News 3/16/12

Top News

CMS pushes back the enforcement date for HIPAA 5010 transactions another three months, to June 30, 2012.

Reader Comments

From HIT Observer: “Re: City of Hope (CA). Looking to acquire some in-house talent. I believe it’s an Allscripts shop.”

From Cowabunga: “Re: UCLA. Was scheduled to go live with Epic patient accounting and registration at its hospitals and 150 clinics on July 1. Pushed the date back to March 2013 this week.” Unverified. You wonder if hospitals didn’t overcommit trying to hit Meaningful Use dates and are just beginning to realize the extent of the work required.

HIStalk Announcements and Requests

Inga is still off on a sojourn of some kind, so it’s just me (Mr. H) at the keyboard (Logitech, not Wurlitzer.)

Listening: new from Ceremony, NorCal punk rockers (think Pixies or Bad Religion.)

Welcome to new HIStalk Gold Sponsor Informatica. The global data integration company’s healthcare provider products include enterprise analytics data management, EMR data migration and archiving, the Informatica Integration Engine, and HIPAA 5010 Crosswalk. A few weeks back, I interviewed Chief Healthcare Strategist Richard Cramer, who has heavy provider-side IT experience from UMass and Penn. It was a good interview – I learned from it. Resources on the company’s site include “chalk talks” on data governance and a master data foundation solution for healthcare, a Webinar on why interface engines are obsolete, and improving care through data quality improvement. Thanks to Informatica for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Mediware will acquire the Cyto Management System chemotherapy management solution from Cobbler ICT Services BV in a $2.2 million transaction. The product, deployed only in Holland and Belgium, is used by hospitals and cancer centers to manage oncology protocols and costs, including drug preparation and administration. Mediware will continue to market the product under existing agreements and will roll it out in the UK and Ireland to complement its medication management product.

Voicebrook and Nuance announce an agreement to work together to develop speech-enabled reporting solutions for anatomic pathology laboratories. Voicebrook will integrate its VoiceOver pathology software with Dragon Medical 360.

I don’t follow stock pickers since most of their wisdom seems retrospective, but if you have a higher annoyance threshold than I do for Mad Money’s Jim Cramer, maybe you care that he’s tired of pitching Allscripts and now throws his questionable prognostication skills behind Cerner. “I’m going to eat some crow, admit the error, and tell you it’s time to put Allscripts in the sell block. If you want a healthcare IT play, the stock to own is Cerner, although I suggest you keep your powder dry on this one because it’s been red-hot and we could get a pullback.” The self-proclaimed expert claims that Allscripts has had problems integrating its “Aclipsys” platform, has a “large number of different versions of its software on the market,” and doesn’t manage expectations well.

Here’s the one-year share price comparison between Cerner (blue) and Allscripts (red). Thanks a lot, Jim – do you like the Giants or the Patriots in Super Bowl XLVI?

Reuters profiles Toronto-based NexJ Systems, which is using its IPO funding to expand its software business into healthcare with its interoperability solutions, portals, and population health management tools.

People

Kevin Fickenscher MD, formerly with CREO Strategic Solutions and Dell Healthcare, is named as president and CEO of AMIA. He replaces Ted Shortliffe MD PhD, who announced plans to step down last year.

Cleveland Clinic CIO Martin Harris MD, MBA is elected to the board of Thermo Fisher Scientific.

Intelligent InSites appoints Major General Terry L. Scherling (Ret.) to its board. She is president and CEO of global security planning solutions vendor TENICA and Associates LLC of Alexandria, VA.

Forbes profiles Grant Verstandig, the 22-year-old college dropout who formed Audax Health (social networking meets insurance benefits) and raised $16.5 million in funding from some heavy hitting backers in less than a year.

Revenue cycle and EHR services vendor Zeus Healthcare names Larry Havelis as CEO. He was previously with Quest Diagnostics and Allscripts.

Announcements and Implementations

Investor’s Business Daily writes up HealthStream-powered medical simulation mannequins and covers the company’s SaaS medical learning center, which has 2.75 million subscribers.

GE Healthcare and Intel open a laboratory in Israel to test new technologies.

Intelligent Medical Objects opens an office in Research Park on the campus of the University of Illinois.

Government and Politics

A security researcher says 84% of government web applications don’t meet security standards. One reason: instead of getting embarrassed or fired for writing bad code, government contractors get to bill extra for change orders to fix the mess they created.

New York eHealth Collaborative held a meeting Thursday to address health IT issues in the state’s Medicaid medical home initiative. A Department of Health official stated that current IT tools can’t bridge the care gaps in the managed care environment, and new applications are needed that can operate on the Statewide Health Information Network of New York.

Innovation and Research

Researchers use patient databases from drug trials and from the electronic medical records system of Stanford University Hospital to identify hundreds of previously undocumented drug-drug interactions and side effects. They developed algorithms to match similar patients to eliminate false alarms caused by gender, age, and disease status. The lead author plans to present the results to FDA as a possible way to improve drug surveillance programs.

Johns Hopkins University has 49 studies of mHealth applications underway as part of its Global mHealth Initiative. Director Alain Labrique says health-related apps should carry a disclaimer since most of them have not been validated through research. The GmI’s mission is to provide evidence-based support to technologies that have the best chance of improving global health in resource-limited settings.

Other

EHRtv posts interview videos from the HIMSS conference.

A Miami passenger cruise industry conference runs its first medical pavilion, covering medical technologies such as satellite-based telemedicine available anywhere in the world, electronic medical records for crew members and passengers, and outbreak detection and public health reporting associated with infectious disease such as norovirus.

Medical College of Georgia Hospital and Clinics announces that an unencrypted laptop stolen in a burglary earlier this year contained the medical information of 513 sickle cell patients.

 Sponsor Updates

• Speakers from Lehigh Valley Health Network will keynote TeleTracking Technologies’ free two-day symposium in New Orleans April 19-20.
• NextGen will host an April 2 webinar featuring Sherry Shults RN, BSN, CIO of South Carolina Heart Center on attestation for MU.
• Kony Solutions and Gartner offer a webinar on best practice guidelines for mobile app development.
• HealthStream offers reasons on why healthcare organizations should continue with their ICD-10 training and preparation despite implementation delays.
• API Healthcare experiences growth due to increased use of its workforce technology by healthcare staffing agencies.
• Certify will participate in IHI’s 13th Annual International Summit in DC next week.
• dbMotion and Allscripts will host an April webinar entitled “Innovative Workflow Leadership” with Rebecca Armato (Huntington Memorial Hospital), Yafa Minazad DO (Southern California Neurology Consultants), and Joel Diamond MD.
• Vocera launches its discharge solution, Patient Connect, at the AONE 45th Annual Meeting in Boston March 22-23.

EPtalk by Dr. Jayne

Healthcare IT News has opened its 2012 “Where to Work: Best Hospital IT Departments” nomination process. Categories are small (under 100 beds), medium (101-150 beds), or large (over 350 beds). If you think your shop is top, this is the time to make it known.

For another opportunity to toot your own horn, HIMSS (along with the American Society for Quality, the National Committee for Quality Assurance, and the National Patient Safety Foundation – that’s ASQ, NCQA, and NPSF for those of you playing along with the acronym soup game) announces a new call for the “Stories of Success!” program. (Yes, the exclamation point is included! Not sure why! But it is!) The blurb says:

This program showcases outstanding accomplishments in the adoption and use of health IT to fulfill national priorities recommended by the National Priorities Partnership (NPP) and The Joint Commission’s National Patient Safety Goals (NPSG). We are looking for real-world, case studies!

More acronyms and exclamation points abound, so be sure to submit your SQUIRE-inspired application form today. (I’m going to go make you look that one up yourself.)

I finally received the “HIMSS12 Overall Evaluation” e-mail today after hearing people talking about it last week. After two pages of the survey I was just aggravated and couldn’t bring myself to continue. I’m annoyed by HIMSS in general right now. The fact that some New Orleans hotels are already booking up is a mess waiting to happen. I may boycott next year and just show up for HIStalkapalooza, hot shoes, beignets, etouffee, and jazz.

NCQA keeps sending me invites to their Health Quality Awards dinner at the end of the month in Washington, DC. One of the honorees is Atul Gawande MD, who inspired me to get back into writing. Individual tickets are $350 a pop though, so I’ll pass.

I just received notice of which PQRS measure my staffing company has selected for me for 2012. Thank goodness they’re super-easy things that we do all the time anyway, so I don’t have to think about them. Just jumping through yet another hoop.

I was intrigued by the item that Inga ran the other day about the allergist who closed his practice to join the Army. Based on the statement that he was coming in as a lieutenant colonel, I assumed that he had previous military experience or was a reservist. After reading the full article though, it seems he has no military background. Anyone want to shed some light on how that works?

I did get one response to my call for medical tattoos – this one of a caduceus with an N for nursing. I like the blue, but not the delightful surrounding inflammation. Medical history tidbit of the day:  the caduceus with its dual snakes and wings was historically the symbol of commerce. Kind of funny that it’s been adopted as the symbol of medicine (especially in America) as opposed to the rod of Aesculapius, which is the original symbol of medicine (single snake, no wings.)

One of my faculty pals is a purist about this, so here’s your historical factoid of the day. In Greek mythology, the god Aesculapius was a healer, and apparently Hippocrates worshipped him. One potential theory of how the symbol originated was that it is a depiction of the stick used to remove guinea worms from the body. (note: picture in link is not for the squeamish.)

Have a question about acronyms, tropical medicine, or what is the maximum number of exclamation points that should be used in a single post? E-mail me!

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Dr. Sam 3/14/12

Mandating Physician EHR-Related Policies

It seems apparent that the problem of physician adoption of electronic health record (EHR) technologies, with which the industry has struggled for more than a decade, is finally lessening as digital technology continues its relentless infiltration into our everyday lives, and as the percentage of hospitals implementing EHR systems increases -spurred on by Meaningful Use financial incentives. Nonetheless, hospitals are still faced with residual challenges, including the creation of policies pertaining to their EHRs.

Creating policy is one thing. Medical staff compliance is something else.

So what does a hospital do when a physician or group of physicians refuses to use their EHR, attend training sessions, or comply with specific EHR-related policies?

If you have read any of my past commentaries, you must know that I am a history buff and enjoy intertwining historical episodes where they seem to apply to challenges of today.

In the case of mandating, President John Tyler comes to mind — mainly because he mandated that he would become president when it was not clear that he had the constitutional right to do so. I guess the analogy lies in creating a position of power and acting on it in a consistent fashion to establish precedent – or in his case, president.

John Tyler was William Henry Harrison’s vice president and was facing in a precarious position when Harrison died just one month into his term in 1841. There had never before been a presidential death in office and the Constitution was not of much help as to what should happen next. The wording within the Constitution is ambiguous, for it reads that, “in case of the removal of the President from office, or of his death, resignation, or inability to discharge the powers and duties of the said office, the same shall devolve on the Vice President.”

This could be interpreted to mean that the vice president’s powers remain ”the same” or that the vice president shall assume “the same” powers as the president had – in which case Tyler would become president.

Tyler was not a very popular man. After Harrison’s death, he was addressed as the “Vice President Acting as President” by his political opponents. He, however, referred to himself as President Tyler, and refused to open any mail addressed to “Acting President Tyler”.

At his first cabinet meeting, cabinet members insisted that he obtain their consensus before he acted. He informed them that he was the President, and if they didn’t like it, they could resign. Shortly thereafter, after a particularly unpopular veto by Tyler, all but two of them did exactly that. Through a long succession of political maneuvers — including virtually daring opponents to try to impeach him — he firmly established his hold on the presidential office, serving from 1841 to 1845.

Because of Tyler’s actions, the ascension to the presidency by the vice president in case of death or incapacitation of the president became standard procedure. There was still no requirement of a disabled president to hand over the reigns of government. This did not become law until the passage of the 25th Amendment to the Constitution in 1967 following the death of President John Kennedy.

Tyler just made it happen.

In the absence of likelihood that a constitutional amendment will come to the rescue of hospitals seeking to establish mandates related to their EHRs, what steps can be taken to stimulate physician recognition of hospital authority?

Step one is consistency in establishing policies – and all policies should be expressed with the entire C-level team on the same wavelength leaving no room for divide and conquer.

Realistically, it should first be accepted that most clinicians have little interest in hospital finances and are much more concerned with their own workflow issues, which are often appropriately viewed in their minds as intimately and directly related to patient safety. Herein lies the big ace up the collective sleeve of the medical staff – and the basis upon which many a shutdown has occurred or been threatened.

It’s difficult to keep an EHR up and running when the medical staff claims that it is impeding their ability to assure the safety of their patients. A medical staff will usually live with workflow impediments, although rarely silently, since most are accepting of the probability that features and functions of the system that are slowing them down can eventually be resolved through a vendor enhancement request process. But they will not live with what they view as imposed workflows that impact their ability to provide safe care — or more importantly, what they view to be safe care.

Therefore, one very important policy procedure to have in place is an effective enhancement request process. Clinicians must know that their suggestions for improvements in the EHR they are using are being heard, responded to, documented, and included in enhancement requests submitted to the vendor on a regularly scheduled basis.

The importance of policy and structure to the enhancement request policy cannot be sufficiently stressed. Nothing creates havoc more efficiently than a cacophony of complaints and suggestions from a large number of doctors directed in a steady stream at a varying number of administrative hospital executives during a complicated implementation process. This may even be further complicated by physicians who communicate directly with vendor sales representatives or even vendor executives to deliver their complaints and suggestions or demands.

The solution to this particular issue lies in an effective governance structure that establishes a clear path by which enhancement requests are evaluated by clinical peers and submitted for approval by a steering committee which is solely responsible for communicating with the vendor. Policy is spelled out to the clinicians and included with the terms to be signed by the clinician at the time they are certified for use of the EHR upon completion of required training.

Such a policy brings clarity and an understanding that a path exists to assure attention to physician issues. It reduces the risk of widespread simmering dissatisfaction, which can be toxic to any implementation process.

Educating the medical staff about Meaningful Use requirements that impact the hospital’s ability to meet these criteria is also very helpful. This understanding should reduce complaints about steps that were previously not part of their workflow, such as using history and physical examination formats that allow for the capture of specific data points, or having to include a diagnostic indicator with a study requisition if such indicators are not automatically included by the EHR in use.

But what to do when policies are not adhered to? This is the stuff that causes sleepless nights for many a C-level hospital executive.

Don’t pull a John Tyler yet!

"Mandating" policy has challenges specific to the institution’s business structure. It is much easier for a hospital that employs all of its medical staff or an academic institution to create policies which must be adhered to as a requirement for continued employment, than it is for a community-based hospital with a volunteer medical staff over which they have less control. Many hospitals have a combination of arrangements with employed physicians or groups (hospitalists, radiologists, pathologists, emergency doctors) and a volunteer staff.

Even mandating policy to employed physicians can be very difficult. It’s easy to write a policy that requires an employed doctor to follow certain procedures, but firing someone is a huge step that brands that person’s professional reputation for a lifetime. Legal consequences may ensue, and the human resources department had better have all of their ducks in line before any such move. Additionally, rural and remote hospitals may be faced with finding replacement services, which might be challenging.

The first place to start is with the hospital bylaws. Careful legal review and appropriate verbiage should be included to place the hospital on solid ground for the imposition of policy mandates and consequences of failure to comply. Included in this process is a clear outlining of credentials of individuals who fall under the category of "providers" of care using an EHR. By including these specifications in the hospital bylaws, individual policies can be created with simple reference to the bylaws without spelling out the affected caregivers impacted by each policy.

Begin the mandating process with something palatable, understandable, and reasonable to the medical staff. For example, an initial mandate that 50% of all orders must be by computerized order entry is a heavy hand applied at the onset to a staff not accustomed to being dictated to. A reaction may reasonably be expected.

However, a mandate that passwords may not be shared under any circumstances is entirely reasonable and understandable. It is a good starting point and establishes an understanding that the hospital is prepared to take a firm stance with future rules to follow. Consequences of failure to comply should be clear and uniformly followed through on without exception. For example: share your password once and you’ll receive a warning letter. Share it twice and you’re off staff.

Such a mandate is reasonable and even expected under the same arguments applied to an EHR that clinicians find cumbersome — possible patient safety and medical legal consequences.

Some creativity may be required if a hospital does not wish to impact the career of an employed, noncompliant physician who refuses to follow required procedures such as attending training sessions or using CPOE. Failure to comply could mean loss of remote access to the EHR as a consequence. Remote access can be reinstated when the physician is trained, credentialed, or has entered a predetermined percentage of orders by CPOE over a designated period of time.

Another creative approach is to deny a noncompliant employed physician from taking emergency call. One might expect such a "penalty" to be received with glee, but the physician’s department head may not be too happy with rearranging a call schedule, or worse yet, having to take call personally to cover the ”penalized” physician. It’s more than likely that the noncompliant doctor will soon receive a dictate from above.

I am always surprised by how rarely community hospitals take advantage if their most reliable ally – the community that they serve. When a community is educated about CPOE, for instance, CPOE becomes an expectation and patients may begin to select physicians who are using technology that reduces the risk of errors.

Just as John Tyler lined up his ducks in finding support to bolster his position, the community being served may become a powerful ally. One creative approach to physician compliance in a community hospital setting is to simply periodically publish a list of physicians in the community who are helping the hospital assure patient safety by using the hospital EHR. A sample heading might read: "XYZ Hospital System is pleased to acknowledge and thank the following physicians who have displayed their dedication to the safety of our patients and high quality of care to which we are dedicated by using our state-of-art electronic health record system"

Not too many community physicians will want to be missing from that list.

There may be similar value obtained by issuing an appropriately worded certificate of EHR credentialing or thanks to a community physician to hang in his waiting room. The doctor’s patients may feel added security with their doctor, and the doctor will have another set of credentials in place if he or she ever decides to explore a second career in medical informatics — in which case they can be the ones dealing with non-compliance, mandates, and creative approaches to their refractory colleagues.

Lest this commentary appears to be one-sided, I should add that I fully understand the frustrations of my physician colleagues who are themselves beleaguered by falling reimbursements, ever-increasing regulation, and medical-legal vulnerability. Frustrations abound for all parties involved.

This is where I enjoy bringing up my favorite metaphor, a lesson that I learned during my years of travel with professional musicians.

Any professional band realizes that the goal is not for the “killer” guitar player to get out front and blast away in order to leave the crowd in awe so that they leave thinking, “What a great guitar player!” Real professionals know that the goal is to make everyone else in the band look good so the crowd leaves thinking, “What a great band!”

We’re all struggling with the sheet music we have been handed. The trick will be to make great music together.

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

News 3/14/12

Top News

Blue Cross Blue Shield of Tennessee will pay $1.5 million to settle potential HIPAA violations, a result of the first enforcement action triggered by HITECH-mandated breach reporting. Fifty-seven unencrypted hard drives containing the PHI of over 1 million people were stolen from a BCBST-leased building that did not have access controls.

Reader Comments

From HIT Cynic: “Re: EMRs and test ordering. Finally someone says what lots of us out here are thinking.” The authors of the Health Affairs article respond to criticism of their study by Farzad Mostashari in an ONC blog post titled Recent Study: Get the Facts and a sub-headline of “Don’t Believe the Hype.” The original article suggested that EMR usage is associated with higher ordering rates of imaging tests, concluding that expected EMR-driven diagnostic savings may never materialize.

Mostashari said (a) any HITECH-related conclusions from an observational study using 2008 data are worthless, especially since it did not consider clinical decision support and information exchange; (b) EMR users didn’t order more tests, but high-volume imaging prescribers  are more likely to view those images using an EMR; (c) the study didn’t look at appropriateness of ordering, so comparing the number of imaging orders omits important factors such as practice demographics and whether the high-volume physicians have a financial stake in the imaging centers they use; and (d) EMR cost savings aren’t dependent on reducing test volume.

The authors respond: (a) physicians who viewed images electronically ordered 40-70% more of them; (b) the famous RAND study that Cerner helped pay for said billions would be saved by reducing imaging and lab test volumes; (c) even though the study data were from 2008, the same EMR vendors are selling pretty much the same products; (d) Mostashari’s explanation that high-volume prescribers probably bought electronic systems specifically to view the results was tested and rejected in their analysis; (e) the study did take into account patient demographics, severity of illness, and other factors; and (f) while observational studies can’t prove causation vs. correlation, ONC has used cherry-picked studies of similarly dubious methodology to cheerlead EMR success and plenty of other studies have found no IT-related quality improvements. The authors conclude:

Dr. Mostashari is also correct in reiterating that randomized trials are the best way to assess health IT. In fact, no randomized trial has ever been published that examines patients’ outcomes or costs associated with off-the-shelf health IT systems that dominate the U.S. market. No drug or new medical device could pass FDA review based on such thin evidence as we have on health IT. Yet his agency is disbursing $19 billion in federal funds to stimulate the adoption of this inadequately evaluated technology. Dr. Mostashari is perhaps the only person in our nation who commands the resources needed to mount a well done randomized controlled trial to fairly assess the impact of health IT, and the comparative efficacy of the various EHR options. Finally, Dr. Mostashari’s unbridled faith in technology is mirrored by his belief that ACOs are the next panacea for health costs and quality. That health policy flavor-of-the-month also remains wholly unproven.

I’m going to score this as a win for Mostashari even though the lady doth protest too much, methinks. The study was only marginally interesting and I would have serious reservations about drawing any conclusions whatsoever from it (particularly in comparing electronic image viewing to the use of full-blown EMRs,) but the authors seem to want to elevate it to a government policy argument, and now are launching a second front on ACOs for no apparent reason. Lazy journalists wrote their usual hysterical headlines with obviously limited understanding of anything in the article, which got Mostashari fired up to launch an unnecessary counterstrike in a war that he not only can’t win, but shouldn’t be fighting in the first place since it just gives the article more exposure.

My conclusion: don’t believe either side. Nobody knows if having previous images available would reduce new orders for them, especially if doctors receive benefit from unnecessary tests. Even if the conclusions of both sides are data driven, unbiased, and definitive (which I’d say is highly doubtful in both cases) they are also irrelevant. Taxpayers are already paying for EMRs and we won’t know for years whether we’ll get our money’s worth in the form of lower healthcare costs. My crystal ball says we won’t unless they’re used to prod patients to change their health risk behaviors, like convincing the 75% of the population that’s overweight to eat better and exercise more.

HIStalk Announcements and Requests

Inga is taking a semi-break, so it’s just me (Mr. H) this time around, other than for a few items she sent over. I’ll dispense with the red/blue icons for today.

Acquisitions, Funding, Business, and Stock

Jiff Inc., a developer of a HIPAA-compliant private healthcare social network and digital health apps platform, completes a $7.5 million Series A financing round led by Aeris Capital. The company also named Derek Newell (Robert Bosch Healthcare) as CEO.

Vocera expects to price its 5 million IPO shares at $12 to $14, using the proceeds to pay down debt and potentially to make acquisitions.

Greenway Medical Technologies announces its first quarterly results as a publicly traded company: revenue up 30% to $29 million, EPS –$0.01. Shares closed Tuesday at $13.75, up from February’s IPO price of $10 but down from their high of just over $15.00 on March 1.

Milwaukee-based point-of-care technology consulting company True Process Inc. acquires the PDA-based VeriScan bedside medication verification system from Hospira. Does anybody even make PDAs these days, and if so, who’s buying them?

Sales

Geisinger Health Plan chooses NaviNet’s Insurer Connect solution to give providers online access to patient benefit information.

Tyrone Hospital (PA) selects Promantra’s RCM system for billing and claims management.

St. Jude Medical Center (CA) chooses PerfectServe’s clinical communications platform.

People

MedAssets appoints Michael P. Nolte (GE Healthcare) as EVP and COO.

MEDecision promotes Ken Young from VP of finance to CFO.

Announcements and Implementations

The Wexner Medical Center at The Ohio State University goes live on its $102 million Epic system. The hospital appended “Wexner” to its name last month to honor $200 million donor Les Wexner, chairman and CEO of Limited Brands (Victoria’s Secret, Bath & Body Works.) He’s worth $3.2 billion, lives in $47 million house, and has a 315-foot yacht.

Health Language Inc. announces that its data mapping software and content support all terminology standards required by MU Stage 2.

NYU Langone Medical Center announces that 125,000 of its patients are using the PatientSecure palm vein scanning identification solution, launched nine months ago and integrated with Epic.

T-System offers integration with the iTriage Web and smart phone applications, allowing hospitals to list their ED wait times and patients to notify the ED that they’re coming in.

Patient teaching technology vendor Emmi Solutions announces that its products now work on Android and iOS smart phones and tablets.

SCI Solutions offers order entry and results reporting via mobile devices for its Order Facilitator product. The new service provides a national physician directory so that hospitals interested in improving their physician outreach and referral programs can integrate with physicians even if they don’t use the hospital-preferred EMR.

Government and Politics

OSEHRA, the open source community created by the VA in August 2011 to oversee VistA and VA-DoD EHR  integration projects, announces three new members of its inaugural board: James Peake MD (SVP of CGI Group, retired Army officer, and former VA secretary), John Halamka MD (CIO, Beth Israel Deaconess Medical Center), and Michael O’Neill (senior advisor of the VA’s innovation program.)

AHRQ is soliciting proposals for the validation of a workflow toolkit it developed to identify and avoid workflow-related problems with technology implementation in the ambulatory setting.

West Virginia’s Department of Health and Human Resources is forced to throw out bids for a Medicaid computer system and start over when HP’s proposal lists a subcontractor that employed the COO of the West Virginia Health Information Network. Philip Weikle says he had nothing to do with the bidder selection and has since left the consulting firm to become a full-time state employee. DHHR had already restarted the Medicaid system bidding last year for unstated reasons.

Innovation and Research

An article in Archives of Internal Medicine supposedly finds that medical residents using iPads felt the devices made them more efficient. I don’t trust the conclusions of reporters when reviewing research articles, so all I’ll say is that the article isn’t available to non-subscribers. I’ll try to remember to pull it up from my hospital PC to see what it says.

A JAMA article concludes that Ontario hospitals that spend the most under the universal healthcare system deliver the best patient outcomes. Patients at the top-spending hospitals had lower rates of death, readmission, and cardiac events and were more likely to be given evidence-based care. However, the authors note that lower-spending hospitals can’t just increase their spending to improve outcomes since the drivers seem to be the use of evidence-based medicine, better nurses, more specialists, and more technology. It may also be that the higher-spending institutions are teaching hospitals. As is always the case, correlation was modest and the unknown or unmeasured factors could be skewing the conclusions.

Other

Poudre Valley Health System (CO), which says its transition to Epic will decrease transcription needs, will outsource 37 transcription jobs to Nuance.

A company that reviews medical insurance claims shuts down, blaming the compliance cost of dealing with a medical data breach after a break-in at its headquarters. Impairment Resources LLC was required to report the breach to numerous federal and stage agencies and says that expense, plus threat of lawsuits by those whose data was exposed, forced the company to declare Chapter 7 bankruptcy. In snooping around, I found that the company’s chairman, Christopher Brigham MD, was a MUMPS programmer at Mass General in 1972.

The local newspaper covers the $750 million implementation of Epic at Providence Health Services. Richard Gibson MD, who runs informatics for Providence’s Oregon Region, says Epic will reduce costs through optimal physician ordering and analytics. He said, “If we’re going to survive and needlessly take money from roads, schools, lunch programs and world peace, let’s not go into diagnostic studies and treatments that don’t do any good.”

TEDMED 2012 will offer a free HD streaming live simulcast at regional locations such as hospitals, medical schools, government agencies, and corporations. It is also offering $2 million in scholarships to in-person attendees, expected to number 1,200 for the April 10-13 conference in Washington, DC. Registration is $4,950.

Several healthcare-related associations release two brochures on personal healthcare records, one for consumers and one for clinicians. They can be downloaded here. They probably should have had readability experts help out since the verbiage is a bit dense for mass consumption. They also mention Google Health, which of course has shuffled off this portal coil (OK, lame pun there by me.)

Here’s another of those overpromising, underdelivering headlines. TV doctor Sanjay Gupta provides his plan to eliminate medical errors, as gleaned from note-taking at weekly hospital M&M (morbidity and mortality) conferences. He’s conveniently included them in his just-released first fictional novel rather than publishing them in a peer-reviewed journal. I’d keep expectations correspondingly modest.

An Oregon jury orders Legacy Health System to pay a couple $2.9 million in their wrongful birth lawsuit. The hospital incorrectly told them their unborn daughter would not have Down syndrome. When she did, they filed suit, saying that if they had been told, they would have had an abortion.

Sponsor Updates

• United Regional Health Care System (TX) builds on its Allscripts portfolio with the selection of Allscripts Care Management.
• Robin Tardif of Hayes Management Consulting posts Part 1 of her series “Reduce Human Error in EHRs.”
• Sam Whitaker, CEO of Greenphire, and Zaher El-Assi, GM for Merge eClinical will present a webinar discussing payment and integration processes for healthcare facilities.
• Versus will participate in the AONE 45th Annual Meeting & Exposition this month.
• Billian’s HealthDATA offers a white paper, Providers’ Perceptions: Accountable Care Organizations.
• OrthoKansas selects SRS for its 12 providers.
• An Aspen Advisors white paper describes the company’s involvement in developing the Epic rollout plan for specialty clinics of University of Utah Health Care.
• Healthwise adds the concept of Patient Response to its patient education EMR module, which allows prescribers to order health education and tools and receive reports back of their degree of compliance.
• Sunquest Information Systems will participate in the 2012 Patient Safety Awareness Week after releasing Collection Manager 5.0, which focuses on POC patient safety.
• Xpress Technologies integrates with DrFirst to launch its end-to-end eRX solution.
• Intelligent InSites integrates WaveMark’s consumables asset tracking system with its RTLS.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Passport Health Acquires STAT Technologies

Passport Health Communications announced this morning that it has acquired STAT Technologies. The Hazlet, NJ company offers Web-based inpatient and ambulatory applications for patient scheduling, eligibility verification, charge capture, transport management, physician portal, patient self-service, and an HIE platform.

Passport CEO Scott MacKenzie was quoted as saying in the announcement, “Scheduling is a natural expansion of the Passport eCare NEXT Suite. It enables hospitals to begin revenue cycle functions at the point the order is received from a physician office, and improve coordination when there are different systems between the hospital and outside physician offices. Within a hospital organization it supports coordination of schedules, precertification, and onboarding between all departments, facilities, and silos of patient information, where disparate scheduling tools and other IT systems often exist.”

Financial details of the acquisition were not disclosed. Passport said in the announcement that it expects to acquire additional companies this year.

Monday Morning Update 3/12/12

From N2InformaticsRN: “Re: Ed Marx and Jim Murry. Did a nice job discussing mobility in healthcare on CIO Talk Radio.” That’s pretty cool – the audio sounds like a real radio station.

From @Cedars: “Re: Cedars-Sinai CPOE go-live. As a consultant going from project to project, it’s easy to forget why I began to work in healthcare, but this weekend I was reminded of it. This means everything to our industry, as past failure is redefined forever. This project has been done right in every way. I was inspired by this note from CIO Darren Dworkin. Please, please interview him.” I think I’ve asked Darren before. The CPOE implementation and quick de-implementation at Cedars-Sinai years ago gives it an honored spot in the Healthcare IT Failure Hall of Fame, right up there with BIDMC’s massive network outage, Kaiser’s waste of $500 million hiring IBM to develop IT systems that were abandoned before completion to instead passionately mate with Epic, and El Camino’s near-shutdown after implementing a patient-endangering Eclipsys medication solution. Feel free to suggest new nominees since every one of these examples provided painful but valuable lessons for not just those involved, but also for the rest of us gawking at the smoking wreckage from the safe side of the “do not cross” yellow tape. All of those organizations learned from their mistakes and came back better than ever, although iterative learning isn’t necessarily a good thing for patients.

From Sinking Ship: “Re: GE Healthcare. Cancels the 2012 Healthcare Technology Symposium due to mounting budget pressures.” The reader provided a copy of what appears to be the announcement letter from VP/CTO Mike Harsh. UPDATE: I asked GEHC what this event is since I could find no reference to it. It’s an internal-only event, so it has no customer implications.

From Bed Manager: “Re: HIMSS13. They are pre-booking hotels and relatively few rooms are available in New Orleans. Did attendees wise up and book early, or are rooms being held back for exhibitors, or does New Orleans just not have enough rooms to handle the increased size of the HIMSS conference? Both hotels of my choice are sold out and they aren’t even in the HIMSS block.”

From Epic Employee: “Re: Farzad Mostashari. Will be speaking at Epic on April 24. Pretty cool.”

From John: “Re: HIMSS conference exhibit layouts. The problem was because it was at the Sands Expo Center instead of the Las Vegas Convention Center, which has high ceilings and a long hall. I heard that the conference was supposed to be in Chicago but fell through at the last minute, leaving the Sands as the only alternative. HIMSS missed revenue since it sold out the Sands space weeks before the show, although I liked the Sands because it involved less walking and easy access to the Strip.” I don’t know if HIMSS planned to return to Chicago after what I would consider a predictably terrible first and only trip there (snowstorms even after screwing up the schedule by moving the event back, surly union workers in the hall, wildly overpriced hotels), but I thought they originally announced a permanent rotation of only Orlando, New Orleans, and Las Vegas. I don’t think that plan lasted long since they’ve been to Atlanta since then. New Orleans was OK last time, but that was right after Katrina when hotels and restaurants really didn’t have enough employees to keep things running smoothly. I’ll still hold out for San Diego as my favorite HIMSS experience and I heard they were expanding the conference center to handle the huge annual comic book convention.

From VA Doc: “Re: digital pens. The VA puts out an RFI for the technology, which has matured to the point where it makes sense to move beyond case studies.”

From MT Hammer: “Re: Clinical Documentation Industry Association. Ceasing operations, annual conference in Baltimore cancelled, financial pressures cited.” CDIA was a trade association for clinical documentation services, basically transcription. HIMSS could have possibly taken it over given a few familiar names among its dwindling list of members: Acusis, Arrendale, Diskriter, MD-IT, MedQuist, M*Modal, Nuance, and Verizon. The former Medical Transcription Industry Association (MTIA) rolled out its new name at the HIMSS conference in 2011, but a year later, both the organization and the conference are defunct.

From Sagacity: “Re: International Society for Disease Surveillance. Seeking comment on syndromic surveillance guidelines for the ambulatory and inpatient settings, targeting potential application for Meaningful Use Stage 3. The organization did the same thing for emergency and urgent care in the past, which led to MU Stage 1 specs.” Information here.

From Just a HIT Guy: “Re: WellStar. Moving off McKesson, NextGen, and GEMMS Cardiology, going to Epic. Internal memos released this week.” I’ll list this as unverified because I agreed to wait for a formal announcement as a courtesy to WellStar, but as usual, the organization’s long list of inpatient Epic job listings tell you everything you need to know anyway.

From EMR_Guru: “Re: WellStar. Announced to physicians they are scrapping NextGen and going with Epic. Wellstar has acquired a large number of physician practices over the last several years, Imagine getting bought and deploying NextGen only to be told a few months later that you have to scrap it and go with Epic.” That’s one of many risks involved in deciding to work for a hospital instead of for yourself.

From Prevailing Winds: “Re: Allscripts. You mentioned a vague acquisition rumor about Allscripts and IBM, but here’s something I’ve heard mentioned that I should say is completely unsubstantiated but potentially related. I’ve heard rumors of a potential buyout of Xerox/ACS by IBM. Allscripts remote hosting is outsourced to Xerox/ACS, so maybe the rumors refer just to that business instead of the whole company. Just rumor mill grist that may or may not mean anything.”

From Bony Moroni: “Re: HIMSS evaluation survey e-mail. It contained confusing instructions, misspellings, and a splash screen apologizing for errors in the e-mail. And we wonder why our industry is the butt of jokes by non-healthcare people. Here’s a crazy thought for an IT association in an industry known for sloppy work: test the damn e-mail merge program first. Not only was the merge done incorrectly, the ‘brief survey’ has a million questions on 11 pages, a status bar instead of an idea of what’s to come, and a pointless listing of the name and company of each recipient apparently just because they could. Obviously this is a contracted vendor, but does HIMSS really want this shoddy effort being the last thing people remember about the conference or the quality of work that HIMSS puts out?”

I’m back and rested after a week off out of the country, woefully behind, facing 500+ e-mails in my inbox, and regretting the loss of an hour due to springing forward since I’m already re-immersed into chaos even before I get back to my “real” job at the hospital. Actually I’m not that well rested since I got only four hours’ sleep Saturday night after downing my first-ever Red Bull to stay awake until  getting home at 3:00 a.m. Still, I’m happy to be back in my multiple saddles even though the horses tend to take off in different directions most of the time. Thanks to Inga for  keeping the HIStalk fires burning in my e-mail free absence. I’m sure I’ll repeat some items she’s already mentioned in trying to catch up, but that should be a one-time occurrence before things get back to normal with Tuesday’s news.

Thanks sincerely to everyone who completed my annual reader survey. It helps immensely and I’ve already made a to-do list for the next year based on the results. Obviously I almost cheated on my no-Internet vacation pledge to Mrs. HIStalk, but rationalized it to her by explaining that it took only seconds to download the results, even if I did spend several frowning and chin-stroking hours thinking about them and furiously taking notes. The preponderance of supportive comments was touching, although I probably won’t run them all here since that seems rather vain (as does re-reading them repeatedly, but at least I keep that particular vanity to myself.)

Readers grade ONC’s MU Stage 2 performance as maybe a D+. New poll to your right: does your PCP document your encounters in an electronic medical record? Mine does, even though the system he uses is about to get the boot in a hospital-mandated EHR replacement.

How did your Daylight Saving Time switchover go? Let me know if you had problems at your hospital. I’m always curious since vendors (some at my hospital, anyway) still haven’t worked out the bugs and punt by just suggesting shutting everything down for a couple of hours. Most of the problems are in the fall, when the “fall back” causes the 2:00 a.m. hour to be repeated, driving some badly designed systems crazy.

My Time Capsule editorial this week happens to be maybe my favorite one (at least until next time): Want to Anger a Nurse? Make Smug Comments about Grocery Store Barcoding. A desensitization dose: “They would buy Doritos by the bag, but would have to repackage and label individual chips and then track every chip – who bought it, who ate it, and whether they ate it in an appropriate quantity and with only complementary foods and according to dynamically calculated nutritional needs. ”

Fujifilm Medical Systems donates $25,000 to a laid-off radiology tech to save her foreclosed home, as seen on the Ellen show. 

Former HHS CTO and athenahealth co-founder Todd Park is named CTO of the United States, replacing Aneesh Chopra. Who would have put their money on the first HIT’er in the White House not being Allscripts CEO Glen Tullman?

Doug Stacy is named CIO at Labette Health (OK.) He was previously CIO at Coffeyville Regional Medical Center (KS.)

Dean Marketti, previously with BCBS, is named the first CIO of Morris Hospital & Healthcare Centers (IL.) I almost gave up trying to figure out what state the hospital is in given the common small-town newspaper website practice of not giving their location, apparently convinced that if you don’t already know, you couldn’t possibly care. Which I’ll concede is pretty much the case. 

Scott & White Healthcare names Matthew Chambers as CIO. I’m guessing he was interim while working for KPMG since his LinkedIn profile says he’s had the job since July 2011.

Holon Solutions (solutions for telepharmacy, order entry, results reporting, and the CollaborNet data sharing solution) names industry long-timer Mike McGuire as CEO. He was previously with MET-test.

Cincinnati Children’s Hospital (OH) and the local technology incubator launch QI Healthcare to commercialize the hospital’s quality improvement software that analyzes EMR data to identify improvement opportunities. I’m a bit skeptical about how easy it will be to commercialize any EMR data analysis application given the inconsistency in how each product and user stores and uses data, but hopefully they will figure out how to make that giant leap from Customer #1 to Customer #2. It took forever to find the startup’s Web page, which appears to be due to a combination of (a) lack of search engine optimization and Web content (just a leering stock art doctor on a GoDaddy parking page,) and (b) a poor choice of names that’s always going to give unrelated Google results. I continue to be amazed that new companies still choose names that won’t stand out in an Internet search.

It’s old news since I’m catching up, but First Databank mentions HIStalk (“the influential industry blog”) in the announcement of its rebranding, which I think is the first time a large, respectable organization has mentioned the name of this small, not all that respectable one in a significant announcement. I was impressed.

In the UK, Lord Carter of Coles, who heads up an NHS group to ensure fairness to its suppliers, is pressured to resign after the newspaper belatedly realizes that he’s also chairman of the UK division of McKesson (which he clearly disclosed when he took the job) and is part of an investment group that owns chunks of several healthcare companies. NHS pays him $90K per year for his two-days-per-week job, while McKesson pays him $1.25 million. Not surprisingly, nobody is suggesting that he quit the McKesson job.

Here’s Vince’s Part 2 of the CliniCom story.

The local paper covers the implementation of McKesson Paragon by McLaren-Bay Region (MI.) I think that’s actually McLaren Health Care, which makes a lot more sense.

A study at Minneapolis Heart Institute finds that surveillance software was able to retrospectively detect problems with implantable cardioverter-defibrillator devices long before the routine monitoring performed by the device manufacturers. The problem, of course, would be in collecting data in near real-time from the universe of patients in order to capitalize on the lead time.

The founder of SAP backs MolecularHealth, which offers software that matches the genomic data of individual patients to scientific evidence to suggest optimal cancer treatments. The application, which the company calls clinical decision support for oncologists, is being refined at MD Anderson.

Inga ran an anonymous reader’s rumor suggesting that GE Healthcare’s Centricity Perinatal could be on the sunset list. Not true, according to GEHC, and I’m sorry we ran that without asking the company for verification. GEHC is really fast and courteous about getting answers to my questions or rumor reports and I would have asked them for confirmation before running it. Inga doesn’t know the contact and probably figured she wouldn’t get a response.

Mrs. Dennis Quaid #3, the mother of the twins who were overdosed on heparin at Cedars-Sinai four years ago that were the subject of Dennis Quaid’s 2009 HIMSS conference keynote speech, files for divorce from the actor.

BCBS of North Carolina rolls out a mobile website that lets patients view claims, check their plan benefits, find a doctor, get a treatment estimate, and comparison shop drugs and insurance plans. The site, developed by Kony Solutions, supports Android and Apple platforms.

Philip White, historian and PR manager of electronic forms management vendor Access, appeared on Fox News last week after the release of his book about Winston Churchill’s Iron Curtain speech in Missouri in 1945. They asked him whether the lessons learned from the previous cold war still apply in situations related to Iran’s nuclear capabilities.

The local paper covers Oakwood Healthcare System’s (MI) $80 million Epic project, to be kicked off in August.

A fun Bloomberg BusinessWeek article discusses the joys of attending a conference in Las Vegas. It contains interesting mentions of the HIMSS conference, including four Craigslist “casual encounters” ads targeting HIMSS attendees like the one above.

A Kaiser Health News/Fortune article profiles Farzad Mostashari and HITECH. A quote:

Remarkably, in an era of partisan government, Mostashari’s program enjoys bipartisan support — or, at least, bipartisan tolerance. While only three Republicans voted for the stimulus bill in 2009, which provided the program’s funding, few have spoken out against it. The fact that the information technology industry is a big supporter — giants such as IBM, Microsoft, General Electric, Hewlett-Packard and a host of smaller health-care specialty technology companies — doesn’t hurt. The $27 billion will flow their way, and plenty of high-priced lobbyists are working hard to keep it flowing.

The New York Civil Liberties union criticizes the state’s privacy and security policies, saying HIEs should require patient consent to access their records and that the all-or-nothing approach to privacy means doctors see a lot of confidential information they don’t need to do their jobs.

Utah Business names Amy Rees Anderson, CEO of HIE technology vendor MediConnect Global, as its CEO of the Year.

State auditors discover that 269-bed Salinas Valley Memorial Healthcare System (CA), which earned scathing headlines last year when auditors found that its retiring CEO was paid over $5 million, did $21 million of business over a five-year-period with firms in which its executives held a financial interest.

A woman whose pending Supreme Court lawsuit argues that the federal government can’t force individuals to carry health insurance files bankruptcy after the family car repair business fails. Among the debts she’s petitioning the federal court to allow her not to pay: several thousand dollars owed to hospitals and physician practices. She had opted not to purchase health insurance.

E-mail Mr. H.

News 3/9/12

Top News

National Coordinator for HIT Farzad Mostashari, MD takes issue with the recently published report that found doctors with online access to patients’ charts ordered more tests. Mostashari disputes the study, which raised questions as to whether or not EHRs cut costs. Mostashari’s contends that the study was based on 2008 data and before the start of the Meaningful Use program and thus does not address certified EHRs’ capabilities for data exchange and clinical data support.

Reader Comments

From EFMHead “Re: OB data management. Rumor has it that GE Centricity Perinatal is to be discontinued and that CPSI is auctioning off its OBIX product. Thoughts? If true, this signals an odd and sudden exodus of two major players from the OB data management market space.” Unverified. UPDATE: per GE Healthcare, the Centricity Perinatal rumor is not true.

From CW “Cake. Here’s a picture of the cakes that were prepared for Vada’s retirement. She was also presented with a quilt that reflected all the company names and colors over the last 24 years.” The cakes were prepared in honor of the retiring Vada Hayes, a longtime Allscripts/Misys/Medic support supervisor.

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: a handy two-page summary of Stage 2 for EPs, prepared by two e-MD physician users. US physicians charge two to three times more than their French and German peers and achieve similar outcomes. MGMA urges Secretary Sebelius to consider adding due diligence to the ICD-10 timeline and limit required adoption to hospitals. A survey finds that 30% of physicians have implemented an EHR that meets MU criteria, 14% will in the next three years, and 17% have no plans to do so. Check out the rest of the goodies on HIStalk Practice and be sure to sign up for the email updates. Thanks for reading.

HIStalkapalooza’s  own singing Elvis is seeking  music video contributions for “Gimme My Damn Data,” as debuted at HIStalkapalooza last month. Dr. Ross D. Martin, MD encourages anyone wishing to promote access to their electronic health information to submit a video clip by March 26th. Check out the video clip – fun stuff.

Mr. H will be back in front of his computer this weekend, following his week-long get-away with Mrs. H. Of course I’m ready for him to be back at the helm, especially since he is the one most likely to feign amusement by my witty e-mails. He did a pretty good job staying off the Internet this vacation, meaning his inbox is likely overflowing; no doubt he’ll immediately be back to his workaholic ways.

Acquisitions, Funding, Business, and Stock

Medivo, a provider of decision support and analytics software, acquires WellApps, a developer of mobile disease management applications for chronically ill patients.

Sales

The 150 physician Holston Medical Group (TN) selects Humedica MinedShare as its clinical intelligence solution to be used in a joint venture with over non-Holston 1,300 physicians.

WellStar Health System (GA) selects PerfectServe’s clinical communication platform.

University Health System (TX) expands its Allscripts portfolio with the selection of Allscripts Community Record, powered by dbMotion, to share data across its 24 locations.

Watson Clinic (FL) selects MedAptus’ Professional Intelligent Charge Capture for its 294 multi-specialty providers.

Oakwood ACO (MI) contracts with Wellcentive to provide its the Wellcentive Advance healthcare intelligence solution suite for Oakwood ACO physicians.

Fairview Health Services (MN) chooses Amcom Software’s communication solutions, including smartphone-ready encrypted messaging and nurse call alerting on mobile devices.

Brattleboro Memorial Hospital (VT) selects Unibased’s ForSite2020 solution for enterprise scheduling.

CSC signs a nonbinding letter of intent with the NHS to move forward with additional implementations of the Lorenzo patient records system, beyond the 10 that have already been rolled out.

People

The Cal eConnect board of directors appoints Ted Kremer as president and CEO. Most recently Kremer served as executive director of the Rochester Health Information Organization.

Former Nuance Communications executive John Shagoury joins Eliza Corp. as president. Shagoury replaces company co-founder Alexandra Drane, who takes over as chairwoman and chief visionary officer of the patient engagement company. Shagoury is the former president of Nuance’s healthcare division.

Physicians Interactive, a provider of mobile and Web-based clinical resources, names Gautam Gulati, MD (Digitas Health) as CMO and SVP of product management and Joe Caso (King Pharmaceuticals, Pfizer) as EVP of new business development.

Announcements and Implementations

Datawatch Corporation partners with HIT consulting firm Jacobus Consulting, enabling Jacobus to incorporate Datawatch’s Monarch Report Analytics platform into its client offerings.

Bayscribe partners with Health Fidelity to integrate Fidelity’s NLP platform into BayScribe’s clinical documentation solutions.

Government and Politics

The Stage 2 proposed rules for Meaningful Use were officially published in the Federal Register Wednesday, marking the start the 60 day commentary period. CMS is accepting feedback through May 7th.

Other

Solo and small practices are now outpacing larger practices in EHR adoption, with single-doctor office adoption growing from 31% to 37% for the second half of 2011. Overall EHR adoption rates remain higher as the number of physicians practicing at each site rises.

Moody’s Investor Service predicts even more consolidation among hospitals over the next few years as institutions look for ways to enhance efficiencies, improve competitiveness, and drive higher payments from insurers.

Forbes profiles Epic founder and CEO Judy Faulkner, whom it dubs “healthcare’s low-key billionaire.” The magazine estimates her net worth at more than $1.5 billion, making her the only woman to reach the rank of billionaire by founding her own technology company.

Weird News Andy checks in with a few goodies, including a story of a three-year-old who ingested 37 Buckyball magnets. The magnets snapped together in the child’s intestine, tearing holes in the intestine and stomach. WNA says, “No MRIs, please.”

WNA wonders how much the living received in overpayments, after an audit finds that Washington, DC paid nearly $700,000 in Medicaid payments for dead people, including one nearly nine years after the patient’s death.

And in an overachieving moment, WNA adds the story of a Texas dialysis nurse, accused of injecting bleach into the dialysis tubing of patients, killing five.

Sponsor Updates

• API reports it added 38 contracts with new and existing clients between Q4 2011 and Q1 2012 to date.
• BCBS North Carolina launches a mobile version of its member web portal that is based on Kony Solutions’ mobile technology
• States and regional HIE’s drive demand for technology from Medicity, Axoloti, and Orion.
• Gwinnett Medical Center (GA) launches MedGift, an online gift registry powered by RelayHealth.
• Pathology Service Associates, a division of MED3OOO, prepares to move into a new, $5.5 million 32,000 square foot headquarters in Florence, SC.
• Health 2.0’s Matthew Holt chats with Kareo CEO Dan Rodrigues about the current state of the one to four physician market.
• iSirona releases DeviceConX 4.0, its latest version of connectivity software.
• Hayes Management Consultant’s Anita Archer, CPC, provides recommendations for preparing for ICD-10.
• Vitalize Consulting Solutions ranks third in the 2011 Best in KLAS Awards for software and services. Apparently KLAS inadvertently left VCS off the original report published in December.
• The Advisory Board reports that nearly 50% of hospital CIOs will hire consultants to help achieve MU.

EPtalk by Dr. Jayne

Nuance announced plans to drop $300 million in cash to acquire Atlanta-based medical transcription and speech editing vendor Transcend Services. The move is aimed at expanding Nuance’s customer base in the small- to mid-size hospital market. We’ll have to see if employees still embrace the “It’s better here” motto after the dust settles.

In other acquisition news, CareFusion will PHACTS LLC. CareFusion hopes that by adding PHACTS to its existing Pyxis products, pharmacies can better manage inventory, manage drug shortages, and of course improve the bottom line.

IBM has named nine members of the Watson Advisory Board to “focus on medical industry trends, clinical imperatives, regulatory considerations, privacy concerns, and patient and clinician expectations around the Watson technology and how it can be incorporated into clinician workflows.” Seven of the nine are physicians, including family doc Douglas Henley MD who is CEO of the American Academy of Family Physicians. I learned at HIMSS that family docs can be a lot of fun so I’m excited to see him on the Board.

ONC is seeking public comment on how health care providers and health systems user mobile devices to access, store, and transmit health information. Laptops, PDAs, smartphones, and tablet computers were specifically called out but storage devices were excluded. Comments are being accepted through Friday, March 30^th.

CMS will be releasing new online billing statements intended to help seniors find bogus charges. The “consumer-friendly format” goes live Saturday on Medicare’s secure web site. Features include larger type and explanations of medical services in plain language. Revised paper statements are coming next year. I cruised the site looking for samples but couldn’t find any, so I’ll use my next best research source: grandma. I definitely want to see one before patients bring them to me to discuss. Apparently the site also allows beneficiaries to check claims status and use an online appeals form. It also includes the Blue Button.

HIMSS released its online photo gallery in case you want to purchase photos of your favorite ONC, CMS, and HIT crushes. Although it’s not from the official HIMSS site, I’ve been told this pic depicts the response of a certain someone when informed that he missed the chance to dance with the ladies of HIStalk at HIStalkapalooza.

No, that’s not a sample of the tattoos that Inga and I had done while we were in Las Vegas – but one of my favorite readers did send an article about the growing phenomenon of medical tattoos. It’s low tech but does make a point for patients with health conditions or who want to make sure first responders understand an individual’s wishes for resuscitation. The tattoo chosen by the reader in question: “afraid of needles.”

Have a question about voice recognition, clinical decision support, or just want to share what you’d choose as your medical tattoo? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

CIO Unplugged 3/8/12

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

CAUTION! Teambuilding Ahead

My affection for teambuilding sparked during the journey through cubscout and webelos. Army experiences further revealed that survival depended upon team. We had to work as a unit to navigate our way through a forest or through complex situations while under fire. Eventually, I recognized the transferable benefits to the corporate world. Today, few things thrill me more than getting my team outdoors to test and build our collective capabilities.

Of course…there is an element of danger involved in these pursuits.

The Burn. My first civilian ropes course. I was a Director at Parkview Medical Center, and all leaders were required to attend this training. We had a blast pushing the boundaries. That is, until we got to the capstone element: the Power Pole. “One participant climbs to the top of a utility pole using staples. Upon reaching the top, the participant leaps from the pole and attempts to catch the trapeze bar suspended in the air.”

A 45-five foot pole towered above me. Few attempted to even reach the top, and I couldn’t blame them. I was the last to go, and peer pressure and pride kept me from bailing out. I climbed to the highest point, and I still recall the effort it took to reach above the climbing staples and hook up to the safety line. Then I stood on top of the 12-inch wide utility pole. It swayed with the wind, keeping me off balance. About 10 feet out and 2 feet lower than my line of sight, the trapeze bar beckoned. I’d never felt so scared in my life—except the time I got arrested for joyriding when I was fourteen.

My halfhearted plan was to make it look like a strong attempt for the trapeze then just fall and wait for the safety line to catch. I removed my gloves, crouched, and made the leap. Before the safety caught, I grabbed the climbing rope attached to the trapeze. Gravity sucked me down about 10 feet until the safety jerked me into a halt. I hung in pain. The skin on the insides of both hands had ripped away.

Once I was lowered, the CNO and ED Director took me straight to the hospital. More agonizing than the burn was the ED doc cleansing the wound before working on it. Even writing this makes me want to clasp my hands shut as I had done after the injury.

Lessons Learned:

• Never do anything half assed or expecting to fail
• When handling ropes, wear gloves!

Rapids. My team had accomplished the incredible. Over 18 months, as part of a start-up, they installed a new application across 23 disparate and independent minded academic departments that represented 750 physicians plus residents. To celebrate, they chose the teambuilding activity of river rafting. A month later, we entered the Class III/IV rapids of the Youghiogheny River. Although I rafted a bit in simulated beach assaults with the Army, I had zero experience with rapids. I became raft captain by default.

We hit the first Class II rapids (easy), and I fell out. My raft-mates grabbed for me, but the current was too swift. Floating downstream and getting beat up by underwater boulders I then remembered the training: float feet first and on top of the water. Easier said than done. The rafting company had a three-tier safety layer in place in the event a bozo like me fell out. Tier one failed. I was headed straight for serious Class III and IV rapids. A Tier two guide in a kayak couldn’t reach me. I started to panic, which made matters worse. In the distance, the Tier three guide stood on a large boulder in the middle of the river with a rope. She threw out the safety line, and my eyes affixed like laser beams on my last hope. She couldn’t have been more than 100 pounds, but she was all I had between life and death.

I grabbed the rope as I hit the Class IV rapids. A “keeper hydraulic” took me under. The jet-like flow ripped through every crevice of my life vest and helmet until I felt as if the water would strip away all my safety gear. The current pushed me under, and I fought for air. I saw the proverbial flash of my life. That one-hundred-pound saint on top of the boulder…to her credit, she remained steadfast and eventually pulled me into an eddy. I stood there, shaking. The Tier two kayak made its way toward me, and the sliver of courage I had left got me back in the water and reunited with my team. And yes, this entire event was caught on video thanks to the “package” we purchased from the tour group.

Lesson learned:

• Listen to and consider all safety precautions
• Don’t stick your ass out too far unless you’re willing to accept risk (that’s how I fell out of the raft)
• If you fall, muster your courage and soldier on

Slide for Life. Prior to being commissioned as an Army Officer, all cadets had to acquire a RECONDO certification. One of the activities in the course was the Slide for Life. You slide down a zip line across a lake, keeping your eye on the flagman on the far side. When the red flag raises, you extend your legs straight until your frame forms an L-shape. When the flag lowers, you let go of the zip line and drop into the water. Given the trajectory, this posture enables you to hit the water butt first and the world is good.

With great amusement, I lingered after completing this event to watch the other platoons execute. Most did fine, but every once in a while, someone decided against the L-shape and let go in an I-shape. The soldier hit boots first resulting in spectacular somersaults. In other cases, some were too scared to release at all and ended up crashing into the sandbags at the end of the zip line.

Lesson learned:

• Follow instructions
• Fear causes paralysis

After a string of traumatic experiences, I chose safer team building activities. Here’s what happened:

Curling. One of my directs was a curling fanatic, so I agreed to some ice time. What could possible go wrong? We dressed warm and headed for the Mayfield Curling Club. My CTO was tall and aggressive. We were in this to win. I shoved our stone down the ice where he was sweeping to heat up the ice and influence trajectory. He pushed too hard on the broom and his feet came out from under him. He fell face first. When we rolled him over, blood gushed from his mouth where his teeth had punctured a hole through his lower lip. Our CMIO and two nurses applied first aid. Given the severity of the cut and apparent concussion, we called an ambulance.

I could just hear my CEO. “We lost our CTO to what? Curling?” Thankfully, the man was released the next day following observation and stitches.

Lessons Learned:

• Ice is slick as hell
• Don’t make fun of curlers

The “low-key” retreat. I held an offsite retreat once with no outdoor events. One of our team accidentally slipped and fell and messed up his knee before the meeting even began. A great object lesson in teamwork followed: The CMIO did an evaluation. The combat medic rounded up some gauze and wrapped the knee. The CTO ensured the meeting room was set-up to accommodate the wounded. The non-clinicians fetched ice and painkillers. And, in the ultimate display of team and knowing nothing was broken, the injured refused to seek medical attention until after the day was done.

Lessons learned:

• Injuries can happen in any environment
• It is smart to have clinicians as your direct reports!

Despite the potential for injury, if you haven’t escaped with your team to develop relationship and strengthen the bond, then plan one today. Mmmmmm…perhaps climbing mountains should be avoided….

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn andFacebook and you can follow him via Twitter — user name marxists.

Nuance to Buy Transcend Services for $300 Million

Nuance announces Wednesday morning a definitive agreement to acquire Transcend Services, a provider of medical transcription and speech editing services, for $300 million, net, in cash. The acquisition accelerates Nuance’s expands the company’s presence in the small- to mid-size hospital market.

Janet Dillione, EVP and GM of Nuance’s Healthcare business said, “The acquisition of Transcend will expand the delivery of our innovative voice and Clinical Language Understanding solutions especially to small- and mid-size hospitals. With Transcend, we will drive change and improvement to the way these hospitals capture and leverage clinical information. The acquisition is a natural extension of Nuance’s existing healthcare business, and will strengthen our solution and services portfolio, as well as enhance our profitability.”

Transcend acquired electronic clinical documentation provider Salar in August of 2011.

News 3/7/12

Top News

Physicians using computerized patient records are more likely to order new tests, leading to higher healthcare costs. Researchers, whose findings were  published in Health Affairs, found that physicians with point-of-care access to imaging were 40 to 70% more likely to order more tests, compared to doctors relying on paper records. Researchers could not determine the reason for the trend but theorize that doctors on computerized systems order more studies because of the the ease of online entry.

Reader Comments

From WallE “Re: HIMSS musings. I think the show would have been better if the floor plan and layout was simpler. After looking at New Orleans floor plan I’m thinking it will be better.They are returning to the single hall with a large “main street” walkway down the middle of the show.” I also prefer the main street, one hall layout, although the argument could be made that there was less walking required with this year’s floor plan.

From CTO “Re: Music.  It was good to ‘see’ you at the sponsor lunch at HIMSS. Since you have the helm this week, how about some insight into your taste in music?  I always like to read about  what Mr. H is interested in.” First let me say that Mr. H and I have very different tastes in music. Mine is a bit eclectic but a short list of my all-time favorite artists include Lyle Lovett, Bonnie Raitt, Aretha Franklin, and Allison Krauss. Some of the more current groups I find fun include Chiddy Bang, Flo Rida, and Bruno Mars.

From Ralphie “Re: Burger, Babes, and Vegas. I thought you might get a chuckle out of what I heard walking back from the HIMSS conference to my hotel behind what looked like two slick make vendor-types.  One turned to the other and said that he had been propositioned by two prostitutes and one of them offered her services for $35. The other one quipped, ‘Wow, that is less than the room service cheeseburger and fries I had last night.’” Love it.

From IDXwatcher “Re: More GE layoffs.  GE Healthcare layoff confirmed March 2nd.” According to an article in the local press, fewer than 30 people (about 2%) were let go last week. GE says the cuts were necessary “to increase competitiveness.”

From Aaron Brrr “Re: Madison Dolly comment on v12 of Epic. Madison Dolly said that v12 of Epic was shown at HIMSS and coming soon. Two questions: what’s in it and when did they change policies about showing that which isn’t available?” Anyone?

From Wondering aloud “Re: Epic. Epic is having a great run like SMS did with INVISION in the 90’s, but their business model is more like MEDITECH’s. Wondering if “in the know” readers think Epic will struggle the same way MEDITECH has recently with 6.0 when Epic attempts its inevitable near term re-platforming as well?”

From HIStalk Fan “Re: Allscripts. A recent analyst report discusses a Q3 restatement involving software transaction, as well as Allscripts’ disclosure of a subpoena in connection with a grand jury investigation and recent litigation involving Medical Services Associates.” Allscripts filed a 10-K last week related to a restatement of a bulk sale and delivery of licenses through a complex structure based on a decision that future performance obligations require the deferral of revenue. The net reduction to operating income was $3.1 million and a $0.01 reduction in EPS. I asked one of HIStalk reader/analysts for his take on the restatement and his opinion was the adjustments were very minor and reflected Allscripts’ conservative approach to revenue recognition. As to the litigation, MSA alleges Allscripts negligently caused the loss of medical billing data, intentionally misrepresented certain facts regarding the computer sold to them, and breached certain aspects of their contract. My take: Allscripts and vendors of their size are regularly hit with similar lawsuits and thus it’s not a cause for alarm.

From Stringer “Re: Medical software sales guy. This guy was convicted today of 1st degree murder of his wife. Very ugly situation, first trial was a hung jury. As you can see he is ALWAYS referred to in the press as a medical software salesman but have never mentioned the company. Thought it might be a good HIStalk expose.” Jason Young was convicted of brutally murdering his pregnant wife five years ago. Young contends he is innocent. I did a bit of digging and could only find one Jason Young in Linked In that could have potentially been a match. If you know the scoop, please share.

From OldTimer “Re: Allscripts send-off. Allscripts says goodbye to 24-year veteran Vada Hayes. Luminaries in attendance included John McConnell, Eric Sellers, Alan Winchester, Steve Shepherd, Bob Bothwell, and many, many others. There were four cakes: Medic, Misys, Allscripts, and the current color scheme. That’s cakes in green, purple, orange, and lime.” Would have loved to seen the cakes, but here is a shot of the retiring Hayes, along with former Medic/Misys CEO John McConnell.

HIStalk Announcements and Requests

A few readers mentioned having difficulty getting onto the HIStalk sites today. Of course I can’t find Mr. H’s email from four years ago that explained who to contact if this ever happened. Hopefully Mr. H will check in soon and the issue will be resolved. Thanks for your patience.

Thanks to all the wonderful readers who sent encouraging e-mails about relief from post-HIMSS exhaustion and to remind me a vacation is in my near future.

Acquisitions, Funding, Business, and Stock

DocuTAP, a provider of EMR/PM solutions for urgent care providers,  secures a two-stage $12 million investment from Bluff Point Associates.

Healthcare software and service company iMedX completes its acquisition of the medical transcription assets from The Inner Office Ltd.

Sales

Iowa Health System contracts with MediRevv for accounts receivable conversion assistance as it transitions its core hospital system to Epic.

The VA selects HP Enterprise Services to continue as a prime contractor for its claims processing program, CAPRI.

Upper Peninsula Health Plan chooses the MedHOK platform for integrated care management, quality, and compliance.

CPU Medical Management Systems selects NDS’s Provider Edge product to automate payment processes and convert EOBs into ANSI standard 835 ERA.

The state of Louisiana contracts with CNSI for a 10-year, $185 million project to develop and deploy a new Medicaid claims processing system.

People

Healthcare data analytics company Qforma promotes Mark Feeney to VP of client services and Joann Flynn to senior director of business development operations and employee development.

AirStrip Technologies announces the addition of Connie McGee (KPMG) as VP of strategic accounts and the opening of a regional office in the Nashville area.

The Open Source EHR Agent (OSEHRA) names James Peake, MD (CGI Group), John Halamka, MD (Beth Israel Deaconess Medical), and Michael O’Neill (VA) to its inaugural board of directors. OSEHRA is a not-for-profit organization tasked with serving as the custodial agent of an open-source development project to upgrade the VA’s VistA EHR system.

Announcements and Implementations

ZirMed launches www.StarStopICD10.com, a site designed to gauge industry opinion and gather comments surrounding the ICD-10 implementation timeline.

The Cleveland Clinic expands its EMR to include a visual repository with diagnostic images of patient X-Rays, lab tissue samples, photographs and other images.

All 15 of the independently owned primary care clinics in the Integrity Health Network (MN) transition to EMR.

QuadraMed launches a remote hosting service for its identity management, RCM, and HIM solutions. Cabell Huntington Hospital (WV) is the first hospital to utilize the service.

McLaren-Bay Region (MI) goes live on McKesson Paragon EMR March 11th.

Intermountain Healthcare (UT) launches a 90-day pilot telehealth program, allowing patient employees to connect with providers via video chat.

Aetna announces the availability of an enhanced version of its iTriage app, which Aetna acquired in late 2011.

Government and Politics

An analysis of eight years worth of Medicare claims data reveals that Hospital Compare, Medicare’s public reporting initiative for hospitals, has had minimal impact on patient mortality. The study found the reporting of quality data led to no reductions in mortality beyond existing trends for heart attack and pneumonia and led to a modest reduction in mortality for heart failure.

Technology

RTLS provider AeroScout partners with McRoberts Security Technologies to introduce a Wi-Fi-based campus-wide infant security solution that enables hospitals to attach an RTLS tag to the infant’s umbilical cord clamp.

Other

The Galveston County HIE (TX) and the HIE of Southeast Texas join the Great Houston Healthconnect, making it the state’s largest HIE market with 133 hospitals and over 14,000 providers.

Mayo Clinic rehab nurse Andy McMonigle and three physicians say an iPad helped saved McMonigle’s life when he suffered a heart attack. The nurse, who was exercising in a Mayo Clinic fitness center for employees, felt the onset of the attack and quickly found three doctors in the center. One of the physicians pulled out his iPad and accessed McMonigle’s online medical chart and previous EKGs. Because they had immediate access to his chart, the doctors quickly identified the issue and had  McMonigle transported to the cath lab to remove a blood clot blocking his artery.

Smartphones are the most popular technology among doctors since the stethoscope, according to this study which looks at the global growth of mobile phone technology in healthcare. The use of mobile technology healthcare has the potential to reduce the cost of elderly care 25%, reach twice as many rural patients, and reduce the cost of data collection by 24%.

Speaking of smartphones, almost half of Americans now own one, making it the most widely adopted type of cellphone device.

Sponsor Updates

• Summit Medical Center (TN) shares how its OB/GYN physicians are using AirStrip Technologies to improve patient care during labor and delivery.
• MEDecision hosts a March 21st webinar on best practices and technology to enhance value-based healthcare.
• Wolters Kluwer Health and HealthStream partner to offer the Lippincott’s Professional Development Programs suite to HealthStream’s client base.
• Billian’s HealthDATA partners with RealTime Medical Data to provide Medicare payment data and analytics through RealHealth Analytics.
• Trustwave signs an agreement to purchase M86 Security to enhance its security product portfolios.
• Versus customer Dr. Brett Daniel of Pacific Medical Centers discusses his organization’s use of Versus RTLS at this week’s AMGA 2012 Annual Conference.
• Ignis Systems releases its free webinar schedule for March and April.
• Medicity client Michigan Health Connect receives second place in the Healthcare Informatics Annual IT Innovator Awards for its use of iNexx to create electronic-referral networks throughout Michigan.
• Memorial Healthcare System’s Joe DiMaggio Children’s Hospital (FL) goes live on GetWellNetworks’ IPC solution.
• LRS offers a Webinar featuring speakers from Carilion Health System and Sisters of Mercy Health System, who discuss ways to lower costs and simplify document management in Epic print environments.
• Shareable Ink customer Dr. Brian Woods, CMO of NorthStar Anesthesia discusses his experience automating with Shareable Ink’s technology.
• The Huntzinger Management Group (HMG) publishes Nathan Kaufman’s HIMSS presentation entitled, “Preparing for the Inevitable Perilous Journey from Entitlement to Accountability.”
• SRS EHR customer Pediatric Associates of Savannah (GA) chooses SRS Patient Portal for its 10 provider practice.
• Inland Empire HIE (CA) selects Orion Health’s HIE suite for its 48 participating healthcare organizations.
• GE Healthcare initiates a 90-day free evaluation period for its Global Safety Network, an online community for hospitals to collaborate on improving patient safety.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 3/5/12

From Observer “Epic CIOs. After seeing that two more Wisconsin CIOs that are installing or expanding Epic have lost their jobs recently, I noticed an interesting trend that I call ‘Epic – the Teflon Vendor Effect.’ Have you noticed that when an Epic clinical system install stumbles and fails, it is the CIO’s fault and when the same thing happens with a different product, it is the vendor’s fault?” I will defer to readers on this question,  but following the same logic: does Epic and not the CIO get (or deserve) all the credit when a project succeeds? And do CIOs get the credit when other products are successfully  implemented?

From Reluctant Epic User “Re: Anodyne. My large practice (over 200 providers) is considering Anodyne for BI. The word is that it can extract Epic’s data at the flip of a switch. Do you know or have you heard anything about their implementation? How much effort was required to by the Clarity SQL writers to connect Anodyne to Epic’s Clarity Database? Thanks in advance for the amazing work you, Mr. H, and the two doctors do. It really does make my job and life easier.”Thanks for the kind words. I know very little about Anodyne but I bet we have readers who are experts and willing to share their experiences.

Mr. H has left me to my own devices for the week while he is taking some R&R with Mrs. H. I must confess I am wildly jealous of Mr. H’s gallivanting across the globe, especially since my mind and body are still  experiencing a HIMSS hangover. Do a girl a favor and drop me an email this week and tell me all the secrets you would have told Mr. H. Or,  just send a note reminding me that my vacation will be coming soon. And thanks for reading.

A tornado rips the outside wall from three patient rooms at Harrisburg Medical Center (IL) and forces the evacuation of patients. The storm damaged multiple windows and tore heating and air conditioning systems from the building’s roof. Hospital administrators estimate damages in the millions.

Saint Alphonsus Health System (ID) signs an an agreement to implement MedVentive Population Manager and MedVentive Risk Manager.

The House Energy and Commerce Committee’s subcommittee on commerce, manufacturing, and trade hears testimony in favor of helping state build interoperable drug monitoring systems to reduce prescription drug misuse.

In case you didn’t get your fill of HIMSS and booth critiques, Dodge Communications sent a link to their fun post highlighting the best and worst from the exhibit floor. They name GE’s booth “Best in Show” based on its approachability and messaging. They also poke some fun at a few vendors’ lack of creativity:

Now, we know it’s tough to find relevant imagery in this business. And we see lots of free stock photography depicting smiling, multi-racial healthcare workers reveling in their use of the exhibitors’ technology. Definitely not easy. But pictures of bridges (“Bridges to meaningful use!”), stethoscopes (“We’re in healthcare!”), puzzle pieces (“Putting all the pieces together!”), and chain links (“We’re the missing link!”)  are not cool! C’mon people, be more creative! The most effective way to see if your imagery resonates is to test it with the market. It’s easy to test, and it doesn’t take long to realize that your audience doesn’t think it’s cool either.

Geisinger Health Plan reports that its use of telemonitoring technology has reduced 30-day hospital readmissions by 44%. Using interactive voice response technology from AMC Health, case managers track post-hospital discharge patients’ biometric and symptom information in real-time.

Oakwood Hospital and Medical Center (MI) prepares for its August 1st go-live of Epic’s EMR.

A PwC study finds that 61% of hospitals and physician groups have formal clinical informatics programs and most plan to add additional technical analysts and clinical informaticists over the next two years.

Cumberland Consulting Group promotes John Waters, Charles Flint, and Leah Wilson to executive consultants.

First Databank launches a corporate rebranding initiative designed to focus attention on the company’s growth and future in clinical decision support. Mr. H checked in from his vacation long enough to point out that FDB’s press release mentions their sponsorship of HIStalk, which they call an “influential industry blog.” We like that.

EHR Scope launches AIMSConsultant, a service to provide anesthesiologists and operative facilities with information on anesthesia information management systems.

The Milwaukee paper profiles the Wisconsin HIE, which currently connects 13 area hospitals. No surprise here: the HIE’s executive director notes that the organization’s biggest obstacle to growth is not technology, but money.

HFMA awards Winthrop Resources its “Peer Reviewed” designation, based on the effectiveness, quality, price, value and support of Winthrop’s offerings.

CincyTech and Cincinnati’s Children’s Hospital Medical Center form QI Healthcare, an HIT company to commercialize Children’s proprietary quality-improvement software. CindyTech and Children’s are each investing $200,000 and have named John Atkinson (WebMD, Mede America, SourceMedical)as the new entity’s CEO.

HKS Medical Information Systems changes the company’s name to OTTR, d/b/a OTTR Chronic Care Solutions. OTTR is a provider of transplant patient tracking solutions.

E-mail Inga.

News 3/2/12

Top News

The Defense Department appoints former Harris Corp. VP Barclay Butler to serve as director of the Defense Department/VA Department Interagency Program Office to manage the development of an integrated EHR for both departments.

Reader Comments

From HairClub: “Re: Shafiq Rab. The CIO at Orange Regional Medical Center is taking the VP/CIO position at Hackensack University Medical Center.” Unverified.

From Free Lunch: “Jason DeSantis. Joining Zanett’s healthcare division as executive director of business development.” Unverified. He’s division CIO at University Hospitals in Cleveland.

From Last Man Standing: “Re: GE Healthcare. Layoff today of 5% targeting services and support.” Unverified. Many of the GEHC rumors I get are somewhat true but exaggerated, so if the company provides an update (which companies usually don’t for HR-related issues) I’ll run it here.

From Printgeek: “Re: Epocrates. Laid off their entire EMR staff on Tuesday and are shutting down their EMR project. The BOD lost patience, as crazy sales expectations were set by previous CEO and CFO. They expected to sell 1,500 docs in 2011 with an uncertified system that was release in July. This exec team did a good job hiring talent, but failed to listen to their feedback on what it takes to actually sell EMR and the subsequent expectations.” I think there’s a lesson to be learned here: if selling EMRs was easy, everybody would be doing it, and HITECH has accelerated the polarization of the successful and unsuccessful vendors. If Epocrates, which has an impeccable brand recognition in healthcare and was seemingly doing all the right things, struggled to meet sales numbers for its EMRs, clearly the age of the mom-and-pop EMR is over. Actually, there’s an even more applicable lesson here: publicly traded companies may say all the right things about being dedicated to healthcare, but quarterly numbers can send them fleeing for cover almost instantly. Whatever docs just bought their EMR are now finding out what it means to be on the wrong side of their vendor’s “core business.” The one-year share price chart doesn’t inspire much confidence that a steady hand on the tiller is what’s needed – shares are down almost 60% in the past year.

From HIT Student: “Re: Connected Care Challenge. I thought some of your readers might be interested.” Janssen is offering $250K in awards for easily adopted, low cost technology solutions that can improve information sharing among hospitals, patients, caregivers, and community physicians, with the goal of improving post-hospital care and lowering the cost of unnecessary readmissions. Submissions are being accepted through March 25.

From Non-Sequitur: “Re: SNOMED. Here are examples of the proposal to require SNOMED in Stage 2/2014 Edition. In the 45 CFR Part 170 Standards Companion, see Pages 45 (cancer registry), 52 (problem list MU objective), 58 (summary care record MU objective), and 90 (lab results to public health agencies MU objective.)” Thanks. I know several readers are interested in the potential requirement to use SNOMED.

From I Was There: “Re: HIStalk sponsor lunch at HIMSS. Great location, great food, a nice mix of heavy hitters and rising stars, and great networking with lots of cards being passed and commitments for follow-up discussions. Art Glasgow’s talk was very well received, talking about how HIStalk plays a part in his daily activities as Duke University Hospital CIO, how vendors and providers should help spread the word about it, and the shifts he made going from the vendor world at Ingenix to Duke. The focus was on the three of you as people were trying to figure out who you are and checking out Inga’s shoes. I thought the event was great.” It was really cool that 100+ folks from our sponsoring companies took time away from a very busy first day of the HIMSS conference to let us say thanks to them for supporting what we do. Naturally Inga, Dr. Jayne, and I felt simultaneously ridiculous and vulnerable appearing in disguise, but we did our best. Most of our sponsors understand that we’re going to objective and fair to sponsors and non-sponsors alike and, to their credit, they support us even when what we say isn’t going to be popular back in their offices. If you were there, thank you very much.

From Judy Judy Judy: “Re: Epic consulting firm. Last week Judy F. of Epic met with executives of [consulting firm name omitted] about their violation of Epic’s non-solicitation clause. An Epic client turned them in to Epic after the firm poached a handful of the client’s employees. Epic banned the firm for a year (which was ‘negotiated’ to a shorter term) from selling to or doing business with any new Epic customers. Seems like a slap on the wrist based on recent discussions with Epic Consulting relations personnel and their stringent expectations for consulting partners. Why not take away their preferred certification program as well?” Unverified, so I’ll leave out the company name for now.

From MD Informaticist: “Re: digital pen technology – mightier than the mouse? Are they really making an impact on usability and clinical documentation? I would be interested in your opinion of the Verizon and other digital pens and clarify for us: can this technology re-energize a dormant innovative industry?” What I’ve seen of them seems pretty cool, but I’m interested in hearing from readers about who is actually using them and what results they are getting.

From Mark Schmidt: “Re: HIMSS. It’s become such a large event that the Booth Crawl brought back feelings of those early days when it was possible to spend time with just about every vendor. I learned a lot and heard the latest from Sunquest, which has not been sitting still as the industry has progressed!” Mark, CIO of SISU Medical Systems of Duluth, MN, won a Sunquest-provided iPad last week. He and I have swapped occasional e-mails going back to early 2008.

From Just a Fan: “Re: 5010. Anyone else having issues with a claims clearinghouse not being ready? Our cash on hand is taking a beating because our claims have been sitting at the clearinghouse and are only just now starting to trickle out to payers, which are requesting information required on 4010 but deleted in 5010. And the enforcement delay was good why?” We keep hearing anonymous rumblings with no specific examples. Give us details and we’ll see what we can find out.

HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Gregg pulls a double shift in an an attempt to diffuse last week’s “mournful silence” on HIStalk Practice while I was busy drinking IngaTinis and walking my high heels off at HIMSS. Dr. Gregg missed HIMSS this year, but still offers some fun HIMSS musings. A proposed rule would require physicians to return improper Medicare payments within 60 days of  notification and allow auditors to investigate 10 years of records. Most physicians believe EHR use is valuable for improving quality and managing patient care, but less convinced that EHR improves diagnosis accuracy or treatment planning. Black Book Rankings announces its ambulatory EHR vendor rankings. Athenahealth CEO Jonathan Bush likens his company to a “snippy kind of overconfident Chihuahua jumping up and trying to nip at the tails of the Dobermans.” By the way, we are conducting a reader survey on HIStalk Practice that is in addition to the HIStalk version; we’d love readers to take a moment to  have a  to provide input. Thanks for reading!

I appreciate the support of Levi, Ray & Shoup (specifically LRS Output Management) for supporting HIStalk as a Platinum Sponsor. The company’s expertise is in document solutions for hospitals, so let’s use a typical Epic shop as an example. Maybe your big Epic print jobs fail; you need centralized capability to monitor and reprint jobs without re-running them on Epic; you are maxing out out your Windows print queues or the Windows print spooler; or you’d like to save print costs by allowing users to preview reports before printing and automatically route large reports to more economical printers. With the LRS solution, you gain centralized control, you can implement load balancing, you avoid installing multiple print drivers on each workstation, and you get rid of the unreliable science fair of printing solutions (UNIX to JetDirects, multiple printer types, a mix of Epic text and ERTF documents, etc.) and you can even require users to verify their identity before printing patient documents to an unattended printer. It doesn’t matter how cool Epic is if the tangible, patient-critical label or report it creates as an end product is hanging out there in the ozone because of a cobbled-together print solution that is far less enterprise grade than the system that drives it. One hospital with four FTEs handling printing issues cut back to just one after implementing LRS Output Management, which can handle anywhere from hundreds to thousands of printers. And while Epic is a good example, the solution works with any application (Lawson, SAP, etc.) Check out their case studies from Carilion, Hopkins, UVA, etc. Thanks to Levi, Ray & Shoup for supporting HIStalk.

Liaison Healthcare Informatics is supporting HIStalk as a Platinum Sponsor. The Atlanta-based integration and data management company has over 9,000 customers all over the world, including more than 600 in healthcare. The company’s cloud-based data integration solutions provide a platform for the secure exchange of data among providers, payers, patients, and HIEs. Some of the pain points it addresses are HIPAA, HITECH, DEA Form 222, Safe Harbor qualification of encrypting PHI data at rest, electronic file transfers, and avoidance of data breaches. Its Liaison Protect solution makes sure you are securing your databases, integrating encryption, tokenization, key management, and logging. Its Liaison Exchange managed file transfer software suite allows cost-effective management of ever-increasing volumes of file transfer exchanges both inside and outside the organization. If you need to accelerate your HIE or ACO efforts, securely share patient information with other organizations, or gain control over risky and poorly monitored file transfers, give their offerings a look. Thanks to Liaison Healthcare Informatics for supporting HIStalk.

Inga mentioned the reader survey — you have one last chance to provide input that we’ll use to plan the next year of HIStalk. Thanks. It really does help us given that we work largely in a vacuum and have to pick and choose our projects since we have limited time to get things done.

For our numbers-obsessed reader(s), we had a record-breaking 125,867 visits in February, along with 196,565 page views. The e-mail blasts go out to 7,935 subscribers, while Dann’s HIStalk Fan Club has 2,268 members (OK, I admit that we’re not entirely comfortable with the idea of having fans, but it’s slightly satisfying to reflect on that fact during our frequent bouts of feelings of inadequacy and lack of accomplishment.) You can move our emotionally needy needles by (a) subscribing to the updates; (b) connecting with us on Facebook, LinkedIn, and Twitter; (c) supporting the sponsors who support us by poring over their ads, clicking those of interest, checking out their Resource Center pages, use the Consulting RFI Blaster to quickly solicit consulting help; (d) sending us news, rumors, guest articles, or anything else that would interest your fellow readers; and (e) feeling the positive thoughts Inga, Dr. Jayne, and I are beaming your way for supporting what we do in whatever form that support takes, which means a lot to the ladies and me.

A reader asked about WellStar’s ambulatory EMR project. I have the information, but agreed to sit on it for a few days. Stay tuned.

The overachievers at API Healthcare, not content to simply mail Gabe Davis (right) of Texas Health Partners his iPad prize from the recent Booth Crawl after he had to leave the HIMSS conference early, sent VP Kyle Allain (left) to his office to hand-deliver “the famous HIStalk iPad” personally. This was Gabe’s first trip to HIMSS and he had nice things to say about HIStalk and API’s support of it. His 16-year-old son will get the iPad and is apparently pretty stoked about it, and rightfully so because iPads are darned cool even if you aren’t an Apple fanboy.

On the Jobs Page: Financial Systems Consultants, Meditech CPOE Go-Live Support, Epic Certified Builders. On Healthcare IT Jobs: Senior Health Information Technology Specialist, Implementation Consultant, Project Manager CMIO Informatics, McKesson Paragon Consultants.

I’m taking a little break to escort Mrs. HIStalk to somewhere warm and sunny where laptops are as rare as bathing suit tops (OK, I’m kidding on that one) so the eminently capable Inga and Dr. Jayne will be holding down the fort as I try to fight the urge to stay off e-mail (I’m rarely successful.) I don’t know about you, but I’m really tired after all the HIMSS-related activities over the past few weeks and I want to see what it feels like to sleep more than five hours in a single night.

Acquisitions, Funding, Business, and Stock

Teledermatology provider Iagnosis raises $1 million from 11 investors.

Accretive Health releases its Q4 numbers: profit of $13.2 million ($0.13/share) compared to last year’s $5.5 million ($0.06/share.) Net services revenue grew 53% to $260.1 million.

HP Enterprise Services notifies the State of Wisconsin that it will be eliminating 157 Medicaid program jobs in Madison and Milwaukee.

Sales

DR Systems announces six new contracts for its Unity platform totaling more than $2.07 million.

Cancer Treatment Centers of America signs an agreement to deploy Unibased Systems Architecture’s ForSite 2020 application suite across all its facilities.

People

Beacon Partners appoints Christina Bertsch (EMD Serono) VP of human resources.

The National Quality Forum board of directors announces that President and CEO Janet Corrigan will resign as of June 2012.

HHS Office for Civil Rights names attorney Juliet K. Choi (American Red Cross) as chief of staff and senior advisor.

Announcements and Implementations

Four Lakeland Healthcare (MI) hospitals go live on their $50 million Epic system.

T-System licenses its clinical terminology to Prognosis HIS, allowing Prognosis to incorporate into its ChartAccess EHR more than 200,000 clinical phrases.

MED3OOO chooses Macadamian to help develop a new product that it says will expand the usability and adoption of its ambulatory systems.

Shareable Ink incorporates Pentaho Business Analytics to create a data analytics platform for healthcare.

Michigan Health Connect wins second place in an IT innovator awards contest for its electronic referrals solution app, powered by Medicity’s iNexx, that was rolled out to nearly 1,000 physicians over 28 counties. 

Government and Politics

The Advisory Board Company does a nice high-level summary of the proposed Meaningful Use Stage 2, nice for CIOs prepping peer execs for what the IT agenda will look like.

In England, two NHS trusts seek a supplier to take over their IT help desk and infrastructure in what would be the first outsourcing contract of its kind. The deal is valued at  $50 million.

I liked Doug Fridsma’s post on HHS’s blog about the Interoperability Showcase at HIMSS. He says Farzad Mostashari showed up there by surprise and challenged the participants to demonstrate impromptu interoperability with another participant with whom no relationship existed. He gave them one hour to make it happen technically, which involved overcoming challenges such as authentication certificates, vocabularies, and firewalls. The result: NextGen sent a C32 to Allscripts, EXCITA HIE and Medical Informatics Engineering exchanged a transfer of care document in ER discharge summary format, and Enable Healthcare sent a CCDA discharge summary to Verison to create a new patient chart. That’s pretty cool.

Other

Ochsner Health System (LA) announces that its neurologists recently completed their 1,000th patient consult as part of Ochsner’s  telehealth stroke treatment program.

KLAS reports that some providers are concerned with a number product gaps and weaknesses in the McKesson Paragon product and wonder if Paragon can scale to larger hospitals, especially those with more than 400 beds.

Jackson Health System (FL) announces the layoff of more than 1,000 people in an effort to save the organization $69 million.

Trinity Health’s Michigan hospitals sign an agreement with University of Michigan to explore ways the organizations can work together to coordinate care, with one of the areas of discussion being information technology. 

A physician’s assistant who sued her former employer, Mercy General Hospital (CA), for sexual harassment is awarded $167 million.

The folks at MED3OOO asked Inga and me to choose and announce a winner from the six finalists in their contest to create the best video testimonial. They offered to pay for our time, but we said it either had to be (a) free to them because they’re a sponsor, or (b) if they really wanted, they could donate whatever amount they wanted to a charity of our choice. Thanks to MED3OOO for their donation to Best Friends Animal Society, a highly rated charity whose mission is “to bring about a time when there are no more homeless pets.” And congratulations to the winner, Kyle Adkins, administrator of Golden Valley Medical Clinics of Clinton, MO (he’s in Interview 1 on the finalist page) which implemented the InteGreat browser-based EHR from MED3OOO. My favorite quote: “You don’t ever make this decision well the second time or a third time. You may make a better one if you’ve made the wrong decision, but there will be someone else making the decision.” Great job, Kyle, and for that you win an all-expense paid trip to MED3OOO’s 2012 National Healthcare Leadership and Users Conference in St. Thomas, US Virgin Islands in October.

Sponsor Updates

• World Wide Technology is sponsoring Geek Day 12 in Washington DC, April 11-12, complete with showcase labs, breakouts, and birds of a feather session divided by industry focus. The event is free and so is lunch.
• API Healthcare partners with Presagia Software to offer Presagia’s workforce absence management solutions to API clients.
• ProHealth Care (WI) goes live with iSirona’s connectivity technology to deliver patient data from anesthesia monitors into Epic EMR.
• A survey by BridgeHead Software finds that most hospitals want vendor neutrality with more control over their image data.
• Black Book names Quest Diagnostic’s Care360 EHR the best EHR for single physician practices and for e-prescribing. It was also ranked eighth on Capterra’s most popular EMRs.
• Alexander Orthopaedic Associates (FL) selects White Plume Technologies’ AccelaSMART resolution engine to bridge the gap between its Exscribe EHR and ADP’s AdvancedMD’s PM system.
• MEDSEEK and BrightWhistle partner to offer a search and social media marketing solution.
• Lawson Software enhances its Cloverleaf Secure Courier and Global Monitor for its Cloverleaf Integration Suite to increase speed and provide greater connectivity.
• New York-Presbyterian Hospital goes live with Awarepoint’s RTLS at its Columbia University Medical Center campus.
• Aventura will participate in the World Congress Inaugural eHealth Innovation Conference this month in Cambridge, MA.
• Santa Rosa Consulting advisor Matt Wimberley  discusses confidentiality, integrity, and availability in the HIPAA security rule.
• Bruce Friedman MD, emeritus professor of pathology at University of Michigan Medical School, keynotes at the Lifepoint Informatics User Conference 2012.
• Evergreen Healthcare (WA) shares how API Healthcare’s Time and Attendance and Staffing and Scheduling technology helped the organization get its productivity and costs under control.
• MedAptus launches a revenue cycle reporting and performance analytics module for its Professional solution.
• Coastal Cardiovascular Consultants (NJ) will implement the SRS EHR at two locations for its six providers.

EPtalk by Dr. Jayne

The American Journal of Preventive Medicine recently published an article about cybercycling. It shows that riding a stationary bike which hooked up to interactive videogames could increase brain function in older adults compared with a standard exercise bike. Elderly study participants who took 3D tours and raced computer generated avatars showed better memory, attention, and problem-solving abilities. Not surprisingly, some reported knee and back pain as well as “frustration with interacting with a computer.” Now we just have to wait for a vendor to allow the cybercycling data to flow through the patient’s PHR into their EHR charts.

Shades of Eliot Ness: Even without federal approval, Illinois is getting tough on Medicaid fraud. The state will start matching Medicaid patient data with the state driver’s license database to make sure only Illinois residents are receiving benefits. Applicants would also have to show additional proof of income to maintain benefits. Even without federal blessing, this seems like a reasonable idea – recently 6% of Medicaid cards were returned as undeliverable or having an out-of-state forwarding address.

It looks like there might be another way for vendors to expand their offerings. The Department of Health and Human Services recently announced plans to look as far back as 10 years when auditing Medicare overpayments. I forsee a whole new subset of vendors offering data archiving and retrieval specifically for Medicare billing. As Medicare goes, so go the rest of the payers, so it’s only a matter of time before providers are forced to maintain massive amounts of data. And we thought seven years for the IRS was bad.

For those of you who work directly with providers, it will be interesting to see how upcoming changes to the Medical College Admission Test (MCAT) affect the physician pool. The test is being updated to gauge “knowledge of the psychological, social, and biological foundations of behavior” as well as critical thinking skills. The goal is to “better prepare students to be doctors in today’s changing health care system.” It will be interesting to see if this really makes a difference in patient care, but I do hope it will also make a difference in being able to intervene with colleagues who are ripping their hair out due to the continuous onslaught of ever-changing federal and payer regulations.

USA Today reports that Hawaiians rank at the top for residents having the best overall sense of well-being. Don’t attribute it all to the sunlight and tropical breezes though – North Dakota, Minnesota, and Alaska also made the top ten. West Virginia finished last. Gallup gathered the data by calling 1,000 people daily for all but 15 days of 2011.

I’m still poring over all the Stage 2 documentation that’s coming across my desk (and phone, and e-mail, and the water cooler) and for better or worse, it seems like I’ve become comfortably numb as far as finding something noteworthy to discuss. Have a thought about your interpretation of those 455 pages of bliss? E-mail me.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

HITlaw 2/29/12

Exposure Disclosure. Liability and Accountability.

HIPAA has been around for a while. I would not say we are generally complacent about it, but I believe we have become at least comfortable with it.

Enter the HITECH Act, which puts real muscle into HIPAA. Providers should recognize the urgency of reviewing not only their current internal policies regarding protection of patient information, but also the agreements they have in place with entities that use and access patient information on their behalf. With everything that is approaching under HITECH (or here already), providers may be unsettled to find that they are exposed to more potential liability and financial consequences than originally contemplated when HIPAA first came on the scene. That said, the good news is that accountability will now be shared with those entities to which you contract services involving patient information.

Capitalized terms refer to defined terms under HIPAA and HITECH Act, and I am purposely avoiding long explanations and citations with the assumption that these terms are known already to HIStalk readership.

As a quick refresher, the HIPAA Privacy Rule (effective in 2003) and Security Rule (effective in 2005) set out the regulations applicable to health care providers (Covered Entities) and their protection and treatment of patients’ Protected Health Information (PHI). Covered Entities were required to enter into Business Associate Agreements that secured written agreement from Business Associates that they would protect PHI from unauthorized disclosure. At that time it was suggested but not required that the Covered Entity secure an indemnification from the Business Associate, protecting the Covered Entity in the event of an unauthorized disclosure of PHI due to the actions of the Business Associate (optional indemnification language was even previously included in the HHS Office of Civil Rights (OCR) sample Business Associate Agreement).

All providers should undertake a complete review of their existing Business Associate Agreements, while also reviewing their own policies regarding privacy and security of PHI. Business Associate Agreements should be amended or replaced as necessary in order to address the changes to HIPAA resulting from the HITECH Act. While reviewing the Business Associate Agreements, identify those that do not have an indemnification provision whereby the Business Associate indemnifies the Covered Entity for unauthorized disclosures of PHI caused by the Business Associate. This one factor alone is worth the entire review process. See HITlaw February 18, 2011 for a brief indemnification explanation.

HIPAA and HITECH

There is a ton of material worthy of elaboration packed into the following points, but space is limited. Being the straightforward type that I am, here goes:

• HIPAA requires that providers review and update their policies, procedures, and safeguards with regard to the privacy and security of PHI.
• HITECH mandates audits of providers to determine compliance with HIPAA (which would include determining if a provider has updated its privacy policy).
• OCR was given authority under HITECH to enforce HIPAA, is investigating data breaches, and has imposed penalties on providers in excess of $1m (two of these in 2011).
• HITECH final regulations will put the bite into HIPAA that until now has had mostly only bark, including required enforcement and mandatory penalties in certain situations.
• HITECH extends compliance regulations and penalties to Business Associates.

In addition to reviewing privacy policies, all providers should review their actual operations with regard to protection of PHI, because while a policy may look good on paper, non-adherence in daily operations will undoubtedly become evident in the event of an audit or investigation.

Liability

Here is the most important item to understand. Just because your organization contracts with a Business Associate that performs certain tasks and operations on your behalf does not mean that responsibility for any data breaches and unauthorized disclosures of PHI is automatically passed on to the Business Associate. Your organization, as the health care provider and Covered Entity, is ultimately responsible to the patient. Having an indemnification provision in the Business Associate Agreement ensures that if a breach or unauthorized disclosure of PHI occurs that is in any part the fault of the Business Associate, you will have legal recourse in order to pursue financial contribution from the Business Associate.

The potential impact on a provider organization without this protection is significant. Suppose a breach occurs and it is completely the fault of the provider’s staff. The provider organization is responsible and pays the price. Suppose however that a breach occurs and it was the fault of a Business Associate. The provider organization is still responsible and will pay the full price if it cannot shift some financial responsibility to the Business Associate under an indemnification provision.

Refer back to the bullets above. Before HITECH, everyone in this industry was fairly settled in with HIPAA and knew about the obligations to protect PHI. With the advent of HITECH, HIPAA takes on a much stronger presence. Audits will be performed, failures in compliance will be discovered, and penalties will be assessed (assuming adoption of the HITECH final regulations that amend HIPAA happens in the not-too-distant future). On a practical note, while assessment of a penalty on either the Covered Entity or Business Associate does not by any means guarantee a patient plaintiff a verdict in court, the very existence of any imposed penalties (on either the Covered Entity or its Business Associate) will certainly be introduced in legal actions by patients for unauthorized disclosure of PHI.

As for the Business Associates (vendors) in the industry, HITECH also requires that Business Associates obtain written agreement from subcontractors that they will comply with the Business Associate requirements to which your companies are subject with respect to your provider customers. All the above advice is applicable to your agreements with your subcontractors, and the indemnification from the subcontractors is essential for protection of your companies. Just re-read the above, and put “my company” in place of provider or Covered Entity, and “subcontractor” in place of Business Associate. Civil and criminal penalties, formerly applicable to Covered Entities under HIPAA, may be imposed on Business Associates for HIPAA violations under HITECH. Careful review of your company’s policies and procedures, especially with regard to administrative, physical and technical safeguards, is important. HITECH mandates Business Associate compliance with these HIPAA requirements, so if you do not have a privacy and security policy in place, this should become a top priority for the very near future.

Accountability

Clearly the HITECH Act calls for increased accountability. First, on the part of providers through audits, investigations, and penalties. Second, by extending compliance requirements (and audits, investigations, and penalties) to Business Associates. This is the real game-changer for technology companies in this industry. Prior to HITECH, the impact and exposure of any breach of a Business Associate Agreement for the Business Associate was dependent on action by the provider customer (Covered Entity). HITECH changes all that and brings accountability, responsibility, and the possibility of civil and criminal penalties right to the Business Associate.

The inclusion of Business Associates in the compliance and penalty aspects of HIPAA though the enactment of HITECH is a strong message from Washington that it is understood providers in some cases are not responsible for data breaches and unauthorized disclosure of PHI, but they alone (until HITECH) were accountable and subject to penalties in those situations. HITECH’s amendments to HIPAA permitting or requiring penalties for Business Associates for their violations is a clear statement of recognition that the penalty, if imposed, should lie where the fault occurred and not just with the Covered Entity which, through no fault of its own, was previously subject to penalty for the actions of others.

I suggest that vendors consider the accountability aspect of HITECH and realize that taking on responsibility and liability is truly becoming a cost of doing business in the industry. Providers did not impose HIPAA and HITECH on themselves. Just as Business Associate vendors should obtain protection from subcontractors for their faults and failings, they should also realize the potential impact on provider customers of any breach with regard to PHI. Fairness dictates that what you require from your subcontractors for your protection you should consider providing to your client base for their protection.

Note I am not anti-vendor, nor am I anti-HIPAA or anti-HITECH. We must all deal with HIPAA and HITECH and the associated benefits for patients, as well as the negative aspects for both Covered Entity and Business Associate offenders. What I suggest is fairness for all, with parties being responsible for their actions.

Providers

Review policies, practices, and Business Associate Agreements and update all accordingly. Note: just because HITECH extends civil and criminal penalties to Business Associates does not mean that liability and responsibility to patients for disclosure of their PHI shifts from Covered Entities to Business Associates. While penalties may be imposed, they are not for the sole purpose of compensating patients whose PHI was disclosed. Some portion of the penalties is intended for this use, but this does not mean that your patients will in any way be prevented from bringing action against your organization directly. This enforces the need for indemnification from your Business Associates.

Business Associates

Review policies and procedures (or establish them now), and obtain a written “Subcontractor Business Associate Agreement” from all subcontractors. In any action for data breach or unauthorized disclosure of PHI, attorneys for the patients will try to bring in as many entities as possible, from the provider Covered Entity to the Business Associate to the subcontractor of the Business Associate. Another practical note – just as the existence of a penalty for violation of HIPAA does not guarantee a patient plaintiff a favorable verdict in legal action, neither does the absence of penalties suggest a verdict for the defendant Business Associate (or Covered Entity). Make sure you are in compliance with HIPAA and have indemnification from your subcontractors as described above.

Although to some the information here may seem basic or obvious, I can assure you that it is not so for all readers. I have composed this posting over the past few months based on real inquiries from, and interactions with, people in different areas of responsibility and levels of leadership within the healthcare industry. Some were truly surprising.

In my various engagements, I represent providers as well as technology companies. This gives me a unique perspective, and in postings like this I try not to take sides but rather to offer advice to all. I also throw in a generous dose of fairness because that is what I believe is most important in structuring and negotiating agreements between parties.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.

News 2/29/12

Top News

Epocrates reports Q4 numbers: revenue up 9%, EPS –$0.18 vs. $0.01. The company reduced 2012 revenue estimates and says it will seek strategic alternatives for its EHR, which includes a native iPad version, since “the effort has hindered our ability to aggressively pursue such [physician network] opportunities.” Maybe that list of EHR mistakes is of theirs.

Reader Comments

From BeenThere: “Re: WellStar. Shutting down its ambulatory rollout of [vendor name omitted].” I’m looking for confirmation and will provide more details if I get them.

From Non-Sequitur: “Re: SNOMED. My manager attended Dr. Mostashari’s session and is able to substantiate what you wrote down about SNOMED and the problem list. He captured the talk on a Flip and we just listened to that segment talking how ‘we now have a standard for this or that’ ontology. Here’s specifically what he said regarding problem lists: ‘There is now a single standard for problem lists: SNOMED.’ I concur with the other people who have commented there is no mention of a requirement for SNOMED in the currently released document. We’ll see if what is published in the Federal Register provides additional detail.“ Thanks! I was hoping I hadn’t dreamed that part so early in his talk.

From Jockey: “Re: Allscripts. Curious if you’ve heard rumors of an acquisition by some big non-healthcare guys.” Two anonymous readers have said that IBM (and possibly Oracle) might be making a move, but I have nothing substantial to back that up.

From BrazosKid: “Re: KC area eClinicalWorks user group meeting. Surprise guest was CEO Girish. Said a few words and took some questions, made time for anyone who wanted to talk to him. A very personable and approachable CEO. You should interview him.” I have, actually: in 2006, 2008, and 2009. Girish Kumar Navani is one of my favorite people to talk to: honest, logical, and insightful, not to mention fun and an excellent businessman.

From Phil: “Re: HIStalkapalooza. The flipbook with Elvis was the highlight of the memorabilia I brought back!” Those were cool. Check them out in the video if you haven’t already. I may need to make Elvis a fixture at future events since he was fun.

From Kathy Wheatley: “Re: thanks for the Booth Crawl iPad from T-System. Coincidentally, some of our facilities use T-System and love it. Paper T’s in the past, but the electronic version is very easy, fast, and reliable. Thank you T-System for sponsoring HIStalk. I get my information from HIStalk, HIStalk Practice, and HIStalk Mobile, pull out applicable info, and copy it in another e-mail for our leadership team. My boss told me not to stop sending them – he was getting a lot of good market info from them. You have a great knack of pulling together applicable and trend information to hand it to your readers with a great synopsis and links to the full articles, which I have used often. I appreciate the writings of Inga, Dr. Jayne, and Dr. Gregg as well, and I enjoy reading Ed Marx – so spot on. Thanks for being the glue that holds this together.” Thanks for those nice comments from Kathy from HCA, for which I’m sure I’m speaking for T-System as well. I also got  nice e-mail from Jason Blunk, who won his iPad from MedPlus and said he enjoyed checking out booths he would have missed otherwise.

From Sagacity: “Re: Meaningful Use Stage 2 references. Along with the bookmarked version of the NPRM, here is a bookmarked version of the ONC Standards, Implementation Specifications, and Certification Criteria. It comes with the added bonus of clickable MU Objective links, which take you back to the CMS MU objective being referenced in the CMS document. (Just be sure to save both in the same folder).” Thanks for sending the links.

From The PACS Designer: “Re: iPad 3. When the iPad 3 is released next month, you’ll find that the majority of changes will be inside, since rumored details indicate that there will be no change in the size of the screen. One new upgrade coming is better High Definition, where the number of pixels will double by using a 4×4 matrix instead of 2×2 currently in the iPad 2.”

HIStalk Announcements and Requests

If you’ve completed my once-a-year Reader Survey, thanks. If not, I’d appreciate your input.

Acquisitions, Funding, Business, and Stock

Halfpenny Technologies secures $2.25 million in VC funding co-led by Vital Financial and Emerald Stage2 Ventures. The company also announces that it has won approval as the first pilot by the Laboratory Results Interface Pilots Work Group.

T-System acquires Clinical Coding Solutions, a provider of technology for facility and professional charge capture and coding for EDs, observation, urgent care centers, and outpatient clinics.

Hello Health raises $10 million in a combination of common and preferred shares and issuance of convertible debentures through its parent company Myca Health.

Sales

CentraState Healthcare System (NJ) chooses Cognizant to develop its ICD-10 transition strategy.

Trinity Health (MI) selects Quest Diagnostics’ ChartMaxx Enterprise Content Management solution.

LifeCare Hospitals (TX) chooses Meta’s integrated HIM and CDI software suite for abstracting/coding and clinical documentation for its 27 long-term acute care facilities.

CMS awards SAIC a contract to provide enterprise remote identity proofing and multi-factor authentication credential services. The total contract value is $78 million, assuming all contract options are exercised.

HMO Simply Healthcare (FL) selects MedHOK’s care management, quality, and compliance software for quality improvement initiatives.

Sacred Heart Health Systems (FL), Piedmont Healthcare (GA), and Orlando Health (FL) sign contracts with QuadraMed for its identity management solutions.

People

KPMG appoints Richard Bakalar (Microsoft Health Solutions Group) to its Global Healthcare Center of Excellence.

CORHIO Executive Director Phyllis Albritton announces that she will step down at the end of March after four years of leading the organization.

Cape Cod Healthcare (MA) promotes Jeanne M. Fallon to VP/CIO.

CareCloud appoints John Hallock, formerly with athenahealth, as VP of corporate communications.

Siemens Healthcare names David Fisher, formerly with the Medical Imaging & Technology Alliance, as VP of healthcare policy and strategy.

Announcements and Implementations

Ochsner Health System (LA) standardizes on the Informatica platform for HIE, BI, and other IS initiatives.

Sentara Princess Anne Hospital (VA) implements EXTENSION’s clinical workflow solutions for nursing staff in its neonatal ICU.

Oakwood Healthcare Dearborn (MI) will go live with an $80 million Epic project in August.

Midwest Orthopaedis at Rush goes live with SA Ignite’s MU Assistant, which documents EHR usage in preparation for assessment.

Delaware Health Information Network announces that all of the state’s acute care hospitals and skilled nursing facilities are participating in its statewide community health record, making it the first state to have all hospitals involved.

New York eHealth Collaborative is accepting presentation proposals through March 23 for its 2012 Digital Health Conference to be held in October.

Shareable Ink announces partnerships with Greenway, NextEMR, and VoiceHIT for its handwriting recognition technology.

Government and Politics

In England, a hospital pilots an analytics service in which drug companies can use the hospital’s de-identified and aggregated data directly from its databases to perform queries and data analysis.

The VA orders worked stopped on its $103 million enterprise service bus that would connect external products to the EHR it’s developing with the Department of Defense. CIO Roger Baker also says the VA is looking for less-expensive alternatives to Microsoft Office, but has no immediate plans to switch.

CMS credits its fraud detection technology for the indictment of a Texas physician and six other people who it claims bilked the government for $375 million of unnecessary home health services. CMS says the physician certified more Medicare beneficiaries for home health service than any other US medical practice, claiming that he recruited them via door-to-door solicitations and visits to the local homeless shelter.

Other

Novant Health (NC) is hiring 150 people with clinical and computer experience as it transitions to Epic.

Weird News Andy extends this story on cosmetic leg-lengthening surgery, which he captions, “Men, grow six inches.” WNA also likes this ink on medical tattoos, including “No CPR” emblazoned on a man’s chest, although the wording WNA suggests for breast implants is not family friendly.

Nuesoft is conducting a survey on attitudes about the transition to ICD-10 and ANSI-5010.

An article in the Minneapolis paper covers the local VA’s use of a virtual ICU to cover hospital ICUs in multiple cities from a single location, which an intensivist there likens to air traffic controllers watching from afar.

Sponsor Updates

• DIVURGENT and Bon Secours Kentucky Health System publish a white paper on implementing an EMR.
• Covisint partners with Anvita Health to add Anvita’s Smart Problem List to its HIE platform.
• Comanche County Memorial Hospital (OK) will migrate from McKesson’s Horizon Clinicals to Paragon HIS.
• ZirMed introduces VeraFund Manager, an end-to-end automated patient/payer solution for healthcare providers.
• CommunityHealth IT (FL) partners with RelayHealth for its HIE.
• Allscripts and MyCareTeam launch a diabetes management system that integrates the MyCareTeam application with Allscripts Enterprise EHR.
• Beacon Partners launches Pillars Project Planner, a Web-based project management and implementation tool that provides organizations real-time access to their projects.
• Nuance introduces two clinical language understanding solutions, Dragon Medical 360 | M.D.Assist and Dragon Medical 360 | QualityAnalytics.
• eClinicalWorks announces Community Analytics, a data analytics solution for communities and ACOs that provides reporting, alerting, and messaging capabilities to manage population health.
• UC Health (OH) expands its use of Streamline Health Solutions in three of its hospitals.
• Central Alabama Health Image Exchange selects MEDecision to deliver its DICOM images and clinical information solution to seven of its hospitals.
• Healthland partners with Imprivata to resell Imprivata’s single sign-on and access management technology.
• Concentra (TX) selects Allscripts EHR to deploy in its 310 urgent care locations across the country. CVS Caremark’s MinuteClinic will transition from its proprietary EMR to AllscriptsMyWay EHR.
• HFMA grants Surgical Information Systems the “Peer Reviewed by HFMA” designation.
• LTC provider NuVista Living (FL) implements the Intelligent InSites RTLS solution as part of its Living Smart Room.
• Trenton Health Team (NJ) selects Covisint as its HIE provider.
• GetWellNetwork says it gained 25 new hospital customers and a 35% increase in live beds for its interactive patient care solution in 2011.
• Healthcare Management Systems (HMS) and Certify Data Systems partner to make Certify’s HIE solution available to HMS customers.
• Microsoft selects Health Language to map patient data within Microsoft Amalga platform.
• Practice Fusion wins top honors for customer satisfaction in the primary care division of the Black Book Ratings
• Imprivata introduces CorText, its secure texting application.
• T-System introduces care coordination technology at the Emergency Nurses Association Leadership Conference.
• PatientKeeper introduces the latest release of its medication reconciliation software.
• Brown & Toland IPA (CA) selects Humedica MinedShare as its analytics platform to assist its 1,500 physicians with Pioneer ACO requirements.
• CynergisTek partners with Iatric Systems to offer Iatric’s Security Audit Manager and Medical Records Release Manager solutions.
• Quest Diagnostics announces a 30-day EHR implementation guarantee to enable bi-directional data exchange between hospitals and ambulatory physicians using the Care360 EHR.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 2/27/12

Mr. Greg Wilson’s here to host the show,
Little Johnny Bush knows where the HISsies go,
We’ll have a fashion show and name the King and Queen,
You can wow the judges if you make a scene,
So let’s rock,
Everybody let’s rock,
Everybody here who loves HIStalk,
Start dancin’ to the HIStalk Rock.

Listening: Nick 13, shuffly old-school country swingabilly or something like that (I just made that up.) I’m not a country fan, but this is good, melodic, and sparsely produced. Their song In the Orchard 2011 is perfect. Live video here.

Now that HIMSS is over, it’s time for my annual reader survey. It would help me a great deal if you could spare a handful of minutes to answer the 14 questions. Just about every improvement I’ve made to HIStalk over the years has started off as a reader’s recommendation in the survey. Thanks for helping out.

Over 60% of respondents think that it was a mistake for HHS to delay its ICD-10 implementation date. New poll to your right: grade ONC’s performance with regard to Meaningful Use Stage 2.

Here’s the latest HIS-tory from Vince, covering the 1980s bedside device maker CliniCom.

A surgeon in India conducts a hip replacement procedure using an iPad to calculate and verify the position of the acetabular cup introducer, hoping to achieve a more accurate placement that can increase the useful life of the procedure by 100%.

Swisslog announces the first sale of its MedRover mobile medication dispensing cabinet.

I don’t think I’ve heard of Health IT Now!, a coalition advocating rapid adoption of patient-beneficial healthcare IT that counts among its members Aetna, Intel, Nortel, and quite a few other large corporations and member organizations. The organization issues a press release saying the proposed Meaningful Use Stage 2 doesn’t go far enough, unacceptably allows a delay in its implementation by an extra year, and doesn’t require referrals have to support electronic information exchange for two years.

This week’s Kaiser Permanente employee e-mail from Chairman and CEO George Halvorson was all about technology and mostly about HIMSS. He mentions that KP’s new smart phone app for patients got a million hits in its first month. He also mentions KP’s IT successes as announced at the HIMSS conference: 36 of the 66 EMRAM Stage 7 hospitals are Kaiser’s and KP won the organizational Davies (he says it’s like an HIT Oscar, except “bigger and shinier.”) Apparently KP’s HISsies win as the “Best Provider Use of Healthcare IT” was not sufficiently impressive to deserve a mention.

MedAssets announces Q4 numbers: revenue up 47%, EPS $0.07 vs. –$0.87. Non-GAAP EPS was $0.32 vs. $0.18. Shares were up 4% Friday on the news.

A reader passes along that if you’re interested in the Healthcare Experience Design conference in Boston March 25-27, you can save $100 on registration with promo code FRIEND. Jonathan Bush (athenahealth) and Todd Park (HHS) will be reunited as keynote speakers.

User-centered design consulting firm PointClear announces plans to open an office in the Atlanta area. The Huntsville, AL firm has 40 employees and expects to add at least 10 in Atlanta.

Odd: two prominent Montreal cardiologists are accused of taking bribes from patients in return for putting them at the front of the line for nationally funded healthcare services. A newspaper article claims that patients put $100 bills under their hospital pillows before being taken to the OR and others made off-the-books office payments of up to $10,000 in addition to what insurance would pay.

The Health IT Accelerator is launched in Cleveland, OH by BioEnterprise, founded by Cleveland Clinic, Case Western Reserve, and other local institutions. Company submissions are being accepted.

A guest article in London’s Daily Mail compares the author’s first-hand experience with Britain’s NHS and a stay at Cedars-Sinai. Conclusion: Cedars had a lot of computer gadgets (“computers on trolleys follow the nurses around like small dogs”) but waits were long, nurses were cold (“as if the price tag attached to medicine has desensitized them”) , and the costs were high. Advantage: NHS.

An employee of North Dakota’s worker compensation program says a claims supervisor violated state law when she ordered parts of a case manager’s patient notes deleted, removing information that would have supported the patient’s claim.

A Washington Post article finds that Medicare’s $77 million anti-fraud computer system, launched last summer and built by Northrop Grumman, prevented only one fraudulent payment by Christmas, saving taxpayers a grand total of $7,591. Medicare says looking at payment suspensions in a vacuum is an “unsophisticated view” of its activities and the actual benefits of the system exceed $20 million even though it can’t measure the actual recovery total. Sen. Tom Carper (D-DE) said, “I wondered, did they leave out some zeroes? … My point is there was off-the-shelf stuff they could have bought and applied … we ought to be seeing savings of $5 billion a month.”

E-mail Mr. H.

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Additional Booth Crawl Winners

HIStalk’s sponsors are the best. After I named the Booth Crawl winners, several companies got in touch and said, “We would really like to give an iPad to some of your readers. Can we do a draw of those who didn’t get all the answers right?” Congratulations to these additional iPad winners, courtesy of the sponsors who appreciate your imperfect but honest effort.

John Harte, Server and Development Manager
Self Regional Healthcare
Prize provided by The Advisory Board Company

Jason Blunk, Project Manager
Reid Hospital & Health Care Services
Prize provided by MedPlus, A Quest Diagnostics Company

Justin Graham, CMIO
NorthBay Healthcare
Prize provided by Medicomp Systems

Mark Schmidt, CIO
SISU Medical Systems
Prize provided by Sunquest

Kathy Wheatley, Clinical Solutions Director
HCA Healthcare
Prize provided by T-System

HIMSS Final Notes 2/24/12

From Mr. H

My body is totally confused after a long week, a redeye flight home, lack of exercise because of overpriced Harrah’s facilities, and not having to make yet another trip to the Venetian. And here I am working on a Friday night nonetheless, with the large Monday Morning Update to write Saturday. I hope everybody makes it back OK with all the weather disruptions going on.

Bettina Dold of Acusis captured this moment on the show floor, which she titled,” HIMSS Men at Play.” People were having a blast (no pun intended) at these Merge Healthcare arcade games every time I strolled by.

Here’s the most exciting news of the week – the original OnBase magician was back! I’m telling you in all seriousness that this is the funniest and most talented guy working in Las Vegas this week, and that includes show lounge performers. I can’t really explain how masterful he is not just doing jaw-dropping magic tricks, but working the crowd, adding humor on the fly, and moving his audience into the booth for sales attention when he is finished. I look forward to him every year. Whatever they pay him isn’t enough. I wanted to ask him about his background since he seems to know a lot about OnBase and the industry in general, but you’ll never find a time that he doesn’t have a crowd around. Way to go, magic dude! You were the highlight of the conference as usual.

I don’t know what this means since I never did figure out how to find Booth 12953 in the poorly marked and laid out Hall G, but I suspect that if companies were paying HIMSS for “hidden gem” booth space, this sign isn’t going to pacify them.

Inga, Dr. Jayne, and I have individually listed our “how to work a booth as a rep” ideas. As a public service, I’d like to put this together into a checklist for HIMSS exhibitors: don’t sit on the job, don’t talk to your co-workers, etc. This is a potentially important masterwork to help guide the youngsters trying to make a place for themselves in healthcare IT, so help me out with your ideas. You don’t need to include the “confiscate all smart phones” item since that’s a given.

Thursday Booth Notes

• Lots of folks bailed on Thursday, so it was much quieter. I still say many of the serious prospects don’t come by until then, so it’s a shame that so many of the reps were sprawling, screwing around on their phones, and conducting animated and sometimes profanity-laden conversations among themselves as passers-by tried unsuccessfully to get their attention. In on area, I counted reps on phones and iPads in seven of eight booths, then four of six in the adjacent space.
• Cumberland Consulting Group caught my eye by having their HIStalk sign out, but they had probably the best consultation area that I saw, with nice seating and a net-like drape to separate areas off without making you feel like you’re in a box.
• Practice Fusion had some cool shirts and a great pitch. Kellie told me they have 32 million patients in their system and that quite a few of their physician users have stopped by.
• I decided to challenge Suzanne in the MobileMD booth, asking her innocently tough questions like, “Why did Siemens buy your company?” and “How do you like working for them?” She gave perfect answers.
• Krina at Ingenious Med, you were very good and engaging me and giving me a good, concise explanation of mobile charge capture for rounding physicians when I pretended I didn’t know anything about it.
• Salar had a row of candy jars and was making custom bags of treats for attendees. That was fun.
• Charlie Cook, president of Orchestrate Healthcare, set a great example for the troops as he engaged me in the booth periphery, got me to pause, and then moved quickly to the bullet lists of why I should care. Although I admit that I was looking at the HIStalkapalooza-winning shoes on display over his shoulder, courtesy of winner and company CEO Megan Cook.
• It takes special talent to be a theater barker to get people to move off the pedestrian highway to sit down for a demo or presentation, but the best I heard all week was Becky from VMware. She was fresh and funny, even though this was in the waning exhibit hall hours on Thursday.
• Good idea, PC Connection – putting out a sign that attendees could print their boarding passes at your booth. Well done.
• I was entertained at Network Hardware Resale, which was giving away a remote-controlled helicopter as a prize. They gave it a test drive all the way to the high ceiling, then promptly crashed it from 40 feet up and in all its lit-up glory directly into the head of an attendee.
• T-System gave me a nice overview of what they do. I already knew, so they passed the test.
• I sat in on a presentation by Andres Jimenez, MD of ImplementHIT, who talked about using Nuance’s Dragon with Allscripts. Seems like a nice guy, a surgeon finishing a PhD in education. A quote: “It’s not about Meaningful Use with the government. It’s more about going home to have a meaningful dinner with my wife.”
• I spent much of Thursday downstairs in Hall G because I felt bad for the vendors HIMSS put down there. On the other hand, several I talked to said they had been quite busy, so hopefully attendees found their way down.
• Carstens was playing classical music in their booth. I think Dr. Jayne or Inga mentioned this, but it really was effective.
• My favorite booth person of the whole conference was Colleen at the 1Call booth in the Mobile Health exhibit. They do secure messaging for mobile devices. I felt bad for her since she was sitting in the equivalent of a hidden telephone booth, but she was just as sweet and fun as she could be, plus she explained their product effectively. If I’d had a trophy in my pocket, she would have gone home with it.
• iSirona was hopping in Hall G. They gave me a short overview of their medical device connectivity product. They also gave me a tee shirt.
• Megan at Intelligent InSites gave me a really nice overview of their RTLS solution when I pretended to not even know what that means, telling her I stopped by only to “see what the colorful diagram on the monitor is.” OK, I’m good at playing stupid, which maybe isn’t something to brag on. She moved me right into benefits and competitive advantage without breaking the flow and without blowing me off since I clearly wasn’t a prospect.
• I cold-called Holon Solutions, asking “what do you do.” They told me pretty well.
• The Apixio guy was fun in a SoCal way, drawing me in to see their EMR search solution. They also gave a free trial, which I need to try since it’s sitting in my e-mail inbox. I asked an obvious questions he couldn’t answer, though: he only demonstrated searching by patient name, which is not only impractical but dangerous, and hadn’t heard of the idea of searching by medical record number. He was still cool.
• Inga misspoke on the Blue Hair Girls. I kept wondering why I didn’t see them in the SIS booth as she wrote, the reason being that it was The SSI Group.
• I tried several times to figure out what RL Solutions does since they had a very cool, Apple-like booth on the far end of the hall, but every time I trolled, their reps were deep in conversation only with each other and refused to react to eye contact. They’ve missed their window of opportunity since I now don’t even care.
• Ruckus Wireless had a really creepy stuffed dog in the booth.
• Barco had the best beer I’ve ever seen on the show floor. Joe the bartender was professionally handing over fresh-from-the-ice bottles of great European beer like Hoegarden, Stella, and Leffe. It was superb.
• My new best bud rep is Joel from Fixmo, a Toronto mobile device security company. I was drinking my Hoegarden from Barco and we started talking beer talk, to the point that I went down and got him a Hoegarden of his own so we could emulate a bar setting as we elbow-leaned and swigged. He gave me some brands to try: Rickard, Brador, and Steam Whistle. I saw him interacting with passers-by and he is very engaging and friendly. I just didn’t feel that invisible shield between us that keeps you from really engaging with a rep.
• I was hanging out with the Medicomp folks as the exhibits closed at 6:00 Thursday evening. I’ve never stayed past closing time, so it was interesting to watch armies of workers and equipment immediately tearing down all that glitzy magic you enjoyed (or tolerated) all week. They were pulling up carpet almost before the last people exited, and by the time I left at around 6:45, the hall had mostly bare concrete floors, all the booth lighting was powered down, and exhibit people were tearing down the village they had built earlier in the week. By the time you read this, there’s probably another conference in that same space that looks like it’s been there forever.
• Here’s another recognition. I wandered in a cul de sac deep in the bowels of Hall G (or is that Hell G?) Eight small booths facing each other, with seven of them featuring reps sprawling and Facebooking. One booth stood out with a sentry-like presence in Lanette Fugit, who was fronting the Mobile Iron booth.  She was like a guard at the Tomb of the Unknown Soldier: ramrod straight, eyes unwavering, ignoring the people around her who were mostly just screwing around. She engaged me, went smoothly into a short and obviously well-rehearsed but not overly glib informational pitch, and then steered me to the two technical guys working with her as the handoff for geek talk. I verified that she’s a contract person. Her pic is below, but despite her obvious attractiveness, I wasn’t even thinking that – I was thinking she’s the one person who cares enough to be professional when she could have gotten away with less since she’s not even an employee.

Some Booth Crawl Winners

Here’s Franklin Crownover, pharmacy informatics coordinator at Tufts Medical Center and Booth Crawl contestant, accepting his iPad from Chris from Shareable Ink. Some of the contestants obviously check e-mail regularly and like iPads immensely since they showed up almost immediately to pick it up after I e-mailed them that they’d won, which I like since it indicates that they were excited about it. Facebook post here. Thanks to all those who played for visiting the booths of the sponsoring companies. Winner Dan Williams e-mailed me to say, “It is a great way to see everything and especially to meet the HIStalk sponsors.”

Another iPad winner – Jonathan Rubin MD of Froedtert Hospital-Medical College of Wisconsin. His prize came from Surgical Information Systems, which commemorated it on their Facebook. I note his enthusiasm as evidenced by the blurred thumbs-up gesture, caught mid-stream as he welcomes his new electronic family member.

Another Booth Crawl winner – Anuj Desai, director of business development for New York eHealth Collaborative. Why was the photo taken in front of the HIMSS bookstore, you might ask? Because the presenter is Guy Scalzi of Aspen Advisors (on the right), who co-authored the book IT Governance in Hospitals and Health Systems, published by HIMSS this month. You may remember Guy from his former lives as an FCG senior vice president and CIO at New York-Presbyterian.

Rick Beberman of Fulcrum Methods seems to be just as pleased to be holding our HIStalk sign as he does to be presenting a brand new iPad for the enjoyment of Jim Hetherington, HIE applications manager at Catholic Health Initiatives. I swear even the boxes Apple uses are sexy. Jim also e-mailed me a photo he took in one of the education sessions, in which a young lady was wearing a coat that was almost identical to the one work by Evan Frankel at HIStalkapalooza. I’m not running it since she might not appreciate the comparison although it’s definitely there.

Cynthia Hartmann, come on down! To Vitera Healthcare Solutions, that is, which presented Cynthia (of University of Mississippi Medical Center) with her shiny new iPad.

Apple loves AirStrip Technologies and is always putting their cool remote monitoring solutions into their commercials and on-stage announcements, so it’s only fitting that Donna Morrow, chief of client operations officer for the company, presents Anthony Schuster MD with an iPad. Tony is CMIO with the outstanding H. Lee Moffitt Cancer Center in Tampa, FL. I note with pride that his LinkedIn profile indicates that he’s a member the HIStalk Fan Club, which I swear had nothing to do with his victory.

Here’s a brilliant idea. We still have a few iPads to give away since we didn’t have enough successful Booth Crawl contestants (more info to follow on the additional winners) but ICA drew their winner from entrants in the food bank donation project. Congratulations to Lisa Lyon, clinical informatics coordinator at Cherokee Nation of Pryor, OK. They were the first tribe to earn an EHR incentive payment from the state’s Medicaid program. That’s Lisa on the right in the group shot above as they accepted the incentive payment last July. Thanks for the work you do and enjoy your iPad, courtesy of Informatics Corporation of America.

Gabe Davis, Booth Crawl winner from Texas Health Resources, e-mailed me to say that he had a ton of fun, and that “I can honestly say that I made several connections with vendors that I wouldn’t have normally spent time with. It was a great idea.” Gabe’s iPad came from API Healthcare.

From Inga

If you missed HIStalkapalooza, check out the video above from ESD. Now that I think about it, I stayed in my one little spot most of the evening and didn’t get to see all the other fun stuff going on. It makes me so happy to see so many people having a fun time! The fashions — from the shoes to the gowns to the tuxedoes — were fantastic! A year from now when Mr. H and I are pulling our hair out with our pre-HIMSS activities, I will pull up this video and remember it was all worth it. Many thanks again to ESD, our emcees, our HIStalk Elvis, and our judges for making it a magical evening.

Many kind folks have forwarded notes expressing their thanks and appreciation for both HIStalkapalooza and our sponsor luncheon. Here is a sampling:

Our team had a lovely time at the HIStalk luncheon. Thanks for recognizing your sponsors and the contributions you make to the industry.

Just wanted to thank you for the invite to last night’s event. I had a great time and got to catch up with a lot of folks I hadn’t seen in a while.

Thanks for the IngaTini(s) and the fantastic hospitality tonight.

Best party at HIMSS year after year.

Another awesome HIStalkapalooza! Jonathan Bush was as simultaneously irreverent and insightful as always. Whoa, those HISsies!

I posted a number of photos from the party on the HIStalk Facebook page, including many of the shoe fashions. I am happy to report my shoes were deemed attractive enough to capture the eye of our shoe judges.

I am hoping someone filmed the HISsies as well because Jonathan Bush was on his A game yet again. He’s funny, smart, doesn’t hold back, and is pure entertainment. And he drinks very large beers.

HIMSS says that as of Friday morning, attendance hit 37,032 attendees, surpassing HIMSS11’s 31,500 attendance figure. A total of 1,123 companies exhibited.

There is nothing hotter than a guy in a pink tuxedo with lights. That’s Trey Lauderdale of Voalte, the company known for their pink apparel.

I didn’t get too many trinkets this year: a couple of t-shirts (including an XXL one from Medicomp – whoops); a couple of hats (I really like the Trustwave one); chocolate; and a few pens. Though not swag, the Intelligent InSites people made sure I received the above poster. I love it! Intelligent Insites offers an RTLS solution that requires less walking for nurses to find equipment and therefore allowing them to switch to the hot shoes like the ones pictured. I just like gazing at the shoes.

Speaking of shoes, despite mostly wearing flats all day, my poor little feet are swollen and have blisters. I am thinking it will be a barefoot weekend.

My brain as well as my feet are exhausted, so that’s it for now. All in all, it was a great week and a great conference.

From Dr. Jayne

I thoroughly enjoyed watching Inga play Quipstar yesterday afternoon, although I must say I was quite jealous of the hardcore security detail that was outside her dressing room (complete with ear pieces!) and the paparazzi that were on hand to capture her entrance. Medicomp did it up right and even had a shoe-cam to focus on her seriously spiky stilettos.

There seemed to be a bit more buzz in the hall – brighter faces and a shift in the general tone from Tuesday’s eerie quiet. Maybe people are doing well in the casino and it’s making them more chipper. I noted huge crowds at the Nuance booth as well as at ICA,  where I dropped my entry to win cash for my local food bank. Lots of friendly folks there who just wanted to chat.

I connected with a couple of specific people to get answers to some technical questions about products that I had posed earlier in the week. It was nice to have follow-up and know that people understand this is a time for many of us to accomplish a lot of data gathering in a short period of time.

But alas, all good HIMSS must come to an end and for me today (Thursday) was the last day. I had to sprint home to prepare for a Big Meeting tomorrow with some physicians who take a dim view of being rescheduled for what they perceive to be merely another trade show. I found a forlorn little post card in my mailbox, urging me to visit the ANX booth to pick up my special “hangover kit” and experience a special photo op inspired by “Hangover.” I hope they’re inspired to follow up with their marketing team to find out why their mailing wasn’t postmarked until February 16, which made delivery prior to HIMSS nearly impossible.

I was happy that my suitcase only gained a pound and a half during this Vegas trip – probably because I took a lot of smart phone photos of interesting materials to reference, rather than picking them up. The airport was full of HIMSS survivors and I spotted several FormFast fedoras as well. I’m looking forward to New Orleans next year (better have some beignets in the booths, people!) but right now I have to cozy up with the Stage 2 proposed rule in all of its 455 pages of black and white glory.

From HIMSS 2/23/12 – Inga’s Update

It’s Thursday afternoon. I left the exhibit floor a bit early to get my bag and write a few updates before getting on my plane for home. A reader suggested my posts have not been very insightful the last couple of days (sorry) and another suggested they have been too short (sorry.) I’ve been going non-stop, taking plenty of notes, so I will attempt to reclaim my insightfulness over the next couple of days as I share details of my HIMSS experience.

I’d say the most-discussed topic this year was the announcement of the proposed Stage 2 MU rules, followed by the ICD-10 delay. Since the rules were not published until Thursday morning, few people had a handle on what was included. Dr. Mostashari’s overview Wednesday morning didn’t include many details, though apparently some of Thursday’s sessions went deeper. So the first part of the week was all about speculation of what was going to be included, followed by a few “what did you understand was included” type conversations. Of course, many folks also grumbled about the rules not being announced a few weeks ago.

On the ICD-10 front, many were speculating that ICD-10 would be delayed indefinitely and that we’d stick with ICD-9 until transitioning to ICD-11. I pity the vendors who had invested years of development work to facilitate the ICD-9 to 10 transition.

Typically at HIMSS we also hear official or unofficial news of acquisitions or mergers. If there were any such deals this year, they flew under my radar. You did see new booths and refreshed marketing spin from several of the entities that have recently changed their name or rebranded, including Optum, Vitera, and M*Modal.

Speaking of spin, I visited one of the relatively new ambulatory cloud-based EMR vendor whose small space was in the downstairs exhibit hall (or the “dungeon” as one of the downstairs vendors termed it.) I can’t say I saw enough of EMR to form an opinion, but I did smile when the young sales guy explained how the product was developed to adapt to the physician’s workflow. I recall using very similar words when I sold EMR software 10 years ago. Seems to me that if you are marketing a product running on the latest greatest technology and with a sexy interface that you should figure out a fresher pitch.

Rather than sticking with my traditionally more comfortable ambulatory-focused world, I sat through a few demonstration of inpatient products, including Cerner Millennium. The demo featured a high-level look at a new (or coming soon?) version that includes a new chart note entry screen. The most curious part of the demo was the sales guy’s comment that the chart note entry is now laid out more like Epic’s.

Several companies were promoting new products that feature natural language processing. I got a peek at QuadraMed’s computer-assisted coding module, which uses M*Modal’s NLP technology. Cool stuff.

Practice Fusion always seemed to have decent traffic and I spent a few minutes asking questions.  The company says it has 150,000 clinical users, of which 40% are physicians, and since rolling out their MU version in September, over 300 EPs have attested. They continue to tweak their ad module, which includes advanced technology to narrowly target the interests of individual physicians and their individual patients and diagnoses.

The Meditech booth was hopping each time I walked by, even though they were not in one of the major thoroughfares.

Allscripts’ booth was the size of a city block, and a busy city block at that. One of the Allscripts execs told me he walked through the downstairs exhibit hall and it brought back memories of not too many years ago when Allscripts had a similar small budget and presence.

A reader e-mailed me this comment: “I am concerned about the industry’s commitment to cleanliness because I can tell you that 70% of the male attendees don’t wash their hands in the restrooms.” I will have to take the reader’s word on that one.

I enjoyed Dr. Mostashari’s Thursday morning keynote. I will start by saying he is a dapper dresser and was wearing a dark pin striped suit, white shirt, and his signature bow tie (yellow.) He also strikes me as a regular, down-to-earth, and smart guy who believes in his organization’s mission. In his talk he highlighted the last few years of EMR adoption, the ONC’s and CMS’s role, and discussed what needs to happen next. One person I asked called Mostashari’s keynote “brilliant.” Another said the whole message could have be summarized with a simple, “Go, team, go!”  I think the content, balanced with the engaging delivery and bow tie, was not necessarily “brilliant” but solid nonetheless.

I had a chance to walk the floor with a physician and later with a CIO. I have to admit I often felt ignored by vendors when I was with them. I realize that the CIO and the doctor are the real prospects but I was a little offended when a couple of vendors barely glanced in my direction. It’s hard to be a diva.

A few booth observations:

NextGen always comes up with entertaining talent to attract a crowd and this year was no exception. NextGen had  a “spelling bee” that included some odd-ball contestants, including a goofy-looking John McEnroe. It may not have been as captivating as last year’s artists, but still fun.

Medecision had a neat ice sculpture and was offering an assortment of unique drinks, from iced coffee in the morning to cocktails in the afternoon.

athenahealth updated its booth a bit and added bamboo and grass here and there. The changes were subtle, but I liked it.

eClinicalWorks never has a huge booth, but always seems to attract a decent crowd.

At 12:30, the line for gelato at Harris’s booth was so long that I am guessing I wasn’t the only one who found it difficult to grab a quick lunch.

Was it me or was there many shades of orange? Optum, Vitera, and Elsevier, to name a few.

dbMotion’s four demo stations and center conference table were full every time I walked by.

Thank you Perceptive for the tee shirt, which appears to be a women’s cut instead of the boring unisex style.

I think my favorite booth was CareTech’s. It was not one of the huge booths and what made it unique was its use of black and white photographs to communicate its vision. So many of the booths are heavy on the bright colors and huge signs, but CareTech’s was simple and not overstated. Well done.

Dell’s booth, on the other hand, was accented in fun colors (pink, yellow, blue, green.) Tastefully done and attractive.

T-System’s booth was decked out to resemble an ER, complete with the “H” hospital sign, wheelchairs, and blood pressure cuffs. Very clever.

Optum’s new booth (orange) was very open and included a theater and conference rooms. I prefer the booths that don’t require you to pass through a front reception area and encourage attendees to walk in and check things out.

3M had a dome-like tent for their demo theater. Different and cool.

MesAssurant had a good-size booth with couches and hardly any booth staff. They had monitors that look like they might have been running PowerPoints, but the PowerPoints weren’t running. I couldn’t figure out if the lack of staff was intentional and they just wanted to offer attendees comfy couches a feel-good space with subtle marketing messages.

McKesson’s booth was of course big, but not as imposing as it has been in some previous years.

I didn’t see any creepy mimes, body contortionists, gorilla costumes, or black body suits. Maybe I missed them or maybe vendors have retired those gimmicks.

I still have not provided many comments about HIStalkapalooza, which was fantastic from the fashion, to the drinks, to the wonderfully accommodating hosts. Look for that in the next day or two. I didn’t get too much in the way of swag this year, but I have photos of a few of the best goodies.

Happy travels if you are heading home today. If you have already made it home, happy wading through your e-mail inbox. And if you were not able to be in Vegas this year, I hope that between Mr. H, Dr. Jayne, Dr. Travis, and me we have shared enough to make you feel that not everything that happens in Vegas stays there.

Booth Crawl Winners

We were overly ambitious on the Booth Crawl requirements given the exhibit hall logistics and the short timeliness. That challenge made it hard for our players to complete the contest successfully. Still, we know it was possible because 12 contestants who are employed by provider organizations got all the answers right by Wednesday evening.

Thanks to everyone who played, including those who visited the booths of the sponsors but were unable to finish in time.

We’ll have more later, including the correct answers to the questions and perhaps some photos of the winners.

Stop by the following booths today to pick your iPad.

Susan Heichert, SVP
Allina Hospitals and Clinics
MED3OOO – pick up at Medicomp, Booth # 855.

Anthony Schuster MD, CMIO
Moffitt Cancer Center
AirStrip, Booth # 870

Cynthia Hartmann, Director, IT Solutions Consultants
University of Mississippi Medical Center
Vitera Healthcare Solutions, Booth # 445

Jim Hetherington, HIE Applications Manager
Catholic Health Initiatives
Fulcrum Methods, Booth # 13247, Kiosk 6

Jonathan Rubin MD
Froedtert Hospital-Medical College of WI
Surgical Information Systems, Booth # 1339

Gabein Lee Davis, Clinical Analyst
Texas Health Partners
API Healthcare, Booth # 2617

Rita Cartwright, Sr. Business Systems Analyst
Tucson Medical Center
Access, Booth # 860

John-Paul Jones MD, CMIO
CentraHealth
MedVentive, Booth # 64661 (ACO Knowledge Center)

Anuj Desai, Director of Business Development
New York eHealth Collaborative
Aspen Advisors (they will contact you for delivery)

Dan Williams, CIS Administrator
Saint Francis Medical Center
dbMotion, Booth # 4219

Franklin Crownover, Pharmacy Informatics Coordinator
Tufts Medical Center
Shareable Ink, Booth # 7100

Aaron Spratt, Director of ARRA implementation
Saint Francis Medical Center
Awarepoint, Booth # 3412