News 8/8/12

Top News

The board of the Kansas HIE, having found few takers for its fee-based services, meets this week to decide whether to dissolve itself and turn its operation over to the state, hoping to reduce its $400,000 in annual operating costs. Taxpayers would be on the hook to cover the remaining half of its costs. Former Kansas Governor Kathleen Sebelius, now HHS secretary, convened the commission that recommended creating KHIE by executive order in 2010, which makes it questionable as to whether the group has the legal authority to simply disband itself. KHIE funded its operations with a $9 million federal grant and has $5.5 million left.

Reader Comments

From InTheKnow: “Re: Alere. Just closed a deal to acquire DiagnosisOne.” Verified, but not announced as far as I can tell. Alere (the former Inverness Medical Innovations, which acquired interoperability vendor Wellogic last year ) offers diagnostic and health management  technologies and programs, while DiagnosisOne sells tools for order sets, decision support, analytics, and public health surveillance. DiagnosisOne is backed by Edison Ventures, which is how I verified the rumor after digging around forever – the acquisition was buried on one of the pop-up pages on their site.

From Justa CIO: “Re: Indiana University Health. Announced that Bill McConnell, Jr. started this week as CIO, replacing Chris Van Pelt, who has left the organization.” Verified. Bill has updated his LinkedIn profile showing that he started this month. He was previously CEO of FlowCo, which makes a stent-related medical device.

From Jeremy: “Re: 3D printed medicine. How would people feel about their EHRs printing the medicine ad hoc?” A research paper speculates that a 3D printer could be loaded with pre-filled, drug-containing vessels, allowing medications to be “printed” on demand.

From Rick Starkey: “Re: JAMA article. Very entertaining.” Indeed it is. John Lennon’s Elbow, by Robert H. Hirschtick MD from Northwestern University’s Feinberg School of Medicine, is funny as it criticizes EMR documentation with Beatles references (I won’t give away its conclusion, which yielded the title.) A snip:

I once asked an intern why his successively longer daily progress notes retained old or irrelevant test results. His response was revealing: “This way, my final progress note is also the discharge summary.” This Twelve Days of Christmas approach—building a final supernote by successive daily addition—yields a discharge summary that is long, thorough, and unreadable. Unreadability is a problem only if readability is a goal. But these notes are not constructed to be read. They are constructed to warehouse data. All the key information is contained within but as hard to find as a radial pulse beneath multiple color-coded wristbands.

From Consultant: “Re: Providence Health Systems. They are slowing down their Epic implementation, one of the largest in the US to learn from initial go-lives.” Unverified. The $750 million implementation was announced in 2010 and the first go-live was originally planned for 2012, with a 30-month completion timetable.

HIStalk Announcements and Requests

My top Olympics’ observation of the day: water polo players rock. Twenty-eight minutes of treading water and swimming and throwing a ball? The athleticism of it has almost inspired me to jump off the couch and go for a run. And speaking of runners, how about Felix Sanchez, the 35-year-old from the Dominican Republic who won the men’s 400m hurdles? Way to beat the youngsters. And speaking of youngsters, I am adding Uruguayan footballer Edinson Roberto Cavani Gómez to my Hot Olympian list.

Acquisitions, Funding, Business, and Stock

HCA reports Q2 results: revenue up 12% to $8.1 billion, EPS $0.85 vs. $0.43. The company reaffirms 2012 guidance, including estimated EHR incentive income of $325-$350 million and EHR expenses of $90-$115 million. The company also announced that it was notified this week that the Justice Department wants to see records from its heart procedures at certain hospitals. A New York Times report suggested that they performed unnecessary procedures to boost revenue in preparation for HCA’s 2011 IPO.

Mediware  will acquire the assets of Strategic Healthcare Group, an Indianapolis-based provider of blood management consulting.

Nuance announces Q3 numbers: revenue up 31%, EPS $0.25 vs. $0.13.

Staffing company Cross Country Healthcare swings to a Q2 loss due to a delay in an unnamed large EMR project for which it provides staffing.

It’s not healthcare related, but it’s a cautionary tale about letting computers do too much thinking (or maybe to do more testing before a rollout.) Stock trading firm Knight Capital, which single-handedly caused wild swings in stock market share prices last week when its newly installed high-speed trading software sent incorrect orders to brokerage houses over a 45-minute period, nearly goes out of business when the SEC holds it accountable for the $440 million in erroneous trades its software caused, four times the company’s profits last year.

Sales

Orlando Health (FL) selects onFocus epm software for enterprise performance management.

Muenster Memorial Hospital (TX), United Hospital District (MN), and Rothman Specialty Hospital (PA) sign with Park Place International for its OpSus|Live cloud-based hosting solution utilizing Meditech-certified servers and storage.

Poudre Valley Hospital (CO) selects ProVation Medical Software for gastroenterology procedure documentation and coding in its GI labs.

Windsor Health Plan will deploy MedHOK’s care, quality, and compliance platform that includes NCQA certified software for HEDIS, pay for performance, and disease management performance measures..

Anderson Hospital (IL) selects M*Modal Fluency Direct for use with Meditech in the hospital and NextGen in its physician offices.

Allied Services (PA) signs a contract to implement Cerner Millennium. It offers rehab, vocational, home care, and residential services.

Announcements and Implementations

South Lyon Medical Center (CA) goes live on CPSI’s EHR.

Powell Valley Healthcare (WY) goes live on NextGen’s Inpatient EHR.

Orion Health is named a reseller and services provider for Caradigm’s Amalga platform and Vergence SSO software in the Asia Pacific region.

McKesson announces McKesson Cardiology Inventory and McKesson Surgical Manager Point-of-Use Integration Module which allows a clinician’s single barcode scan to document, charge, and reorder items.

Chicago Mayor Rahm Emanuel proclaims October 30 – November 7 to be Informatics Week (plus a couple of days, apparently), a “city-wide celebration” of biomedical and health informatics that will precede the AMIA meeting there.

The VA begins its RTLS implementation at seven VA VISN 11 medical centers in Indiana, Illinois, and Michigan. HP is managing the project, which involves several brands of sensors providing real-time information to its Intelligent InSites RTLS software to track equipment and supplies, monitor temperatures, and trigger workflows. The $543 million project will eventually cover 152 medical centers.

Hospitals in Franciscan Alliance Northern Indiana Region go live on Epic, right on time from their project plan.

Zynx Health announces Version 3.0 of its AuthorSpace clinical decision support authoring tool.

Katalus announces an EHR Total Cost of Ownership model that will be offered as a cloud-based solution.

Government and Politics

The Substance Abuse and Mental Health Services Administration awards $4 million in grants to six organizations for HIT tools to expand access to substance abuse treatment in underserved areas.

Innovation and Research

Researchers from NorthShore University HealthSystem (IL) find that the increased use of EHRs by hospitals and health systems could help physicians make more exact, real-time decisions when prescribing antibiotics.

Technology

Health engagement management provider Eliza Corporation receives a notice of allowance from the patent office for its Complex Acoustic Resonance Speech Analysis System, which provides conversational, high-performance speech recognition.

Other

Hospital officials at Olympic Medical Center (WA) tell commissioners that their ongoing transition from Meditech to Epic will cost about $6 million, with ERP software from Infor/Lawson running an additional $1 million.  

A blog post from John Glaser of Siemens Healthcare compares his selection to throw out the first pitch at a baseball game to the impending accountability of healthcare IT to improve care (in neither case would you want to pull a Baba Booey in front of a crowd.)

HHS records show that the medical records of 21 million patients have been exposed by breaches since September 2009, with six organizations reporting incidents that affected more than a million people. Leading the pack is the federal government itself, whose Department of Defense / TRICARE (specifically, federal contractor SAIC) lost backup tapes during shipping in September 2011 that contained information on 4.9 million individuals.

ONC’s Office of Consumer eHealth puts out a video pitching EHRs to consumers.  

If you’re an Epic competitor, there’s not much good news in the KLAS Mid-Term Performance Review from June that a reader just sent my way. Unless you sell anesthesia information systems, anyway.

A pharmacy technician at University of Miami who “seemed to live beyond his means” in paying $56,000 in cash for a BMW is suspected of stealing $14 million in drugs from the cancer center pharmacy over a three-year period. The university’s CFO admits that the pharmacy had no inventory controls at all in place. The technician was caught pocketing drugs on surveillance cameras, but his lawyer says that while he did steal some drugs, it could have been anyone who nabbed the $14 million worth since anybody could just grab what they wanted. He was caught when the pharmacy buyer noticed discrepancies in the quantities on hand of the drug Neulasta, which she then inventoried manually since the new inventory software “was not the most trustworthy.”

Seattle Children’s Hospital, trying to cheer up a 16-year-old cancer patient who has been hospitalized in isolation for months and missing her cat Merry, crowdsources through Facebook to collect 3,000 cat photos to project in a “virtual feline cocoon” they built for her. Her response: “You guys remind me that there is so much good in the world, and its just makes me feel so much better, and connected. I can’t tell you how it feels sometimes, feeling disconnected and cut off from the world, and then with something like cat pictures bringing me back.”

Sponsor Updates

• GetWellNetwork launches a video on the future of patient engagement using interactive patient care solutions.
• Billian’s HealthDATA recognizes five hospitals to watch on Twitter.
• e-MDs hosts a webinar featuring Jen Brull MD, FAAP and her practice’s use of social media to build community and engagement with patients.
• GE Healthcare releases details of its Centricity Perinatal National Users Group conference in October.
• OTTR Chronic Care Solutions will participate in next week’s NATCO Conference in DC.
• Forrester Research names Covisint a cloud identity and access management leader in its Enterprise Cloud Identity and Access Management report.
• A Surgical Information Systems survey indicates that drivers for implementing perioperative IT include facilitating improvements in OR efficiency, the quality of patient care, and reduction of documentation errors. 
• Howard County Medical Center (NE) selects BridgeHead Software’s healthcare data management solution as its backup and archival system.
• Cumberland Consulting Group promotes Mark Riley to principal.
• T-System hosts a free webinar on proper documentation of E&M services to optimize reimbursement.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 8/6/12

From Fact Checker: “Re: New York Times editorial. Implies that an EHR might have prevented a 2007 death at Wyckoff Heights Medical Center, but a Meditech announcement says it went live on Q1 2006.” I don’t know which Meditech applications went live in 2006, but it probably wasn’t all of them. The hospital CEO’s comment specifically referenced clinician documentation of vital signs.

From The PACS Designer: “Re: chemo preparation. No one wants to hear they have cancer, but if you have to deal with it, there’s a website called Guide2 Chemo to help anyone get prepared for their treatment plan, along with an iPhone application.” The advertising company that offers it, Health Monitor Network, has a variety of sites and tools to “create a dominant presence in targeted physician waiting and exam rooms” that results in “NRx and TRx [new and total prescriptions] script lifts.” It sells its mailing list of condition sufferers to marketing companies. The company publishes a weird magazine called New York Giants Health Monitor with a claimed readership of 3 million “male condition sufferers 40+” that not only ties Giant players and coaches to health articles, but also offers companies promotional opportunities for hair growth, erectile dysfunction, and “always adding more.” If you want to control healthcare expenses, you might logically look at anything so profitable (i.e., costly to the system) that companies spend big money to promote it directly to patients. In fact, you might conclude that a lot of this mess started when laws were changed to allow companies to market to directly to patients and to run TV commercials, drumming up demand for products that patients themselves aren’t actually paying for.

Put your money in athenahealth if you’re buying a healthcare IT stock, say 40% of poll respondents. New poll to your right, checking up on interoperability: was the information from your most recent doctor visit immediately available at your hospital of choice? Mine was.

Welcome to new HIStalk Platinum Sponsor PeriGen. As the Princeton, NJ company’s name suggests, it offers fetal surveillance systems that support real-time decision-making in caring for mothers and babies. They include PeriCALM Tracings (bedside fetal surveillance with complication recognition and evidence-based data analysis for physicians and nurses); PeriCALM Plus (ONC-ACTB certified physician and nurse documentation, labor progress analysis, and decision support); PeriBirth (ONC-ATCB certified specialty EMR for obstetrics with protocols and best practices, real-time patient integration, and enterprise EMR integration); and PeriCALM Shoulder Screen (a Web-based prenatal tool for identifying shoulder dystocia). PeriGen systems are installed at over 150 hospitals. You may know former Allscripts sales SVP Matt Sappern, who was named CEO of the company in January 2012, or former Misys VP Mike Pritts, who is president and CTO. Thanks to PeriGen for supporting HIStalk.

Here’s a new YouTube video I found that covers PeriGen’s PeriCALM Plus.

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

Stanford Hospital announces that a laptop containing the information of 2,500 patients was stolen from a doctor’s locked office in mid-July. The article says the laptop was password protected but doesn’t specifically say it was encrypted, although the university’s IT security site says patient information cannot be stored on a computer without explicit permission, and if it is, the disk should be encrypted.

Weird News Andy finds this interesting. A 17-year-old high school student hears cries for help from a child swimming in the ocean. He pulls the child out, bystanders call for help, and both are taken to the hospital by ambulance. Weeks later, the student receives a bill for $2,600, including $1,907 for the 15-minute ambulance ride. His family, who has nine children and no insurance, is trying to arrange payments. After the story ran on TV, two anonymous volunteers offered to pay the full amount.

I mentioned the $70 Leap Motion input device awhile back. Some healthcare folks are discussing how it might be used in the clinical setting. Register for the company’s discussion board and then go to this forum to participate. The device, which won’t ship until December, is supposedly 200 times more accurate than Microsoft’s Kinect and can track the movements of all ten fingers individually. There’s a software developer kit that might be fun.

Wayne Memorial Hospital (PA) launches its Direct program using Secure Exchange Solutions.

A self-described “doctor uber-nerd” whose practice has been using an EMR for 16 years says Meaningful Use incentives have shifted focus away from the patient and instead caused a preoccupation with gathering compliance data. He says his vendor, who was “stuck in a pre-Internet, office-network design” shifted all their resources to Meaningful Use. He concludes:

This is sadly ironic. We were once using our computers in a meaningful way for the benefit of our patients, but now we are being pressured to abandon the patients in order to qualify for “meaningful use.” This should come as no shock to anyone who has watched American health care over the past 20 years. We have beaten doctors over the head with “clinical pathways,” and “evidence-based medicine,” all with a good intent: to make sure doctors gave good care. The problem was, however, that these criteria become more important than the patients they were meant to serve. The same is true with our payment system: designed with the initial intent of enabling patients to have access to care, but becoming a behemoth in the exam room, standing between the doctor and the patient.”

In Canada, an Alberta Health Services EVP/CFO resigns his $425K position after his expense reimbursements from his previous position are made public by a CBC Freedom of Information request. In three years with Capitol Health Authority (which was later absorbed into AHS) Allaudin Merali turned in $346,000 of expenses, which included costs for fixing his Mercedes, installing a car phone, buying gasoline and car washes, and purchasing a golf membership. He previously worked for scandal-ridden eHealth Ontario, where he billed an average of $76,000 per month, even turning in expenses for chocolate bars and tea. In investigating the expense claims, it was discovered that he had been paid $2.6 million in severance from his previous job, even though he ended up going to work for its successor organization. He’s eligible for almost $500K in severance this time around. His former boss at Capitol Health, who also found her way to Alberta Health Services as a board member, also resigned on the news. She had signed off on his expenses at Capitol Health, not to mention that when her CEO job there was eliminated, she received $4.1 million in retirement benefits.

A reader forwarded a client alert from law firm Post & Schell that warns companies, especially hospitals, to check their use of terminal and security software from Attachmate. They say Attachmate is aggressively auditing and suing its customers, especially those in healthcare.  The law firm warns that organizations might not even be aware that Attachmate software is installed, and since the products are licensed per PC, Attachmate could argue that running it on a Citrix server means that every PC needs a license. Attachmate bought Novell in 2011, so they advise checking those licenses as well.

The VA says the open source Web viewer it’s calling Janus will give clinicians a combined view of patient information from the DoD’s AHLTA and the VA’s VistA EMR systems, the first step in their integration project and also the first use of code from the VA’s OSEHR repository.

WellPoint takes a financial position (apparently $12 million worth) in SoloHealth, which offers a consumer health screening kiosk for vision, blood pressure, weight, and body mass index. According to the company’s site, the kiosk, which was just approved by the FDA, also allows consumers to find a doctor and schedule an appointment. An earlier investor in SoloHealth was Coinstar, the company behind Redbox.

Massachusetts announces that it will create a statewide HIE, with the $16.9 million cost paid for by the federal government in the form of ARRA and Medicaid money from CMS. Orion Health was chosen as its technology provider.

A Xerox survey finds that only 26% of Americans want their medical records stored in digital form, and 60% of them don’t think EMRs will improve care. On the other hand, the survey was conducted online and Xerox sells electronic document systems and the services of the former ACS Healthcare consulting firm (which it acquired for $6.4 billion in 2009) rather than EMRs, so the conclusion could be disputed.

SAP acknowledges that its ERP software has usability issues after companies such as Varian Medical Systems start to look for replacement products for non-core applications, citing changing user expectations brought on by the iPad and iPhone. SAP plans to offer software that allows IT departments and individual users to personalize its screens.

An $8.1 million federal lawsuit against Kernan Hospital (MD) that claimed the hospital intentionally coded patients with a rare malnutrition disease to increase reimbursement is dismissed. A federal court said the government did not provide evidence that the hospital actually submitted the claims for payment. The hospital’s claims for kwashiorkor as a secondary diagnosis increased from three in 2005 to 358 in 2008. One of the patients was also documented as being overweight and was counseled to go on a diet. The University of Maryland Medical System, which owns the hospital, said the coding is confusing.

A GAO report covering only Florida, New York, and Texas finds that 7,000 Medicaid providers who were paid $6.6 billion in 2009 owned $791 million in back taxes. It recommended (and the IRS agreed) that more rigorous review is needed. One provider owed over $6 million in unpaid federal taxes.

Chicago-based startup Procured Health, which helps hospitals evaluate medical devices for potential cost savings,  raises $1.1 million in seed funding from several investment groups and athenahealth’s Jonathan Bush. The company is testing its product and plans to launch in 2013.

Vince’s HIT time travels this week involve Pentamation (spoiler alert: they were acquired by Keane indirectly via an acquisition in 1992) and a sales executive who ended up as a Hollywood and Broadway producer. Vince got help this time from Gary Pollock and Doug Abel and he would he happy to receive your assistance as he continues to dig into the (sometimes) storied histories of the (sometimes) fondly remembered healthcare IT companies of yesteryear.

E-mail Mr. H.

News 8/3/12

Top News

Even though the Stage 2 MU final rule has yet to be published, the HIT Policy Committee MU Workgroup releases its preliminary draft recommendations for Stage 3 MU. Among them:

• Threshold requirements are higher in several areas, including the percentage of EP prescriptions sent electronically (50%), percentage of hospital discharge medications sent electronically (30%), percentage of lab results that must be stored in the EHR as structured data (80%), and percentage of patients using secure messaging communications with providers (15%).
• More clinical support interventions are required (15 related to five or more clinical quality measures).
• New EHR certification standards, including requirements that EHRs maintain up-to-date and accurate problem and medication lists.
• Increased emphasis on patient and family engagement, including requirements to provide patients an option to submit data online and to offer additional patient education material in languages other than English.
• Expanded requirements to improve care coordination and population and patient health.

Reader Comments

From Hilltopper: “Re: AHA Solutions endorsement. Two years we (naively) responded to an AHA RFP to become an endorsed solution provider for a specific category of consulting services. We were down-selected, went to Chicago for a presentation, and were eventually named their vendor of choice for the prescribed consulting services. We then found out they wanted way in excess of six figures for their endorsement (advertising, promotion over a three-year period) and a percentage of new business, we declined. What a waste of time, and it was not disclosed earlier in the process.”

From Benny Hanna: “Re: MUMPS. It’s ugly and I despise it, but like XML, DB2, or NoSQL, it works. If you index properly (or at all) and your storage is fast, the database will perform. The biggest news around MUMPS was your item about Dell/Epic to allow virtualization of their servers, both application and database. Now you can throw a whole farm of processing and storage power behind that old flat file database.”

From Lovelietuva: “Re: Adventist Health System vs. Moleski. The pre-trial hearing is October 8, 2012 at the Orange County Courthouse in Orlando. AHS is the Goliath that owns the Orange County justices.” This is the “Death by Deletion” former Adventist Health System risk manager and whistleblower who claims she was ordered to deleted electronic patient information to cover up errors and who also says AHS’s Cerner system caused incidents of patient harm. She should definitely press for a change of venue.

From BlueDog: “Re: Community Health Systems contractors. The rumor is true, although the number seems high. I know that they sacked roughly 80 contractors working on Allscripts Enterprise EHR projects and scaled back a lot on Allscripts and athenaclinicals implementations. All eyes within CHS IT are on an Oklahoma City Allscripts Enterprise EHR implementation that begins in five days.” Unverified.

HIStalk Announcements and Requests

I’ve been struggling with badminton today. I admit there probably has been a time or two I intentionally threw a gutter ball while bowling in order to commence happy hour, and I do recall a certain strip poker game in college. But intentionally losing at the Olympics makes no sense to me. Maybe my real issue is that I dislike badminton since it conjures images of sixth grade PE and those horrible one-piece uniforms we had to wear. Speaking of images, if you haven’t seen one of US rower (and Wilhelmina model) Giuseppe Lanzone, he’s worth a Google.

 HIStalk Practice highlights from the last week: as mentioned below, a few observations  from the just announced Stage 3 MU draft recommendations. Medicare and Medicaid issue $6 billion in MU payments through the end of June. Dr. Gregg whines about his unread EMR prose. My thoughts on why some crunching of MU attestation numbers may be meaningless. The ONC says the TOC is higher for a SaaS EHR than an in-office solution. I’ll keep it simple this week: go to HIStalk Practice, read good stuff, and sign up for e-mail updates. Thanks for reading.

Listening: new Rush, thanks to reader Mark, who tipped me off that Amazon is running it as a $0.99 full-album download.

Acquisitions, Funding, Business, and Stock

Visage Imaging signs a definitive agreement completing the sale of its Amira Division to Visualization Sciences Group for $15 million.

Quality Systems, Inc. continues its public spat with big shareholder and director Ahmed Hussein, who has nominated his own slate of directors to be considered at the upcoming shareholder meeting. Management says he’s trying to take the company over without paying a premium via a proxy fight and hasn’t made a convincing case that his nominees would enhance shareholder value, also calling out the company’s historically successful (until recently) share value growth, its sales opportunities, and its opportunity to focus on revenue cycle management. They also say Hussein has violated the company’s insider trader policy by pledging all of his company shares as collateral for margin accounts, requiring him to liquidate 2.24% of the company’s shares and further driving share price down. They also comment that his track record in creating value for his other businesses is poor. His press release says as a board member, he’s never heard anything about the strategies the company says they’ll follow and that his gripes aren’t with management, but rather with the current board.

MedAssets reports Q2 results: revenue up 11%, adjusted EPS $0.28 vs. $0.23, beating consensus estimates of $0.22. Shares jumped 20% Thursday on the news.

Vocera reports Q2 numbers: revenue up 30%, non-GAAP EPS of $0.09 vs. $0.00, beating expectations of $0.01 and raising guidance. 

Sales

The Purdue REC will use SA Ignite’s MU Assistant for client MU reporting.

Franciscan Alliance chooses Merge Healthcare’s iConnect Access to image-enable its EMR.

People

AirStrip Technologies hires Lori Jones (McKesson) as chief commercialization officer, Matthew Patterson MD (McKinsey) as SVP of business transformation, and Rudy Watkins (GE Healthcare) as SVP of business development.

NexJ Systems appoints former SAP North America president Robert Courteau to its board.

Cumberland Consulting Group promotes Amy Meiners from principal to partner.

Kelley Schudy, group SVP at Allscripts, announces that he’s leaving the company.

Baptist Memorial Health Care (TN) promotes chief nursing officer Beverly Jordan to VP/chief clinical transformation officer, leading its Epic implementation.

Precsyse appoints former IDX CEO James H. Crook, Jr. to its advisory council.

Announcements and Implementations

St. Francis Medical Center (CA) goes live with electronic medical records from QuadraMed, including medical device integration using iSirona.

Government and Politics

Medicare’s fraud unit opens a $3.6 million command center in Baltimore that includes a giant video screen that two Republican Senators are labeling a boondoggle, saying that the fraud unit is not implementing common sense recommendations in claiming that they are understaffed. The unit’s computer system went live last summer, but by Christmas had only stopped one suspicious payment totaling $7,600.

Other

Providers are concerned about vendor training and readiness for hybrid OR suites when selecting interventional systems, according to KLAS. Toshiba earned top scores for overall satisfaction, though Siemens had the greatest market penetration.

About 50 unionized transcriptionists at The Ottawa Hospital (CN) complain about losing their jobs to Dragon Voice Dictation, trying to get doctors on their side by sending them a Christmas card saying they were being let go and including an instruction book for Dragon. According to the union’s spokesperson, “Not only was technological change implemented without any canvassing of staff, but an interesting fact is that at the end of a transcription, the voice recognition software adds a disclaimer stating that the document ‘may contain errors.’ There has got to be a better solution, especially when it comes to patients’ health.”

Olympus, fresh off accounting fraud problems, informs the Department of Justice that its physician training program in Brazil may have violated the Foreign Corrupt Practices Act. The company says that DOJ was already asking questions, potentially indicating that Olympus and perhaps other companies were being investigated following DOJ’s multi-million settlements with Biomet and Smith & Nephew over bribing foreign doctors to use their medical devices.

The TV program “In Focus with Martin Sheen’” will cover electronic medical records in a series of reports. The show doesn’t say it’s a paid infomercial that runs between PBS programs, but it seems like that might be the case.

In Canada, patients at St. Joseph’s General Hospital have been without TV since mid-May after Healthcare Resource Group shut down its prototype touchpad-driven bedside entertainment system. The company restructured and found that its server licenses from Microsoft, Adobe, and Dell had been illegally registered under the name of their former CTO. The hospital says HRG missed their final deadline to sort out their problems and will be replaced.

Strange: a blind Native American man files suit against a hospital, several doctors, and others, claiming he’s the victim of a racial hate crime because his non-blind friends are telling him that scars from his emergency stomach surgery kind of look like the letters KKK.

Also odd: the family of a deceased man files a $2 million lawsuit against a New York medical school, claiming the school humiliated them by declining to accept the man’s donated body as a medical cadaver because he was too heavy.

Sponsor Updates

• TELUS Health Solutions and Sun Life launch an eClaims solutions for extended healthcare providers in Atlantic Canada.
• BridgeHead Software and the European Centre of Expertise for the Health Care Industry EEIG partner to provide a cloud-based archiving solution for European hospitals.
• Lippincott Williams & Wilkins, part of Wolters Kluwer Health, launches an EHR learning tool to prepare nurses for new practice requirements.
• GE Healthcare IT reports that its customers have received more than $100 million in MU incentive payments since the program’s inception.
• CommVault and Fujitsu expand their partnership to offer an integrated solution with Fujitsu’s ETERNUS DX storage arrays powered by CommVault Simpana 9 software.
• Kareo CEO Dan Rodrigues advises physicians on the use of technology to thrive in business.

EPtalk by Dr. Jayne

HIMSS issues its call for proposals for the HIT X.0: Beyond the Edge “conference within a conference” at HIMSS13. No, that’s not a mistake in the link – it’s a HIMSS12 link. If they can get their act together, they will accept proposals from August 1-31. I’m pretty burned out on HIMSS between the annoying mailbox clutter and the feeling that they’re not really doing anything new or different these days. But I am looking forward to getting my New Orleans on, whether I actually attend the meeting or not.

Northwestern Memorial Hospital’s Home Hospice office was burgled last week, resulting in the theft of laptops and tablets. Supposedly their security controls were suspended because they were receiving upgrades. They are offering credit monitoring services to affected patients. Luckily the authorities do not suspect that PHI was specifically a target of the theft. That’s a good thing, because I can’t imagine anything more pathetic someone preying on hospice patients.

In a reminder that they’re not just a software company, McKesson is ordered to pay $151 million in a legal settlement involving related to Medicaid drug price inflation. Although New York State Attorney General Eric Schneiderman issued a statement that, “This settlement holds McKesson accountable for attempting to make millions of dollars in illegal profits,” the company denies price manipulation or illegal activity.

News outlets continue to report that there will not be enough physicians to meet the country’s health care needs in coming decades. I don’t disagree, yet I don’t see people dangling money in front of me to convince me to return to traditional primary care practice. I’m not hopeful for the next generation, either. A high school student I have been mentoring decided that he wouldn’t be meeting with me any longer because he had decided on a new career path. His choice: game warden.

I’m a sucker for technology stories of all kinds, so I was interested to hear today about a Dark Matter detector in a former gold mine in South Dakota. Here’s to unlocking more mysteries of the universe right in our back yard.

No, it’s not Las Vegas: Cerner partners with the town of Nevada, Missouri (pronounced Ne-VAY-da) to reduce costs and improve care. The project will involve health education via the local school district, construction of sidewalks and bike lanes, and digitizing health records at Nevada Regional Medical Center.

As the world comes together at the Olympic Games, I am reminded of the vast disparities still present in world healthcare with two sad stories from Uganda. Ebola virus is causing an outbreak of hemorrhagic fever, and this is on top of a mysterious illness called nodding syndrome that has killed more than 300 children and neurologically devastated more than 3,000. Even with all the negative things about our healthcare system, we should be reminded of how lucky we really are.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 8/1/12

Top News

Accretive Health will pay $2.5 million to settle charges by Minnesota’s attorney general’s office over its aggressive patient collection tactics in hospitals (including those of Fairview Health Services) and lax security controls involving a stolen PHI-containing laptop. The company will cease all business operations in Minnesota, is banned from returning for the next two years, and can re-enter the state within the following four years only with the attorney general’s approval. Accretive is also required to return all patient information to the hospitals that provided it. The attorney general says she will turn over the patient affidavits her office collected to CMS, suggesting that Accretive’s hospital clients may have violated EMTALA laws that require them to treat emergency patients before trying to collect payment. The $2.5 million settlement will be added to a fund to compensate patients. Chicago Mayor Rahm Emanuel, who had previously inserted himself into the proceedings by trying to use his Democratic Party influence to get AG Lori Swanson to back off, declined to answer questions about his involvement.

Reader Comments

From Yesterdays: “Re: Community Health Systems. Contractor friends tell me they were part of the nearly 600 IT contractors laid off by CHS recently.” Unverified. I didn’t bother trying to confirm since I recently e-mailed someone at the for-profit hospital operator about a rumor that they were switching EMRs, but didn’t hear back.

From Wildcat Well: “Re: Practice Fusion. They have discontinued their affiliate program, which pays websites to promote signups for their ‘free’ EHR.” Unverified. They’re still taking signups on their Web page from what I can tell.

From Carolyn: “Re: National HIT Week. Are you involved in any of the activities?” No. To be honest, I’ve hated that concept from the day HIMSS started pitching the idea that provider IT people should stand shoulder to shoulder with their vendor brethren in trying to persuade politicians to throw taxpayer money at products sold by the vendor members of HIMSS (or as HIMSS nobly rephrases it, “public and private healthcare constituents will work in partnership to educate industry and policy stakeholders on the value of health IT for the US healthcare system.”) I don’t blame vendors for trying to influence the DC crew, but I am totally mystified how hospitals can justify spending the time and money required to send their IT people traipsing around Capitol Hill for the benefit of for-profit companies.

From Safety Paradocs: “Re: Wyckoff Heights. Wired for safety ‘well before ARRA’ as reported by the newsroom of Meditech, yet the young patient was not safe. How can we prevent such striking deaths?” Wyckoff Heights Medical Center in New York, which The New York Times politely calls “one of the most troubled hospitals in the city” because of mismanagement and its hiring of political cronies, admits a 22-year-old student who had consumed a diet drug and beer while pulling an all-nighter for her college Latin course. The hospital gives her IV lorazepam, ties her arms to her bed, and makes no notations in her chart (all documentation was on paper) that anyone was checking on her. Nobody notifies her family. She dies. A few weeks ago, the hospital’s own 83-year-old former chairman, who had been forced to resign and was then admitted for fainting spells, was found in his hospital room with a broken neck. Despite its problems (check out its reviews on Yelp), the hospital earned HIMSS EMRAM Stage 6 and $4.9 million in federal taxpayer dollars for its Meditech MAGIC implementation. To be fair, the incident occurred in 2007, which I assume was long before all of its EMR accomplishments. My takeaways are as follows: (a) while it’s true that better hospitals use more technology, it’s also true that technology didn’t make them substantially better – its use is correlated, but not causative, and plenty of crappy hospitals are using cool systems; (b) all the IT systems in the world won’t help if you have unskilled or uncaring caregivers, so choose your hospital based on quality and reputation, not what they’re packing down in the data center; (c) never, ever go to a hospital for anything serious without having an intelligent and alert advocate sitting by you at close to around the clock as possible, because having worked in several hospitals for most of my adult life, I can say that every one of them screwed up regularly due to inattentive or poorly trained staff, overworked doctors, unwashed hands, failure to notice when patients start to slip, overly aggressive treatment just because it’s possible, and lack of care coordination by all the one-trick specialists running around treating their particular body part of interest. Bring along a friend or family member to check your meds, personally challenge each major decision to make sure it’s based on conviction and science rather than lack of objection, and ask nurses whether your doctor and treatment plan are any good because they know but won’t say unless you press them. I think most hospital employees would agree that you need a wingman.

From Westie: “Re: cancer patient whose costs exceeded insurance cap. Wins a victory via Twitter.” Treatment of a 31-year-old’s colon cancer exceeds the lifetime dollar limit of his Aetna student insurance plan, leaving him with no insurance. He gets into a Twitter debate with Aetna CEO Mark Bertolini, who decides to cover the $118K in bills the patient racked up before was able to sign up for a different insurance plan. The tweets are fascinating as observers jumped on Aetna, blaming the company for selling insurance with low caps, questioning what would have happened had the patient not drummed up his own social network, ridiculing the CEO’s $10.6 million salary, and questioning how the Affordable Care Act will or won’t help. I’m glad he’s getting help, but we’re back to the original issue that patients can easily run up more expenses than the insurance they voluntarily signed up for will cover, and unlike every other kind of insurance, everybody expects someone else to pay without objection even though they met their legal obligation. I’d be interested to see who charged what of the $118K University of Arizona Cancer Center bill since those folks aren’t sharing Aetna’s financial sacrifice on the patient’s behalf as far as I know.

From Frank Fontana: “Re: paid endorsement programs such as those from AHA Solutions and the HFMA Peer Review Program. What do readers think about those programs?” I said years ago that they were pay-to-play, but they do still require products to be vetted, leaving me neutral on their value (I don’t see the benefit, but if they help connect vendors with prospects, then I see no harm.) Your opinions, please.

From EMR User: “Re: downtime penalty terms in contracts. We negotiated that any issue that we deem adversely affects our access or system usability allows us to subtract 5% of our monthly fee. We can do this daily up to five times per month.” I’ve said it before, but maybe it bears repeating. List the top handful of items that would be worst-case to you once you’re live on a vendor’s system (downtime, vendor acquisition, hardware failure, lack of acceptable implementation people, poor support) and insist on a penalty if any of them occur. Or, if you’re a glass-half-full type, reduce your fixed payment amount and offer a bonus if none of the events happen (same result, but it sounds nicer.) That makes sure your vendor has a vested interest in not allowing your worst dreams to come true, and at least if they do, you get the slight satisfaction that you’re getting paid for your trouble.

From Laboratorian: “Re: Epic. Could you opine to the extent to which MUMPS is constraining the growth of Epic? Everyone suggests this is a limiting factor, but so far it hasn’t been. How and when would they hit the proverbial wall?” It’s armchair quarterbacks, not customers, that keep trying to create a non-existent Epic Achilles’ heel out of MUMPS and Cache’. Most of that hot air comes from competitors Epic is killing, self-proclaimed experts who’ve never worked a day in IT or in a hospital, and cool technology fanboys who can’t stand the idea that Epic doesn’t care what they think. Despite the use of some ancient underpinnings, Epic’s product is apparently almost infinitely scalable, it does everything customers need it to do, and it works reliably. Nobody cares what it’s written in except their programmers – customers just want solutions, and the decision-makers when Epic is purchased are usually end users and operational executives, not IT geeks who salivate over source code. The only walls Epic could hit would be if InterSystems decided to go out of business (that’s not happening – they were absolutely printing money even before all those thousands of new Epic Cache’ user licenses dropped into their lap); if InterSystems decides to get greedy and either raise their Cache’ licensing fees or stop developing it (doubtful); or if Epic can’t get programmers willing to learn MUMPS (which has never been a problem because they do all of their training in-house and new UW psychology grads aren’t exactly swimming in job offers from Microsoft or Cisco). Anyone who claims Epic is about to hit the technical wall is just trying to plant fear, uncertainty, and doubt in the market. If there’s an Epic wall to be hit, it will be high costs that hospitals can no longer afford with reduced reimbursement, lack of ability to scale as it tries to extend its dominance outside of the US, some kind of meltdown like Judy stepping down and creating a vacuum of power, or perhaps some major and heretofore unfelt shift toward open systems that would put its rather closed model at risk. You’ll know that’s happening when you see the KLAS scores move from green to yellow. The only opinions that count are those expressed by customers with their dollars.

From Infrastructure Manager: “Re: downtime. I used to work with McKesson Horizon Clinicals, which didn’t have a great downtime report system. We scripted a routine that generated a PDF on a different server than Horizon and also copied it to a few PCs. It’s not a fast system to begin with, and you can’t help but feel the system drag when running those reports every hour, even with a huge Oracle server farm run by skilled DBAs. Also, the database design is poor and the tables are not indexed properly – you’ll see 4000 IOPS on a table/storage location and wonder that the hell is going on. If you’re hosted, who cares? Chew up those servers in a data center you don’t run and hope they’ve scaled to the appropriate size. If you aren’t hosted, take these reports very seriously.”

HIStalk Announcements and Requests

Unlike the curmudgeon Mr. H, I have watched a good deal of the Olympics. Who knew team handball was even a sport, much less an Olympic one? Yep, that’s what’s on at 5:00 a.m. on Sunday (don’t ask why I was up so early.) Go Iceland, by the way. So far my biggest complaint is that the men beach volleyball players don’t wear uniforms that are nearly as hot as the women’s. Thank goodness for men’s synchronized diving, however. I have decided that someone ingenious needs to develop an app that blocks all spoilers on Twitter and Facebook so that I will be totally surprised when Michael Phelps becomes the most decorated Olympian of all time (thanks all you expats in England who just had to share the news on Facebook.) Finally, good thing Rio is only one hour ahead of Eastern time so we’ll all see more live coverage in 2016.

Just  to prove to Inga that I’m not totally Olympics ignorant even though I haven’t watched the tape-delayed spectacle, here’s an interesting fact: the 300 hospitals beds used in the producer’s opening ceremonies tribute to NHS will be donated to hospitals in Tunisia.

Listening: reader-recommended Son Volt, music for driving or moping in smoky bars. Born of the remnants of 1990s minor stars Uncle Tupelo, somewhere between alt-country and roots rock. REM meets Neil Young.

Acquisitions, Funding, Business, and Stock

CommVault beats Wall Street expectations with its Q1 performance: net income of $10.1 million ($0.21/share) compared to $3.1 million last year on revenues of $111.3 million, up from $91.5 million.

Merge Healthcare announces Q2 numbers: revenue up 13%, adjusted EPS $.02 vs. $0.06, beating earnings estimates by a penny.

Sales

The Canadian Centre for Addiction and Mental Health selects Cerner Millennium as its clinical information system.

North Carolina HIE expands its relationship with Orion Health with the implementation of the company’s Health Direct Secure Messaging. The HIE went live in April 2012 and 70 providers have signed up, with the next phase being rollout of Orion’s EMR Lite. NC Direct is free for NC HIE participants and $100 per year per mailbox otherwise.

St. Louis-based Mercy chooses Humedica MinedShare as the Epic-integrated clinical intelligence solution it will use to manage population health for its 31 hospitals and 200 hospitals.

People

Lifespan (RI) names Eric Alper MD (UMass) as information systems medical director, charged with overseeing the development and implementation of clinical applications for the health system.

Amanda LeBlanc (Encore Health Resources) joins CTG Health Solutions as managing director of marketing and communications.

Announcements and Implementations

Yavapai Regional Medical Center (AZ) implements Cerner.

Christus St. Vincent Regional Medical Center (NM) goes live on the second phase of its Cerner implementation with the addition of CPOE and documentation for physicians, nurses, and ancillary care providers.

The VA system in western New York announces its participation in the HEALTHeLINK HIE as part of the VA’s Virtual Lifetime Electronic Record Health Communities Program.

Vocera announces the availability of its B3000 Communication system in France and introduces the Vocera Secure Messaging application for tracking messaging communications.

Jacksonville Medical Center (AL) goes live on CPSI.

E-prescribing system vendor NewCrop will incorporate interactive drug services from PDR Network into its platform, allowing its users to receive updated drug information, safety alerts, and regulatory and liability messages at the point of prescribing.

Caradigm (the GE-Microsoft joint venture) announces GA of Vergence 5, the latest release of its single sign-on and context management platform for healthcare.

Iowa Medicaid says its integrity program saved the state $30 million in its second year of operation, bringing the total to more than $50 million. Optum administers the program that analyzes provider claims for overcharges due to upcoding, unnoticed private insurance coverage, fraud, and simple math errors in bills.

Technology

The FDA clears Proteus Digital Health’s ingestible sensor, which works with a companion wearable patch and mobile app to monitor medication adherence.

The DoD and VA release PE (for prolonged exposure) Coach, a free smart phone app to assist service members and veterans with PTSD.

Other

Minnesota achieves the highest rate of e-prescribing use in 2011, with 61% of prescribers routing prescriptions electronically. Massachusetts and New Hampshire had the highest physician adoption rate at 86%.

The New Orleans paper reveals that two-thirds of the full-time physicians working in Louisiana state prisons have been disciplined by the state medical board for issues that include pedophilia, substance abuse, and dealing methamphetamines.

Hartford Hospital (CT) and a home care group announce that information about 10,000 patients was contained on a laptop stolen from an employee of Greenplum, a “big data analytics” vendor and division of EMC that was doing readmission analysis for the organizations. The laptop was not encrypted.

I’m always skeptical of the Meaningful Use attestation numbers, so here’s an example that Meditech sent over in response to some of our recent posts. Inga’s analysis of numbers provided by CMS showed Meditech with around 120 hospital customers attested through May 2012. Meditech’s official number is 431, and even if mega-customer HCA is counted as only one hospital, they’re still at 271. That would place Meditech at #1, far above CMS’s #1 Epic, except that maybe CMS has their numbers wrong, too. I personally don’t think the number of attesting customers means much and this makes me even less interested in the vendor totals.

Physicians and experts testify to a House subcommittee that small practices are dropping like flies, with physicians moving to employed positions because of declining payments and increased reporting requirements. An orthopedist said his group shut down and took hospital jobs after spending $500K on an EMR hoping to reduce cost and improve quality, but the initial savings were eaten up by increased IT labor costs, upgrade fees, and the work required to document Meaningful Use.

Weird News Andy dubs New York Mayor Michael Bloomberg as “Dr. Bloomberg” after his push for hospitals to discourage new mothers from using canned baby formula instead of breast-feeding. WNA adds that he assumes the newborns won’t be allowed to have 32 ounce Big Gulps, either.

Sponsor Updates

• Wolters Kluwers executive board member Jack Lynch discusses the emergence of “compliance clouds” during the company’s Half Year Media Roundtable meeting in Amsterdam.
• Informatica gains partner support for its latest release of Informatica Cloud.
• Impact Advisors earns the highest ranking in KLAS’s HIE consulting report, specifically identified as the only fully rated vendor providing HIE advisory and technical work.
• DrFirst Chief Strategy and Privacy Officer Thomas Sullivan testifies at an ONC hearing on identity-proofing solutions for the electronic prescribing of controlled substances.
• HIStalk sponsors earning a spot on Modern Healthcare’s Best Places to Work in Healthcare in 2012 include Aspen Advisors, DIVURGENT, Encore Health Resources, ESD, Hayes Management Group, Iatric Systems, Impact Advisors, Imprivata, Intellect Resources, Intelligent InSites, maxIT Healthcare, Santa Rosa Consulting, and The Advisory Board Company.
• Allscripts, Beacon Partners, Cumberland Consulting Group, ESD, Merge Healthcare, and The Advisory Board Company receive the Healthcare’s Hottest companies designation by Modern Healthcare.
• eClinicalWorks and Intelligent Medical Objects host webinars to introduce eCW IMO Problem IT Smart Search for ICD-10 coding.
• United Hospital System of Kenosha (WI) renews its licensing agreement for Streamline Health’s Enterprise Content Management Solution.
• MED3OOO customer Family Healthcare Network (CA) receives over $500,000 in EHR incentive payments.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

John Gomez 7/30/12

HIT Integration Analysis Guide

Over the past several months, one of the biggest questions I have gotten regarding the state of HIT is related to platform and technical integration. Specifically, the debate related to single platform vs. an integrated platform. Typically the question is posed by someone who is not technical and who is concerned about separating vendor hyperbole from reality.

In order to try and shed some light on this topic (which is not a simple one), I have developed what I am tentatively calling the “HIT Integration Analysis Guide,” which I outline below. The purpose of the guide is to provide those analyzing single vs. integrated platforms a means to better understand the true nature and ability of integration. I will provide further light on this shortly, but for right now, let’s create some definitions for what I mean by single vs. integrated.

A “single platform” is one that provides a single set of technologies and database across a set of applications. The common example of this is where you have an EMR which relies on a single database across ED, lab, surgery, OB/GYN, pharmacy, acute, ambulatory, physician and nursing documentation, CPOE, and other venues. In a single platform offering, you have a single technical offering with all data being shared across the different venues of care.

An “integrated platform” is one which uses technical and architectural approaches to “integrate” the various venues of care together. Data and other features may or may not be shared, depending on the level of integration.

To help clarify this a little, let’s consider an analogy.

A store such as Target is a good example of a single platform system. When you shop at a Target (or similar department store), you are able to have most of your needs met (to varying degrees of satisfaction) while never leaving the store. You can get a DVD, clothes, food, household items, and appliances. Regardless of the department in the store, you expect consistent signage, vocabulary, customer service, and support. When you check out, you can use a single method of payment. You have more than likely have saved time by simply dealing with a single vendor. If you need to return an item or have another issue, you can resolve it with a single vendor — the department store.

In contrast to this is the mall (such as the Mall of America), which is representative of the “integrated platform” experience in HIT. In this model, you go to the mall, and although everything is housed in a single location with similar look and feel in common areas, similar operating hours, and other shared services, the experience you have with each vendor in the mall is unique to that vendor. Customer service levels, return policies, product quality, and other attributes are specific to the store you enter within the mall. Although there is some commonality throughout the mall, it ends at the door of the individual store.

Each of these models has its pros and cons. What is important to keep in mind is that the tradeoff is often on depth of service vs. convenience and “good enough” service. For instance, you are apt to get better service regarding an iPad at the Apple store in the mall then you would for the same iPad at Target. Yet the number of people and level of chaos at the Apple store may not make it right for you.

Unlike this analogy, in the world of HIT there are some hidden factors which need to be evaluated when you are deciding the “single platform” vs. “integrated platform.” This bring us to the “Integration Analysis Guide” and the meat of this diatribe. Although there may be other tests, criteria, or scorecards for measuring how well things integrate, I think it is important to have something that is simple to understand, that provides some key and direct questions you can ask your vendor’s executive management, and that removes the complexity and the “marketecture” from your vendor’s presentation.

Single Platform Analysis

The key concern here is related to understanding if the vendor’s system is truly on a single platform and using a single set of technologies. This should not take long to determine. To be honest, the technologies they are using are not as important for this analysis as to whether or not there is a single set of technologies. Here is what I would be asking:

1. Do all your applications run from a single database?
2. Do you have a single technical stack across all of your applications?
3. Do you employ a single programming language across your technical stack?
4. Do you have a single configuration system, help system, HIE system, HL7 sub-system, reporting system, security framework, and user documentation across your platform?

That’s pretty much it. The answer should be a resounding “yes” to each question for a vendor to declare a single platform architecture with single database. Are there are other things to consider? Of course, but to keep this simple, those are the big things to understand.

If the answer is “no” or “we are working on it,” then start asking for percentages of completion. “What percent of your system is on a single security framework?” for instance.

Integrated Platform Analysis

Analyzing the Integrated platform is not as simple as the single platform analysis, but I will do what I can to keep it as simple as possible. For the techies among you, please note that I am deliberately pushing topics related to technical integration to the bottom of the list, because unlike single platforms, the specifics of workflow are more important then what technology or programming language is being utilized. At the end of the day, the goal of embracing an integrated platform by a healthcare system should be that the individual specialties of the system (ED, lab, CPOE, etc.) are much more advanced then that offered by a single platform vendor. Hence we will focus first on workflow and then on technical integration.

Level 0 Integration – The Basics

If we think of this as a set of building blocks, the most basic building block is the exchange of rudimentary information among the various components and application offered by the integrated platform vendor. How this integration occurs is not as important as the fact that it does occur reliably. To understand how well your vendor is doing this, here are some questions to ask and the right answers:

• Question: please list for me the basic data you are sharing among your modules and applications. Answer: problems, allergies, immunizations, history, orders, demographics, family history, billing information, and care team. This is a pretty basic list, and to be honest, most of it is what is required to effectively support HIE systems (regardless of what the government thinks.) Also, much of this can be done via HL7 or other simple data exchange. The point being that if your vendor cannot exchange this information, then regardless of how advanced their technology, you are in for serious workflow challenges.
• Question: what is the latency encountered with sharing data? This is how long it will take for data to show up that is entered in one application in another application. For instance if you update an allergy in the ED system, how long before it shows up in the ambulatory system? Answer: three minutes. I know three minutes sounds like forever in healthcare, right? But it is realistic, and without a major infrastructure investment by you the healthcare provider, you should consider this an adequate answer.
• Question: what occurs if there is an application outage? If we enter an allergy in the ED system and the ambulatory system is down for maintenance, what happens? Answer: the applications will resynchronize after an outage to assure all information is correct. Simply stated, all the data is always up to date give or take three minutes, even after a system outage.
• Question: how does integration support workflow? Answer: any data that is exchanged is treated as if it was entered by a human, and so all workflow remains effective. The goal here is to assure that when data is passed back and forth behind the scenes between systems, it does what is supposed to do. For example if you have a rule in your ambulatory system that if a patient’s body weight drops more then 12 pounds a blood test should be drawn, then that rule should fire even if the data was entered in an ED system and sent to the ambulatory system behind the scenes.

Level I Integration – Content Integration

Assuming your vendor can fully support your needs for Level 0, then you should begin Level I analysis. If the vendor cannot support Level 0, there is no need to consider Level I or continue your analysis of the vendor, if your goal is to hope for a truly integrated platform that is not on a single platform.

Level I is concerned with content integration and how critical it is that information that is heavily relied on by the care team is always available, regardless of how it was entered. To be frank, most vendors can do Level 0, but they cannot do Level 1 unless they are on a single platform. Level I is by far the most difficult part of integration, and frankly, the most critical to get right.

• Question: do you exchange all nursing and physician observations and are they editable? Answer: yes. All nursing and physician observations are exchanged among all systems. You can edit them and update them in any application. Let’s walk through an example. A nurse inputs an observation in a surgery system. That observation should now be in the acute care system. If the nurse using the acute system needs to amend that observation, they should be able to do so without issue. (Editing is something debatable, but the point is the observation should be exchanged and should act as if it was entered by a human.)
• Question: do you exchange all nursing and physician documentation and allow it to be edited? Answer:  yes. All nursing and physician documentation is exchanged among all systems in our platform. You can edit them and update them in any application. Again, the issue here is that you need to share content. A physician sees a patient in their office, makes some notes on the patient, admits the patient, and then later sees them in the hospital. They need to see that note and then continue updating it. Same goes for the nurses’ needs related to documentation.
• Question: is your content ubiquitous throughout your system? Answer:  yes. We provide the same level of content across our system. You want to make sure that all content is the same. You don’t want a situation where one application on the platform supports oncology content and then another application does not or doesn’t support it to the same level.
• Question: do you support the same vocabulary throughout all your applications on your platform? Answer: yes. If you are going to eventually be doing analytics related to performance, cost management, and compliance, you are going to need a single vocabulary shared among all the applications.
• Question: does personalization follow the user? Answer: yes. Things like patient list layout, favorites, order sets, documentation sets,  and personal rules and shortcuts follow the user regardless of the application they are using. Users tend to spend a good deal of time once they get to know a system setting it up to meet their needs. If their personal settings are not available or don’t follow them, you need to know this upfront.

Level II Integration – Infrastructure

Here is where we start to look at the technical integration, but still from a business and user perspective. We are not going to concern ourselves with technical choices, but rather with technical implementation by the vendor. Most of these questions will be similar to those you ask of a single platform vendor.

• Question: do you have a single reporting and analytics system? Answer: yes. Regardless of the application you are using, we provide a means to access all data from a single location for purposes of reporting and analysis. It is important that reports, dashboards, and other analysis can be run across applications. If you are going to truly have a holistic view of your platform, the vendor most provide you with reporting tools that go across all integrated applications.
• Question: do you have single security framework? Answer: yes. You only need to define a single set of user groups and user IDs and you can centrally manage all users. If the vendor does not support this, it will mean that a physician using a system in their office will have a different user ID and password for that system than the one in the hospital. The vendor at a minimum should support a single sign-on solution, but keep in mind most SSO solutions don’t allow for role-specific management and policies across applications.
• Question: do you have a single configuration system? Answer: yes. You can manage all configuration some a single set of tools. Again, if this is not the case, you will need to figure out how you will manage and configure each system on the platform and how you will distribute changes. This becomes much more of an issue as you consider things like content changes, standardized care, reporting, and other workflow items.

Level III – TCO Analysis

This section is not so much a series of questions to the vendor, but more so a series of things to consider when you are evaluating a single vs. integrated platform. Each of these items relates to the impact of costs. How much of an impact and if it is of concern is left to you to determine. What is important is to consider the tradeoffs in depth versus breath that you get from a single platform vendor vs. that of an integrated platform.

• If the vendor doesn’t support a single look and feel across all their applications, will the cost of training different users on multiple systems be an issue? Most integrated platform vendors do not provide a single look and feel across all their applications. This means that a user who has to interact with multiple applications will need to learn different menus, commands, and layouts.
• Will you need to increase staff to manage different applications using different configuration tools if the vendor doesn’t have a single configuration system? If the vendor doesn’t support a single configuration toolset, what impact will that have on your staff in responding to changes and upgrades?
• Does the vendor require different technology for each application? Although we didn’t dive into technical architecture, you should understand if on a per application basis the vendor is using the same technology and database across all their systems. If not, you may have to maintain technical staff with different areas of expertise, different licensing agreements, and even manage different versions of a similar technology.

Although this is a rather lengthy article overall, I tried to keep it as short as practical and provide some focused questions that help you quickly determine what is right for you. And more importantly, to understand if your vendor is able to meet your needs. There is so much more that we could evaluate regarding either side of the coin, but I am rather confident that if you use the information above, you will quickly be able to pinpoint where your vendor stands and if they are able to deliver.

Lastly, yes you can and should analyze the single platform vendor as to if they can truly do all that we asked of the integrated platform vendor. Although chances are that they can, and it is probably harder for an integrated platform vendor to achieve the same level of ability, there is a chance that a single platform vendor made design choices that preclude them from sharing data among their applications in a way that you need. If you feel you need to dive deeper, you can certainly ask all of the “integrated platform” questions of the “single platform” vendor.

I will refrain from providing an opinion here on weather or not you should move in one direction or the other (single vs. integrated). What I will say is that you need to keep in mind that at some point you will need to integrate third-party systems into your ecosystem. Regardless of if you go single or integrated, you do need to consider the openness or closed nature of your vendor offerings.

I do believe there are many myths related to this topic in HIT. It is a topic I will think about exploring and writing about in the future. But for now, let me say that I do not see any one vendor being tremendously more open or closed then any other vendor. In fact, I would say that most HIT vendors offer closed systems, which is unfortunate.

All that aside, I hope that as you continue your journey the information here is somewhat helpful and useful.

John Gomez is CEO of JGo Labs.

Roper To Acquire Sunquest for $1.4 Billion

Roper Industries announced this morning that it will acquire laboratory and diagnostic information systems vendor Sunquest Information Systems. The all-cash transaction is valued at $1.415 billion.

Roper Chairman, President, and CEO Brian Jellison was quoted in the announcement as saying, “Sunquest meets all of Roper’s key acquisition criteria and is an ideal fit with both our Medical and Software platforms. The business is the market leader in software solutions for the critically important healthcare provider laboratory market. We expect Sunquest to benefit in all economic environments from very favorable market forces – an aging population, expansion of anatomic pathology, and the need for reduced healthcare costs and improved quality of care. Sunquest’s software and application engineering capabilities deliver an outstanding return on investment for their customers. The company has attractive cash return characteristics and generates significant recurring revenue through long-term customer relationships and very high retention rates.”

Jellison also stated that the company will continue to operate under the Sunquest name with full continuity of personnel. Closing is expected within 30 days.

Sarasota, FL-based Roper Industries is an industrial manufacturer whose medical units include measurement systems, medical devices, and imaging solutions. Sunquest is owned by an investor group that includes Huntsman Gay Global Capital and Vista Equity Partners.

Monday Morning Update 7/30/12

From Meaningful Juice: “Re: GAO report from last week. Of 4,855 eligible hospitals, 776 were awarded eligible $$$ juice for 2011. Phew – my tax dollars are not being wasted!” Among the GAO’s recommendations was that CMS needs to beef up its scrutiny of whether providers really were eligible to get their payouts.

From Dave: “Re: Michael Stearns, before being fired as e-MDs CEO. See this document.” This is old news that has been mentioned here before. The Maryland State Board of Physician Quality Assurance suspended the medical license of Dr. Stearns in 1997 after he pleaded guilty to four counts of assault and battery in a US Navy court-martial case in which four female patients claimed “inappropriate sexual touching” during his examinations of them. David Winn, who as e-MDS board chair fired and replaced Stearns as CEO on July 2, defended him in this 2011 write-up, saying that Stearns was never convicted of a felony and was perhaps misled by poor legal counsel in a Tailhook-sensitive environment and inconsistent behavior by the Maryland board after the fact. Mike Stearns says he will address this and other issues in an HIStalk Readers Write article in a couple of days. He hasn’t said that he’s suing his former employer even though he claims the allegations behind his termination are meritless, but one might assume that’s his only remaining option. I’ve heard from several folks who extolled the character and capabilities of both Dr. Stearns and Dr. Winn, so hopefully they will avoid the public debate, reach some kind of agreement, and move on without further embarrassment.

From Happily Hosted I Hope: “Re: host environment performance. Do any of your readers have language around system performance and high availability in a hosted environment that they could share? We’re going to be installing an EMR through a hosting arrangement with a local hospital and I’m looking for advice.” Given the high-profile downtimes that have come up recently, I think it’s a great topic to address. If you’ve put terms and conditions into a contract with an EMR hosting provider and would care to share details, please send them my way. I won’t mention either client or vendor and will strip out anything identifiable, so your non-disclosure terms are safe.

From EHR Warrior: “Re: NextEHR. Looks like it’s finally dead as the company that bought the intellectual property changed its name to iPenMD.”

From ITKnowsTheScoop: “Re: [vendor name omitted.] Under FDA review regarding surgery and anesthesia solutions. They had to remove or reclassify features, which halted sales for four months.” Unverified, so I’ve omitted the company’s name.

From IT Director: “Re: Cerner. I have an unfortunate trove of horrid experiences related to extended planned or unplanned service interruptions, some of them due to a shoddy corporate implementation of Cerner Millennium. Our implementation spanned time zones, so we had a six-hour downtime twice a year when Daylight Saving Time changed. We has spectacular outages where the entire hospital system went dark with no local backup whatsoever. The corporate implementation was insistent on a paperless workflow, so we weren’t even allowed to print periodic paper backup copies of order synopses or MAR summaries. During our first major downtime, a little girl was left in writhing pain for most of the night because the house officer didn’t know the timing and dose of her pain meds. This downtime was rumored to have been caused by a profound error in hardware sizing, but poor database design didn’t scale well even with additional hardware. I don’t blame Cerner as their staff were truly engaged and helpful, but rather a centrally managed health system corporate mentality of arrogance and ignorance that discounted the local reality and specialized workflows. Perhaps the morale of the story is simply that any given implementation is only as good as its implementation team. If they’re evil, then the implementation will be similarly evil. In some ways, Cerner as much as a victim as the hospitals of setting poor implementation leadership.” Your experience matches mine. Unless every vendor’s implementation has been a disaster, it can’t be their fault alone (i.e., one successful comparable client means the stuff basically works). The main problems usually involve: (a) lack of customer technical and implementation resources; (b) poorly developed, self-deceiving project budgets that don’t support enough headcount, training, and hardware to get the job done right; (c) letting IT run the project instead of getting users involved, which is especially problematic if the corporate IT people are clueless; (d) unreasonable and inflexible timelines as everybody wants to see something light quickly up after spending millions; and (e) expecting that just implementing new software means clearing away all the bad decisions (and indecisions) of the past and forcing a fresh corporate agenda on users and physicians, with the vendor being the convenient whipping boy for any complaints about ambitious and sometimes oppressive changes that the culture just can’t support. I might also mention sloppy contracting on the client’s side, since I’ve seen hundreds of contracts and am often amazed that the interests of the vendor weren’t legally aligned with those of their customer via a few standard terms and conditions.

From Commando: “Re: Cerner. Cerner has two electronic downtime solutions for remote hosted clients. The read-only methodology referred to requires the user to be able to log into the system back in KC, which wouldn’t be possible with the DNS servers out of business. There is another level of downtime service – something I guess his/her organization decided not to purchase. That next level dumps patient information to local computers (at our hospitals, at least one on each floor) at regularly scheduled intervals. i.e. updated every 5 minutes. That way, even if all connection with KC is lost, staff has information (including meds, labs and more) locally on each floor which is accurate up to the time of the last update. Finally, since this outage was due to a DNS problem, anyone logged into the system at the time it went down was able to stay logged in. This allowed many floors to continue to access the production system even while most of the terminals couldn’t connect.” Assuming this is an accurate description of the available options with Cerner hosting, it might be a good time to check out the local caching option. That would be protection against even internal network problems, which in a lot of hospitals is not uncommon. I recall that Kaiser uses that with good success for its Epic/HealthConnect system that’s deployed regionally. You could probably create a poor man’s solution by running specific reports (MAR, active orders, recent lab results, etc.) to a PDF file and dropping them in specific folder locations on a frequent schedule, like maybe once an hour.

From West Coast: “Re: John Muir Health. Hires a CIO.” The internal memo sent my way indicates that Jim Wesley has been announced as SVP/CIO of John Muir Health. He was most recently a consultant, but has healthcare CIO experience. John Muir’s hot button is getting Epic up and running.

From Maryann: “Re: Epic. I work directly for a hospital that is implementing several Epic modules over the next 5-7 years. I have two Epic certifications. I applied to several consulting companies and each one told me that they couldn’t hire me if my hospital was in the middle of an Epic implementation because of an agreement with Epic. Is this legal? How long to I have to wait if I leave my hospital before a consulting company will hire me?” Welcome to the murky world of Epic non-competes and recruitment restrictions. Epic controls your opportunities with potential employers via separate agreements and/or implied punishment for poaching Epic-certified people. Is their practice legal and binding? Almost certainly not, but you’d need a lot of lawyer money to find out, and by the time you got a ruling, you could have just sat out your time as an untouchable by working in a non-Epic role somewhere (I think it’s a two-year timeout, but it may just be a year … I seem to remember there was discussion about changing it.) Epic’s practices are designed specifically to thwart exactly what you want to do – use your short-term Epic experience and certification to bail out on your employer and cash in with a consulting firm. Even if you had the financial resources and extended timeline needed to mount a legal challenge, there’s still no guarantee that you’ll get hired, because legal or not, nobody wants to cross Judy for fear of choking their own particular gold egg-laying goose. Not to add more rain on your parade, I’m not sure you can even easily move to another Epic hospital, but I’ll let those who have first-hand experience explain how all of this works.

From The PACS Designer: “Re: waterproof accessories. If you want to limit infection from entry devices, there’s now a solution from Seal Shield. They feature waterproof keyboards and other computer input devices that are easily washable and ready for reuse, thus reducing the spread of infections that could come from multiple users of those devices.” I’ll say this – they make a fantastic commercial. You can waterproof your iPad for $30 or your iPhone for $20.

Welcome to new HIStalk Platinum Sponsor M*Modal. The company’s cloud-based Speech Understanding solutions that are used by 2,400 customers include Fluency (converts physician’s narrative into electronic documentation that can be integrated into workflows, in effect speech-enabling EHRs); Catalyst (retrieving information from unstructured encounter documentation, with the first in a series of tailored versions being Quality and Radiology); and SpeechQ (dictation capture for radiology). The company also offers transcription services via its 10,000 transcriptionists (it’s the largest in the US) as well as coding services for clients struggling with Discharged Not Final Billed accounts and the possibility of negative audit findings. We know from recent headlines that M*Modal is a very successful company since arguments have been made that JP Morgan is getting too good of a deal in acquiring it for $1.1 billion, so that’s a nice debate to be having. Thanks to M*Modal for supporting my work.

Here’s an M*Modal video I found on YouTube.

Listening: new from Citizen Cope, which is primarily singer-songwriter Clarence Greenwood. A uniquely American mix of soul, blues, and roots music. Eric Clapton is a fan.

TPD has updated his list of iPhone apps.

I have zero interest in the sprawling commercial spectacle of the Olympics for a variety of reasons (athletes itching to bag endorsement deals the day the flame and their short-lived fame are simultaneously extinguished, smug US cheerleading, glorification of photogenic participants and sports to the exclusion of most of the others, participation of state-sponsored and chemically altered participants and richly compensated professionals like LeBron James that make a joke of the phony, feel-good “amateur” aspect) so I won’t have anything to add to the already smothering media coverage that I won’t be following (except for articles involving widespread Olympic Village debauchery.) Inga bah-humbugged me and says she’ll pipe in with anything HIT-related (like the frequent GE commercials she’s already mentioned to me), so we’ll count on her to make it interesting.

Speaking of Inga’s Olympics chime-in, she sent this newspaper article criticizing the UK’s NHS promoting itself to a worldwide audience just after several high-profile incidents of patient harm that occurred under its supervision:

Sitting in a home somewhere while fireworks lit up the Olympics opening ceremony would have been the family of Kane Gorny. They watched their cherished teenage son die of thirst at the hands of incompetent doctors and nurses … The letters ‘NHS’ dazzled in bright red like some triumphant advert. All around these pranced self-indulgent nurses who had volunteered to take a few days off to be part of the ceremony … That such a politically divisive subject was included at all is utterly shocking. Not least because it glossed over the cracks in a system that is creaking at its seems crying out for urgent reform.

And speaking of NHS, it apologizes to the family of a 76-year-old hospitalized cardiac patient who died right after her son discovered three workers drilling holes in the ceiling above her head to install a patient entertainment system.

Readers say the future of public HIEs is bright, at least if you count dying a screaming death in a giant nuclear fireball of failure as bright. New poll to your right: in which HIT-related company would you invest $100K today? (assuming you have to choose one).

Defense Secretary Leon Panetta disappoints a House committee by advising them that integration of the respective electronic medical records systems of the DoD and VA (AHLTA and VistA) won’t be finished until at least 2017, and he didn’t even sound confident about that date. VA Secretary Eric Shinseki observed that simply reaching DoD-VA consensus on a open architecture system was quite an accomplishment given previous discussions with “a proprietary contractor.” Rep. Bill Johnson (R-OH) wasn’t happy with that answer: “I understand that you can’t account for the last 10 years, Mr. Secretary. And I understand that you’ve got two bureaucracies that don’t necessarily like to be told what to do and (don’t) get along all the time. But I will submit to you that another five years is unacceptable (and) ought to be unacceptable to you.”

HIE Networks and Hillsborough County Medical Association (FL) announce their collaboration to deploy a county HIE. HIE Networks operates the Florida Health Data Network.

Some quotes I highlighted from the McKesson earnings call:

• The clinical conversions — when we talked about our Horizon to Paragon strategy, we talked about the fact that we believe it is a viable solution for our customers, and that over time they need to evaluate that as an alternative because of its more tightly integrated infrastructure and its lower cost of operations … we’ve seen many of our Horizon base evaluate the products. We’ve seen some of that base already contract to move to Paragon, and some already have moved because of whatever remaining development is necessary and Paragon was not of import to those customers. Others have said, you know what, we’re going to go, but we want you to build out another module or we’re going to go after we get our Meaningful Use dollars settled.
• We are really pleased with our position in RelayHealth. I have to admit that the e-prescribing portion of the market’s transition is not a particular profit driver for us. We’re in that transaction both in our electronic medical record businesses as well as in Relay. But that’s not really where the opportunity lies. The opportunity lies in the continued build out of our financial systems.
• And if it’s a surprise to anyone that clinical buying is beginning to wane, they must not be deep in the industry. We believe that our customers have largely made their clinical decisions … We’re in the implementation phase now. Actually if you look at our results under the cover, you actually will see that our hospital buyers are beginning to come back to purchasing other solutions beyond clinicals. And I think those companies that don’t have a portfolio beyond clinicals are probably feeling the effect of a pipeline that is probably headed in a different direction.

Some quotes I highlighted from the Cerner earnings call:

• While there is one competitor that remains a challenge, our competitive position against them continues to strengthen. At the same time, their weaknesses are becoming more known in the marketplace. As we’ve discussed, our significant improvements to our physician solutions and the workflow is neutralizing one of the primary areas they used to compete. And we believe the capabilities we are rolling out in Millenium+ and PowerChart+Touch surpass their capabilities. In addition, our investments in our operability, data analytics and population health management are becoming an increasingly important differentiator against them as their platforms make interoperability and data analytics very challenging. We also believe they will face an inevitable upgrade from their MUMPS-based platform that is needed to catch up in these areas, and this will be very disruptive and expensive.
• Currently, approximately 45% of our core hospital clients have attested for Stage 1 Meaningful Use, and we expect approximately 85% of them to have attested for Stage 1 by the end of the year.
• As background, our experience with data and analytics dates back to 1996 when we started Health Facts, which is a research database that now has over 150 million patient encounters and nearly 2 billion lab results. While in the past this data has largely been used to support pharma and biotech research, our server map organization is now using it along with published evidence to accelerate the development of predictive clinical agents.
• But we clearly have a significant amount of cash on the balance sheet. We think we are in a situation in kind of part of the market that there could be some interesting opportunities for us to deploy that cash in a way that could be — either supportive of Millennium, get us more quickly into some of the new businesses that we’re looking at. I think, relative to the existing traditional HIT market, the window is getting very close to being closed for that being interesting to us. So I think the status of many of those competitors are a little bit on the downhill side of the hill.
• I think probably the one country that’s got a lot of demand is going to really be — just a funding issue — is the UK. As more and more of those trusts are becoming foundation trusts, which means they control their capital outlet — outlay as opposed to the government putting the dollars out there, we think that’s going to turn into a more normalized US- type market where each trust is going to go out to the market and look to acquire technology. In 2015, the current NHS contracts expire. So almost all of those trusts are going to be looking in the market in some form or fashion, probably depending on their access to capital.
• The RFP volume, I’d attribute a lot to the failures of many of our competitors to be ready for the changing landscape. And so they’re in the midst of either — they’ve done acquisitions and they’re trying to put things together, they’re trying to move to new platforms, they’re sunsetting existing platforms, they are on old technology. And those types of things, as people look to what the future is, they know that they have to have data liquidity, their systems have to be interoperable, and they’re going to need that data no matter where the person is in the entire care cycle, inclusive of the home … the recognition that Cerner can do that work, that their current providers can’t do that work.

Vince’s HIS-tory continues with the story of Keane and its Threshold product that could run on any hardware vendor’s UNIX platform.

E-mail Mr. H.

News 7/27/12

Top News

Quality Systems Inc. (NextGen) reports Q2 numbers: revenue up 18%, EPS $0.26 vs. $0.32. The company also eliminates future guidance, apparently burned in this case by impending deals that didn’t close by the expected dates. CEO Steven Plochocki blames the drop in net income on fewer higher-margin software system sales. Shares dropped 33% (Nasdaq’s biggest percentage loser of the day) on the news to their lowest price since November 2008, dropping the company’s market cap to under $1 billion. In the conference call, President Scott Decker said the loss of long-term client HMA was caused by HMA’s lack of resources to roll out its product, and said HMA won’t replace NextGen completely but that HMA wasn’t contributing all that much revenue anyway. The company says it will move more work to India to reduce costs. It also predicts that Meaningful Use Stage 2 and ICD-10 will take out a bunch of its competitors. When asked about pressure on hospital-owned practices to move to competitive products, Scott Decker said he wasn’t worried about Cerner, Siemens, or Meditech, but Epic is “a challenge for us like it is for everybody in the market” that “causes a little bit of pain.” Above is a one-year share price chart, with QSII in blue and the S&P 500 in red.

Reader Comments

From Winning: “Re: Microsoft. It will sign now business associate agreements with partners for Azure storage and core services (their cloud offering). That means Microsoft will shoulder some of the burden of ensuring HITECH and HIPAA compliance in the cloud. Hosting costs are high for a startup like us since HIPAA requires the database to be logically separated from the Web server, meaning we need at least two servers. That’s not cheap with .NET/MS SQL. The value proposition from a major player like MS Azure is pretty high. I wonder if we’ll see more of this from other vendors?” I appreciate that update. I would have put in a little plug for Winning’s company to return the favor, but I was running too late to ask if that was OK. The topic might make a good Readers Write if he’s inclined to write one. That’s a nice move by Microsoft.

From Jonathan Grau: “Re: AMIA 2012 Annual Symposium. We’re in Chicago this year from November 3-7.” Jonathan, VP of corporate relations and development for AMIA, keeps me in the loop about their activities. I couldn’t help but notice that five of the seven conference sponsors are also HIStalk sponsors (CAP, FDB, IMO, Philips, and nVoq).

From IT Director: “Re: Cerner downtime. Just so you know, it lasted about six hours … and you didn’t hear it from me.” According to the purported Cerner communication attached, a Cerner network administrator received an error when trying to update DNS records via the management console, so he or she made the change manually and inadvertently deleted a DNS zone while doing so, an unfortunate change that was then replicated to all servers. Anything using that zone was instantly hosed, and the tools needed to fix the problem were also not available because of the error. They had to restore the file from backup and replicate it manually to all the controllers.

From Doc Down: “Re: Cerner downtime. I’m a doc at a Cerner remote hosted site. We got our first e-mail about a ‘performance problem’ at 12:45 p.m. and the downtime was resolved at 5:35 p.m. In between, we got an e-mail that referred to some sort of DNS issue, but it was a bit confusing to understand what actually transpired. We got one message saying it should be fixed by 4 p.m. then another saying it would be fixed by 5 p.m. We have the read-only product for use during downtimes, but that couldn’t be accessed either. We recently moved our inpatient physician documentation to electronic, so reverting to paper with no access to anything recent was a nightmare. Don’t know anything that could have been done any differently on the hospital end, but it would be nice if Cerner would be transparent and describe to organizations and interested users what really happened as it doesn’t inspire much confidence. Unanticipated things do happen, but I’ve personally been unimpressed by the software or support. Though I have met a few topnotch Cerner folks, most seem fixated on selling us new modules, consulting and programming devices, etc.” Downtime is going to happen despite best intentions and known ramifications, but I’d be concerned that the read-only option, which exists solely for that eventuality, didn’t work.

@histalk We had e mail updates from Cerner every 15 minutes.Our production owner called us with updates. Handled well by Cerner.

— Richard Turner (@Therapist38) July 25, 2012

HIStalk Announcements and Requests

This week’s HIStalk Practice includes a statement from former e-MDs CEO Michael Stearns regarding his recent firing. Epic, Allscripts, and eClinicalWorks lead other vendors in the number of ambulatory EHR attestations. ONC says the total cost of ownership of an in-house hosted EMR is less that the SaaS option. A Florida ACO uses Craigslist to recruit physicians and offers up to $100,000 a year in shared savings. Julie McGovern of Practice Wise points out a few considerations for practices moving their applications to the cloud. When you pop over to HIStalk Practice, click on an ad or two because you might find a sponsor offering a solution that will make your world better. And sign up for the e-mail updates because it could be the only way I know you care. Thanks for reading.

On the Jobs Board: Manager Systems Development, Database Administrator, Services Implementation Project Manager.

The HIStalk vital signs consist of measurements that you can actually influence: number of readers, number of e-mail subscribers, and the vitality of reader interaction in the form of comments and news tips. That means that you get to control our electronic destiny, which makes you a pretty powerful force with which to reckon (cue some tears-inducing Sarah McLachlan heartfelt warbling to move you to action). Actions that will stave off our eventual demise include (a) signing up for my spam-free e-mail updates, so you’ll be the first to know when I dig up some incredibly juicy industry gossip or random sophomoric humor that I can’t resist sharing; (b) electronically mate with Inga, Dr. Jayne, and me on Facebook, LinkedIn, and all that truck; (c) peruse the fun Resource Center, where you can search and navigate through a bevy of benevolent sponsors who crave your electronic attentions just as much as I do; (d) use the Consulting RFI Blaster to … well, that one’s pretty self-explanatory; (e) get off your figurative couch and out here on the healthcare front lines with us and participate with your comments, insight, or anonymous tips (e-mail works, but so does the nauseatingly green Rumor Report button glaring spitefully from the right side of the page); and (f) play a few rounds of Sponsor Roulette, scrolling the page and randomly clicking the ads to your left to see where you land, assured that it will be among friends since only the cool companies sponsor HIStalk instead of the boring alternatives. Inga, Dr. Jayne, Sara McLachlan, and I appreciate your participation in our continued non-flatlining. Every day we wake up and the page is still displaying is a good day.

Speaking of the three of us working in healthcare day jobs, Dr. Jayne’s healing talents were required for an encore shift in her local hospital’s ED, meaning she didn’t have time to contribute this time around. I suppose saving lives and all that stuff is a good enough excuse to let her slide this time.

Acquisitions, Funding, Business, and Stock

Compuware releases Q1 numbers: revenue down 2%, EPS $0.05 vs. $0.08, beating consensus earnings expectations of $0.04. Revenue for the company’s Covisint business unit grew 27% to $21 million.

McKesson announces Q1 numbers: revenue up 3%, adjusted EPS $1.55 vs. $1.27, beating expectations of $1.49. Revenue in Technology Solutions was up 4%, with adjusted operating profit of $109 million.

Clinithink secures multi-million dollar investments from Finance Wales and existing investors to fund ongoing technology development and establish the company’s US operation.

Cerner reports Q2 numbers: revenue up 22%, adjusted earnings $0.59 vs. $0.44.

CPSI announces Q2 results: revenue down 6%, EPS $0.75 vs. $0.72.

Facebook’s first earnings report wasn’t so hot, with revenue increasing 32% to meet expectations, but growth was the slowest in 18 months and the company doesn’t appear to be monetizing heavily increasing mobile usage very well. Shares dropped 9% Thursday and are down another 11% in after-hours trading Thursday evening. In the mean time, shares in Facebook-dependent game maker Zynga (FarmVille) continue their toilet orbit after a bleak Q2 earnings report, knocking another 40% off the share price and dragging shares down to 70% less than their December IPO price to the embarrassment of idiotic stock pickers who somehow thought Zynga had a real, sustainable business instead of a hyper-annoying fad with a low barrier to entry.

The CEO of HealthStream says the education and HR technology company may move into related healthcare business such as long-term and behavioral care.

Sales

Cedars-Sinai Health System (CA) chooses Health Care DataWorks to provide a clinical data warehouse and analytics solution.

The Commonwealth of Virginia’s Department of Medical Assistance Services awards HMS a contract to provide a customized Medicaid fraud and abuse detection system.

Norton Healthcare (KY) contracts with CSI Healthcare IT to provide 100 resources for the second wave of its Epic activation.

People

Healthcare analytics company ArborMetrix appoints former Covisint VP Brett Furst as CEO.

The Commonwealth Fund, a private healthcare-focused foundation and think tank, names former National Coordinator David Blumenthal MD its next president, effective January 1, 2013. He is chairman of the organization’s Commission on a High Performance Health System. Blumenthal will replace Karen Davis, who announced previously announced plans to step down at the end of the year.

Luther Nussbaum, retired chairman and CEO of the former First Consulting Group, is elected to the board of consulting firm MedSys Group.

Healthcare billing and payment systems vendor Zepherella names David Bond (A4 Health Systems, Allscripts) as EVP of sales and marketing.

Announcements and Implementations

St. Francis Medical Center (CA) and O’Connor Hospital (CA) go live on iSirona’s device integration solution that connects medical devices to their QuadraMed EMR.

Transitional care provider Remington Medical Resorts (TX) goes live on HealthMEDX Vision at all of its Texas facilities, including rolling out a paperless environment that allows physicians to work from iPhones or iPads.

The new Palomar Medical Center (CA) will open next month, a 288-bed, $956 million “hospital of the future” that has been under construction since December 2007. Space was pre-built to allow expansion to twice the number of beds if needed.

In Australia, New South Wales completes the initial phase of the rollout of TeraMedica’s Evercore imaging exchange in 12 hospitals.

Government and Politics

HIMSS proposes language for inclusion in the Democratic and Republican National Committee party platforms in support of HIT to improve healthcare efficiency, quality, and outcomes:

“In order to improve the quality of healthcare for all Americans while reducing costs, the Party will continue its strong support for the rapid, nationwide adoption of Health Information Technology including electronic health records and secure health information exchange capabilities.”

Other

The Ventura County Board of Supervisors (CA) approves an additional $5.75 million for its $41 million Cerner EHR implementation, which is scheduled to be operational at two county hospitals by July 2013

Compared to physicians, physician assistants, APRNs, and RNs spend more time online for professional purposes, use smartphones more during patient consults, and more frequently access pharma or biotech Websites.

A Milwaukee newspaper article notes that Wisconsin hospitals are charging victims of sexual assault up to $1,200 for the cost of collecting evidence to identify and prosecute their attacker. Sometimes insurance pays, sometimes the hospital knows to bill the government fund that was set up to cover the cost, but in some cases the patient ends up getting stuck with the bill.

A Harvard health economist says that 90% of the country’s economic growth over the past 10 years got sucked up by increased healthcare spending, but the CEO of Marshfield Clinic says at least some parts of the Affordable Care Act (though he declined to guess which ones, but IT is mentioned) will eventually slow the increase. As I always say, everybody’s for reducing excess costs as long as they don’t personally have to take a pay cut.

Weird News Andy found this story, in which Mayo Clinic apparently fired a pediatrician who wrote a Arabic blog post advocating female circumcision. Mayo says female genital mutilation not only has no medical justification and thus can’t be performed in its facilities, but is also considered a felony-level child abuse crime in the US.

The University of Missouri School of Medicine will use a $13.3 million HHS grant to create electronic dashboards that will allow physicians to get a quick read on how individual patients or groups of patients with a single condition are being managed. The project has been christened LIGHT².

Kiplinger’s Personal Finance ranks Madison, WI as the best city for young adults, with UW-Madison and Epic helping push it to the top. Rounding out the Top 5 were Austin, Boston, Washington DC, and Denver.

It really bugs me when PR-seeking hospitals decide to magnanimously waive their bloated, cost-shifted charges for high-profile victims. Three Colorado hospitals say they won’t charge victims of the Dark Knight shootings, some of whom had no medical insurance, for their care. I’m all for generosity, but I like it better then it’s less self-serving and selective. I’d rather they take it out of their executive salaries instead of just pushing the cost onto those who have insurance and less-publicized medical problems. Everybody struggles to pay for their healthcare, and fuzzy accounting like this isn’t helping.

In Canada, Eastern Health fires a nurse for inappropriately accessing and sharing the records of 122 patients. She’s the fifth employee the hospital has terminated for privacy violations so far this year.

Some bored newspaper folks apparently decide to check whether former HHS Secretary (and former lobbyist and current Senate candidate) Tommy Thompson ever had a VeriChip implanted in his arm as he said he would in 2005 when he joined that company’s board. Answer: no. His reason: hospitals didn’t buy the technology to read the chips, so the company tanked. He sure was pitching it hard on Squawk Box back in the day, but he’s a politician after all.

Sponsor Updates

• Software Testing Solutions will have an active presence at the Sunquest User Group conference August 6-10 in Scottsdale, AZ. STS will demo Version 4 of its Test Manager product; CEO Jennifer Lyle (above as your HIStalkapalooza co-host in Las Vegas) will conduct an automated testing cost justification session on August 8; and the company will offer its popular Breakfast with the Puppies event on Thursday to collect donations (which the company will match) for Home Fur Good, a Scottsdale-based no-kill shelter.
• Santa Rosa Consulting is named to Modern Healthcare’s Best Places to Work in Healthcare for 2012.
• Trustwave and Microsoft partner to support additional Web server platforms, including Microsoft’s Internet Information Services and Nginx.
• Certify Data Systems earnsMajor Player distinction in IDC Health Insights’ HIE vendor assessments report.
• Consulting firm ESD (your gracious HIStalkapalooza sponsor last time) earns a Healthcare’s Hottest award recognizing fast-growing established healthcare companies. ESD also was named by Modern Healthcare as one of the Best Places to Work in Healthcare for 2012, the second year in a row.
• Prognosis participates in this week’s Texas Healthcare Trustees Annual Conference in San Antonio.
• NextGate’s continued growth requires a second move into larger space in Monrovia, PA.
• The Huntzinger Management Group reports significant growth in 2012 as it helps organizations address regulatory compliance issues, changing reimbursement models, and IT demands.
• MedAssets heads to San Antonio next month for the AHRMM 12th Annual Conference..
• Wellcentive introduces Provider Benchmarking capabilities within its Advance Outcomes Manager solution.
• Macadamian CEO Frederic Boulanger is selected as a Quebec finalist for Ernst & Young’s 2012 Entrepreneur of the Year in the Technology and Communications category.
• FTI Consulting signs a five-year licensing agreement with Streamline Health for its OpportunityAnyWare business analytics and patient financial services solutions.
• NextGen Healthcare selects Health Language to provide standardized terminologies within its ambulatory product suite.
• Culbert Healthcare Solutions publishes a white paper on centralizing patient access and revenue cycle functions.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 7/25/12

Top News

@Erblove Our apologies for the inconvenience today. The downtime should be resolved at this point.

— Cerner Corporation (@Cerner) July 23, 2012

Cerner had an apparently significant disruption of its remote hosting service on Monday, leading to extended downtime for clients all over the country (and possibly outside of the country as well, according to some reports.) Information is hard to come by, so feel free to leave your comments if your organization was affected. Would you do anything differently next time in terms of preparation or downtime procedure?

Reader Comments

From Mr. Allscripts: “Re: Surescripts outage. I have more info.” Mr. A included a document suggesting that the Surescripts network had connectivity problems over about an hour last Thursday, during which time prescription routing and medication history transactions may have failed.

Thank you Cerner for being down all day. Just how I like to start my week…with the computer system crashing for all of NorCal

— Avinesh Raman (@UhVeeNesh) July 23, 2012

@histalk we have not charted any pts today. Not acceptable from a health care leader.

— scott newcomb (@wsnewcomb) July 23, 2012

From Kaplan: “Re: Cerner. Remote hosting is down – it’s all over Twitter.” Apparently true, but I got just one reply to my Twitter inquiry of affected users for more information. Judging from the timing of some of the tweets, it looks like it was down for at least four hours. You can imagine the disruption of having your entire hospital go offline at once without warning, but at least it’s someone else’s problem as the IT folks sit and wait along with their users. I’d want an explanation, of course, and hopefully those affected were smart enough to have put a downtime penalty clause in their agreements.

From Mister X: “Re: Cerner downtime. Communication was an issue during the downtime as Cerner’s support sites was down as well. Cerner unable to give an ETA on when systems would be back up. Some sites were given word of possible times, but other sites were left in the dark with no direction. Some sites only knew they were back up when staff started logging back into systems. Issue appears to have something to do with DNS entries being deleted across RHO network  and possible Active Directory corruption. Outage was across all North America clients as well as some international clients.” I’ve lived through a lot of downtime it’s the same story as in this case. You don’t know when the systems will come back up until right before they do in most cases – 90% of the time required is diagnosis, not treatment. Users always want to know “how much longer” and you as the IT organization hate to tell them, “Beats me” even though that’s usually the case. Not to mention that when resources are stretched trying to get the problem fixed, there’s nobody sitting around to shoot the breeze with users wondering how it’s going (the user-to-geek ratio is about 1,000 to one, and you haven’t lived until you kill your pager battery within about 15 minutes with the constant pages demanding an individual briefing on what’s going on.)  And I can also say from experience that the worst problem isn’t server or power failure since those systems are backed up – it’s something like this, where Active Directory gets trashed, your name server dies, or you lose IP connectivity inside your data center. It takes forever to diagnose and fix.

From HERSS: “Re: mHealth Summit. I got an e-mail from HIMSS saying a certain company ‘will make their first appearance at the 2012 mHealth Summit as a Platinum sponsor and as such will have a significant role in the summit program and a key presence on the exhibit floor.’ I head to read twice to make sure this wasn’t from the basement sweatshop World Healthcare Congress sales reps and their over-the-top spamming. HIMSS has dropped to a new and very disturbing low. I would never have come out and said that a vendor will play a significant role in the program – that hardly inspires me to spend my hard-earned money for a conference pass. ‘A key presence on the exhibit hall floor’ means the vendor paid their prostitution dues to the pimp and are being properly rewarded for it.” Most of the HIMSS e-mails I get these days are just another form of vendor spam, pitching products, Webinars, or urging political action to interfere with the free market in healthcare IT. To be honest, I’ve twit filtered them into oblivion. When HIMSS speaks, it’s like a bad ventriloquist act – it’s easy to spot the arm up their backside. I really think they mean well and they have some honorable and dedicated people working there, but like a politician pandering to special interests, they lost their connection to the average provider once the dollar signs filled their eyes.

Nurses bragging on doctors, & doctors bragging on nurses. One doctor had no time to wait for an OR & began surgery in middle of the ER…

— Jacob Tamme (@JacobTamme) July 22, 2012

From Colorado Health Exec: “Re: Aurora shootings. While I was not involved, I want to extend my thanks to the healthcare professionals that did a great job in the early hours of Friday morning.  There were many heroes that day, from people in the theater, to the police, firefighters, and last but not least the nurses and doctors that treated the patients injured and consoled families trying to make sense of a senseless act. My thoughts and prayers go out to the victims and their families. Say what you want about the politics of healthcare these days, but professionals like these are the reason I am proud to be in healthcare.”  The above is from Denver Broncos tight end Jacob Tamme, who continues to tweet about being moved by his ongoing visits to Swedish Medical Center to visit with hospitalized survivors.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor CIC Advisory. Their tagline is “trusted informatics experts” and you probably really would trust them – the principals are Cynthia Davis, RN, FACHE (who’s been a CIO and has led several EHR/clinical transformation projects) and Marcy Stoots, MS, RN-BC (who has an interesting history of being an ICU nurse, wrote her master’s paper on data mining, is finishing a DNP in informatics, and led the EHR implementation at BayCare and other places). They’ve also just co-authored a HIMSS book called A Guide to EHR Adoption: Implementation Through Organizational Transformation. Testimonials are here. I was impressed that both ladies are members of the HIStalk Fan Club on LinkedIn, which always scores points with me. If you need help with EHR projects, informatics issues, Meaningful Use, business intelligence, or strategic planning, Cynthia and Marcy would be happy to speak to you. Thanks to CIC Advisory for supporting HIStalk.

It’s not quite as pervasive as squeezing “sort of” into every sentence, but what’s with everybody suddenly leading off a thought with the word “so” like they’re telling a story in a bar? You ask someone when they’ll finished a particular task and you get, “So we’re working on the documentation …” I’m also noticing that the young folks (who raise their inflection to a painfully high pitch at the end of every sentence as though they’re asking a question even when they aren’t) are also prone to sticking a confusing “no” in front of their “yeah” when excited. Example: “I just heard this great new band …” and they burst in with, “No – yeah, they were dope.” Curious.

I was thinking about the “deceased” flag in everybody’s EMR system after reading a story about a dead patient receiving an appointment in the mail in the UK. I assume that field populated only if the patient dies while admitted and someone keys in the discharge disposition. For research and population management purposes, it would be nice to know whether the patient is actually still alive, not just whether they went home that way last time from your own facility. If there was a national patient identifier, state and national death records could update everybody’s system. Seems pretty basic if we’re really going to try to account for patients between episodes. Or maybe somebody’s already doing this. Seems pretty basic: “Is this patient still alive?” “All I know is that he was the last time he came to the office.” Small-town doctors used to peruse the newspaper obituaries to send condolences and archive charts when appropriate.

Acquisitions, Funding, Business, and Stock

The senior management team of Quality Systems (NextGen) sends shareholders a letter voicing their strong support for the QSI board nominees. This move follows actions by dissident director and board member Ahmed Hussein, who is attempting to gain control of the board by nominating his own director candidates. The letter urges shareholders to support the QSI board nominees at next month’s annual meeting.

The FTC grants early termination of the waiting period for the acquisition of M*Modal by One Equity Partners, clearing the way for the deal to close.

HealthStream announces Q2 numbers, which were in line with estimates: revenues up 23% to $25.8 million; net income up 33% to $2.4 million.

Philips reports Q2 numbers, with earnings beating expectations and healthcare leading the way with a 7% jump in sales.

Apple misses Q2 expectations, turning in its second quarterly miss in year and setting lower guidance for the next quarter. iPhone sales were way down, which could be attributed to the lack of the iPhone 5 rollout, a struggling world economy, or impatient users moving to hotter new phones like the Samsung Galaxy S3.

Sales

Providence Health & Services will deploy Nuance’s Dragon Medical 360 voice recognition technology across its 250 clinics and 27 hospitals, integrating it with Epic for the health system’s 8,000 clinicians.

Centura Health (CO) selects the Explorys platform and Enterprise Performance Management applications for their ACO and PCMH initiatives.

Jordan Hospital (MA) selects dbMotion’s interoperability platform to connect multiple acute and ambulatory HIT systems throughout its local medical community.

Pomona Valley Hospital Medical Center (CA) selects ProVation Order Sets.

People

The Missouri Health Connection names Mary Kasal (Cornerstone Advisors) president and CEO of its statewide health information network.

HIT Application Solutions hires Richard Crook (onFocus Healthcare) as VP of consulting services.

Rodney M. Hamilton, MD (PointClear Solutions) joins ICA as its CMIO.

Floyd Medical Center (GA) names Jeffrey D. Buda (WellStar) as CIO.

Announcements and Implementations

The SE Michigan HIE announces that it has completed all milestones to provide its e-disability claim filing service to the Social Security Administration, which will accelerate the processing of disability claims from 457 days by paper to six hours electronically.

Canada’s Eastern Health goes live with NexJ’s Disease Screening solution for its Colorectal Screening Information and Reporting System project.

Military robot maker iRobot, worried about losing profits due to reduced military spending, decides the time is right to jump into the healthcare market with a new product in a partnership with InTouch Health. iRobot, which also makes the Roomba room vacuum cleaner, says the head of its new robot head is a moveable monitor that can be controlled, allowing the remote physician to look around the room. It comes with a stethoscope that it doesn’t know how to use, which makes it very doctor-like if you’re talking about psychiatrists, dermatologists, and physician executives who haven’t actually listened to anybody’s chest since residency, but who strut around in a white coat and draped stethoscope so they look more doctorly.

The chief administrative officer of Northwest Imaging (MT) develops a shift-budding app that he plans to complete and commercialize.

Cleveland Clinic and The Ohio State University announce a partnership to commercialize products that include medical software.

Technology

HELO announces its new TabletStrap PRO, a rotating leather hand strap for 10-inch tablets. Looks pretty cool for $60. Holding the iPad is awkward for me, especially when walking and poking at it, and this looks like it would be more comfortable and secure.

Other

A reader last week asked if we were aware of updated MU attestation data by vendor. As it turns out, CMS published new information last week that includes details through the end of May. I used Excel to play with the numbers a bit, but a more robust reporting tool would probably be more efficient. EHRs by Epic, CPSI, Cerner, and Meditech were the most widely used products by attesting hospitals, which really isn’t much of a surprise. If you are interested in ambulatory EHRs, I created a similar chart on HIStalk Practice showing EP attestations by vendor, with Epic, Allscripts, and eClinicalWorks leading the pack.

Cerner partners with the city of Nevada, MO to focus on creating a culture of health in the community through education, incentives, infrastructure, and partnership with local employers and community organizations. Cerner will also deploy its CommunityWorks critical access clinical suite at Nevada Regional Medical Center.

AHRQ issues an RFI pertaining to quality measures enabled by healthcare IT.

Sponsor Updates

• Stockell Healthcare Insight client Cooper Green Mercy Hospital earns $2.1 million for meeting Alabama State Medicaid’s EHR adoption, implementation, and use requirements.
• A Calgary newspaper highlights TELUS Health and its remote patient monitoring tools.
• MED3OOO’s chief medical executive, Paul McLeod, MD tackles the question of bundled payments in the company’s July newsletter.
• Orion Health HIE is named to the Leader category in IDC’s MarketScape Vendor Assessment report.
• Holon Solutions will install its CollaborNet interoperability solution at George Tech’s Interoperability and Integration Innovation Lab.
• Aspen Advisors produces a white paper on assisting Frederick Regional Health System (MD) develop a business intelligence strategy.
• Hayes Management Consulting offers a free white paper on patient portal design and implementation.
• Over the last 15 months, Emdeon has boosted its employee count by 300 as a result of acquisitions and organic growth.
• Informatica Corporation joins the Google Cloud Platform Partner Program as a Technology Partner.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 7/23/12

From So SARry: “Re: Epic stock ownership. My information is a bit dated, but here’s how it used to work, anyway. Two classes of stock were issued – A and B. Judy owned all the B stock, which I suspect is how she controls the company. In the beginning, anybody could own A stock, and there actually is some stock floating around privately that’s never been owned by an employee, but selling stock like this was discontinued a long time ago. Employees received stock as well, but originally, there was no rule to sell stock when you left. Shares still trade privately, but later employees must sell their stock when they leave the company. At some point, they must have hit the 500-shareholder limit or foresaw this and created Stock Appreciation Rights. New employees from that point got SARS. While they advertise that they are the same as stock, the rules are quite different, mainly in that you can only hold a SAR for so long, which limits its appreciation. Pretty scammy, actually. Employees getting SARS get pretty small numbers. No new employee gets stock, and with the older employees leaving and being forced to sell their stock in most cases, the ownership of the company is increasingly concentrated into certain long-time employees (certainly not all) who get the repurchased stock from the other employees as bonuses. They don’t advertise that, either. There are probably in the neighborhood of 150 employee shareholders or less now.”

From Ossia: “Re: Surescripts. Was offline this week.” Unverified, but above is a snip of an explanatory e-mail that clients supposedly were sent.

From Emu: “Re: MU attestations by vendor. Do you know of anybody keeping these stats up to date and publicly available?” I don’t follow it much, so I’ll defer to Inga or readers who may know.

Listening: Baby Woodrose, a dead ringer for fuzz guitar / organ / tambourine paisley psychedelic rock bands from the Sunset Strip in the late ‘60s (The Seeds, 13th Floor Elevators), surprising since it’s basically one guy from Denmark with occasional rotating backup musicians. Luckily nobody was in the vicinity when I fired up the first few tunes on Spotify because someone could have been harmed by my involuntarily spastic desk drumming. This tune ought to be hit, other than nobody listens much to real music these days. Baby Woodrose just rips it up and leaves it on the stage. I like it a lot. Similarly good but from Sweden: The Maharajas.

Most readers think the loosely defined “telehealth” will improve quality and costs. New poll to your right: will public HIEs survive?

Welcome to new HIStalk Platinum Sponsor Accent on Integration. As the Texas-based company’s name suggests, its raison d’etre is eliminating data silos via intelligent data exchange, giving hospitals better access to clinical information and thus helping them improve patient care. Areas of focus include interoperability (EMR integration, HIE to HIE integration, accountable care), device integration (monitors, OB and ECG systems), and systems integration (HL7, IHE, CCD, CCR, XML, Web services). Accelero Connect is the company’s enterprise-class clinical data integration platform (vendor-neutral, manufacturer-neutral, and modality-neutral) that connects patient care devices to hospital clinical systems and EMRs, an FDA-registered Medical Device Data System that passed all tests in the Patient Care Device Domain of the 2012 IHE Connectathon. Hospitals that use bedside monitoring systems from multiple manufacturers or that need to capture data from multiple modalities (IV pumps, ventilators, wired or wireless patient care devices, etc.) get a consistent message structure for sending information from those devices to their clinical systems. Clinicians can choose specific incoming data points to include in their EMR documentation (since most EMRs can’t handle a constant barrage of frequent data readings) or the whole process can be placed on autopilot by setting IHE’s device observation filter to pass through only the desired information. Stillwater Medical Center (OK) chose Accelero Connect after an ICU monitoring system upgrade to automatically integrate patient information into the EMR, reducing the time and errors involved with having nurses document manually and giving physicians a real-time view into patient condition to allow faster intervention. Thanks to Accent on Integration for supporting HIStalk. 

I’ve warned a couple of times that Meaningful Use attestation is based on the honor system only to a point: HHS has said from the beginning that audits would be done after the fact. They’ve started, apparently, despite the lack of a formal announcement. Providers are getting letters from Medicare cost auditors Figliozzi and Company (check out their ultra-cheesy 1990s FrontPage site, which will shatter any confidence you may have had in them as technologically astute auditors) requesting specific MU-related documentation: a copy of their product’s certification, an explanation of how they calculated ED admissions, and supporting documentation to back up meeting the core and menu set items claimed. CMS awarded Figliozzi a three-year, $3 million contract in April to do the job.

Integrity Transitional Hospital (TX), a 54-bed long-term acute care hospital, chooses HCS INTERACTANT EMR and financial solutions.

Shares in Quality Systems Inc. continued their slide this week on news that the physician network of Florida-based Health Management Associates will replace QSI’s NextGen products with those from athenahealth. QSII shares that were trading in the $45 range in mid-March closed at $23.41 Friday. Over the past year, ATHN shares are up 78% (they jumped nearly 7% on Friday alone), while QSII’s are down 48%. That’s a one-year chart above. Athenahealth’s market cap is now $3.3 billion, with Jonathan Bush holding about $29 million worth. That makes athenahealth worth only a little less than Allscripts ($1.89 billion), Quality Systems ($1.39 billion), and Greenway ($445 million) combined. You would have more than quadrupled your investment if you’d bought ATHN shares two years ago.

In the athenahealth earnings call, Jonathan Bush outlines some of the company’s strategies: Jedi (adding services such as provider credentialing and denials); Beautiful (improving the user experience in working with the company and engaging design firm IDEO on “future medical record user experiences” and design philosophy); Coordinate (not really explained except to say it’s not working yet); and More Disruption Please (working with other disruptive technology entrepreneurs). Worth reading just to pick out fun JB quotes, which must have the stock guys linting up their suits while rolling on their floors:

• “I had our Physician Advisory Board in yesterday. The biggest thing that they said is, ‘Listen, it makes perfect sense, both as a receiver and as a sender, to be on this Coordinator service. The problem is it’s not really worth doing as a sender unless there’s a lot of receivers, and it’s not worth really doing as a receiver unless there are a lot of senders.’ So I bought five chickens, and I am going to figure out how these freaking eggs get going.”
• [on the replacement system business] “Well, Ryan, thank you for bringing up one of my favorite parts of the athena hospital, the Burn Unit. No question about it, the Burn Unit is getting busier and busier across all segments. I actually saw the KLAS survey did something recently, 30% to 50% — was it 40% to 50%? — of large groups are engaged now in replacing the EMR that they rushed out to buy because they rushed out to buy the one that they knew when the Obama administration told them they needed one, and that was the software-based Flock of Seagulls-era EMR system that they had looked at and chose not to buy in the early 90s.”
• [on increasing sales rep productivity] “So you have a small group guy who’s in her 20s, shows up and she plugs into a desk. It’s like getting on a bull, and the demos come pouring in. And she’s doing demos like the Beatles when they worked at those strip clubs back in the ’60s. They do 10 to 15 shows a day. They get very good very quickly. And you see their close rates pop up into the normal sort of 20% close rate range within a quarter, two quarters max.”
• [on terms of the HMA deal] “They can all leave whenever they want, but hopefully, we don’t get boring. We keep changing our outfits, and they stay forever. We cut our hair short, we let it grow long.”
• [on competing with Allscripts] “I call it O-negative day, that earnings call from Allscripts when they became a universal donor.”
• [on competitors] “It’s our business model that’s on the side of history. Now I am not smarter than those other guys. We didn’t start out better, we’re not better people, we don’t work longer hours. We’re attracting the next generation of brilliant developer because the business model makes sense to people. So over time, we might actually end up with a better raft of people and a more inspired raft of customers. But I really think it really boils down to just the accident of our stumbling upon to this business model, lo those 13 years ago.”
• “We are a nation of shoppers. And the reason healthcare sucks so much, both from a satisfaction and a cost perspective, is nobody’s allowed to shop. It turns out, the way policy has gone, the consumer will not be shopping for a while. That was on the rise. Since the inauguration, that has been on the fall. But it turns out the doctor could shop. The doctor could be the first generation of American shopper for healthcare.”
• “I think this quarter speaks for itself. I do think that we took on, as I said in the beginning of my prepared remarks, more than we could chew. And so we won’t be done chewing by the end of the year in terms of our bolder projects. But anyway, that makes it less hard to figure out what to do next year. And we get the joy and the binding experience that comes from a little bit of failure along the way, which keeps us real because we are so much smaller than this mission we’re on, and we have so much, so much farther to go.”

NIST releases a guide on EMR usability for delivering care to pediatric patients. It’s a free download.

Weird News Andy finds this story interesting. The hospital technician who was charged with infecting at least 30 New Hampshire patients with hepatitis C (he was injecting himself with drugs and then re-using the syringes) was an agency traveler, having worked in at least six states in the past five years. He’s apparently good at sounding sincere – he was reported by a co-worker as “foaming at the mouth” while on the job, but made up a story about crying over a dead relative. What WNA liked is his response to questioning about how all those patients contracted hepatitis: “You know, I’m more concerned about myself, my own well-being.”

Visage Imaging’s server-side rendering and support for Windows, Mac, and iOS platforms is mentioned in an AuntMinnie article covering the technology approaches to developing mobile apps for medical imaging.

Political attack ads aimed at Missouri State Senator Brad Lager, a candidate for lieutenant governor and a part-time Cerner employee, challenge, “While Kinder fights Obamacare, Brad Lager profits from it. Records show a healthcare company that’s made billions from Obamacare pays Lager thousands.” His opponent, the incumbent lieutenant governor, fared even worse – an ad questioned, “Skipping work to hang out at the Horny Toad?”, referring to his admitted visits to a St. Louis strip club of that name and his rumored involvement with a stripper who was plying her trade there.

GE announces Q2 numbers: revenue up 2%, EPS $0.38 vs. $0.35. GE Healthcare contributed profits of $711 million, up from $661 million quarter-over-quarter.

Beth Israel Deaconess Medical Center (MA) notifies 3,900 patients that their PHI has been exposed after a physician’s personal laptop is stolen from hospital property. The hospital was already encrypting its own laptops, and prompted by the incident, now requires non-owned devices to be encrypted before using them to access patient information.

Philips recalls 226 of its Xcelera Connect interface systems after a hospital reports to the FDA that it was sending incomplete cardiology test data to EMRs. The company found that if a physician hit Enter in the summary section of their interpretation, any following information in the report was sometimes lost. Xcelera Connect exchanges data to and from cardiac-related modalities to hospital information systems.

Meditech cloud hosting services provider Park Place International signs on as the first client of CyrusOne, which operates a new Texas data center that it says is ideally located to minimize geographic risk, is connected to highly available electrical and cooling systems, and is hardened with physical security controls.

The 5,800 square foot Memphis house that Steve Jobs secretly bought in 2009 to prepare for his liver transplant there was owned by the University of Tennessee and used as a residence for the chancellor of its Health Science Center. It was appraised for $1.3 million, but the university, anxious to shed some of its residential real estate and spooked by the tanking real estate market and lowball offers on the property, sold the house to Jobs for $850K. After Jobs went back to California, the house was sold to his transplant surgeon.

This amuses me, but then again, it doesn’t take much.

E-mail Mr. H.

News 7/20/12

Top News

WorldOne acquires the 130,000 physician-member Sermo, which adds to WorldOne’s global network of 1.7 million healthcare professionals across 80 countries.

Reader Comments

From Simple Simon: “Re: ambulatory EMR satisfaction. First the CDC reports that 55% of US doctors are using some type of EHR and 85% of those claim to be somewhat or very satisfied with its day-to-day operations. Now KLAS says that 49% of practices with existing EHRs are considering replacing their systems. Somebody has to be wrong.” Perhaps, but keep in mind the sample sizes and methodologies were quite different. CDC’s findings are based on the results of a mail-in survey from 3,200 physicians. KLAS used a  smaller sample of 302 practices. KLAS suggests that practice consolidation may be contributing to the high replacement figure as entities search for a single solution to replace disparate EHRs. In other words, a good number of providers may be perfectly happy with their EHR, even as the organization searches for a new system. As a whole, I think you can draw some broad conclusions that adoption is up, that support and product issues are creating discontent among some users, and that the replacement EHR market will continue to flourish. I am reminded of the advice that Mr. H regularly administers: be leery of the conclusions drawn by many of these surveys because methodology and biases sometimes make them questionable.

From CDMer: “Re: DoD-VA Interagency Program Office. They’ve issued an RFI to survey the market for vendors who can meet the specs of the future iEHR that will allow them to replace AHLTA and VistA. It’s always nice to have 100-year goals!”

From Wurka Round: “Re: NYU Langone. Paper checklists are being deployed to keep results from being silo-bound in the ER.” The hospital, stung by media coverage of the death of a 12-year-old boy who was discharged from the ED despite available lab results showing significant infection, now requires ED employees to complete a pre-discharge checklist indicating that they have reviewed labs and vitals one last time. The hospital also says it will make sure that any post-discharge abnormal lab values are communicated to the referring physician, which also didn’t happen in the boy’s case.

From Clownface: “Re: Epic. What qualifies as an employee-owned company? In my training class, Epic says it’s employee owned, but SEC reporting of financial data is required for more than 500 shareholders and Epic does no reporting. With more than 5,000 employees, that means less than 10% of them are shareholders. How is that employee ownership? Does the CEO just have to be an employee to count?” Good question. From what I can tell, SEC requires detailed financial reporting for private companies exceeding $10 million in revenue and 500 shareholders. Meditech is a good example. I don’t see any Epic filings on EDGAR, but maybe they use a less-obvious name to avoid prying eyes. Or, you could be right that most employees will never get a shot at owning shares. Maybe someone who works there can enlighten us, although I’m not counting on that happening.

From Albert: “Re: UC Health, Cincinnati. Ambulatory applications went live in big bang fashion last week, replacing an extremely customized GE Centricity. Nearly 100 clinics and 3,000 users are up and running!” I believe they’re implementing Epic.

From MT Hammer: “Re: M*Modal. Nuance tried to buy them?” An interesting blog post makes a strong case that Nuance was the unidentified company that offered $17 a share for M*Modal in June, an offer that was rejected because the unnamed company had just purchased an M*Modal competitor (presumably Nuance’s acquisition of Transcend), leading to uncertainty about whether the deal would actually close due to antitrust issues. Quite a few folks (some of them working for securities class action law firms) say M*Modal sold out to JP Morgan Chase too cheaply, so they will undoubtedly point to this news to support their position.

HIStalk Announcements and Requests

I am back from my semi-vacation and still busy cleaning out my inbox. If you haven’t had a chance to read the recent HIStalk Practice posts, here are a few goodies you might have missed. Highlights from KLAS’s recent report on ambulatory EHRs, including the most replaced and most considered vendors. NCQA extends a “Distinction” designation to 60 PCMH primary care practices. Greenway publishes a cool infographic that overviews the MU process. MGMA’s tips for practices considering a social media presence. New payment methodologies may have helped primary care physicians increase their 2011 compensation by more than five percent. Aaron Berdofe discusses health record banks in the third part of his series on healthcare infrastructure data models. Dr. Gregg explains the commonality of clubbing, EHRs, and religion. Brad Boyd of Culbert Healthcare Solutions highlights the great promise of centralizing patient access and revenue cycle. Take a moment to cool yourself from the summer’s heat with HIStalk Practice’s refreshing ambulatory HIT news. Sign up for the e-mail updates while you are there. And, thanks for reading.

Here’s a gentle reminder for PR folks anxious to get the executive hires of their clients listed in the “People” section of HIStalk. I like including a photo since it’s 100 times easier for someone to recall if they know someone if they’re looking at a photo (can you imagine a text-only high school yearbook?) Every executive should have a LinkedIn profile that includes a high-quality, professionally made head shot (not resized down to the tiny, low-resolution thumbnail – LinkedIn does that automatically, but the high-res version still pops up if you click the thumbnail.) No full-length dramatic pose shot at an angle, no tiny head in a big picture that can’t be cropped without an astounding loss of quality. And of course, as I always preach, don’t bother sending me a press release that hasn’t been posted to the news services or the company’s own site – I can’t use it unless I have something to link to. I’m not in the PR biz, but all of this seems pretty obvious to me.

Welcome to new HIStalk Platinum Sponsor ICSA Labs. The company, which is an independent division of Verizon, offers testing and certification of EHRs and health IT technology. They’ve certified over 100 health IT products since launching ONC-ATCB services in March 2011. Vendors (and self-certifying providers) have a choice of testing and certifying partners, so why choose ICSA Labs? (a) their folks have a lot of healthcare and/or interoperability experience (every employee has at least 10 years’ worth); (b) they make sure their clients are prepared for testing, providing them with documents that include sample code, interoperability tips, and step-by-step instructions; (c) they offer low prices, flexible payments, and any needed re-testing within two business days at no extra charge; (d) they help their clients market their certification. Fresh news this week is that ICSA Labs was just accredited by ANSI as a permanent certification body for ONC, meaning they can certify complete EHRs and EHR modules after the temporary program (ONC-ATCB) expires. They created a cool web page just for HIStalk readers, and based on e-mails Inga and I have swapped with some of their folks, they actually read what we write (that isn’t always true of sponsors, although thankfully it usually is.) Thanks to ICSA Labs for supporting HIStalk.

You know what’s coming next: I went to YouTube to scrounge for ICSA Labs videos that would give you a visual on what they do. Here’s a recent and nicely done webcast covering the 2014 Edition Security and Privacy criteria. I was just going to post it and move on, but I got kind of hooked on it and ended up watching a good bit of it.

On the Job Board: McKesson HSM and MAC Activation Support, Account Executive – NE and Mid-Atlantic.

Acquisitions, Funding, Business, and Stock

Gateway EDI, a subsidiary of The TriZetto Group, expands into the hospital and large-practice base with the acquisition of ClaimLogic. Terms were not disclosed, but Sermo had raised $40 million in its seven-year history.

Microsoft reports its first quarterly loss in 26 years as a publicly traded company, triggered by the full write-down of the $6.3 billion it paid to buy ad platform company aQuantive.

Application development tools vendor Progress Software names former Allscripts board chair Phil Pead as non-executive chairman. It also hires former Picis CFO Melissa Cruz as SVP/CFO.

Athenahealth reports Q2 numbers: revenue up 33%, adjusted EPS $0.24 vs. $0.12, beating consensus earnings expectations of $0.23.

Sales

The Denver Hospice selects HEALTHCAREfirst for its clinical and business operations.

Health Management Associates will implement athenahealth’s solutions for its 1,200 employed providers. athenahealth will also offer services to the 10,000 independent physicians affiliated with HMA hospitals.

In the UK, Royal Berkshire NHS Foundation Trust signs a $26 million contract with Cerner for Millennium hosting and system support.

People

MedVentive appoints Bernard Chien (Radisphere) chief technology officer.

John Lynch (Provena Health) is named VP/CIO of Greater Hudson Valley Health System (NY).

Announcements and Implementations

Duke University Health System (NC) goes live on the first phase of its $500 million Epic implementation this week at 33 primary care practices.

ANSI announces the first accredited certification bodies for the ONC’s Permanent Certification Program for HIT. They include CCHIT, Drummond Group, ICSA Laboratories, InfoGard Laboratories, and Orion Register.

CareTech Solutions releases BoardNet 4.0, a new version of its Web-based portal for hospital board members.

Healthcare Growth Partners releases its healthcare IT and services quarterly report.

Three Sentara hospitals are scheduling inpatient procedures in its Epic system, which the apparently detail-challenged local newspaper interpreted as being synonymous with “smart room technology” because the words were close together in announcement’s headline.

Government and Politics

A House Appropriations subcommittee votes to cut $1.3 billion in HHS funding and eliminate all funding for AHRQ.

CMS announces the 15 ACOs that will participate in the Advanced Payment ACO model and receive upfront and monthly payments to invest in their care coordination infrastructure.

Other

Demand for HIE consulting services is on the rise, according to KLAS. However, hospitals are struggling to differentiate among the 13 firms that offering the service.

A KLAS report on ambulatory EMR perception finds that there’s a lot of rip-and-replace going on, especially in larger practices. Systems from Allscripts, GE, and McKesson are the most replaced (not surprising since they have a lot of customers and have been around for a long time.) Most often chosen as replacement systems are eClinicalWorks, Epic, and Greenway. In addition, the win rate for vendors outside the most popular group increased significantly in the past year. Common reasons for replacement are poor support, hidden costs, and products too technically complicated for a small practice to keep running.

Vermont leaders express frustration with lack of results from $70 million in healthcare IT investment, even though most of that money came from the federal government. A Senator said, “I hear genuine frustration from providers who are spending time and resources trying to modernize and make their offices more efficient, and prepare for the future, and yet every one of them feels like they’ve been burned. Basically we’re not getting any results for these millions and millions of dollars that have been pumped into IT. We should be a lot further along. I just don’t think the leadership’s in place.”

A study finds that registered dietitians can enter physician-approved nutrition orders faster and more accurately than RNs and clerical employees. The original research article, which appeared in a nutrition journal, urges that dietitians be given access to electronic diet order systems.

A pretty funny Gawker article entitled If You Go to a Hospital in July, Get Ready to Die covers The July Effect, which fascinates laypeople because they think we hospital folks try to hide the bungling that happens when clueless new residents first try out their medical wings (we do actually try to hide that, but nobody really denies it.) Gawker’s gonzo journalism summarizes, “Being a doctor is one big game of Operation to these punks. You go in with a headache and all of a sudden they’re trying to remove your Wish Bone with a pair of tweezers, being real, real careful not to touch the sides. The stethoscopes around their necks are made of plastic. Their doctor’s coats are just one of their dad’s white dress shirts.”

Bloomberg covers a California surgery center chain that bills insurance companies exclusively at out-of-network rates, allowing its surgeon-investors earn up to 200% rate of return. The chain’s seven centers bring in $100 million per year in revenue. Aetna is suing the chain, saying it gouges on rates, excessively rewards surgeons for referrals, and defrauds health plans. One surgeon says his partnership was terminated because he didn’t refer enough patients whose insurance had extensive out-of-network coverage, or as the text message the company sent him explained, “Simple rule of thumb is Aetna, United, Cigna, and Blues with no daily max.” The company’s marketing pitch to surgeons was that their $10,000 investment would give them monthly payouts of $6,709. The Iranian immigrant who started the company did so after being inspired by her sister and brother-in law, who were making $10,000 for each out-of-network colonoscopy they performed from a rented office.

Three Chicago-area men contemplate filing lawsuits against Northwestern Medical Faculty Foundation, whose sperm freezers and alarm systems failed in April, ruining the men’s sperm samples they had stored there before undergoing fertility-affecting medical procedures.

Sponsor Updates

• GetWellNetwork creates a highlights video from its May user conference in Orlando. It’s far more interesting and entertaining than you might expect.
• eClinicalWorks was the most-used EHR among respondents to an OIG survey research the use of EHRs, the company says.
• Beacon Partners expands its HIPAA and HITECH privacy and security services into an Enterprise Information Assurance practice.
• Park Place International receives Meditech’s approval to provide OpSus|Connect and secure Meditech VPN support connectivity.
• Billian’s HealthDATA releases its report on the Ten Busiest Home Health Agencies.
• BridgeHead Software demonstrates that its Healthcare Data Management Solution meets the requirements of Integrating the Healthcare Enterprise at the European Connectathon.
• Boca Raton Regional Hospital (FL), The Independent Physicians Association of Nassau/Suffolk Counties (NY), The Huron Valley Physicians Association (MI) and The Arizona State Physicians Association are some of the new health systems and IPAs choosing Greenway’s PrimeSUITE EHR/PM solution.
• The Illinois Department of Healthcare and Family Services expands its contract with Optum to include an expanded data warehouse for advanced analytics.
• OTTR releases details of its September OTTR Users International 2012  meeting in Omaha, NE.
• MDeverywhere selects Health Language’s Language Engine and provider-friendly terminology to integrate with its charge capture software.
• Peoria Tazewell Pathology Group (IL) selects McKesson Revenue Management Solutions to provide RCM services.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

SAIC To Acquire maxIT Healthcare for $473 Million

SAIC has announced that it will acquire maxIT Healthcare in a $473 million all-cash transaction. SAIC says it will combine maxIT, which is the largest private, independent healthcare IT consulting company in the US, with its previous healthcare IT acquisition Vitalize Consulting Solutions to create the country’s largest EHR consulting practice.

SAIC had previously announced its interest in expanding its EHR implementation and integration services to offset declining federal government revenue.

maxIT Healthcare’s 1,300 employees will join SAIC’s Health Solutions Business Unit. The acquisition is expected to close in August.

News 7/18/12

Top News

Shareholder materials from Quality Systems, Inc. (NextGen) indicate that “dissident shareholder and current Board member” Ahmed Hussein has launched his fourth attempt to gain control of the company by nominating his own slate of director candidates. In announcing his action, he said, “I am confident in the potential of Quality Systems, but a hand-picked board is allowing the non-executive chairman to be declared an independent director and act in an inappropriate executive capacity.” Most interesting is that one of his director candidates is Pat Cline, the former Quality Systems president and chief strategy officer who retired in 2011.

Reader Comments

From HIT Guy: “Re: shifting capacity in the Madison market. I know there is some behind-the-scenes software that looks for doctors making referrals out.” Insurance company Physicians Plus says it will save $30 million per year in moving services from UW Hospital to Meriter.

From Stephen Yoder: “Re: prescription drug abuse. Do you think efforts like this will help?” Any solution that involves restricting the supply and not the demand is doomed to fail – all that does is raise prices and thus profits for those selling drugs. Much of the country has been blasted out of its mind since the 1970s when Valium and Librium became the mother’s little helper of choice. Drug companies have convinced patients and doctors that everything from difficulty sleeping to minor pain requires immediate pharmacologic intervention, and you don’t hear patients complaining about popping pills. Even if you completely shut off the flow of illegal drugs, you’d still have millions of people altering their consciousness with legal ones. I don’t know the answer since routine drug use no longer carries much of a stigma when everybody’s grandma is doing it.

From Doc Martin:“Re: Martin Memorial in Florida. I’ve heard their Epic installation is not going well. Supposed to cost $80 million and now north of $100 million and still climbing. The stuff is not working well and their A/R and billings are a mess.” That’s not the case, VP/CIO Ed Collins says. They hit a few snags early, but are now meeting their budgeted revenue and A/R targets. The $80 million number was spread out over 10 years and they are pretty sure they’ll meet or beat that number. Martin successfully attested for MU Stage 1 for Medicaid and Medicare last week.

From HITEsq: “Re: McKesson lawsuit. A small Texas practice is suing McKesson for a failed EMR install. It’s not clear what happened, but there are complaints about failing to transfer patient histories, a weird HIPAA violation, and the price of hardware. They’re seeking less than $100K in damages.” It’s something about copying records from one practice to another when the former office neighbors went their separate ways, but only for patients that were moving to the new practice. The new practice’s doctor says McKesson couldn’t copy just the specific records, so they copied everything. We haven’t heard McKesson’s side of the story, but it sounds like the doc should have done more due diligence, as evidenced by complaining the lawsuit that the contract required the practice to buy the “severely overpriced” hardware from McKesson. I would hope the parties will settle instead of making their lawyers rich.

From A CEO: “Re: ambulatory healthcare IT market. Lots of rip and replace. Significant teasers from investment bankers on EHR deals. Practices that sold their souls to hospitals are getting a peek at reality.”

HIStalk Announcements and Requests

Today’s post may be a bit less comprehensive and more likely than usual to contain grammar or spelling errors. I missed work today (which almost never happens) with a temperature of 101.5 and I’m feeling less than stellar, but I’ll do what I can despite fuzzy cognition and sweat dripping onto my keyboard.

Here’s a brief Listening, involving the singer-songwriter genre, which I usually detest because I don’t like warbled twee love songs. My one and only exception: John Dawson Read, who had a modest hit or two in the 1970s and then disappeared from the music industry. I first heard this song, which he wrote about his friend Tommy Davidson (not the guy from In Living Color) going blind from muscular dystrophy, many years ago on late-night radio when it was already old, and I never forgot it despite only one listen. I just happened to run across it on YouTube this week. Pure genius. He’s even making new music after a three-decade break.

Welcome to Wellcentive, joining HIStalk as a Gold Sponsor. The Roswell, GA-based company offers solutions for population management, care management, Patient-Centered Medical Home, and accountable care. Consider its Advance Outcomes Manager, an open, cloud-based data aggregation platform that provides analytics, risk modeling, and a clinical rules engine for management population health and quality (here’s a case study from Lakeshore Health Network). Clinical decision support capabilities include care gap alerts, medication reconciliation, patient report cards, and secure messaging. It’s pretty cool that the company announced its sponsorship, although making me blush by calling HIStalk a “thought leader” (although maybe it’s my pyrexia that’s causing the blushing.) Thanks to Wellcentive for supporting HIStalk.

My predictable YouTube foray turned up this recent video on Wellcentive’s Advance Outcomes Manager, which explains it in two minutes.

Acquisitions, Funding, Business, and Stock

Zebra Technologies acquires LaserBand LLC, a maker of patient ID wristbands.

Internet-based transcription provider iMedX completes the acquisition of the medical transcription assets of Electronic Medical Transcription Services (eMTS).

Sales

Epic Medical Center (OK) selects RazonInsights’ ONE solution for inpatient clinicals, financials, and ambulatory practice management.

Hacienda HealthCare (AZ) purchases Healthland Centriq EHR for its 15-bed hospital and long-term care facility.

Pacific Health Corporation (CA), Physicians for Healthy Hospitals (CA), and Optim Healthcare (GA) select McKesson’s Paragon HIS.

People

The SSI Group announces the retirement of Bobby Smith, its founder, CEO, and president. VP/CFO James M. Lyons will replace him.

Former Vitera SVP Lee Horner joins Eliza Corporation as SVP of sales for the company’s health engagement management segment.

EnovateIT appoints Mike Wilson (Compuware) as its chief strategy officer.

Huron Consulting Group promotes Hazel Seabrook to lead the company’s clinical operations solution within Huron’s healthcare practice.

Maxim Healthcare Services appoints Andrew Friedell (Medco Health Solutions) as VP of government affairs.

Announcements and Implementations

The Hawaii Island Beacon Community announces the expansion of its Alere Wellogic HIE following a successful pilot at North Hawaii Community Hospital.

Hunterdon HealthCare Partners establishes an ACO with Aetna using Medicity’s HIE technology.

ADP AdvancedMD deploys its 2012 Summer release, which includes an iPad app, new ICD-10 tools, and workflow improvements for pediatrics.

ICA announces the launch of Kansas Health Information Network’s direct messaging capabilities.

NCHICA and Oak Grove Technologies create a mobile app of the HITECH Act Breach Notification Risk Assessement Tool. Its $1.99 on iTunes.

Amcom Software releases Version 5.0 of its critical test results solution, which it recently acquired from IMCO Technologies. It has earned FDA’s 510(k) clearance as a Class II medical device.

Botsford Hospital (MI) joins the Michigan Health Connect HIE.

Orlando Health’s neurologists use Polycom’s RealPresence to assess and treat stroke patients from their tablets. The health system will expand its use of the technology to trauma collaboration.

Aprima announces an app to provide mobile EHR access on iPhone or Android devices.

Other

The CDC finds that 55% of US doctors use some type of EHR, with 85% of them reporting being either somewhat or very satisfied with its day-to-day operations.

Weird News Andy says this is what happens when the government runs healthcare. In the UK, NHS addresses budget cuts by suggesting that all provider contracts be redrafted, to include pay cuts, elimination of overtime and holiday pay, and reduced vacation. If they don’t like it, they’ll be let go.

Two UK hospitals say that problems with their Cerner Millennium implementation caused appointments to be cancelled or were mailed to patients with incorrect dates, requiring the spending of $7 million to fix the problems. However, an independent review says the hospitals themselves were the problem – they didn’t have enough skilled employees, training was inadequate, they let IT run the project instead of operational leadership, and the trust ignored outside advice and declined to follow its own governance processes.

Sponsor Updates

• Allscripts VP of Strategic Initiatives Rich Elmore provides details of his one-year leave of absence serving as ONC coordinator for Query Health.
• MedHOK achieves 2012 Disease Management performance measures certification for its 360Care software.
• University of Louisville Hospital is using Access Intelligent Forms Suite to import electronic documents into Siemens Soarian without manual indexing.
• Beacon Partners offers a hospital roundtable discussion white paper on ICD-10.
• Surgical Information Systems releases the results of its survey showing that surgeons view technology as a tool to reduce errors and improve quality of care.
• eClinicalWorks, Allscripts, GE, NextGen, and Greenway are named among the top nine EHR vendors the Office of Inspector General in a report on the progress of EHR implementations.
• Alfa Insurance selects Kony Solutions to launch its Alfa2Go mobile app.
• Streamline Health Solutions and nTelagent enter into a joint marketing agreement to support revenue cycle improvements and patient access.
• INHS announces that 16 of its clients have been named “Most Wired” hospitals for 2012.
• Cloud-MD contracts with DrFirst to integrate DrFirst’s e-prescribing capabilities into Cloud-MD’s PM/EHR.
• Iatric Systems highlights how its PtAccess solution enabled Griffin Hospital (CT) to successfully meet Meaningful User criteria.
• Digital Prospectors Corp receives three awards in the Top 2012 Businesses of New Hampshire.
• Macadamian’s Director of Research Lorraine Chapman presents best practices at the 9th Annual Healthcare Unbound Conference in San Francisco this week.
• Culbert Healthcare Solutions promotes Tom Gantzer and Jason Drusak to managers of Epic Consulting Services.
• An AT&T-sponsored physician practice technology survey finds that 37% of practices have fully implemented an EHR. Expense continues to be the top reason practices say they’ve not done so.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 7/16/12

From The PACS Designer: “Re: Bromium Microvisor. An interesting concept is forming at Bromium in the development of a micro-web browser within your main web browser. The Bromium Microvisor encapsulates e-mails, PDFs, and other documents within a micro-visor so that malware can’t infect your operating system. When you delete an e-mail or other document, the malware is deleted as well, and your operating system is protected. This concept may be a solution to consider for healthcare institutions who have to daily deal with numerous mobile devices.” Bromium is a lightweight and transparent hardware-based utility that limits what a launched malware application can do, isolating it so it can’t infect anything outside of its own assigned micro-virtual machine even if the malware penetrates company e-mail or secured sites. A standard laptop can run hundreds of simultaneous micro-VMs, each of which run in their own little world without running a separate instance of the operating system. It would be great for bring-your-own-device security, but only if your own mobile device runs Windows on an Intel processor (not likely) since that’s all Bromium supports at the moment.

From The Borg: “Re: resistance is futile, you will be assimilated – signed, Epic. This may have always been out there, but in the 2012 release, they have renamed ‘Now Showing’ as Epic Earth.”

From DBD: “Re: video. See Death by Deletion.” I think I’ve mentioned this before since it’s an old story. Whistleblower and risk manager Patricia Moleski claims her former employer, Adventist Health System, manipulated electronic patient information for various reasons to protect itself against liability. She also claims that a bug in AHS’s Cerner system caused patient injury and death. She says she was then fired, legally bullied, and intimidated by gunshots to her house and the burning of her car. That’s her side of the story, which I would be cautious about taking at face value without hearing the other side. She’s not mentioned on the Web very much, other than by sites catering to workers’ rights and those who claim the Adventist faith is a cult, so I don’t know what happened with her claimed involvement as an informant with the FBI, which she says was investigating her charges. This incident is a couple of years old, so you would think it would have been resolved one way or another by now.

Listening: new from Marina and the Diamonds, which is really just quirky Welsh-born singer-songwriter Marina Diamandis and her backing band. She’s intentionally playing the character of a witty, cynical, and insightful pop star with an American celebrity attitude, fronting music that ranges from faux bubblegum to 80s New Wave. Good for fans of Florence + The Machine, although the less-concepty first album (The Family Jewels) is probably a better starting point.

Go after insurance companies if you want to control healthcare costs, said respondents to my most recent poll (though they are also suspicious of malpractice attorneys). New poll to your right: will telehealth improve healthcare quality and/or reduce costs? Before complaining that I should have included 20 other answer choices (as a few folks always do when faced with the polarizing characteristics of questions with a Boolean answer choice), note that you are not only permitted but actually encouraged to add a comment after you have been forced under duress to choose one answer or the other. That’s where you may opine more extensively than your allotted one click allows.

Thanks to new HIStalk Platinum Sponsor CommVault, whose Simpana solution allows its health system clients to protect, manage, and access their organizational information. Hospitals use Simpana’s single console to manage all of their enterprise information: application data, messaging, files, and databases, from laptops to the cloud. Simpana bundles backup, archiving, and reporting into a single platform. The company is partnering with EMR and PACS vendors to simplify healthcare data management, ensuring security and compliance, managing data growth, cutting storage costs by up to 50%, and supporting the establishment of a common set of data and information management policies. Data growth has messed up the backup and restore capabilities of many organizations, motivating 16,000 users to save time and money by leaving NetBackup, Networker, and TSM behind and moving to Simpana (CommVault has conversion tools). If you run legacy backup software, CommVault suggests that you ask these five questions before renewing your maintenance agreement. Thanks to CommVault for supporting HIStalk.

 
I headed over to YouTube to look for a CommVault Simpana overview, so here’s a webcast that explains it. I also found this Gartner video that includes an interview with CommVault customer Sharp HealthCare, as VP Teri Moraga talks about the health system’s storage needs and solutions at around the 6:30 mark (and why they switched to Simpana at around 9:15).

Dr. Jayne has previously pontificated on both the zombie apocalypse and smartphone addiction, so I thought of her when I saw this.

The Florida National Guard hosts representatives from five Caribbean islands to discuss the military’s use of electronic medical records.

Penn State Hershey Medical Center names Rod Dykehouse (ProHealth, UCLA – left) as CIO. Former CIO Tom Abendroth MD (right) will become the hospital’s first chief of medical informatics, leading efforts to use its EMR to improve care and research.

Former Mediware COO John Damgaard is named president of nursing home software vendor MDI Achieve.

Huntington Memorial Hospital (CA) chooses Infor’s Lawson solutions for financial management, supply chain, and analytics.

Representatives of a local hospital district in Minnesota are “reeling” after the breakdown of talks with executives of Essentia Health, which leases the 25-bed critical access hospital. Hospital board members complained that Essentia isn’t investing in Essentia Health – Sandstone and gave notice that the board was cancelling Essentia’s lease that expires in August. Essentia then fired the top two hospital executives and said it would exercise its option to buy the hospital outright. The two main issues are hospital oversight and the EMR system used by the hospital, which they want to keep instead of replacing it with Essentia’s system (which I believe is Epic.)

The San Francisco business paper mentions that Washington Hospital Healthcare System (CA) is halfway through its $86 million Epic implementation.

The Joint Commission revises its standards pertaining to the use of scribes in hospitals, adding Physician Assistant as a professional for which scribes may perform EMR documentation under their supervision (along with physicians and advanced practice nurses.) TJC also specifically said that scribes should not enter orders directly into CPOE systems.

A BMJ article says the British government is premature in advocating the widespread use of telehealth as a way to cut cost and improve care, claiming that preliminary findings are inconclusive. One of the authors says her own hospital trust has looked at everything that might reduce hospital admissions and none of the potential solutions, including telehealth, has reduced the rate of increase. A previous study by the same trust concluded that increased efficiencies in discharging patients may have simply opened up more beds for doctors to fill, allowing them to admit more patients. I noted, however, that despite the imposing BMJ (the former British Medical Journal) on the article and a list of academic-looking citations, this particular article is a feature written by a freelance journalist. The same issue has several articles on telemedicine, though.

I’ve reported this previously: FDA launched electronic surveillance of its own scientists, intercepting the e-mails of those on its “enemies list” who criticized the agency. The FDA’s document imaging subcontractor botched the project by inadvertently posting the intercepted documents to the Internet, allowing anyone (including The New York Times) to read e-mails that had been sent to members of Congress and even the President. The scientists found out and are suing. Senator Chuck Grassley, upset that e-mails of one of his employees turned up in the surveillance database, called FDA “the Gestapo.” FDA used parental monitoring software sold commercially for $99.95 to spy on its scientists, who they suspected of leaking confidential vendor information about medical imaging equipment which they believe exposes patients to excessive radiation.

A Mississippi oncologist, her office manager, and her billing clerk plead guilty to overbilling Medicare and Medicaid by $15 million for cancer drugs. Prosecutors say the cancer clinic administered drugs while the doctor was overseas and also reused needles and diluted chemo drugs. The clinic was shut down and $6 million was seized from the doctor, but she has been held without bond because she has plenty of money left and is considered a flight risk to head back to her native India.

An editorial in The Australian says the government’s Model Healthcare Community Roadshow is guilty of misleading advertising in pitching that country’s $1 billion personally controlled e-health record (PCEHR). The critique says PCEHR may contain a few physician-uploaded medical summaries, but there’s no way for hospitals, EDs, specialists, or pharmacies to add information, and any updating that occurs is not real time. The road show truck shows diagnostic images even though PCEHR can’t accept images yet. The article concludes that as a voluntary system, doctors have already said they won’t rely on its information for making treatment decisions.

A Weird News Andy find: a California urgent care doctor suspected of writing prescriptions for cash examines an undercover officer, studying the x-ray the patient brought in and helpfully pointing out the bones causing the pain for which the doctor recommended “Roxicodone? Or oxycodone? Or whatever you want.” His diagnostic acumen might be questionable, however, given that he missed the fact that the patient had a tail, according to the x-ray (which was actually of a German shepherd and was clearly labeled as coming from an animal hospital). The doctor, who was previously convicted of taking kickbacks for Medicare home health referrals, was arrested for improper prescribing.

Vince ties up loose ends on HMS, including taking an interesting peek into what systems the under-100 bed hospitals use and what they cost. For the next HIS-tory, Vince will start a series on Keane. He’s looking for help from anyone with details about the companies Keane acquired over the years — Source Data Systems, Infostat, PHS Patcom, CHC, or Pentamation / Ferranti. If you can help out with fun anecdotes or yellowing documents, e-mail Vince. He is always effusive with his thanks and generous with his acknowledgments.

E-mail Mr. H.

Dr. Sam 7/13/12

MEMS and the Patient – Computer Real-Time Interface

We are an industry of fads and trends. As a close consultant friend of mine often says, our industry spends hundreds of millions of dollars annually trying to differentiate between the two. "Futurists" tell us what is happening next – or sometimes what is happening after what is happening next – a relatively safe place from which to operate since by the time whatever happens after what happened next happens, it is too late to get your money back.

I’d like to discuss an essential technology with unlimited application to healthcare technology and quality care that has been quietly happening while everything else that is happening next has been happening – almost completely under the healthcare IT industry radar.

Have you ever wondered how your cell phone or iPad display knows how to orient itself depending on the position in which you are holding your phone? How your digital camera remains stable enough to take a perfect picture even though you know you moved a little bit when you pressed the shutter button or icon? How the compass application on your cell phone knows the direction you are pointing the phone? Or how your Wii game reproduces the tennis stroke, golf stroke, or punch that you deliver with the handset swinging in midair with just the right direction and intensity?

Just a few decades ago, we marveled that entire computer circuits could be on a single chip the size of the head of a pin. Today, micro-machines are created and produced on silicon chips that fit easily on chips of the same size. Almost any machine that you can imagine – with actual moving parts – can now be embedded in microchips. That includes (but is no means limited to) gyroscopes, radios, sensors (pressure, radiation, stress), transmitters, levers, hinges, gears, chain assemblies, micron-sized motors, tweezers, pumps, separators, injectors, needles, scalpels, propellers, turbines, mirrors, …. and on and on. The Industrial Age is being reborn on a microscale and even a nanoscale level. The science of MEMS – Micro-Electrical-Mechanical Systems – is well underway and has been for more than a decade.

That positional sensor that rotates your cell phone display is a microscopic acceleration detector. Micro gyroscopes keep your camera steady. MEMS sensors keep choice lists and drop-down menus scrolling on device screens when you speed up your touch movements. Combinations of such devices tell your Wii machine if you just threw a jab or an uppercut and how hard you punched. Within a few months of the tsunami disaster in Japan, micro-radiation detectors were available within cell phone circuitry to serve as alerts to radiation exposure.

On the nano scale, sensors based on silicon chips use electron spin instead of charge to store information using nanoscale layers of magnetic film with thickness measured in atomic levels.

The implications for medicine and healthcare are both endless and mind-boggling. Embedded microchips are currently capable of measuring and transmitting real-time blood pressure and glucose levels in a linear timeline. Hearing aids are likely to be replaced by self-adjusting artificial cochleas. There is active development of artificial implantable retinas. Cardiovascular stunts are being designed to measure and transmit blood flow and therefore the integrity, patency, and efficiency of the stent (cheaper and more accurate than CT scanning). Embeddable microchips can perform and transmit lab analysis studies and even do DNA analysis. Micro pressure sensors can transmit intra-arterial pressure in abdominal aortic aneurysms. Pressure sensors in contact lenses and even embedded in the iris can transmit intraocular pressure measurements for real-time monitoring of glaucoma treatment.

As we struggle to implement electronic health records to maximize real-time documentation, order entry, lab reporting, and data sharing, an entire science is developing that is capable of delivering direct exchange of digital information. Not between external devices, but directly from within the bodies of our patients.

Imagine how this capability might eventually impact health information exchanges, data collection, outcomes monitoring and adherence to protocols, developing personal health records, and the concept of the Medical Home.

The trends of today may well fade to fads that have been eclipsed by science that has outpaced them.

The MEMS industry itself is no fad. In 2001 it was a $215 million industry. According to IHS iSuppli‘s market intelligence, MEMS revenue will grow at an enviable 9.7% CAGR (compound annual growth rate), from $7.9 billion in 2011 to $12.5 billion in 2016. This compares to only 4.5% for the overall semiconductor industry. In term of units, shipments of MEMS sensors and actuators will more than double, from 5.4 billion in 2011 to 13.7 billion devices in 2016—a 20.7% CAGR.

An entire renovation and revolution in how we diagnose, treat, measure, and monitor is soon to envelop us.

Gentlemen, start your nano-engines.

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

News 7/13/12

Top News

University of Virginia settles its $47 million breach of contract lawsuit against GE Healthcare over what it claims was a botched IDX implementation going back to 1999 (the suit wasn’t filed until 2009.) UVA wanted a refund of the $20 million it paid IDX (later acquired by GE Healthcare), but GE said UVA violated the contract by neglecting its own responsibilities related to project staffing and workflow analysis. UVA signed an Epic contract, then terminated its agreement with GEHC. Terms of the settlement were not disclosed.

Reader Comments

From HITEsq: “Re: Allscripts and Cerner. Both sued by RLIS for patent infringement. Based solely on the complaint, it appears that RLIS tried its hand at the EMR industry in the late 1990s and failed.” I’ve never heard of the company, but they did file the lawsuits.

From Lindy: “Re: MD Anderson. They got tired of trying to build their own EMR over the past eight years when everyone around them is up on Epic or Cerner. Their new president probably forced a fresh look at the huge costs and minimal results from their internal software development effort.” Unverified, and I assume speculative based on the wording provided. If it’s true, I would add one comment – the vendor pickings were slim back when MDA first started developing ClinicStation. Then-CIO Lynn Vogel wrote on HIStalk about their development work in January 2009.

From Newport: “Re: Capsule. Acquired by JMI Equity. The press release makes it sound like this was simply an investment, but it is an outright acquisition of 100% of the shares.” Capsule announces a strategic investment from JMI Equity and the appointment of Gene Cattarina as CEO, replacing Arnaud Houette (who will remain on the company’s board). Cattarina’s background includes executive roles at Impulse Monitoring, Lynx Medical, E&C Medical Intelligence, Landacorp, Medicode, and TDS Healthcare Systems. Some of JMI’s other healthcare IT holdings are Navicure (revenue cycle management),  Courion (identity management), and PointClickCare (EHR for long-term care.)

From Ross: “Re: reading suggestions. I’m a relative newcomer to HIStalk and to the industry in general. I’m interested in reading suggestions to deepen my understanding of the field. I’d love to know what readers are reading, even if it’s not about healthcare.” Leave a comment if you’d care to pass along suggestions to Ross.

HIStalk Announcements and Requests

I’m back from vacation, sort of. Even though I posted several times that Inga and I would be out this week in a rare but unavoidable simultaneous absence, a few folks kept e-mailing the same requests every day, apparently either unwilling to believe that we aren’t hard wired to e-mail 24×7 or thinking that a lack of immediate action on our part meant we were being unresponsive and thus in need of a more forceful request (I really dislike that about post-iPhone electronic communication – expectations for e-mail are what they used to be for instant messaging, where a delay of more than a few hours is perceived as being irresponsible.) I figured I might as well forget the rest of vacation, come home early, and get back to work. I was annoyed enough that I cancelled a new sponsor who was e-mailing me daily wanting one thing or another immediately, even though I replied every time that I was on vacation and would get to it when I got back. For everybody else, I will most likely spend the weekend catching up before going back to work at the hospital on Monday. At least I got to take a short break, working only a few hours early in the week while enjoying time away with Mrs. HIStalk.

Sales

Parkland Hospital (TX) selects M*Modal Fluency for Coding(TM) in preparation for ICD-10.

Memphis Obstetrics & Gynecological Association (TN) chooses MED3OOO’s InteGreat EHR for its 24 providers.

South Hills Radiology Associates (PA) will implement McKesson Revenue Management Solutions for its 13-physician practice.

Jacobs Engineering Group announces a $20 billion contract award it won to provide a variety of IT support services to NIH and other federal agencies.

Announcements and Implementations

INTEGRIS Health (OK) deploys Amalga from Caradigm.

Quintiles and Allscripts partner to develop solutions improving processes for clinical and post-approval drug research.

Ten-bed Guadalupe County Hospital (NM) goes live on Medsphere OpenVista.

Other

Here’s the latest cartoon from Imprivata.

KLAS announces a new enterprise imaging report, finding that the top two strategies are vendor-neutral archive and PACS enterprise archive solutions. Those surveyed mentioned GE and Philips most often as strategic enterprise imaging partners, while Agfa and Merge are mentioned most often for the VNA-centric strategy.

CSC begins laying off employees involved with the failed NPfIT project in the UK.

The local TV station covers the $70 million implementation of Epic (which they inexplicably spell EPIC) at Lee Memorial Health System (FL). It’s the typical TV piece, light on research and heavy on anecdotal chat, but aimed appropriately for laypeople with marginal interest.

FDA’s Jeffrey Shuren MD, JD, in an NPR interview, says some apps that behave as medical devices (like those that turn a smartphone into an EKG machine) need FDA’s review before marketing, but the agency has no interest in overseeing apps related to lifestyle, wellness, and management of personal medical conditions.

Weird News Andy finds this news cool, but scary (and asks, “First Amendment, anybody?”) The Department of Homeland Security has developed a laser-based scanner that can analyze people at the molecular level from up to 164 feet away, detecting everything from illegal substances to high adrenaline levels. It’s the last paragraph of the article that gets WNA’s attention: “Although the technology could be used by ‘Big Brother,’ Genia Photonics states that the device could be far more beneficial being used for medical purposes to check for cancer in real time, lipids detection, and patient monitoring.”

Sponsor Updates

• Imprivata receives a patent for its “biometric authentication for remote initiation of actions and services.”
• TeleTracking announces enhancements to its capacity management software to help hospitals manage length of stay and increased transfer center volume.
• AlliedHIE (PA) and ICA announce the go-live of Allied-DIRECT allowing AlliedHIE to recruit providers to join the statewide DIRECT grant program established by PA eHealth Collaborative.
• The Salvation Army and MedAssets partner to provide healthier choices in food and nutritional items at a better cost through MedAssets buying contracts.
• OTTR will host a July 18 webinar demonstrating its soon-to-be released OTTR Mobile.
• Merge Healthcare will offer OrthoPACS, its new image management and digital templating solution for orthopedics, as a subscription model.
• A military-specific version of the Vocera Communications System earns the Department of Defense’s Joint Interoperability Test Command certification.

EPtalk by Dr. Jayne

NCQA offers a seminar on facilitating PCMH recognition. It will be held on August 21 and 22, with a session on PCMH Best Practices and Lessons Learned to follow. I guess that’s like a stiff drink with a chaser. I’m not sure I could handle three full days of PCMH, especially with the steep price.

The Institute of Medicine reports that as baby boomers age, the nation is unprepared to deliver mental health services to that population. I would argue that based on the decline of primary care and the challenges of Meaningful Use as well as the continued problem with Medicare payments, we’re pretty much going to be unprepared to deliver a lot more services than just mental health.

Wisconsin-based Asthmapolis receives FDA approval for its asthma inhaler sensor. The prescription device captures timestamp data on asthma attacks and transmits it to the company. Patients can use mobile and web software to track asthma symptoms and triggers. Additional features include text messaging for medication reminders.

IT staffers beware: a recent study links sitting more than three hours each day to a shorter life span. I wonder if they controlled for various different types of sitting? I think sitting in meetings viewing endless badly-done PowerPoint presentations will take much more off one’s life expectancy than sitting on the beach with an umbrella-bearing cocktail.

Hallucinogenic club drug ketamine (known as Special K) is being tested as a potential treatment for depression. Ketamine is used as a horse tranquilizer and as a sedative for pediatric patients. In adults, it can give them disturbing hallucinations. One scientist comments, “If not used carefully, we could end up curing depression with schizophrenia.” Anyone want to volunteer for that clinical trial?

According to a recent report, fear of errors in computer-aided E&M coding may lead physicians to code visits manually. The CEO of the American Medical Association is pushing for testing of coding recommendations during EHR certification. How about this: we convince CMS to institute a fair system for compensating physicians instead of giving them games to play with two different coding schemes and a nauseating array of arcane rules and aggressive auditors.

I appreciate the number of readers who were able to identify the photo of Harney Peak (also known as Black Elk Peak or Saint Elmo Peak) and especially those readers who didn’t cheat and load the link associated with the photo. The structure in question is a fire lookout tower – correctly identified by several other readers even if they didn’t know the specific location. Two readers tried to identify it as a fire tower near El Centro, CA which tells me there must be one pretty similar. Another thought it looked like an 18th century European signal tower, and having seen a few of those, I tend to agree. Our winner is Richard S., who gets the bragging rights.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 7/11/12

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

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

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

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

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

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

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

Sponsor Updates

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

E-mail Mr. H.