Monday Morning Update 10/1/12

From DanburyWhaler: “Re: Western Connecticut Health Network. The manager we thought was being groomed to take over as CIO is gone after three months. They are laying off people left and right. The major construction budget is way over.” The hospital recently laid off 28 employees, citing economic conditions, state taxes, and general healthcare trends. The $150 million expansion is pictured above.

From Boomer: “Re: Patrick Soon-Shiong. The billionaire’s healthcare coming out event is this Wednesday, when he will announce the results of an oncology-focused application of his supercomputer / high-speed fiber / middleware / mobile platform that he has been building for years. He claims that 8,000 oncologists using his decision support tools lowered the patients receiving the wrong treatment from 32% to 0%.” He’s presenting at the Bipartisan Policy Center’s October 3 conference in Washington DC, Accelerating Electronic Information Sharing to Improve Health Care.

From At Northwestern: “Re: Epic. No commitment from Northwestern Memorial Hospital to move to Epic.” Like the original rumor saying they were making that move, this one is unverified.

From Bean Multiplier: “Re: Allscripts. I hear from a good source that the company would be willing to take a private equity deal for $15 per share.” Unverified. Shares closed Friday at $12.42, up 14% on rumors that the company is exploring a possible sale to private equity. Shares were last above $15 on April 26, the day before the company fired Chairman Phil Pead, after which three of the company’s board members quit in protest. Even now the P/E ratio is at 40, about the same as Cerner’s. I assume the P/E ratio takes into account the $200 million of repurchased shares, which would have raised earnings per share by reducing the share count rather than reflecting increased profits. Bloomberg did not cite the source of the “possible sale” rumors, which could either be an informed, unbiased source or a pump-and-dumper trying to unload some shares on the market’s reaction to the non-news.

From The PACS Designer: “Re: RIS/PACS integration. There’s been some fresh looks at how a RIS fits into the flow of information between radiology presents, and the submission for and completion of a radiology study. Since most configurations between the RIS and PACS are customized at each institution, it leaves many opportunities for a future RIS/PACS upgrade to be a more robust information source. This upgrade should provide two-way information flow so everyone can plan their activities each day more efficiently. One way to achieve the better information flow goal is to insist that the new system of a combined RIS/PACS come from the same vendor.”

From Miraculous Miler: “Re: John Landis of Cerner. Rumor is that he’s gone.” Cerner’s media relations department confirms that John Landis, SVP of ClientWorks, has left the company.  

From MumpsInToronto: “Re: University Health Network, Toronto. Going to RFP. They are running QuadraMed now, which is MUMPS based. From the volume of data that will need to be converted, you can bet they will be looking at Epic.” Unverified.

McKesson announced Better Health 2020 and an investment of $1 billion in R&D in last December. Three-quarters of poll respondents said the company’s healthcare IT position is worse now than then. New poll to your right: has the use of EHRs increased Medicare fraud?

Welcome to new HIStalk Gold Sponsor Agilum Healthcare Intelligence of Franklin, TN, which describes its offerings as “Business intelligence in a box.” Modules include Service Line Costing and Profitability (margins by service line and payer, case mix trends, length of stay and volume trends, DRG mix, margin by physician, etc.); Revenue Cycle Performance (dashboards, A/R performance indicators, ageing reports, net revenue modeling, and denials by reason); Operational Performance (executive view with KPI line item indicators, facilities operations and department dashboards, daily volume dashboards and forecast, and operating ratios); and Productivity Manager (departmental dashboard, pay period reports, daily reports, overtime ratio reports, and skill mix reports). One of the most technologically astute hospitals in the world, Bumrungrad International Hospital in Thailand, recently signed up for Agilum’s business intelligence solutions to improve its operational, managerial, and financial decision making. Thanks to Agilum Healthcare Intelligence for supporting HIStalk.

I headed over to YouTube to see what I could find on Agilum Healthcare Intelligence. Above is an overview.

I had heard reports that HCA signed a big contract with Epic to replace its Meditech system, but two HCA sources told me off the record that it’s still just one HCA site piloting Epic so far. HCA is still rolling out Meditech CPOE.

Epic consulting firm Nordic Consulting announces that it has raised growth capital from SV Life Sciences, Health Enterprise Partners, and HLM Venture Partners. All three backers focus on healthcare, with the one catching my eye being SV Life Science since Bruce Cerullo is a venture partner there in addition to being the CEO of Vitalize Consulting Solutions that was sold to SAIC a year ago.

CapSite releases its 2012 Ambulatory EHR & PM Study. It finds that 40 percent of organizations are still in the market for an ambulatory EHR, with most of them planning to buy within the next two years. The practice management market offers less opportunity, with only 27 percent of responding organizations indicating their interest in buying or upgrading and just 21 percent saying they would replace their current practice management system to move to an integrated PM/EHR.

Pearson and Cerner announce RealEHRPrep, an EHR learning tool for nursing students.

The UK’s Department of Health admits that the failure of its NPfIT project means it no longer owns rights to the software developed for it by CSC using billions of dollars of public funds. The original contract called for software ownership as one of four terms that were to protect the government’s interests if the project failed, which it did, but either the contract was incorrectly drafted or the government negotiated the rights away in trying to avoid a CSC termination lawsuit. The Department of Health and vendors involved (CSC and BT) are ignoring information requests, according to the ComputerWeekly.com article.

Also in the UK, and external review finds that the rate of clinical errors increased after NHS turned over operation of its pathology laboratories to the multinational corporation Serco. The report by a non-profit watchdog also found that the money-losing JV required hospitals to chip in cash to keep it afloat, and even then the company will pull out of certain markets. Computer problems caused some of the patient-related problems: a patient received the wrong blood type after the software failed to issue a warning, an incorrect creatinine clearance calculation was highlighted as a near miss, and the company’s blood analyzers were shut down for four days after becoming infected with a computer virus.

And also in the UK, a report commissioned by Imperial College Healthcare Trust concludes that 3,000 of its cancer patients have not been seen promptly because the hospital uses 17 different computer systems, some of them requiring manual data entry. The trust says they’re looking for a single system, but the report warns them of the risks involved.

A Wall Street Journal article listing the top 50 startups says that healthcare has fallen out of VC favor based on its somewhat subjective criteria, with last year’s top-ranked Castlight Health dropping off the list entirely.

The VA was expected to award a contract for mobile device management software by Sunday, September 30, the end of its fiscal year.

Weird News Andy likes this story, in which police used fingerprints to locate the former owner of a human finger that was found inside a fish caught from an Idaho lake. When the sheriff called a wakeboarder who had lost four fingers in a towline accident in June, he immediately responded, “Let me guess – they found my fingers in a fish.” The sheriff offered to return the well-preserved digits, but the man declined, saying, “Uh, I’m good.”

Another WNA find: pathology researchers at Georgetown Lombardi Comprehensive Cancer Center (DC) develop a method of testing the susceptibility of a patient’s specific cancer cells to various chemotherapy drugs, much like the routine culture and sensitivity tests that help doctors choose an appropriate antibiotic for a given infection.

Here’s Vince’s HIS-tory on QuadraMed, Part 3, which purely coincidentally provides a history of the Quantim product line that the company just announced that it’s selling to Nuance.

Sponsor Updates

• Vitera Healthcare’s VIBE user group meeting was held September 12-14 at Disney’s Grand Floridian Resort & Spa in Lake Buena Vista, FL.
• Optum announces an ICD-10 education program for hospitals.

E-mail Mr. H.

News 9/28/12

Top News

The American Hospital association agrees in a letter to HHS Secretary Kathleen Sebelius and the Attorney General Eric Holder that EMR-assisted cloning and upcoding should not be tolerated, but retorts that CMS has ignored its repeated recommendations to expand E/M (evaluation and management) codes to create a national standard for hospital ED and clinic services. My opinion: the election-sensitive, administration-friendly HHS’ers got blindsided by a Center for Public Integrity article that insinuated but didn’t prove that a shift to higher complexity codes means that EDs and physician practices are gaming the system to the tune of $11 billion, so given too little time between now and the November 6 election to actually do something useful (like identify and prosecute someone who’s actually guilty), HHS just went public with meaningless finger-wagging to make it appear that they’re on top of the situation. HHS keeps bragging on how great their fraud detection systems are (which they should be, given the hundreds of millions paid to fat cat contractors to develop them), yet they apparently trust journalists more than their own armies of bureaucrats to tell them they have a problem. The reimbursement system is even worse than the tax laws in being a confusing hodgepodge of rules that nobody, even CMS, really understands or can interpret consistently. Some providers are undoubtedly committing fraud and the 99% honest ones would love to see them shut down and punished. However, as with tax loopholes, there’s nothing illegal or immoral about taking the maximum benefit that the law allows. There’s a reason that crime syndicates are moving from drug dealing to Medicare fraud: payment is quick and rarely questioned, the money is great, and the risk of actually going to jail is almost zero.

Reader Comments

From High Roller: “Re: QuadraMed. Quantum is just the first QuadraMed domino to fall. Franciscan Partners isn’t interested in holding on to the rest of the company forever, so it won’t be long before the other pieces are sold off. QuadraMed has a large enough client base, so they could milk their revenue stream for awhile. More likely, Franciscan will look to sell what’s left to someone like Allscripts who’d be interested in having a larger client base to sell into.”

HIStalk Announcements and Requests

Highlights from the last week on HIStalk Practice: patients want more online access to their health records but most doctors don’t offer the option. Lack of staff impacts EHR adoption, especially in smaller practices. Tips for using an EHR as a marketing tool and to increase patient satisfaction. Parents are more likely to fill children’s e-prescribed prescriptions than paper ones. Physicians are working fewer hours and seeing fewer patients than they were four years ago. I am looking for some MGMA picks. Thanks for reading.

Welcome to new HIStalk Platinum Sponsor Emdat, which offers hybrid clinical documentation and transcription solutions that improve the productivity and satisfaction of EHR-using physicians. Instead of pointing and clicking, physicians continue to use the most efficient method of documenting patient encounters – dictation. Emdat’s DaRT system automatically tags sections of transcription content (chief complaint, medical history, etc.) and then seamlessly auto-populates discrete information directly into the EHR just as though the physician entered it directly using structured documentation. Its Emdat Mobile solution not only allows physicians to document encounters on the go, but provides a more patient-friendly way to document during an encounter. Loyola University Health System uses it with Epic and says the setup was simple, reducing transcription turnaround time by 50% and allowed doctors to continue dictation, which they say is faster and better for patient care. Thanks to Emdat for supporting HIStalk.

Mr. H took off a little early to treat Mrs. H to some fun, so today’s post is a bit shorter than usual.  He’ll be back to serve up a full course of the Monday Morning Update over the weekend.

Acquisitions, Funding, Business, and Stock

As reported earlier today, Nuance will acquire QuadraMed’s Quantim product line. You have to wonder if Nuance didn’t rush the announcement a bit following our Wednesday mention of the deal on Twitter and HIStalk: early Thursday morning Nuance posted these (now corrected) announcements referring to “QuadaMed” and “Quantrim.”

The Kentucky Economic Development Finance Authority approves a $150,000 grant for Health Catalyst, a business accelerator for companies creating health-related software, including life-sciences and HIT companies. Health Catalyst will nurture five startups a year by providing work space, mentoring, and seed funding.

Sales

Evergreen Health (WA) selects MEDSEEK’s ecoSmart Patient Precisioning solution for predictive analytics.

Adventist Health selects MedeAnalytics’ Patient Access Intelligence solution for point-of-service cash collection across its 16 hospitals.

People

Mark Burgess (Cerner) joins Allscripts as director of solutions management.

Fletcher Allen Health Care (VT) hires Adam P. Buckley, MD (Beth Israel Medical Center) to be the organization’s first CMIO.

Announcements and Implementations

Wake Forest Baptist Health (NC) goes live on Epic.

Wellcentive announces Advance Risk Manager, a predictive risk modeling system for population health management that allows providers to focus on patients with specific risk profiles.

The three largest health systems in St. Louis join the Missouri Health Connection HIE.

Government and Politics

Rep. Mike Honda (D-CA) will introduce a bill to set up an Office of Mobile Health at the FDA to provide recommendations on mobile health issues. The legislation also calls for the creation of a support program at the HHS to advise app developers on privacy regulations and for a low-interest loan program for physician offices to purchase new technology.

Technology

The West Health Institute is developing Sense4Baby, a wireless and portable fetal monitor for high-risk pregnancies in remote clinics. The system, which is being piloted in Mexico, sends the captured data over a cellular network to the patient’s physician.

Other

The Seattle Times covers Caradigm, the Microsoft-GE joint venture whose headquarters opened this week in Bellevue,WA. Positive comments from Providence about Amalga are included, along with less enthusiastic ones from Swedish CMIO Tom Wood, who says he’s not sure how they can add a layer on top of EMRs without a lot of cooperation.

UMass Memorial Health Care (MA) will eliminate 140 positions, some of them in IT, in seeking $80 million in cost reductions.

John Reynolds, the former CEO of Hospital for Special Surgery (NY), is arrested for racketeering, charged with soliciting kickbacks from prospective vendors and extorting $300,000 from a hospital employee in return for arranging an annual bonus.

Weird News Andy wonders how this is possible. A women who is “internally decapitated” when her skull is torn from her spine in a car accident not only survives, but is basically back to normal.

Here’s a new video from St. Jude Children’s Research Hospital, featuring patients, employees, and celebrities singing “Hey, Jude” to highlight National Childhood Cancer Awareness Month. Some of those featured are Jennifer Aniston, Betty White, Robin Williams, and Michael Jordan.

Two-thirds of CHIME members report staff shortages and are in most need of more specialists to implement and support clinical applications.

A study published in the Journal of the American Medical Informatics Association concludes that CPOE was the main challenge among hospitals failing to achieve MU in the program’s first year.

Sponsor Updates

• TELUS Health brings its TELUSHealth.com portal live to showcase its solutions that link Canadian patients to their providers.
• Elsevier unveils its EduCode Clinical Documentation Improvement eLearning curriculum for ICD-10 at next week’s AHIMA meeting.
• New York eHealth Collaborative spotlights five health IT champions at the NYeC gala October 15.
• Muhannad Samaan, MD of Aultman Inpatient Medicine discusses how Ingenious Med’s charge capture software improved patient hand-off and communications.
• Software Magazine ranks Macadamian #435 on its Software 500 list, which is based on revenues of the world’s largest software and services suppliers.
• Sandlot Solutions releases a report on using data and analytics to improve healthcare delivery.
• Skylight Healthcare Systems integrates its Service Recovery process with Vocera’s communication devices.
• Optum launches its Optum ICD-10 Core Education program.
• TI combines its DM8148 system on-a-chip with Imprivata OneSign to provide out-of-the-box strong user authentication into any software application.
• McKesson expands its Intelligent Coding portfolio to include observation services.
• First Databank executives Keith Fisher, MS and Patrick Lupinetti, JD  will present educational sessions at next month’s AMCP 2012 Educational Conference.
• Vitera Healthcare Solutions reports record attendance at this month’s VIBE conference in Orlando.
• 3M Health Information Systems adds 18 physician education modules to its Web-based curriculum to address ICD-10 readiness.

EPtalk by Dr. Jayne

Don’t forget — October 3 is the last day for Eligible Professionals to begin their 90-day reporting period for the Medicare EHR Incentive Program, aka Meaningful Use. One of my buddies in the consulting business has been sharing e-mails he is receiving from providers. Today’s special: “I would like to be Meaningful Use but do not know to begin. I need the money. Please send tips for me to start?” I guess that’s someone’s idea of a consulting RFP.

An American Medical News article lists common EHR blunders. I’ve seen all of these in various forms across practices from small to large. Topping the list: lack of infrastructure, lack of workflow assessment, lack of training, lack of buy-in, failure to communicate with patients about delays during the transition, and failure to appropriately integrate the computer into the patient-physician relationship.

News flash: Nearly one-third of US medical school students who initially planned to enter primary care ended up switching to a more lucrative specialty. Surveys of students in New York show that “medical students who anticipated high levels of debt upon graduation and placed a premium on high income were more likely to enter a high-paying medical specialty.” Really.

In similar news, the US medical schools that still don’t have Family Medicine departments are starting to get with the program. Some of these schools are big name and I know all too well what it’s like to attend one. Now we just need to get all medical schools to incorporate informatics into their programs. Let’s teach budding doctors (and nurses, and everyone else) how to leverage technology to better care for patients rather than fighting it or trying to undermine it. Although the new generation seems tech savvy, I see too many students trying to short-cut their documentation.

Mashable lists “10 Office Technologies on Their Way Out.” The list of items they predict will vanish in the next five years includes obvious items like fax machines, tape recorders, and the Rolodex. I’m not sure about desktop computers, cubicles, and standard working hours. There are a lot of entrenched management types out there who will resist. Although I won’t miss formal business attire, which includes pantyhose (#7), I’d like to lobby to keep fashionable shoes part of the equation. If I see one more pair of flip-flops in the office, I just might scream.

The Greater Atlanta area is a hotbed of health IT vendors, so I hope that none of you were recipients of the free kittens given away in the parking lot of the McDonough Walmart. Apparently they were rabid.

As Mr. H mentioned earlier this week, HIMSS registration is open and the room supplies are dwindling. I’m glad he gave me a reminder. I booked tonight, yet wasn’t able to get my preferred hotel or even my preferred dates. I’m leaving a day early, but that’s probably OK since I have to take vacation to attend this year. My hospital no longer has a conference budget or paid professional development days, so I’m not complaining about spending one less night in an overpriced hotel. Plus, I was able to snag a super-cheap plane ticket so I can afford some hot new shoes for Histalkapalooza.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Nuance To Acquire QuadraMed’s Quantim HIM Line

Nuance Communications announced this morning that it will acquire QuadraMed’s Quantim product line for health information management. Quantim includes applications for coding, compliance, computer-assisted coding, abstracting, clinical documentation integrity, record and document management, and workflow.

HIStalk reported Nuance as the buyer Wednesday on Twitter and on HIStalk following the filing of Federal Trade Commission documents. The announcement was reportedly originally scheduled for October 1, the first day of the AHIMA conference.

News 9/26/12

Top News

HHS Secretary Kathleen Sebelius and US Attorney General Eric Holder warn AHA and other hospital organizations that the government will take appropriate steps to pursue healthcare providers who misuse EHRs to defraud Medicare, specifically calling out upcoding and cloning of medical records.

Reader Comments

From Wicked Fun: “Re: HIStalkapalooza planning. I just moved from the vendor side to a provider organization. As much as I am loving my brand new job, I miss the ‘fray’ of the world of HIT. The first comment from one of my MD friends  was, ‘What if you don’t go to HIMSS? We always go to the HIStalk party together!’’” The lesson here for the HIStalkapalooza faithful is to add our annual event as a mandatory condition of employment in your contract negotiations. If you like planning ahead, the 2013 version of HIStalkapalooza is scheduled for Monday, March 4, with registration opening sometime in January.

From Plinker: “Re: Northwestern in Chicago. Going Epic.” I don’t recall if I’ve mentioned that previously.

From Squint Eastwood: “Re: Vermont. Not a rumor, but interesting.” Fletcher Allen Health Care and Dartmouth-Hitchcock Medical Center submit an ACO plan that would create the for-profit OneCare Vermont LLC, which would include 13 of the state’s 14 hospitals (Porter Medical Center passed), 58 medical practices, two FQHCs, and other organizations. If approved in October, OneCare would be up and running by January 1, serving most of the state’s 105,000 Medicare beneficiaries. Fletcher Allen SVP Todd Moore, who will be CEO of OneCare if it’s approved, says access to data was a driver. “This is really an access to information revolution as much as it is anything else for us. This gives us access to the full claims set for the first time to Medicare beneficiaries that we treat … to understand how they seek care, how often they go to (the doctor) — whether it be at Fletcher Allen or at Northwestern Medical Center or in Florida.”

From Adam: “Re: Tampa General Hospital. Saw they’re going with RelayHealth for HIE. Aren’t they an Epic shop?” They are indeed.

From HereWeGo: “Re: MCK acquisition of MedVentive. The fat, spoiled kitty found a new toy to bat around and destroy until the next shiny object captures its attention.” Usually the fat cat in a given deal is the seller, so at least some of MCK’s cash trickled down to the MedVentive owners. I should clarify that the rumored MCK acquisition that I mentioned last week isn’t MedVentive, so another announcement could be coming if the rumor turns out to be accurate.

From Bobby D: “Re: MCK acquisition of MedVentive. This is the second company that Nancy Brown has been involved with that McKesson bought, the first being Abaton.com. She has two to go to catch Mike Myers of CliniCom history, who has sold them four companies.” Mike’s at QuadraMed now, I’m told, so he could bag “one for the thumb” if MCK happens to buy QuadraMed’s Quantim line, if indeed the rumor is true that it’s about to be sold (and even if it is, MCK hasn’t been mentioned as a player.) UPDATE: per Federal Trade Commission filings, Nuance will be the acquirer of Quantim.

From Moak: “Re: upcoding. How did you miss this one?” I get at least one e-mail per day (including this one) with a link to a big news story that I’ve already covered, so skimmers are missing out. Still, I appreciate the notice just in case I really did miss something, and Moak brings up an interesting point: the feds gave Faxton St. Luke’s Healthcare (NY) as an example of an ED whose higher levels of treatment jumped 43 percent in 2009, the same year it implemented EHRs. He says the hospital only has 22 days’ cash on hand and therefore is not stealing from anyone. I wouldn’t necessary make that assumption since poverty usually encourages rather than discourages criminality, but I think his point is that the hospital was struggling financially and may have simply cracked down on sloppy billing practices. One might assume that the feds would do some audits before slamming the entire healthcare provider universe with unproven fraud innuendo, but given its poor track record in uncovering even widespread fraud (see: South Florida), maybe the only arrow in its quiver is to bluff. If they have found even one case of EHR-abetted fraud and wanted to deliver an effective message, they should have had a photo op with someone in handcuffs.

HIStalk Announcements and Requests

A big thanks to all the readers who sent me notes bragging that they had already gotten their iPhone 5s after little or no wait at their local Apple store. My phone will arrive from China on Thursday. I loved the lightweight feel of a friend’s iPhone and had fun taking a few panoramic photos. My friend claims it is much faster than the iPhone 4, but she is not yet convinced the battery life is dramatically improved.

Welcome to new HIStalk Platinum Sponsor VersaSuite. The Austin, TX company offers an integrated system for medical enterprises (hospitals, clinics, surgery centers) that includes a hospital information system (including CPOE and eMAR), inventory management, RIS/PACS, laboratory information system, pharmacy management system, accounting, and HR. It’s all built on a single Windows-based stack running on a single database, standardizing the user experience across inpatient, outpatient, and ED. The company says it holds the largest number of CCHIT certifications of any single product, including CCHIT’s enterprise certification, giving healthcare systems one product that is MU certified for both EPs and hospitals. VersaSuite’s EHR includes specialty-specific templates for 24 disciplines, keyboard-free data entry, dashboards, tablet support, and a four-click assessment/plan for outpatients that takes only 5-10 seconds vs. up to two minutes in competing EHRs. The company is a member of IHE and its products support interoperability standards such as HL7 and DICOM and are compliant with HIPAA 5010 and ICD-10. Thanks to VersaSuite for supporting HIStalk.  

I booked my HIMSS room this week and suggest you don’t wait too long. I got my first choice, but the supply for close-in rooms is dwindling. HIMSS usually opens up more hotels later, but they’re usually a long shuttle bus ride to BFE.

Acquisitions, Funding, Business, and Stock

Cancer support site Navigating Cancer raises $2.3 million to hire developers and integrate its patient portal into EMR applications.

McKesson announces that it will acquire MedVentive, which offers population and risk management tools.

Sales

Wentworth-Douglass Hospital (NH) selects the Siemens perioperative management system by SIS.

The Upper Peninsula HIE (MI) will implement ICA’s CareAlign CareExchange platform.

Tampa General Hospital (FL) selects RelayHealth Enterprise HIE for CCD data exchange.

Johns Hopkins Hospital and Health System (MD) selects 3M’s 360 Encompass System for automated coding and clinical documentation.

Health plan service provider Magnacare (NY) will offer online appointment scheduling services from DocASAP, a startup competitor to ZocDoc.

Methodist Dallas Medical Center (TX) selects ProVation Order Sets from Wolters Kluwer Health.

Amcon’s Australian division announces the launch of its Messenger clinical alerting middleware at the 848-bed St. Vincent’s Hospital Melbourne.

People

M*Modal hires Mike Etue (OptumInsight, Allscripts) as EVP of sales, replacing Michael Clark.

Former PatientKeeper VP Michael Bertrand joins home health software provider HealthWyse as VP of development.

RemitDATA appoints John Stanton (Beacon Partners, above) as VP of consulting and Phillip McClure (MedeAnalytics) as VP of sales.

Beacon Partners promotes Christopher Kondrat from principal to VP of professional services.

Phillip Madden (Cerner) is named director of client sales at Orion Health.

Yuma Regional Medical Center names Robert Budman, MD (Catholic Healthcare East) as CMIO.

Besler Consulting appoints Edward J. Niewiadomski, MD (Southern Ocean Medical Center) as senior medical advisor.

Quality Systems, Inc. appoints Daniel J. Morefield (LEADS360) as EVP/COO.

Announcements and Implementations

Munson Healthcare (MI) implements VPLEX Metro virtual storage from EMC and private cloud technology from EMC and VMware.

SCIOinspire Corp. changes its name to SCIO Health Analytics.

Prognosis adds a configurable template engine and a physician rounding tool to its ChartNotes EHR.

In the UK, CSC admits that it will sunset the former iSOFT physician systems, including Synergy, Premiere, and Ganymede, that are used by about six percent of England’s practices. It denied the rumor of the impending retirement until Monday’s announcement.

PerfectServe adds a patient-centered rounding feature to its communications system, allowing clinicians to contact the appropriate physician for each patient.

Cleveland Clinic is implementing software from its new spinoff iVHR, which will present information from its Epic system to doctors in a visual form. The software will create maps patient locations with indicators of patient condition that link to all the background data from Epic, displaying it visually to help doctors see the big picture.

Government and Politics

The FCC’s mHealth Task Force recommends that wireless health and e-Care technologies be incorporated as best practices for medical care by 2017. Example technologies are remote monitoring devices, apps, body sensors, implanted microstimulation devices, medical device data systems, provider apps for remote image viewing, patient portals, clinical decision support tools, and a broadband-enabled HIT infrastructure. Some of its specific recommendations to the FCC include: (a) fill the open position for an FCC healthcare director; (b) provide education and outreach; (c) work more closely with ONC and CMS, specifically helping ONC with secure health messaging and communications standards; and (d) open up more of the communications spectrum for mobile broadband.

UC Davis Health System signs a 16-month, $17.5 million agreement to take over the state’s struggling HIE, formerly run by Cal eConnect. The project has been renamed the California Health eQuality Program (CHeQ) and will be led by Ken Kizer, MD MPH of UC Davis, who was previously CEO of the VA healthcare system, Medsphere, and the National Quality Forum. The project is halfway through its four-year, $39 million grant. They claim they are confident they’ll seamlessly move to a post-grant revenue model when the federal breast runs dry in 2014, which will make them one of almost none if they actually pull it off.

NPR posts the audio and transcript from Tuesday’s “The Diane Rehm Show,” featuring Farzad Mostashari and others on “The Pluses and Minuses of Electronic Medical Records” (but not Diane Rehm, who was on vacation, and not Farzad for the second half because he had to leave). The substitute host led an inordinate amount of the discussion toward upcoding, which made it a lot less interesting. What Farzad said: (a) maybe the EHR just captured the charges correctly; (b) the current system pays doctors more for recording what they actually do, so why wouldn’t they?; (c) EHR or not, fraud is illegal, and in fact the audit trails of EHRs can make it easier to detect. A former healthcare CIO and practice manager named Jim called in to say that his docs always intentionally downcoded with paper records because they were afraid insurance companies would challenge their recordkeeping, but were more confident that electronic records made it safe to bill accurately.

Other

OIG finds that Essentia Health (MN) overbilled Medicare by $865,000, or $3.18 for every $1.00 it was owed. Essentia blames its billing system, which it says it has replaced.

Avado CEO Dave Chase opines in a Forbes article that New York is “the epicenter of healthcare’s reinvention.” He cites as examples health accelerators, Medicaid HMOs, WebMD, the New York eHealth Collaborative, the state HIE, IBM, and Farzad Mostashari.

Weird News Andy finds an article from the physician author of Bad Pharma stating what everybody knows: drug companies selectively publish studies that make their drugs look good, using tricks such as small-numbers studies and statistical tricks that exaggerate questionable benefits. Less-flattering studies get shelved. Industry-funded drug trials were positive 85 percent of the time, while only 50 percent of government-funded studies were. Industry-sponsored studies of statin drugs were 20 times more likely to favor the test drugs. From the book’s description, “We like to imagine that doctors are familiar with the research literature surrounding a drug, when in reality much of the research is hidden from them by drug companies. We like to imagine that doctors are impartially educated, when in reality much of their education is funded by industry. We like to imagine that regulators let only effective drugs onto the market, when in reality they approve hopeless drugs, with data on side effects casually withheld from doctors and patients.”

Another WNA find, which he labels “workaholic”: the New York Post digs through public records to find city-employed psychiatrists who make multiples of their base salaries by claiming extensive overtime for ED coverage. One psychiatrist boosted his $173K base pay to $481K by claiming he worked 80 hours per week. The same doctor made $689K in 2009 by turning in 3,820 hours of overtime, including one non-stop stretch of 96 hours. The physicians are also allowed to operate private practices.

Here’s the latest cartoon from Imprivata.

Sponsor Updates

• eClinicalWorks releases the agenda for its October 25-28 National Users Conference.
• DrFirst creates an infographic called “Key Dates You Need to Know to Maximize Meaningful Use Incentive Payments.”
• Lifepoint Informatics announces its Gold Level sponsorship of the G2 Lab Institute Conference in Alexandria, VA October 10-12.
• MED3OOO VP Steven Stout discusses the risk and rewards of contracting for global risk in an October 3 Webinar.
• McKesson hosts a September 27 Webinar on strategies for driving reimbursement.
• A survey by commissioned by simplifyMD finds that EMR vendors often convince practices to replace their practice management system when implementing their EMR, but practices often experienced problems with cash flow and employee productivity as a result.
• MedVentive offers demos of its Population Manager and Risk Manager products during next week’s AMGA Institute for Quality Leadership Annual Meeting.
• Benefis Health System (MT) realizes a $4.9 million increase in appropriate hospital charges, a $3.5 million increase in reimbursement, and a $2.3 million reduction in uncompensated care within four months of implementing the first phase of its RCM initiative with MedAssets.
• MedAptus releases its Mobile Schedule application for Apple iOS.
• An Imprivata-sponsored survey finds that 72 percent of hospital IT decision makers believe pagers will be replaced by secure text messaging within three years.
• iSirona releases a white paper on device integration.
• Wellsoft will participate in the 2012 ACEP Scientific Assembly next month in Denver.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

McKesson To Acquire MedVentive

McKesson announced this morning that it will acquire MedVentive, which offers population and risk management solutions. Terms were not disclosed.

MedVentive, based in Waltham, MA, was founded in 2005 by Jonathan Niloff, MD. Its solutions include MedVentive Risk Manager and MedVentive Population Manager. McKesson will add its offerings to its McKesson Enterprise Intelligence suite.

Monday Morning Update 9/24/12

From Eddie T. Head: “Re: Forbes 400. They’re pulling Judy Faulkner’s net worth out of the air, seeming to make up their numbers based on an alternate reality where Epic is publicly traded and the stock price is based on the nonsensical P/E ratios of companies like Cerner (35) or athenahealth (195). For comparison, Google and Apple have P/E of 21 and 16.” My first thought on seeing that Forbes estimated Judy’s net worth at $1.7 billion: they couldn’t possibly know what she’s worth since none of her assets, including Epic’s ownership structure, have been publicly reported. Epic has previously corrected reporters who referred to Judy as a billionaire – they say she’s not. Cerner’s market capitalization is five times revenue, and by that formula, Epic would be worth about $6 billion if (and it’s a huge “if”) it went public and was able to earn stock market credibility as Cerner does without screwing up the operation. Judy supposedly owns 40% of the company, so that would value her stake in the theoretically publicly traded Epic at $2 billion. That doesn’t mean she has $2 billion in the bank, but it’s safe to assume that she’s not overdrawing regularly.

From Milkshake: “Re: Forbes 400. Now I know why Judy and Neal are always smiling. I wonder how long they will keep their smiles once Grassley catches wind of the ubiquitous up-coding scams their instruments facilitate.” I don’t think they have a lot to worry about from Chuck since, despite the high expectations I had for him, seems to excel only at writing stern letters and then moving on to whatever headline grabs his attention next. Someone intent on scamming Uncle Sam in any fashion (medical or other) would probably find it more efficient to use a computer, but that’s hardly a good reason to ban computers. I’m somewhat anti-gun, but I still laugh at the folks at the anti-gun rallies who carry signs saying “Spoons made me fat.” In other words, the problem is people, not their choice of inanimate objects.

From Thinking Ahead: “Re: Epic. What’s their succession plan? Judy is almost 70, few people on the planet could afford to buy her out, and she doesn’t have much appetite for going public. Employee-owned models are nice in theory, but few if any have really worked, and to my knowledge Judy doesn’t have family engaged who could take over. The succession plan is important to a hospital that has paid tens or hundreds of millions for a product with a shelf life of decades.” I’ve talked to people who have seen the succession plan and they are comfortable with it. Epic would certainly change without the presence of the visionary and sole public face of the company who is personally involved with even the most trivial company decisions. However, I said the same about Apple and Steve Jobs and they seem to be doing just fine without him, although it’s been just a year since he died.

From The PACS Designer: “Re:Information Week 500. This year’s InformationWeek 500 finds Beth Israel Deaconess Medical Center at the #1 position. TPD salutes CIO John Halamka, MD for guiding his institution to the top of the IT world with innovative solutions, such as their search tool called Clinical Query which can be emulated and used by other healthcare organizations to improve processes.”

From Looking Deeper: “Re: HIStalk Advisory Panel on patient-facing technologies. I’m loving it. Finally we get some honest opinions on a topic that hasn’t been discussed to death like EHRs.” I agree — it was interesting information. EHRs get 90% of the attention these days, but they don’t address every problem. I’ve really enjoyed hearing what the Advisory Panel has to say. I send them a topic or two once a month, so you can look forward to more frontline reports. Thanks to those panel members who take the time to provide thoughtful answers – the industry benefits.

From Cache’ Jedi: “Re: Epic, MUMPS, and Cache’. VC and software guru Paul Graham describes a kind of momentum like Epic has now in this article.” The 2001 article describes why a less-popular programming language might actually be a “secret weapon” that stymies competitors because — geek arousal factor aside — it might allow companies to develop software better and faster. “In business, there is nothing more valuable than a technical advantage your competitors don’t understand … the people who understood our technology best were the customers. They didn’t care what language Viaweb was written in either, but they noticed it worked really well … the only programmers in a position to see all the differences in power between the various languages are those who understand the most powerful one … they’re satisfied with whatever language they happen to use, because it dictates the way they think about programs … the median language, meaning whatever language the median programmer uses, moves as slow as an iceberg …the more of an IT flavor the job descriptions had, the less dangerous the company was. The safest kind were the ones that wanted Oracle experience. You never had to worry about those.”

Most of us haven’t requested and reviewed copies of our EHR information. New poll to your right: McKesson announced Better Health 2020 in December 2011. Since then, how has its position in healthcare IT changed?

Rumor from a couple of readers is that McKesson has closed on the acquisition that I mentioned several weeks ago. I won’t run the target’s name since MCK is publicly traded, but above is a graphical hint.

Condolences to Intermountain Healthcare VP/CIO Marc Probst, whose daughter Heather died of leukemia last week. She was 16.

St. Rita’s Medical Center (OH) eliminates 60 jobs, some of them transcription positions that are no longer needed after its Epic implementation.

The finance minister of Ontario, Canada proposes legislation that would cap the salaries of public sector employees at around $400K per year. Most of the 150 employees who would be affected are hospital executives. Ontario Hospital Association is “deeply disappointed” since it says hospital leaders manage half of Ontario’s annual budget and therefore should be the most skilled and experienced leaders instead of those willing to work in “an arbitrary compensation environment which bears no relation to the job market.” I thought we were the only country where non-profit hospitals and high-profile charities pay on par with publicly traded companies in competing for the apparently immense talents of the altruism-free executive hired guns who are available only to the highest bidder.

Cerner speeds up construction of its new campus in Kansas City, KS, deciding to start immediately on the second nine-story tower instead of waiting until later. Construction will be completed 18 months earlier than originally planned, with the first tower opening next year and the entire campus finished by mid-2014.

Georgia Tech and Emory University are developing Remotoscope, an otoscope-like iPhone attachment that allows parents to take a picture or video of their child’s eardrum and send it to a doctor for review instead of heading off for the ED to be checked for an ear infection.

New River Medical Center (MN) is looking for a buyer after financial problems following a spat with a large physician group. The doctors took there business to a competitor hospital, with one of their stated reasons being that the other hospital used the same EMR they use and OMC recently chose a different product.

The New York Times publishes another story insinuating that EMRs inflate hospital and medical practice Medicare bills through up-coding. It includes vague references to fraud and OIG’s complaints that EMRs make it easy to bill for work not performed. Nobody seems to blame a screwy, code-driven payment system, the lack of CMS vigilance, and the strong possibility that providers are submitting accurate bills that just happen to inconvenience payers who have structured their operations around perpetually under-billing providers who are now armed with better tools. Fraud is fraud regardless of the tools used and haven’t seen CMS prosecute anybody or change its hopelessly complex payment rules. This would be like the IRS complaining that tax collections are down because taxpayers are using TurboTax to file more accurate returns. Instead, the IRS audits tax returns electronically, goes after cheats, and hopes that the majority of taxpayers it won’t audit will stay honest for fear of incurring its wrath. Some folks are raising an out-of-the-box question: why aren’t doctors paid by the hour instead of by the procedure? They could inflate their time spent, but that wouldn’t be as hard to detect. Are those Chicago-area pathologists really worth $2 million a year in taxpayer money just because they oversee big labs?

A Johns Hopkins surgeon and author starts out his Wall Street Journal opinion piece on hospital errors with the tired “jumbo jets full of patients harmed” cliché, but gets quickly to some interesting transparency measures that could improve safety. Specifically, hospitals should: (a) post dashboards of infections, readmissions, surgical complications, “never events,” and patient satisfaction; (b) post the results of anonymous safety and teamwork surveys of their employees; (c) record video of procedures and other process to review for quality improvement opportunities and as a permanent record if questions arise later; (d) use “open notes” where patients see what is written about them and correct any mistakes or add their comments; and (e) eliminate the use of gag orders that prevent patients from speaking about negative experiences and malpractice lawsuit settlements.

Wood River Health Services (RI) goes live on NextGen’s EMR. The Federally Qualified Community Health Center was already live on patient billing and dental services.

The surgery waiting room of the replacement Kaiser Permanente Fontana Medical Center (CA) that opens in May will have a computer bar where visitors can use their technology and the hospital’s WiFi network.

The board of Olympic Medical Center (WA) approves a $1.5 million hardware budget request for its Epic implementation, which the board approved two weeks ago in a $7.6 million agreement with Providence Health and Services. Epic will replace five OMC systems. The hospital hopes to earn $7.2 million in HITECH payouts over four years and chose to affiliate with Providence’s Swedish Medical Center because it needed help with its implementation.

Intelligent InSites mentions that its RTLS software is one of the technologies mentioned by a local TV station mentioned in covering last week’s opening of the new 50-bed Texas Health Resources hospital in Fort Worth. Intelligent InSites will integrate with Epic, Cen Trak, LodgeNet, Rauland-Borg, Siemens, TeleTracking, and Vocera. You would think that with all the emphasis on hospitality that THR would have chosen a more patient-friendly name than Texas Health Harris Methodist Hospital Alliance. Quick, shut your eyes and say the name you just read. See? Even the apparent shortcut name – Texas Health Alliance – doesn’t actually include “hospital” in its name, and sounds more like a vaguely threatening lobbying group instead of a place of healing.

Strange: a physician’s former office manager (also her landlord) sues him for sexual harassment, claiming he made her take an Internet sex test, sent her obscene text messages, offered her a watch in return for sex, and asked her to hand him a “Happy Birthday” teddy bear from his children to cover his face while he watched live sex on a webcam via Skype. She says he fired 40 percent of his employees and then fired her when she complained about not being paid overtime to cover. The doctor collected $5.3 million in 2008 as a Medicare fraud whistleblower after turning in University Hospital for using unlicensed beds to treat addiction payments.

More on QuadraMed in this week’s HIS-tory from Vince, with help from alumnus Frank Pecaitis.

E-mail Mr. H.

News 9/21/12

Top News

 

The Forbes 400 list of richest Americans includes Epic’s Judy Faulkner (#285 with a net worth of $1.7 billion) and Cerner’s Neal Patterson (#391 at $1.12 billion).

Reader Comments

From HIStalk Fan: “Re: EHR experience reporting. The IOM recommendations could improve outcomes and safety. It remains puzzling that ONC is against robust vetting for safety and efficacy.” ONC asked the IOM to suggest ways to collect and report EHR user experiences, particularly those involving problems with patient safety. IOM’s just-published paper lays out ways that could be done. Possibilities include (a) testing vendor products against use cases; (b) placing a “report a problem here” button on EHR screens to allow users to quickly report problems; (c) have EHRs collect information such as number of clicks or the number of screen views and mine that data to look for problems; (d) conduct user surveys; and (e) develop a formal reporting program. The article recommends posting the collected information on a website that would rate individual functions vendor by vendor using a star-type rating system.

From Misys_Ex: “Re: QuadraMed. Not all to be sold, only the HIM/Quantim line. Sale to close in a week. Spending and hiring freeze in effect. MModal is the rumored buyer.” Unverified. An all-company call has been scheduled for October 1, rumor has it, which would logically place the announcement on the first day of the AHIMA conference.

From Dale Sanders: "Re: odd iPad requirement. The Colorado Department of Health Care Policy and Financing is re-competing its Medicare and Medicaid Information System contract. The draft RFP requires each vendor to submit their response on seven iPads, one for each member of the selection committee.” The rationale is that the iPad saves printing and shipping cost, although you could do a lot of printing for the $3,500 or so. The state says vendors like the idea and the iPads are more secure than paper, ensuring that documents don’t fall into the hands of competitors and thereby force an expensive re-bid and/or legal challenge for the $100 million project. None of that would seem to preclude returning the iPads given that the state plans to erase and reuse them anyway.

From Laura: “Re: Practice Fusion. Another cloud downtime.” Only for a few minutes, apparently, but judging from the comments, I bet that Like button didn’t get much action while the users killed time waiting to get back on.

From Writing My Resume: “Re: McKesson’s Better Health 2020. Will go down as the largest mistake in the history of HIT. Customers like Providence, Southwest Washington, Ohiohealth, John Muir, Valley Health, WellStar, HealthEast, and Resurrection are moving from Horizon to Epic. The new Paragon customers are small community hospitals and it will take 10-15 of them to replace one Horizon customer. Rumors of another layoff coming.” Unverified. I interviewed MPT President Dave Souerwine when the program was announced in December 2011. Better Health 2020 was a series of commitments to (a) invest $1 billion in R&D over the following two years, a good bit of that in enhancing Paragon over a 30-month development cycle; (b) sunset no products, but shift resources away from Horizon clinical applications to Paragon; (c) stop the development of Horizon Enterprise Revenue Management and lay off 174 employees immediately; and (d) continue to support Horizon customers through Meaningful Use and ICD-10.

HIStalk Announcements and Requests

Are you current on all the latest ambulatory HIT news? Here are some highlights from HIStalk Practice over the last week: RAC auditing of physicians begins in 15 states, focusing on higher-level E/M codes. The state of Colorado reports that Medicaid medical homes are reducing hospital inpatient stays and ER visits. EHR adoption at community health center grows to 74 percent, thanks to HITECH funding. eClinicalWorks predicts a 23 percent increase in revenues for 2012. Implementation costs and low patient adoption are big barriers for practices wanting to add patient portals. A physician weighs in on the impact of the ACA, incentives, and EHR. Nuesoft Technologies’ Blake LeGate offers tips for preparing for ICD-10. Dr. Gregg thinks (a lot) about going back to paper. Some days, especially those when Mr. H is especially busy at his day job, the only way I know I am appreciated is to see that someone new has subscribed to HIStalk Practice. When you check out these stories, show me the love and sign up for the e-mail updates. Thanks for reading.

Working anonymously is good in some ways, bad in others. On the “bad” side, Inga, Dr. Jayne, and I labor in our otherwise empty rooms with no human contact, meaning our little HIStalk world will evaporate the moment we quit or get hit by that proverbial bus. It’s up to you to write our electronic epitaph in advance, as follows: (a) connect with us and Like us (note to Mark Z — a Love button would be better) on the usual ego-feeding social not-working sites; (b) sign up for our spam-free electronic updates; (c) show your appreciation for the companies that keep our caustic keyboards clacking by reviewing the gallery-quality ads to your left and impulsively clicking those that pique your interest; (d) inspect the more detailed sponsor information housed in the Resource Center and consider using the Consulting RFI Blaster to effortlessly contact several consulting firms at once about your needs; (e) send us news, rumors, photos, ideas, or anything else that interests you and therefore would probably interest the rest of the HIStalk universe; and (f) look into the nearest reflective surface and give yourself a jaunty thumbs-up on our behalf for being discerning enough to recognize that despite its amateurish presentation, occasionally inappropriate content, and intentionally ironic pipe-smoking logo character, HIStalk does a mostly OK job in keeping you informed as well as a guy with a full-time hospital job can do.

My inbox is bulging and I have a lot of catching up to do this weekend. That’s the best I can do, unfortunately. Re-sending your e-mail doesn’t really help solve my problem of needing to sleep five hours or so, which is about all the time I have left at the end of the day. I promise I have not forgotten you.

Welcome to new HIStalk Platinum Sponsor TeraRecon of Foster City, CA. The company is a global leader in enterprise image management solutions, especially with regard to advanced imaging procedures. Its zero-footprint iNtuition EMV (Enterprise Medical Viewer) can deliver interactive images to any Web browser for even the largest and most complex CT exam, even interactive 3D. Instead of a peering at static JPGs in the EMR or a generic 2D viewer short on useful tools, physicians get a rich viewer with contextual tools and viewing configurations that are automatically set based on image type. Specialists in particular get real value from 3D images. The flagship iNtuition solution integrates with any vendor-neutral archive, so it works with a wide variety of systems including PACS from any vendor. TeraRecon created the concept of advanced visualization and iNtuition is the leader in enterprise-wide, thin-client server-based visualization with over 4,500 installations all over the world. Thanks to TeraRecon for supporting HIStalk.

I admit that imaging solutions aren’t my strong suit, so hopefully this TeraRecon overview video that I found on YouTube will make up for any deficiencies that I shamelessly exposed in my introduction above.

Acquisitions, Funding, Business, and Stock

Skylight Healthcare Systems, a provider of interactive patient systems, raises $5 million in Series D financing.

Sales

The New York eHealth Collaborative selects MedAllies to operate its Direct Solution on the Statewide HIN of NY.

CMS awards HP a $43 million task order to continue providing IT services for the EHR incentive program and for maintaining the CMS Integrated Data Repository database.

Loma Linda University Medical Center (CA) selects Nuvon to provide medical device connectivity and interoperability as it migrates its OR, ICU, and dialysis center to Epic.

The VA awards Systems Made Simple (SMS) a $27 million renewal contract to support the Veterans Service Network program and Benefits Gateway System development project.

People

Bill Conroy joins Kareo’s board, a position he also holds for Prognosis Health Information Systems and Phreesia.

Ben-Tzion Karsh, a University of Wisconsin-Madison professor of engineering and one of the authors of the IOM article on EHR experience reporting that I mentioned above, died last month at 40.

Announcements and Implementations

INTEGRIS Health (OK) implements PatientSecure by HT Systems for biometric palm scanning.

Intelligent Medical Objects announces a search engine appliance to deliver just-in-time secure terminology services at the point of care.

Elsevier releases a version of its ClinicalKey reference system aimed at individual clinicians, which features information from 900 textbooks and 500 medical journals covering 41 specialties.

In Canada, three-employee Clinisys launches its first product, a cloud-based EMR.

New in the AMA’s CPT 2013 data file: consumer-friendly descriptors of each CPT code for patients and caregivers.

Santa Fe-based Seamless Medical Systems launches an iPad app for physician waiting rooms that allows patients to complete their forms online, review educational material, take notes during the visit and e-mail them to themselves, and play games.

Government and Politics

Sen. John Kerry (D-MA) introduces MITECH, a bill that expands the MU program to include safety net clinics that don’t necessarily qualify under the Medicaid incentive program. Kerry’s legislation would allow providers to qualify for incentives if at least 30 percent of their patient volume comes from lower-income patients.

ONC posts the vendors who signed up for the Blue Button Pledge (Alere Wellogic, Allscripts, athenahealth, AZZLY, Cerner, eClinicalWorks, Greenway, Intellicure, NextGen, and SOAPware) and invites other vendors to tweet their #VDTnow pledge to be added. Above is Farzad Mostashari’s welcome to the Consumer Health IT Summit where the companies were announced.

The US Army tests real-time medical communication software that uses mobile devices and 4G networks to support battlefield medics treating severely wounded solders. Portable physiologic monitors are used to to send streaming video, voice, and photos, along with treatment records, to surgeons that in real-life situations would be located in remote hospitals.

Innovation and Research

Mobile health apps that help manage medications and blood glucose are linked to improved diabetes management in socially disadvantaged populations.

Other

The board of directors of the Kansas HIE votes to transfer its duties to the Kansas Department of Health and Environment by October, 2013, which will save $350,000 a year.

The Joint Commission designates 620 hospitals as top performers on 45 evidence-based care processes closely linked to positive outcomes.

Joe Goedert of Health Data Management wrote a rebuttal to the Soumerai and Koppel editorial that ran in The Wall Street Journal this week called A Major Glitch for Digitized Health-Care Records. Joe mentioned some of the same points I did in my criticism of the editorial and the studies it selectively cited, but added quite a few more in Bad Research Shouldn’t Affect Good Policy. I respect the opinions of the authors and I’m as cynical as the next guy, but the editorial had just enough citations to possibly fool someone into thinking that it was new research (or that the old research mentioned was actually well done, which it wasn’t.) My criteria for assessing the objectivity of articles on almost any contentious topic (religion, politics, sports, or healthcare IT) is this: if the authors never give credibility to anything that doesn’t match their own beliefs, then I simply don’t bother reading because I already know what they’re going to say. I should note, though, that Ross Koppel was one of the authors of the IOM report on EHR problem reporting that I mentioned above and that’s a nice credit.

Job postings for healthcare professionals with EHR skills have jumped 31 percent over the last year.

Georgia Tech is offering a free, online Health Informatics in the Cloud class taught by Mark Braunstein MD, who has more relevant experience than anyone I can think of. Students don’t need a technical background – just five to seven hours per week for 10 weeks. The class is offered via Coursera, an online education startup that has already enrolled 1.5 million students in its “massive open online courses.” Its partners include Brown, Columbia, Stanford, Penn, and other topnotch schools that aren’t ordinarily interested in giving away their courses for free. This looks really good, especially for folks who don’t have a lot of formal healthcare IT education on their resume.

The family of a man who died in the ED of Beebe Medical Center (DE) files suit against the hospital and the ED staffing company it uses. The patient was discharged from the ED after being seen for chest pain, but he made it no further than a chair in the lobby before dying of a heart attack while waiting for a ride. Nobody noticed until hours later.

People who have eaten in Epic’s cafeteria will enjoy this profile of Executive Chef Eric Rupert (not celebrity French chef Eric Ripert, although I’m sure Epic could afford him if they wanted). The chef says Judy is a serious foodie — the only non-chef he’ll talk to about food — and she insists that Epic’s employees and visitors be fed well. He leads a staff of 78 Epic employees and describes the company environment: “There really is very little hierarchy here. You’re either a team member or a team leader, and the team leaders do everything that team members do, and then they also manage people. It’s not considered a promotion to go from a team member to a team leader; it’s just additional responsibilities.” He says Epic is different from its Silicon Valley counterparts in that employees pay the cost of ingredients for their meals instead of getting them for free, and everything is made in-house, even the baked goods. But like Google and other high-tech companies, Epic uses their food as a recruiting tool and has a diverse group of employees to feed, representing 55 countries.

Inga masquerades as Weird News Andy in finding this story. A Colorado man sues several food companies for “popcorn lung,” claiming that he ate microwave popcorn for years and the artificial butter fumes damaged his lungs. The jury, who apparently didn’t find his years of exposure to carpet-cleaning chemicals to be contributory, awards him $7 million. Inga adds that she hopes he gets his money in a Jiffy.

Epic UGM Report
By David Miller

Dave Miller, vice chancellor and CIO of University of Arkansas for Medical Sciences, e-mailed me privately about Epic’s UGM. I asked him if I could run his comments on HIStalk since non-Epic customers are always mystified by the company’s cult-like following. If you were one of the 8,000 UGM customer attendees and would care to share your thoughts about why it’s different than other user group meetings you’ve attended, I’d like to hear from you.

I have been to a number of UGMs at Epic, though it has been about three years since my last one. I am always amazed at the creativity of the Epic staff and the almost flawless way in which they execute the logistics to handle almost 8,000 users.

It continues to be primarily a user-driven event, from the advisory councils to the UGM sessions and even to the entertainment. The sessions themselves demonstrate the excitement that their users feel with what they have been able to do with one of the top healthcare IT products.

At the end of the day, it really comes down to Epic’s ability to instill their culture in each and every employee. Their simple focus on customer service was demonstrated by every employee I encountered. They had people stationed everywhere on campus to give directions, to drive golf carts to your destination, or just about anything else you needed.

I actually did not see a lot of Judy, but when she was present, she cheerfully took pictures with about anyone who would ask. Pretty amazing for a CEO of that stature. In my experience, most individuals in her position are self-absorbed and would never mingle like she does. I’ve also known Carl Dvorak for about 15 years, and he is about the most down-to-earth individual you would ever want to meet.

Judy creates an atmosphere for her employees that encourages and enables them to be at their creative best. The end result is a really good set of tools to manage the complexity of issues that healthcare organizations deal with every single day. Yes, there are imperfections, but they are so outweighed by the positives that they become irrelevant.

They used to say that no CFO ever got fired for hiring a Big 8 firm. Short of having someone completely inept in that role, I think I would say the same thing about a CIO.

Sponsor Updates

• ChartWise Medical Systems profiles Jennie Stuart Medical Center (KY) and its use of ChartWise:CDI to improve documentation an reporting.
• SuccessEHS reports that more than 10 percent of its EHR and PM client are now using its RCM services.
• Health Care DataWorks offers a September 25 webinar on CMS’s Value-Based Purchasing program.
• DrFirst offers Meaningful Use webinars over the next three weeks covering avoiding penalties, data exchange, the EHR as a clinical tool, and clinical quality measures.
• Orion Health’s portal solution for Alberta Netcare reaches 100 million views since its 2006 implementation.
• Versus features Northwest Michigan Surgery Center in its October 17 Webinar on maximizing patient flow with RTLS.
• TELUS Health Solutions and Sun Life Financial launch an eClaims solution for extended care providers across Canada.
• The Web Marketing Association recognizes CareTech Solutions as Outstanding Website Developer for winning nine WebAwards in 2012.
• CommVault joins The Association of Certified E-Discovery Specialists as an affiliate member.
• Awarepoint integrates its awareED module with Rauland Responder’s nurse call system.
• CDN Channel Elite recognizes NexJ Systems with gold awards for best cloud computing and best mobile solutions.
• MEDSEEK hosts roundtable discussions on marketing’s role in MU at this week’s Society for Healthcare Strategy and Market Development conference.
• Greenway hosts a Webinar series addressing the trends of electronification, consumerism, and improving population health.  
• Lifepoint Informatics will sponsor the Pathology Informatics 2012 conference in Chicago October 9-12.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 9/19/12

Top News

Massachusetts Eye and Ear Infirmary and its physician group will pay HHS $1.5 million to settle potential HIPAA violations following the theft of an unencrypted laptop containing electronic PHI of patients and research subjects.

Reader Comments

From Honky Cat: “Re: Waiting in line at Apple. Don’t wait in line for your iPhone upgrade. Go to this link and pre-order your phone. They will ship it to you in two to three weeks. Surely you can wait that long for it.” I considered setting my alarm to be one of the first people to go online last Friday and place an order. Instead, I slept in and waited until 6:00 am to get online. By that time Apple had stopped taking orders to reserve the iPhone 5s for pick up at the local Apple store, so I’ll wait for mine to be delivered in a couple of weeks. Apple, by the way, sold two million iPhone 5s in the first 24 hours of pre-orders, more than double the previous record set in 2011.

From The PACS Designer: “Re: mobile image viewing. TPD congratulates Aycan Medical Systems for being one of the first to gain FDA approval for its Aycan Mobile for the iPad. Now that the FDA is involved with mobile solutions, we’ll see more teleradiology mobile solution approvals for other vendors.“

From Steve: “Re: QuadraMed. To be sold in the next 7-10 days.” Unverified.

From Pointer: “Re: EHRs. A vendor-agnostic viewpoint on how they don’t change the cost curve.” It may be vendor-agnostic, but this particular article is a clearly labeled opinion piece written by authors who have been historically negative toward EMRs, EMR vendors, and government. They are entitled to their opinions, but recognize them as such despite the bait-and-switch newspaper headline trumpeting “A Major Glitch.” Their editorial conclusion is accurate, though – most studies have failed to prove that EMRs save money (I haven’t seen any studies that convinced me that paper records save money or improve outcomes either, of course.) That’s not to say they don’t, only that it’s tough to prove since nothing in healthcare stays unchanged long enough to get a baseline. It’s also true that expecting technology alone to create savings without changing incentives is unreasonable. I agree with the authors that blowing taxpayer billions to get providers to buy software they weren’t willing to spend their own money on was illogical, but no amount of Monday morning quarterbacking will bring that cash back or cause providers to toss their EMRs out the nearest window. It’s time to move on, realize that healthcare IT is here to stay, and constructively make it better instead of hand-wringing. Like everything else, the industry has 10% cheerleaders, 10% naysayers, and 80% rational people who don’t need the self-proclaimed experts on either end of the spectrum to tell them what to think or do. If you’re a provider, choose EMR or paper as you desire, do something innovative with it that improves outcomes and reduces costs, and then write your own article. That’s the one I’d rather read.

From Looking Deeper: “Re: patient portals and self-scheduling. I install patient portals for a living, including scheduling. There really aren’t technical challenges any more. Providing convenient, immediate online scheduling is a solved problem even in healthcare, especially in primary care. The problem is in people’s heads. Whenever online scheduling comes up, physicians and clinic staff will tell you that their patients can’t possibly handle it – they’ll schedule the wrong kind of visit (office visit vs. physical) or create some other vague problem. I dutifully inform them that online scheduling is working fine in clinics and practices across the nation. ‘Other clinics find that their patients can handle this,’ I always say. They usually say, ‘Not our patients.’ Interestingly, clinics serving less-affluent areas and the indigent tend to be more in favor of such patient-centric services. ‘Our patients are an especially incompetent group’ is a pretty negative view to hold of the people you’re trying to care for. If we could just get past this attitude, pretty much all primary care visits could be scheduled online. In the rare case where something needs to change, the clinic can call or e-mail the patient and reschedule, but that’s less than 5 percent of appointments scheduled online. Specialty and procedure visits are a different beast and need some careful analysis before they are opened up to online scheduling, but online scheduling for primary care is a solved problem.”

HIStalk Announcements and Requests

I have newfound respect for anyone working with insurance companies to secure payments. I had mentioned a few months ago that I had a minor medical procedure that resulted in some complications, lots of doctor office visits, and about 20 different medical claims. I was lucky enough to have both primary and secondary coverage in place since the claims were in the thousands. I also thought I was lucky because both policies were from the same very big insurance company. Unfortunately, the insurance company has spent the last four months trying to decide internally which policy should be primary, and so far no claims coordination has occurred. After several weeks of hour-long phone calls, yesterday I finally turned “not nice” and demanded to speak to a supervisor. I explained that I didn’t give a (expletive) which policy was primary or secondary, it was all one insurance company, and the (expletive) claims needed to be paid. I actually believe the claims will finally be processed correctly. The moral of this story is that if you work in a hospital or practice, take a moment to say thanks to your billing and collection staff. And bring them chocolate on a regular basis.

I don’t know about you, but I’ve been busy turning off all my Facebook and Twitter connections to folks who keep preaching politics. Has anybody ever convinced someone to change their political beliefs by proudly posting a Facebook link to the latest nut-job partisan article? Actually, they sometimes almost convince me to vote the other way out of annoyance.

Thanks to Healthcare Quality Catalyst supporting HIStalk as a Platinum Sponsor. The Salt Lake City company offers a practical clinical data warehouse solution that combine technology and clinical improvement methodologies to improve care. The information needed to answer a clinical improvement question is scattered in most hospitals (satisfaction surveys, Epic Clarity transactions, and lab and prescription information, for example) and HQC puts it together in its Adaptive Data Warehouse and subject-specific data marts (such as women and newborns) to support continuous, evidence-based care improvements. HQC offers more than just the tools, supplying clinical improvement methodologies such as role definitions and process templates to create effective improvement teams. If you’ve been around the industry for some time, you surely know some of their folks: Todd Cozzens, Larry Grandia, Dale Sanders, Bruce Turkstra, and David Burton, MD were some of those I immediately recognized. I interviewed co-founder and CIO Steve Barlow a year ago and got a good background on the company. Thanks to Healthcare Quality Catalyst for supporting HIStalk.

I naturally cruised over to YouTube and found this video that introduces Healthcare Quality Catalyst better than I did.

Acquisitions, Funding, Business, and Stock

PE firm ABRY Partners makes a “significant” investment in SourceMedical Solutions, a provider of software and services for ASCs and rehab centers.

In England, a company that commercializes university research invests in an Oxford spinoff whose software that can monitor pulse, respiration, and oxygen saturation using only a webcam.

Also in England, eHealth Insider reports that CSC will stop selling iSoft GP systems to NHS markets, in which it has 582 practice customers. CSC denies the report.

Vipaar, which sells surgery proctoring software based on technology developed at the University of Alabama at Birmingham medical school, raises half of its $1.2 million funding goal.

Sales

Community Medical Center (NE) selects BridgeHead Software’s Healthcare Data Management Solution for backup and archiving.

CommUnity Care (TX) will deploy NextGen RCM Services throughout its 22 clinics.

Pemiscot Memorial Health Systems will expand its deployment of Prognosis Health Information System by implementing its financial system and its laboratory information system powered by Orchard.

Community Hospital Grand Junction (CO) chooses the perioperative system of Surgical Information Systems.

People

Zotec Partners hires Kristy Floyd (American Society of Anesthesiologists) as director of anesthesia business development.

The Medical College of Wisconsin appoints David C. Hotchkiss (University of Texas Health Science Center) VP/CIO.

Healthland names Patrick Spangler (Epocrates) CFO.

Douglas Billian, founder of Billian Publishing, died September 15 at 84.

Announcements and Implementations

HIMSS Analytics recognizes Fort HealthCare (WI) with its Stage 7 Award for EMR adoption.

Providence Medford Medical Center and Asante Rogue Regional Medical Center (OR) will complete their hospital and clinic implementations of Epic in April.

Nuance will purchase Ditech Networks, a provider of voice technologies and voice-to-text services, for $22.5 million.

AMA releases the 2013 CPT code set, which goes into effect for claims filed as of January 1, 2013.

Certify Data Systems announces the general availability of its HealthLogix HIE platform, which it says is the first to deliver an aggregated patient view from all community health encounters regardless of EHR.

Cincinnati Children’s Hospital Medical Center (OH) implements Passport Health’s PatientSimple and Smart Statement online billing solutions.

eClinicalWorks launches its $10 million open, secure collaboration platform that works with any EHR or even paper-based practices. The NHIN Direct-compatible network allows members to transmit electronic referrals and patient records with attachments.

Government and Politics

ONC posts the second wave of draft test procedures for the 2014 Edition EHR certification criteria.

I don’t think Farzad ever followed through on his promise to name the EMR vendors who took his #VDTnow pledge to allow patients to view, download, and transmit their medical information. Claudia Williams of ONC tweeted her list, which I assume is complete: Allscripts, NextGen, AlereWellogic, Intellicure, eClinicalWorks, Greenway, SOAPware, athenahealth, Azzly, and Cerner. Conspicuously but not surprisingly missing is Epic, which doesn’t even have a Twitter account as far as I know. Maybe they already offer the capability as some have suggested, but if so, all they had to do was tweet out their already-met pledge. Judy’s on ONC’s Health IT Policy Committee, after all.

Innovation and Research

The National Library of Medicine awards The Ohio State University College of Medicine’s Department of Biomedical Informatics $1.3 million to develop a system that uses EHRs to identify potential patients for clinical trials.

Other

Wider use of EHRs over the last decade may be contributing to a growing up-coding trend that has added $11 billion to healthcare costs. Physicians argue the higher codes are justified because care of seniors has become more complex and technology allows them to code more accurately. Critics say the findings suggest billing abuse and fraud. I I were still selling EMRs, I’d be handing this study to doctors and touting it as proof that technology is helping physicians bill and be paid for the actual care provided. Meanwhile, naysayers like Mr. H will probably dig deeper and suggest objections to such hasty conclusions.

Hell hath no fury: a Washington dermatologist wins a $600,000 settlement and a rare apology from state health officials who had investigated him for drug abuse and medical fraud. An anonymous tipster had reported that the doctor was falsifying drug records, using cocaine, and running in-office orgies among his staff, patients, and prostitutes. In a separate lawsuit, the doctor was award more than $100,000 from his former wife, who turned out to be the anonymous tipster who had filed the complaint late in the couple’s bitter divorce proceedings.

The folks from Arizona Associated Surgeons sent over their video for the Western Users Group meeting at ACE (the Allscripts user meeting) last month.

Want to rub elbows with sexy celebrities on your hospital employer’s dime? CHIME’s Fall CIO Forum will feature Olympic beach volleyball gold medalists Misty May-Treanor and Kerri Walsh Jennings, mostly known for leaping around nearly naked in prime time reminiscent of the much-beloved “Girls on Trampolines” segment of The Man Show except with smaller bikinis. Misty and Kerri (or was that Misti and Kerry?) will discuss Meaningful Use Stage 2 and … no, wait, they’ll pose with star-struck CIOs, sign autographs, and collect a big non-amateur payday courtesy of patients who pay $5 for an aspirin.

A group of 30+ physicians labeling themselves as “Doccupy” complain to Contra Costa, CA county supervisors about the $45 million implementation of Epic at its hospitals. They said 10 percent of ED patients are leaving without seeing a doctor, a number that increased after the hospital’s July 1 go-live as the average time in the ED increased from three hours to four. Patient loads were cut in half to prepare for the implementation, but the doctors claim that several of their peers still quit because of stress, saying, “We were not ready for Epic and Epic was not ready for us.” An ED physician going off shift said she still had documentation to complete for 16 patients, adding, “It’s going to implode.” Some doctors spoke up about the advantages of Epic, and all agreed that it’s important to have an integrated electronic record. Detention facility nurses had complained about Epic to the supervisors last month.

The Cure JM Foundation (juvenile myositis) is in the running for a $250K research grant that will go to the charity with the highest number of Facebook votes. Information and voting links are here. Several HIT folks I’ve heard from have children with JM and I’m sure they would appreciate your vote.

Patients storm Charlton Memorial Hospital (GA) after a contracted collection company incorrectly manipulates the hospital-provided data file, sending patients collection notices for bills they don’t owe.

Of the seven highest-earning non-profit CEOs in the country, four run hospitals, according to the Chronicle of Philanthropy. I think they’ve missed a few since I’ve seen several hospital tax forms with CEO salaries above these figures.

Bloomberg Businessweek profiles Terry Ragon, founder of the Boston-based InterSystems, which sells the Cache’ database that runs Epic, Meditech, and quite a few other MUMPS-based healthcare systems. The article calls Ragon a “Hidden Software Billionaire,” estimating the value of the company he directly owns at $2 billion.

Here’s a fun coincidence. Dave Miller, vice chancellor and CIO of the University of Arkansas for Medical Sciences, sent over the above video of him doing a nice cover of “Mustang Sally” at Epic’s UGM (his wife had the camera 90 degrees off kilter for a few seconds, but his singing was fine). The day they got back home, he impulsively bought some raffle tickets from a charity fundraiser. He won the prize, which was made in 1967, the same year Wilson Pickett released “Mustang Sally” on an album – a classic Ford Mustang.

Sponsor Updates

• SuccessEHR grows its RCM services business 92 percent over the last year.
• First Databank hosts its 2012 FDB Customer Seminar this week in San Diego.
• T-System offers Webinars this week on  improving ED throughput.
• Melanie Pita JD, EVP of product management at Prognosis Health Information Systems, presented a session on EHRs and Meaningful Use at the Georgia Rural Health Association conference this week at Callaway Gardens.
• TeraRecon is exhibiting its advanced visualization solutions for medical imaging this week at CIRSE 2012 in Lisbon, Portugal.
• Michigan Health Connect HIE and Greenway Medical will provide data exchange between Greenway’s PrimeSUITE customers and hospitals on the Michigan Health Connect platform.   
• MedPlus offers a three-part Webinar series hosted by Steven Waldren, MD, director of the AAFP’s Center for Health IT.
• White Plume releases a white paper discussing practical considerations to minimize losses while migrating to ICD-10.
• ChartWise Medical Systems unveils its ChartWise:CDI software at this month’s AHIMA convention in Chicago.
• Orion Health opens an office in Singapore for development and technical support employees.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 9/17/12

From Another View: “Re: your Time Capsule editorial. You have missed a competitor to Epic … Sunrise/Eclipsys. Ring any bells? Long Island Jewish has it installed as well as others and it is well received. Is the price tag of Epic is going to bankrupt medicine? I really think Sunrise could very well be the Apple product that beat the giant Microsoft. Any thoughts?” Read more closely: I specifically mentioned (twice, in fact) Cerner, Eclipsys, and McKesson as Epic’s big-hospital competitors. That was true when I wrote the article in 2007, but I would expect that Allscripts/Eclipsys and McKesson have faded since then in terms of big-hospital customer count. Epic’s huge number of wins since 2007 were replacements, meaning their gain was somebody else’s loss. No, I don’t think that Allscripts (or any other vendor, at the moment) can compete with Epic in the large-hospital inpatient clinical systems market. Reasons: (a) incomplete integration; (b) narrower product line; (c) lower customer satisfaction; (d) lack of momentum; (e) hospital consolidations favoring existing Epic customers; and (f) trying to disrupt the status quo with one hand firmly planted in Wall Street’s lap. It’s not the end of the world for Allscripts – 80% hospitals aren’t candidates for Epic but need a lower-priced, pre-packaged, hosted product, meaning the biggest companies to beat are Meditech, McKesson, Cerner, and Siemens. Struggling to compete against Epic in big-hospital accounts hasn’t hurt Cerner, which doesn’t bag a lot of fresh Millennium wins over Epic but still has turned its assets into a $12 billion company. If you want to score Epic vs. Allscripts without emotion or subjectivity, it’s easy – just watch the number of new sales, the total number of beds and EPs covered, and KLAS scores.

From Music Lover: “Re: Epic UGM. You missed it, Mr. H! Some cool end users rocked the house Monday night. Anyone have pics or YouTube?” I only found the video of the opening session above, which is a clever riff on a horrible Journey song (was that redundant?) that reminds of me when Mrs. HIStalk dragged me to grit my teeth through the traveling Broadway version of “Rock of Ages” (who would have guessed that disco would be more fondly remembered than 80s hair bands?) By user group standards, though, it is darned cool. From the end of the video, it appears next year’s theme will be, predictably, Deep Space (the new 14,300-seat Deep Space auditorium pictured above will be open then.)

Listening: new from The Avett Brothers from Concord, NC, who have matured from frantic newgrass revivalists into something like an indie, rootsy Beatles with banjos. Long-term fans will have to decide whether the de-emphasis on hillbilly picking and grinning is inevitable maturity or perhaps overly slick production by hit-maker Rick Rubin. The new album is more accessible and probably less embarrassing to crank up in a vehicle that isn’t a pickup truck.

I was making an appointment for my annual PCP visit last week. After navigating through the annoying phone tree, waiting on hold, and negotiating with the scheduler for a convenient appointment time, the phone connection dropped on their end. My call-back went right to the “we’re too busy to talk to you now” message, so I figured I’d just try another day. The next day, I got an e-mail confirmation for a date/time I had declined, so it must have gone through as we were changing it. I noticed an unobtrusive link in the e-mail to “click here to cancel or reschedule” and darned if it didn’t work – I clicked, it gave me available days/times on the screen, I clicked on a convenient date/time, and I was all set. It actually felt like 2001 instead of 1980 in using Expedia to book a flight instead of wasting everybody’s time by calling a travel agent for an inefficient and entirely unnecessary telephone conversation. It’s not exactly cutting edge, but very few businesses let you schedule appointments online (restaurants being one exception, and that’s only because of OpenTable). Scheduling an appointment is a lot different than buying a product online, so the usual snarky Amazon references don’t apply.

Forbes chose the wrong company as the most innovative in healthcare, according to readers who said it’s actually Epic (had Forbes included non-publicly traded companies, of course). Cerner wasn’t too far off the mark, though. New poll to your right: have you ever requested and reviewed your electronic medical information from your PCP? The poll accepts comments if you’d care to elaborate on your experience. I didn’t even bother asking about hospital records since I know what a nightmare that can be.

Allow me to introduce new HIStalk Platinum Sponsor ChartWise Medical Systems. The Rhode Island-based company describes ChartWise:CDI as a Computer-Assisted Clinical Documentation Improvement solution that improves the accuracy and speed of documentation. it guides physicians to high-quality and complete documentation, using its built-in intelligence to analyze labs, meds, and procedures to suggest diagnoses and complications that may not have been correctly coded. Easily retrievable, auditable, and AHIMA-compliant query templates ensure compliance and consistency for internal QA and external auditors, with physician communication automatically initiated and documented by e-mail. Customers can reduce staff and physician training, ensure continuity when key team members leave, and get real-time metrics for their CDI programs. It’s offered by a subscription-based license, online training is free, and ICD-10 is built in and carries no upgrade fee. Customers can use it their way, regardless of whether documentation is on paper or EMR and with or without the participation of physicians. Half of Medicare paybacks are due to erroneous or incomplete documentation and you know the RAC auditors are out there digging since they’re paid a percentage of recovered dollars. The company was founded by Jon Elion MD, who also developed the Heartlab imaging software that was acquired by Agfa in 2005. Thanks to ChartWise for supporting HIStalk.

CapSite releases its new HIE report. It shows a big jump in hospital HIE participation in the past year (from 30% to 50%), with 71% of respondents planning to invest in new HIE technologies in the next two years. Surprisingly, two-thirds of respondents chose their primary HIE vendor because the company was an extension of their core hospital system (Epic was the most-named HIE vendor, so that gives you an idea). That probably reflects the uptick in private HIEs.

A hospital in England uses Skype for video teleconsultations with ADHD and Asperger syndrome  patients.

The flagship product of Detroit-based startup SchedFull manages an online waiting list for physician practices that allows them to fill appointments opened up when patients cancel, alerting the standby patient by e-mail or SMS if an opening matches their expressed preferences. The product is in beta.

Twenty-three employers participated in a jobs fair that was held last week in the new Sheik Zayed Tower at The Johns Hopkins Hospital, hoping to hire healthcare IT and informatics graduates from Johns Hopkins University, George Washington University, and University of Maryland University College (surely the strangest and most multiply-redundant college name ever, which they cheerfully admit and explain here). The event was held in the Chevy Chase Conference Center, which I assume is named after the nearby municipality rather than the embarrassingly unfunny comedian who did in fact have a Hollywood theater named after him for six weeks in 1993, which is all it took for his horrible late night TV show to flatline.

The Dallas-Fort Worth TV station covers the technology used in a new Texas Health Alliance hospital.

The local paper covers the use of shared medical appointments by Reliant Medical Group (MA), in which 90-minute visits are scheduled with groups of patients suffering from the same chronic health issues. Patients have the option to request one-on-one doctor time during the visit if they feel the need, but three-quarters of them like the group appointments. That’s an interesting approach to maximizing the use of resources while providing peer support for patients, which is probably far more effective than the usual online groups. All that’s missing is a financial incentive for consuming fewer resources, which is of course a healthcare problem not limited to how patients schedule their visits.

Raul Recarey is named executive director of the Illinois HIE in his third HIE leadership role in less than three years, having been named COO of the West Virginia Health Information Network in November 2009 and CEO of Missouri Health Connection in March 2011.

Indian River Medical Center (FL) will implement centralized appointment scheduling using McKesson’s Paragon Resource Scheduling, which issues printable appointment itineraries and procedure instructions. After the May go-live, the hospital will implement patient self-scheduling.

A hospital in Scotland is found by NHS to be cancelling 12% of its outpatient appointments due to problems with its new computer system. The hospital cancelled 105,000 outpatient appointments and 7,500 inpatient appoints in a 15-month period.

The author of an upcoming book says that children’s hospitals are banking huge cash surpluses and paying eye-popping executive salaries despite their non-profit status and ongoing solicitation for donations, which he says threatens their non-profit status, government subsidies, and community reputations.

California’s attorney general sends out subpoenas to several big health systems (Scripps, Sharp, Sutter, and others) in launching an antitrust investigation to determine whether consolidation among hospitals and physician groups is increasing healthcare costs through increased pricing power over payers.

A nurse working for an Atlanta-area anesthesia service is released to rehab after being charged with driving the wrong way on a highway and causing several vehicles to crash, injuring six people. She is alleged to have stolen propofol from Gwinnett Medical Center and starting an IV on herself to administer it in her car right before the accidents.

Vince tells the story of Compucare and QuadraMed this week, going right to the source in somehow connecting with Dynamic Control co-founder David Pomerance, who then introduced him to Ron Aprahamian, whose fascinating story is that he bought all of Compucare’s stock for $50,000 as a 29-year-old, struck a deal with Meditech, took Compucare public for $40 million, took leadership roles at Superior and First Consulting Group as those companies were acquired … well, just check Vince’s slides because it’s too amazing for me to summarize. I’m glad Vince shared Ron’s story because even though I knew his name, I had no idea how much influence he had on so many major industry players. We would never have heard these stories if it weren’t for Vince, who seems to be the only person willing to work hard to preserve our industry’s history. If you can help him with stories, photos, or connections to folks he should talk to, give him a shout.

E-mail Mr. H.

News 9/14/12

Top News

Mediware will be acquired by PE firm Thoma Bravo LLC for $195 million, the company announced Wednesday. The $22 per share cash offer represents a 40% premium over Tuesday’s closing price.

Reader Comments

From Shades of Green: “Re: RECs and EPs. You point out that only 17,144 EPs have demonstrated Meaningful Use through the REC program. I did a little digging and found that total grants for RECs to date (which does include some funding for rural hospitals) is $706 million. That comes to $41,181 for each of the 17,144 EPs demonstrating Meaningful Use.”

From N2InformaticsRN: “Re: MappyHealth. You mentioned a few weeks back our entry into the HHS NowTrending 2012 Challenge. I have an update – we won! Not bad for two nurse informaticists and a computer science student.” Social Health Insights LLC’s free application mines real-time tweets via Twitter’s open APIs to serve as an surveillance system for emerging health issues. The challenge, which drew 33 entries, was created by HHS after it observed that social media trends can be correlated to disease outbreak. The team is Brian Norris, Charles Boicey, and Mark Silverberg. I’m sure they are keeping their fingers crossed that their app doesn’t get hosed as Twitter continues to reduce the functionality and terms of service of its APIs in hopes of monetizing tweets instead of allowing others to build applications around them. Several small companies whose only products were Twitter add-ons have already gone belly up when their data hose went dry.

From The PACS Designer: “Re: iPhone 5. Faster, thinner, 4” display, and iOS 6. Apple is prepared to meet Q4 demand by preparing suppliers to ship as many as 50 million of them in the quarter.” The only Apple products I own are an iPad and a Nano, but I still watch blow-by-blow live-blogging of every Apple announcement, which is an indication of how dramatic Apple makes their unveilings (not to mention how well they keep those huge, world-impacting announcements a secret, which is truly amazing to me). I can’t think of any reason I should care given that I’m not in the market for new Apple products, but I still do. I’m not convinced that the iPhone 5 is better than some of the Samsung or other Android phones (many of the new iPhone features have been on Android for a long time, leading some analysts to openly ridicule Apple for under-delivering), but I can safely predict that the fanboys will be camping out at the Apple store next Thursday night (what recession?) I read the other day that Apple’s iPhone sales volume alone is bigger than all of Microsoft.

From Arnold: “Re: KLAS report on Epic consulting firms. They just posted an update saying one firm has been removed because KLAS mistakenly gave them credit for another company’s survey. How shoddy, and it isn’t the first time we’ve seen this kind of mistake.” I blurred the company’s name on the KLAS announcement since it’s a good news/bad news thing – in removing some other company’s negative survey, this company’s score went up, but then it didn’t have enough surveys, so KLAS removed it completely from the updated report.

From Blue Dog: “Re: Allscripts Enterprise EHR. Heard CHS in Oklahoma City had a great implementation and they are re-looking at using it in other markets. They had a huge contractor downsizing and had postponed or shifted to athenaclinicals in many markets.” Unverified.  

HIStalk Announcements and Requests

This week’s HIStalk Practice highlights include an example of “EMR garbage.” Opinions on why specialists may seek MU incentives less often than primary care providers. Healthcare expenditures fall when patients have more access to office-based care after hours. An internal medicine physician grades his EHR. More feedback from the HIStalk Practice Advisory Panel on the ACA’s potential impact on patient volumes. Culbert Healthcare Solutions VP Jeff Wasserman offers strategies to help independent practices enjoy the financial benefits of quality-based care. Thanks for reading.

Despite the inconvenience of the new adapter, I am ready to take advantage of the $199 option to upgrade my iPhone 4 to the 5. The fast-draining battery has always been my biggest gripe with the iPhone, so longer battery life is the most appealing new feature. A bigger display will also be nice and I am envisioning all the cool panoramic photos I’ll be able to take at the upcoming MGMA meeting. I’ll be one of the geeks standing in line at the Apple store on September 21.

I was waiting for the elevator at work today with the “going up” button lit. As I stood patiently, some guy charged around me and gave the already-lit button several quick jabs. Do you suppose he thinks there’s an algorithm built in that gives preference to the number of times the button is pushed, does he harbor suspicions that elevator lights are rigged, or is he just an impatient jerk who assumes I’m not capable of pushing the button correctly?

Acquisitions, Funding, Business, and Stock

Streamline Health reports Q2 results: revenue up 22%, EPS –$0.04 vs. $0.00.

MRO Corp. acquires the assets of Florida Medical Records Services, a provider of release of information services.

Athenahealth signs a definitive agreement to acquire Healthcare Data Services, a provider of healthcare data analysis and population health management solutions for payers and providers.

Nightingale Informatix secures $2.75 million in Series B funding.

In England, mental health EHR vendor Strand Technology is acquired by Advanced Computer Software Group for $3 million.

Sales

Community Hospital Anderson will use Summit Healthcare’s Express Connect and Provider Exchange technology  for internal and bi-directional integration with its Meditech system.

Cherry County Hospital (NE) chooses Access Intelligent Forms Suite for electronic forms management as it migrates to Meditech 6.0.

The Federal Economic Development Agency will use the Connected Wellness Platform of NexJ Systems for its Connected Health and Wellness Project.

Fort Drum Regional Health Planning Organization (NY) selects Wellcentive to provide disease registry, case management, and predictive analytics.

Anne Arundel Medical Center (MD) chooses Medseek’s ecoSmart Patient Precisioning CRM solution for patient engagement and education.

Key-Whitman Eye Center (TX) selects Versus Advantages RTLS to track patient progression and staff workflows.

HealthEast Care System (MN) chooses Humedica for its ACO and PCMH initiatives.

People

Lance Fusacchia (Webmedx) joins Shareable Ink as CFO.

CHIME awards its State Advocacy Award to Texas Health Resources SVP/CIO Ed Marx.

Tom Penno (Indiana HIE) joins NoMoreClipboard as VP of channel management.

SuccessEHS promotes Lori Junkins and Elizabeth Featheringill Pharo to VP and Elizabeth Pitman to general counsel.

Jim Speros, who led the VA’s innovation prize contests and promoted its use of Blue Button, died September 3 at 59.

John Cox, former CIO at the Hospital for Special Surgery (NY), died September 12.

Announcements and Implementations

HIMSS names Hawai’i Pacific Health the winner of the 2012 Enterprise HIMSS Davies Award of Excellence.

In the UK, Moorfields Eye Hospital NHS Foundation Trust adds three modules to OpenEyes, its self-developed, open source patient management system. The new modules include surgical notes, discharge letters, and prescriptions.

Government and Politics

HHS announces $983,100 in grants to support improved healthcare access and coordination for veterans living in rural areas using telehealth and health information exchanges.

HHS Secretary Kathleen Sebelius admits to violating the Hatch Act, a federal law that restricts the political activity by government employees. Sebelius called for the re-election of President Obama at a February speech to a gay rights group. Sebelius has apologized and the Democratic National Committee has reimbursed the government for the cost of her trip.

ONC’s blog urges nurses to request a copy of their own electronic health record, verify the accuracy of its contents, and sign an online pledge. I suspect few of us in healthcare IT have requested electronic copies of our information, so I will post this as a challenge of my own to all readers. Request a copy of your EHR information and let me know how the process went – how convoluted the request process was, how long it took, and how accurate and complete your information was. I’ll run anything you send me. Somehow I think that, like almost everything related to healthcare, it doesn’t work nearly as well as patients have a right to expect. It’s not exactly Golden Rule territory.

ONC releases its educational security training game for medical practices. I played it and it’s pretty cool.

Medicare says it won’t pay providers based on copied-and-pasted patient notes.

Other

Beth Israel Deaconess Medical Center is named the #1 company in the InformationWeek 500 list of the most innovative users of business technology. Other healthcare organizations in the top 50 include Quintiles (#6), Sparrow Health System (#16), Premier Inc. (#30), Miami Children’s Hospital (#31), RadNet (#32), McKesson (#34), Intermountain Healthcare (#48), Kindred Healthcare (#48), and Sharp HealthCare (#50).

CareCloud will establish a Massachusetts office to take advantage of the region’s technical talent.

I said in January when US CTO Aneesh Chopra resigned that I expected him to run for lieutenant governor of Virginia, but instead he went back his previous employer, The Advisory Board Company. I should have paid more attention to the election calendar: the election is in 2013 and he has announced as a Democratic candidate for that office.

A Financial Times article called “Healthcare: Cyber wards” covers Silicon Valley companies trying to break into healthcare. It doesn’t contain anything all that interesting, but it does quote an entrepreneur who says VCs are still wary of investing in companies because of long healthcare sales cycles and their previous experience with products that were never perfected.

University of Minnesota Medical Center, Fairview violated patient protection and EMTALA laws by its aggressive collections tactics overseen by Accretive Health, a federal investigation finds. Fairview says they “continue to learn from this experience.” Shares in Accretive were down 11% Thursday on the news, by far the biggest percentage loser on the NYSE. The company had already paid a $2.5 million fine and agreed to cease operations in Minnesota. Shares owned by founder and CEO Mary Tolan  are still worth $108 million.

Weird News Andy is convinced that being real smart doesn’t preclude being real stupid. Richard Keller MD, a pediatric endocrinologist and Harvard Medical School instructor (WNA summarizes as “a vile human being,” at least assuming he’s found guilty), is arrested when a package containing 50 DVDs of child pornography is delivered to his attention at Phillips Academy, where he was medical director until last year. He might be one of few people whose life goes directly into the toilet because he forgot to update his shipping address or perhaps had the misfortune of back-ordered porn.

Markle Foundation puts out a video promoting the consumer use of Blue Button.

The computer hacker / brain tumor patient in Italy who cracked the proprietary formats of his electronic medical records so he could post them publicly to seek help has updated his site with the ideas he has received so far. It’s getting interesting – he’s about to publish a tutorial explaining the quirks he found with DICOM images and he’s putting out some rather eloquent ideas about health and technology:

The definition of "diseases" is "reserved" to doctors. Often using words which we don’t understand and, most important of all, touching only a part of the human condition, which is made from body, but also of spirit and sociality. The DICOM format is open, yes, but in a very "peculiar" condition of openness: it is like the openness of the words which they use to tell you about your health condition, and with which they describe and actuate their version of the "cure": you can’t understand it, you can’t reuse it, you can’t combine it with other possibilities. It is thought for "experts" and "professionals" (of one single type), leaving little space for other possibilities for expression and socialization … Maybe we could start to think about an "open" world in this sense, too, not dedicated to "professionals" and "procedures", but also to human beings.

Sponsor Updates

• Vonlay created a Web page featuring live tweets and photos from the Epic UGM this week.
• PDR Network announces that its flagship service meets Meaningful Use Stage 2 requirements in delivering real-time FDA drug safety alerts and product program information at the point of prescribing.
• More than 50 employees from the Burlington, VT office of Allscripts will take part in a Habitat for Humanity build this week.
• Amerinet makes McKesson’s pharmacy automation solutions available to its 3,000 hospital members.
• Intelligent InSites integrates its RTLS with Haldor’s ORLocate surgical instrument tagging to offer a surgical instrument management and tracking solution.
• Lifepoint Informatics announces its Silver Level sponsorship of next month’s Pathology Informatics 2012 conference in Chicago.
• LDM will provide consumer medication information from Polyglot Systems in its point-of-care messaging solutions.
• HIStalk sponsors Allscripts, NTT Data (formerly Keane Inc.), and World Wide Technology earn spots on the annual InformationWeek 500 list of innovative business technology users .
• Forbes cites Greenway as being “ahead of the pack” in delivering information exchange and interoperability between its PrimeSUITE and the EHRs of other vendors.
• Orion Health will incorporate images from Agfa’s clinical imaging platform into its clinical portal.
• DrFirst and Meditech will demonstrate their combined solutions during a series of Webinars in September and October.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Tweets and Photos from Epic UGM 9/12/12

They have the best swag! #epic #ugm2012 #newbie

— Michael Lamb (@lambatwork) September 10, 2012

Barry Bershow from Cedars-Sinai (Lake Wobegon West) where all the men, women, children, and Epic progress notes are good looking. #UGM2012

— Jorge Scheirer (@infomedoc) September 10, 2012

I’d like to thank google maps for the ability to see in real time that traffic at Epic Lane is already backed up to exit 77 #ugm2012

— K Wroblewski (@kdwroble4) September 11, 2012

#UGM2012 stats: 7900 customer attendees, 3400 gallons of coffee

— borborygmi (@nickgenes) September 11, 2012

Epic CEO Judy Faulkner on rock theme for #UGM2012: says “hey Jude” has particular meaning for #healthIT “take a sad song and make it better”

— borborygmi (@nickgenes) September 11, 2012

Only 1.2% of US hospitals are at top HIMSS stage for #EHR integration — and 3/4 of those hospitals are at Epic’s #UGM2012

— borborygmi (@nickgenes) September 11, 2012

CEO Judy Faulkner says Epic is installed in over half of US academic medical centers #UGM2012

— borborygmi (@nickgenes) September 11, 2012

47% of Epic expenses are R&D. Moving into long term care, home care. Faulkner wants her programmers to have individual offices #UGM2012

— borborygmi (@nickgenes) September 11, 2012

Epic CEO Judy Faulkner: too few physicians on meaningful use committees, and their input is lost on way from ONC to CMS #UGM2012

— borborygmi (@nickgenes) September 11, 2012

Next big things for Epic seem to revolve around mobile apps on your phones and tablets. #UGM2012

— Sarah Nelson (@Sarah_at_Vonlay) September 11, 2012

#UGM2012 physician slicer dicer: from evidence based practice to practice based evidence. Cool!

— Arjen Noordzij (@dokter_no) September 11, 2012

Especially excited about Epic planned release of patient centered product for pts in hospital. Very cool for pt engagement#UGM2012

— Luis Saldana (@lsaldanamd) September 11, 2012

Great riff on ICD-9 and ICD-10 in relation to Spinal Tap and going to 11. "It’s one version higher. So it has to be better." #UGM2012

— Sarah Nelson (@Sarah_at_Vonlay) September 11, 2012

RT @gruntdoc: #EPIC #EPICUGM 14K here, about 7.4K are clients, rest Epic staff; 10 countries rep’s. #UGM2012

— Luis Saldana (@lsaldanamd) September 11, 2012

#UGM2012 Wouldn’t it be great: the UGM2013 app with your schedule notifying when to go and showing how to get there?

— Arjen Noordzij (@dokter_no) September 11, 2012

After day 1 at #ugm2012 I am exhausted, but #Epic has been fantastic, need to take notes on guest services!

— Autumn (@rhodes_aut) September 12, 2012

In upcoming Epic release, patients will be able to log into myChart and download their records to a PDF #UGM2012

— Robert S. Miller, MD (@rsm2800) September 12, 2012

#ugm2012 300/500 of the Epic hospitals are using barcode med administration. Very good for patient safety!

— GruntDoc (@gruntdoc) September 12, 2012

Good job Epic – lots of cool new features. Loving the emphasis on analytics! @epicugm #UGM2012

— Krishna Ramachandran (@krishna_gr) September 12, 2012

#ugm2012 good news, Epic is going to have an opt-in for benchmarking across Epic hospital systems. Terrific!

— GruntDoc (@gruntdoc) September 12, 2012

Beacon oncology updates: therapeutic substitutions 4 antiemetics 4 drug shortages; breast ca survivorship plans; better analytics #UGM2012

— Robert S. Miller, MD (@rsm2800) September 12, 2012

Epic will use protocols from #DirectProject to push information to outside EHRs #UGM2012

— Robert S. Miller, MD (@rsm2800) September 12, 2012

Mobile payments to be built into Epic myChart. Can also sign up via mobile for paperless statements #UGM2012

— Robert S. Miller, MD (@rsm2800) September 12, 2012

#ugm2012 Need this Cogito data model! It is a data warehouse that compiles Epic and non epic data in one place to help reporting.

— GruntDoc (@gruntdoc) September 12, 2012

#UGM2012 #Carl Dvorak did it! His childhood dream came true: live on stage with a guitar.

— Arjen Noordzij (@dokter_no) September 12, 2012

#ugm2012 surreal seeing software planned for release in 2 years, that we won’t get for at least three. Like hearing about the cool1/2

— GruntDoc (@gruntdoc) September 12, 2012

Fun idea to improve clinical note quality: ‘Like’ button on peer’s progress notes! #UGM2012

— K Wroblewski (@kdwroble4) September 12, 2012

Was intently watching #UGM2012 tweets and Apple anncmt live blogging. Neither affects me, but I felt temporarily cool.

— histalk (@histalk) September 12, 2012

News 9/12/12

Top News

ONC publishes a Health IT Dashboard that includes six views and 250 custom dashboards for states, ONC programs, and grantees. It includes charts, maps, and downloadable tables pertaining to EHR adoption, REC programs, and HIT workforce training. An interesting statistic: of the 143,890 EPs enrolled in RECs, only 17,144 (12%) have demonstrated MU. Also surprising: only 39% of acute care hospitals were using even a basic EHR by the end of 2011.

Reader Comments

From David: “Re: Dr. Jayne’s comment on ‘educational session’ put on for members of Congress. As someone who used to put these on, these are simply a forum for making a lobbying pitch to lawmakers and Congressional staff under the guise of education. The ‘education’ is to get lawmakers to vote in the interests of the event’s corporate sponsors.” Sponsors listed include HIMSS, Ingenix, Allscripts, BCBSA, and a bunch of other companies, government contractors, and member organizations. It was the Washington schmoozing and complete surrender to its Diamond members that largely turned me against HIMSS as an organization that represents me as a non-profit hospital employee and dues-paying member instead of a piece of meat offered up for ogling by its conference exhibitors. I would rather see HIMSS split into two groups, one for providers only (like it almost was before the current regime got dollar signs in their eyes) and the other being the vendor trade association that HIMSS denies being despite ample similarities.

From Dell-lightful: “Re: Dell Services layoff. It’s true. I’ve spoken to two senior salespeople in the healthcare vertical who were laid off in recent weeks. One of them said the action was called Operation Savings Storm. He e-mailed me a picture of him shaking hands and smiling with Michael Dell. I suppose that only Michael is smiling now since his labor cost just went down, good for his quarterly report.”

From Eileen Dover: “Re: Lahey Clinic. Scrapping their Allscripts implementation and going big with Epic. You probably already knew that.” I ran reader rumors to that effect in June, but got no response from the CIO when I asked about the “unified architecture” the rumor said they were pursuing (which means they’re planning to buy Epic nine times out of ten). Their original strategy involved using Orion Health to serve up scanned PDFs of inpatient records and using Allscripts on the outpatient side, which doesn’t sound like much of a strategy at all given Meaningful Use requirements and changing care models. I’ll leave this as Unverified since I’m missing the standard confirmation: the posting of a ton of Epic jobs on their site.

From SubDude: “Re: athenahealth. Saw this poster on the green line of the Boston T.”

From Empty Handed: “Re: Encore Health Resources. In talks to be acquired by Dell.” I asked the Encore folks a few weeks back and they said this rumor isn’t true. I believe them, but I also noted from experience with other companies being acquired that you always get that same answer even when it really is true, with an apology later for being less than truthful out of necessity. All I can say is that I’ve heard the rumor from anonymous readers twice now, the company denies it, and I have nothing to back it up.

From Debunker: “Re: the EMR cost study you mentioned. There are also significant issues with how the HIMSS Analytics data collection is performed when you look under the covers at the raw data.” That’s a good point. Everybody trying to do these lazy database-matching “studies” assumes that those databases have perfect information, which I’m sure they do not.

From Neal: “Re: Glen Tullman compensation by Allscripts. Thanks for keeping an eye on the mega-earnings of the vendor CEOs. However, it’s fair to note their value is not reflected solely by share price. Tullman grew Allscripts from a niche ambulatory vendor to a near-competitor with Cerner if not yet Epic across virtually every segment of the market. It’s too early to tell if he’ll be successful, but they will be a serious competitor if they can integrate their myriad solutions. He has one year, two tops, to deliver or face the boot from his new board.” Glen did a masterful job of wresting control of the company from Misys and then buying Eclipsys. The mistakes he’s made from my cheap seats view: (a) paying too much for Eclipsys, which nobody else seemed to want; (b) declaring mission accomplished with Sunrise integration almost immediately after the acquisition, backing up that statement with questionable comments that having two unrelated systems both running on Microsoft-powered servers meant they could just start happily interoperating once the ink dried on the sales collateral; (c) trying to pass off Allscripts as a serious competitor to Epic; and (d) escaping an ugly board power struggle and then caving in to a proxy fight that gave a dissident shareholder board seats. You are right that Wall Street encourages actions that boost share price for all the wrong reasons, often at the cost of long-term possibilities, like when Cerner stock took a beating in the late 1990s as they dared spend research dollars to build Millennium instead of booking big earnings per share. Allscripts needs to deliver technically before the competition (both inpatient and ambulatory) pushes it permanently into the mid-majors. If you’re a customer, you’re better off with Glen in charge than selling off to private equity investors, who would have a field day retiring products, selling off divisions piecemeal, and milking services revenue to juice the bottom line to enable a quick flip. We’re already down to basically three vendors for big hospitals (Epic, Cerner, and Allscripts plus a bit of Meditech in the mix). I don’t see Allscripts gaining much inpatient ground given its few announced sales to mostly small hospitals, which is the same problem Eclipsys had despite an arguably superior product, but I hope they keep it competitive. I should have also mentioned that despite seemingly generous compensation, this particular bonus plan announcement actually represented a pay cut for Glen.

HIStalk Announcements and Requests

Say hello to LDM Group, supporting HIStalk as a Platinum Sponsor. The St. Louis-based company offers behavior-changing prescription management programs. Specifically, its patented process improves patient compliance and outcomes by connecting patients with their prescribers and pharmacists. The company’s electronically targeted ScriptGuide messaging (print, e-mail, SMS) helps build tighter provider-patient relationships and helps meet Meaningful Use and ACO requirements for customized patient education and engagement. LDM Group’s network of providers, EMR/EHR vendors, and sponsors of educational material (pharma, payers, health plans, and PBMs) help patients become better educated about their healthcare via personalized messaging from their trusted providers right at the point of service. The company’s case studies show that medication adherence increases up to 16% for specific disease categories, potentially avoiding expensive interventions due to non-compliance. Thanks to LDM Group for supporting HIStalk.

Epic’s UGM is underway. Your report, photos, etc. are welcome since we are not in attendance. So many conferences, so little time.

Acquisitions, Funding, Business, and Stock

Mediware completes its acquisition of the assets of Strategic Healthcare Group, a provider of blood management consulting, education, and informatics solutions. Mediware also reports Q4 results: revenue up 4%, EPS $0.29 vs. $0.25.

Elsevier acquires ExitCare, LLC, an enterprise-wide solution for patient education and discharge instructions.

Sales

Rush University Medical Center (IL) selects MethodCare’s Charge Recovery Solution to optimize charge capture.

The University of Colorado Hospital will implement Infor Lawson Healthcare’s financial, supply chain management, and human capital applications.

Coordinated Health (PA/NJ) selects Allscripts Sunrise Clinical Manager. Their hospitals are Coordinated Health Allentown Hospital (22 beds) and Coordinated Health Bethlehem Hospital (20 beds).

Cancer Treatment Centers of America chooses QlikView to replace its existing business intelligence software, using its analytic capabilities to find opportunities for improvement and planning its future use to predict which therapy options will work best for a given patient.

People

Clarity Health names Bill Bunker (Vertafore Agency Markets) as CEO, taking over for founding CEO and newly appointed executive chairman Peter Gelpi.

The GAO appoints Christopher Boone, director of outpatient quality and HIT for the American Heart Association, to fill a vacant patient advocate seat on the HIT Policy Committee

Announcements and Implementations

West Virginia University Healthcare installs the Patient Safety Net incident reporting system from Datix and UHC.

HIMSS Analytics recognizes Hennepin County Medical Center (MN) and Truman Medical Center (MO) with its Stage 7 award for EMR adoption.

Franciscan Alliance goes live with iSirona’s device connectivity solution at multiple facilities.

In Southeast Texas, CHRISTUS Health, Texas Children’s Hospital, UTMB Galveston, and Legacy Community Health Services sign up with Greater Houston Healthconnect to exchange patient information.

Medecision’s care management solution is added to the Availity network to support post-discharge planning and coordination.

Government and Politics

ONC posts draft test procedures and test data files for the 2014 Edition EHR certification criteria.

HHS Secretary Kathleen Sebelius announces that the public can vote for their favorite innovation among finalists in the HHSinnovates Program, which is designed to recognize innovative projects developed by HHS employees to solve healthcare challenges. Public voting is open until September 14.

Allscripts CEO Glen Tullman pens a Forbes opinion piece extolling the accomplishments of his friend President Barack Obama, also saying great things about his stimulus bill, particularly the HITECH part that benefited Allscripts immeasurably. He concludes, “Now what he needs is one more term to finish the job.

Technology

AirStrip Technologies is awarded a patent for its technology and process for delivering physiologic monitoring data to smartphones, tablets, and other devices.

A 17-year-old invents an inexpensive and portable EKG that collects heart rhythm data via Bluetooth and sends it to a remote physician.

An orthopedic surgeon uses an iPod Touch in knee replacement surgeries, saying it allows more precise placement of the artificial knee and thus reduces complications and provides a greater range of motion.

Weight loss company Diet Doc offers its customers weight loss consultations with physicians at its 30 locations via Skype. The (female) CEO cites the “growing possibilities that telehealth has” in decided to replace its telephone-based consultations with video in managing its human chorionic gonadotropin diet plans. They’re probably the only telehealth-using provider featuring a Star magazine cover of Kim Kardashian with the CEO’s unsolicited opinion that “comfort foods added a few pounds to her frame” but that she has thankfully “slimmed down to snag a man.” The FDA doesn’t have anything good to say about HCG diets and has banned non-prescription sales. It requires prescription HCG products to be labeled with a warning that there’s no proof that they work.

Other

Two University of Miami Hospital employees are accused of selling the information of thousands of patients they obtained from registration face sheets over 22 months. The university’s medical school reported the theft of a pathologist’s briefcase earlier this year that contained an unencrypted flash drive with six years’ worth of patient medical record data.

A computer hacker in Italy with brain cancer, desperate for second opinions, cracks the proprietary format of his electronic medical records, converts them to an open format, and shares them on his Web site. Two doctors responded in the first 24 hours to what the patient is calling “My Open Source Cure.” He invites doctors, hackers, musicians, or anyone who can help to review his information and e-mail him their “cure,” which he will post on his site. If you’d like to help out, you will need someone who can read Italian to translate the scanned records.

The former hospital equipment designer who in 1982 designed the first laptop computer, the GRiD Compass, has died. Bill Moggridge was 69.

In the UK, Fujitsu is reportedly blacklisted from being awarded any government services contracts after previous failures, notably its work on the failed NPfIT project.

A Chicago-area health department says EMR implementation temporarily reduced the walk-in patient capacity of its clinics by half right after go-live last week. At a two-physician clinic whose appointments are booked out for months, one patient said the line that snaked around the corner looked like “a Depression-era soup line.”

Weird News Andy says an interdiction might be placed on the future work of this surgeon, who is being sued by a patient whose lawsuit claims his cancerous penis was amputated without his consent.

Sponsor Updates

• HTMS, an Emdeon company, and Managed Care Executive Group launch the fourth annual Industry Pulse Survey to identify issues and concerns important to healthcare payers.
• Pivot Point and NextGate collaborate to offer identity management, credentialing, and RCM enhancement solutions to HIEs, ACOs, and health systems.
• Orion Health posts the agenda for its October Healthcare Collaborative in Colorado.
• Imprivata demonstrates its secure no-click access at Epic’s annual UG meeting and offers a white paper on optimizing Epic clinical workflow.
• Awarepoint adds VT Group as a VAR for its aware360 RTLS suite.
• MED3OOO announces the keynote speakers and agenda for its October National Healthcare Leadership Conference in St. Thomas, USVI.
• Greenway recognizes Pediatric Associates (WA), Premier Family Physicians (TX), and Medical Park Orthopaedic and Sports Medicine Clinic (AR) for their innovative use of Greenway solutions to improve care delivery.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 9/10/12

From Lickety: “Re: percentage of EPs/EHs achieving MU Stage 1. Does anyone know the percentage of all EPs/EHs to get a feel for where the country is in total?”

From Candy Albicans: “Re: Allscripts. Considering selling its profitable MyWay division to SYNNex, a reseller that has purchased 1 million licenses.” Unverified.

From Eric the Well-Read: “Re: your posts. I’m pretty sure I see another site that you’re writing for under a different name. True?” False. I barely have enough hours in the day to write HIStalk. I suppose I could attempt to pimp myself out in several ways (writing elsewhere being one) and use the proceeds to quit my hospital job, but I like things the way they are, which is they way they’ve been for the past nine years. That represents either high satisfaction or low ambition (probably the latter).

From Mrs. Beasley: “Re: EMR implementations led by hospital business units. This seems to be more common, especially with Epic. I’m curious to hear whether anyone else thinks the role of the CIO is changing because of this. I’m in the middle of one and wondering whether after the install, it will be business as usual for IT.” I’ll expand your original thought a bit for the benefit of the many CIOs whose hospitals are implementing Epic: if your hospital has been live on Epic for more than a year, how did your IT budget, staffing, priorities, consulting budget, staff training costs, and personal responsibilities change? I bet I’m not the only one curious about what happens in the Epic afterlife.

President Obama would win a close race if the election were held today and my poll respondents were the only voters. New poll to your right: which of the five listed inpatient clinical systems vendors offer the most innovative products? I’m asking since Cerner was just named by Forbes as one of the top 10 innovative companies overall, but I’m skeptical about how the magazine arrived at that conclusion since they didn’t actually say. And note that there’s no “none of the above option” since it’s unnecessary based on the question being asked.

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

Listening: new from Katatonia, brooding Swedish progressive metal that is admirably devoid of the characteristics of suckier bands that drive many potential fans away: grunting, screaming, excessive tempo, and a wall of impenetrable noise. Good vocals, minor key melodies, and fine musicianship.

Hey, EHR vendors! tweet a pledge to do View/ Download/Transmit in 2012. Will shout out on Monday. #ONCPledge #VDTnow #HealthIT4U

— Farzad Mostashari (@Farzad_ONC) September 7, 2012

I’m impressed with how openly Farzad Mostashari uses Twitter. Granted the bar was set low by his deadpan predecessors, who probably would have been happy to turn the ONC Twitter account over to a federally contracted, chirpy, 23-year-old marketing ghostwriter with a blissfully empty head, but he’s out there tweeting away with original thoughts at all hours. Here’s a brilliant throw-down he posted Friday afternoon: which vendors are willing to publicly promise that they will roll out View / Download / Transmit capability for patients by the end of 2012? He says he’ll post the names Monday, with takers so far being eClinicalWorks, athenahealth, SOAPware, and Greenway. What say you Epic, Practice Fusion, NextGen, Cerner, McKesson, SRS, Allscripts, and GE? Farzad wants to know whether you own cattle or just big hats.

Speaking of ONC, they decide not to proceed with their intended regulation of NHIN’s “conditions for trusted exchange.” Reason: regulation might slow things down, which is just about the last thing that HIEs need.

The board of Allscripts approves a $1.9 million 2012 incentive for CEO Glen Tullman. His total compensation in 2011 was $7.2 million. Above is the two-year MDRX share price (blue) compared to Cerner (green), athenahealth (red), and the Nasdaq (brown). Had you invested $10,000 in each two years ago, the value of your holdings today would be worth $6,257, $22,854, $32,844, and $14,025, respectively.

Orchestrate Healthcare names former Dean Health Systems IT VP Jerry Roberts as VP of its Epic practice.

Olympic Medical Center (WA) will spend $7.6 million to get Providence Health and Services to implement Epic for its hospital and clinics over the next year. They expect to get $7 million in HITECH money in return. Annual support fees will run around $750K. The CEO says they’re getting a tremendous deal, especially given that Epic will replace five systems. “I think our current systems really don’t help us take care of our patients the way they should. I think Epic is the best system available.”

Nuance announces its 2012 Understanding Healthcare Challenge, offering prizes to the top three developers to describe how they would integrate Nuance’s clinical language software into their products. Entries are due October 5.

Crain’s Chicago Business found 10 Illinois physicians who are making at least $1 million per year from Medicaid, with four of them being pathologists (as with most businesses, those higher on the supervisory food chain did better than those doing the actual work). Leading the pack: the head of pathology at safety net hospital Sinai Health System (also their CMO), who pocketed $5.9 million in a three-year period. The second-highest was a urologist who raked in $5 million while being investigated for questionable billing. The third was the medical director of Planned Parenthood of Illinois, who just agreed to a $367K settlement for overbilling. She made $3.9 million in just over one year of the study period before being cut off because of the billing investigation.

Vince finishes up his HIS-tory of Keane with the stories of First Coast Systems and Source Data Systems. As always, he welcomes your contributions about vendors of yesteryear.

A reader sent over an article from the HIMSS cheerleader rag, knowing I wouldn’t have seen it since I don’t read free healthcare IT magazines (they’re mostly just re-worded press releases). The article proclaims, “It’s confirmed. Electronic medical records can indeed yield marked savings for hospitals.” Just to be a contrarian, I dug up the original article to see what they were gushing about (other than everything that’s pro-vendor).

As I expected to find, this is another example of the pitfalls of outsourcing your conclusions to non-experts armed with the dual motivations of (a) not biting the hand that feeds them, and (b) drawing in readers with sexy headlines that the article doesn’t support. I think the work of the study authors was OK, but hardly conclusive or even convincing.

What the paper actually says is that EMRs have provided “mixed performance,” i.e. the paper isn’t suggesting predictive value. The authors tried to prove (unsuccessfully, in my opinion) that the driver of whether hospitals save money as a by-product if implementing an EMR is the availability of local technical expertise, which just doesn’t make a bit of sense given that (a) technical resource availability doesn’t have much impact on cost since it’s a tiny portion of overall hospital cost, and (b) hospitals use remote and/or contracted technical resources all the time, making geographic location only marginally relevant.  

My reactions:

• The study is just a paper, so it hasn’t gone through peer review or acceptance. I would hardly say it “confirms” anything.
• This was yet another drawing room study where someone just mashed up conveniently available but questionably relevant data, in this case the HIMSS Analytics database, the Medicare Cost Report, and the AHA Hospital Survey.
• The databases were current only through 2008, so this is four-year-old information that predates almost every significant EHR event.
• The study’s main finding is that the average hospital that implemented an EMR during the 12-year period saw no improvement in efficiency, and in fact, saw their costs go up after adoption (“quite high,” the article says). I notice that didn’t make the magazine’s headline.
• Hospitals located in areas with a lot of IT talent saw costs go down 4% from previous IT cost (those adopting basic EMRs) and no change (those adopting advanced EMRs).
• Hospitals in low-talent areas increased their costs 2-3% with EMR adoption.
• I didn’t really understand how they considered hospital ownership, which is a good predictor of both IT utilization and overall cost structure. Or for that matter, separating hospitals that outsource IT functions from those that don’t.
• I don’t think most hospitals buying an EMR in the early 2000s expected or even wanted to reduce costs, so I don’t really see the value of finding out whether they did.
• The idea that the likelihood of a given hospital reducing its costs by implementing an EMR is based solely on how many programmers live in its area does not pass any sniff test I can envision.
• The article’s abstract contains the real conclusion: “Adoption of EMR is generally associated with a slight increase in costs. We argue that this average masks important differences over time, across locations, and across hospitals.”
• The thrust of the article can be inferred from its title, “The Trillion Dollar Conundrum: Complementarities and Health Information Technology.” It is actually, to a certain extent, debunking the questionable conclusions of CMS and the Cerner-funded RAND study in proclaiming that EMR adoption will reduce healthcare spending. The article says EMR cost savings will be “mixed” until technical resources are more widely available. That doesn’t really sound like the upbeat conclusion the magazine trumpeted.
• As always, even if you buy the study’s methodology, it at best identifies a slight correlation rather than causation. I would not attempt to predict the impact of a $200 million Epic install in a large academic medical center to generalized, old information of mostly small hospitals (which as a percentage, is most of them).
• Implementing an EMR to save money is an iffy proposition at best, not to mention that maybe patient outcomes should be the stronger consideration.

My conclusion is that it’s not a bad study, just not all that conclusive and certainly not worth detailed coverage in an industry magazine. I lost interest in further analysis at this point since it was time to have a beer and watch some college football. If you didn’t, feel free to elaborate further.

E-mail Mr. H.

News 9/7/12

Top News

Merge Healthcare’s board hires an investment bank to seek strategic alternatives for the company that could include a merger or outright sale. Merge, which has lost money for six straight quarters, has seen its share price drop 40% on the year, although shares were up 10% Thursday on the announcement. Above is the one-year share price compared to the S&P 500 (green) and Cerner (red).

Reader Comments

From Acorn: “Re: emergency power off switch. An engineer fell onto ours today.” Been there. We had just moved into a new data center at my previous employer and the entire data center was going dark a couple of times per day. We couldn’t figure it out, but suspected a construction mistake. The UPS wasn’t kicking on and the standby generator wasn’t coming up, so all systems were going down hard, creating a nightmare of system outage and recovery downtime (we’re talking every server, connection, telephone system, etc. spanning several hospitals). We eventually figured out the problem: the big, red emergency power-off switch was right beside the exit door where the old data center’s “press here to open door” button was located. Employees were smacking it by habit as they exited, and then sheepishly running for the hills without telling anybody when the data center suddenly went dark and quiet. We put a $1 plastic cover over the switch and that was the end of the problem.

From Sadie: “Re: Merge Healthcare. Three weeks after an RIF in France and one week after a 56-person RIF in the US, Merge announces plans to sell the company. I hate to say that I called this months ago.”

From MindYourOwnBusiness: “Re: UPMC. They’re in the hospital (and EMR) business, not the law enforcement business.” A patient who says she contracted hepatitis C from syringes infected by a drug-using radiology tech at UPMC sues the hospital and two of its staffing agencies. The lawsuit says UPMC caught the tech in the act of stealing fentanyl from the OR and told his contract employer to stop sending him to work there, but didn’t notify anyone else. The tech then worked at eight more hospitals, spreading hepatitis C to at least 30 cardiac cath patients and possibly hundreds or thousands. I’ve negotiated the “resignations” of a couple of hospital employees for known or strongly suspected drug theft over the years, and as irresponsible as it sounds, begrudgingly let them walk away without a resume blemish. The reason: the hospital’s legal counsel said that unless we had an airtight case against them (which is almost impossible to obtain) and ran them through a couple of cycles of optional drug rehab at our expense, they would probably sue us immediately for even insinuating to a potential employer that their records were anything but impeccable. In this case, the tech wasn’t even a UPMC employee. Nobody is bothering to sue the actual criminal, of course, given his unattractively shallow pockets.

From Curious: “Re: Dell. Heard they’ve cut a large number of experienced senior people from their outsourcing group.” Unverified.

HIStalk Announcements and Requests

HIStalk Practice highlights from the last week include: MGMA urges CMS to remove duplicate e-prescribing requirements in the MU and PQRS programs. Physicians express concerns about the impact of the ICD-10 transition on finances and practice operation. GenX physicians want a life outside of work, rely heavily on EMRs and smartphone apps, and like sharing the load with other doctors. Dr. Gregg has a geeky moment about Scanadu. The HIStalk Practice Physician Advisory Panel provides insights on patient volumes and the impact of EMRs and other technologies and the anticipated impact of the Affordable Care Act, with the possibly surprising finding that many of them won’t increase their patient volumes or workload even if it means higher incomes. Thanks for reading.

On the Jobs Board: Cerner and Epic Resources, Inside Sales Manager, Services Implementation Consultant.

Travis’s post on HIStalk Mobile, What I Learned about Health IT in Medical School, seems to be popular based on who’s linking to it or tweeting it (including some high-profile folks). Sign up for his updates and you’ll get the viewpoints of somebody who’s both a doc and an mHealth expert.

If Inga, Dr. Jayne, and I were running for office, we would kiss babies, try to appear humble by wearing carefully casual costumes to our scripted photo ops, and make a lot of promises we know we can’t keep. We aren’t, so the only vote we seek is one of approval, which you may cast by (a) connecting with us on the usual social not-working sites (and thus enlarge your own network significantly); (b) signing up for spam-free e-mail updates; (c) sending us news, anonymous rumors, and anything else that might amuse us; (d) enjoying the company as we do of our much-appreciated sponsors, whose click-worthy electronic greetings you see entirely coincidentally on this page (they look a bit like ads); (e) peering into the Resource Center, which contains more detailed sponsor information; and (f) telling others that you are shocked by the irresponsible and objectionable material you see here since nothing draws Internet page views like bad behavior. We thank you for reading, and if you were in the room with us, there’s a good chance Inga and Dr. Jayne would plant a kiss on each of your cheeks simultaneously.

Acquisitions, Funding, Business, and Stock

Registerpatient.com, which offers a Web-based patient registration and scheduling system for $50 per provider per month, raises $1.1 million towards a $4.1 million target.

Pamlico Capital acquires home health technology provider HEALTHCAREfirst from fellow PE firm The Riverside Company.

Vocera Communications announces a public offering of 4.5 million shares of common stock.

MobileHelp, a provider of mobile emergency response technology for personal use, acquires Halo Monitoring, a developer of home monitoring products.

Harris Corp. is investigating potential violations of US anti-bribery laws by its Carefx China division, whose employees were found to have provided gifts and payments to prospects and customers. Healthcare executives in government-run healthcare facilities in Europe and Asia are considered foreign government officials by the Justice Department and SEC.

Physician networking site Doximity secures $17 million in series B financing led by Morgenthaler Ventures, bringing its total funding to $27 million.

Sales

Intermountain Healthcare (UT) chooses Accelarad’s medical imaging solution for its 22 hospitals and 185 clinics.

Medical Center of the Rockies (CO) selects ProVation from Wolters Kluwer for GI documentation and coding.

People

Healthcare Quality Catalyst names Todd Cozzens (Optum) to its board. Todd got in touch to say that the company is building data warehouses and Subject Area Marts on top of Epic and incorporating quality and workflow principles developed at Intermountain into more of an industry quality engineering type capability. He’s been around healthcare for a long time and has a nice viewpoint from his work at Sequoia Capital, so when he says it’s the next big thing, it just may be. I interviewed Steve Barlow, CIO and co-founder, a year ago.

Intelligent InSites appoints Margaret Laub (Policy Studies, Inc.) president, CEO, and board member. Interim Doug Burgum will become executive chairman of the board.

Ivo Nelson (Encore Health Resources) is announced as a financial partner of Health Care DataWorks, where he has served as a board member.

Announcements and Implementations

HIMSS Analytics recognizes the University of Iowa Hospitals and Clinics with its Stage 7 award for EMR adoption.

Caverna Memorial Hospital (KY) and Palestine Regional Medical Center (TX) go live on their HMS information systems.

OB-GYN PM/EMR vendor digiChart will integrate Dialog Health’s text message patient reminder system into its product.

Oregon Community Health Information Network will provide Epic to 10 public health centers in King County for $500K per year.

Government and Politics

CMS reports that through the end of July, 128,000 EPs and 3,624 hospitals have collected almost $6.6 billion in MU incentives from Medicare and Medicaid.

A BMJ editorial by two professors says that, based on their fields of behavioral economics and social psychology, pay-for-performance probably won’t deliver the expected results. Their reasons: (a) risk adjustment methods are inconsistent; (b) the system can be gamed by upcoding; (c) process-based indicators are poor proxies for quality of care; (d) social characteristics of patients can make good doctors look bad; (e) overly detailed criteria may encourage just checking off the boxes instead of really taking care of the patient; and (f) doctors may stop exhibiting empathy and pride in their work since nobody’s paying them for those qualities.

A new report from the Institute of Medicine says that the US healthcare system wastes 30% of its cost, or $750 billion, on unneeded care, administrative overhead, and fraud. It says that if other industries worked like healthcare, an ATM transaction would take a full day, laborers building a house would each use different plans without talking to each other, stores wouldn’t post prices, car warranties would not be offered, and airline pilots would make up their own pre-flight check list if they felt like following one at all. Many of their potential solutions for creating a continuously learning healthcare system involve technology.

Other

Surescripts will connect Epic’s Care Everywhere interoperability framework to its network, allowing Epic users to exchange patient-specific information with other providers regardless of their technology platform.

Forbes puts Cerner in good company as one of the 10 most innovative companies in America, citing it as #8 because “its servers handle 150 million healthcare transactions a day.”

Florida’s HIE adds Broward Health, Health First, Martin Health System, Mt. Sinai Medical Center, and Tampa Bay Regional HIE to its clinical exchange network.

Bill Clinton was such a good president (especially when graded on the 25-year curve) that the man formerly known as Slick Willie has completed his ascent to Elder Statesman/Rock Star, capped by his ad-libbing convention speech this week (how many people were like me and thought, “Why can’t we vote for him?”) and the announcement that he will deliver the Wednesday afternoon keynote at the HIMSS conference in New Orleans in March. HIMSS didn’t mention Hillarycare or his Monica Lewinski-driven impeachment, which I find myself being OK with since his relatively benign scumbaggery was eclipsed by his results in office. He could easily be elected president again, I expect, were it not for the anti-FDR 22nd Amendment that limits him to the two terms he already served. I don’t know what HIMSS is paying for his hour or so at the podium, but his rumored rate is in the $400K neighborhood. Also announced on the post-election, politics-heavy HIMSS keynote schedule: James Carville and Karl Rove, which I would find more interesting as a boxing match.

An ACO formed by Blue Shield of California and Dignity Health (the former Catholic Healthcare West) saved $37 million in projected costs over two years for the CalPERS state retirement program, with most of the improvement due to shorter hospital says and fewer readmissions.

Temple Community Hospital (CA) notifies 600 patients that their information was contained on a computer that was stolen from a locked office in the radiology department. The hospital says it will upgrade its security, presumably meaning it is belatedly considering encryption.

Lucile Packard Children’s Hospital (CA) announces a 150-bed, $1.2 billion expansion ($8 million per bed, $2,300 per square foot).

The San Franciso Jewish newspaper profiles David Jacobs, who started kidney paired donor-matching software company Silverstone Solutions within a month after his own kidney transplant in 2004. He expects to add several large hospital groups as customers in the next few weeks.

The feel-good Weird News Andy, temporarily changing his e-mail signature to Wonderful News Andy, likes stories about surgeons who help others (“a cut above,” he calls them). Two Salt Lake City surgeons win awards for their combined 100+ foreign medical trips, taken at their own expense to treat individual patients and educate physicians. WNA’s carriage turns back into a pumpkin with what he calls, “Doctors – The Flip Side,” as he reads the story of a patient undergoing surgery in a Swedish hospital whose anesthesiologist decides to knock off for lunch at the stroke of noon even though he’s the only anesthesiologist working. The patient crashes an hour later, employees can’t reach the anesthesiologist, and in the confusion someone turns off the respirator of the patient, who dies weeks later of brain damage.

Ministry Health Care (WI) tentatively agrees to join Ascension Health. Ministry’s stats: $2.2 billion annual revenue, 12,000 employees, 15 hospitals, and 46 clinics.

Self-proclaimed “EMR geek” Rob Lamberts, MD lists 10 ways EMRs could be made better. Ones I particularly liked: (a) require all visits to have a simple summary entered; (b) since the patient is often the “interface” between EMRs anyway, allow them to pull up their own records and show them to their new doctor; (c) maintain one comprehensive patient calendar that can be shared among providers; (d) let the patient manage the information they provide, such as family history, meds list, and social history; and (e) make patient records searchable.

Sponsor Updates

• A letter to the editor of SIIM by Brad Levin of Visage Imaging offers suggestions on how the organization can decrease radiology technology commoditization by offering crowdsourced innovation theaters, product showdowns, and demonstration of extreme use cases.
• Trustwave introduces security education services to help organizations protect against security risks and compliance missteps.
• Jay Deady, president and CEO of Awarepoint, discusses RTLS technology in an interview.
• MED3OOO announces that its customer PriMed (CT) will participate as an ACO in the CMS Shared Savings Program.
• SimplifyMD will offer Capario’s EDI platform to its customers.
• 21st Century Health selects Sandlot Solutions as a profiled business.
• MedHOK’s 360ACO solution is NCQA certified for P4P, HEDIS, and disease-management performance measures.
• NextGate begins operations at a new corporate office in Monrovia, CA.
• Divurgent hosts The After Party September 12 after Epic’s UGM.
• Wellsoft demonstrates its EDIS at next week’s 2012 ENA Scientific Assembly in San Diego.
• T-System issues a call for presentations for its April linkED emergency care conference.

EPtalk by Dr. Jayne

I’ve spent a lot of time the last several weeks digesting everything there is to read about Stage 2 Meaningful Use. My eyes are glazed over and my brain has become addled. To help providers make sense of it all, CMS has released some tables comparing Stage 1 and Stage 2 Objectives and Measures. I’ve found them helpful, although I wish their page breaks made a bit more sense and didn’t chop a single row into multiple pages.

Mr. H wrote Monday of the Epic vs. McKesson patent appeal. For those readers who enjoy shoes as much as Inga and I do, here’s a bit of patent news. The 2nd US Circuit Court of Appeals reversed a lower court decision, with the outcome that Christian Louboutin was entitled to trademark protection of its well-recognized red soles, but only on contrasting shoes. Competitor Yves Saint Laurent is still allowed to make red soles, provided they are attached to red shoes.

A Medscape article reveals results from a survey on physician EHR preferences. Although nearly two-thirds of users were happy, that means there are a lot of unhappy users out there. Other interesting (but not surprising) tidbits: many physicians are unaware of whether their systems are hosted vs. locally installed, the magnitude of maintenance or installation costs, or what happens in the back office.

CMIO magazine has renamed itself Clinical Innovation + Technology, citing a recognition of “the ever-growing convergence of the IT and technology management teams within the provider setting.” I’m pretty sure that at most places the IT and technology management teams were already intermingled. I think it would have made more sense to say that the IT and clinical management teams were converging. For those hospitals that are still in denial about the need for a CMIO in the first place, it’s probably validating.

A recent study demonstrated that men who consumed chocolate reduced their likelihood of stroke by 17%. It’s not entirely proven how chocolate provides health benefits, but dark chocolate in particular is thought to have anti-inflammatory properties. Maybe I should try some medicinal cocoa instead of ibuprofen after my next workout.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 9/5/12

Top News

HL7 will make its standards and other intellectual property available to all healthcare stakeholders at no charge by the first quarter of 2013. The company says it hopes to increase private and governmental use by eliminating licensing fees, thereby improving care and reducing costs.

Reader Comments

From Mandrake: “Re: NuPhysicia. I’m looking for information from healthcare systems that have worked with them, but I’m not having any success and I see they haven’t been mentioned on HIStalk even though they’ve been around for several years.” I couldn’t find anything either, but I snooped around and found that the company – which has offices in Houston, Brazil, and Malaysia – shares its Houston address with medical staffing company eCareGroup and is apparently the same operation even though they never actually say so (NuPhysicia also offers telemedicine services under the name InPlace Medical Solutions). NuPhysicia is selling a commercialized version of telemedicine software developed at UTMB, best known for its use in prisons, but also used in retail clinics and on oil drilling rigs.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Vonlay. Given their location in the epicenter of Madison, WI, you might cleverly guess that Vonlay is an Epic consulting firm and a successful one at that, with 30 clients in more than 20 states. It deploys some of the industry’s best EHR consultants individually or on teams, working at your site when you need them there or via Vonlay’s Remote Services program, which offers big savings to its customers. If your Epic go-live is impending or completed, Vonlay’s remote experts can help work down your open tickets, pitch in on applying upgrades and SUs, and help you phase out more expensive on-site consulting services. The company also provides application mentorship and management-level strategy consulting on how to design, build, and roll out EHR projects, including technical assistance with system builds, Cache programming, interfaces, Web services, and portals. You’ll be in their neighborhood if you’re going to next week’s Epic UGM, so keep an eye out for their folks. Thanks to Vonlay for supporting HIStalk.

Here’s a fun Vonlay video I found, Attack of the Issues List.

Acquisitions, Funding, Business, and Stock

Net Health Systems, which offers an EHR for wound care, acquires competitor Wound Care Strategies.

Data analytics startup Predilytics raises $6 million in its first round of VC funding.

Sales

Geisinger Health System (PA) selects TeleTracking’s RTLS technology to track mobile medical equipment at two of its six hospitals.

Saint Vincent Health System (PA) contracts with onFocus Healthcare for its enterprise performance management software.

St. Vincent Hospital (WI) will implement Merge Healthcare’s complete cardiology solution across its enterprise.

Rex Healthcare (NC) will use Passport’s eCare NEXT solution for eligibility checking, demographic verification, precertification, and estimation of patient payment.

People

Virtual Radiologic names John Way (UnitedHealth Group) CFO.

John Gomez of JGo Labs is interviewed at Apple’s WWDC.

Announcements and Implementations

South Lyon Medical Center (NV) will complete transition to CPSI’s clinical applications by the end of the year. 

Government and Politics

The VA says that over one million patients have registered to download their health information via Blue Button.

The FDA issues a warning letter to Merge Healthcare, saying the company isn’t manufacturing its blood pressure monitoring kiosks within FDA’s guidelines.

Other

Picis, Epic, and GE own the largest share of the anesthesia information system market, according to KLAS. The survey found that customer satisfaction is highest when AIMS purchasing decisions are handled cooperatively between the hospital and OR/anesthesia department rather than either entity making the decision alone.

ZirMed will undertake a $5.1 million expansion project that is expected to create 85 jobs over the next two years at its Louisville, KY headquarters. The state is offering $2 million in incentives for up to 10 years.

Apple announces a September 12 event that is likely to include its announcement of the iPhone 5 (note the shadow in the picture. )

Scotland-based Craneware says demand for its hospital revenue products has returned to high levels after a slow first half caused by US hospitals focusing on EHRs.

The government of China will invest $63 billion in its healthcare system over the next seven years, with part of the money going toward creation of an electronic health information network.

Technology investor and Sun Microsystems co-founder Vinod Khosla says computers will eventually replace 80% of doctors because computers are cheaper, more accurate, and objective, while healthcare is “witchcraft … based on tradition.” He also says that it will take outsiders to fix healthcare rather than those working within it. He has a knack for throwing out outrageous sound bites that earn him exposure, such as saying that hybrid cars offer no environmental advantage – they just make their owners feel better about themselves.

Highly regarded UCSF physician Bob Wachter, MD (chief of medicine, invented the term “hospitalist,” author) says UCSF’s new Epic system generates an impressive-looking progress note from fragments of manually entered information, but the “monkeys and typewriters” approach not only violates the legendary teachings of SOAP note inventor Larry Weed MD (in the 1971 video above that everybody who designs physician documentation systems should study regularly), it’s not as useful as the old fashioned written note. However, he also offers a solution: ditch the use of Epic’s Smart Text and offer a “Big Picture” field where physicians are encouraged to tell the patient’s story as of that moment (although he wonders whether natural language processing will make that unnecessary at some point). Wachter describes the current state as:

Why did Epic and our UCSF IT gurus structure things this way? The primary virtue is that this charting-by-problem approach allows the patient to be followed longitudinally, since one can track problems such as “hypertension” or “ovarian cancer” over years, seeing how they have been managed and observing the response to therapy. It isn’t a bad conceit, and it probably makes tons of sense when described in a fishbone diagram on an informatics seminar whiteboard. But the effect I witnessed on patient care and education was less positive. When I was on clinical service in July and read the notes written by our interns and residents, I often had no idea whether the patient was getting better or worse, whether our plan was or was not working, whether we need to rethink our whole approach or stay the course. In other words, I couldn’t figure out what was going on with the patient.

Small software vendor QueueVision says the Tampa VA hospital is refusing to pay for its medication tracking software despite using it since 2006. The company says the purchase was approved by the hospital’s pharmacy administration, but the VA won’t cough up the $214K it owes. Says a partner in the company, “We were suckers. They took us. I figured the veterans were so happy, the staff was so happy, everybody loved it. So we thought they would pay. We never fathomed that they would lie to us.”

In England, small blood-tracking systems vendor MSoft eSolutions is expanding after winning eight of eight RFPs last year. Its Bloodhound system provides positive ID of employees and patients throughout the blood transfusion process.

I liked this Facebook article by disgraced investor / interesting author Henry Blodget, in which he says publicly traded companies destroy their own value by trying to appease impatient investors and venture capitalists. He explains why nobody should be surprised at the fall in Facebook’s share price (May IPO price $38, Tuesday’s closing price $17.73) given the clear message that CEO Mark Zuckerberg has sent all along that he’s focusing on the customer experience and long-term value as Amazon has always done rather than next quarter’s share price. A snip of Blodget’s paraphrasing of a section of Zuckerberg’s pre-IPO shareholder letter:

Let me remind you that I own 57% of the voting stock of Facebook, which means I have complete control over it. I organized the company this way many years ago, with the very deliberate intention of maintaining complete control over it. I did this so I wouldn’t get overruled and canned by venture capitalists, a fate that unfortunately befalls many entrepreneurs. I also did it so in the event that we ever had to go public—which we unfortunately have to do now—I would never have to pay attention to whiny short-term public shareholders. Those whiny short-term public shareholders have destroyed many great companies by making management obsess about absurd near-term financial targets … Maximizing near-term profits" often means under-investing in future innovation, customers, and employees. And although it sometimes temporarily boosts stock prices, it often guts companies and clobbers their value over the long haul.

The Florida teenager accused of impersonating a PA and practicing medicine without a license is found guilty by a Florida jury and could go to prison for up to 10 years.

Sponsor Updates

• Aetna will offer eviti’s oncology decision support tool on its Medicity iNexx platform.
• The Surgical Information Systems anesthesia information management system earns the highest client satisfaction scores in KLAS’s anesthesia specialty report.
• MED3OOO CMO Paul McLeod, MD discusses the challenges of controlling ER visits in a blog post.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 9/3/12

From HITEsq: “Re: McKesson. Won its appeal against Epic for patent infringement. The Federal Circuit, en banc (i.e., before all the court of appeals judges), overturned existing law to find in favor of McKesson. The case is remanded to the lower court to decide if Epic really does infringe.” It’s a complex issue, and since I covered it when McKesson lost the original appeal in April 2011, I’ll recap from there. McKesson said Epic’s MyChart violates a McKesson patent for a method of placing visit-specific patient information on a Web page so that patients can schedule appointments and request prescription refills. The original  “joint infringement” decision (about which the three-judge panel argued a lot) was that Epic wasn’t liable since it doesn’t directly offer those capabilities, but rather allows individual patients to request MyChart access subject to the approval of their physician. Since no single party violated McKesson’s patent, the original court said Epic wasn’t liable. Legal experts are troubled with this latest decision, which appears to make “inducing infringement” actionable even if no infringement has been proven. All of this is way over the heads of mere non-lawyer mortals like myself who can’t resist snickering while repeating phrases from the document like “joint tort feasor” in humorous voices because it’s just so weird and funny, so if any legal beagles wish to expound pro bono, here is your electronic lectern.

Patent on personally controlled health record with notation of source/ authority (filed 3 yrs ago) HT @craigjoseph patft.uspto.gov/netacgi/nph-Pa…”

— Farzad Mostashari (@Farzad_ONC) August 31, 2012

From Lex Luther  Van Dam: “Re: Epic’s patent for a patient-controlled, patient-generated health record. This is bizarre. Much of this was already on the market when the patent was filed, so either Epic didn’t know or forged ahead anyway, and either is not good. Epic has seemed indifferent to patients controlling their own information, to the point that they don’t even talk about Lucy, their own PHR solution, and they certainly don’t cooperate with anyone else offering a PHR solution.” My guess is that this patent either covered Lucy when it was first being developed or was simply a legal stake in the ground to prevent further legal incidents like the McKesson one above. I also don’t know that Epic’s customers, being turf-protecting and somewhat patient-paternalistic academic medical centers, have a heartfelt interest in empowering their patients via PHRs from Epic or anyone else. Or for that matter, avoiding the “walled gardens” between proprietary EMRs that Farzad was railing against given that Epic-to-Epic direct data exchange has displaced the interest in a vendor-neutral exchange in some areas where most of the major players run Epic.

From MU Nick: “Re: worksheet. Has anyone created a worksheet for MU2 for the EP and EH requirements (as opposed to a PDF?)” If you’ve put something together and are willing to share, let me know.

From DanburyWhaler: “Re: Western Connecticut Health Network. Hired Steve Laskarzewski, Waterbury’s former CIO, as clinical applications director. Looks like they’re grooming him for the top spot when Kathy DeMatteo steps down later this year.” Steve’s LinkedIn profile says he started in June. He’s one of the 2,716 members of the HIStalk Fan Club that reader Dann started years ago, so he gets a shout out.

From Douglas: “Re: Mr. HIStalk. Why do you use that name?” I needed an e-mail address when I started HIStalk back in 2003, and being in a minimally creative mood at that moment, the best I could come up with was mr_histalk (the name HIStalk itself was equally lame, with the HIS standing for Hospital Information System, which was in vogue at the time). I had zero readers and minimal expectation of gaining any, so I didn’t give it much thought. I don’t recall having actually called myself that at any point, but readers did over time, and then Inga at some point shortened it to Mr. H. It feels odd since I have never even once referred to myself as Mr. Anything in real life since I’m not too impressed with titles in general. My latest pet peeve: family members of dead doctors who stick “Dr.” in the title of their obituary listing instead of just their name like everybody else does, apparently hoping that like Egyptian boy kings, their most valued earthly possession will carry over into the afterlife. Putting “MD” after your name is perfectly fine on your office door, as is “Doctor” in front of your name is for professional encounters. A doctor who is so deficient in self-esteem as to demand the use of those titles in social situations when nobody else is calling themselves Mr. or Ms. is, in my opinion and experience, an arrogant ass. Lots of people earn doctorates, many of them requiring more education than a medical degree, and yet it’s most often an MD (or, in the case of male MDs, their wife) who insists on cramming their title down everybody’s throat at the auto repair place or at school meetings (my theory: that’s why hospital administrators enjoy putting physicians in their place). So, to complete my circular logic, the Mr. HIStalk thing is not indicative of a superiority complex since if anything, my tendency is the opposite.

It’s Labor Day, so I am appropriately laboring (in the non-obstetrical sense). I hope your holiday is – or was, depending on when you’re reading – delightful.

We are collectively fatigued with the endless Meaningful Use palavering, apparently, as 46% of respondents say they are indifferent to release of the Stage 2 rules. Of those who cared, reaction was split between positive and negative. New poll to your right: if the presidential election were being held today, who would you vote for? An online issues quiz says that I’m exactly evenly split between the two major candidates with a 63% alignment with my beliefs for each, but both are far dwarfed by my 91% match with Libertarian candidate Gary Johnson, who I’d never heard of until I took the quiz. That leaves the same options I had in the last presidential election: vote for either of two candidates that I would dread seeing take office or vote for one I’d like to see win who doesn’t have a chance.

Surescripts acquires Kryptiq, of which it previously owned a 21% share. Surescripts uses Kryptiq’s secure messaging technology for its network. Other healthcare IT vendors are also among its customers (GE Healthcare and Vitera), and its other offerings include clinical messaging, a patient portal, and electronic prescribing. Kryptiq announced earlier this year that its revenue grew 60% and its user count exceeded 40,000.

Cambridge Health Alliance chooses EDCO’s Solcom electronic document management system for managing historical paper records and paper documents originating outside of CHA. It will integrate that information with its Meditech and Epic systems to eliminate the file room and hybrid record environment.

Joint Township District Memorial Hospital (OH) chooses the Optimum general accounting suite from NTT Data. The company also announces that its NetSolutions Point-of-Care clinical and billing system for long-term care facilities will now send care data toAssured Proactive Analytics to optimize payment.

A Wells Fargo Securities report sent over by a couple of readers says that hospital users of Meditech, Cerner, and CPSI lead the pack in total number of Meaningful Use attestations through June 30. On the ambulatory EHR side, it’s Epic, Allscripts, and eClinical Works, although Epic would drop to third if it didn’t have 10,000 Kaiser doctors of its 15,000 attestations. Of new attestations, it’s Cerner and CPSI leading for hospitals (those same two vendors also led in the overall percentage of client base attesting) and athenahealth and Practice Fusion for EPs. A reader, however, notes that the numbers suggest that Epic has 650 hospital customers, which seems awfully high, so there’s always the question of what’s behind the data.

CoCentrix hires Clayton Ramsey (Elsevier) as SVP of delivery.

I chose this graphic in mentioning the new KLAS evaluation of Meaningful Use consulting firms a few days ago and regretted it the next day when I had more time to ruminate on it. I’m unhappy with how KLAS presented the graphic since they committed the cardinal sin of not setting the Y-axis of the graph to zero. That’s usually a red flag indicating that someone is trying to make an overly dramatic point that their data points don’t support. In this case, the actual range of consulting firm “money’s worth” scores was 7.1 to 8.8, which are pretty good numbers within a fairly narrow spread. The KLAS graph only shows the range of 7.0 to 9.0, making it appear that huge gaps separate the firms, which is absolutely not the case. This doesn’t give me a lot of confidence that the behind-the-scenes work at KLAS is statistically rigorous, a often-made but never-answered charge. I would also question whether this graphic means anything at all considering that the Y-axis is customer-reported value, while the X-axis is “relative cost per resource,” whatever that means. Should we infer that a company with a high per-resource cost can’t be worth it no matter how satisfied their customers are? My main gripes with KLAS (and the Most Wired surveys and HIMSS Analytics and so on ) is their tendency to take a modest amount of data and over-extend it to lofty conclusions using a black box that nobody’s allowed to peer into. I like what they do, but as we healthcare types say, “In God we trust – everybody else bring data.”

Among the speakers at this past weekend’s health IT conference in Hyderabad, India were Lee Shapiro (Allscripts president) and Marc Probst (Intermountain Healthcare CIO).

TeraRecon launches its iNtuition Review, iNtuition Enterprise Medical Viewer, and iNtuition SHARE at the AOCR/RANZCR radiology conference in Sydney, Australia. The products provide multi-modality review and the capability to distribute images throughout the enterprise via a browser-based viewer.

Cancer Care Group (IN) announces that medical information of 55,000 patients and the organization’s own employees was exposed when server backups were stolen from an employee’s locked car. The announcement leads off with, “Patient confidentiality is a top priority,” which is apparently now a bit closer to the truth since they’re suddenly considering encrypting backups and mobile devices. It’s an immutable rule that nobody encrypts anything until they are publicly embarrassed for not having done so, and then they can’t jump on board fast enough.

Novant Health (NC) rolls out a screensaver featuring former UNC star Michael Jordan to remind employees of its zero-tolerance handwashing program, launched in 2005 after three premature babies died in one of its hospitals from MRSA infection. The source was tracked back to staff who hadn’t washed their hands, which Novant found was common with a compliance rate of only 49%. They’re at 98% now.

In Australia, a hospital CEO sues a nurse who he says disparaged him in her Facebook comments that were brought on by a labor dispute. One of her comments: “We don’t take kindly to misinformation by well-paid fat cats who only visit the hospital wards for photo opportunities.”

Surgeon and best-selling author Atul Gawande, one of the most visible and respected people in healthcare, apparently is sold on the use of analytics but  isn’t a fan of using technology in his own practice. Some snips from a recent interview:

• I do use the iPad here and there, but it’s not readily part of the way I can manage the clinic. I would have to put in a lot of effort for me to make it actually useful in my clinic. For example, I need to be able to switch between radiology scans and past records … I haven’t found a better way than paper, honestly. I can flip between screens on my iPad, but it’s too slow and distracting, and it doesn’t let me talk to the patient.
• I think that information technology is a tool in that, but fundamentally you’re talking about making teams that can go from being disconnected cowboys in care to pit crews that actually work together toward solving a problem.
• I worry the most about a disconnect between the people who have to use the information and technology and tools, and the people who make them. We see this in the consumer world. Fundamentally, there is not a single [health] application that is remotely like my iPod, which is instantly usable … In many of the companies that have some of the dominant systems out there, I don’t see signs that that’s necessarily going to get any better.
• The reason [data analytics] works well for the police is not just because you have a bunch of data geeks who are poking at the data and finding interesting things. It’s because they’re paired with people who are responsible for responding to crime, and above all, reducing crime … That’s what’s been missing in health care. We have not married the people who have the data with people who feel responsible for achieving better results at lower costs.
• Timeliness, I think, is one of the under-recognized but fundamentally powerful aspects because we sometimes over prioritize the comprehensiveness of data and then it’s a year old, which doesn’t make it all that useful. Having data that tells you something that happened this week, that’s transformative.

More on Keane’s HIS-tory this week from Vince.

E-mail Mr. H.

News 8/31/12

Top News

SAIC announces Q2 results: revenue up 8%, EPS $0.32 vs. $0.32, beating expectations on revenue and meeting on earnings. The company announced plans to split itself into two independent, publicly traded companies, one offering technical services and the other delivering solutions. Healthcare will be part of the solutions business. Shares are up 10% in after hours trading. SAIC acquired Vitalize Consulting Solutions in August 2011 and maxIT Healthcare in August 2012.

Reader Comments

From Klinger: “Re: Epic support. I always heard it was second to none, but what I’m getting is lacking. Have other people noticed, or is it just the TSs that I have?”

From Palmetto Jack: “Re: Palmetto Health. Not an affiliate of USC.” Thanks for the correction. Wikipedia says Palmetto Health Richland is affiliated with University of South Carolina and Palmetto Health’s graduate medical education page says the USC School of Medicine is a “partner and close affiliate,” so it’s one kind of affiliate but not another. I don’t really claim to know the difference.

From Honey Badger: “Re: Cerner. Heard a rumor that they will switch to Greenway’s ambulatory clinic EHR product.” Unverified.

HIStalk Announcements and Requests

This week’s top picks from HIStalk Practice: Consumer Reports publishes ratings on over 500 Minnesota practices. Practice administrators at large groups see a rise in median compensation, while their small practice peers experience a decline. AMA urges CMS to delay the move to ICD-10 by at least two years. Is HealthTap’s model viable in the long term? Physicians give high scores to Amazing Charts, Epic, and the VA’s ambulatory EMR. Practice Wise CEO Julie McGovern advises practices to avoid tackling other projects in the midst of an EMR implementation. We don’t have a Like button for our posts, so the next best thing is to sign up for the e-mail updates on HIStalk Practice. Thanks for reading.

Listening: new from Dispatch, their first new material since disbanding in 2002. The indie band hoped to draw 10,000 people to its free final concert in its home town of Boston in 2004, but instead became record-holders as the largest independent music concert in history when 166,000 fans came to say goodbye. The band’s mostly Northeastern tour starts in three weeks.

Welcome to new HIStalk Platinum Sponsor Health IT Quality Solutions, a certification program offered by Quest Diagnostics to vendors of ambulatory EHR products that support Quest’s DEX lab orders and results network. The program’s goal is to maximize lab data quality and enhance interoperability for the 500,000 patients per day that use Quest’s testing services. Three certification tiers are available based on solution capabilities, implementation processes, and participation in mutually beneficial activities. The entire program is free for vendors who qualify, with benefits that include customer satisfaction, solution visibility, faster interface approval, and priority access to Quest’s IT staff. Download a brochure and take a look at the several vendors that have already earned certification. Thanks to Quest Diagnostics and Health IT Quality Solutions for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Greenway announces Q4 results: revenue up 24%, EPS $0.07 vs. –$1.09, missing on earnings expectations. The company also projected lower than expected earnings for FY2013. Shares fell 7.1% on the announcement, making GWAY the biggest percentage loser of the day on the New York Stock Exchange. Shares priced at $10 in its February IPO are at $15.27.

Sales

The 300-provider Cornerstone Health Care (NC) selects MedAptus Pro Charge Capture solution for coding and billing.

People

HealthTech Holdings hires Stan Gilbreath (Allscripts) as VP of client services for its HMS and Medhost divisions and Eric Anderton (Jackson Key Practice Solutions) as VP of new account sales for HMS.

Joe Miccio (maxIT Healthcare) joins Divurgent as client services VP.

In Canada, Nancy Martin-Ronson RN, who joined Peterborough Regional Health Centre three months ago as CIO, will also take on the role of chief nursing officer.

Arkansas Governor Mike Beebe names Ancil Lea, executive director of HITArkansas, as coordinator for the Arkansas Office of Health Information Technology.

Announcements and Implementations

The Karmanos Cancer Institute (MI) implements Versus Advantages RTLS in once of its clinics to monitor patient location, track throughput, and manage workflow.

McKesson will offer NovoPath’s anatomic pathology solution to its LIS customers.

Craneware earns CMS’s Electronic Submission of Medical Documentation certification, allowing it to offer customers the ability to electronically submit medical records to review contractors.

Government and Politics

ONC names CCHIT, the Drummond Group, ICSA Labs, InfoGard Laboratories, and Orion Register as certification bodies under the Stage 2 certification program.

Farzad Mostashari says that ONC will not allow EHR vendors to drag their feet in supporting data exchange with competing EHRs.

Other

KLAS names its top-rated Meaningful Use consulting firms in three categories: Impact Advisors (enterprise implementation leadership and advisory); Cumberland Consulting (team implementation leadership and advisory); and Navin, Haffty, & Associates (team implementation leadership and staffing). Of the 51 firms identified, more than half achieved satisfaction scores of 89 or above out of 100.

SCI Solutions announces record growth for the first six months of 2012, with 82 hospitals choosing its solutions for care coordination, referral management, and scheduling.

Queens Health Network (NY) honors Congressman Joe Crowley for supporting ARRA, which will pay the hospitals and clinics of New York City Health and Hospitals Corporation up to $200 million.

Madison Memorial Hospital (ID) unblocks access to Facebook from its wireless network after patient complaints. One employee said it was “stupid” that as a patient, she couldn’t post photos of her newborn baby on Facebook. A newspaper reader was more rational: “What an inconvenience when we have to go to a hospital and we can’t get on Facebook. I guess most of us in this day and age feel entitled to more than that what we get.”

Real estate sources say that Meditech is finalizing a deal to acquire 200,000 square feet of office space in Foxborough, MA. The company abandoned plans for a Freetown, MA campus earlier this year after running into a mountain of red tape triggered by the discovery of native American artifacts on the property.

Epic not only submitted MU Stage 2 comments to ONC, it even helpfully distributed them to their customers so they could submit the same comments under their own names. David Clunie noticed this and lists the hospitals who sent in the boilerplate, including University of Miami, which submitted the same comments five times without noticing the “Remove Before Submitting” headline that prefaced Epic’s explanation of why its customers should share its opinions with Uncle Sam.

In Kenya, the country’s hospital insurance fund won’t issue insurance to a man who claims to be 128 years old because its computer system can’t handle birth years before 1890. His family says they don’t appreciate the implication that he should be dead, and until the issue is sorted out, he’s relying on the insurance of his youthful wife of 89.

Odd: a 29-year-old man sues the maker of the sexual enhancement supplement VirilisPro, claiming that the ensuing sex with his partner in a Scottish Inn damaged his manhood to the point that blood was squirting out onto the walls. A physician expert says the man’s story is “the most absurd thing I have heard of in my life,” explaining that men often arrive embarrassed in the ED with damaged sex organs and make up elaborate stories to explain their predicament. He says, “The most common one told is they walked into an ironing board.”

Sponsor Updates

• Billian offers its fellow HIStalk sponsors discounts on first-time purchases of its programs for vendors, including the HealthDATA database and prospecting portal and Porter Research market analysis.
• NextGen will integrate the TRUEresult blood glucose monitoring system from Nipro Diagnostics into NextGen Ambulatory EHR.
• Velocity Data Centers hosts an open house at its Ann Arbor, MI facility on October 25.
• T-System offers two September 5t webinars on attesting to MU with T SystemEV.
• HealthStream expands its suite of products with the addition of NurseCompetency’s exams and skills checklists.
• Cumberland Consulting Group promotes Christopher Miller to principal and Jennifer Vesole to executive consultant.
• Emdeon expands its Clinical Exchange solution to include e-prescription routing, lab orders and results exchange, care alerts, medication history, and clinical messaging.
• Worldwide Clinical Trials selects Merge Healthcare’s eClinical OS solution for data capture, processing, and reporting on clinical trials.
• ICSA Labs hosts two September webinars to help EHR technology developers understand the 2014 Edition certification criteria and testing requirements.
• A CareTech Solutions white paper offers customer insights on achieving Meaningful Use Stage 1 for the 82% of hospitals that haven’t completed it yet.
• Kareo updates its website and branding to reflect its commitment to small practices and billing services.
• TeleTracking invites hospitals to visit its new Enteprise Solution Center in Raleigh, NC to try its capacity management solutions hands on without the time challenges of a site visit.
• An informatica blog post covers Hadoop and big data.

EPtalk by Dr. Jayne

I often wonder how Mr. HIStalk does it all, balancing his day job with his HIStalk duties. He’s done an amazing job for just short of a decade, so when I run across a bit of writer’s block, I know I have no reason to complain.

The last few days have been bereft of ideas. Maybe it’s the weather (I hope all of you in storm-tossed areas are safe) or maybe it’s just the end-of-summer doldrums. I was particularly pleased, though, when an idea squeezed its way into my mind this morning (pun intended, keep reading).

Why All the IT in the World Will Not Fix Health Care

Like many women, I go every year for a certain radiologic screening test. This year’s adventure was a prime example of why technology is not necessarily the answer. There was a fair amount of hassle in my attempts to complete this testing, and it largely revolved around people failing to look at the monitors right in front of them.

First, I had to schedule. As in previous years, I scheduled over the phone. I have my films done at an independent imaging facility, which is funny being the CMIO of a pretty good-sized hospital. Frankly, despite all the HIPAA training, I don’t trust the hospital staff to not discuss employees who are patients. The imaging center also charges half the amount the hospital does, which makes sense with my insurance coverage limits. Plus, I don’t want to have to disrobe for people who I might have to later “counsel” about their bad EHR habits.

The first annoyance was when I was asked (after the staffer pulled up my account) whether I’d been there before. I chalked it up to someone just following a script without thinking about what they were asking. Knowing the billing and scheduling system they use, she should have been able to see the date of my last visit on the patient information screen.

Due to family history, I’m being screened at an age much younger than the standard recommendation. Because of this, I know exactly what my insurer will and will not cover. Luckily, I have a “pseudo health savings account” type of coverage which allows me a lump sum (no pun intended) for preventive services. I can use it as I see fit — exams, labs, tests, etc. — as long as they’re preventive in nature.

The staffer proceeded to argue with me about needing a physician order for the screening test, citing, “Your insurance won’t cover it without an order.” Being a doc (and a savvy patient), I know what they cover and how they cover it. I reminded the scheduler that I’ve never needed an order in the past (especially since my state allows women to have screening mammograms without an order).

She was insistent, so off I went to call a physician. I was tempted to just write my own order, but that would have been too sassy even for me. I just shook my head at the barriers to care that were being placed in front of a paying patient with a valid medical need.

Even though I regularly drink martinis and hang out with my personal physician, I didn’t want to abuse our friendship with something so clearly silly, so I called the office. They unfortunately are pretty early in their EHR transformation and do not yet have a patient portal (which would have been ideal for something like this – e-mail the request, get the order electronically, and be done with it). I survived phone tree hell and reached a nurse (they didn’t have a choice for “Press 3 if you need an order that you don’t really need, but it’s totally not urgent, requires no clinical skill, and you’re embarrassed to even have to ask for it.”) Luckily it was a nurse I know, who laughed with me and agreed to mail the order.

It was with my order in hand that I dutifully arrived 15 minutes early this morning. No one asked for it. After a few minutes of deliberation (while filling out the same information on a paper clipboard that I fill out every year), I decided to proffer the order. The receptionist handed it back to me kindly, telling me they already have my physician’s information on file and don’t need orders for screening tests.

For the actual testing, the imaging center has an excellent facility, caring staff, and “on demand” results, which is another key reason I go there. Who wants to wait to get results in the mail (or even from a patient portal) if you can get them directly from the radiologist while you wait? Especially for cancer-related screenings. If it’s not normal, I want to know right away, so I value the service they provide.

The technician didn’t bother to look at my record, instead asking me if this was my first screening, and if not, how many films have I had and where were they done. At this point, I was ready for a mint julep or perhaps some smelling salts.

Fortunately, the radiologist did take the time to look at the previous films and determine there was no change (which was good, because sometimes I have to have additional views and was spared that particular fun) and came in to chat. He knows I work for Big Hospital and usually has something funny to say about my not using their radiology department. I in turn tease him about the candy-colored kiosks from Merge Healthcare that I tried to get them to purchase a few years ago to spice up their lobby.

I decided to gently broach the details of my experience and my concerns about barriers introduced that might have been important to less-savvy patients. He’s an owner of the facility, so he has a significant interest in the amount of money spent on technology. He seemed genuinely frustrated that employees are using old paper-based processes rather than new ones supported by the technology at hand.

He pulled up my record and showed me that I am clearly flagged as high risk, an existing patient, and as a VIP (although apparently my VIP status is funny to his partners since I’m an exec at the competitor — it seems I’m not the only one.) He plans to address the workflow at the weekly staff meeting, which I appreciate.

Still, as a physician, patient, and payer (aren’t we all payers these days?) I find it striking how difficult it is to achieve ideal healthcare. In my dream world, patients are only asked information once (unless they’re asked to validate their existing information) and the staff uses the information at their fingertips to provide high-quality, expedited care. Even in a facility with a very favorable payer mix, well-paid staff who don’t appear overworked, engaged owners and managers, and a huge IT budget, they’re still part of the healthcare problem, and technology just isn’t going to fix it. Until we start addressing process, procedure, and performance, we’re just throwing money and technology at the problem.

On a lighter (but still feminine) note, an old friend of mine made my week by sending an article about the new Bic pens “for Her.” Of course, I had to go to the actual Amazon UK website and read the reviews for myself. In the words of one of yesterday’s reviewers, “If they made Bic for Her keyboards, I could write this so much easier! Darn my silly lady hands …”

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.