like a welcome center and offer information on HIStalk’s sponsors, or (b) I find some other company in tiny booth Siberia and tell them I’ll be their next-door neighbor and bring lots of traffic their way if they’ll pay for my space. Then I recruit volunteers to serve as my proxy to host the booth in rotation. I was excited about putting out kegs of beer until I Googled the price at the Morial Convention Center: $450 for crappy domestic brands.

HIStalk Announcements and Requests

Medicomp commemorates Inga’s participation in its Quipstar game on the HIMSS exhibit hall floor with a video. Note the Shoe Cam pictures, security entourage, the IngaTini in her hand, her green M&M snack, and the carefully placed reflector thingy that I bought her as part of her disguise. She was scared to death, but determined to earn Mobile Loaves & Fishes the $5,000 charitable donation offered by Medicomp in return for her involvement.

Welcome to new HIStalk Platinum Sponsor Jardogs. The Springfield, IL company connects patients, providers, and communities with its Jardogs FollowMyHealth Universal Health Record, an ONC-ATCB-certified cloud-based solution that aggregates information from disconnected organizations (it was recently selected by Iowa Health System, I recall). Patients become gatekeepers of their own information from anywhere in the world using a single comprehensive view instead of running around to a bunch of individual, proprietary patient portals. They can electronically complete physician-requested forms that are pre-populated with the practice’s EMR information, check in for appointments, and get real-time updates. Providers improve their patient relationships and address ARRA incentives for patient access (send reminders, provide electronic copies of results and med lists, share information per patient authorization, and connect to public health registries). The company also offers a patient kiosk that streamlines registration and data collection. Next up: home and wellness applications, such as for home physical therapy and potentially for home monitoring. Thanks to Jardogs for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

RCM provider MD On-Line acquires MD Technologies, a provider of RCM products and the Medtopia Manager PM system.

Axial Exchange announces that its care transition solutions, Axial Provider and Axial Patient, are available for cloud deployment. The Raleigh, NC-based company offers care coordination and communications applications that connect first responders, hospitals, physicians, and health plans via a clinical dashboard.

In the UK, University of Lincoln and the local hospital trust develop a prototype of an orthopedic surgery training simulator that uses the Nintendo Wii to mimic the use of a surgical drill, allowing surgeons to improve their hand-eye coordination.

Sales

The non-profit United Health Organization (MI) will use video-to-handheld technology from JEMS Technology to connect patients requiring specialized medical attention with off-site physicians for consultation. Volunteer specialists who can’t leave their practices can visually examine the patient and provide treatment recommendations from their mobile devices.

DR Systems announces new contracts for its Unity CVIS with Twin Cities Community Hospital (CA), Good Shepherd Medical Center (TX), Healthcare Partners Medical Group (CA), and St. Luke’s Cornwall Hospital (NY).

The Maryland Department of Health and Mental Hygiene awards CSC a $297 million contract to replace the state’s Medicaid management information system and to provide fiscal agent services. The contract is for five years with three two-year options.

The Maricopa County (AZ) Board of Supervisors approves a $4.55 million contract to NaphCare for EMR licenses and installation services for its correctional healthcare system, which lost its accreditation in 2008 for issues that included poor recordkeeping.

People

Two weeks after agreeing to serve as CEO of Cal eConnect, Ted Kremer withdraws his acceptance and announces plans to stay on as executive director of the Rochester RHIO after learning that Cal eConnect’s funding is uncertain. Cal eConnect interim CEO Laura Landry will assume the CEO post.

Legacy Health System (OR) names John Kenagy PhD as interim SVP and CIO. He was previously with Providence Health & Services.

Healthcare analytics company Qforma appoints Valerio Aimale MD as chief of advanced products, William Howard PhD as SVP of new product development, and Delphina Perkins as director of client services.

Authentidate Holding Corp. names former Viterion Telehealthcare CEO Sunil Hazaray its chief commercial officer.

Announcements and Implementations

Cookeville Regional Medical Center (TN) implements MEDHOST’s EDIS.

Susquehanna Health Partners (PA) adopts Summit Healthcare’s Downtime Reporting System to address its business continuity and data protection needs.

Practice Fusion launches its research website to help public health agencies and physicians predict and manage outbreaks.

Objective Health, part of McKinsey & Company, announces the release of its Objective Scorecard performance dashboard and analytics solution for hospital executives.

UPenn Health System goes live on Brainware and Ascend solutions for accounts payable automation, helping it manage paper invoices and integrating with its Lawson ERP system.

The EZ DERM iPad EHR adds speech recognition using Nuance’s cloud-based technology. I accidentally strayed onto the cool new EZ DERM video above on YouTube. The company modestly calls its product “The Best EHR in the World.” I can’t vouch for that, but it might well make the best EHR videos in the world.

SAIC’s COO talks up the company’s Vitalize Consulting Solutions acquisition in Tuesday’s earnings call: “SAIC’s acquisition of Vitalize Consulting Solutions continues to support strong, double-digit growth in the commercial health IT arena.” In not-so-positive news, SAIC racked up a $161 million Q4 loss after setting aside $500 million to settle a criminal investigation involving cost overruns on a payroll system it developed for New York City.

Government and Politics

ONC releases a new version of its Connect software that incorporates updated technical standards and descriptions for the NwHIN Exchange. Connect version 3.3 supports such functions as patient discovery, document queries, and information retrieval.

Louisiana behavioral providers say that the state’s new Medicaid reimbursement software, which was supposed to make their claims submission easier, isn’t working. Providers say they can’t always enter new client information and some of what they’ve entered was lost, the progress notes function isn’t working, and nobody’s been able to bill for their services.

Other

TeleTracking posts a fun video of The Capacity Blues, a Cajun-flavored piano tune written and performed by one of its employees in honor of its upcoming New Orleans patient flow symposium.

Divya Shroff MD, HCA’s chief clinical transformation officer, writes a company blog post called Can Access to an EKG on your Phone Save a Life? in discussing the company’s collaboration with and investment in AirStrip Technologies. Her example involves door-to-balloon time for cath patients, with the potential to send EKGs directly from the ambulance to the cardiologist as both are in transit to the hospital.

I’m watching interviews filmed at HIMSS in Las Vegas by EHRtv that our pal Eric Fishman MD has been posting. Here’s one with Matthew Hawkins, CEO of Vitera, and here’s another with Shareable Ink’s Stephen Hau.

In England, hospital officials admit that they ordered the IT department to clone and snoop around the computer hard drive of a whistleblowing doctor who complained about unqualified staff and and was later fired. His boss justified the action, saying she had heard from employees that he was on the Internet a lot and wasn’t seeing enough patients.

The local newspaper interviews eClinicalWorks CEO Girish Kumar Navani.

Dr. Wes says EMRs bury doctors in data without giving them useful information:

There’s so much data that we risk doctors becoming lost in it. It is entirely possible that we are in danger of not being able to find our most important clinical signals amongst the noise and clutter of all the data. Worse: time with patients is disappearing. Our health care information gold rush has acquired teams of programmers to feverishly implement a myriad of bureaucratic information system requirements in just a few short years. To this end, these programmers have been extremely effective. But almost as incredibly, these same programmers have little perspective of what physicians do or how we interact with patients and THEIR data. As a result, doctors are not only confronted by all of this this information placed before them, but waste precious time sifting amongst the data and continue to be the fall-guy for data entry. Codes, quality measures, documentation requirements and, oh, yeah, the progress and operative notes, are all being entered by doctors. In return, our screens have become crowded intersections of buttons, flags, options, icons, colors, warning alerts and (if we’re lucky) text. Oh yeah, and a new “upgrade’s” coming next week.

Note to companies: just in case you can’t spell HIPAA correctly, at least leave it out of the press release’s big-font headline.

University of Louisiana at Lafayette is looking for healthcare geeks to participate in its free Cajun Code Fest on April 27-28. Speakers include US CTO Todd Park, Intel’s Eric Dishman, and the guy who founded Priceline.com.

A Crain’s New York study finds that the 25 highest-paid New York City hospital executives earned a combined $60 million in 2010, with New York-Presbyterian’s Herbert Pardes topping them all again at $4.3 million.

Sponsor Updates

• CapSite GM/SVP Gino Johnson will provide an overview of the HIE market at next week’s 4th Annual Health IT Insight Summit in Boston.
• Liaison Technologies will offer Preventice’s wireless monitoring technology to collect and transmit patient data via its cloud services.
• Bloomberg Businessweek profiles Digital Prospectors Corp.
• CTG Health Solutions will participate in the Allscripts Central Region Users Group meeting in Des Moines, IA on April 19.
• Trustwave completes its acquisition of M86 Security.
• Health Care DataWorks selects Health Language’s Language Engine to map disparate data into its data warehouse.
• BESLER Consulting will use the Inventu Flynet Viewer to give its hospital customers access to the Medicare Common Working File stored on 14 CMS mainframes, allowing faster and more efficient claims review.
• DIVURGENT’s David Shiple discusses the proposed MU Stage 2 emphasis on personal health records vs. low consumer interest in using them in a blog posting.
• The local paper discusses Premier Health Partners’ use of MEDSEEK’s predictive analytic tools for targeted consumer mailings.
• Merge Healthcare and AG Mednet partner to integrate AG Mednet’s image collection platform with Merge’s Clinical Imaging Management System (CIMS) to enable higher quality images and data flow directly into Merge’s CIMS and EDC solutions. 
• Capsule announces that it has surpassed the 1,000 mark for healthcare organizations using its medical device integration solution, including 200 new customers added in the last four months.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 3/19/12

From Eric Rose MD: “Re: proposed MU rules. Like a lot of people, I get annoyed at how difficult it is to get to the actual regulatory text because the headings are embedded. I’ve extracted the actual text and marked them up with section headings. Turn on the Navigation Pane in Word and you can easily find the sections, particularly those with certification criteria or MU objectives. I created these for my own convenience, but others might find them useful. Feel free to share with the HIStalk community.” I’ve set up the certification criteria and MU objectives for downloading. Thanks to Eric, who is a clinical terminologist with Intelligent Medical Objects.

I’ve been having problems with the e-mail blast application that nobody can figure out, so I’m changing it to a hosted solution since I have no time for further investigation. The differences you’ll notice are: (a) the update notices will be HTML messages, which are a little bit nicer looking and easier to use than plain text; (b) the e-mails will look better than before when reading on mobile devices; and (c) hopefully the e-mails will go out faster and get delivered more often. I’ve learned way more than I ever wanted to know about the technical side of Exim, SMTP hosting, and server message queues and it’s not nearly as simple as just sending someone an e-mail. I’ve still got some fine tuning to do and I may need to change again if this doesn’t work as well as I’m hoping, so be patient and we’ll get through it.

Listening: Penelope Houston, one of the better female folk-rockers you’ve never heard of. She used to be singer of punk band The Avengers, but now does moody Euro-sounding 60s pop with mandolin, autoharp, some vintage Hammond B3 organ in the mix.

My Time Capsule editorial this time: US Healthcare Value is Low – Follow the Fancy Buildings, summarized by this snippet: “I’m not smart enough to figure out who the good guys and bad guys are in healthcare, so I look at just one thing: buildings. When I see stunning hospitals, vendor headquarters, insurance offices, and doctors’ houses, I figure they’re doing a little better than I’d like.”

A couple of readers chimed in on my comment about Epic implementations slipping from their aggressive, MU-driven timelines, saying they’ve heard of places having that problem. I think you’ll hear more about this. Big money at risk or not, system implementations are always harder and more complicated than they seem, and hospitals are notoriously bad at change management (although Epic leads them through it by the hand.)

This is encouraging in an “eat your own dog food” kind of way: 80% of respondents have primary care providers who use electronic medical records. My university-associated doc does and it’s made a huge difference in how my encounters work: I get accurate medication reconciliation performed at every visit with the system (even though all I take is a diuretic), he has all my history right in front of him (it’s fun to see how my weight has changed over the years, mostly because it’s gone down quite a bit), and we have avoided duplicated lab tests. The doc looks smarter, I feel like my entire health situation has been considered, and we use the on-screen information together as a teaching and planning tool. I’ll say something I would not have said a couple of years ago: I really think I’d sadly have to find another doctor if mine was stuck in the paper chart world. New poll to your right, in honor of the Mostashari vs. academic researchers flame wars: will wider EMR usage reduce the number unnecessary imaging exams? Maybe someone should just ask doctors themselves instead of trying to make inferences from sketchy data.

On the Jobs Board: Client Care Engineer, Mobility Software Engineer, Epic Inpatient Module Go-Live Support, Vice President Healthcare, Meditech CPOE Activation Support, Consultant. On Healthcare IT Jobs: NextGen Analysts and Consultants, Horizon Meds Manager Consultant, Assistant Health Services IT Director. I don’t know about your phone, but mine is ringing constantly from recruiter calls, although I do have specific expertise that’s hard to find. A lot of the calls are from folks looking for consultants.

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

An article in the newsletter of the USAF’s Hurlburt Field describes the Air Force’s MiCare Portal, a RelayHealth-powered site that allows patients to send secure messages to clinicians and request refills, while the providers can send patients appointment reminders, results, referral information, and changes in clinic hours. The group practice manager says the goal is to make MiCare the preferred method of communication after in-person appointments, avoiding phone tag and missed handoffs. Other bases using MiCare: Hanscom, Langley, Nellis, Offutt, Scott, Seymour-Johnson, and Travis.

Weird News Andy offers his own flavor of March madness with this story, in which an enterprising urology group is offering a free pizza with each vasectomy performed in March. The practice says March is their busiest time as men figure they might as well recover on the couch while watching basketball games on TV. WNA finds the last line of the story, which describes the free pizza, disturbing: “It does actually come with one topping. Maybe you can put some meatballs on it.” He also adds his own joke: what did the urologist’s wife sing to her husband when he finished his residency? “Urine the money, urine the money, we’ll have a lot of what it takes to get along.” </rimshot>

Here’s Vince’s HIS-tory of CliniCom (Part 3.) Check out the resemblance of the 1980s-era CliniCare handheld nurse terminal to the iPad.

I remembered Friday at work to print off the Archives of Internal Medicine article that has generated all the simplistic rag headlines that meet their goal of being stupid-simple and sexy at the expense of accuracy in summarizing the original study (example: iPads: Increasing Doctor Efficiency, Decreasing Patient Wait Time). The actual University of Chicago study wasn’t nearly that conclusive. The university gave iPads to 115 internal medicine residents and taught them to use Epic on it, along with online publications and the internal paging system. Four months later, the residents were surveyed. Results: 90% were using the iPads for work (it’s interesting that 10% weren’t) and 75% of those were using them daily (meaning 38% of those given an iPad weren’t.) Three-quarters of those said they thought they were more efficient and 68% of them said they thought patient care delays had been avoided because of the iPad. Residents entered a few more (5%) orders before 7 a.m. rounds and within the first two hours of admission. Study weaknesses:

• A sample size of 115 residents in one academic hospital isn’t all that predictive and doesn’t cover other specialties.
• Residents work a lot differently than attending physicians and community-based docs.
• Asking residents if they thought their free iPads were useful may have encouraged them to inflate the results to avoid having to return the iPads.
• The difference in order timing was tiny and compared 2010 patterns with those of 2011, a time during which other factors surely changed.
• The team had no way to determine which orders were entered from the iPad vs. from a desktop or laptop, so there’s no proof that the “earlier” orders came from iPads at all. It was also not stated whether Epic was available on wireless devices in 2010.
• It was not stated which devices were in use in 2010 – wireless laptops or hard-wired desktops. If residents didn’t have their own individual wireless laptops in 2010, you would expect orders to be entered more quickly (no waiting for a device) and closer to post-call rounds (the device would be at hand in the conference room).
• Placing orders early doesn’t necessarily translate to better outcomes or increased patient satisfaction, although it’s still a good thing overall.
• Epic has a native iPad client that most systems don’t offer, so experience with a less-functional clinical systems client would likely be less positive.
• Still, all that aside, if you can make residents think they’re more effective (not to mention cooler) for just $500 and you even potentially avoid the cost of buying them their own laptops, why wouldn’t you?

Mission Health (NC) names Sulaiman H. Sulaiman, formerly CIO of Cleveland Clinic’s hospital in Abu Dhabi, as SVP/CIO, replacing the retiring Arlo Jennings.

Athenahealth will hire 80 people to work at its Belfast, ME office, raising its headcount by 20%.

An article in The Atlantic says innovators develop products for people who are like themselves, which is why mHealth apps influence only the already-good health of what it calls “The Social Network” (well-educated, technically savvy, and affluent whites and Asians living on both coasts) while having minimal influence on the behaviors of the more diverse and more healthcare-expensive population as a whole. As Dr. Travis has said on HIStalk Mobile, running apps are a lot more popular with runners than couch potatoes. Or as Bill Gates says, we already have healthcare technology that tells people that they need to change their habits, but unhealthy people just ignore what it’s telling them (bathroom scales.)

E-mail Mr. H.