Post Acute Care Market and Providers 11/30/11

I am a long-time reader of HIStalk. Even though I do not work in the acute care space, I find that monitoring what is going on in hospital and physician practice IT helps in planning for what might be coming down the road for post acute care.

A while back, there was a request for information about providers in the post acute care market, and I thought, “Hey, I know about that.” So, like the “long-time listener, first-time caller” that you hear on radio talk shows, I contacted Mr. H about a journalistic opportunity. He agreed, so here we go.

This article is the first of a two-part series about providers and technologies in the post acute care market. This is not meant to be an exhaustive analysis, but more of an overview to give you a bit more insight in to this part of the health care continuum.

Home Health

The term home health includes several types of providers, which can be quite confusing for consumers and healthcare practitioners alike. For purposes of this discussion, home health means a Medicare-certified agency that provides skilled care services. In 2009, 3.3 million Medicare beneficiaries received care from 11,400 home health agencies, for which Medicare paid $19 billion.

Population served

People who are under the care of a physician who require intermittent (less than eight hours per day), skilled (nursing, physical therapy, occupational, or speech therapy) home health aide, or medical social services. Almost exclusively, the payer is Medicare. Other payers include Medicare HMO, Medicaid, and commercial insurers. Home health eligibility is not dependent on a hospital stay; however, hospitals are by far the majority referral source for home health.

Special rules and regulations

The “patients” must be confined to their home in order to receive services. “Confined to home” is a misunderstood regulation in home health, even amongst the providers themselves. Essentially, what Medicare says is: the patient should leave the home only infrequently, and, when they do, it is a significant and taxing effort, usually because of medical reasons.

Medicare-reimbursed home health services are not for long-term custodial care. The services are focused on helping the patient become independent as soon as possible. The average number of visits (all disciplines) per patient for a 60-day episode of care in 2008 was 37.

Reimbursement structure

In 2000, Medicare changed from “we will pay you what it costs you” per-visit reimbursement to the Prospective Payment System. Patient acuity (clinical and functional) is measured at specific points in a patient’s episode of care. These skilled assessments are performed using the OASIS assessment tool. The result of the assessments is a Case Mix Weight (acuity) that determines how much money the home health agency will receive for a 60-day episode of care. Patients do not pay a co-payment or deductible to receive home health services.

Regulatory environment

Post acute care is highly regulated, with regular on-site surveys by state and federal regulators. Many home health agencies have achieved accreditation through the Joint Commission or other accrediting bodies.

Ownership

Home health agencies can be affiliated with a hospital, free-standing, for-profit, or not-for-profit.

Private Duty

Private duty home care agencies provide home care aides, companion care, homemaker services, and possibly nursing services in the client’s home or place of residence.

Population served

This varies tremendously from agency to agency—from newborns to seniors. Some agencies provide only unskilled (aide and companion care) and some provide highly skilled nursing (infusion, ventilator) services.

When compared to the costs associated with a retirement community, private duty home care can be an affordable option for many seniors. The average annual cost for a nursing home is $69,715. The average annual cost for an assisted living facility resident is $36,372. (Source: MetLife Market Survey of Nursing Home & Assisted Living Costs). Seniors who want to remain in their homes can often do so cost effectively with a few hours of care a week. For example, 20 hours of companionship home care a week costs approximately $1,500 a month, or an average annual cost of $18,000.

Reimbursement structure

Many services are paid directly by the “client”. Some insurance models will pay for some private duty services — Medicaid, long term care insurance, worker’s compensation, and commercial payers.

Regulatory environment

This is all service dependent. If only companion services are provided, depending on the state, only a business license may be required. If personal care (home care aide) or skilled nursing services are provided, then state department of health services (or equivalent) regulations will apply.

Ownership

There are some national chains, but many are privately owned by individuals who tend to be active in their local communities.

Home Health Registries

The reason I specifically chose to discuss registries is because they many times are confused with home health agencies since their name or advertising may include “home health.” These businesses are essentially a referral agency. They are the middleman between certified nursing assistants, home health aides, companions, etc. and an individual looking for services.

Population served

No particular population—newborns to seniors.

Special rules and regulations

None, since they are only a placement resource.

Reimbursement structure

Cash. They take a percentage from the person that is able to gain employment from their referral.

Regulatory environment

Business license. May having a bonding requirement.

Ownership

Private.

Hospice

Population served

Individuals who are terminally ill, their families and friends, and the communities in which they are located. Most hospices accept payment from Medicare, Medicaid, and commercial payers. Some with excellent funding may not require the individual to pay and will not bill insurance.

Hospice services may be provided in the client’s place of residence (home, assisted living facility, and skilled nursing facility) or a dedicated hospice facility, many times referred to as a “Hospice House.”

Special rules and regulations

Specifically, I will discuss the regulations for a hospice that is reimbursed by Medicare. All of the “clients” must have a “Certification of Terminal Illness” signed by a physician that states that it is reasonable to believe that the individual has less than six months to live due to their terminal illness. When the individual elects the Medicare Hospice benefit, they are stating that they no longer will seek curative treatment for that specific ailment. This election may be revoked by the person at any time during their care in hospice if they decide to receive potentially curative treatments for the terminal illness.

A significant percentage of the services hospices provide must be performed by volunteers. The agencies are responsible for supporting their local communities with education about terminal illness and will provide counseling services to the community — for example, in a high school where a tragedy has taken place. Hospices must provide bereavement services for 13 months after the person has died to any person designated to be a member of the client’s “family.”

Reimbursement structure

Paid on a per diem basis for as long as the client is under Medicare-reimbursed hospice care. Medicaid and commercial insurers will pay differently depending on the state and the client’s policy.

Regulatory environment

Medicare regulations state that the care provided to the client is done by an “interdisciplinary team” made up of nurses, social workers, spiritual support, aides, counselors, and the hospice medical director.

Ownership

National chains, hospitals, foundations, and communities,

Skilled Nursing Facilities, Nursing Homes, Long-Term Care

A nursing home or skilled nursing facility (SNF) is normally the highest level of care for older adults outside of a hospital. Nursing homes provide what is called custodial care, including getting in and out of bed, and providing assistance with feeding, bathing, and dressing.

However, nursing homes differ from other senior housing facilities in that they also provide a high level of medical care. Each resident’s care is supervised by a physician, with skilled nursing care and rehabilitation services available on site. Some facilities specialize in stroke care, dementia and cognitive services, neurological disorders, etc. Many folks who have had orthopedic surgery (total joint replacements) will go to the skilled nursing facility to get rehabilitation services after their acute care hospitalization.

2011 statistics: 15,682 facilities serving 1.4 million residents. The average facility size is 109 beds at 80% of capacity.

Population served

Mostly frail seniors, the severely disabled, and individuals with cognitive disorders.

Special rules and regulations

It is said that outside of the nuclear industry, long-term care providers are the most regulated. There are local, state, and federal regulations. Under the federal Older Americans Act, every state is required to have an Ombudsman Program that addresses resident and family complaints and advocates for improvements in the long-term care system.

Like home health, a standardized clinical and functional assessment called the MDS must be performed at regular intervals to determine the resident’s acuity and the services they require, which drives reimbursement.

Medicare residents must have a qualifying hospital stay prior to admission in to the SNF. Medicare will cover 100 days of service for that “spell of illness.” If the resident is discharged from the facility prior to the 100th day, either to the community or the hospital, they can return to the facility within 30 days and continue that same 100 days of coverage. If they do not, they must wait for 60 days and have another three-day hospital stay in order for Medicare to cover another episode of care. So if they return to the facility between Day 30 and 60, Medicare is not paying.

Reimbursement structure

Medicare 14.2 %, Medicaid 63.6%, other/government 22.2%. There are some commercial payers, workers compensation, and long term care insurers.

Ownership

National chains, regional companies, private, for-profit, not-for-profit. About 6% are hospital owned.

Assisted Living Facility

Assisted living is a retirement housing facility that provides independent living while offering extra help where needed. Some common services are help with getting dressed, laundry assistance, transportation, housekeeping, cooking and preparing meals, and medication assistance.

Assisted living facilities can stand alone,or be a component of a senior living facility which includes independent living, assisted living, and skilled nursing facilities all on one campus. Many assisted living facilities have special secured (locked) dementia or “memory” units.

Population served

Individuals of retirement age.

Special rules and regulations

Have to meet many of the same regulations as a skilled nursing facility with regard to building, safety, personnel requirements, etc. Nursing oversight is required for personal care services and medication assistance. Ombudsman oversight occurs in this environment as well.

Reimbursement structure

Mostly reimbursed by the individual. Some long-term care insurers will cover.

Regulatory environment

Highly regulated, oversight by the state where the facility is located.

Ownership

National chains dominate the market, some affiliated with religious organizations.

Durable Medical Equipment

Durable medical equipment is special equipment for home use that provides therapeutic benefits or helps patients perform tasks they would otherwise not be able to accomplish. Durable medical equipment is defined as equipment that can withstand repeated use, serves a recognized medical purpose, generally is not useful to an individual without an illness or injury, is appropriate for home use, and is prescribed by a physician as medically necessary.

Typical equipment supplied: wheelchairs, hospital beds, lift chairs, scooters, diabetic supplies, canes, crutches, walkers, commodes, home oxygen, and traction. Many vendors will have a retail store front and equipment warehouse with home delivery service.

Population served

Newborns to seniors.

Special rules and regulations

Depends on the payer source and whether or not they are accredited. Medicare reimbursement brings special requirements.

Reimbursement structure

Cash, commercial payers, Medicaid, Medicare.

Regulatory environment

Recent changes to the DME landscape has turned the industry upside down. Section 302 of the Medicare Modernization Act of 2003 (MMA) established requirements for a new Competitive Bidding Program for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to furnish certain items in competitive bidding areas, and the Centers for Medicare & Medicaid Services awards contracts to enough suppliers to meet beneficiary demand for the bid items. The new, lower payment amounts resulting from the competition replace the Medicare DMEPOS fee schedule amounts for the bid items in these areas. All contract suppliers must comply with Medicare enrollment rules, be licensed and accredited, and meet financial standards.

Ownership

Some national chains, many private.

I hope this information helps you understand these post-acute health care services and providers. Part Two of this series will cover the information systems typically found in these environments, who the major players are, and what things to consider if looking to partner with these entities in shared payment arrangements, or ACOs.

Cindy Gagnon, RN, FNP has worked as a provider of post acute care services as well as a functional / clinical designer, implementation specialist, and manager of support services within the post-acute care information technology community. You may contact Cindy at: cindy.gagnon@comcast.net.

Meaningful Use Stage 2 Deadline Extended

Under a news release headline of “We can’t wait: Obama Administration takes new steps to encourage doctors and hospitals to use health information technology to lower costs, improve quality, create jobs” HHS announced today that providers starting participation in the Medicare EHR incentive programs in 2011 will not be required to meet Stage 2 standards until 2014, a year later than was originally announced.

The previous timetable allowed providers to sit out a year and begin participation in 2012, thereby automatically extended their own Stage 2 deadline until 2014.

The announcement includes an HHS reminder that “doctors who act quickly” (by February 29, 2012, according to previously published dates) can still qualify for 2011 incentive payments.

The announcement also cites a new CDC study that found that 52% of office-based physicians plan to seek HITECH money, with 34% of practices now using electronic records software with at least “basic” capability.

From the announcement:

HHS also announced its intent to make it easier to adopt health IT. Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013.  If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.

These policy changes are accompanied by greater outreach efforts that will provide more information to doctors and hospitals about best practices and to vendors whose products allow health care providers to meaningfully use EHRs. For example, in communities across the country HHS will target outreach, education and training to Medicare eligible professionals that have registered in the EHR incentive program but have not yet met the requirements for meaningful use. Meaningful use is the necessary foundation for all impending payment changes involving patient-centered medical homes, accountable care organizations, bundled payments, and value-based purchasing.

News 11/30/11

Top News

HIMSS EHR Association responds to NIST’s EHR usability draft. Its concerns:

• There’s no proof that usability issues are a barrier to EHR adoption
• The document does not take into account how EHRs are used in practice
• The document’s references are old and the checklist-based review method has limitations
• The stated expert review requirements are “unwieldy and unproven”
• The summative testing requirements are impractical and don’t reflect practice customization and limitations imposed by vendors of the underlying operating system
• Users prefer a system that’s efficient to one that’s easy to learn and the main beneficiary of usability improvements would be novice users
• Usability reviews are subjective and even expert evaluators often don’t reach the same conclusions
• Prescriptive standards for functionality and aesthetics will hinder innovation

Reader Comments

From Blue Horseshoe: “Re: ViaTrack acquisition by NextGen. Verified.” According to the e-mail, QSI’s acquisition of its NextGen EDI partner closed on November 14, with the goal of expanding the company’s inpatient EDI market (with no impact to its ambulatory clearinghouse partners, the e-mail emphasizes).  

From Red Flag Raised: “Re: Epic. Why are they talking to the New York Stock Exchange?” Epic’s CFO speaks at the Wisconsin School of Business in a presentation stated to be “a practice run through the material that the Epic group is planning on giving to the NYSE.” The topic was on the Dodd-Frank Act that addressed Wall Street reform. A bit of sleuthing turns up Anita Pramoda’s November 29-30 NYSE audience – a CFO forum for institutional investors at NYSE Euronext. She’s moderating the session, which doesn’t appear to have anything to do with an Epic plan to go public. Unrelated: she’s apparently also the CFO of OnTech, which makes self-heating drink containers for coffee. Above is what rather surprisingly displayed when I pulled up her LinkedIn profile.

From ShakingMyHead: “Re: UMCSN in Las Vegas. Finally signed an agreement to buy Horizon Clinicals. Now that is weird news.” The hospital chose McKesson as vendor of choice in August 2010, but ran into money problems until McKesson apparently came way down on price.

From The PACS Designer: “Re: Nimbula. TPD has blogged about cloud applications in the past, and now that the concept is becoming widespread, thought HIStalkers would like to try out this concept themselves. Now they can with a free trial called Nimbula Director 1.5.” The company says the product provides “a one-stop virtual data center management solution.”

Acquisitions, Funding, Business, and Stock

Optometry HIT company RevolutionEHR is raising $600,000, according to an SEC filing.

Xerox subsidiary ACS acquires The Breakaway Group, developers of the PromisePoint cloud-based service that allows providers to practice using their EMR technology in a simulated environment.

Sales

Beth Israel Medical Center (NY) signs a five-year contract with CriticalKey for its KeyEngine software, which enables the electronic transmission of patients results from Beth Israel’s RIS system to the individual EMRs of participating physicians.

The Johns Hopkins Hospital selects Versus Advantages RTLS for staff locating, asset tracking, and automated nurse call cancellation.

Abbeville Area Medical Center (SC) selects Virtual Radiologic’s Enterprise Connect, a PACS alternative solution.

Wake Forest Baptist Medical Center (NC) chooses Huron Consulting’s Click Portal software to automate clinical trials business processes.

Vitera Healthcare Solutions announces that Medical Group of North County (CA), Bloomingdale Medical Associates PA (FL), Doctor’s Medical Center (FL), Rheumatology Associates PC (MA), Women’s Care Group, PC (TN) and Robert C Byrd Clinics (WV) have selected Vitera Intergy Meaningful Use Edition EHR solution.

Northern California Surgery Center selects the ProVation EHR solution for ambulatory surgery centers from Wolters Kluwer Health.

St. Jude Heritage Medical Group (CA) chooses MediRevv for insurance resolution A/R management services.

Acuo Technologies announces contracts for its vendor neutral archiving solution with University of Rochester Medical Center (NY), Kettering Health Network (OH),  and CHRISTUS Health (TX).

People

Good Shepherd Medical Center (TX) appoints Ralph Holcomb as CIO. He was previously with Baylor Jack and Jane Hamilton Heart and Vascular Hospital (TX).

MedQuist Holdings hires Matt Jenkins as SVP of corporate business development. He was previously with Allscripts.

Elsevier/MEDai names Thomas H. Zajac as president. He was previously with CareScience and TSI.

Cardiology center software vendor Perminova announces Craig Collins as its president and CEO. He was previously with PetriTech.

Medicalis names Jim Boyle (Stentor, Perot) as COO and Guy Anthony (Solaicx) as CFO.

Announcements and Implementations

Children’s Mercy Hospital & Clinics (MO) completes its 30th installation of SeeMyRadiology.com for the communication of radiology images between hospitals, imaging centers, and physician practices.

Willis-Knighton Health System (LA) deploys EMC Symmetrix VMAX storage systems to accommodate its Meditech, Siemens Soarian, and Sectra PACS applications.

University Behavioral Healthcare, a division of the University of Medicine and Dentistry of New Jersey, goes live on vxVistA and vxMental Health Suite from DSS, Inc.

Martin Memorial Health Systems (FL) gets a mention in the local paper for going live on the first phase of its $80 million Epic EMR this week. VP/CIO Ed Collins checked in with an update last week.

Kony Solutions announces Member Mobile, which allows health plan members to browse and purchase plans, locate care services, request appointments, check benefit status, and refill prescriptions.

RTLS vendor Intelligent InSites will introduce its “big data” business intelligence solution at IHI’s quality improvement forum in Orlando next week. The company also announces a consulting service to help hospitals place a value on their RFID and RTLS technologies.

Walgreens subsidiary Take Care Health Systems, which operates employer health and wellness centers, will run Cisco’s San Jose health center and provide telemedicine services from there to the company’s Durham, NC campus using Cisco’s HealthPresence technology.  

Healthcare imaging vendor Barco announces MediCal QAWeb Mobile, calibration software for tablets used for viewing medical images. A free version is available on iTunes.

Select Data introduces an iPad application for use in the home health market.

Candelis announces that its cloud-hosted medical image services will be integrated with Microsoft HealthVault, allowing patients to import and share images.

Montage Health Solutions says that its enterprise search and analytics technology for EHRs and radiology information systems is live at Keck Medical Center of USC (CA), Children’s National Medical Center (DC), and University Health Network (Ontario).

Government and Politics

Rep. Tom Marino (R-PA) is taking heat from critics of his bill that would allow providers to report suspected EMR-related errors without legally admitting wrongdoing. Attorney Cliff Reiders, who sues providers for a living, says giving providers immunity would “encourage the wrong thing” and wouldn’t provide encouragement to improve EMRs.

The National Library of Medicine updates its RXNorm clinical drug vocabulary, adding standardized drug names linked to NDC numbers and also including the full NDC set from the Red Book by Thomson Reuters.

The VA says 89% of its project milestones were met on time in FY2011, exceed the goal of 80% that was set in 2009 when fewer than 30% of its projects were finished on schedule.

Innovation and Research

ONC announces four finalists for its developer challenge for apps related to using public data for cancer prevention and control. They are Ask Dory! (locates nearby clinical trials), My Cancer Genome (provides treatment options based on clinical trials involving specific genetic mutations), Health Owl (provides cancer recommendations from family history and demographics), and Cancer App by mHealth Solutions (offers suggestions for reducing cancer risk).

Technology developed by a hospital in Israel allows the family members of patients undergoing cardiac catheterization procedures to watch in real time on their iPads. The original version of the story said the app was co-developed by McKesson, but that reference has been removed.

Other

Sanford Health (ND) is hiring 100 part-time and full-time employees to help with its $8 million transition to the Sanford One Chart EHR (aka Epic).

Oxford University Hospitals Trust pushes back this week’s Cerner go-live at three of its hospitals, saying it needs more time to prepare.

I couldn’t help but reminisce about  Mrs. Fletcher reading this story. An 81-year-old woman activates her medical alert system when her 55-year old daughter attacks her in bed after an argument over money. Paramedics saved the day.

One day I will check out RSNA, mostly because I am intrigued by the size and scope of the event. OK, I also like the idea of holiday shopping on Michigan Avenue. RSNA was expecting about 700 exhibitors and over 58,000 attendees from over 100 nations. If you are there, send us an update and your best photos.

UCSF, Brigham and Women’s Hospital, Weill Cornell Medical College, and Inland Imaging partner with Medicalis to form a radiology workflow consortium to enable direct scheduling of radiology orders from the point of care.

Karen Pletz, the former president of the Kansas City University of Medicine and Biosciences, is found dead in her Florida home. Under her leadership, the school expanded its campus and fund-raising efforts, but she was abruptly fired in 2009 amidst charges of embezzling $1.5 million.

MedicalRecords.com, which offers a free online database of EMR applications to generate leads that it sells to vendors for $150-300 each, says the 400 EMR vendors clamoring for business is “like a gold rush” with 7% of them buying its leads.

The New York Post runs just-released compensation information for executives of New York’s hospitals, naming four hospital CEOs whose one-year bonuses exceeded $1 million. Herbert Pardes, retiring CEO of New York-Presbyterian Hospital, made $4.3 million, while the CEO of a struggling 326-bed hospital came in #2 with $4.2 million in total compensation in a single year.

Weird News Andy, observing that “people are smarter than governments” since healthcare insurance doesn’t carry a two-year contract like cell phones, likes this story: a study finds that “jumpers and dumpers” are taking advantage of a Massachusetts law that forces insurers to accept patients with pre-existing conditions. They are buying insurance, having expensive elective surgery, and then dropping coverage. That practice costs the state $37 million per year. WNA also likes this story about electronic surveillance of hospital handwashing practices, which he entitles, “Big Brother is Washing You.”

Sponsor Updates

• Quality IT Partners sponsored the 12^th Annual Scott Hamilton & Friends Ice Show and Gala, held in Cleveland on November 5. The company’s guest was a patient undergoing cancer treatment at Cleveland Clinic. 
• Medical Transcription eXpress joins MD-IT as a Medical Transcription Service Organization associate, allowing it to resell the MD-IT platform and EMR.
• Nuance Healthcare and Bayer HealthCare’s MEDRAD launch an interoperable solution that connects the MEDRAD Certegra informatics platform and Nuance PowerScribe 360 reporting technology .
• Sarah Corley MD, CMO of NextGen Healthcare, and Gregory Sheffo MD, CMO of Clearfield Hospital (PA) will discuss the impact of healthcare reform to the ambulatory care sector during a December 15 Webcast.
• Dell says its acquisition of InSite One a year ago has increased its managed object count by 25%, with the company managing over 65 million clinical studies and 4.5 billion diagnostic imaging objects.
• Robert Hitchcock, MD FACEP, T-System VP and CMIO, discusses five key reasons a CDS should be used in the ED.
• Worcestershire Acute NHS Trust goes live with Orion Health Clinical Portal.
• At RSNA, Merge Healthcare unveils its cloud-based platform Honeycomb along with its first application, free image sharing.
• T-System expands its partnership with Iatric Systems to include interfacing technology for hospitals connecting T-SystemEV EDI with enterprise EHRs.

Contacts

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

Monday Morning Update 11/28/11

From Ganglion: “Re: Franciscan Health System (WA) going to Epic. An internal memo referenced ‘a major payer’s requirement for providers to be on the Epic platform’ was unusual. I wasn’t aware that payers had that much say in such matters.” I found the item below by Googling. Maybe the major payer in question is the federal government and the ‘requirement’ involves earning MU bonuses / avoiding MU penalties.

Franciscan Health System (FHS), Tacoma, WA, along with CHI’s ITS and clinical leaders, has recommended that FHS work directly with Epic to purchase and implement Epic’s Enterprise Suite as its electronic health record solution. The project plan and budget will be presented to President’s Council in February for approval. CHI’s decision for FHS to implement Epic is based on several factors that have the potential to significantly affect the organization’s ability to remain competitive and accelerate growth, including a major payer’s requirement for providers to be on the Epic platform and Epic being the pervasive clinical IT platform in western Washington. The project will include a fully integrated electronic health record, a revenue cycle application and other applications for inpatient and ambulatory centers and employed physician practices. The Oregon facilities in the same CHI Division as FHS will implement Meditech 6.0 and Allscripts. The project is expected to begin in early 2012 and to be complete in mid to late 2013. As part of OneCare, the project will have full leadership, ITS and project management support from CHI’s national office.

From Is3Mreallyafriend?: “Re: 3M interfaces letter to customers. Looks like a desperate attempt to protect a market. You decide.” The purported e-mail from 3M was attached, with some relevant snips below. It says that the company is merely enforcing agreements already approved by customers in their contracts and that 3M will issue licenses at no charge for interfaces that meet those requirements.

The rapid transition to digitized records and expanding use of “machine learning” capabilities make it possible for some software applications to utilize 3M intellectual property in ways it was not intended nor authorized to be used … We are reviewing our current vendor relationships to verify that all existing interface license agreements include provisions that protect 3M intellectual property and ensure the compliance and validity of the output produced by our products …. If 3M agrees to enable an interface and an interface license agreement is finalized with a vendor, we will provide the vendor, at no cost to the vendor or to you, 3M confidential interface specifications … We can assure customers there will be no impact until the July 2012 3M software release, at which point direct interfacing from any vendor application not covered under an interface license agreement will be disabled.”

From BadgerMom: “Re: Martin Memorial announcement. How many times do we have to say it’s Epic, not EPIC?” I noticed that and let it slide since it seems so be a hopeless cause to expect customers sending dozens to hundreds of millions of dollars to a four-letter-word vendor to know how to spell its name. It’s annoying when vendor marketing people insist on capitalizing a company’s name for no apparent reason in press releases, but they’re innocent in this case since even Epic spells its own name correctly, as clearly shown in its logo.

From Ken Lawonn: “Re: Epic at Alegent Health. I can confirm your reader’s post.” Ken, who is SVP of strategy and technology at the Omaha-based Alegent, provided the following information:

I am the CIO at Alegent Health and wanted to confirm the post today by Nikita that the Alegent Health Board has approved a recommendation to move into due diligence with Epic. This recommendation was the result of an high level evaluation done by an IT Evaluation Committee made up of board members, physician leaders, and system executives that considered the future needs of the organization and the best platform to support us. In the end, this was about an integrated solution across the continuum of care as we move to a future where our success will be based on our ability to effectively manage a population and our need to be as clinically integrated as possible. In our evaluation, we believed Epic would provide us with the best platform for success. It was a tough decision as we have been partners with Siemens for many years, have enjoyed many great successes with the Soarian product, and Siemens is aggressively working to build out their platform to support this future environment. And while I personally believe they will be successful, the overall Committee felt Epic’s proven record was too much of an advantage. Our final decision will come in March, but we are entering full evaluation of Epic at this time.

From Pretty Patty: “Re: ViaTrack Systems. Acquired by NextGen.” Unverified. I’ve seen no announcement about the Augusta, GA claims and eligibility transactions vendor. I would have expected publicly traded parent company Quality Systems to have filed an 8K if the rumor is true, but I don’t claim to be an expert in that area.

From Wally LG: “Re: HCA. Has chosen Epic, or so I’ve heard. Heard from Epic staff that top implementation positions have been staffed even though no official announcement has been made.” Unverified.

From Reverend of Funk: “Re: whole hog vs. best-of-breed. I’ve worked at three HIT shops. One implemented everything that Cerner ever created, the second did the same with Epic, and the third (my current employer) is an academic system with a Cerner backbone and lots of best-of-breed extremities. Is #3 an oddity among most new Cerner and Epic implementations? Things are so confusing here that people don’t even know where data comes from, and just putting together data for basic purposes involves tweaking interfaces or creating new ones.” My limited, anecdotal experience is that Epic implementations usually involve replacing everything with Epic except for its obviously weak systems like lab (although with Epic, it rarely takes long to progress from new/weak to slightly less new/best available, so we’ll see if Beaker LIS makes the usual quick climb to the top of the heap.) Epic is often chosen as the solution to a hospital’s data-chasing problem and the company isn’t known for its friendly integration cooperation with competitors, but I would say both issues are less true of Cerner. That’s a cue for readers to chime in with a description of their own experience.

From DW: “Re: Patty Vogel. You may want to let people know of her passing. She was CEO of Barrow Neuro in Phoenix, but earlier in her career was a pioneer in the MSO market in North Carolina. A fine person with a long and successful career in the HIT business.” Patty Vogel died on November 4 at 68.

HITREC’s aren’t worth the $650 million in taxpayer money that’s funding them, so say 84% of poll respondents. New poll to your right, from a reader’s earlier comment and just in time for holiday-related food binging: would you discount the opinions of a healthcare-related speaker or author who appears to be significantly overweight?

Listening: new from White Wizzard, LA-based retro-metal that isn’t all that original or interesting, but serviceable in a pinch for someone feeling nostalgia for Rocklahoma-type 80s hair band music that could pass at times for Whitesnake, Dio, Iron Maiden, or Rush. I don’t love it, but I don’t hate it.

Weird News Andy worked busily through the Thanksgiving holiday to locate this tasty morsel, which captions as, “At least this man has some skin in the game.” The former world’s fattest man, who has lost almost 500 pounds after costing British taxpayers over $1.5 million in medical care over the past 15 years, is demanding that the British government pay for a $10,000 skin-tightening operation. NHS says that’s not happening until his weight stabilizes. The former letter carrier had gained so much weight that he was transferred to the letter sorting department, where he was fired for stealing money from the envelopes. He wasn’t just big boned: he was scarfing down 20,000 calories per day until taxpayers provided him with gastric bypass surgery.

WNA also contributes this story, in which a male nurse says he was fired from the health department of Dearborn, MI for disobeying a Muslim supervisor’s orders to not treat women wearing Islam garments and instead take those patients to the supervisor. He stopped doing that when a doctor complained about the treatment delays caused by that practice. The 63-year-old nurse, a former Army medic in Vietnam, has filed a sex discrimination lawsuit. WNA ponders whether the families of those patients would have sued the nurse if he had followed the rules and detrimentally delayed the care of their their relatives.

An Alaskan chiropractor whose patient information was found to be wide open on the Internet says a EMR4Doctors.com, a Las Vegas-based EMR vendor he used for a short period in 2008, is responsible. He says the vendor stored his patient information in an unsecured text file that a patient found when Googling his own name. The chiropractor thanked the patient, notified HHS, and says he’ll sue the vendor if there’s anything left to sue (he thinks the company is defunct.) An Internet search suggests that EM4Doctors is run by a chiropractor named Don Lewis, who uses the address of a small house in Las Vegas (above.) Its Web page is still active and the 1-800 number brought up a PBX message when I called it Sunday afternoon.

CMS Administrator Don Berwick says he’ll resign effective December 2, four weeks before his appointment would have expired anyway. President Obama, who gave Berwick the job in July 2010 using his “recess appointment” authority to avoid Senate confirmation hearings, says he will nominate Marilyn Tavenner (above), a nurse and Berwick’s second in command, as his replacement. Most of her career was spent at Hospital Corporation of America, ironic given that she worked as an executive of the for-profit hospital operator during the time it (as her previous employer) earned a record $1.7 billion fine for Medicare fraud (against her current employer.)

Vince Ciotti provides HIS-tory Episode # 32, the third part of his HIS, Inc. coverage. This one reads like a novel, full of intrigue and unpredictable twists and turns. Very enjoyable.

A doctor in Canada runs afoul of a peer review group over her practice’s use of an EMR. Her practice manager (also her husband, who is also the developer of the MedScribbler EMR she uses) asks for a peer review assessor who has EMR experience since her practice is paperless, but also advises the peer review group that the practice will bill them $150 per page for completing its questionnaire and $400 per hour for providing access to the practice’s records. The peer review group files a complaint and the doctor is advised that her medical license will be suspended immediately. The husband agrees to complete the forms at no charge, but tells the assessor to bring his own computer on which to install a copy of MedScribbler for reviewing the records. The assessor has installation problems and the husband says the assessor can call his company’s support line to get help for the usual $100 charge. The assessor walks out and files a complaint saying the doctor was uncooperative, resulting in another threat to revoke the her license. The husband says it’s not his fault that assessors aren’t tech savvy enough to review electronic medical records, he wouldn’t have been expected to provide free tech support if he didn’t coincidentally happen to be the software developer, and assessors should not have unrestricted access to the non-clinical part of patient records.

Nuance announces Q4 numbers: revenue up 18.5%, EPS –$0.02 vs. $0.01. Excluding one-time acquisition costs, the company beat expectations with earnings of $0.42.

In England, University Hospitals of Leicester issues a $930 million (USD) tender notice for a vendor to help it deliver electronic patient records and technology-related benefits over a 15-year period and then help it commercialize its knowledge as an IT services provider.

A Wisconsin technical college plans to discontinue its programs for medical transcription and health unit coordinator, saying the medical transcription program isn’t attracting very many students and graduates aren’t getting jobs because speech recognition technology has reduced the need for their services. It says HUC program graduates can’t find jobs because CPOE requires doctors to enter their own orders.

Fast Company runs a fun (but sadly accurate) article called How to Commit Medicare Fraud In Six Easy Steps. A key element: focus on quantity rather than quality since CMS doesn’t have the resources to check rejected claims, so a fake provider can just keep shot-gunning claims and some will eventually go through.

A woman being treated in a Scotland hospital’s ED for broken fingers starts receiving Facebook messages from  someone who said he was “checkin u out” and asking about her hand. Her unknown admirer admits to being a hospital maintenance worker who saw her in the ED and looked up her information in the hospital’s computer system. The contract maintenance employee has been suspended by his employer, the police are involved, and privacy practices are being reviewed.

E-mail Mr. H.

News 11/23/11

Top News

A USA Today article examines the effect of stimulus money on publicly traded companies, with those in healthcare IT being “the clearest connection between the stimulus and the economy.” I don’t get this statement: it says Cerner clients have earned $100 million in stimulus money and Cerner has 20% market share, so it concludes that industry sales must have been boosted by $500 million per year, when (a) stimulus payments to providers have nothing to do with vendor sales; (b) even if they did, it wouldn’t be an annual increase; and (c) the number is probably much larger than $500 million a year, given that Epic alone has probably exceeded that number even just on the software and services part of its contracts. The article mentions sales increases for Allscripts and athenahealth, although Jonathan Bush of athenahealth opined that his company is “… a beneficiary of stimulus spending, but we’d be doing even better without it. What you really needed was hundreds of cloud-based companies innovating.”

Reader Comments

From A Muse: “Re: weighty issue. Does anyone else feel a bit uncomfortable when we have industry thought leaders, spokespeople, and senior management of do-good healthcare companies or organizations who are overweight? When I see obese people in organizations advancing remote patient monitoring or other disease management, it makes me think, ‘Yep, it’s working for you, partner.”

  From Teena Martini: “Re: picture perfect. I saw the shoe when I was in Las Vegas and crawled into it. And I am a Martini!’” All Inga BFFs beware: there is some stiff new competition from Teena Martini (that’s her real name!) Teena, who is director of clinical applications at Gwinnett Medical Center in Georgia, sent me her photo after I mentioned a desire to crawl in this exact shoe with an Inga-Tini in hand. During HIMSS, I am dragging Dr. Jayne with me to the Cosmo for a serious photo shoot.

  From EMRsehole: “Re: [vendor name omitted.] The acting head of HR whacked numerous sales reps and others have had to sign an airtight non-compete.” Unverified.

From Mack Chiavelli: “Re: Newt Gingrich. All true. My former healthcare IT company, now dead and therefore nameless, ‘donated’ much, much money for Newt’s influence to drive interoperability and open systems in government circles. We even sponsored a number of his speeches to pre-HIMSS CHIME annual Fall Forums and later to CHIME members when the organization capitulated to HIMSS. I don’t know how successful we were, but Newt certainly made out well.”

From Insider: “Re: Epic moving into Meditech territory at Poudre Valley. It’s true that PVHS is getting rid of Meditech 6.0 and putting in Epic. Meditech’s 6.0 performance was just too painful and their response was not enough to keep the business.”

From PigEarstoPurses: “Re: 3M. I received this e-mail today about a 3M interface policy change. Wondering if others got it? It true, I would hope customers tell them to take a hike since it’s none of 3M’s business where and how customer data is utilized.” A letter from OptumInsight to its own customers says that a new 3M policy requires customers to submit an inventory of anything that interfaces with 3M’s applications. It also requires vendors of those systems to license their interface with 3M because its intellectual property is at risk. The letter claims 3M says it will disable any interfaces that aren’t covered by licenses by July 2012. Readers have sent rumors about 3M supposedly not allowing their encoder product to interface with non-3M speech recognition applications, so that may or may not be related. 3M is welcome to provide a response since this is just one side of the story.

From Ed Collins: “Re: Martin Memorial Health Systems, Florida. I’m an avid reader and find HIStalk to be a valuable tool in my CIO arsenal. Here is a bit of news that your readers might enjoy. MMHS will be going live with Epic inpatient and ambulatory apps at our two hospitals, our freestanding emergency department, and nearly half of our medical group (45 PCPs) on December 1. The specialists who represent the remaining half of our medical group go live in March. The local ad campaign started over the weekend. Nine days and counting to go-live!” I asked Ed (he’s the VP/CIO of MMHS) if he got tired of shuttling people to Verona for the never-ending Epic training, but he observes that the product just works, so the training focuses on user and analyst knowledge of the system. I swapped e-mails with another CIO earlier this week and we reached that same conclusion: you begrudge the huge time and money investment for Epic’s upfront training that seems like overkill, but only until the day you go live and everybody’s ready (extensive training, documentation, and proficiency testing is part of Epic’s secret sauce that competitors rarely emulate.) Above is MMHS’s ad in the local paper explaining the transition. I know from a long-ago site visit I took there that MMHS’s outgoing system is Meditech, so this is yet another instance of a previously unthinkable but now increasingly common phenomenon. Thanks to Ed for the report – I always enjoy hearing from the front lines.

From THB: “Re: Franciscan Health System (WA). Going Epic.” According to its project page, Franciscan brought in Deloitte for planning (seems like Deloitte gets a ton of that business) and will name a consulting firm to help with the implementation any day now.

From The Fixxer: “Re: UPMC’s altered EMR lawsuit. I am amazed that electronic medical records are being used to tamper with evidence. Why would an old geezer retired surgeon want to learn how to enter a finding in an EMR? The hospital has training facilities and Cerner experts to teach him. The bigger story is who advised him to do this. Might there just be a Penn State like scandal involving the attempted cover up of deaths of adults?” A judge orders UPMC to allow its head of quality assurance to be deposed to explain why he changed the electronic medical record of a patient who had died three days earlier in the hospital. UPMC’s lawyer in the malpractice lawsuit against it argued that the QA director was doing routine peer review work, but the plaintiff’s attorney says he not only changed the record after the fact, but also asked another doctor to add documentation about how the patient died.

From Nikita: “Re: Alegent in Omaha. They have also begun the popular to journey to Epic, starting from Siemens in their case. The board is planning a final act on the subject in March 2012, with a stated 4-5 year migration period. Part of the support argument references Epic’s being ‘a single system.’” Unverified. Alegent and Siemens have been ultra-chummy for years. If the rumor is true, Soarian gets the boot.

HIStalk Announcements and Requests

  Looking for some interesting HIT companies to follow on Twitter? I created an “Inga’s Fav” list on Twitter, so if you follow me, you should be able to access the list.

I don’t know about you, but I’m particularly thankful for the Thanksgiving break because I’m tired. I will most likely not post again until the Monday Morning Update (unless I can’t resist), so we will reconvene here then. If you are traveling, spending time with friends and family, or just slouching in front of football on the TV while dribbling gelatinous globs of cylindrical canned cranberry sauce down your front, I hope you have a wonderful holiday reflecting on those things for which you are thankful.

Acquisitions, Funding, Business, and Stock

Telemedicine provider Foundation Radiology Group raises $1 million to expand its network of community hospitals.

Sales

In advance of its migration to the Meditech 6.0 platform, Parkview Medical Center (CO) expands its agreement with Summit Healthcare to include Summit Express Connect.

Children’s Mercy Hospital & Clinics (MO) chooses Accelarad’s SeeMyRadiology for image sharing. The company says its growth in the past 12 months makes its platform “effectively a Health Information Exchange for imaging in the region.”

People

Cal eConnect appoints Robert M. (“Rim”) Cothren, PhD as its CTO, tasked with overseeing the organization’s HIT and exchange projects. He previously served as CTO for Cognosante.

Announcements and Implementations

SCI Solutions convenes its charter Executive Advisory Board to advise the company on solution development and the acceleration of the company’s growth. Some of the familiar names on it: Dave Garets (The Advisory Board Company), Ivo Nelson (Encore Health Resources), Jay Toole (Dearborn Advisors), and Allana Cummings (Northeast Georgia Health System.)

Nuance Communications signs a reseller agreement with Montage Healthcare Solutions, allowing it sell Montage’s healthcare data mining and performance measurement technology to its radiology customers.

St. Vincent Healthcare (MT) replaces its GE Centricity EHR with a $4 million system from Epic. It’s part of Sisters of Charity of Leavenworth, which is moving all facilities to Epic.

Innovation and Research

 

Aetna and the Center for Biomedical Informatics at Harvard Medical School will partner to apply bioinformatics data analysis techniques to aggregated clinical databases, hoping to evaluate treatment alternatives for outcomes and cost, study patient compliance in chronic disease, and evaluate the potential of combined EHR and claims data to predict disease. The project will be co-directed by Zak Kohane MD, PhD of Harvard and Brian Kelly MD of Aetna (above.)

Other

  A 46-year-old former physician is arrested for practicing medicine without a license out of her home and for committing a series of burglaries that include the theft of landscaping lights, decorative patio chairs, and bicycles. She has also been charged with selling phony lottery tickets. Lisa Marie Cannon was a licensed pulmonologist until she failed to renew her license in June. The local police chief calls the case “very bizarre.”

The Joint Commission issues a statement saying it is “not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting.” It notes that texting does not provide the ability to verify the sender and  it can’t store the original message for validation.

HIMSS is launching mHIMSS, a new organization focused on mobile health technologies. The new website indicates a late November launch.

EHR adoption for midsize and large ambulatory practices will exceed 80% by 2016, according to IDC Health Insights. IDC provides an assessment of 10 EHR products from eight vendors, based on their current successes and predicted performance over the next three years. eClinicalWorks earns the top score, followed by Cerner, Sage, and NextGen. 

Weird News Andy calls this article “Abs of steel, butts of steal.” Florida police officers arrest a transgender woman for practicing medicine without a license after complaints that her derriere-enhancing procedures involved injecting patients with toxic substances such as Super Glue and Fix-a-Flat. WNA also tracks international news as evidenced by this story, in which a German gynecologist is arrested for taking photos of his patients during their exams without their permission, with the evidence search yielding 35,000 nude pictures. And WNA likes the development of a talking plate in England that commands diners to stop bolting their food down, although he’s hoping that the 1,500 pound plate refers to British currency rather than weight.

A couple of items sent over by Roger Maduro of Open Health News from the just-ended VISTAExpo & Symposium in Redmond, WA. Oroville Hospital (CA) goes live on VistA without using outside consultants after spending $500K of its own money to enhance the VA’s product to meet its needs, tapping into the developer community to create its own modules and interfaces. The total project cost was $10 million, which includes all hardware, replacement lab and medical equipment that could interface to VistA, and iPads. Roger also notes that VA CIO Roger Baker made a surprising announcement in embracing newly named VistA custodial agent OSEHRA (Open Source Electronic Health Record Agent), saying the VA will use the OSEHRA product as its own and will contribute development to it.

I got Vince’s HIS-tory (HIS Inc., Part 2) a bit late for Saturday, so here it is, including naming “the most pathetic name in the HIS industry.” I really like this week’s instructional guide on “How to Sell Vision-Ware,” which I found to be deadly accurate. Another excellent installment from HIT’s de facto historian.

Sponsor Updates

• Covisint will participate in Michigan’s Council of Women in Technology Signature Event on December 3.
• Passport Health Communications announces its educational and online demonstration webinars through December.
• Gateway EDI will participate in next week’s PriMed Midwest meeting in Rosemont, IL.
• Software Testing Solutions offers its free eBook, The Who, What, When and Why of Validation.
• Trustwave announces three December webinars on security trends.
• Amit Hajra of Hayes Management Consulting blogs on ways to optimize EHR to improve efficiency and increase ROI.
• Practice Fusion wins Top Ten ratings in ten categories from AmericanEHR Partners, a program of the American College of Physicians.
• RelayHealth co-sponsors a free on-demand webcast on medical home leadership.
• CapSite’s SVP and GM Gino Johnson will present findings from CapSite’s recently published HIE study at next week’s 23rd Annual Piper Jaffray Health Care Conference. The Advisory Board, Allscripts, GetWellNetwork, Imprivata, MedAssets and PatientKeeper are also conference presenters.
• Transcription Unlimited (MO) signs a partnership agreement with MD-IT to offer the MD-IT platform and EMR to its physician clients.
• Culbert Healthcare Solutions becomes an Executive Corporate Partner of AMGA.
• Sixty-three of Texas Health Care’s 140 physicians have demonstrated Meaningful Use compliance with NextGen EHR.
• Oracle awards Orion Health the Oracle PartnerNetwork APAC ISV Partner of the Year for 2011, reflecting Orion’s performance using Oracle products and technology to create value for its customers.

Contacts

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

Monday Morning Update 11/21/11

From FunFacts: “Re: Newt Gingrich. The 2010 Cerner Health Conference had a speaker from Newt’s Center for Health Transformation, Melissa Ferguson. Any idea what she talked about?” Newt’s business is getting scrutiny from everywhere now that the dearth of decent Republican candidates puts him in front of the pack by default. The Washington Post says his think tank pocketed $37 million from healthcare companies. Not to mention that HIMSS gave him its Advocacy Award in 2005, admiring his “consistent support and insight for the adoption of interoperable health records” as a “key collaborator and advisor with HIMSS and others on healthcare information technology topics.” CHT has locked down its online membership list, but I mentioned some of Newt’s clients back in 2007: GE Healthcare, Siemens, Allscripts, CHIME, and more.

From From the ONC Annual Meeting: “Re: Epic. In the usability session, Janet Campbell from Epic said the government would need to pay Epic to perform usability safety validation. An audience member asked how much more than $27 billion would be needed. Silence from young Ms. Campbell. Is this an indication of the way the EHR industry (or maybe just Epic) is going to react to the IOM report on HIT safety?” Unverified. The shame is that customers aren’t pressing vendors for improvements. That being the case, I can see the vendors’ point of view: why should they (and thus their customers) be forced to pay for an unfunded mandate for changes that customers aren’t demanding? (much like EHR certification.) 

From Quixotic: “Re: Epic moving into Meditech territory. The board of Poudre Valley Health System has approved the decision to move from Meditech to Epic. This comes right on the heels of the Edwards decision you published last week. Both were Meditech 6.0 sites.” Unverified. Poudre Valley is a Baldrige winner and CIO Russ Branzell (above) is a pretty high profile, quoted on Meditech’s site from 2009 as saying, “being committed to excellence also meant being committed to our Meditech system.” It was just this past January that Russ said PVHS’s Meditech implementation would be complete right about now after spending $30-40 million.

Regardless of whether this item is true, what can we learn from recent decisions that have gone Epic’s way?

• It used to only be Cerner who needed to worry about Epic and even then only with its bigger customers. Now it’s every vendor of inpatient clinical systems and hospitals of every size.
• Epic used to be selective about which customers it would take on. Either it has relaxed the requirements or the demand must be overwhelming given the huge ramp-up of customer count, most of it in last two years.
• As hospitals and practices consolidate, Epic’s footprint grows by default since its large customers are usually the acquirer rather than the acquired.
• Everybody said Epic couldn’t scale up to handle a lot of business. They were wrong, at least so far.
• Epic’s revenue is up to around a billion dollars a year. The “small company risk” argument used by big competitors isn’t working.
• Hospitals are so anxious to move to Epic that they don’t care about the money and organizational energy they’ve spent on recent implementations. Hospitals with freshly implemented systems costing dozens to hundreds of millions of dollars are happy to dump them and move to Epic, so incumbents can’t even count on switching costs to protect their customer base.
• If even seemingly happy customers of Epic’s competitors are willing to replace their current systems with Epic, imagine how easily Epic could steal the unhappy ones if it wanted.

Since both Epic and its competitors just keeping doing what they’ve always done, you might suspect the leading team will keep piling on points in this embarrassingly lopsided victory. Time and customer money is running out to mount significant competition, so the only Plan B is to hunker down, try to keep existing customers happy since new ones will be hard to come by, and hope Epic’s dominance causes it to stumble to the point that customers will walk away from their huge investment and go shopping yet again for systems they didn’t want the first time around. That or just cede the core inpatient systems market to Epic and find less-competitive territory, which some pretty cool small companies are already doing.

From Clearing House: “Re: Netwerks. They are our clearinghouse and changed to 5010 on November 7, 2011. The vast majority of our claims have not been processed by payors. We have physicians having to go to their line of credit to make ends meet. Almost two weeks and counting.”

Listening: a rare “highest recommendation” for reader-recommended Zip Tang, the most stunning, heart-racing progressive rock I’ve heard since early Genesis or Kansas. For my fellow prog heads, think Flower Kings or Spock’s Beard without the wimp factor and with regular wisps of Gentle Giant, ELP, and maybe a little Styx thrown in, but stripped of the 70s excesses and with a harder edge, more soul, and catch-your-breath harmonies. They are just stupendously good, to the point that I can’t sit still while listening and I almost got a lump in my throat a couple of times from the sheer brilliance of it. Their version of Tarkus is better than ELP’s. Here’s the kicker: these are day-jobbers, with Passport Health SVP Marcus Padgett on horns and keyboard and Richard Wolfe MD of Resurrection Health Care on bass (but I’m not giving them a mulligan for that – their excellence requires no asterisk.) These guys make me remember why I love prog so much. I’ll be playing Zip Tang’s three albums all weekend and buying them from iTunes for the Nano. Truly awe-inspiring, and I’m not prone to hyperbole.

My Time Capsule editorial this week from November 2006: The Bandwagon Effect and Healthcare IT Purchases. A test dose: “After all, everyone whose organization is as good and well-known as yours is buying Vendor A’s products, they say. Those customers are not only deliriously happy, they’ve formed a high school-like clique that makes fun of Vendor B losers and dates cheerleaders after football practice instead of attending chess club meetings. ”

Thanks to one of my CIO readers for this great idea. He gives HIStalk sponsors first crack when seeking consulting help and suggested I create a single form that allows prospects to contact any or all of them in a single step. The result: the Consulting Engagement Request for Information page. Fill in the very basic information about your needs, add a supporting attachment if you like, check off the companies you want to send it to (one, many, or all) and click Submit. Your work is done – the companies you chose get your information immediately by e-mail. I’ll be adding a linked graphic later, so if you can think of a more memorable name for it (I thought of RFI Blaster, but couldn’t warm up to it) let me know.

OhioHealth selects the athenaCommunicator patient communication service from athenahealth. It’s an odd-looking press release since both organizations surgically excised the logical space between their two names, with one choosing to capitalize both names of their artificially conjoined twins while the other chose to capitalize neither. I blame marketing people run amok.

Want to see Farzad Mostashari and Aneesh Chopra bust a move? I’m not exactly sure who shot this video at ONC’s annual meeting (the screen capture above is the best I could get), but I have to say that the bow-tied National Coordinator Dr. FM is looking good out there on the makeshift dance floor with some nice improvisational and rhythmic movement, while the US’s CTO appears somewhere between bemused and mortified. I like to think that they were pulled to the dance floor by the excellent music, the legendary Meaningful Yoose Rap from Dr. HITECH (Ross Martin, MD.) I like that they loosened up and aren’t afraid to have fun. Inga and I tried to connect with Farzad’s predecessors (Brailer, Kolodner, and Blumenthal) and all of them stiffed us repeatedly like we were unworthy interlopers on sacred ground, but the new boss seems a little more tolerant to riffraff of our ilk.

Speaking of Farzad Mostashari, is it just me, or does he strongly resemble the outstanding actor Enrico Colantoni (Veronica Mars)?

And speaking of ONC, 60% of readers say it will do little in response to the IOM’s healthcare IT safety recommendations. New poll to your right: are HIT Regional Extension Centers worth the $650 million in federal grants designated to fund them?

Two tiny Washington hospitals consider affiliating with Swedish Medical Center, with one carrot being that they’ll get Epic cheap. Jefferson Healthcare, with 25 beds, says they could never afford Epic on their own, while 45-bed Forks Community Hospital says it’s facing a $1 million Meditech upgrade anyway and would welcome Epic at a lower price even though it “may be overkill” for a small hospital.

A Maryland woman says she may sue the hospital where her baby was born after nurses restricted the time she was allowed to spend with her newborn son. The baby had tested positive for drugs, but as an addictions nurse herself, the woman demanded to be tested and was found to be drug-free. The hospital later apologized, saying scheduled computer downtime resulted in erroneous lab results.

Weird News Andy makes a rare weekend appearance, calling out this story in which a woman suddenly goes completely deaf after delivering her third child (and not from the crying, WNA helpfully adds.) The happy outcome: a University of Utah surgeon diagnoses her condition as otosclerosis, a genetic condition in which the hearing bones are fused together. He fixed her problem and she says she’s hearing better than she has in decades.

Another WNA find: a three-year investigation by a group of 21 scientists concludes that there’s not enough evidence to prove that drinking water prevents dehydration, so bottled water companies will be prohibited by law from claiming otherwise. Said a Member of European Parliament, “This is stupidity writ large. The euro is burning, the EU is falling apart, and yet here they are: highly-paid, highly-pensioned officials worrying about the obvious qualities of water and trying to deny us the right to say what is patently true. If ever there were an episode which demonstrates the folly of the great European project then this is it.” 

E-mail me.

News 11/18/11

Top News

CMS announces a 90-day period of “enforcement discretion for compliance” for the HIPAA 5010 transaction set, meaning CMS will not enforce compliance until March 31, 2012. The announcement follows mounting pressure to delay enforcement since many payers, providers, and vendors are reporting they are behind in their internal and external testing. And the rejoicing commences among procrastinators and those dependent on procrastinators.

Reader Comments

From Kaiser-ite: “Re: fixing MU payment mishap. After doing some digging, I have a contact for someone that should be able to correct the issue with the doctor who was not paid her Meaningful Use incentive because it was incorrectly paid to Kaiser. From what I could tell, Kaiser’s  Meaningful Use payments are sought through a combination of different entities, but there is an overall PMO for getting it done. Being a Kaiser-ite, I hate to see the opacity of the org frustrate people.” I have connected Kaiser-ite with Unibroue, who originally sent us the note on behalf of his frustrated client. I’m thankful we have so many great readers that are eager to lend a hand when possible. We hope to hear a happy ending to this mess.

From Beantower: “Re: giant shoe sculpture at Cosmo. This made me think of you. Possible venue for the HISsies.” OMG that is beautiful! If our sponsors hadn’t already secured another Vegas venue, I would be lobbying hard for the Cosmo. Actually, I might be too easily outed if HIStalkapalooza were somewhere close to this shoe as I would be the one trying to crawl into the sculpture with my Inga-tini in hand.

From Little Honey Bee: “Re: Connexin Software. Connexin receives a multi-million dollar investment from Bluff Point Associates. Note the plan for ‘broader clientele’, which is code for ‘no longer focusing on pediatricians’ because there’s no VC company in the world who’d focus on the lowest paid of the specialties.” Connexin offers Office Practicum EHR/PM, which has traditionally been marketed exclusively to pediatricians. The press release makes numerous references to pediatrics, so at a minimum Connexin trying to ease potential concerns from customers that the company’s commitment to pediatrics will be lost in the “next stage of growth.”

From TH: “Re: 5010 enforcement delay. The questions have started pouring in to vendors, payers, and providers on implications.” It seems the government never sticks to a firm date when HIT is involved, which given some of what the government requires is like a death row inmate hearing that the electric chair is broken, but the repair person has been called. I don’t know that a three-month option enforcement period really changes anything, other than to give laggards hope that 5010 will just go away if they ignore it long enough.

From TheBus: “Re: Epic’s reputation. I attended a Minneapolis Collaborative meeting this morning, which focuses on innovation and startups. This one was focused on healthcare innovation, with a great lineup of startup and CEO panelists. Epic was cited specifically by two separate panels as a barrier to progress. Startups and legitimately funded innovators are chomping at the bit to share healthcare data and make it more actionable and Epic’s unwillingness to share and cooperate is a major issue. This group of driven CEOs will move on without Epic if they need to. Epic needs to decide if it’s an innovator or a cash cow. It’s beginning to act like the latter, which is good for its owners, but bad for everyone else.” Just to play devil’s advocate, few companies go out of their way to help their competitors. It’s kind of their job to earn the business on their own. But if we’re talking “healthcare is different than other businesses” even though it really isn’t no matter how often we keep saying it, then it would be nice if Epic played well with others, although as Steve Jobs urged, “Control the user experience.”

From CDSMavin: “Re: UpToDate. A study found that use of UpToDate’s clinical decision support shows shorter length of stays, lower risk-adjusted mortality rates, and better quality performance.”  I don’t find the Journal of Hospital Medicine article impressive. The quality differences were almost imperceptible (LOS 5.6 days vs. 5.7 days, for example) and it was another of those public health-type studies that just matched up a bunch of readily available databases (the UpToDate customer list being one) and looked for differences between customers and non-customers without any attempt to distinguish between cause vs. effect. Were those tiny differences in the cherry-picked numbers due to using UpToDate, or rather due to the differences in characteristics of which hospitals buy UpToDate and which ones don’t? (like if your hospital is hemorrhaging cash and can’t afford to buy medical databases, you’re probably falling short in clinical areas as well.) They didn’t even ask how  hospitals were using UpToDate, so if you believe the authors’ conclusions, all you need to do is buy the product and put it on the shelf. The authors had the data right in front of them that would have provided a more conclusive answer to their vague assertion that UpToDate improves outcomes: show us the mortality rates of individual hospitals before and after they signed up. UpToDate is an excellent product (full disclosure – Wolters Kluwer Health is a sponsor, but I was using UpToDate way before then), but as a vendor of critically evaluated, soundly researched medical evidence, I wouldn’t promote this article too hard if I were them.

HIStalk Announcements and Requests

This week on HIStalk Practice: the Wichita City Council entices Pulse Systems to stay local. Medley Health secures $20 million in Series A financing. gloStream expands it partners program. AAFP’s president encourages members to achieve PCMH recognition. Practice Wise’s Julie McGovern reflects on the similarities between HIT and medicine. In you are curious about the above photo, details here. Stay in the ambulatory HIT loop by signing up for email updates and checking out our sponsors’ offerings. And thanks reading.

Listening: reader-recommended Kevin Salem, a reclusive, commercially indifferent but very talented roots rocker (Tom Petty meets The Replacements) whose modest peak of reluctant fame came in the mid-‘90s. He’s a smart writer on his site, with this fun snip: “In this way, becoming a parent is a lot, I imagine, like being Newt Gingrich: you wake up one day fat and changing your position on virtually everything, blaming your transgressions on the overflow of devotion (in his case, to country, in ours, to our progeny).”

  Go ahead, make Inga’s day: (a) sign up for e-mail updates; (b) electronically canoodle with us via Facebook and LinkedIn; c) send news and rumors by clicking the puzzlingly green Rumor Report box to your right; (d) thank a sponsor since CEOs just gush when a reader tells them their sponsorship is appreciated; and (e) behold in the mirror the face of a rebel, a thinker, a self-directed universe-denter who isn’t afraid to get news from a thoroughly unprofessional site of uncertain provenance, for which I am eternally grateful since it would be lonely here otherwise.

My latest pet peeve: desperate pseudo-news sites that insist on running dumb slide shows or photo galleries, forcing you to click endlessly through unrelated pictures one at a time just to see the crappy list they’ve hastily assembled with dumbed-down headlines that would have easily fit onto a single page, like”12 Great Places to Raise Kids” or “25 Gourmet Ramen Noodle Ideas.” You know, of course, why they do that: every one of your time-wasting clicks counts as a page view, eliciting gooseflesh on the part of Internet-savvy but marketing-stupid advertisers who don’t catch the fact that such mindless clicking, no matter how many impressive statistics it generates, provides them with no benefit whatsoever.

On the Jobs Board: Clinical Applications Analysts, Director Client Programs – HIE Architect, Senior Implementation Project Manager. On Healthcare IT Jobs: SQL/EHR Programmer, Manager IS Enterprise Systems, Epic Revenue Cycle.

Acquisitions, Funding, Business, and Stock

Safeguard Scientifics leads a $7 million Series A financing for Medivo, an HIT company providing data analytics and lab testing services. Safeguard also recently added billing system software provider AdvantEdge Healthcare Solutions to its portfolio.

The stocks of nursing home operators and their landlords have fallen sharply since July, when the government announced a 11.1% cut in Medicare reimbursements. Landlords are concerned that some nursing homes won’t have enough money to pay their rent. Industry analysts believe investors may be over-reacting since many nursing homes have ample cash to manage operations for at least another 12-18 months, and most landlords set rents low enough so that operators have cash available in the event of earnings shortfalls. 

Perceptive Software releases its ModusOne document output management solution for GA.

AirStrip presented at the mHealth Conference in Paris this week as the company prepares for an international launch, with GE Healthcare as its global distribution partner.

  GE announces that it will open a global software center in San Ramon, CA, hoping to speed innovation and commercialization of software technologies in its many business lines and to lead its 5,000 software professionals. The announcement mentions intelligent systems that operate on the “industrial Internet.” Healthcare gets the only customer quote, with Mount Sinai Hospital President and COO Wayne Keathley talking up GE’s tools to manage patient flow and costs. The gratuitous photo accompanying the press release didn’t do the company any favors other than to boost CT scanner usage as readers suddenly come down with unexplained headaches.

New Mexico Software changes its name to Net Medical Xpress Solutions. It offers PACS, a radiology reading service, and a newly announced telemedicine service.

Sales

HANYS Solutions, a subsidiary of the Healthcare Association of New York State, expands its agreement with QuadraMed to include identity management solutions.

Northern Ireland Health and Social Care selects Mediware’s JAC Computer Services Limited technology for enterprise medication management.

San Diego Beacon Community (CA) selects OptumInsight to build its health information exchange.

Huntington Hospital (CA) engages MedAssets for revenue cycle solutions that include tools for charge master management, charge capture auditing, and cost management of drugs and supplies.

People

The  Patient-Centered Primary Care Collaborative announces that Marcia Nielsen, PhD, MPH, will take over as executive director as of January 2, 2012. She is associate dean for health policy at the University of Kansas Medical Center. 

Revenue cycle and PM vendor MedSynergies names Vicki Laurie as CIO. She was previously with Anthelio.

Healthcare Quality Catalyst brings on HIT long-timers Dale Sanders (above) as SVP and Larry Grandia as a board member. Dale was CIO of the Cayman Islands health system and at Northwestern University Medical Center before that. Larry was CTO of Premier, but those who’ve been around awhile remember him from DAOU Systems and Intermountain Healthcare (Vince mentioned him in his HIS-tory recently, in fact.) HQC sells clinical improvement data warehouse solutions; I interviewed co-founder Steve Barlow in August.

Frank Maddux is named chief medical officer of renal therapy provider Fresenius Medical Care North America. Health IT Services Group, the EMR company he founded, was acquired by Fresenius in 2009. It sells the Acumen nEHR nephrology EMR.

  Mary Alice Annecharico, formerly SVP/CIO at University Hospitals (OH), is named SVP/CIO of Henry Ford Health System (MI) in an HFHS internal e-mail forwarded by a reader. The announcement mentions HFHS’s “clinical transformation with Epic,” the impending $350 million project to replace its just-implemented $100 million system.

Announcements and Implementations

The 25-bed Grande Ronde Hospital (OR) enters its initial stages of EHR implementation. The hospital’s IT manager tells the local press that “the electronic health record system doesn’t necessarily save time because physicians will have a lot more data to type into the system, but it’s more efficient and the government is requiring more information on costs and quality.” The article also notes that the EHR could provide other benefits “if the system works.”

CureMD Healthcare launches its HIE connectivity with HCA.

Northern Michigan Regional Hospital goes live on CPOE with Cerner PowerChart.

Massachusetts General Hospital goes live on the Sunquest CoPathPlus 5.0 anatomic pathology solution.

SCI Solutions announces that it signed 53 new clients in FY11, raising its total to more than 450 hospitals.

Sectra’s newly announced RIS v 7.0 includes enhancements to allow radiologists to meet Meaningful Use objectives, including a referring physician portal, a patient portal, and lab test tracking.

Government and Politics

CMS releases the 2012 application for its Medicare Shared Savings Program. ACOs have the option of starting April 1 (applications accepted December 1-January 20) or July 1 (applications March 1-30.)

Technology

Home care software provider Procura launches Procura Mobile for Android, adding that option to its existing BlackBerry client.

Business analytics company Pentaho announces native HL7 support with Pentaho Business Analytics.

Other

HIMSS releases its full agenda for the HIMSS12 educational program, which includes over 300 sessions.

CHIME and eHealth Initiative release an HIE guide for CIOs.

AHIMA expresses disappointment with the AMA’s opposition to the ICD-10 implementation schedule, noting that ICD-10 offers “countless benefits.” AHIMA says it has demonstrated that administrative systems can be easily implemented for most primary care practices and that specialty practices will only be using a small number of codes.

Despite widespread success recruiting  and enrolling providers, RECs have helped relatively few providers attest for Meaningful Use. Of the 90,000 providers enrolled nationwide, only 1,000 have attained Meaningful Use; the goal for RECs is for at least 20% success. Some RECs have faced challenges with staff recruiting and retention, while others complain of difficulties getting software upgrades from vendors on behalf of their clients.

A blogger visiting the Epic campus posts a great collection of photos from her tour of Intergalactic Headquarters. She captures everything from obscure works of art, architecture, and the assorted whatnots.

GetWellNetwork PatientLife System earns the top spot in KLAS’s just-released review of interactive patient systems, beating four competitors. The category covers hospital in-room systems that can provide patient education, on-demand video, patient surveys, entertainment, Internet access, patient requests, and nurse communication.

A laptop stolen last month from Sutter Medical Foundation contained personal information for 3.3 million Sutter Health patients, although that information was benign (patient names, contact information, medical record number, and insurance information.) The laptop wasn’t encrypted, although Sutter says its encryption project was underway and it will now accelerate that effort.

Health Outcomes Sciences posts a free trial of its ePRISM clinical risk modeling software, which provides patient-specific automated consents and outcomes forecasts for angioplasty.

Verizon makes its Fraud Management for Healthcare software available to government and private health insurers. “Makes available” was not qualified with “for free,” so this is apparently a product announcement.

This is a rare two-Newt mention edition: USA Today calls out Newt Gingrich for shilling healthcare vendors who pay fees to his big-money Center for Health Transformation without disclosing his vested interest. Example: he and Sen. John Kerry lauded his Center’s clients Allscripts and Misys in promoting electronic prescribing legislation that would benefit them back in 2008. I’ve ripped Newt’s center here for years because he passes it off as a noble think tank working for the betterment of society, when in fact its primary purpose is to line Newt’s pockets and keep him publicly visible. In fact, here’s what I said in 2008 when I was annoyed at another example of Newt’s shameless pitching:

Newt Gingrich pops up at Silver Cross Hospital (IL) to brag on Misys technology, of all things. Well, mostly about himself and his business, Center for Health Transformation, which the newspaper calls a "collaboration of public and private sector leaders." He’s our Jesse Jackson, sticking his head anywhere there’s a camera, somehow becoming wealthy without ever having had a real job, and working the system for personal benefit. I still kind of like him, but it’s trending down.

 This is one of the most egregious medication errors I’ve heard of: a hospital nurse intending to give Pepcid IV to a patient who is suffering from heartburn instead grabs pancuronium, the muscle blocker most often used for intubation (with respiratory support) and to kill prisoners (without respiratory support, basically smothering them). He dies; the family is suing. An investigation found that the nurse pulled the pancuronium from the secure area in which it was stored, didn’t read the label, skipped the bar code checking step, and then left the patient alone for 30 minutes afterward. She was fined $2,800, received a warning, and still works at the hospital.

A man trying to commit suicide in a hospital’s ED parking lot by mixing deadly chemicals in his VW convertible changes his mind, strolling into the ED at 3 in the morning. The ED had to shut down for over four hours as the hazmat team cleaned up. The man is fine and may face charges.

Sponsor Updates

• Shepherd Center (GA) implements RelayHealth’s MedGift patient gift registry and social media network.
• Buchanan County Health Center (TX) says its implementation of  the Access Intelligent Forms Suite has streamlined the organization’s paper process and facilitated integration with its Meditech 6.0 system.
  Billian’s HEALTHDATA releases its list of the 25 Best & Worst Rated US Hospitals, based on patient experiences at 3,002 hospitals.
• Concerro revamps its website and asks for feedback. Those sharing their opinion on Facebook, LinkedIn, or Twitter will be entered into a drawing for a $100 Amazon gift card.
• Practice Fusion reveals its iPad prototype and roadmap at last week’s Connect 2011 meeting.
• MED3OOO congratulates its client PED-I-CARE (FL) for winning the MGMA/ACMPE Fred Graham Award for Innovation in Improving Community Health.
• Healthcare Management Systems (HMS) announces that 17 additional client hospitals have successfully attested Stage 1 MU.
• Cynergisk Tek CEO Mac McMillan will discuss healthcare privacy and security issues at seven regional HIMSS conferences in Q4 2011.
• David Nace MD and Arien Malec of RelayHealth participated in ONC’s annual meeting this week in sessions related to IT requirements of Patient-Center Medical Homes and interoperability, respectively.
• Elsevier Clinical Decision Support collaborates with ExitCare to integrate ExitCare content into the Elsevier/Gold Standard and MDConsult products.
• NextGen names Port Gabmle S’Klallam Tribe (WA), Drs. Goodman & Partridge OB/Gyn (AZ), and Nautilus Healthcare Management Group (CA) as winners of its sixth annual Best Practice Awards for exemplary use of NextGen solutions.

The Centers for Disease control recently released its final review of the Healthy People 2010 program. The results of its 10-year health goals aimed at improving the health of Americans are mixed. Although targets were met for 23% of the 733 objectives and progress was made in half of the remainder, there was no change for 5% of the objectives and 24% of them actually became worse. Obesity and health disparities targets were among those missed. Now that we have a baseline, I’ll be interested to see if Meaningful Use makes a difference on any of these metrics.

Surprise, surprise: a new study published in the Journal of the American Medical Association finds that physicians who own and bill for nuclear stress and stress echo testing are more than twice as likely to order those tests than physicians who don’t bill for those services.

News of the Weird: enterprising parents who want their children to be naturally infected with chickenpox are apparently using Facebook to arrange shipment of items contaminated by sick children. Pre-licked lollipops, blankets, and other disgusting items were reportedly being exchanged. In addition to being gross and disgusting, it’s also illegal.

Disco isn’t dead: researchers looking at effective technique for cardiopulmonary resuscitation (CPR) compared the chest compression technique of providers listening to either silence or the songs “Achy Breaky Heart” or “Disco Science.” Although the disco beat helped providers give compressions at a more ideal rate, it didn’t improve the depth of compressions.

The AMA announces a series of workshops to assist with the ICD-10 transition. Exciting locations include Baltimore, New Jersey, Dallas, Atlanta, and Las Vegas, all during the first part of December.

To Wear, or Not To Wear: hot on the heels of a UK ban on wearing white coats or long-sleeved uniforms in health care, a pair of articles show that maybe traditional garb isn’t as bad as was thought. A study performed in Jerusalem showed that upwards of 60% of physician and nurse uniforms harbored bacteria, some of the multidrug-resistant variety. Authors note, however, that “it remains to be determined whether these bacteria can be transferred to patients and cause clinically relevant infection.”

A separate study published earlier this year showed no significant difference in bacterial colonization rates between infrequently washed white coats and short-sleeved uniforms which were donned fresh each day. After eight hours of wear, the newly laundered uniforms were as contaminated as the white coats.

Frankly, I think some of the grossest places in the hospital are the computer workstations. I see very few keyboard covers that can be wiped down, and what’s even worse is the food crumbs in the keyboards, meaning someone is actually eating while using a dirty keyboard. Eww. That’s one more reason I carry my own personal tablet on rounds – I know when it’s been sanitized and I know for sure I don’t ever document without washing my hands first.

While researching this topic, I came across a related study which showed that “non-conventional” nurses’ attire (i.e. brightly colored clothing) helped lower children’s distrust of healthcare providers and reduce fear. Maybe Patch Adams was onto something after all. Interestingly, coloured uniforms (honouring the British spelling) also improved parental perception about the reliability of the nurse.

No surprise here: empathy can’t be taught. A study in the Archives of Surgery shows that surgical residents who attended communication training increased their communication scores, but not how much empathy they are perceived to have.

People notes: HIStalk Medicine Cabinet member Micky Tripathi was featured in a Medical Economics piece on Regional Extension Centers.

Have a question on billing practices, keyboard sanitizing, or choosing sassy scrubs? E-mail me.

Contacts

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

News 11/16/11

Top News

The AMA’s House of Delegates votes to “work vigorously to stop implementation” of ICD-10, which it says will create “significant burdens” on the practice of medicine with no direct benefit to the care of individual patients. AMA President Peter W. Camel, MD also notes that physicians are concentrating on EMR implementation and the switch to ICD-10 would “add administrative expense and create unnecessary workflow disruptions.”

Reader Comments

From Big Scout: “Re: NextGen User meeting. Kicked off today with a multimedia presentation including keynote speaker John Foley, former lead solo pilot for the Blue Angels. Some of the key themes so far: Meaningful Use preparation, ICD-10, and high performance teams. Farzad Mostashari is also in attendance.” We love the “from the field” reporting, so thanks for sharing. Big Scout is one of over 4,200 participants at this week’s NextGen user meeting in Las Vegas.

From Unibroue: “Re: HITECH mess. One of my clients just got rejected for her ARRA money because Kaiser claimed her payment earlier in the year. She had supposedly signed a contract with them while still in medical school, though she never actually went to work for them. She has no idea how it happened, but expects a nightmare to undo it. The feds don’t even provide any kind of contact information and have just advised her to ‘get in touch with Kaiser Foundation.’ A billion-dollar conglomerate has her $22K and she’s not happy.” Maybe readers have suggestions on how to resolve. Good luck.

From Not in Kansas: “Re: NHS. The National Health System is a thing to be seen. Of course on the way to seeing it, you have to deal with impossible parking, non-working lifts, a large bucket catching the drips from the ceiling, and hazardous waste parked in the corridor.” Not in Kansas reports that she is across the pond assisting a relative who is having surgery. While some American patients might envy the cost of NHS care (it’s free), the US model does, for the most part, afford us an abundance of well-maintained facilities and other niceties.

From Non-Sequitur: “Re: HIStalk quoted. I just loved the sweet irony of seeing you quoted in the pages of one of those magazines you described, which ran an article on the Colorado HIE cost challenges saying the story was ‘plucked from the HIStalk web site.’” I thought that was darned nice of Health Data Management (or perhaps more accurately, reporter Joe Goedert,) for hat-tipping HIStalk instead of just following my link and pretending they found that story on their own. Joe’s one of the good writers who learned the players and the lingo, sticks to reporting the news objectively and skillfully, and doesn’t confuse being an sideline observer with being a participant who’s qualified to render advice or provide expert editorial opinion (“I’m not a doctor, but I play one on TV.”) The first thing I do when I read an editorial or self-assured comment telling providers or vendors what they should or think is check LinkedIn for the author’s education and experience. I’m usually not impressed.

From Olly Oxen: “Re: Cleveland Clinic. A healthcare market research report says Cleveland Clinic has exceeded Epic’s capabilities for data analysis and revenue cycle tools that will be needed to manage populations in an ACO-type model. Executives there are apparently disappointed that Epic isn’t interested in helping them in those areas, forcing the clinic to bring in other vendors after paying all that money for Epic.” Unverified, but OO provided an excerpt from the report.

From Janga: “Re: NIST’s draft on EHR usability testing. HIMSS provides their commentary.” The HIMSS response expresses concern at having actual usability experts doing the testing, favoring instead “inclusion of individuals with practical clinical experience.” I don’t agree – the document clearly identified steps in which subject matter experts would be involved to provide subjective analysis and comments, but real usability testing is product-agnostic (are menus labeled clearly, how many clicks to complete a task, etc.) HIMSS also thinks testing conditions should reflect real-life interruptions and competing workflow, which sounds nice on paper but isn’t really how usability testing is done (remembering again that usability is a profession with its own literature and standards, not just a bunch of nerds deciding arbitrarily how products should be tested.) Having said that, though, I think HIMSS was admirably restrained in not nitpicking the draft to death and trying to insert itself into the process (like it did for EHR certification.) So I’ll moderate my comments: HIMSS brings up some industry-specific points worth considering, although usability experts and NIST have way more expertise and thus should have the final say.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor NextGate, whose MatchMetrix master index solution manages over 50 million unique entities (patients, providers, terminology) worldwide. The Pasadena, CA-based company was founded by the technical brains behind one of my favorite products of all time, the STC Datagate integration engine (we’re talking mid-1990s here that I was involved in buying it for my health system), arguably the first generation of what eventually became vendor-independent interoperability solutions. The NextGate folks are serious technologists with expertise in EMPI, enterprise registry, enterprise application integration, and service oriented architecture, all vital for presenting consolidated data views and exchanging information. MatchMetrix gets high KLAS scores; is used by both providers (HIEs and health organizations) as well as vendor partners; and offers low TCO, fast implementation, and straightforward management. For those of us who appreciate high-achieving geeks, note that every single member of NextGate’s leadership team has earned their technical stripes. Thanks to NextGate for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

simplifyMD secures $4.5 million in new capital and names Michael Brozino as president and board member. He was previously with McKesson and the McKesson-acquired A.L.I.

PHR vendor MMRGlobal reports a Q3 net loss of $2.1 million, compared to last year’s loss of $1.7 million. Revenues were $352K compared to last year’s $270K.

Nashville-based critical access hospital software vendor Custom Software Systems, Inc. changes its name to CSS Health Technologies. It sells the ChartSmart EMR.

Healthcare learning and research solutions vendor HealthStream opens the public offering of 3,250,000 shares of its common stock, with the sole book-running manager being William Blair & Company, LLC. Proceeds could reach more than $50 million.

Sales

Avalon Health Care Management selects HealthMEDX Vision as its enterprise-wide solution for its 39 long-term care facilities.

Alabama Medicaid and the state of Alabama partner with Thomson Reuters to build the infrastructure for a statewide HIE known as One Health Record.

Barnabas Health (NJ) selects the MedAptus Professional Intelligent Charge Capture solution for its 4,500 physicians.

Healthcare Access San Antonio (TX) chooses Medicity’s HIE technology to connect its providers and area hospitals, initially using the iNexx platform to create a 22-county referral network. HASA is one of only two regional grant recipients to qualify for state funding to start implementing an HIE.

Florida Medical Clinic selects Humedica MinedShare for managing its patient population and improving clinical outcomes.

Catholic Healthcare West signs a three-year, $4.3 million deal to implement AirStrip OB remote fetal monitoring on mobile devices.

University Medical Center (NV) gets county approval to buy an unnamed $31 million clinical system (presumably McKesson.) The hospital said in July that it couldn’t come up with the $60 million needed and had only $25 million to spend with McKesson, its vendor of choice.

The board of Edward Hospital (IL) voted Monday evening to approve the purchase of Epic as its core system along with Lawson for ERP, VP/CIO Bobbie Byrne MD, MBA tells me. She says, “I have a great deal of respect for many of the vendors in our industry and I was impressed with several of the proposals we received. Epic was the right choice for Edward because of the robust integrated products for clinical and revenue cycle across both hospital and physician office settings. One patient, one record, one bill …” You may remember Bobbie from her four years with Eclipsys as SVP of clinical solutions.

The Portland VA chooses Magpie Healthcare’s CareConnect to connect clinicians with on-call staff and to activate care teams. Magpie was one of six organizations to receive funding under the VA’s Innovation Initiative.

People

Mediware CFO Michael Martens will step down effective February 15, 2012 to rejoin a former employer. He joined the company two years ago. The company will conduct a national search for his replacement.

Sean P. Kelly, MD joins Imprivata as chief medical officer. He will continue his practice as an emergency physician at Beth Israel Deaconess Medical Center.

ZirMed names former Culbert Healthcare and GE VP Kent Rowe as VP of sales.

Jack Walsh, formerly with IMS Health, Inc., joins SRSsoft as CFO.

Intelligent InSites names Mary Jagim chief nursing officer.

Carol Simon, PhD is named director of the just-announced Optum Institute for Sustainable Health.

Announcements and Implementations

Henry Ford Health System (MI) launches its $100 million EMR this month (the article says it’s a homegrown product, but I believe it’s actually RelWare’s EXR.) That’s a temporary solution since the health system is negotiating with Epic in a deal valued at $350 million, which based on HFHS’s most recent financial report, will cost the health system six years’ worth of net income.

MRO Corp announces that it is among the first health information handlers to successfully pass all critical integration tests for CMS’s CONNECT Gateway Pilot Program, which facilitates the electronic submission of medical documentation to RAC auditors.

Cincinnati-based HIE HealthBridge selects IBM Initiate Patient software for its infrastructure.

Greenway Medical launches PrimeDATACLOUD, a care delivery platform that recognizes and aggregates data from various EHR and HIS platforms and facilitates health information exchange.

Government and Politics

HHS’s own Indian Health Service is struggling with the transition to ICD-10 for its RPMS, IHS’s version of the VA’s VistA. CIO Howard Hays says ICD-10 is his highest short-term priority.

Florida Governor Rick Scott, appearing on a public radio talk show, seemed to be referring to the Florida Health Information Exchange when saying, “There haven’t been a lot of studies to date that suggest electronic medical records have saved a lot of cost. They’ve increased cost because of the way you have to keep all the records. I’m the one who should be taking care of my information and not relying on the government to do it because I believe it will raise the cost of healthcare without a result.”

Innovation and Research

Researchers in Belgium are developing technology to embed “electronic noses” in mobile phones to verify the freshness of food, test air quality, and measure blood alcohol levels. It’s all part of a human “Body Area Network” (BAN) system that also incorporates wireless sensors for monitoring heart rates and blood glucose levels.

And in other nose news, Grand Challenges Canada and the Bill & Melinda Gates Foundation award The Electronic Nose a $950,000 grant to support further development and testing of its technology for detecting TB immediately and non-invasively from a patient’s breath.

In England, a former Royal Army Medical Corps captain working on his PhD in computer science develops Mersey Burns, an iPhone and iPad app that calculates the IV fluid needs of severely burned patients such as soldiers on the battlefront. His research, conducted with two plastic surgeons, won an NHS innovation award this month.

Other

Michigan Health Connect (MHC) announces that Olympia Medical Services is extending MHC’s HIE solutions to its 500 physician members.

Massachusetts doctors who take patient photos for their EMRs and in reaction to the Red Flags identity theft rule are losing patients who claim the practice is an invasion of their privacy. The practices highlighted say they’ll scan the patient’s own photo or driver license instead of taking their picture if the patient prefers, but the patient interviewed by the local paper says “people are being tracked.” The executive director of the World Privacy Foundation says medical identify theft is usually an inside job that the photos won’t prevent, not to mention that “we don’t want our healthcare providers to become the new airport TSAs.”

In South Korea, the medical doctor who founded the country’s leading anti-virus software company donates $133 million (USD) to educate the children of low-income families. He’s also a top candidate for next year’s presidential election.

ECRI Institute announces its Top 10 Health Technology Hazards for 2012, all related to recent incidents that made headlines:

1. Alarm fatigue / lack of alarm response
2. Exposure hazards from radiation therapy
3. Infusion pump-related medication errors
4. Cross-contamination from flexible endoscopes
5. Change management with regard to medical device connectivity
6. Mixing up enteral feeding lines with IV lines
7. Surgical fires
8. Sharps injuries
9. Anesthesia equipment problems not discovered during surgery
10. Poor usability and design of home medical devices, leading to misuse

Sponsor Updates

• Optum launches The Optum Institute for Sustainable Health to provide analysis and insight on the landscape of healthcare.
• Miami Children’s Hospital’s nursing manager Deborah Hill-Rodriguez, MSN, ARNP, PCNS-BC, will discuss best practices during GetWellNetwork’s November 17 Webinar entitled Leveraging Technology to Support Pediatric Fall Prevention.
• NextGen Healthcare recognizes five client hospitals for successful Stage 1 Meaningful Use attestation.
• David Finn of Symantec Health shares his thoughts on the need to take action on security and privacy in healthcare in the company’s Healthcare Online blog.
• The Detroit Free Press names CareTech Solutions a Top Workplace in the large company category for the third year in a row.
• Apixio announces that its Community Search product has been integrated with Allscripts Sunrise EHR and is available on the Allscripts Application Store and Exchange.
• AdvancedMD announces the availability of its 2011 Fall release, which enables practices to send ANSI 5010-formatted claims.
• Awarepoint is awarded four additional patents for its real-time location systems for hospitals.
• Imprivata wins the Security Projects of the Year award at the 2011 Computing Security Awards.
• MEDSEEK announces that 18 of its healthcare clients received a total of 25 honors at the Strategic Communications eHealthcare Leadership Awards competition.
• The Technology Services Industry Association and Impact Learning Systems designate TeleTracking Technologies as a Certified Support Staff Excellence Center.

Contacts

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

Monday Morning Update 11/14/11

From THB: “Re: Cheyenne Regional Medical Center. Going Epic.” The 218-bed hospital gets board approval to replace McKesson Horizon with Epic in a $19 million deal, saying it will cost about $5 million over five years to implement Epic. It says Meaningful Use money will offset that amount, and after that, Epic will actually be cheaper that McKesson. Epic doesn’t usually sell to hospitals that small, so either CRMC is affiliated with a larger Epic customer or Epic is started to push down into Meditech territory.

From WSDiner: “Re: HCA. At a Credit Suisse Healthcare conference investor dinner Thursday night, HCA’s management said they piloted Meditech 6.0 this year and will pilot Epic next year. They said that no other vendors (i.e., Cerner) were under consideration.” The reader provided a Credit Suisse contact to confirm, but he didn’t respond to my e-mail. This will be interesting if it’s true – my read has always been that HCA just wants to scare Meditech into better pricing by bringing in competitors, but Epic doesn’t walk away without a contract in most cases. HCA is Meditech’s largest customer, contributing 8% of the company’s revenue in 2010.

From Commodore: “Re: Cerner running poorly on the iPad. Do other inpatient vendors have native apps?” The only one I know of is Epic, which has Canto (above.) There may well be others. I tried using a couple of my hospital’s clinical apps the iPad using the Citrix portal and that’s definitely not something that’s workable for clinicians. The shrunken screen is impossible to comfortably read, you have to constantly zoom to hit tiny drop-downs with your finger, and the clicking doesn’t feel sure-footed at all. I think it’s safe to say that for most vendors, there’s not much to brag on if your iPad capability consists of running an emulated desktop screen. Only your marketing people will be impressed.

From The PACS Designer: “iPad viewer. The FDA has now approved an iPad viewer from Carestream called Vue Motion. The application permits the viewing of image files from many different PACS platforms, including cloud-based offerings, and can be integrated into EHR solutions to permit viewing of image files and patient records through a single sign-on.”

Here’s my summary of business lessons learned from the Steve Jobs biography. 

My Time Capsule editorial from October 2006:  Economics 101 and the Healthcare IT Market (that’s a pretty lofty premise to cover in 500 words). A Sam’s Club tiny paper cup-sized sample: “Hospitals can be convinced by questionable claims of product superiority or patient risk, and even more so by seeking vendors just as prestigious as they fancy themselves (no Walmart shopping for big academic medical centers, even though patients are the ones paying.)”

Note the reduced number of animated ads to your left thanks to those overachieving sponsors who have already traded out their animated ads in advance of the January 1 target date. I always feel bad when requiring changes like that, but it will benefit sponsors as well since readers will pay more attention to more subtle ads. I’ll digress by saying that while few things surprise me these days, one that does is the non-financial support I get from sponsors. Not all of them, since a few are purely ad placements without much personal connection, but the majority have executives and regular employees who keep in touch, send me music recommendations, e-mail me a well-timed attaboy right when I’m feeling overwhelmed or under-accomplished, or send off-the-record snarky comments about one thing or another. HIStalk is an after-work hobby for me rather than business and I like that the connections aren’t always business related.

Venture capital superstar and billionaire Peter Thiel, speaking at Practice Fusion’s conference (he’s an investor), says highly paid salespeople can land big businesses as customers and relentless marketing can get consumer sales, but companies that can sell to small businesses (like most medical practices) are rare since those small businesess are reluctant to change. He gave as examples QuickBooks and PayPal (implying Practice Fusion as well, naturally.) Also at the conference: Practice Fusion rolls out its iPad app, although I’m not clear if that’s a new native app or just the LogMeIn remote control version that was announced at HIMSS.

Doctors and hospitals in Boulder, Colorado are questioning whether joining Colorado’s statewide RHIO (CORHIO) is worth the subsidized cost. Small practices say the upfront training costs and $85 per doctor monthly fee are steep, and doctors at Boulder Medical Center says there’s not much value to them since they’re already connected via their NextGen systems. CORHIO’s five-year business plan called for taking in $26 million in federal grants and $19 million in subscriber fees.

Polls that list companies always bring out ballot box stuffers, but they’re fun nonetheless. Epic wins this one handily, with a fairly even spread among the losers. New poll to your right: how will ONC respond to the IOM’s report that criticized patient safety efforts related to electronic medical records?

We already know what HIMSS thinks of the IOM recommendations since Steve Lieber quickly released a statement. He zoomed right past all the patient safety concerns, preferring to focus on one sentence that says paper records are also risky, thereby summarizing the entire work as “a strong endorsement for the path healthcare is on.” Well, OK. He also is somewhat dismissive in saying IOM looked at only at the patient safety aspect of HIT and it’s already fussed about that before (which is exactly what you’d want IOM doing given that there are plenty of loud voices, especially that of HIMSS, extolling the virtues of technology for purely commercial reasons and ignoring IOM’s previous recommendations). A critic might say, “Who’s this association executive  with no credentials in medicine, research, or technology speaking on behalf of his unpolled membership to critique the work of a large group of unbiased and extremely well-credentialed IOM medical experts whose thoughtful opinions were commissioned by ONC?” but to question the authority (audacity) of HIMSS to weigh in on complex national matters is just not done. If you say anything even slightly negative about commercially sold healthcare IT, HIMSS is going to hit the PR airwaves, often cherry-picking a few HIMSS-friendly members to chime in for credibility support. Choose your side: an unbiased group of scientists vs. an exhibit hall-funded trade group. I like some (maybe even most) of what HIMSS does, but its predictable knee-jerk defense of the industry and federal grants just annoys the heck out of me as a dues-paying member, especially given that so many of us members pride ourselves in spotting and debunking shoddy research methods, investigator bias, and inconclusive evidence, all in the interest of improving patient outcomes and reducing healthcare costs just like IOM is trying to do.

Here’s Vince’s latest HIS-tory, highlighting Healthcare Information Systems. I’m cringing a little because he attacks someone at the end, to be named in the next installment. I don’t know who it is, but I’m hoping that person is (a) not a reader; (b) dead; or (c) one of Vince’s pals he’s just joking around with.

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

Epic hosted a college team programming competition in its offices this past Saturday. You wonder how many of the geeky combatants left with job offers, and also how the reporter kept a straight face in writing up details: “Winners and awards will be announced after the 4:30 p.m. conclusion of the competition, which will be held in the Nebula room in the Heaven building. Parking is available in the Yoda underground garage.”

Jackson Memorial Hospital takes part in a quickly assembled telemedicine project that will connect Miami specialists with hospitals in Iraq, part of a $1 billion contractor’s project as the State Department takes over field hospitals and medical care when US troops pull out December 31.

Weird News Andy wonders how many EMRs have edits that would prevent documenting this. In Mexico, a 10-year-old girl gives birth. You have to either admire or detest the creativity of the UK-based newspaper’s accompanying photo of a girl packing a toddler along in some kind of serape, clearly desperate for a visual, yet struggling with the lack of an Enquirer-like picture of a 10-year-old: the photo has nothing to do with the actual story and was “posed by models.” Its readers are apparently so stupid that reading text without even an irrelevant picture is unthinkable.

WNA also notes that health conditions are leaning toward the Third World in the Occupy Wall Street encampment. The unfocused unemployed there are coming down with a variety of respiratory infections as they sleep among their trash, pee in bottles without washing their hands, pass cigarettes and alcohol mouth to mouth, and refuse free flu shots because they’ve concluded that vaccines are a government conspiracy. They have a volunteer-staffed medical tent, but it only stocks herbal remedies.

ONC’s blog (which is actually written by its contracted PR company – it’s not like Farzad’s going to bare his innermost thoughts or music recommendations there) highlights the VA’s Blue Button initiative in honor of Veterans Day.

As Dr. Jayne mentioned, Walmart is denying that it plans to develop some kind of national primary care program, but they might want to check with their RFI people they’re clearly looking for partners to “rapidly create a comprehensive healthcare solution to deliver low-cost, high-quality primary healthcare services nationally.” The RFI lists specifically that partners should be able to offer chronic care services (diabetes, hypertension, etc.), lab tests, vaccinations, physical exams, health screenings, and durable medical equipment support. They say they will consider vendors who offer only “enabling technologies” as well, and the RFI requires prospective vendors to describe their proposed information system and “data sharing model.”

Ed Marx updated his most recent post to respond to reader comments. He’s always gracious, even to his anonymous attackers. And here’s the secret I shared with Ed: I don’t usually delete negative comments because I’d rather let readers provide the majority opinion via their own responses.

Speaking of Ed’s pieces, a few folks howl if I dare run anything that’s not directly related to their jobs, but many (most, maybe, especially at the senior levels) enjoy a mental break with personal stories about patients, working in HIT, or life’s lessons learned. Yours are welcome.

An Investor’s Business Daily article notes that its medical software sector dropped from #2 a month ago to #67, mostly due to the huge drop in CPSI’s share price after it missed expectations. The article says Cerner beat estimates but profit margins slipped in the most recent quarter, while Quality Systems shot itself in the foot in its earnings conference call by implying (but later clarifying) that most of its new sales were coming from replacements, suggesting that the market was past its peak. Athenahealth is mentioned for beating expectations but not by enough (double expectations?) and took a 7% share price drop as a result. On the positive side, shares in MedAssets jumped 14% and later 17% after beating estimates and Allscripts share price took a slight turn north after reporting results. Above is a one-year price chart of the shares of all those companies: Allscripts (blue), Cerner (red), Quality Systems (dark green), athenahealth (yellow), MedAssets (brown), and CPSI (light green). Leading the pack are Cerner and athenahealth. Looking at just the past three months, the clear winner is Allscripts, with MedAssets and Cerner basically tied for #2 but pretty far off the pace. Looking back five years, your best return would have been Cerner and Quality Systems. Always amusing is that ever-vigilant stock analysts flip-flop their recommendations a day or two after unusually good or bad news is announced, providing no benefit whatsoever for the clients paying them for non-retrospective advice.

I’m beginning to be annoyed by research companies selling expensive reports under the headline, “XX Market to Reach $X.XX Billion by XX.” One of these days I’m going to check the accuracy of their past predictions, which I suspect is minimal. Inga loves to run those press releases like they’re real news, along with the splashy results of questionably conducted surveys that are favorable to the companies paying to have them done. She’s usually good natured about my edict that she’s allowed only one survey mention per post.

Inga notes that Sage’s new name, Vitera, is also a band’s name. She and I don’t usually like the same music, but they’re good for an unsigned band, a Latin-style pop with a harder guitar edge, like a Spanglish Guns N’ Roses. Check out this live video and the flying V fiddle, which sounds to me like prog rock meets Texas swing. 

A Jacksonville, FL woman starts a booming business that provides scribes to do patient care documentation for ED physicians. The scribes, often pre-med or nursing students, are contractors billed out at $20-25 an hour, a bargain according to the company’s medical director. “For every hour we spend, we get about 15 minutes at the bedside of patients and 45 minutes of every hour documenting everything … part of it’s insurance. Part of it’s medical-legal. Part of it is a federal mandate to have everything documented electronically.”

Startup accelerator Rock Health signs on UnitedHealth Group as a sponsor. It joins Microsoft, Nike, Qualcomm, and Quest.

Outsourcer and iSoft acquirer CSC reports Q2 numbers: revenue up 1%, EPS –$18.56 vs. $1.19, cutting guidance. The ugliness was caused by a massive $2.69 billion write-down of goodwill and a settlement of a contract dispute with the US government. Shares predictably tanked.

Two nurses file a class action lawsuit against Aurora Medical Center (CO) after being written up for trying to clock in before putting on their hospital-provided scrubs. They say they should be paid for the time it takes to go to the scrubs room, find some that fit, put them on, then go clock in.

History Mingles with Innovation in Atlanta
By Erin Sweeney, Director of Marketing
The Friedman Marketing Group

The “who’s who” on the Atlanta healthcare scene met at the historic Fox Theatre this week to discuss innovation and opportunity—along with military weaponry. The HealthIT Leadership Summit, founded by the Technology Association of Georgia, Metro Atlanta Chamber, and Georgia Department of Economic Development drew nearly 200 attendees and such notables as Drs. Robert Kolodner, Mark Dente from GE, and Kenneth Wilson, a U.S. Army Major who served three tours in the Middle East.

Key takeaways from the eyes of this healthcare marketing guru include:

• There is a whole new generation of healthcare IT experts ready to lead the charge.
• Analytics are a key capability for all healthcare IT systems.
• There are some really cool virtual reality glasses being tested in Afghanistan to help military medics and other first responders save lives—may come stateside soon.
• Vendors that enable ACOs through harmonization of multiple systems will be winners.
• Vendors that are behind can easily get ahead using new technology.
• Cloud computing is here to stay, on-premise is antiquated.
• Patients will spur providers to innovate.
• Boards will be more involved in quality improvement.
• Interoperability must happen between states.
• Average venture capitalist investment in healthcare IT is $3 – $5M.
• VCs are more interested in companies where technology is driving a service; and the two are not treated separately.

Amidst all the innovation, attendees did hear one reality check offered up by a panelist and based on research from Cigna Health: the average patient has 200 documents located in 19 different places.

And finally, Justin Barnes from Greenway Medical painted a gloomy picture for physician reimbursement and suggested groups ask themselves, “Do we interoperate or join an ACO?” Another panelist encouraged groups to look around and decide who they’ll affiliate with instead of waiting until the best dance partners are taken.

Overall, the Summit was interesting and a bit eye-opening. The TAG speakers and panelists added some fun and humor to the discussions. Dr. Dente pointed out that women are caregivers for not only their own elderly parents, but also their in-laws. Doctors’ appointments, prescriptions, transportation to and from check-ups — the women do it all. Looks like the upcoming holiday gatherings will be a walk in the park compared to what’s in store for this gal.

E-mail Mr. H.

News 11/11/11

Top News

National Coordinator Farzad Mostashari says ONC will beat the IOM’s suggested 12-month deadline in rolling out a program to accept and analyze patient safety reports related to computer systems.

Reader Comments

From Duck Hunter: “Re: West Johnson. West Johnson, vice president for healthcare revenue cycle consulting at Huron Consulting Group, is leaving at the end of December. He was an original Stockamp person.” West sent me a note confirming his departure.

From Phone Geek: “HIT Policy Committee meeting. This afternoon I have been listening to the HIT Policy Committee meeting. There’s now a rah-rah session about consumer access to their EHR records. President Obama wants every person to access his personal health record by 2014. I keep wondering if we should be more concerned about every person having access to healthcare and ensuring that rural America has access. And maybe making sure that we have good EHR implementations delivering systems that clinicians like to use and that they and their delivery systems receive value from.” Well, the HIT Policy Committee really has no influence on healthcare accessibility, however important the need. On the other hand, isn’t there a workgroup that focuses on EHR adoption and certification – and presumably considers usability?

From B.S. Walks: “Re: Cerner finally fulfilling the façade prophecy. Look at the stock dump that happened 10/27 and 10/28, dropping from $72.88 to $63.67. They are going counter-market, which isn’t a good sign unless you’re a short seller.” Above is a three-month share price graph of CERN (blue), DJIA (red), and Nasdaq (green). The trend line definitely looks better over a full year, but there was a big dip in August and the second starting in October. It could be more of a reflection on the sector since some of the HITECH luster seems to be wearing off as some companies haven’t met lofty expectations that were built into the share price.

From Horned Frog: “Re: Epic. Salaries are in line with what most new college grads get, or better I suspect since many of them are liberal arts majors. However, their incomes rise quickly, often exceeding what the typical med tech, nurse, or hospital IT person might make, although they typically work more than 40 hours a week. And with regard to requiring everybody to live in Madison, there’s a lot of advantage in having people show up at corporate, sharing knowledge and networking. Corporate offices often had the greatest product expertise, and vendors allow road warriors to travel from wherever. It doesn’t necessarily cost more to travel across the company than to take a shorter trip.”

From Porcini: “Re: Vince’s article on Epic. Hiring fresh grads isn’t new – Cerner started that. I doubt you can attribute cost overruns to training cost since organizations plan for those and it’s a good investment. Regarding ‘the Epic way.’ how do you define success in allowing user to customize – inefficient workflows? Unhappy clinicians? Epic charges so much because it can, and because it delivers what it promises in a timely fashion for a price that customers seem to find justifiable. And if Epic brainwashes its users to earn high KLAS scores, why aren’t other vendors doing that? I’ve never seen anything like Epic’s most collegial user group meeting. The amount of education and information sharing is absolutely astounding.”

From Buffalo Tom: ”Re: IOM report. Maybe I’m reading too much into it, but organizations with internally developed software fall under this definition, at least with regard to certification. I’m involved in the certification program and have seen firsthand how good ideas and intentions can create a lot of extra (and arguably unnecessary), like developing EHR modules that will be never used beyond earning certification. Compounding these recommendations is the discussion of mobile healthcare applications falling under FDA purview. Imagine if all of our clinical projects required certification or FDA approval before go-live. That might push hospitals to third-party solutions exclusively and we know there is no vendor that has a solution for every provider and scenario. I’m for safety checks and resources to help develop safer software are needed and valuable, but with regard to in-house development, I don’t think they need to jump through additional regulations imposed because of some shop that popped up last month to hurry up to get into the healthcare space.”

From Hat Creek: “Re: TEDMED 2012. Are you going?” Probably not – registration is $5,000, the attendee list is “curated” (meaning you don’t automatically get to come just because you have $5,000 to wave around), and it’s not all HIT-related. They had fun speakers last time around, including Dean Kamen, Michael Graves, Tim O’Reilly, Loudon Wainwright III (I could have sworn he was dead, but he’s not), Steve Wozniak, and some semi-celebrities.

From Lugubrious: “Re: Health IT Leadership Summit in Atlanta. SoloHealth won the Intel Innovation Award for their health and wellness kiosk. Bart Foster, the CEO and founder, was a very nice guy who accepted the award with a lot of humility and brought his team up on stage with him.” I found the above video on YouTube. The touch screen kiosk checks vision, blood pressure, weight, and BMI and lists doctors and “valuable offers from healthcare partners” (meaning ads, I assume.) I’d skeptical that a glorified, electronified scale and eye chart can have a significant impact on health (the people who need to hop on the scales tend to steer a wide berth, no pun intended, around them), but the technology itself seems interesting and the direct-to-consumer approach is different. I like the idea that users can create an account and access their information from any of the company’s kiosks. Maybe it should include a one-click connection to a nurse-staffed telemedicine center where you swipe your credit card to get a consultation for $20 or something. Ask Walgreens – they are clearly the leader in putting technology and innovative services right in their existing stores, turning what used to be “the pharmacy” into a “health center.”

HIStalk Announcements and Requests

Wondering what treasures await you on HIStalk Practice? A few gems from the last week: 52% of office-based doctors are e-prescribing. Greenway Medical is named a preferred EHR vendor for at least 10 RECs. MGMA’s Rosemarie Nelson provides great recommendations on improving EMR adoption. athenahealth earns a spot on a list of Top Places to Work in Boston. Brad Boyd of Culbert Healthcare Solutions tackles ICD-10 and 5010 readiness.  Sign up for your HIStalk Practice e-mail updates because you never know what booty you may find there (and I mean the treasure kind, though the foot kind often makes an appearance on HIStalk Practice as well.)

I perused my calendar last night and realized that HIMSS is just over three months away. Wow! Mr. H mentioned that HIStalkapalooza is on the calendar for February 21, which means it’s time to start shopping for the perfect party outfit (new shoes!) Returning this year: our always-popular “Inga Loves My Shoes” contest, sashes for the sassy, and the crowning of our HIStalk King and Queen (for the best-dressed partygoers.) Of course we will name the winners of the HISsie awards and hope that Jonathan Bush will return as emcee (Neal Patterson has agreed to step in if JB is unavailable.) We’re also considering a few new things for both the party and HIMSS in general, so stay tuned.

Friday, which contains the 11th hour of the 11th day of the 11th month that marked the end of World War I hostilities, is Veterans Day. Unlike Memorial Day, which is set aside to honor those who died in military service, Veterans Day is when we honor all American veterans (hopefully we do that on other days as well.) It’s a refreshingly non-commercial commemoration that involves no Hallmark moments, mandatory gifts, or heavily sponsored sporting events, so why not start your own tradition and take the opportunity to tell a veteran that you appreciate their service and sacrifice? If you served, are serving, or have loved ones in the military, thank you.

Listening: reader-recommended Ratatat, a couple of Brooklyn guys with a spare bedroom full of synthesizers (and a few guitars) that somehow make rocking instrumentals that are real songs (not background music) that sound like a non-computerized mad stew of Genesis, Boston, and Muse with some hip hop drum loops for rhythm. Sometimes the occasion calls for soaring, dramatic music free of unskilled singing of uninspired lyrics and these fellas deliver. Like most reader recommendations, this one was spot on with what I like. If I were making a movie, I’d want them to do the soundtrack.

On the Jobs Board: Support Consultant, HIM Coding Manager, Director Client Programs – HIE Architect. On Healthcare IT Jobs: Research Informatics Analyst, Epic Revenue Cycle, eGate Integration Analyst. 

Inga, Dr. Jayne, and I work day jobs, so we do the best we can with HIStalk given the time we have, trying to compete with well-funded armies of full-timers running around and reporting for various magazines and sites. You can help by reading, telling others, and supporting our sponsors. We can always use guest articles, insightful comments, and news tips. There’s the usual stuff I always mention (friending, liking, connecting, and signing up for e-mail updates) but we’re open to ideas if we can figure out how to find the time to do them.

Acquisitions, Funding, Business, and Stock

Emdeon reports Q3 numbers: revenue of $282.1 million (14.7% increase); non-GAAP adjusted EBITDA of $76.7 million (15.3% increase.)

Siemens AG announces that it ended its fiscal 2011 with record operating results that included several orders worth over $100 million for Soarian Revenue Cycle. Siemens Healthcare also just finalized a $28.7 million contract with Hawaii Health Systems.

Millennium HealthCare Inc. completes its acquisition of medical billing and consulting firm Premier Technology Resources.

Vista Equity Partners completes its acquisition of Sage Healthcare Division and renames the company Vitera Healthcare Solutions. Matthew Hawkins, previously CEO of library software vendor SirsiDynix, is named CEO, replacing former Sage Healthcare President Betty Otter-Nickerson. The ambulatory product line remains intact.

Sales

Northwest Michigan Surgery Center selects the Versus Advantages RTLS to automate process flow management for the clinical staff.

SUNY Upstate Medical University (NY) signs an agreement with TeraMedica to implement Evercore Enterprise Vendor Neutral Architecture, which will support integration for SUNY’s Epic EMR. 

John C. Lincoln Health Network (AZ) selects iSirona to connect medical devices to its Epic CIS.

Lakeland Regional Health System (FL) chooses RelayHealth for its enterprise HIE.

Twelve-bed Sedgwick County Health Center (CO) selects the ChartAccess Comprehensive EHR from Prognosis.

Four-hospital Lifeline Hospital Group will partner with Optum to bring that company’s billing and collection systems to Lifeline’s hospitals in United Arab Emirates and Oman. Optum says it will take what it learns there to aid its expansion in the Middle East.

People

Merge Healthcare appoints Peter Urbain (IBM) SVP of partner sales and Steven Tolle (OptumInsight, Allscripts) SVP of solutions management.

Omnicell founder and CEO Randall Lipps is named to the board of outsourced radiology provider Radisphere.

Announcements and Implementations

The Tri-State REC announces that it has met its enrollment goal of 1,739 primary care providers in Ohio, Indiana, and Kentucky.

North York General Hospital (ON), the first hospital in Canada to go live on CPOE and bedside bar code scanning of medications, earns the Innovation in the Adoption of Health Information award from Canada’s Health Informatics Association. The Cerner customer had been previously been recognized as HIMSS EMRAM Stage 6 hospital.

LSU Health Shreveport goes live on electronic medical records (Epic?) The implementation moves on to E.A. Conway and Huey P. Long hospitals.

Web-based PM/billing vendor Kareo launches its electronic patient statements and payment portal for practices.

Government and Politics

HHS’s Office for Civil Rights will begin conducting HIPAA compliance audits this month for office-based physicians, hospitals, and health plans. Twenty audits will be performed in the initial round and selected entities will be notified in writing within 10 days. Officials will visit the audited sites within 30 to 90 days of notification.

A Senate technology subcommittee chaired by Sen. Al Franken (D-MN) frets over recent healthcare data breaches at Minnesota hospitals, with Sen. Franken saying, “The same wonderful technology that has revolutionized patient health records has also created very real and very serious privacy challenges.” Ranking committee member and physician Sen. Tom Coburn, MD (R-OK) opines that maybe electronic records aren’t all that great. “They gotta get into my office to get it when it’s on a piece of paper.” Above is the Senator in his former life as a comic with partner Tom Davis (old timers will remember them from SNL) in an excellent Rolling Stones parody. Franken should get the band back together and run for governor with Davis as his lieutenant.

Technology

Steve Jobs gets his first posthumous nod for being right yet again: Adobe is abandoning its attempts to make Flash work on mobile browsers, and in fact, may be admitting that Flash is obsolete for the Web in general. Steve refused to allow Flash to run on Apple’s mobile devices, saying it’s proprietary, buggy, full of security holes, a CPU pig, incapable of responding to a touch screen interface, and a battery-eater. He said Apple mobile users enjoy videos and games just fine without Flash and that Adobe should dump Flash and focus on HTML5, which they apparently are now doing. Adobe canned 750 employees this week with the usual “restructuring to focus on core business” excuse, taking a $94 million charge for eliminating 7% of its work force.

Indigo Identityware announces iDNA for the iPad, which it says offers password-free strong authentication via a four-digit PIN to access a virtual desktop (including Citrix.)

A CIO article reports that a few clinicians at Seattle Children’s Hospital tested the iPad for running a virtual desktop in patient care areas. The verdict: every one of them returned their iPad, saying Cerner apps that were designed for desktop-and-keyboard users sucked big time on the small touchscreen.

Several states and technology vendors in the EHR/HIE Interoperability Workgroup define standards by which EHRs connect to HIE in a plug-and-play (their words) fashion.

Other

Epic goes before the Verona (WI) Planning Commission to present an expansion project that will add 900 offices and 700 underground parking spaces. Three buildings will make up the “Farm Campus” and may feature barn siding rather than brick, and possibly a silo. Epic, by the way, expects 2011 revenues to reach $1.1 billion, up from last year’s $825 million. A Verona city administrator estimates the new project will cost Epic $75 million.

Kudos to the eClinicalWorks employees who spent time this week volunteering with Habitat for Humanity in Boylston, MA. The eCW folks helped with painting, laying down floors, and assorted other projects.

The rate of healthcare employment fell from 45,000 new jobs in September to only 11,600 in October. Physician offices accounted for 8,000 of the new opportunities in October.

A new report estimates that the combined ambulatory and inpatient EMR market will grow to over $8.3 billion by 2016. Allscripts hold the largest share of the ambulatory EMR market while Meditech leads in the acute care segment.

The Clark County Commission (NV) considers a $30 million proposal for a McKesson EMR system for University Medical Center. The contract includes a one-time fee of $27 million, $4 million in annual fees for the next four years, a $1 million reserve, and $1.3 million to backfill employees and perform ongoing system maintenance.

A three-year study from the RAND Corporation concludes that providers are interested in bundling payments to cut health costs, but find the strategy difficult to implement. Technical challenges include deciding what problems should be subject to bundling and providing clinicians with the information needed to improve care. Cultural issues include convincing providers that cost cutting measures will not reduce the quality of care.

Elected officials urge residents of Freetown, MA to show their support for a proposed Meditech facility to be located in their town, an option Meditech walked away from in September after tangling with the state’s historical commission over preservation issues. Given that the unemployed citizenry vastly outnumber the archaeologically astute, just about everyone is trying to neuter the commission’s authority in their pleas urging to Meditech to reconsider.

Notorious patent troll Acacia Research Corporation announces that EMR vendor Aprima has decided to pay the company off in the form of a “license agreement” rather than spend money defending itself against a nuisance infringement lawsuit. Acacia’s intellectual property is, “The generation of a document utilizing user-modifiable document structures, a database including information to be placed into a particular document structure, and a computing device which combines the particular document structure with relevant information stored in the database.” Legal chest-puffing is good business: Acacia booked $63 million the most recent quarter. The company owns patents for such medical innovations as catheter insertion, cardiac stents, performing laparoscopic surgery, medical monitoring, PACS, and wireless physiologic monitors.

Sponsor Updates

• On the first day of its go-live, Baptist Healthcare System’s (KY) ED exceeds Meaningful Use thresholds using T SystemEV.
• Passport Health releases its November schedule of live demonstration webinars.
• Trustwave’s security and compliance portal TrustKeeper is named a 2011 Chicago Innovation Award winner.
• MED3OOO announces upcoming dates for its webinars featuring InteGreat EHR with Quippe technology. MED3OOO will give away an iPad 2 at each session.
• e-MDs and TMF Health Quality Institute offer free assistance to Texas e-MDs customers interested in earning incentives under PQRS 2012.
• Covisint releases a report on three PQRS misconceptions that could prevent providers from obtaining CMS incentive dollars.
• Scott Besler and Jonathan Besler of Besler Consulting  will present Medicare Hot Topics at the HFMA NH/VT Annual Health Care Reimbursement Seminar December 8.
• The Kansas and Missouri regional extension centers select Greenway Medical’s PrimeSUITE EHR for their combined 2,548 providers.
• Wolters Kluwer Health announces the addition of general surgery to its UpToDate clinical knowledge system.
• Baptist Hospital (TN) is using MyHealthDIRECT to schedule community provider appointments for its discharged patients.
• Healthcare Integration Strategies enters into a Provider Consulting Organization agreement with CapSite, enabling Healthcare Integration Strategies to offer the CapSite service as part of its consulting engagements.
• An Aspen Advisors case study covers its engagement by Indiana University Health to analyze the personal health record market and best practices use of PHRs by health systems.

EPtalk by Dr. Jayne

It seems as though we’ve had a couple of slow news weeks lately, but the past few days have been what you could call a target-rich environment. Of course, the Institute of Medicine report is tops on many colleagues’ minds. Mr. H did a great job with his digest, which thankfully gave me enough talking points to look as if I had read the whole thing, when in fact I had spent my time watching Fast Five rather than doing actual work in the evening at home as I usually do.

Personally, I’m intrigued by the comments about regulating software, but I also think we need to hold users accountable for certain behaviors. I have physicians who regularly strive to defeat EHR safety features and others who complain about every safety feature which is introduced. No matter how non-intrusive the code, they take it as an assault on their profession. Maybe for those physicians who demand to wear the mantle of medicine as it used to be rather than living in the present, I say adepto super is: get over it.

Merritt Hawkins releases the 2011 Survey of Final-Year Medical Residents, which looks at career preferences and plans of those completing their training. Not surprisingly, over the last decade there has been a ten-fold increase in the number of physicians who are looking for hospital employment. Solo practice continues to be a non-starter. The number of residents who owe between $200,000 and $250,000 in student loan debt has grown from 7% in 2003 to 19% in 2001. My take on it: more validation of the impending primary care shortage. It’s much harder to pay off that kind of debt as a PCP than as a radiologist or dermatologist.

Speaking of the primary care shortage, the headline “Walmart wants to be your MD” certainly caught the eye of THIS medical doctor. Just when you thought that we’d seen the worst of the worst ideas in healthcare reform, this one comes along. Apparently Walmart requested information from partners looking to reduce healthcare costs and then had to issue a statement correcting its position, stating it was “not building a national, integrated low-cost primary health care platform” even though that’s what the statement said.

Walmart’s track record of driving jobs out of the economy in the name of low prices is well known. I hardly think a company that hasn’t even figured out how to offer affordable health insurance to its own employees has any business getting into the healthcare fray. Within days of this request, they also announced that they will no longer offer health insurance to new part-timers. As the article states, primary care isn’t what is driving up the cost of healthcare in America. My favorite quote from the article summarizes this as just another retail clinic attempt to gain market share: “If you get someone in the door, you can also sell them milk and a shotgun.”

Speaking of great quotes, I love this one from an article on transitioning from paper to electronic records. When asked what data should be transferred to the EMR, one physician answers, “depends on how anal-retentive you are.” This absolutely hits the nail on the head.

A friend of mine just went through the grueling process of prepping all of her charts for bulk scanning. She quickly discovered that her practice had kept every scrap of paper that ever came into the office, regardless of relevance or utility (and independent of liability as well.) She falls into the “slash and burn” camp and quickly rid her charts of duplicate and meaningless information, but not every provider is that motivated or has that much free time. Most want to keep everything, which often results in simply converting a messy paper chart (where nothing can be found) into a messy electronic chart (where nothing can be found.)

An interesting survey finding mentioned in the article: 44% of organizations are not explicitly measuring the effectiveness of productivity of their scanning process. My final quote of the day comes from Pretty Woman:  Big mistake. Big. Huge.

Considering the massive effort involved in converting from paper to EHR, scanning is one of the places where the work is reproducible as well as being amenable to applying lean manufacturing principles. Unlike work with patients or families, you can look at cycle time, accuracy, and per-page outputs when you look at scanning. Charts CAN be treated like widgets. Unless you just want to spend more money than you actually need to or prefer to be scanning for years, this process should be looked at carefully.

Have a question about milk and shotguns, takt time, or what’s next in my Netflix queue? E-mail me.

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

News 11/9/11

Top News

A remarkably frank Institute of Medicine report commissioned by ONC, Health IT and Patient Safety: Building Safer Systems for Better Care, urges significant government intervention with regard to the safety of healthcare IT systems. It takes shots at both HIT vendors and HITECH incentives, saying in the preface,

Stories of patient injuries and deaths associated with health information technologies (health IT) frequently appear in the news, juxtaposed with stories of how health professionals are being provided monetary incentives to adopt the very products that may be causing harm.

On the committee were researchers, academics, and practicing physicians. Vendors were not represented, although John Glaser of Siemens was a reviewer. These are the most interesting points from my quick read of the report.

• The report recommends that ONC require all health IT vendors to publicly register their products with ONC, starting with certified EHRs.
• It urges HHS to eliminate non-disclosure and limited liability clauses in vendor contracts that discourage users from sharing patient safety-related software concerns.
• It suggests that reviews of software applications be published publicly.
• It recommends that HHS form a council to develop criteria for the safe use of information technology.
• It urges HHS to require software vendors to report IT-related patient safety harm or concerns to a central organization and also encourage users to voluntarily report to that organization as well.
• Software-related problem reports would be reviewed by a new group that would be the HIT equivalent of the National Transportation Safety Board. The report says FDA is not up the task since it’s an oversight body, AHRQ is too research-focused, CMS is mostly good at threatening the income streams of providers, ONC doesn’t have the expertise, and Joint Commission and related organizations are so dependent on income from special interests that they can’t be objective.
• It observes that “poor user interface design, poor workflow, and complex data interfaces are threats to patient safety” and “lack of system interoperability is a barrier to improving clinical decisions and patient safety” once you get beyond lab-related terminologies such as LOINC. Overall, it is quite critical of system usability and observes that vendors don’t have much incentive to make their products interoperable with those of their competitors.
• The report says that the industry has done a poor job of regulating itself with regard to patient safety and suggests turning the whole thing over to the FDA to regulate if the foot-dragging continues: “These and other recommendations would comprise the first stage for action, greatly advancing current understanding of the threats to patient safety. However, because the private sector has not taken substantive action on its own, the committee further recommends that HHS monitor and publicly report on the progress of health IT safety annually, beginning in 2012. If progress is not sufficient, HHS should direct the Food and Drug Administration (FDA) to exercise its authority to regulate health IT.”

Reader Comments

From Pachelbel: “Re: Vince’s article on Epic. Cache’ is not proprietary to Epic as it is owned by InterSystems. It can be an extremely fast database if implemented properly. Ask QuadraMed or any of the hundreds of other HIS vendors that use it. I suspect your gripe is with the way Cache’ was implemented. No database works well if the data structure or queries are malformed. Full disclosure: I’m a Cache programmer who has seen the good, bad, and plenty of ugly implementations of Cache’.” Cache’ is one of few technologies developed for healthcare that was adopted by the financial industry for mission-critical applications, with organizations such as Credit Suisse, Ameritrade, and a couple of stock exchanges using it.

From SouperDooper: “Re: Vince’s article on Epic. I agree with the points made about the Epic way, rookie staff, and high costs. But to say that GE and McKesson have equal functionality is beyond ridiculous.”

From Astrid: “Re: Vince’s article on Epic. This feels like ‘nobody ever got fired for buying IBM.’ I know a hospital where the VP had Epic where he came from and wanted Epic there, so it was a total rip-and-replace without a business analysis or needs analysis. I understand that a strict implementation keeps clients from shooting themselves in the foot, but that usually speaks to their lack of business sense, discipline, and management ability. Having an implementation guided by people without healthcare experience and knowledge seems to guarantee rework later.”

From Lorenzo’s Oil: “Re: Catholic Healthcare West. Hear they’ve scrapped their dual Cerner/Meditech strategy and are moving forward with Cerner system-wide after Meditech problems, with Cerner picking up about 20 sites once they’re done. I also heard Epic tried to jump into the fray, but CHW didn’t like the exorbitant price tag.” Unverified.

From Unbiased Consulting Firm: “Re: Epic. They clearly have a huge lead in implementations over the last 24 months, but the talent pool is not available to support those implementations, nor does the application support this market advance. Meditech, Cerner, and Allscripts … there is much to do with marketing and creating awareness. If you purchase Epic, you need to be able to support and implement it successfully. Each of these applications are market leaders – do not be taken by the media. Make your choice, but consider all the factors.”

Acquisitions, Funding, Business, and Stock

Grant Thornton, LLP acquires Computer Technology Health Associates’ Health Solutions division, including five military healthcare contracts and the staff supporting them.

HMS Holdings Corp. announces plans to buy RAC contractor HealthDataInsights for about $400 million. HMS expects HDI to contribute $85 million in revenue next year.

Days after the SEC releases new guidance on the matter, HCA revises its accounting for the recognition of income from HITECH incentive payments. Last week the SEC indicated that the “gain contingency” accounting model was the appropriate income recognition model for payments. Under this model, HCA will “recognize HITECH income when its hospitals have demonstrated MU and the cost report information for the full cost report year that will determine the final calculation of the HITECH payment that is available.” HCA expects to recognize HITECH income of $100 million to $130 million in Q4 and $190 million to $220 million for the full year.

San Diego-based Perminova, which offers SaaS-based applications for managing cardiac electrophysiologic labs and cardiovascular surgery, gets $7 million in venture funding. Its software is used by UC Sand Diego and Mount Sinai in New York.

Sales

UC Health (OH) selects Ciena Corporation’s 4200 Advanced Services Platform to provide network connectivity across four hospital buildings and its data center facilities.

Iowa Health System chooses Jardogs’ FollowMy Health Universal Health Record to provide online access to its patients.

Conway Medical Center (SC) purchases PatientKeeper’s clinical suite of applications to automate physician workflow and drive physician adoption of HIT.

Kindred Healthcare signs for practice management and revenue cycle tools and services from MED3OOO.

People

IT service provider Systems Made Simple hires Viet Nguyen, MD as CMIO to advance technology initiatives to improve continuity of care and enhance patient safety. He was previously with KForce eGovernment Solutions and the VA Office of Information.

Optum’s Accountable Care Solutions team, led by Todd Cozzens, now includes over 700 cross-functional team members focused on aligning hospitals, physicians, and health plans for integrated care models.

Fast Company profiles Zynx Health Chief Nursing Officer Pat Button EdD, RN.

Announcements and Implementations

Cedars-Sinai Medical Center (CA) launches Voalte’s point-of-care communication solution following a year of research and testing.

Platte Valley Medical Center (CO) goes live on eCareNet, powered by Soarian Clinicals.

Rochester General Hospital (NY) and seven affiliated practices go live on Epic. They will spend $65 million over the next two years to convert the entire health system, which includes two hospitals and 40 practices.

Kronos announces its InTouch time clock that features a color touch screen, gives employees access to their accrual balances and schedules, and supports off-peak use of apps such as employee surveys or streaming of informational videos.

Technology

Panasonic expands its Toughbook line of ruggedized laptops, popular in hospitals, to the Android-powered Toughpad, initially available in 2012 in a 10-inch form factor ($1,299) with a 7-inch version to follow.

Other

CCHIT announces that AOD Software’s Answers EHR and HealthMEDX Vision are the first EHRs to earn its Long Term and Post Acute Care certification.

Home health agencies, by the way, will see a 2.3% decline in Medicare payments next year under a newly released regulation. Opponents claim the cuts will leave half of Medicare home-health agencies operating in the red in 2012.

Community hospitals are progressing with their EMR implementations, with 69% saying they have acquired the technology and 39% of those reporting that their EHR project will cost over $8 million. The same report finds that almost all community hospitals have begun the conversion to ICD-10, though only a quarter are currently undergoing remediation. Forty-three percent of the hospitals say they are participating in HIEs.

The local paper provides an update on Cape Code Healthcare’s (MA) $20 million HIT investment, which includes a replacement of Meditech Magic with Siemens Soarian. Mr. H. interviewed Cape Cod VP/CIO Sheryl Crowley last year.

The HIMSS EHR Association announces its support of iHealth Alliance’s EHRevent, an online system for reporting adverse events. It’s part of the PDR Network, whose CEO Edward Fotsch MD was interviewed on HIStalk a year ago.

Eighty-three percent of clinical informaticists participating in a Billian’s HealthDATA survey report an improvement in quality outcomes from using EMRs.

CMIOs, CNOs, and senior nursing executives believe their roles and responsibilities will continue to evolve as new technologies are developed, according to a research report by Capsule. CMIOs indicate their most basic job function is to bridge the gap between clinical needs and IT, while CNOs and senior nursing execs see their roles evolving to be more inclusive of departments outside of nursing.

The EHR/HIE Interoperability Workgroup issues technical specifications to standardize connections between providers, HIEs, and other data-sharing partners.

Rival health systems HealthPartners and Allina Hospitals and Clinics (MN) claim their collaboration allowed them to shave $6 million in medical costs for patients across two counties. The organizations are participating in a seven-year “learning lab” that involves the pooling of resources, sharing of EMRs, and mining of insurance claims data for about 26,700 people with private insurance.

Kevin Lasser, CEO of JEMS Technology, compares Ford’s smart phone app for owners of the Focus Electric to his company’s own telemedicine app in My Ford Magazine, distributed to 4.7 million recipients.

I featured Aventura in one of my Innovation Showcases and at least two readers have told me they’ve gone to work for the company. CEO Howard Diamond writes a post for Boulder Startups urging entrepreneurs to jump into healthcare IT: “The software and other tools that are supposed to be building efficiencies, reducing errors, and building collaboration and trust across caregivers are actually having the opposite effect; they are creating barriers to efficient quality care.” I like the list of information sources he provides for those interested in the healthcare revolution: Clayton Christensen (the Harvard professor who wrote The Innovator’s Dilemma), Regina Herzlinger (the Harvard professor who wrote Who Killed Health Care?), HIMSS (which needs no introduction), and HIStalk (the non-Harvard, non-professor known mostly for goofy music recommendations and HIT rumor-mongering.) Howard’s just being nice since I profiled his company.

I bet the Harvard people have more time after their day jobs to pursue their side ventures than I do, though. Mrs. HIStalk keenly observed this weekend that “whatever it is you do upstairs all the time won’t get done when you kick the bucket.” That’s the extent of her knowledge about HIStalk.

New York’s state controller nixes a proposed $22 million deal with Allscripts that would have created a call center for SUNY Downstate Medical Center. Allscripts had reserved the right to send work offshore, raising confidentiality concerns.

Practice Fusion is named top EMR for ePrescribing and helping practices achieve Meaningful Use by Brown-Wilson’s Black Book Rankings.

I’m not an attorney, but this ruling by Colorado’s Supreme Court seems to uphold a previous verdict that a man suing Kaiser for malpractice can’t claim physician-patient privilege in denying Kaiser’s lawyers access to his electronic medical records. He had a heart attack while taking a treadmill stress test and is suing Kaiser and one of its doctors, but didn’t want the defense to be able to study his medical records. A footnote in the ruling sounds like a HealthConnect (Epic) commercial: “Kaiser’s integrated electronic medical record is instantaneously accessible by any and all Kaiser healthcare providers and is a hallmark of the services Kaiser provides.”

Next month’s mHealth Summit has added as keynote speakers Surgeon General Regina Benjamin MD and HHS Secretary Kathleen Sebelius. HIStalk (in the form of HIStalk Mobile) is a media partner, so our own Travis Good, MD will be providing daily reports. He’s outstanding at understanding and explaining the business of mHealth, so he’ll provide both health and business perspectives. It’s December 5-7 at the Gaylord National Resort and Convention Center in the DC area. Full registration is $525, or $195 for federal government employees. I had a pretty good time there last year and the venue looks much better than last time, although I’d miss the proximity to the National Mall and all the fun sites and restaurants nearby.

Sponsor Updates

• Mike Marvin of CareTech Solutions and Kara Wingerter of Blessing Health Systems (IL)  will present a case study on increasing revenue with online pre-orders and sales at this week’s Greystone.net Healthcare Internet Conference.
• OptumInsight launches additional capabilities for its Netwerkes EDI service, including integration with Epic PM Systems claim administration and clinical information workflows.
• GetWellNetwork appoints Wellford Dillard as CFO.
• Facilities of Vitalité Health Network (Canada) will go live next week with a pharmacy medication order management system connected to its Meditech system and powered by Perceptive Software’s ImageNow enterprise content management system.
• ICA releases a white paper entitled All Health Information Exchanges Are Not Created Equal.
• Mac McMillan, CEO of CynergisTek and chair of the HIMSS Privacy and Security Policy Task Force, will serve a panelist for Clearwater Compliance’s HIPAA-HITECH Blue Ribbon Panel webinar How to Prepare for HIPAA Audits.
• Tee Green, president and CEO of Greenway Medical, will host a November 15 webinar on future trends in healthcare.
• Beacon Partners receives Epic’s “Community Connect” certification.
• McKesson launches RelayHealth in Canada at the HealthAchieve 2011 Conference.
• University Medical Center of Princeton at Plainsboro (NJ) selects ProVation MD for its GI department’s documentation and coding.
• DST Health Solutions LLC announces an agreement with 3M Health Information Systems to integrate 3M’s ICD-10 Code Translation Tool with DST solutions.

Contacts

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

Monday Morning Update 11/7/11

From The PACS Designer: “Re: iPad. A new, free iPad application called Line2 HD turns your iPad into a phone. This extended feature could increase the penetration of iPads into healthcare environments.” It’s very cool, but it should be noted that while the app is free and so is the service for a seven-day trial, the ongoing cost is $10-15 per month depending on the options chosen. That gets you a new or transferred number, voice mail, and conference calling, all over Wi-Fi or cell. A cool feature: if you’re not connected, it will forward incoming calls to up to six other numbers. This CNET review is positive.

From Lobstah: “Re: Meditech. New executives.” Meditech promotes Chris Anschuetz to SVP of technology and Scott Radner to VP of advanced technology. They’ve been with the company for 36 and 21 years, respectively. 

From Ralph Hinckley: “Re: NextGen. Drops MEDSEEK as a white-label enterprise portal, developing its own.” Unverified. Ralph sent over an e-mail saying that NextGen will release its own enterprise patient portal in 2012, integrated with its HIE platform and physician portal. The companies signed their agreement just three months ago.

Speaking of Meditech, the company releases its Q3 report. Revenue was up 19% to $141 million, EPS was unchanged with profit of $32 million for the quarter.

My Time Capsule editorial this week, gasping for air after being entombed journalistically for five years: Leapfrog’s Leap into Irrelevance. I looked back to Leapfrog Group’s founding: “Predictions were dire back then in the post dot-bomb nuclear winter. Hospitals would be wildly overbedded. Savvy baby boomers, emboldened by buying books and dog food online, would be calling the shots, making shrewd healthcare decisions and choosing providers based on stringent quality measures that would be plastered all over the Web. Unfocused, change-resistant hospitals, which included all the ones I’d ever worked for or heard of, would be road kill. ”

Listening: Frosting on the Beater, a 1993 album by The Posies, alt power pop from Washington with a big, radio-friendly guitar sound. You either found it a guilty pleasure on VH1 or missed it entirely.

Welcome to new HIStalk Platinum Sponsor Henry Elliott & Company of Wellesley, MA. The company operates in a fascinating, high-demand niche: providing certified experts in InterSystems Cache’, M/MUMPS, and Ensemble for almost 20 years. The company offers experts in those technologies (contract, temporary, remote, and direct placement.) Or, if you are skilled in those areas and are feeling under-appreciated, review the plethora of opportunities in case you’re in the job-changing frame of mind and want to connect with a company that understands and values your highly specialized talents. If you need or have Cache’ or MUMPS expertise, Henry Elliott & Company would love to hear from you. Thanks to those folks for supporting HIStalk.

Also supporting HIStalk is Acusis, a new Gold Sponsor. Pittsburgh-based Acusis offers clinical documentation solutions in the form of outsourced medical transcription. Customers choose whether they would prefer US or global CMT-certified transcriptionists. Their Six Sigma-driven processes include a separate Quality Control editing step, and medical language specialists are paired with the customer’s dictating clinicians to give consistently high quality and fast turnaround time. The company’s team of 50 software engineers created dictation options that include telephone, VoIP, digital recorders, and smart phones, also supporting rules-based report distribution (network printing, fax, e-mail), multiple electronic signatures, and integration with just about every HIT system. Back-end speech recognition is offered, providing customers with a lower-cost solution for their more consistent clinicians. An iPhone-based, Dragon-integrated front end speech dictation option was announced a few weeks ago.Customer testimonials are here. Thanks to Acusis for supporting HIStalk.

It’s a 60-40 split that today’s healthcare software cannot or can, respectively, support needed improvements in cost and quality. New poll to your right: a quick read on which vendor is “doing things right” more than the others, which you can define however you like (quality, vision, business, etc.)

Financial performance solutions vendor MedAssets reports Q3 numbers: revenue up 50%, EPS –$0.02 vs. $0.14. Excluding integration costs from its Broadlane Group acquisition, earnings of $0.26 handily beat expectations of $0.16, sending shares flying on Friday to close up 16.7% as Nasdaq’s seventh biggest percentage gainer. I’m not much of a stock-picker and I own no shares in MDAS, but after a year of not-so-good performance (MDAS in blue, Nasdaq in green, and the Dow in red), it looks as though MDAS is moving up out of its trading range on increased volume, which is usually a good thing (duh). Market cap is $712 million.

Weird News Andy can’t decide whether this is a trick or a treat. A man walks into a hospital complaining of leg pain. Astute clinicians postulate that a potential etiology is the bullet lodged there from a Halloween shooting three days earlier. The patient said yes, he did recall that unfortunate eposide, but didn’t think it was a big deal.

New York-based Netsmart Technologies, run by former Cerner COO Mike Valentine, will relocate to Kansas City, creating 130 jobs with plans to hire up to 520 total employees. CEO Valentine never moved from Kansas City since he left Cerner in April 2011 and joined Netsmart in May 2011, so he gets to make all the employees move so he doesn’t have to (those handful willing to leave New York to go to Missouri, anyway, although the company will keep a New York office.) Netsmart sells solutions that include behavioral, public health, substance abuse, and social services.

Here’s Vince’s Part 2 HIS-tory of Computer Synergy.

Medicare’s pilot projects for commercially run disease management programs actually cost taxpayers more money and didn’t improve quality, a study finds. Five of the eight participating companies were losing so much money they paid an exit fee to drop out early. The conclusion is that just calling or visiting elderly patients occasionally doesn’t really accomplish much, and health coaches in such a program need to be given access to hospitals and practices and their patient information to coordinate care.

News I missed: Meditech co-founder and original president Mort Ruderman died October 12 at 75. A tribute video is here.

The DC RHIO is shut down when the city declines to continue funding it. The mayor apparently wants to take the federal grant money and start a new HIE.

The Louisiana Health Information Exchange launches after conducting pilots with Lafayette General Medical Center and Opelousas General Health System. They’re trying to recruit Ochsner, LSU, and Franciscan Ministries to sign up.  Orion Health is providing the technology. The HIE received $10.6 million in federal taxpayer dollars in March 2010.

UCLA Health System notifies 16,000 patients that their personal information was stored on a hard drive that was stolen in a burglary of the home of one of its doctors. The drive was encrypted, but the doctor had written the password on a slip of paper near the drive and that appears to have been taken as well.

Lawrence Memorial Hospital (KS) warns that patient billing and credit card information was exposed on the Internet for more than a month due to “failed security measures” by the Web host of the hospital’s online bill-pay vendor.

Blue Cross Blue Shield of Delaware offers to spend $30 million in charitable projects, including donating $1 million a year for the next five years to support the Delaware Health Information Network, in an attempt to convince regulators to allow it to merge with Pittsburgh-based insurer Highmark. The state’s attorney general says Delaware citizens have subsidized BCBS to the tune of $181 million and he wants at least $45 million set aside to benefit Delaware. 

Massachusetts plans to allow casinos to operate in the state, earmarking 23% of the hefty license fees involved, or around $50 million, toward encouraging the use of electronic medical records in hopes they will help control the state’s rising health costs.

E-mail Mr. H.

HIStalk Innovator Showcase–Caristix

Company Name: Caristix
Address: 1400 St-Jean-Baptiste Avenue, Suite 204, Quebec City, QC G2E 5B7
Web Address: www.caristix.com
Telephone: 877.872.0027
Year Founded: 2009
FTEs: 5

Elevator Pitch

The Caristix HL7 software suite helps healthcare IT vendors and hospitals reduce interface deployment from months of work to a few days.

Business and Product Summary

Caristix develops software for healthcare IT analysts and developers. With a focus on HL7 and data mining, Caristix streamlines the delivery of interfaces that support the flow of data in healthcare. If we look at innovation in this space, we took a leap forward about 15-20 years ago with the introduction of interface engines. The next leap forward is going to come from automating the manual scoping and configuration work involved in interfacing, leaving integration analysts free to add value on other more complex data integration topics.

With our software offering, we help vendors and providers scope HL7 interface requirements more quickly before coding, test more thoroughly before go-live, and troubleshoot over the interface lifecycle. Benefits to vendors and providers include lower interfacing costs, faster time to value, and reduced process waste and risk. We provide annual licenses that include support and maintenance releases. We also offer services, such as creating interface specifications for our customers, and getting them started on documentation and interfacing best practices.

Target Customer

HIT software and service providers, hospitals and IDNs, and HIEs.

Customer Problem Solved

The biggest bottleneck in HL7 interfacing isn’t coding or setting up the interface. With modern interface engines, that’s easy. What’s hard is figuring out what to code. In other words, which data should you handle and what does each piece look like in the real world (not on paper in the spec)? Our software figures out what to code automatically.

The way the industry solves this problem today isn’t going to work for much longer, especially with volume of data enabled through Meaningful Use. Right now, folks are essentially using trial and error. In other words, you set up an interface based on a site survey form and a broad product spec, connect up to a test system to get some data coming in, see what’s broken, then fix it. Rinse and repeat. If you’re lucky, you’ll make your schedule. If you’re not, you might be six months out. If you decide to go live anyway, the vendor and/or the hospital’s IT team will be facing one heck of a support backlog, which in turn, can tank adoption rates.

Trial and error is increasingly problematic with today’s interfacing volumes. It’s certainly going to get tougher to sustain once Meaningful Use forces real data integration, with multiple sources of clinical data coming into and going out of the EHR and other information systems. We’re seeing early-adopter vendors and hospitals moving away from trial and error. We think we’ve hit a sweet spot with our software. We’ve come up with a way to not only get proactive on scoping, but also keep scoping documentation up to date for future integration projects.

Competitors

Our competitors are niche tool vendors and a few of the interface engine vendors. However, that second category includes a little overlap: we also complement interface / integration engines and are working with two vendors in this space. But our biggest competitor is the status quo, folks just going along with business as usual.

Advantages Over Competitors

We integrate data mining so analysts can easily grasp their data and what it means. This can drive up interface quality while driving down project risk. The functionality we provide around HL7 data helps interface analysts to grasp sending and receiving system specifications easily. This enables analysts to identify gaps to be bridged by interfacing and integration early during a project. With complex interfacing and integration projects, project leaders can increase interface quality and confidence without jeopardizing timelines.

Fast Facts

• KISS (Keep It Simple…) If our spouses let us, the founders would tattoo “KISS” on our respective foreheads. At Caristix, we really want to keep things simple for our customers.
• We’re concentrating on HL7 for now. But keep an eye on us for other data standards over the next year.
• We’re an experienced healthcare IT team and we have a shared work history. Some of us even go back 12 years, and our team brings over 50 years of combined experience, in both technical and business areas in healthcare IT.
• The company has a product management focus. In other words, our products reflect market and user needs and where we think the market is going. As a startup, the last thing we’re interested in is the tech fantasy of “build it and they will come.”
• Here is a customer quote: “This is the only tool that provides me with the filter functionality needed to successfully dissect thousands of transactions and find all of the deltas, without jeopardizing timelines.”

Pitch Video Created Specifically for this Showcase

Customer Interview (a system analyst for a large healthcare IT software vendor)

What problems have you solved using Caristix products and what impact has that had on your organization?

We are seeking ways to continuously improve our customer enablement process for our product. An activity in that process is understanding the customer environment. The Caristix Conformance product assist the SME knowledge of their environment and not to rely on outdated documentation and assumptions. Conformance gives us (and the customers) a great visual of their environment.

With this improved visibility, we reduced the rationalization logistic interactions – a lengthy Q/A process (i.e. what systems are involved in the project?  what data comes from that system? <<…implementation period…>> Are you sure? Well, we’re seeing this type of data and it does not agree with the initial statements. Are there any more surprises? etc.). This form of interaction occurs over weeks or months and creates much re-work as information becomes known. Knowing upfront the true reality not only mitigates loss time (and financial expenditures), but also improves customer satisfaction and overall product experience.

Caristix also has other products which we review:

• Cloak, which de-identifies data – another great product in the making. One colleague commented, “… this is the simplest interface I’ve ever used…”
• Pinpoint, which enables what I call “finding a needle in a haystack” simple. Pinpoint cut so much time out finding what’s occurring within the data flow, it’s amazing! One colleague said, “…I wish I had this product when dealing with customer ABC — it would have saved me days of work.”
• Although we have not looked at their other products, based on the ones we did, I’m confident they pointedly address the intended concerns.

What alternatives or competing products did you consider and why did you choose Caristix?

We searched for products that address our specific concerns, but didn’t find any. Also, as we began to use the product, the company was open to our product improvement suggestions. And the most amazing thing occurred — they not only implemented the suggestions, but also saw the general benefits to other users as well. Their turnaround time to implement was truly Agile. We saw results in weeks, not months or worst, year(s). As Conformance continues to mature with new features, plus the incorporation of the suggestions, I foresee retiring some of our legacy tools.

How would you complete this sentence if speaking to a peer? "I would recommend that you take a look at Caristix under these circumstances:"

If you are looking for a company who really wants to work with you to solve the problems that their product set addresses, then certainly call Caristix. They truly try to understand the customer use cases, see how (and which product(s)) can meet those needs. And on the rare occasion when their isn’t a “match,” they are upfront to let you know, but still try to see if it’s possible within their reach.

Their response is impeccable, from showing you mock-up to real running code. They are willing to see how your suggestion can make their product better. The proof is when you see the implemented result! Now that’s amazing! Their Say:Do ratio is on par.

They have a good idea where the market is progressing and are making plans to be there as you review their product roadmap. I believe they are flexible enough to make the necessary course corrections as they occur.

An Interview with Stéphane Vigot, President, Caristix

HL7 interfacing sounds simple, at least on paper. Why do organizations need your products?

HL7 is called a standard, but it’s more of a framework. It’s extremely flexible. You’ve got some guidance regarding the way you could organize the data, but each and every hospital adapts the organization of the data to its clinical workflows.

For example, if you consider the admit status sex of a patient, you can have up to six different possibilities. There are very, very few systems that would use those six possibilities. Most of them will use three or four, and even when they pick only three or four, let’s say for a male and a female, one could say, “OK, a male is designated as an M and a female as an F,” or another will say, “In my organization, we’d rather use an 1 and a 2.” That’s a real example.

For any kind of field, you’ve got a type of flexibility. Even though two hospitals are using the very same ADT system, let’s say –  admission, discharge and transfer — and they use the very same vendor, the very same version of the system, the data will most likely be organized in a different way.

Thanks to our technology, instead of having an interface analyst looking and reading, literally, HL7 messages, we get the feed from the system that you have to connect. In a matter of a few minutes, we do some reverse engineering on the metadata and then we issue a document that will very precisely tell you how the data is organized within a system.

With interfaces, you often just play back a bunch of messages and try to figure out all the exceptions and rules, with an application expert on one side an an interface expert on the other. How would a hospital use your product to create their own interoperability?

They would get the software platform that we have. They would get HL7 logs, so basically several HL7 messages, and they can deal with tens of thousands of different messages. They would put that file into our platform, and then automatically the platform will do a reverse engineering process. It will read the data and issue a Word document that will tell you precisely how the data is organized.

Then the technician, either from their vendor side or from the hospital side, will know exactly how to configure the interface engine. They will know exactly what data is what and how it is organized — the length of the field and everything. That’s basically it. It’s a very straightforward application that saves hours and sometimes days or weeks of work for an interface analyst. We’ve got a customer testimonial where a task that usually took up to eight hours is done in three minutes, thanks to our platform.

Does the typical customer buy your product just for a specific interface problem they’re trying to solve, or is it in their tool chest of things that they end up using a lot?

They end up using it a lot, because an average hospital in the US will usually deal with more than 100 interfaces. Every single time there is an update to any of the systems they’re using, then the interface will need to be adapted to the update. We know hospitals that have up to five persons dedicated to managing the interfaces. That’s what they do all day long. That’s why our platform can be used on a daily basis.

How would a customer use your product to validate the integrity of an interface, either a new one or an existing one to make sure nothing has changed?

They will just get the logs, do  a reverse engineering on the new or existing system, and perform gap analysis between the current interface, or on the old interface if you will, and then the new interface that they want to build. There’s a built-in functionality within our platform that allows you to perform in a matter of a few minutes a gap analysis between two specifications.

You’re based in Canada. Do you see any particular challenges that you’ll face when working with the US?

It’s our target market. In fact, 80% of our customers are in the US. Historically, the team of Caristix worked for a major US vendor for a number of years. The genesis of Caristix was because of a reduction of forces — we had to let go several software developers that were working for that US vendor, so our expertise was really in the US.

Who is it you market to and how do you reach those people?

We market to two segments: hospital vendors and hospitals. We are currently working on a free application for hospitals that will allow the hospital’s IT teams to document the specification of the different systems, again, in a matter of a few minutes. 

We use a lot of white papers, we use a lot of reference, if you will. Since we’ve been working with US companies for years, we know a lot of them, so that’s how we reach out to them. We’re now getting more visibility and we’ve got some consultants — or I’d say gurus — in healthcare IT that are also talking a lot about us.

The nice thing about our platform is that once you see how it works, you automatically understand the benefits and you automatically understand the savings that as a vendor or even as a hospital you’re going to be able to make. I’d say it’s an easy sell. As soon as you talk to people who know and understand the complexity of HL7 Interfacing, it’s almost – and I hate to use this term – but it’s almost a walk in the park from a sales standpoint.

What do you hope to gain from the exposure on my site?

Any hospital is dealing with HL7. You’re extremely visible in the HIT world. I was at HIMSS this year – I’ve been attending for the past seven years – and a lot of people know Mr. HIStalk. You’ve got quite some followers there. I think that’s going to provide us a lot of visibility.

Most of the people who are dealing with HL7 interfacing will definitely take a look at our website. When they take a look, we’ve got a great response and they automatically understand what we do. The savings are very positive. That’s where we see a lot of potential, and thanks to your help, we see a lot of lead generation, thanks to the HIStalk blog. 

The feedback we’re getting from existing customers is that within their first interface project, the return on investment is immediate. You don’t have to be using our platform for months to get to see the benefits. It almost pays for itself with the first project.

Siemens To Acquire MobileMD

Siemens Healthcare announced this morning that it will acquire HIE solutions vendor MobileMD of Yardley, PA.

John Glaser PhD, CEO of the Health Services Business Unit of Siemens Healthcare, was quoted as saying:

The goals behind many of our country’s broad, health reform initiatives are intended to improve the quality of care by doing two basic things: increase utilization of electronic technology, for a variety of benefits, and improve the coordination of care among entities that had previously not shared data well. Patients come into the healthcare system expecting physicians to help them get well by coordinating their care. Patients generally should not need to be concerned with the logistics of how their care is coordinated – they should rightfully expect that it will be coordinated. Siemens was impressed with MobileMD’s capabilities to enable this level of data sharing while maintaining an impressive focus on customer satisfaction. MobileMD customers can expect to continue to experience this same level, or an improved level, of service, commitment and partnership.

MobileMD’s HIE service is used by 110 hospitals and 2,000 physician practices, according to the announcement.

HIStalk interviewed MobileMD CEO Todd Fisher this past January. He named Axolotl and Medicity as MobileMD’s main competitors, both of which had been recently acquired at that time.

Terms of the acquisition, which is expected to close promptly, were not disclosed.

News 11/4/11

Top News

Citing the need for more time, ONC announces it will delay the launch of the permanent program for EHR certification until mid-2012. The timeframe coincides with the anticipated final rule of Stage 2 of Meaningful Use and standards and certification criteria. ONC says it can’t make the original January 1 deadline to approve testing labs and authorize certifying bodies.

Reader Comments

From Viking: “Re: doctors, texting, and HIPAA. This video on how to make a ‘pager scanner’ shows how easy it is for anyone to listen in and breach via texting.” Though I was distracted by the painful-looking lip piercing on the geek chick, I need to get someone to build me one of those. Go to about the 2:45 mark to see her computer screen filling up with pager messages. It’s definitely a target-rich environment at my hospital, although I expect the messages are amazingly dull.

From Megan: “Re: HIStalk page loading improvement. Thank you! I’m new to the industry and like to stay on top of news, but that one little fix made this site so much more reader-friendly.” I’m embarrassed that it was a relatively simple change once Dave Dillehunt suggested it. I wish I’d done it sooner. I find myself pulling up the page several times a day just because I like watching it snap to attention on my command. The beauty of it is that everything still displays, sponsor ads and all, but just in a slightly different order. 

From AnotherDave: “Re: HIStalk page loading improvement. I second, third, and fourth the shout-out to Dave Dillehunt. Instant access to HIStalk: priceless.” This may well be Dave’s finest hour. I mean, sure, he’s a CIO and everything, but how many times do strangers publicly sing his praises?

From NoSleepTillEpic: “Re: Kadlec Regional Medical Center. Live with Epic inpatient, ambulatory went in August, One of Epic’s smallest customers, a PlaneTree hospital with a reputation for doing technology right. JCAHO showed up the week before go-live!” Nice.

From Anon: “Re: ONC budget. Is this something to be concerned about?” I don’t know the source of the attached material and I don’t understand all of it, but it says ONC’s 2011 budget was $61 million and the President requested $78 million for 2012. The Senate Budget Committee recommended holding the budget to $61 million, but supposedly (and this would be the big news, if true) that figure would also include ONC’s HITECH allocation, which was $57 million in 2010 and was scheduled to increase to $499 million and $874 million in 2011 and 2012, respectively. A House subcommittee has proposed only $28 million. If you know more about this, please share since it sounds important if it’s true.

Unrelated, but while Googling the subject, I came up with ONC’s 2012 budget justification, which has key indicators that include the percentage of practices and hospitals using EMRs and receiving Meaningful Use payments. ONC requested 189 FTEs for 2012 with an average cost per FTE of $148,000.

HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Gregg enlightens readers on the behind-the-scenes coordination for AAP’s Pediatric Office of the Future. A reader comments on providers who seem overwhelmed by Meaningful Use-fueled EHR purchases and rushed implementations. MGMA calls on CMS to establish a 5010 contingency plan in case practices and their trading partners can’t meet the looming deadline. Physicians believe EHRs are safer than paper, but patients disagree. CMS advises providers to report on all clinical measures in their EHR, even if the data is incomplete – and thus meaningless. Shuffle on over to HIStalk Practice, get your ambulatory HIT fix, and sign-up for e-mail updates. Thanks for reading.

Welcome to new HIStalk Gold Sponsor New York eHealth Collaborative. The not-for-profit, formed in 2006, strives to improve healthcare for New Yorkers through the use of healthcare IT. It helps develop policies and standards to help providers move to electronic health records and coordinates connecting providers statewide. It runs a Regional Extension Center and the Statewide Health Information Network (SHIN-NY). They’re presenting the NYeC Digital Health Conference 2011 December 1-2 at Pier Sixty on the Chelsea Waterfront in NYC, with keynotes by HHS CTO Todd Park and journalist T. R. Reid. Registration is $395 general and only $195 for practicing physicians and government employees. I’m running a text ad for them over to your right just in case you want to check it out later. I would loved to have gone, but it was just too hard to get time off from the hospital, which left Mrs. H deprived of the opportunity to enjoy New York near Christmastime. Thanks to New York eHealth Collaborative for supporting HIStalk.

On the Jobs Board: Java Developer, Senior Interactive Graphic Designer, Cerner and Epic Resources. On Healthcare IT Jobs: Research Informatics Analyst II, III, IV, Lab Information Systems Analyst, Regional Sales Executive, Senior Pharmacy Analyst.

Suggestions on how to spend your extra minutes of free time each day now that HIStalk loads faster: (a) seek Inga, Dr. Jayne, and me on Facebook and LinkedIn and consummate our electronic union by Liking, Friending, and Connecting; (b) sign up for spam-free e-mail updates on HIStalk, HIStalk Practice, and HIStalk Mobile; (c) send me scandalous rumors, squelched news, and anything that would interest readers like yourself by clicking the atrocious-looking green Rumor Report box to your right that sends your secure message and an optional attachment right to my inbox; (d) peruse the friendlier-loading sponsor ads to your left and click those that seem fun, or check out the Resource Center to browser and search, pausing to marvel that polished and powerful executives command their underlings to mail a check to a PO box to support an anonymous hospital guy’s amateurish blog; and (e) look yourself in the mirror while giving yourself a little nod and a Bill Clinton finger-pointing recognition gesture to acknowledge your role in reading and doing all of the above, which keeps the vivacious and erudite Inga and Dr. Jayne smiling.

Acquisitions, Funding, Business, and Stock

HealthGrades signs a definitive agreement to merge with CPM Marketing Group, a provider of customer relationship-management services for hospitals.

Mediware announces Q1 numbers: revenue up 24% to $15.5 million and profits up 42% to $1.49 million or $0.18/share.

Medical practice documentation management software vendor Updox gets a $500K loan from the state of Ohio to develop a mobile version of its product, to integrate with more EHR products, and to promote its free secure messaging service.

Advisory Board Co. reports Q2 net income of $5.2 million ($0.30/share) compared to $4.9 million ($0.30/share) last year. Revenues grew 30.7% to $92.9 million.

Allscripts reports Q3 numbers: revenue up 13%, EPS $0.11 vs. $0.01, beating expectations. The company raised guidance on both revenue and earnings. The earnings call transcript is here. Interesting snips from it: (a) CEO Glen Tullman says the new January 1 readmission rule in which hospitals eat the cost of patients readmitted for the same condition within 30 days is driving interest in care management and discharge management applications; (b) he says Allscripts beat Cerner and Epic at Flagler Hospital (FL) because the hospital wanted to connect to a variety of EMRs used by community-based physicians (c) several new hospitals signed up for the EPSi performance management system, among them UC-Davis and Stanford; (d) Glen sees big opportunity from ICD-10 (“you’re going to have to replace every practice management and revenue cycle management system out there”) and analytics; (e) he says Sunrise Clinical Manager is used by “all the best names out there,” saying it’s “open” and “not outdated” and “what the market wants, what physicians want, is one comprehensive patient view, not one database, because they realize you can’t do that”; (f) their most frequent ambulatory competitors are Greenway and eClinicalWorks.

UPMC Health Plan and The Advisory Board Company form Evolent Health, which will offer the Identifi population and health management software developed by the health plan and used by UPMC to manage the health of its 54,000 employees. Each organization capitalized the venture with $10 million. Its first customer will be MedStar Health. Former Advisory Board CEO Frank Williams will serve as CEO of Evolent Health.

Merge Healthcare reports Q3 results: revenue up 33%, EPS –$.01 vs. –$0.06, missing consensus estimates by a penny.

Sales

Health Care Authority for Baptist Health selects MEDSEEK for clinician and patient engagement tools.

Lompoc Valley Medical Center (CA) will deploy Allscripts’ Sunrise Clinical Manager EHR and offer the Sunrise Clinician Portal to it physicians. Also, DMC Children’s Hospital of Michigan selects Allscripts EHR for its employed and affiliated physicians.

Houston Healthcare (GA) selects Wolters Kluwer Health’s ProVation Order Sets for Houston Medical Center and Perry Hospital.

Wake Forest Baptist Medical Center chooses RelayHealth’s RelayCare for readmission management.

Intermountain Healthcare signs a five-year agreement with Accretive Health to manage its revenue cycle. The organizations say they will create a Salt Lake City-based revenue cycle Center of Excellence that will provide best practices, technology, and education.

Harris Corporation wins a $4.5 million VA contract to develop Web-based mental health self-documentation tools for the MyHealtheVet personal health record.

People

Apixio names Darren Schulte MD as chief medical officer. He was previously with Anvita Health.

Availity promotes Russ Thomas from COO to CEO, succeeding Julie Klapstein, who will remain on the board of managers.

Recombinant Data Corp. hires Jason D. Oliveira as managing director of health system consulting.  He previously led the healthcare BI practice at Kurt Salmon Associates.

AMIA President and CEO Ted Shortliffe MD, PhD announces that he’ll be leaving the job he’s held since mid-2009 to pursue other interests. The board will initiate a search for his replacement, expected to be in place by early 2012.

Main Line Health (PA) promotes Karen Thomas to SVP/CIO. She was previously VP/CIO.

Announcements and Implementations

Physician practice marketing and communications company Medley Health partners with athenahealth to integrate its physician-patient communications platform with athenahealth’s suite of offerings.

Guam launches the first phase of its HIE with the deployment of secure messaging and clinical document exchange using the ApeniMED HIE platform.

The Wichita HIE signs up its first two physician practices.

New Hanover Medical Group (NC) goes live on Epic, the first step in a system-wide, $53 million upgrade. The local TV station covers its rollout of MyChart.

Inland Northwest Health Services (INHS) announces that 12 client hospitals have successfully attested for Meaningful Use.

Trustwave introduces its Web application security offerings, including an enhanced version of Trustwave WebDefend.

Three rural Adventist Health hospitals in California will share a $1 million Blue Shield of California grant to implement electronic medical records.

Healthcare IT services provider Anthelio will add 200 jobs in Detroit and Flint, MI to support its area customers, which include Detroit Medical Center and McLaren Health Care Group.

Innovation and Research

Stanford’s Lucile Packard Children’s Hospital publishes a NEJM article describing its use of patient information from its electronic medical records system to choose drug therapy for a patient’s rare disease. The 13-year-old patient had lupus complications and was a candidate for anticoagulants, but cases are so rare that a literature search came up with nothing on the risk-benefit profile. Jennifer Frankovich MD (above) used a research tool to query de-identified EMR data and found the records of 98 patients over a five-year period who had similar conditions and determined that the risk of clots was high enough to justify starting anticoagulants right away. Their conclusion is that a physician probably couldn’t have figured it out otherwise since there were so few patients, recall is sometimes biased, and EMRs have so much information that it’s hard to pick out the important data elements. They also expect that aggregated patient information will be used during rounds to make treatment decisions in the not-too-distant future. I assume the EMR in question was Cerner, which Packard is supposedly having to give up despite publishing extensively about its patient safety benefits (parent Stanford Hospital uses Epic.)

Technology

Toyota announces that it will start selling mobility robots in 2013, one of them being Independent Walk Assist, a computer-controlled mechanical exoskeleton. It was developed at the University of California at Berkeley, where one of its students who is paralyzed was able to walk across the stage to receive his diploma with the help of the technology. Toyota is working on another version that will lift and move patients.

Mobile healthcare apps tools vendor Diversinet is awarded a patent for encryption technology that prevents data from being transferred from one mobile device to another.

Other

From KLAS: over the next five years, almost half of providers will replace their RCM system; 87% of those will make the switch in the next three years. Most providers are looking at a new RCM in terms of how it fits in with a single-source enterprise strategy, often driven by the clinical vendor. Epic and Siemens top the list of considerations for over-200 bed providers, while McKesson and Meditech were the most considered by community hospitals.

A Richmond TV piece covers the use of AirStrip Cardiology at Bon Secours St. Francis Medical Center, in which one of the doctors sheepishly admits that the previous standard of practice for ED doctors to get cardiology consults was to send them an iPhone picture of the EKG.

A Virginia psychiatrist avoids becoming the first physician to be prosecuted for HIPAA violations when the judge dismisses charges against him. Prosecutors claimed the doctor retaliated against a patient who had complained about him by telling her supervisors that she had been involuntarily committed. The doctor says “it could have collapsed the entire system” had he been convicted since doctors would become reluctant to provide such warnings.

The Rhode Island Department of Health investigates four Lifespan hospitals after getting reports they gave 2,000 discharged inpatients prescriptions for immediate-release drugs instead of the timed-release versions ordered by the physician. Lifespan blames “software used to generate medication instructions provided to discharged patients.” State Senator Jamie Doyle says he is “shocked” and wants a review of all Lifespan hospitals and the Rhode Island Department of Health.

Weird News Andy is positively lyrical over this story, which he titles “Crystal Gayle, where are you?” A California doctor (and former entertainment lawyer) develops a laser procedure that can permanently turn brown eyes blue in 20 seconds. WNA provides the soundtrack: “Colored contacts, with you I’m through; That laser beam oh, it’s so brand new; Doctor Gregg now, let your aim be true; And don’t it make my brown eyes blue.”

Sponsor Updates

• Medicomp Systems announces that Quippe, powered by the MEDCIN Engine, is now embedded into MED3OOO’s InteGreat EHR. Medicomp, by the way, exhibited at MGMA and trained seven people every hour on Quippe.
• The latest newsletter from TELUS Health Solutions includes several articles on using data to drive transformational change in heath systems.
• Virtelligence is participating in this month’s VA and Midwest HIMSS conferences.
• Orion Health CEO Ian McCrae calls out his company’s continued success, calling Orion Health the leading healthcare IT software vendor in health information exchange.
• MedAptus President Larry Hagerty discusses the company’s use of Internap’s cloud solution.
• Carefx will participate in the Midwest HIMSS 2011 Fall Technology Conference in Indiana.
• CareTech Solutions is recruiting 60+ people for installation and support of hospital IT systems.
• Concerro opens registration for its November 29 Webinar entitled, “Achieving Compliance with the Joint Commission’s Staffing Effectiveness Requirements.”
• CynergisTek CEO Mac McMillian is presenting “Data Security – Eliminating Imaging Informatics Risks” at the virtual AuntMinnie.com RAD Expo 2011 November 2-3. He will also  present a Health IT Capstone Course at the American College of Physician Executives Fall Institute 2011 November 8-9.
• MyHealthDIRECT CEO and Founder Jay Mason will discuss the changing landscape for Medicaid health plans at the upcoming Medicaid Health Plans of America Annual Meeting in Washington, DC.

EPtalk by Dr. Jayne

This time of year as it starts to get a little chilly, I think fondly of places where sassy CMIOs can go for some fun in the sun. News from the sun belt: Cigna purchases HealthSpring, which runs the Medicare insurance plan for Miami-based Leon Medical Centers. The $3.8 billion dollar deal brings the plan’s 37,000 Medicare beneficiaries to Cigna and is seen as a major move into the Medicare Advantage market.

The AMA claims a win for helping to extend the deadline for providers to file for hardship exemptions to prevent penalties for not ePrescribing. Not a huge win in my book — the previous deadline was November 1 and it was very well publicized.

Mr. H usually reports on health IT vendor earnings calls and I rely on his summaries because I’m usually looking at pharmaceutical and other industry outlooks. Pfizer admits to its plan to work towards marketing an over the counter version of Lipitor. As the company’s best-selling drug goes off patent, they’re obviously trying to resuscitate their cash cow. The concept of bringing this class of drugs OTC comes up periodically – Merck asked the FDA three times over a seven-year period to allow them to take Mevacor OTC and was rejected every time.

When most people think of healthcare IT, they think of hospital and ambulatory documentation software, revenue cycle, laboratory information systems, and the like. In my opinion, one of the more fascinating breakthroughs is the computing power that helps scientists sequence the genome of various organisms. The journal Nature reports success in sequencing the DNA of Yersinia pestis, the agent that caused Black Death in the mid-1300s. Researchers extracted the DNA from teeth of victims buried in 1348.

I hope the HIPAA compliance zombies don’t hear about this one. The Defense Advanced Research Projects Agency (DARPA) challenges techies to reconstruct handwritten documents that have been shredded. Screenshots of shredded documents are on the Shredder Challenge website. Get your decoder rings ready – winners will be announced on December 5. Should emerging technology make it easy to piece together these puzzles, I’m sure we’re all in for compensatory advances in document destruction technology.

In the weirdest research study of the week, Israeli researchers conclude that drinking cold water increases the resting energy expenditure of overweight children, helping them burn calories. The patients drank water cooled to 4 degrees Celsius while watching a movie lying down. Not exactly my idea of a good time, but just illustrates how desperately people are looking at the obesity problem. I’ve got an idea: how about asking the kids to do stretching exercises or even calisthenics while watching? Bet that would work too.

Bad news for social habits favored by the ladies of HIStalk: a study published in this week’s Journal of the American Medical Association documented a statistically significant increase in breast cancer risk among women who drank small to moderate amounts of alcohol – the equivalent of three to six drinks per week. The data comes from the Nurses’ Health Study, a prospective observational study of over 100,000 women which has produced a multitude of findings.

Contacts

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

News 11/2/11

Top News

Hospitals are becoming more optimistic about their Stage 1 Meaningful Use readiness compared to seven months ago. About 41% now say they are well positioned to meet Stage 1. The HIMSS Analytics report also finds higher adoption rates among academic medical centers and larger hospitals.

Reader Comments

From Marquis: “Re: Dr. Jerry Stonemetz. He’s a world-famous anesthesiologist, an expert in anesthesia information management systems, and head of anesthesia services at HCA. All told, he is a very cool dude. He writes a blog about AIMS, but recently incorporated his other passion (wine) into the blog. It’s not exactly HIT, but it is kind of fun. And our industry could use more fun.” I agree that HIT needs fun, as well as more wine. Dr. Stonemetz’s first post includes tips on how to create a wine cellar and is geared to those of us who lack the discipline to accumulate wine ahead of consumption.

From Lee: “Re: new Siemens announcement about Soarian for small hospitals. Looks like the death knell for MedSeries 4. I’m sure they will deny it, otherwise they would be sending 200+ clients to the RFP mill.” One big lesson learned from reading the Steve Jobs biography and Vince’s HIS-tory of failed HIT vendors: companies should not offer products that overlap each other or confuse customers (not to mention products that force a company’s own salespeople to compete with each other).

From LeBronze: “Re: Meaningful Use. Good thing CMS is there to answer our questions.” LeBronze forwarded the transcript of auto-generated responses he received in response to a question he posted on CMS’s EHR Information Center about criteria for maintaining a problem list. His question was filed on August 18. Nine auto-responses and escalations later, he still doesn’t have an answer after more than two months.

From Flow: “Re: Endo Pharmaceuticals. It acquired Urochart recently, and now has acquired its major competitor in the urology EMR space, meridianEMR. Meridian had filed an infringement lawsuit against Urochart.” Verified, apparently. According to Endo’s earnings announcement last week, it has made “strategic investments in Intuitive Medical Software (IMS) and meridianEMR, Inc., two providers of electronic medical records for urologists. Together, IMS and meridianEMR provide access to approximately 1,800 urologists using data platforms that will enhance service offerings in urology practice management.” I always like to read the executive bios and found some fun facts about the folks who run meridianEMR: CEO and Chairman Michael Custode was the designer and architect of the Medic Vision PM product that Misys bought; CMO Herschel Jackson MD developed the ScriptLetter prescription writing system; CTO William Bartlett is a Certified Ethical Hacker; and Chief Software Architect G. Ralph Kuntz MD, MS wrote the link-editor and dynamic linker for the UNIX C compiler for Bell Labs.

From Kaity: “Re: sales job. I’m an avid reader of yours and I LOVE your blog. I’m a software sales rep who likes listening to customers and understanding how the products I’m selling can make their lives better. If you were going to sell software to hospitals, what are your Top 3 target companies? (probably not EMR since that ship has sailed with everybody buying Epic).” I’ve spent almost my whole career working in non-profit hospitals, so I have only limited experience working for a vendor and none working in sales. Luckily, what I do have are smart readers who have my back – if you’re one, feel free to leave a comment giving Kaity some ideas. She put “love” in all upper case, so I figure I owe her.

HIStalk Announcements and Requests

Here’s a shout-out to Dave Dillehunt, CIO of FirstHealth of the Carolinas, who gave me a brilliant idea. He said nobody would mind how long it takes the main HIStalk page to load if there was a way to display the article itself first, with the sponsor ads and other sidebar content loading in the background. I didn’t think that was possible, but after some Googling and fun Javascript programming (not me – I hired it offshore) it’s magic – the article scrolls out almost immediately and everything else quickly follows. Sounds minor, but it’s much more satisfying to start reading so quickly. I may create a HISsies category just for Dave to win.

Acquisitions, Funding, Business, and Stock

Fortune profiles appointment-booking site ZocDoc, which is now available in 12 cities. The company, which has raised $95 million in funding, hints that it collects enough patient information that it could create an application that would allow them to self-register at practices and hospitals.

Sales

Orlando Health’s Physician and Professional Services Group expands its relationship with VisiQuate, a provider of enterprise performance management tools.

Spartanburg Regional Healthcare System (SC) contracts with Wellsoft for its EDIS, which it will integrate with its McKesson systems.

Brown & Toland Physicians (CA) selects the Allscripts Community Record, powered by dbMotion, for its 1,500 physicians.

Central Ohio Primary Care Physicians chooses eClinicalWorks for its 230 physicians.

Centracare Health System’s St. Cloud Hospital (MN) selects Merge Healthcare’s iConnect vendor neutral archive (VNA) and iConnect Share. Also, HealthPartners chooses iConnect VNA for its enterprise-wide imaging strategy.

People

MedHOK appoints Rahul Singal, MD as its chief medical officer. He’s a former president and CEO of WorldDoc and was VP and medical director of Southwest Medical Associates.

Announcements and Implementations

Oakland Physician Network Services (MI) extends Michigan Health Connect’s HIE solutions to its 425 physician members.

Healthland EMR client Glacial Ridge Health System (MN) becomes the first hospital in Minnesota to achieve Meaningful Use under Medicare’s EHR incentive program.

Cerner implements Oracle Enterprise Manager to support cloud-based services.

Children’s Hospital and Health System (WI) begins training users on its new Epic system in preparation for a go-live in late 2012 or early 2013. The project will cost $120 million over five years.

Convergent renames its RCM division Convergent Healthcare (formerly AHC) and introduces its Convergent CARE product line.

Ohio State University Medical Center goes live on iSirona’s device connectivity solution, connecting 700 wired monitors and wireless ventilators to Epic.

Iatric Systems launches EasyConnect Jaguar, an advanced healthcare interface engine.

Denver-based virtual clinician desktop vendor AventuraHQ hires 15 new employees, most of them in sales and marketing, following its first round of institutional venture funding.

Innovation and Research

The Robert Wood Johnson Foundation announces its Aligning Forces for Quality (AF4Q) $100,000 app challenge, designed to encourage the development of easy-to-use online tools that consumers  can use to find quality information on their local physicians and hospitals. The deadline for the competition’s first phase is December 31, 2011.

Technology

Penn Medicine adds a second pilot using its Penn Research Trial Advisory software, a homegrown application that flags candidates for clinical trials. It’s programmed to look for specific patient criteria that fit current clinical trails and delivers a pop-up alert when medical staff enter patient data into the hospital’s EMR.

Other

Peirce College (PA) will use software applications from QuadraMed and 3M in its new Health Information Administration bachelor’s degree program.

A Wolters Kluwer Health survey of physician finds that search engines like Google and Yahoo are second only to professional journals and colleagues as a source of information for diagnosing and treating patients. The same study lists physicians’ top barriers to technology adoption: too expensive, too much data and not enough actionable information, too hard to learn, and too hard to use at the point of care.

Siemens Healthcare announces its commitment to deliver its Soarian solution to small community and rural hospitals. Siemens recently implemented Soarian Clinicals at the 70-bed Platte Valley Medical Center (CO) and at the 202-bed Palisades Medical Center (NJ).

George Reynolds, VP/CIO and CMIO of Children’s Hospital and Medical Center of Omaha, tells me they’ve decided to go with Epic (displacing Allscripts on the inpatient side, I assume.) They were already using Epic ambulatory. Phase 1 will go live in early 2013 with inpatient, ED, pharmacy, and surgery. If you don’t know George, check out his credentials: he’s an MD, has a Master’s in Medical Management, was director of pediatric critical care at University of Nebraska Medical Center, and now is both CIO and CMIO at Children’s. Not to mention that he’s a funny guy. I need to interview him sometime.

What might have been: as Steve Jobs was near death, he was sketching plans for an iPad holder for hospital beds and designs for other hospital equipment.

Doctors  know that text messaging patient information from smart phones may violate HIPAA, but it’s so efficient that they do it anyway.

Researchers find that gastroenterologists who listen to Mozart during colonoscopies improve their precancerous polyp detection rates from 27% to 36%.  Other bodies of research has found that listening to Mozart’s music may result in significant short-term improvement in spatial temporal reasoning.

Weird News Andy finds that this sad story sets the pace. A man living in a Chicago group home tells staff he’s having chest pains and asks them to call an ambulance while he waits in his room. Paramedics arrive, and noticing a puncture wound to his chest, think someone stabbed him. Someone did: the man himself, who cut open his own chest to try to remove his pacemaker. He died in the hospital.

Sponsor Updates

• The Advisory Board Company will host a conference on transforming physician talent development on November 14 in Washington, DC.
• Encore Health Resources will participate in this week’s Louisiana HIMSS 2011 Fall Conference.
• DIVURGENT is attending the Virginia HIMSS 2011 Fall Conference and the Midwest HIMSS Fall Technology Conference.
• API Healthcare will participate in the HealthcareSource User Conference in Las Vegas.
• Florida Hospital Celebration Health implements the GetWellNetwork solution in its new patient care tower.
• Cumberland Consulting Group promotes Lindsay Lopez to executive consultant.
• Hayes Management Consulting announces its new inpatient consulting division, which will be led by Amitav Hajra, formerly of Epic Systems.
• Stockell Healthcare Systems receives ONC-ATCB certification for its InsightCS Revenue Cycle Information System.
• Eastland Memorial Hospital (TX) and Hamlin Memorial Hospital (TX) qualify for Meaningful Use money using the Prognosis ChartAccess Comprehensive EHR. Eastland signed their contract in February, went live in June, attested in September, and got their check in October.

Contacts

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

Monday Morning Update 10/31/11

From What About Bob?: “Re: HIT Stack Exchange. Took a year to get enough people to commit, now we need the masses to ask and answer questions so the site can survive. Give us nerds some love.” HIT nerds or nerd-wannabes should take a look.

From Orlando Cepeda: “Re: Dr. HITECH’s Rainbow Button Initiative Rap. Lyrics are here.” Ross did great with these. Here’s a section where he lyrically explains the VA’s Blue Button medical record download:

I been to far-off lands, tryin’ to do what’s right, I had dreams and plans, when I got caught in a firefight.
Now back in the states, I’m a wounded warrior, all my doctors are great, but sometimes I ain’t sure,
Exactly how to keep it straight, or know just how to navigate, all my meds and lab results, and how they relate,
But now I push the Blue Button, and it’s all there to see, just a click of the mouse, and it all comes to me. 
And it’s not just for this vet, heck that ain’t nuttin’, just see what stuff *you* get, when you hit the Blue Button.

From Arcturus: “Re: exposure. You recently mentioned our company on HIStalk. We got several inquiries from companies wanting to be a VAR for us, several VCs inquired, and it caused some buzz. Very much appreciate your doing this.” My pleasure. If I’ve heard about something and it interests me, I’ll almost always mention it. It does get a bit tough when companies try to press me to write about them and (a) I don’t find their product or service all that interesting, or (b) I’m too busy. People sometimes forget that HIStalk is an after-work thing for me, meaning I can’t chat on the telephone during hospital working hours and I’m not usually willing to give up some of my handful of free hours each week to watch a demo or comment on a white paper, especially if it’s a company or person I’ve never heard of.

Three-quarters of respondents say it’s silly for docs to be required to crank out engaging, unique narrative for every repetitive patient encounter, but a fourth don’t want HHS paying for encounters described in boilerplate. New poll to your right: can healthcare reform’s needed improvements in cost and quality be realized with today’s IT systems?

My Time Capsule editorial from 2006: Misys Lesson: Mama, Don’t Let Your Vendors Grow Up to Be Conglomerates. I don’t like to show paternal favoritism toward my editorial offspring, but I admit this is one of my favorites, with hyper-caffeinated ramblings like, “Why did a British financial software company get into the US healthcare IT market in the first place? Well, let’s just say it wasn’t a noble desire to better humankind. From their Web site, ‘The main objectives were to reduce the Group’s exposure to a single market (insurance) and to increase its size in an already consolidating software sector.’ That’s about as unemotional as an accountant’s nimble calculator fingers determining the net present value of three dinners with Myra the secretary vs. the potential passion-filled payout.” 

Unrelated (mostly, anyway – it does involve exercise and personal motivation) but for a guaranteed Monday morning smile, check out this brilliant commercial for Contrex mineral water, which I can’t get out of my head. I know Inga will like it.

The merry pranksters at Epic put up a Halloween-inspired Web page that includes interactive spider-smashing. I’m sure it will be gone after Monday, so last call.

Encore Health Resources announces that Joe Boyd has replaced co-founder Ivo Nelson as board chair. Boyd has been advising the company for the past 18 months and has worked with Ivo and CEO Dana Sellers before at Healthlink, where Joe was board chair, Dana was president and COO, and Ivo was CEO until they sold the company to IBM in 2005. Encore has been quickly ramping up revenue and headcount and was named the #2 best HIT advisory firm by KLAS. Ivo will remain on the board.

Coincidentally, I’d been thinking for several days about something Ivo told me in my 2009 interview, reminded of it while reading the Steve Jobs biography:

This is nothing more than me doing what I love to do. If it leaves a legacy, I think that’s OK, but I’m not sure what you really get out of that. When I’m hopefully up in my 80s or 90s and I pass away, the people that are going to come to my funeral are going to be my family. It’s not going to be clients. It’s going to be people that are close to me personally in my personal life, my kids and my sisters and a handful of friends probably that I have. That’s a legacy. You say, "What kind of legacy would I want to leave?" and it would be a legacy that’s more related to being a good father to my children and being a good husband to my wife. That kind of stuff. Not anything I do professionally.

Inga encroaches on Weird News Andy air space in summarizing this story as, “I guess the guy wanted the doctor to give him a hand.” A homeless man with a history of mental problems rushes into a urologist’s office gushing blood, saying he had just accidentally chopped off his arm on a homemade guillotine. Nurses call 911 (probably the best course of action for a urology practice dealing with an amputation,) and when police check out his wooded camp, they find a huge guillotine built from scavenged timber, along with his recently severed arm. One world-weary police officer observed, “My goodness, a lot of thought went into this.” One can only imagine the intended purpose of his handiwork given that his self-amputation was accidental.

Vince’s HIS-tory covers a company I’m not familiar with: Computer Synergy. He says its product was so progressive that its still running in dozens of hospitals and its successor firm was just acquired a few months ago, with details coming next time.

Shareable Ink CEO Stephen Hau is named Innovator of the Year by the Nashville Technology Council. They haven’t posted pictures of the winners yet, so I’ll go with a company team lunch pic that I found on Facebook, with Stephen on the right.

CHIME Foundation gives Allscripts CEO Glen Tullman its 2011 Lifetime Achievement Award.

Omaha-based transplant systems vendor HKS Medical Information Systems is acquired by an investment group led by Argenta Partners LLP. Louis Halperin is named CEO and Paul Markham COO.

AventuraHQ names neurosurgeon and venture partner Teo Dagi MD as CMO. How about these educational credentials: Columbia undergrad, Hopkins MD/MPH, Harvard MTS, Wharton MBA, Queens University DMedSc. I profiled Aventura, which offers a virtual desktop for efficient clinician access, in July.

Small hospital systems vendor CPSI announces Q3 numbers: revenue up 2.8%, EPS $0.54 vs. $0.45, missing expectations by quite a bit and falling short of previous guidance. System sales were down, which is not exactly cheery news knowing that the HITECH effect is close to peaking. Shares were hammered, taking a 28.5% haircut at Friday’s close as the Nasdaq’s biggest percentage loser by far. Above is the one-year chart of CPSI (blue, straight vertical line on the right) compared to the Nasdaq (red) and S&P 500 (green). The stock had been climbing nicely, but tanked enough in a single day to barely put it above the indices for the year. Market cap is $564 million.

Speaking of stock, shares in MedAssets jumped 14% Friday, with an analyst attributing “weakness across the rest of the health IT group” that includes Cerner, Quality Systems, and CPSI. Michael Cherny of Deutsche Bank Securities says MedAssets “has no exposure to electronic health records” like those previously mentioned EHR vendors whose earnings reports this week were “disappointing” or “confusing.” That may just be a reaction, however, since after-hours trading shows MedAssets, which reports earnings Thursday, giving back the full amount of its Friday gains. And while MDAS shares had a nice Friday, the past 12 months haven’t been nearly as kind, with shares down 40%. The one-year share price graph shows compares MedAssets (blue), Cerner (green), and Quality Systems (red).

The Rockford, IL paper covers the HITECH status of local hospitals. OSF Saint Anthony uses Epic and has been paid $2.5 million in MU money. SwedishAmerican, with Meditech and Epic, has earned $7.5 million for the hospital and $4.5 million for physician practices. Rockford Health is installing Epic in its practices and hospital and will attest in 2012 and 2013, respectively.

For my techie brothers and sisters: Tom Munnecke (software architect, VistA) has an after-dinner chat with Ward Cunningham (inventor of the wiki) and Ralph Johnson (computer science professor and author) on the subject of “refactoring",” specifically with regard to VistA. Tom’s iPhone made a darned nice video with good audio. It’s kind of like Live from Daryl’s House for geeks. I got myself thinking about my techie sisters reference – nothing’s more attractive than a smart, cynical female programmer, of which there are sadly too few.

Meaningful Use and Beyond, a book by Fred Trotter (healthcare open source expert) and David Uhlman (CEO of open source EMR vendor ClearHealth), is published by O’Reilly.

The Federal Trade Commission will require the parent company of prescription data vendor IMS Health to sell two product lines of its acquisition target SDI Health to receive FTC’s approval for the sale to occur. SDI’s tools for promotional audits (estimates drug marketing costs) and medical audits (analyzes physician prescribing by condition) would give IMS Health a monopoly, according to the complaint by FTC, which must approve the buyer of the two product lines.

I feel like a Facebook stalker for posting this, but I will anyway. I noticed a “Like” for a recent post from Mark Work, IT director at ProMedica Health System in Toledo. Checked out his info, it linked to a site for Madison Avenue Band, a ten-piece cover band with horn section and no computers (thank goodness.) Check the video above – these guys (including Mark, I assume – looks like him on keyboard, but I’m not sure) are real-deal rockers. Check out this smokin’ version of “Vehicle” and here of “Wild Nights.” Not only do I love the music, Mark’s Facebook pics are a trove of cool 70s music history – Foghat, Uriah Heep, ELP, Queen, Foreigner, Heart, Styx, and Yes. Well worth my half hour to watch the videos and check out the pics. My arms are tired from air-drumming.

Cisco CEO John Chambers and the King of Jordan launch the Jordan ICT Task Force, which will promote Jordan’s HIT vendors.

GetWellNetwork is named Emerging Business of the Year by the Montgomery County (MD) Chamber of Commerce, which featured the company in a three-minute overview video.

A state-mandated Web site that allows Ohio consumers to compare hospital performance is apparently going down the tubes. The Ohio Hospital Association is supporting a bill that would eliminate the requirement that hospitals provide their data for the Ohio Hospital Compare site, saying they already send the same data to CMS’s Hospital Compare site that anyone can use.

Texas Health Resources runs an ad campaign around its use of AirStrip Cardiology that includes billboards (“Now Your EKG Gets Here Before You Do”) and TV commercials (above).

Merge Healthcare says 11 radiology practices have bought its RIS v7.0 to achieve Meaningful Use. One of its customers brings up the Complete vs. Modular HER issue, saying, “If you utilize a modular system, you as the provider, the onus is on you to find another product or combination of products that meet the remaining criteria before you can claim to be using a certified EHR and qualify for MU funds.”

Chiropractors are getting their HITECH payments, too.

Medtronic hires Symantec to assess the security of its insulin pumps after a McAfee team demonstrates how a hacker could control them from up to 300 feet away. 

In England, a terminally ill, mostly blind 14-year-old boy has his iPad stolen from his hospital bedside, which had been donated my Make-A-Wish Foundation so that he could enjoy it for the short time until he goes fully blind. All is well, however – a local supermarket was touched and bought him a replacement, with his reaction to it pictured above.

A new poll finds that only 34% of Americans like the Affordable Care Act, while 51% view it unfavorably, the worst numbers since it was introduced last spring.

A Massachusetts court dismisses a lawsuit against Tufts Medical Center, sued by a patient who claimed their faxing of her hysterectomy surgery records to her employer’s fax machine violated her privacy because co-workers read them. The patient had given the doctor instructions to send the records there, but still feels her lawsuit was justified.

E-mail Mr. H.