HIStalk Innovator Showcase–OptimizeHIT 10/28/11

Company Name: ImplementHIT
Address: 4001 S. Decatur Blvd., Las Vegas, NV 89103
Wen Address: www.optimizehit.com
Telephone: 888.457.3332
Year Founded: 2009
FTEs: 20

Elevator Pitch

OptimizeHIT provides an innovative training platform that enables both pre- and post-implementation training to significantly drive clinical adoption via a more comprehensive, yet easy way for physicians to access the training curriculum.

Business and Product Summary

OptimizeHIT offers a sophisticated, physician-friendly, dynamic EHR training portal. OptimizeHIT’s staff, comprised of MD EHR experts and PhDs in education, have developed innovative, patent-pending learning technologies that integrate seamlessly with any practice setting or specialty. With proper EHR training significantly impacting the success or failure of any implementation, OptimizeHIT’s training suite delivers powerful and relevant training that is easy for physicians to access, significantly reducing the time they spend out of clinic to learn how to use the EHR.

With this technology, organizations are realizing higher rates of clinical adoption beyond Meaningful Use, with a bonus of significant cost savings via a reduction in trainer hours consumed during live training time and time physicians spend out of clinic for training. Management can view learner progress on training as well as their productivity in graphical form, using real-time implementation statistics, and objectively understand the status of each site’s implementation. The solution can also allow on-site support to customize each physician’s learning curriculum to their specific knowledge gaps, keeping their learning time focused on what is most needed for them to learn.

Our cost model is based on per month/per user charge, which can accommodate a small physician’s practice or clinic as well as large, multi-location hospitals. Furthermore, we recently introduced a new no-risk pricing model, where there is no cost per user till a user actually completes their basic EHR training. Once a user becomes an intermediate or advanced user, the EHR benefits to patient safety and ROI quickly climb in to the $1000s per provider.

Target Customer

Large academic hospitals all the way through two-physician practices use this solution successfully.

Customer Problem Solved

Clinical adoption. It is when physicians achieve intermediate- and advanced-level use of an EHR that the greatest patient safety benefits and cost savings are realized. Our portal is built specifically for health IT training, recognizing the unique challenges of training physicians and other healthcare professionals with very little spare time. We are not only getting physicians ready for Meaningful Use Stage 1, but later phases and beyond. Customers live with the portal can easily distribute system upgrade training, new best practices, and even ICD-10 training when the time is right.

Competitors

Other groups that provide standard EHR training with go-live being the end point, like most EHR vendors and a few specialized service consultant groups. However, no one else offers a solution that targets post-implementation training, and that is where you achieve the most efficient leaps in EHR use.

Advantages Over Competitors

We don’t recommend moving all pre-implementation training online, but through a hybrid approach that was featured at HIMSS this February in a presentation by one of our customers. We want to minimize the amount of time physicians must spend out of clinic to learn. Furthermore, we know that physicians learn more advanced features of the EHR a lot faster once they have had an opportunity to use an EHR, which is why our portal integrates the more comprehensive post-implementation training. By providing one integrated solution for pre- and post-implementation training, along with enabling implementation management to see learning and productivity progress in real time, we are much better than any competitor.

The system is also task-based, which means it is more relevant to the learner instead of talking about EHR modules that are abstract for beginner users. Furthermore, because it is task-based and since we deliver standard EHR tasks from beginner to advanced — including Meaningful Use for 10 specialties — the effort to customize the learning content down to the physician specialty is greatly reduced, which makes the content far more relevant and meaningful to the learner.

Pitch Video Created Specifically for this Showcase

Customer Interview (an applications trainer for a large orthopedic practice)

What problems have you solved using the OptimizeHIT technology and what has been the overall impact on the practice?

The first problem solved by using OptimizeHIT’s computer-based training (CBT) modules was improving our training model as we began to prepare our EHR rollout. We were looking at hours of preparation and actual classroom training time with users who were all over the map in terms of PC skills. It was a daunting project and would have required users to be out of clinic and coming in for Saturday training classes as well, which would have meant overtime for some employees. While we still had a few Saturday classes, it was held to a minimum. Our providers never had to take time out of clinic and the overtime was also kept to a minimum.

Anyway, then I was introduced to Andres by a friend, and as soon as I started talking with him, I knew we would work together. His company created customized CBT modules for us using our workflow and screens so that our users were learning how to use the EHR on screens that were our screens – it wasn’t a generic or canned version of training. They worked closely with us to make sure the training modules included great detail. We were able to put much of the responsibility for basic training on the users and they rose to the challenge. We did have to manage the process, checking to see that they were completing the CBTs and where they were weak so we could do focus training with them. But for the most part, our employees did a great job. For those who needed a bit of encouragement, they got “the e-mail” reminding them their CBTs were mandatory.

As far as the impact on the practice, I would say that our users, especially our medical assistants, were well prepared on their first day of live. By the end of the first week, they were fairly confident users. We intentionally designed the training process so that the medical assistants could act as a resource for their providers and they do just that.

If you were talking to a peer from another practice, what would you say about your experience with OptimizeHIT?

To be honest, I’d say don’t even try to train your users without really well designed CBTs, and that you can’t go wrong with OptimizeHIT. They are professional, efficient, epitomize customer service, and even more, they are kind and are comfortable with humor. It was just fun to work with this company and we ended up with an excellent product. I have said exactly that to other organizations.

For those of us who have been in this field for a few years, we have recognized for years that end user training/education is the great hole in the process of implementing healthcare software. Vendors have not, historically, educated the clients (there’s a difference between training and education) and in turn, the clients do not understand the importance of educating their users. With healthcare records, you want confident, accurate users and that means educating them to use the system, but to also think about their use of it critically. Andres and OptimizeHIT focus on exactly that – they are combining adult educational concepts with technology and offer it to sites. 

We call it the gift that keeps on giving. Besides training users for our rollouts, we now use the CBTs for new hire training, upgrade training, user review etc. We are also looking forward to using their new tool to create a post-implementation educational process as a continuing education requirement for our clinical staff and providers.

How would you complete this sentence in summarizing for them: "I would recommend that you take a look at OptimizeHIT under these circumstances:"

If you are a mid- to large-size organization and have a small EHR build/training team, you will simply not be able to meet the demand of build, workflow design, workflow validation, and training. And if you don’t have anyone on staff that has a background in adult education, then you need to consider using this company.

If you’re planning on taking your users through a set of screens and allowing them to do hands-on once or twice – you cannot really consider them educated, and it will show when you take the system live. They will have no confidence and won’t even know when they are making a mistake, so they won’t be able to report it. It could be months or longer until you see that your users are failing to use the system accurately or efficiently.

An interview with Andres Jimenez MD, CEO, ImplementHIT

What’s wrong with the way organizations train physicians to use technology?

There are several issues. Implementation is typically the endpoint of most training curriculums designed for health IT implementations. The challenge is that without the user ever using a system, it’s impossible to teach them everything they will need to know to become an advanced user. Maybe not impossible, but extremely difficult and inefficient.

The challenge with trying to move your training over time to extend it beyond implementation is having a vehicle or a platform like ours to deliver just-in-time training that’s convenient, relevant, and very powerful for end users and extends beyond implementation and builds upon the experiential knowledge that users gain after the first week or two of using an EHR, where learning more advanced features is far more efficient.

Tell me about the technology that you use. I know you have or are seeking a patent.

It runs on Google Web Toolkit, Google Apps Engine. It’s kind of like Gmail for training. It essentially is real-time, Web-based technology. We’ve structured it in a way where it provides real-time statistics to management. It allows us to plug into practice management systems so we can deliver to learners who may be physicians. We can deliver to them real-time productivity metrics, like how many patients are they seeing per day, how is their increase in learning affecting the number of patients they’ve seen per day, how they’re billing, their level of coding. We’re able to pull that data real time. That’s one of the ways that’s very, very unique.

Very often, training and on-site support are two different processes going on in an implementation. We try to combine them, because we feel on-site support is a great opportunity to further the user’s knowledge on the system. We’ve provided input so that the on-site support personnel can continue to assist learners and then they can fine-tune or focus their training curriculum. If the doctor has 10 minutes or an hour to log in to the training programs late at night, they can focus in just on their specific knowledge gaps instead of starting from scratch. That’s another thing that I think is very innovative about the program.

We really feel that it’s going to become the future of health IT training, where it’s task-based, it’s not necessarily module-based. We can assign specific task-based skills that are usually on the two- to three-minute timeframe or are using bite-size training clips. We can assign specific ones to learners based on their role, based on their specialty, and even within two specialties that are different sites. We can customize training at that level. That makes it very relevant, and that’s very important for adult learners.

I’m sure one of the things that you’ve experienced both as a physician and an entrepreneur is that physicians typically don’t like to sit in a classroom with other physicians. Either they get frustrated with the pace or they just don’t feel like they’re being treated individually enough. Is what you’re offering an alternative to that, or is classroom training still a part of their experience? How do you feel about how classroom training works with doctors?

You’re absolutely right. That is one of the challenges that we hear from other physicians. I think on-site training still has an important role. One of our customers at HIMSS this past February presented some results where they were able to reduce the amount of training time, to cut training time in half because they had a Web-based component and a live training component.

Another one of our customers was able to train their physicians without any time out of clinic before the implementation. Now that doesn’t mean that they didn’t do any on-site live training, but what it means is that they were able to move a significant component of the pre-implementation curriculum to a Web-based component through our platform. Then they were able to focus in the on-site session just what the learner needed to go live and do well those first two weeks. Then, since they have the platform, they can allow the users to progress in their use and start learning more advanced functions at their own pace.

So I agree, the traditional on-site training approach has its weaknesses. A curriculum that only relies on that is part of the reason that you see so many implementations failing, because you can’t get that customization. But even on other types of computer-based training, we’re not the only ones that deliver a training online, but our platform allows to do it in a way where it’s very easy to customize it.

One of the other challenges that we see is that many vendors offer e-learning that is just a number of clips by modules in the EHR that are geared towards one specialty. If you’re a cardiologist, the last thing you want is sit down and watch training – especially when you’re having a busy day – with the clinical context of a kid with an ear infection and how to take care of him with the EHR. We make it easy to inject that relevance in training with our platform, which is extremely important for adult learning to get their interest piqued and  their attention level is high. They really learn, and when you want them to perform, they’re able to recall that information.

How do you convince a prospective client who plans to do their own training or pay the vendor to do it to that they need you instead?

We partner with many vendors, so we never want to go necessarily head-to-head with the vendors. They certainly have their place in providing training, but the challenge for most vendors is that they’re scrambling right now just to acquire market share. They haven’t necessarily been able to provide the focus needed on a very specialized approach on training. Not just training that gets them to use the basics, but that drives to Meaningful Use and beyond, where you get the advanced features and the greatest safety benefits for your patients and the greatest return on investment.

We typically tell our customers that we’re providing a platform that is very innovative. It will help your users get to advanced clinical adoption faster with less of an impact on overall productivity. One of our customers was able to get their physicians to full productivity about a week after implementation. That had a huge impact for them. They’re an orthopedic group and some of their physicians see 60 patients per day. We combine our training with the phased rollout approach to make sure that they can return to full productivity. Those are the things that are very important to a lot of customers.

Obviously cost is a factor. We’ve been able to show, for instance at HIMSS this past February, a return on investment of $6 for every $1 invested in our training. 

It’s important for our customers that this platform stays around for awhile. While they may have a cost incurred on just the implementation training, they’re working with the vendors, etc. our platform can stay around. They can start with Meaningful Use functionality and the platform, but right around the corner, there are updates from the vendor, ICD-10, and many other initiatives. They can build into the platform additional training. That’s been very important to our customers. They can do that on their own.

What do you hope to gain from this exposure?

We really feel that our platform is going to be future of health IT training. The fact that not all computer-based training is created equal, that our training specifically drives adoption, gets folks to full productivity faster, and we have a number of customers that have really appreciated and seen the benefits of that. 

What I’m hoping to get from the exposure is actually people getting the chance to hear about us. We’re a small organization, so we don’t have the advertising budgets or the large-scale sales team that existing companies have. Because we’re a smaller group and very innovative, we’ve been able to produce a platform that’s very cutting edge. We’re hoping with this exposure that we can get the word out and more people come on to our site and learn. We’re happy to provide more demonstrations and happy to connect prospects with existing customers, because they’ve been our greatest sales force to date.

News 10/28/11

Top News

Cerner announces Q3 numbers: revenue up 24%, EPS $0.45 vs. $0.36. beating estimates excluding one-time items and raised guidance. The conference call transcript is here. Cerner says customers of an unnamed competitor (Epic) are concerned about their vendor’s ability to keep up with Meaningful Use requirements beyond Stage 1. It also says Epic’s customers are vulnerable to Cerner poaching because of Epic’s deficiencies in ACO readiness, lack of analytics capabilities, and poor total cost of ownership. Recently announced products were mentioned, as was the company’s acquisition of Clairvia and hints that other acquisitions may be forthcoming as “the clock is ticking” in acquisitions starting to look less attractive. It’s also implied that competitors (again, that would have to be Epic) may be getting bottlenecked in their ability to start implementations promptly.

HIStalk Announcements and Requests

This week on HIStalk Practice: daily reports from Las Vegas on MGMA’s annual conference. Mr. H declared I was “full of myself” (harrumph), but you will have to read the updates and make your own assessment. The posts include impressions on various speakers (Dr. Farzad Mostashari and Intel’s Eric Dishman were my favs); assessments of the hottest topics (connectivity, communication tools, and more); the exhibits (nice booths, annoying Elvises, a bit of technology, and the best giveaways); and, of course, hot shoes. Thanks for reading.

Listening: The Black Keys, an Akron-based white nerd duo whose Brothers album sounds like bluesy soul from the early 1960s (but they really rock out on earlier stuff in no-frills ‘70s Ted Nugent fashion). Excellent. And “Not Listening” despite a reader’s calling it to my attention (“Holy Shatner,” he said): yet another hideous and uber-hammy William Shatner non-musical recitation, this time to the tune of Queen’s Bohemian Rhapsody, making his previous masterwork Lucy in the Sky with Diamonds sound like Beethoven by comparison. If you like Star Trek, Queen, music, or your sanity, you’ve been warned because it will bore into your skull like an earwig (entomologically incorrect, I know, but an apt metaphor.) I suppose we can all only dream of being as cornily popular and scorn-immune when we reach Bill’s age (80).

Jobs on the sponsors-only Job Board: Project Specialist I, Account Manager, RVP Sales – Ohio Valley Territory. On Healthcare IT Jobs: Lab Information Systems Analyst, Regional Sales Executive, Epic Security Analyst, Network Administrator.

Acquisitions, Funding, Business, and Stock

Perceptive Software increases its Q3 revenues by about 15%, but less than parent company Lexmark says it expected when it acquired the company last year. Perceptive contributed $23 million of Lexmark’s $1.03 billion in quarterly revenues.

UPMC announces Q operating income of $155 million on operating revenue of $2.4 billion. A year ago, operating income was $93 million. The gain includes $36 million for demonstrating Stage 1 Meaningful Use.

McKesson’s earnings call transcript is here. There wasn’t much new about the technology division, other than profit was up 25% excluding an impairment charge. Analysts who asked questions were more interested in Lipitor and flu vaccine.

Healthcare billionaire Patrick Shoon-Shiong’s NantWorks acquires Ziosoft, a Japan-based vendor of supercomputing software that merges data from a variety of medical images (CT, MR, ultrasound) to allow 3D, 4D, and 5D analysis for diagnosis. The company will be renamed Qi Imaging everywhere except in Japan, where it has 2,000 of its imaging workstations installed.

NextGen parent Quality Systems Inc. reports Q2 numbers: revenue up 32%, EPS $0.35 vs. $0.23. A two-for-one share split took effect Thursday.

Sales

Meditech announces eight new clients.

The Virginia Department of Health awards Community Health Alliance a contract for the statewide HIE. CHA’s strategic and technology partners include MEDfx (IT services), MedVirginia (support services), Troutman Sanders (governance), and Verizon (HIE platform.)

The VA gives Harris Corporation a two-year, $5.3 million contract to transition its billing to ICD-10.

Tucson Medical Center selects MethodCare’s Charge Recovery application to improve coding compliance and identify missed charges.

Shamokin Community Area Hospital (PA) selects ProVation MD for gastroenterology documentation and coding.

People

BridgeHead Software appoints Jim Beagle CEO and president. Former CEO and founder Tony Cotterill will serve as executive chairman of the board and as EVP and chief products officer.

Allscripts appoints Catherine Burzik, president and CEO of Kinetic Concepts, to its board of directors.

MGMA and ACMPE name David Bowman, MD Physician Executive of the Year for outstanding leadership to achieve exceptional performance in healthcare delivery. He is executive director of IPC The Hospitalist Company.

HealthTech Holdings, the holding company that owns HMS, MEDHOST, and Sentry Healthcare Services, names Alan MacLamroc CTO and Geoff Roten CIO.

Announcements and Implementations

Houston Healthcare goes live on Meditech on October 31. CIO Robert Rhodes indicates the organization has invested about $6 million to implement the system.

Springfield Service Corporation and its subsidiary Laguna Medical Systems rebrand into a single organization named SPi Healthcare. The company specializes in RCM, health information management, and ASP hosting.

Piedmont Healthcare (GA) partners with TeleHealth Services to implement TeleHealth’s TIGR system for on-demand patient education and interactive communication.

Aetna President Mark T. Bertolini tells investors that its Medicity subsidiary has a $200 million contract revenue backlog and recently launched its iNexx application store. On supporting the ability of consumers to pay for medical services at the point of sale, “We also can now real-time auto-adjudicate a claim on a smart phone at the doctors office, by the consumer or the provider should they choose to do that, because we’ve now been able to create real-time auto-adjudication connection mobilely. The real issue, the ultimate issue here is whether or not people have the incentive to use it. And I think that’s where plan designs and the accountable care organizations and how they link to these platforms — that’s why we bought Medicity, will create people’s ease-of-use in using the system and using this technology to make decisions at the point-of-sale. And that’s ultimately where this needs to head.”

Olympic Medical Center (WA) signs on as an affiliate of Swedish Medical Center, with OMC’s CEO touting as a key benefit its access to Swedish’s Epic system. He said Epic is “the best” EMR and that 75% of Seattle-area hospitals will be running it.

Government and Politics

US Representative Tom Marino (R-PA) introduces legislation to create a system for reporting potential medical errors that occur when using EHRs. It would include protection that provider-supplied information could not be used as a legal admission of wrongdoing.

The VA announces plans to remove an inappropriate restriction on data sharing with the Department of Defense. The update would allow the VA to share information about treatment for drug abuse, alcoholism or alcohol abuse, HIV status, and sickle cell anemia.

CIO Roger Baker talks up the VA’s use of iPads, starting with access to VistA, but  potentially expanded to include tablet-based access to physiologic monitors, blood chemistry results, and full-motion video to support telehealth.

Innovation and Research

The folks from Project HealthDesign (a project of the Pioneer Portfolio of the Robert Wood Johnson Foundation) sent over an “early findings” presentation on using patient-sourced data in treating chronic conditions. They’re testing apps to determine how to collect “observations of daily living” (ODLs) from patients and how clinicians can use that information to help them manage their health. The five projects involve a smart phone-based inhaler study, iPad tracking of Crohn’s disease ODLs, sensor-based tracking of senior citizen task completion, smart phone collection of ODLs related to high-risk infants and their caregivers, and an iPod Touch study of activity and exercise in obese teens. Caregiver challenges: clinician workflows need to be developed to use the incoming information and EMR limitations make it tough to store information there.

Technology

Finally, a legitimate HIT shoe story. GTX Corp and Aetrex Worldwide are designing an GPS-enabled shoe to keep track of Alzheimer’s patients. If a patient walks outside of a certain geographic region, a device automatically sends an alert to the patient’s caretaker. Hopefully by the time I am completely demented the shoes will be a little more stylish.

Other

Though shoes are my first love, I also have quite a fancy for lattes from Starbucks. Maybe so does Alvin Mingczech Yee, a California doctor who preferred to meet most of his patients in various Starbucks outlets. A federal grand jury just indicted him on 56 counts of prescribing drugs “outside the usual course of professional practice and without a legitimate medical purpose.” It turns out hat Yee’s patients preferred oxycodone and other addictive opiates over espresso drinks.

Less than 10% of providers believe they are over halfway prepared for ICD-10, with most still in the strategy and planning phases of preparation.

Kaiser Permanente takes the top spot on Computerworld’s list green IT organizations. It earned high marks for data center cooling and its “Keep IT Green” program for brainstorming energy-saving initiatives.

HP changes its mind and says it won’t sell its PC division after all, with new CEO Meg Whitman saying the plan of her predecessor, the fired Leo Apotheker, “makes no sense.”

I ran my interview with Aetna’s Charles Kennedy the same day Emory Healthcare announced that it will operate a Patient-Centered Primary Care pilot with Aetna for its employees and some Medicare patients, which he described in general in the interview.  

I ran a link to a Kirby Partners survey on job satisfaction a few weeks back, so they sent over some of the findings. More than two-thirds of hospital CIOs work more than 51 hours per week, but still grade their job satisfaction as 7.2 on a 10-point scale (managers and directors scored 6.8 and non-management staff 6.2.) An amazing 96% of IT employees said their working conditions are stressful, and 74% of the non-CIO respondents say they’ll be on the lookout for a new job in the next 12-18 months. Short-term departmental turnover, however, is expected to be only 0-3%.

Weird News Andy concludes that there’s no good answer to this problem: an uninsured illegal alien who was paralyzed in a Texas workplace accident has been treated by UTMB for three months, but the hospital says it’s time for him to go back to Mexico since their only obligation was to stabilize him. They’ve offered him a free flight back, but he’s not leaving. A local aid group says Texas has the highest level of uninsured residents in the country, Galveston and UTMB are still reeling from 2008’s Hurricane Ike, and financially strapped state government has cut the hospital’s funding.

Here’s a Disposable Film Festival submission involving puppets, the Rainbow Button Initiative, and music by our cult favorite (and puppetized) Dr. HITECH. It would have been better with on-stage microphones (or maybe some directional shotguns), but it gets easier to hear when the music starts. The idea is that in addition to the government’s Blue Button for one-click patient downloading of their health information, there should be a Red Button (lock your record as private), a Green Button (make your de-identified information available to researchers), and White Button (send your information in CCD format directly to a chosen provider).

Yet another study finds few lives are saved when normal-risk women get a mammogram each year.

An anecdotal article picked up by MSNBC concludes that the use of outsourced radiology services can cause miscommunication and patient harm. It cites the example of an ED patient in a small Pennsylvania hospital who had a contrast CT performed. The digital copy was sent to the hospital’s contracted radiology service in a city four hours’ away, but since they were closed, it auto-forwarded to a radiologist in Hong Kong. He found the problem and noted it in his report, but neither the ED doc nor the radiology service followed up. The patient was discharged, her brain abscess ruptured, and the ensuing 11 weeks in a coma left her brain damaged. The article lists several potential problems since nobody actually talks to each other while looking at films in a dark room these days: outsourced radiologists may just rubber stamp their reports, offshore companies may fraudulently sign reports without having them read by a licensed radiologist, and Indian companies offer cut-rate radiology reads of unverifiable quality for radiologists to pass off as their own when billing.

Google donates 100 Web-only Chromebooks to the American Red Cross, to be used by wounded military members being treated at Walter Reed.

Hartford Hospital (CT) is elated to find its name used in the first iPhone 4S commercial, where a woman is shown asking its Siri personal assistant function, “What’s the fastest way to Hartford Hospital?” Says the hospital’s SVP of strategy on being asked early on by Apple to use its name, “We didn’t even know what the product was. We’d never even heard of Siri before. Knowing it was part of Apple, I knew it was going to be a quality commercial.”

A Massachusetts man convinces his doctor and others to invest in his thriving software company, which he said was about to be acquired by IBM. The company was fake — he spent the money of his investors on a second home and a fleet of luxury cars, supplementing his fraud revenues by forging prescriptions for narcotics. He’s been indicted on a long list of charges. The man says he’s the real victim even though the doctor is out $3.5 million.

Sponsor Updates

• Carefx and Tracline will showcase their technology partnership at EHI Live 2011.
• Inland Northwest Health Services (INHS) goes live on its Spokane Connection project, enabling the exchange of information with the Social Security Administration. The initiative is part of the Electronic Disability Benefits Eligibility Determination pilot project and connects data through the Nationwide Health Information Network Exchange.
• GE Healthcare, McKesson, NextGen, Practice Fusion, and Sage Healthcare will participate in a two-year Medical Economics EHR study to determine best practices for PCPs.
• The Great Lakes HIE and University of Michigan Health System announce a partnership to share patient health information using the Axoloti HIE platform from OptumInsight. Also, Optum and Lifeline Hospital Group (Abu Dhabi) launch Optum Middle East LLC to improve RCM processes and performance.
• Imprivata introduces its OneSign Virtual Desktop Access for Citrix XenDesktop at Citrix Synergy Barcelona.
• St. Peters Health Care Services (NY) adds Thomson Reuters Pharmacy Xpert.
• ZirMed introduces SimpleResponse to simplify payer rejection messages.
• TeleTracking Technologies receives designation as a Support Staff Excellence Center by the Technology Services Industry Association.
• Practice Fusion will host a “Doctors of the Future” photobooth during the Bay Area Science Festival.
• eClinicalWorks says its 2011 National Users Conference set a new attendance records with over 3,000 participants.
• Baylor Health Care System (TX) creates an enterprise HIE using AT&T’s Healthcare Community Online platform.
• St. Peters Bone & Joint (MO) says it will save $30K annually by improving its Sage EHR workflow using EMR Optimization software and services from MD-IT, which added dictation solutions and an iPhone app.

EPtalk by Dr. Jayne

HIMSS submits comments in response to FDA’s draft guidance on Mobile Medical Applications. Its key point: lots of groups, including hospitals and health systems, are developing mobile apps while having no experience with the FDA’s regulatory processes. HIMSS calls on the FDA to help educate developers.

Health Services Research publishes an article about readiness for Patient Centered Medical Home initiatives, concluding that nearly half would qualify for NCQA recognition. It cites lack of infrastructure and notes that small practices will need assistance at achieving recognition.

CMS issued guidance last week clarifying attestation requirements for eligible hospitals. I’m not sure it told us anything we didn’t already know, but I give them full credit for trying to make sure that hospitals understand what’s involved in attestation. I continue to be surprised when I speak with colleagues who really have no idea what Meaningful Use is about or how it will impact them.

I’m a little behind in my reading, but a piece in the Journal of the American Medical Association caught my eye as I flipped through my ever-rising stack of paper. Automated Identification of Postoperative Complications Within an Electronic Medical Record Using Natural Language Processing compared coding-based identification of complications to data identified by natural language processing. The authors concluded that natural language processing analysis of electronic medical records at a VA hospital had higher sensitivity “compared with patient safety indicators based on discharge coding.” Contents of EHR notes were mapped to SNOMED for analysis. The authors propose that natural language processing could be used to better identify complications by analyzing documents while the patient is still hospitalized, as opposed to the coding approach, which typically occurs after the patient is discharged.

Weird health technology story of the week: a study in the American Journal of Cardiology suggests that pacemakers recycled from funeral homes could assist patients in the developing world. Although the study involved a small number of patients, 38 of 40 recipients improved after receiving a donated pacemaker. Since pacemakers are approved as single-use devices, researchers are seeking FDA approval to perform a more extensive study.

One of my organizational duties is to work with providers who are struggling with EHR adoption. Usually this involves a fairly painful session with a colleague who really wants nothing to do with the computer and who doesn’t see any benefit to learning. These visits showcase interesting behaviors — avoidance, denial, whining, begging, anger, and hostility. Today I had the privilege (and pleasure) of shadowing one of the most proficient EHR-using physicians I’ve ever seen. He seamlessly integrated the EHR into the patient experience and delivered care far more comprehensively than he could have done with a paper chart. An added bonus: his patients love having their charts in the EHR and are active participants in reviewing their records and assisting with updates. It gave me hope and was a nice recharge for my seriously depleted CMIO battieries.

Bedtime reading: The Final Rule for the Medicare Shared Savings Program, aka Accountable Care regs. Quite the page-turner, with nearly 700 pages of risk-sharing bliss, if you ask me. Changes include a rolling application process, reduced numbers of primary care providers who need to meet Meaningful Use requirements, and fewer required measures. Of course I’ll have to read the whole thing if I want to stay employed, but I’m interspersing sections of it with chapters from my newest chick lit find. I’m pretty sure the cover model is Inga, but it’s hard to know for sure without the shoes.

Contacts

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

News 10/26/11

Top News

ONC names Judy Murphy, RN, FACMI, FHIMSS as deputy national coordinator for programs and policy, the position Farzad Mostashari held until being named National Coordinator. She was previously VP of EHR applications at Aurora Health Care and has served on the boards of HIMSS and AMIA.

Reader Comments

From Legal Beagle: “Re: MedAssets. Cook County, IL is suing them for a salesperson having a laptop containing PHI stolen from his car.” Unverified.

From ShareBear: “Re: Continuity of Care Document. Does Canada use it as well? Just wondering if US patients could carry and delivery a CCD from their ONC-certified vendor.” I thought it was US-only, but experts can chime in.

HIStalk Announcements and Requests

Inga is all full of herself running around at MGMA in Las Vegas (or “Vegas,” as the logo annoyingly states), trying hard not to compromise her stealthy Inga identity while composing her daily summaries for HIStalk Practice, so I’ve given her the HIStalk day off. I’ll still put my little blue icons here and there since I’d miss them otherwise. The red ones will be back Thursday.

I’m a good way through the Steve Jobs biography (reading it on the iPad, not too ironically), so I’m sure I’ll have something to say about it by the weekend. My impression so far: he was an brilliant, rebellious, insensitive jackass who had amazing ideas and who didn’t hesitate to use his overpowering personality and caustic scorn to streamroll over anyone who stood in the way of seeing them realized, either by their intentions or their lack of equally shared enthusiasm. But it definitely worked for him and for Apple. I felt sorry for Steve Wozniak after reading how he was treated, but even Woz admits that there would be no Apple without Jobs. He should be the next to write a book (I have no doubt it’s coming, if for no other reason than for him to tell his side of the story.)

Save the date for HIStalkapalooza 2012: Tuesday, February 21, 7:00 to 10:00 p.m., at the HIMSS conference in Las Vegas. I was losing interest since I had too little time to figure out the details, but a fun sponsor stepped forward to take the load off my shoulders. Actually, several companies volunteered to foot the bill and meet my attendee-centric requirements (which I really appreciate) and in the interest of fairness, I simply chose the first one that met my checklist. We’ve chosen the venue, menu, and entertainment, so now Inga and I have to work out the stage show (shoe awards, beauty queen sashes, HISsies, etc.) Remember that everything is a day behind in Las Vegas: Monday is the old Sunday (pre-conference workshops, opening reception) and Tuesday is the old Monday (opening session, exhibits open). We’ve always had HIStalkapalooza on Monday, so this year is no different except it will be Tuesday (that makes no sense, but neither does the HIMSS schedule.) We’ll get all the registration stuff together later, probably right after New Year’s. Ladies, start your fashion shopping engines.

Admire the animation-free ad of new HIStalk Platinum Sponsor Passport Health Communications of Franklin, TN. The company, founded in 1996, offers business operations and payment certainty solutions to hospitals and providers. It serves over 1,900 hospitals and 8,000 practices and processes 300 million transactions each year through its eCare revenue cycle solutions, making it one of the fastest-growing SaaS service companies in the country. Its eCare NEXT Patient Access Suite is a single solution that handles patient information verification, address checking, and payments, offering (as the animation-free ad says elegantly) Payment Certainty for Every Patient. The company just announced a big deal to provide 27-hospital Providence Health & Services with payer eligibility connectivity services. You can read case studies on its site from organizations such as Vanderbilt Medical Group, UNC Health Care, West Virginia University Hospitals, Meriter, and Advocate Health Care. Thanks to Passport Health Communications for supporting HIStalk.

Speaking of Passport Health Communications, this is a first. To celebrate their HIStalk sponsorship, they got together with their customer Quorum Health Resources and put together the video above, which is pretty darned funny (my favorite part was the last few seconds). As I watched, I was thinking that the guy who played the boarding pass taker was a good actor, then I saw at the end that it’s actually Passport CEO Scott MacKenzie. I’m impressed.

Acquisitions, Funding, Business, and Stock

Health business intelligence vendor Analytix On Demand acquires Integrated Revenue Management Inc. and changes its name to CentraMed, which will offer a BI platform and professional services.

McKesson announces Q2 numbers: revenue up 10%, EPS $1.63 vs. $1.25, beating analyst expectations by $0.24 (excluding a $118 million one-time contribution to litigation reserves related to the drug pricing lawsuits it faces). The company also beat revenue expectations and raised guidance. Technology Solutions had revenue of $825 million, up 7%. The conference call was this afternoon, but the transcript hasn’t been posted yet.

Long-time IBM CEO Sam Palmisano steps down, replaced by sales and marketing SVP Virginia Rometty. Palmisano will remain as chairman.

HealthStream announces Q3 numbers; revenue up 24%, EPS $0.08 vs. $0.04, beating expectations for both. The Nashville company, which offers healthcare learning and staff competency solutions, has a market cap of $317 million. Shares were just mentioned in a Forbes article called Fifteen Small Company Stocks To Buy Right Now. 

A Japanese company says it saved Italy-based pharmacy IV automation vendor Health Robotics from a hostile takeover by unnamed US companies by acquiring a minority stake in the company. Health Robotics and McKesson sued each other after their distribution agreement went sour.

Sales

Seton Healthcare (TX) selects dbMotion Collaborate as its interoperability platform to cover 11 counties.

Walsall Trust (UK) chooses TeleTracking Technology’s TransportTracking system to replace an existing patient transport system.

Scripps Health (CA) selects Allscripts Community Record powered by dbMotion for its 2,600 affiliated physicians and five hospitals.

Memorial Hermann Healthcare System (TX) selects the T-SystemsEV EDIS to automate physician documentation in its nine EDs, including integration with the EMR and computer-assisted coding solution.

St. Peters Healthcare Services (NY) chooses the Pharmacy Xpert clinical intelligence dashboard for pharmacists from Thomson Reuters.

People

Awarepoint Corporation hires Merrie Wallace, RN, BSN, MN (McKesson) as EVP of product solutions; Chris Cosgrove (McKesson) as senior VP of sales; Greg Arthur (Microsoft) as VP of client management; and Carla Gallegos (Cisco) as VP of national account sales.

Healthcare data exchange vendor Proficient Health of Greensboro, NC names Dennis Barry to its board. He is a pharmacist, CEO Emeritus of Cone Health (NC), and a former educator and administrator for the University of North Carolina at Chapel Hill.

Announcements and Implementations

RelayHealth wins the VA’s “Blue Button for All Americans” contest. Its one-click Blue Button download of a patient’s information was implemented on the required 25,000 physician sites. VA Secretary of Veterans Affairs Eric K. Shineski says, “We wanted to give Veterans and their families easy access to their health data with the Blue Button so they can have greater control over the health care they receive. RelayHealth’s contribution to this goal is more than commendable.” The company will donate its $50,000 prize to the Wounded Warrior Project.

Froedtert Hospital implements NCR Wayfinding to improve the patient experience.

El Centro Regional Medical Center (CA) implements the PatientSecure palm vein scanning patient ID system from HT Systems.

Kansas Health Information Network and eHealthAlign merge their two ICA CareAlign HIE contracts to increase efficiencies and reduced cost to providers.

Fujitsu and Osmosyz announce a scanning product suite that converts paper charts to interoperable documents that meet HL7 Clinical Document Architecture standards. They’re demoing the solution in the booth of partner Aprima at MGMA.

In India, Wipro announces a new version of its Hospital Information Management System that’s used by over 100 customers in India, the Middle East, and Africa.

Government and Politics

Rep. Tim Huelskamp (R-KS), in an interview with reporters from The Heritage Foundation, is asked about Epic CEO Judy Faulkner’s role on the Health IT Policy Committee:

Reporter: Congressman, we at Heritage have done some reporting about, specifically, one member of the Health IT Policy Committee sort of controlling where these federal funds are being spent, who seems to be using her position — this is Judith Faulkner at Epic Systems — to advance her company’s interests, using $20 billion in stimulus funds. Have you looked into how the people who are directing this policy stand to gain from this potential conflict of interest, the sort of cronyism at play here?

Huelskamp: We discussed that in our office just yesterday, and saw an article this morning … I appreciate your work about exposing that. You know, you roll back a little bit of history to the Hillary Clinton era, and that’s helped kill that when that was being put together. Given the closed nature of the process … and I’ll tell you, for Congress to say it’s not transparent on that end, while down the street we’ve got 12 folks around a table dictating the entirety of policy, it rings hollow. 

But the point being, I think most Americans are saying, "Hey, wait a minute. That just doesn’t smell right." So I think that’s an angle to talk about and continue to push on that. We don’t have anything to add. You guys have done great research. We’re going to continue to push on that. We are looking for soft spots, and we just talked about that yesterday — where we can find those. Because there’s somebody in there, without a doubt. If I know Governor/Secretary Sebelius as well as I think I do, there’ll be plenty of other places. You follow the money, and you’ll find out where.

This is a multi-billion dollar initiative. I served on the information technology committee in the state legislature for about 10 years. They couldn’t put together a Medicaid system — am I right on that, Brian? I mean, it was millions and millions of dollars. It would fall apart every year, and then they’d start again and again. This is a cash cow, without a doubt. There’s only, in my understanding, two or three companies that could potentially pull that off and they’ve got connections to the administration.

And later in the interview:

Huelskamp: I’m just thinking about Judith Faulkner and her appointed group. They’re not for sure who appointed them? Yeah, surely you’re joking. We know it’s all political appointments, and that’s how it works, and we understand that.

Australia creates an oversight body to identify and manage patient safety risks related to its national electronic medical records rollout. The group will determine the severity of risks and provide guidance on how quickly to resolve them.

Innovation and Research

Graduate students at University of California Merced are developing an avatar-led virtual physical therapy software application to provide physical therapy services to the elderly.

Partners Healthcare Center for Connected Health gets a $25,000 Verizon Foundation grant to develop a wireless pedometer (a sneaker chip) for teens and a text messaging program that sends them health and nutrition suggestions based on their activity. That’s a pretty brilliant idea and the execution looks good.

Sponsor Updates

• Robert Hitchcock, CMIO of T-System is interviewed for a podcast on the survival of hospital EDs and the necessity of EHRs.
• CareTech Solutions is recognized with “Outstanding Website Developer” and “Information Services Standard of Excellence” awards from the Web Marketing Association, while 13 of its clients win WebAwards of their own.
• Modern Healthcare’s Best Places to Work in Healthcare names Aspen Advisors, Encore Health Resources, Hayes Management Consulting, Iatric Systems, Impact Advisors, maxIT Healthcare, and The Advisory Board Company among its top 100.
• Cumberland Consulting Group promotes Jessa Sprenkle to executive consultant.
• Orthopaedics of Steamboat Springs, PC (CO) selects the SRSsoft EHR.
• ZirMed announces the release of its Patient Payment Developer Kit at MGMA.
• ADP AdvancedMD announces cloud integration between its practice management system and Modernizing Medicine EMA-Ophthalmology EHR.
• Carondelet Health and Ascension Health Information Services (KS) select eClinicalWorks PM/EHR and Electronic Health eXchange.
• Coastal Medical (RI) announces that 47 providers have achieved MU using eClinicalWorks.
• MedVentive Inc. closes a $12 million offering of Series D preferred shares.
• Billian’s HealthDATA affiliate HITR.com launches a blog called Nurse Tech Talk – Bridging Nursing and IT.
• Health Language Inc. launches its LEAP I-10 claims analytics module at the Workgroup for Electronic Data Interchange Fall 2011 Conference.
• Greenway Medical releases an analysis of Medicare’s final ACO rule, authored by VP Justin Barnes, who also is co-chair of the national Accountable Care Community of Practice.
• Intelligent InSites will present Getting the Most out of an RFID/RTLS Implementation at the Northeast Healthcare Technology Symposium in Groton, CT next week.

Contacts

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

Thoughts on NIST’s EHR Usability Document 10/24/11

NIST’s EHR usability report, Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records, can be viewed here. It is in draft status and available for public comments. Comments can be sent to EHRUsability@nist.gov.

ONC has also pledged to review comments left HIStalk. Cllick the link at the end of this article to add yours.

My Disclosures

• I’m not a usability expert, but I have attended usability workshops and possess some familiarity with how software usability is defined and measured.
• I’ve used badly designed software.
• I’ve had to tell clinical users to live with badly designed software and patient-endangering IT functionality because we as the customer had no capability to change it and our vendor wasn’t inclined to.
• I’ve designed and programmed some of that badly designed software myself, choosing a quick and dirty problem fix rather than a more elegant and thoughtful approach.
• My hospital job has involved reviewing reports of patient harm (potential and actual) that either resulted from poor software design or could have been prevented by better software design.
• I’ve seen examples from hospitals I’ve worked in where patients died from mistakes that software either caused or could have prevented.

First Impressions

My first impression of the report is that it was developed by the right people – usability experts. Vendor people and well-intentioned but untrained system users were not involved. Both have a role in assessing the usability of a given application, but not in designing a usability review framework. That’s where you want experts in usability, whose domain is product-agnostic. 

My second impression of the report is that it is, in itself, usable. It’s an easy-to-read overview of what software usability is. It’s not an opinion piece, an academic literature review, or government boilerplate.

The document contains three sections:

1. A discussion of usability as it relates to developing a new application.
2. A review of how experts assess an application’s user interface usability after the fact.
3. How to bring in qualified users to use the product under controlled conditions as a final test to analyze their interaction with the application and their opinions about how usable it is. This is where the user input comes in.

A Nod to the HIMSS Usability Task Force

I was pleased to see a Chapter 2 nod given to the HIMSS Usability Task Force, which did a good job in bringing the usability issue to light. They were especially bold to do this under the vendor-friendly HIMSS, which has traditionally steered a wide berth around issues that might make its big-paying vendor members look bad. I credit that task force for putting usability on the front burner.

In fact, the HIMSS Usability Task Force’s white paper is similar to the NIST document, just less detailed. I’ll punt and suggest reading both for some good background. I actually like the HIMSS one better as an introduction.

Usability Protocol

A key issue raised early in Chapter 3 (Proposed EHR Usability Protocol) is that it’s important to understand the physical environment in which the software will be used. This is perhaps the biggest deficiency of software intended for physician use.

User interfaces that work well for users who are seated in a quiet room in front of a desktop computer may be significantly less functional when used on laptops or other portable devices while walking down a hospital hallway, or on a laptop with only a built-in mouse. That’s a variable that programmers and even IT-centric clinicians who spend their days riding an office chair often forget. The iPad is forcing re-examination of how and where applications are actually used and how to optimize them for frontline use.

The document mentions that ONC’s SHARPC program is developing a quick evaluation tool that assess how well an application adheres to good design principles. Three experts will review 14 best practices to come up with what sounds like a final score. It will be interesting to see what’s done with that score, since it could clearly identify a given software product as either very good or very bad. In fact, the document lists “violations” that range from “advisory” to “catastrophic,” which implies some kind of government involvement with vendors. Publishing the results would certainly put usability at the forefront, but I would not expect that to happen.

The document points out that usability testing “does not question an innovative feature” that’s being introduced by a designer, but nonetheless can identify troublesome or unsafe implementation of the user interface for that feature.” That’s the beauty of usability testing. It can be used to test anything. It doesn’t know or care that what’s being testing is a worthless bell and whistle vs. a game-changing informatics development. It only cares whether the end result can be effectively used (and with regard to clinical software, that patients won’t be harmed as a result of confusion by the clinician user.)

Methods of Expert Review of User Interfaces

Chapter 5 covers expert review of user interfaces. When it talked about standardization and monitoring, I was thinking how valuable a central EHR problem reporting capability would be. Customers find problems that either aren’t reported to vendors or aren’t fixed by them, meaning patients in potentially hundreds of locations are put at risk because of what their caregivers don’t know about an IT problem.

If the objective of improving usability is to reduce patient risk, why not have a single organization receive and aggregate EHR problem reports? It could be FDA, Joint Commission, ONC, NIST, or a variety of government or non-profit organizations. Their job would be to serve as the impartial intermediary between users and vendors in identifying problems, identifying their risk and severity, alerting other users of the potential risk, and tracking the problem through to resolution.

The NIST document cites draft guidance from FDA on usability of medical devices. It could be passionately argued either way that clinical IT systems are or aren’t medical devices, but the usability issues of medical devices and clinical IT systems are virtually identical. Since FDA has mechanisms in place for collecting problem reports for drugs and devices, making sure vendors are aware of the issues, and tracking those problems through to resolution, it would make perfect sense that FDA also oversee problem reports with software designed for clinician use. This oversight would not necessarily need to involve regulation or certification, but could instead be more like FDA’s product registration and recall process.

The document highlighted some issues that I’ve had personal gripes about in using clinical software, such as applications that don’t follow Windows standards for keystrokes and menus and those that don’t support longstanding accessibility guidelines for the disabled.

Choosing Expert Reviewers and Conducting a Usability Review

Chapter 6 talks about the expert review and analysis of EHR usability. So who is the “expert” involved in this step? It’s not just any clinician willing to volunteer. The “expert” is defined as someone with a Master’s or higher in a human factors discipline and three years’ experience working with EHRs or other clinical systems.
 
The idea that clinicians are the best people to (a) design clinical software from inception to final product, or (b) assess software usability ignores the formal discipline of human factors.

Validation Testing

Chapter 7 describes validation testing. It explains upfront that this refers to “summative” user testing, meaning giving users software tasks to perform and measuring what happens. It’s strictly observational. “Formative” testing occurs in product development, where an expert interacts collaboratively with users to talk through specific design challenges.

Validation testers, the document says, must be actively practicing physicians, ARNPs, PAs, or RNs. Those who have moved to the IT dark side aren’t candidates, and neither are those who have education in computer science.

How many of these testers do you need? The document cites studies that found that 80% of software problems can be found with 10 testers, while moving to 20 testers increases the detection rate to 95%. FDA split the difference in proposing 15 testers per distinct user group (15 doctors, 15 nurses, etc.)

The paper notes that EHRs “are not intended to be walk-up-and-use applications.” Their users require training and experience to master complex clinical applications. The tester pool, then, might include (a) complete EHR newbies; (b) those who have experience with the specific product; and (c) users who have used a competing or otherwise different EHR.

Tester instructions should include the fact that in summative testing, nobody’s asking for their opinions or suggestions. They are lab rats. Their job is to complete the defined tasks under controlled conditions and observation and nothing more. They are welcome to use help text, manuals, or job aids that any other user would have available to complete the defined tasks.

The NIST report listed other government software usability programs, including those of the FAA, the Nuclear Regulatory Commission, the military, and FDA.

EHR Review Criteria

Appendix B is a meaty list of expert EHR review criteria. This is where the report gets really interesting in a healthcare-specific way. It’s just a list of example criteria, but if you’re a software-using clinician, you can immediately start to picture the extent of the usability issue by seeing how many of those criteria are not met by software you’re using today. Some of those that resonated with me are:

• Does the system warn users when twins are admitted simultaneously or when active patients share similar names?
• If the system allows copying and pasting, does it show the viewer from where that information was copied and pasted?
• Does the system have a separate test environment that mirrors the production environment, or does it instead use a “test patient” in production that might cause inadvertent ordering of test orders on live patients?
• Does a screen require pressing a refresh button after changing information to see that change fully reflected on the screen?
• For orders, does the system warn users to read the order’s comments if they further define a discrete data field? (example: does a drug taper order flag the dose field to alert the user that the taper instructions are contained in the comments?)
• When a provider leaves an unsigned note, are other providers alerted to its existence?
• Do fields auto-fill only when the typed-in information entered matches only one choice?
• Can critical information (like a significant lab result) be manually flagged by a user to never be purged?
• Are commas automatically inserted when field values exceed 9999?
• Are “undo” options provided for multiple levels of actions?
• Is proper case text entry supported rather than uppercase-only?
• Do numeric fields automatically right-justify and decimal-align?
• Do error messages that relate to a data entry error automatically position the cursor to the field in error?
• Do error messages explain to the user what they need to do to correct the error?
• Do data entry fields indicate the maximum number of characters that can be entered?
• Are mandatory entry fields visually flagged?

My Random Thoughts

Usability principles would ideally be incorporated in early product design. To retrofit usability to an existing application could require major rework, which may be why some vendors don’t measure usability – it would simply expose opportunities that the vendor is unwilling or unable to undertake. 

On the other hand, improving usability doesn’t require heavy duty programming or database changes. The main consideration would be, ironically, the need for users to be re-trained on the user interface (new documentation, new help text, etc.)

Usability can me measured, so does that mean there is “one best way” to do a given set of functions? Or, given that users are often forced to use a variety of competing CPOE and nurse documentation systems, is it really in the best interest of patients that each of those vendor systems has a totally different user interface?

Car models have their own design elements to distinguish them commercially, but it’s in the best interest of both the car industry and society in general that placement of the steering wheel and brake pedal is consistent. With PC software, this wasn’t the case until Windows forced standard conventions and the abandonment of bizarre keystroke combinations and menus.

I always feel for the community-based physician who covers two or more hospitals and possibly even multiple ambulatory practice settings, all of which have implemented different proprietary software applications that must be learned. This issue of “user interoperability” is rarely discussed, but will continue to increase along with EHR penetration.

From a purely patient safety perspective, we’d be better off with a single basic user interface for a given module like CPOE, or even a single system instead of competing ones (the benefits of the VA’s single VistA system spring immediately to mind.) It’s the IT equivalent of a best practice, Usability can be measured and compared, so that means if there are 10 CPOE systems on the market, patients of physicians-users of nine of them are being subjected to greater risk of harm or suboptimal care.

Usability testing does not require vendor participation or permission. Any expert can conduct formal usability testing with nothing more than access to the application. Any third party (government, private, or for-profit) could conduct objective and meaningful usability assessments and publish their results. It’s surprising that none have done so. They could make quite a splash and instantly change the dialogue from academic to near-hysterical by publicly listing the usability scores of competing products.

Conclusion

Read the report. It’s not too long, and much of it can really be skimmed unless you’re a hardcore usability fan. If nothing else, at least read the two-page executive summary. 

For the folks who express strong reaction to the word “usability” while clearly not really knowing what it means, the report should be comforting in its objective specificity.

Even though the document is open to public comment, there really isn’t much in it that’s contentious or bold. It’s just a nice summary of usability design principles, with no suggested actions or hints of what might future actions are being contemplated (if any.)

I’m sure comments will be filed, but unless they are written by usability experts, they will most likely be unrelated to the actual paper, but rather what role the government may eventually take with regard to medical software usability.

It should also be noted that no product would register a perfect usability score. And, that humans are infinitely adaptable and will learn to work around poor design without even thinking about it. In some respects, usability is less of an issue with experienced system users who have figured out a given system’s quirks and learned to work capably (even proudly) around them.

This document really just provides some well-researched background on usability. The real discussion will involve what’s to be done with it.

Let’s hear your thoughts. Leave a comment.

Monday Morning Update 10/24/11

From Mintonw: “Re: NorthCrest Medical Center (TN). It’s the first hospital to receive a Medicaid EHR incentive payment by just using ED patients and an EDIS, in their case Allscripts ED 7.0, the only EDIS certified as a Complete EHR.” The hospital’s press release is here. SVP/CIO Randy Davis says the 109-bed hospital was already in the high 90s percentile and didn’t need to change much. The hospital says it will meet Medicare’s MU requirements later this year.

From Tommy Tune: “Re: Jim Fitzgerald. Definitely no longer at Dell. My source says it was his choice.” Unverified.

From Rigoletto: “Re: GE Healthcare. Says Centricity Practice and EMR can’t generate accurate Meaningful Use reports. See link here to its letter to customers.” It sounds like basic technical stuff, made interesting only because the company admits that there could be problems for clients who have already attested – the corrected reports may show that they didn’t hit the required thresholds after all . GE says they will provide “further instruction on how to work with CMS related to any changes related to attestation.” The recommend changes in practice are: (a) choose specific race/ethnicity codes instead of free text and don’t choose “multi-racial,” “Hispanic,” or “other;” (b) use specific options for describing smoking status; and (c) us prescribing to measure patient medication education since issuing handouts that the EMR did not suggest doesn’t count toward Meaningful use. I don’t see any of this as a slam on GEHC other than they are awfully late in identifying the problems, which seem pretty obvious. Let’s hope the triggering event wasn’t an eligible provider getting in trouble with CMS.

From Dr. Nurse: “Re: McKesson CEO John Hammergen’s $131 million one-year compensation. Their products are a patchwork of jury-rigged acquired code which has never been upgraded and they clearly have no idea what a usability standard is (the joke is, ‘just keep scrolling down and to the right and you’ll eventually find the right checkbox.’) They perform paper-based billing for specialty practices (Fedexing boxes of paper forms to Pittsburgh – really?) and use antiquated reporting systems that cannot be altered (you can’t add columns due to system limitations). His compensation package is obscene considering McKesson’s ongoing loss of market share, discernible lack of innovation, and adherence to outdated methodologies and business practices. He’s not alone – the CEO salaries of third-party payers are off the grid, too.” Above is the five-year performance of MCK (blue), the Dow (red), the Nasdaq (green), and the S&P 500 (yellow). A big chunk ($112 million) of that compensation was from stock options that he won’t get to exercise every year. At least shareholders (including employees) got to make money along with him. Not to mention that IT isn’t the company’s bread-and-butter business, although that product line is still profitable.

From Por Favor: “Re: WNA. I totally love Weird News Andy, but as a Canadian, I’m appalled by the actions of the clinicians at the hospital. There once was a time where it didn’t matter how you came to be in the ER. I was in the ER several years ago when a young man of about 17 was brought in with a terrible leg break. He was from England on a rugby tour with his school. I remember him crying and trying to tell the doc he had insurance and hoped the doc would take care of him even though he couldn’t produce the documents right there. I’ll never forget what the doc said: ‘Son, I don’t care if you have insurance or not. I’m going to take care of you. Rest easy, try to relax, and do not worry. You’re in Canada and under my care.’ That demonstrates why doctors became doctors in the first place – to heal the sick. It is so sad that somewhere along the way, we have lost this. Please tell Andy to keep the weird news coming – it’s always fun!” The example was from Canada, but I’m certain we have at least as many such cases on this side of the border.

From Neil Louwrens, MD FACP: “Re: physician’s malpractice award as a patient at Northwestern. I’m vehemently opposed to the current tort system, but passionately for justified litigation, including substantial earnings to injured patients. I’m equally and passionately against trivial pestering from the legal profession, claiming wrongdoing and pain-and-suffering that runs up ridiculous tabs at this nation’s expense. The physician in this case is a patient and the case must rest on that. When we fight for tort reform, we are asking for some sense of sanity to be infused back into the system. Nowadays, even the best doctors doing the right thing are still sued. It’s a lottery mentality and the nation picks up the tab. Most physicians who have wronged someone are remorseful and wish they could compensate the patient for their wrongdoing, but to watch the lawyers walk away with 50-60% of the winnings is a travesty. Give patients their money back! Wall Street’s wrongdoings pale in comparison with what the Association of Trial Lawyers of America has managed to carve out for themselves in the current system, backed and perpetuated by the preponderance of lawyers in Congress. Tort reform will reform this inequity, but will not touch the earnings to the injured for their costs, such as justified pain and suffering. We need tort reform – not ‘we’ as physicians, but ‘we’ as patients.”

Thanks to Jacob Reider, ONC’s new usability guy, for taking the time to interview. A reader had tipped me off that he’d taken the job, I e-mailed him, and he asked me to hold off for a couple of days (the details weren’t quite finalized, I surmise.) He not only gave me the first interview, but didn’t tell anyone about his new job until I could get back from vacation so we could do the interview and have the scoop here. Above is another interview he did on usability before he took the ONC job. ONC is interested in reaction to NIST’s usability paper, which I’ll be providing once I’ve had a chance to read it over. Hopefully those readers who constantly gripe about poor EMR usability will channel some of their energies into reviewing the NIST document since it’s the best hope so far (short of some super-secret vendor development project that nobody’s seen yet) to improve the healthcare IT usability landscape.

Listening: reader-recommended Elizabeth Cook, who sounds a good bit like Dolly Parton. The youngest of 11 children, moonshiner dad in prison, took dual degrees in accounting and computer information systems, and worked as an auditor for PWC.  She writes most of the songs, which have brilliant lyrics and range from the good old boy rowdy (“Say Yes to Booty”, “Sometimes It Takes Balls to Be a Woman”) to the starkly moving (“Heroin Addict Sister”).  Modern country is one of my least-favorite genres because it’s been taken over by industry-groomed, overproduced pretty faces faking credibility in the pain and loss department while fronting pop music that has the absolute barest minimum of mandolin or steel guitar, but this is the real deal.

My Time Capsule editorial this week, squinting its eyes upon seeing its first daylight since October 2006: GM and Intel are Right: Healthcare Is Too Expensive, but Technology Alone Can’t Fix It. A taste: “Most US job growth since 2001 was in healthcare, and that’s not something to be proud of. We’re leaving an expensive mess for our children to clean up just as Baby Boomers suck the system dry with healthcare demands. If GM doesn’t like it today, they’ll hate it tomorrow, unless they’re watching from China or India.”

Good stuff on HIStalk Mobile, where Dr. Travis Good covers How to Make Money on Consumer Health Tools and Enterprise Provider Apps. He started out covering straight news, but now that he’s comfortable, he’s putting together some really good analysis and opinion posts that I appreciate since I’m learning from them. Sign up for the e-mail update over there if you like what you see. Thanks to our sponsors there, too: founding sponsors AT&T and Vocera and platinum sponsors Voalte, 3M, Thomson Reuters, Patientkeeper, Kony, and Access.

I’ve said before how much I like using speech recognition for certain tasks (composing e-mails and sometimes writing HIStalk, for example). I was about to upgrade my Dragon Naturally Speaking when I found about Windows Speech Recognition. Like DNS, it’s great for dictation and controlling Windows by voice. Advantages: its system performance seems to be better, its accuracy is almost as good (96% vs. 99%), and it’s included free in Windows 7 (you’ll find it in Control Panel.) Well worth experimenting with since everybody can talk faster than they can type and sometimes your fingers just get tired.

Here’s the latest HIS-tory from Vince, this time with Part II of JS/Data, with lots of info about its eventual (many-named) acquirer.

Most respondents (some of them with considerable skin in the game) think HITECH should pay providers for starting their EHR use even before HITECH started. New poll to your right: should HHS require doctors to generate personalized, unique documentation (i.e., no boilerplate or macros) in order to be paid?

Dr. Jayne brought up an interesting point in her latest post: the government seems to want everybody to be fooled into thinking that Medicaid is insurance rather than a social program that takes money away from taxpayers and gives it to non-taxpayers (all warm-and-cuddly positives aside, that’s what it is.) We’ve already taken the shame out of being on the dole courtesy of the ever-fewer working Americans (Social Security and Medicare being the big drains among many), so unless you have a lot more faith than I do that either politicians or voters will start exercising responsibility instead of acting in their own self-interest, keep an eye on what’s happening in Greece because we’re getting close to that point of non-sustainability. Politicians won’t stop handing out financial lollipops and the taxpayer/non-taxpayer ratio keeps shrinking, so something has to give regardless of the indignation and injustices involved. Our lavishly funded healthcare system isn’t exactly helping as it sucks up an ever-increasing chunk of GDP.

ProHealth Care (WI) finishes its implementation of Epic.

GE announces Q3 numbers: revenue flat, EPS $0.31 vs. $0.28, meeting expectations.

Interesting revelations from the Steve Jobs biography, hitting stores Monday: (a) he apparently lied about the extent of his medical problems; (b) he initially resisted having surgery for his pancreatic tumor, so he tried diets, acupuncture, a psychic, and remedies he found online, to his apparent eventual regret; (c) he claimed Google stole iPhone features in creating its Android phone, saying he would “spend every penny of Apple’s $40 billion in the bank to right this wrong.”; (d) his last ambitions, possibly involving Apple products yet to be released, involved developing an integrated TV and taking on the textbook monopoly. He also told President Obama that he was destined to be a one-termer because he is business-unfriendly; described Microsoft as “mostly irrelevant” and struggling like most other companies that put salespeople in charge; and said HP is being “dismembered and destroyed” by poor leadership. Nobody quoted him all that much while he was alive and he stayed out of the limelight for the most part, but now every scrap of writing and video is being assembled into the Gospel According to the Recently Canonized Steve (and I admit being just as fascinated by it as everybody else.)

Speaking of Apple, here’s the first commercial for the iPhone 4S and its Siri voice command system.

Kaiser needs to dig into its Epic database to evaluate this study from Canada. Overweight people (BMI of 25 to 29.9) were found to have the same risk of health problems as normal-weight patients. The study found that the big health problems start with a BMI of 35 (defined as “obese.”) Hopefully the study looked longitudinally at patients rather than just current weight. You can calculate your BMI here.

Washington Hospital Center (DC) and AT&T develop CodeHeart, a mobile collaboration app that provides real-time audio and video contact in critical care situations, such as for ambulances in transit.

A lawsuit against Abbott Northwestern by a kidney stone patient alleges that a drug-addicted nurse stole his ordered narcotics for herself, leaving him to suffer excruciating pain through the procedure. The patient says the nurse told him she couldn’t give him very much medication and that he should just “man up.” During the procedure, he says the nurse was unsteady and slurring her words as she coached him for his pain, telling him, “Go to your happy place, Larry. Go to your beach.”

E-mail Mr. H.

News 10/21/11

Top News

HHS announces its Accountable Care Organization rules (Medicare Shared Savings and the Advance Payment Model.) Some differences between the preliminary and final versions:

• Quality measures reduced from 65 to 33
• Use of an EHR is not a requirement to participate
• Introduction of a savings-only track without financial risk during the initial contract period
• CHCs and rural health clinics now have an option to lead ACOs
• A longer phase-in for reporting and performance measures
• Multiple start dates established
• CMS will provide approved marketing guidelines and language (so ACOs don’t have to wait for CMS approval, as was stated in prelim)

Reader Comments

From EHR Geek: “Re: Joel Diamond. I love your posts so much that sometimes I feel like a stalker. With the current healthcare environment, it seems like you could make so much more money (just by dropping your malpractice alone) by doing standup comedy. Please?” Like EHR Geek, I love Dr. Diamond’s posts, which I find laugh-out-loud funny. This week, he discusses all that is good in healthcare. The topic only sounds benign.

From WhatTheDell: “Re: resignation. Jim Fitzgerald recently resigned from Dell’s Meditech Solutions Group. Big loss given his role of all things Meditech.” Unverified. There is no change in his LinkedIn profile or on Dell’s “About Us” page.

From Colorado Kid: “Re: University of Colorado Hospital. Went live on Epic in September, including physician documentation, CPOE, RN barcoding and charting, OR, anesthesia, inpatient pharmacy, labor and delivery, radiology, and ED. Outpatient clinics are 70% deployed, to be completed with Beacon oncology and Phoenix transplant by mid-2012.”

From Lady Pharmacist: “Re: National Pharmacy Week, October 16-22. It’s time for the annual shout-out for pharmacists and pharmacy technicians. Healthcare informatics plays a vital role with and for these clinical and medication distribution folks who make medication usage safe in our institutions!” As I usually say, a hospital is a very clean hotel that offers only three interventions: surgery, treatments, and drugs. Pharmacists and techs manage that last set of interventions with extraordinary skill given the complexity involved (not to mention that most of the country is taking a plethora of pills – a new study found that 11% of Americans over the age of 12 take antidepressants, which is in itself depressing.) Congratulations to those folks behind the counters, down in the basement, and (increasingly) out on the floors.

From MM: “Re: Dr. Jayne on cloned documentation. Did we really expect anything else? If you have been around medical reimbursement rules for any amount of time, you know that when the rules begin to be met by the majority of providers, the rules will change. It is really all about who gets to keep the money. We used to bill by diagnoses, then by time, now by documentation. All these rules were created by the insurers, and each time we achieve competence at following the billing rules, they change them.” I’ve said that for years. Payment is a shell game, where there isn’t enough money to stick under every shell. It is inevitable that when some individual or group starts winning too often, the dealer will move the shells around and change the rules, sometimes drastically altering the lifestyles of professionals along the way (nurse anesthetists and physical therapists come to mind if you look back 25 years or so). That’s really the problem with healthcare – providers flock to profitable services like bugs to a zapper, but patients don’t usually benefit. Expecting healthcare providers, even theoretically non-profit hospitals, to just keep doing the same work without regard to what they’ll get paid is just silly.

HIStalk Announcements and Requests

I am heading to MGMA in Las Vegas this weekend and will be posting updates on some of the action. If you are attending, be sure to take a look at HIStalk’s Must-See Vendors for MGMA 2011. The guide includes some tips on vendor giveaways (hint: you don’t want to miss a visit to Allscripts, MED3OOO, and Culbert Healthcare.) And if  you see one of these desktop signs in a vendor’s booth, please take a moment and thank them for supporting HIStalk, HIStalk Practice, and HIStalk Mobile.

Listening: reader-recommended The Heard, rootsy Southern rockers from Reading, PA. Sounds kinds of Allmans-meet-R.E.M. to me. Also reader-recommended: BluesMotel, some guys from the Netherlands that play Chicago blues. I can almost smell the smoke and beer.

This week on HIStalk Practice: in addition to our MGMA guide and a post from Dr. Joel Diamond, athenahealth reports that pediatricians are under-reimbursed for certain vaccines almost half the time. CalOptima REC names its preferred EHR vendors. The Department of Pathology at the Medical City Dallas Hospital (TX) goes with McKesson for billing and RCM. Emdeon expands the capabilities of its Office Suite solution. Radiology Medical Group (CA) announces plans to outsource its billing and lay off 24 employees.  If you are interested in the ambulatory HIT world,  highlights from MGMA, shoe fashion, and/or Inga’s mental health, please sign up for e-mail updates while visiting HIStalk Practice. Thanks for reading.

Thanks to NexJ Systems of Toronto, ON, now supporting HIStalk as a Platinum Sponsor. The company is all about eHealth, offering its Health Information Exchange solution that includes its Universal Health Connector (global messaging and controlled vocabularies and terminology) to facilitate interoperability among providers, ACOs, payors, and public health agencies. They also offer tools for chronic disease management, disease registry, electronic referrals, patient portal, provider credentialing, and a wellness platform. Other offerings include platforms for provider health, consumer health, and analytics. Click the image above to check out their October 28 Webinar on next-generation, open-architecture HIE technologies that are fast, flexible, and cost effective. Thanks to NexJ for supporting HIStalk and its readers. 

Pardon me while I communicate in techo-gibberish with my fellow geeks (non-nerds, hands over ears, please). You may have noticed that HIStalk loads faster now. Reason: I replaced Apache with the Litespeed WebServer. It’s hard to picture a Web server that’s running *NIX without Apache, but you’re soaking in it. I also had the PHP handler changed from DSO to SUPHP to improve security and to fix some CHMOD problems. (end of nerdspeak)

October is Breast Cancer Awareness Month, meaning it’s time to watch those cool Pink Glove Dance videos. My favorite so far is from Victoria Hospital – Prince Albert Parkland Health Region, Prince Albert, Saskatchewan (although they’ve disabled putting the video directly on HIStalk this time around, so you’ll have to click.) Check out all great videos and vote for your favorite here.

On the Jobs Board: Senior Business Analyst – Salesforce.com, HL7 Interface Developer, Account Manager. On Healthcare IT Jobs: Director – Epic and Clinical Systems, Security Engineer, Business Continuity Analyst, Clinical Nurse Analyst.

Don’t let Inga’s swaggering online demeanor fool you. Those of us who know her recognize that she’s sensitive (sniffles at movies), self-doubting (always convinced she doesn’t know enough to write authoritatively about topics she’s followed for many years), and fragile (I’ve quit telling her to stop double-spacing after a period because it devalues her). You can imagine the emotional harm wreaked by those who don’t sign up for e-mail updates; who fail to connect with us on LinkedIn and Facebook; who don’t support our sponsors and click their ads and Resource Center listings occasionally; and who hurtfully neglect to send her newsworthy scoops and fun information so she can at least temporarily feel confident about her knowledge base (cue emotion-tugging Sarah McLachlan warbling). In lieu of giving her a hug, consider checking off the items on the list above, ‘cause when Mama ain’t happy, ain’t nobody happy.

Acquisitions, Funding, Business, and Stock

TransUnion acquires Financial Healthcare Services, a provider of a patient payment estimation solution.

Microsoft announces Q1 numbers: revenue up 7%, EPS $0.68 vs. $0.62, beating and meeting expectations, respectively.

Athenahealth announces Q3 numbers: revenue up 33%, EPS $0.15 vs. $0.11, beating expectations on both and raising fiscal year guidance.

San Diego’s West family, who made their $2 billion fortune from telemarketing and who established the West Wireless Health Institute in 2009, create a $100 million venture investment fund to invest in early-stage technology companies that can reduce healthcare costs. They pledge to invest any profits in medical research.

Sales

Alexian Brothers Health System (IL) expands its relationship with athenahealth by selecting athenaClinicals and athena Communicator for its network of 150 employed providers. In addition, athenaCollector client Harbin Clinic (GA) adds athenaClinicals for its 210 providers. Both are Allscripts replacements.

People

The Hay Group consulting firm promotes Bill Quirk from director of business development to national director of its US healthcare practice. He was previously with Sullivan, Cotter and Associates and Towers-Perrin.

The TriZetto Group names President and CEO Trace Devanny as the company’s chairman, succeeding TriZetto founder Jeff Margolis, who will serve as chairman emeritus. Devanny was president of Cerner until last year.

Streamline Health hires Tom Dean, formerly with CareCentric, as VP of product engineering.

Robert J. Bunker joins the board of directors of T-System. He is chairman and CEO of The Medical Staffing Network Inc. and started his work in healthcare as Humana’s COO in 1994 after serving 20 years in the US Air Force Medical Service, retiring with a rank of lieutenant colonel.

Joan Bishop, formerly with Lockeed Martin, joins Encore Health Resources as principal of its government client services business.

Announcements and Implementations

AtlantiCare (NJ) announces plans to to launch AtlantiCare Health Solutions, an accountable care organization.

Aprima Medical certifies GFI Software’s FaxMaker for use with Aprima’s EHR and PM solutions. Which reminds me of a recent need I had for a copy of certain medical records. My doctor’s office said I had to fax them a request form. Since I don’t have a fax machine, I asked if I could e-mail the form. They responded that they didn’t have e-mail. I had to double check the year to make sure I wasn’t in some sort of time warp.

ONC validates the South East Michigan Health Information Exchange (SEMHIE) for conformance and interoperability testing, allowing SEMHIE to go live on the Nationwide Health Information Network Exchange.

Intelerad Medical Systems launches InteleSuite, a RIS/PACS solution that combines Interad’s standalone PACS and RIS offerings.

University of Michigan Health System and Great Lakes Health Information Exchange sign an agreement to exchange information. Other members are Michigan State and Sparrow Health System.

A Detroit jury finds that Beaumont Hospital (MI) and an OB doctor let a woman deliver a 10-pound, 12-ounce baby vaginally instead of by C-section, causing brain injuries in the newborn girl. Despite the hospital’s claim that the disabilities of the child (now a teenager) were caused by the mother’s gestational diabetes, the jury awards the family $144 million.

I received an e-mail from Steve Pelton, VP of enterprise applications for Ministry Health Care (WI). They have completed their EHR certification tests through Drummond Group (“tough, but fair,” he says) and expect to demonstrate Meaningful Use and attest early next year after the 90-day demonstration period. He raises an interesting point:

From the CHPL web site, it appears that only 16 hospital and health systems have achieved either modular or complete EHR certification. While many or even most hospitals will wait for their vendors to provide updated, certified products for them to install, it does seem surprising that so few of the over 5,000 hospitals in the US have not gone through the self-certification process. Like Ministry Health Care, most of the 16 hospital and health systems achieved modular certification, which allows for the Meaningful Use of a collection of certified products. The most common modules that are self-certified seem to be homegrown data repositories. One would expect that many hospitals that have either homegrown systems or uncertified niche systems would attempt to certify them. One would also expect hospitals to self-certify their existing systems while they are working to replace or upgrade to a certified version. What is everyone waiting for?

Weird News Andy summarizes this story as, “Socialized medicine. Gotta love it.” An 82-year-old woman visiting her dying husband in a Canadian hospital falls in its lobby, breaking her hip. Two ED nurses and a security guard observe her lying face-down on a metal grate and bleeding, but refuse to help until an ambulance arrives. The  top executive can’t explain why a code wasn’t called. The same hospital made headlines last year when a woman who had stopped breathing was driven to the hospital by her boyfriend, but the ED staff refused to help since the couple were in their car in the parking lot and told the boyfriend to call 911 instead. The 39-year-old woman died a few days later of a heart event. The employees thought they wouldn’t be covered by malpractice insurance if they helped someone outside the four walls of the hospital.

Government and Politics

ONC adds a principal deputy position to its organization, tasked with duties similar to that of a COO in the private sector. The yet-unnamed deputy will report to ONC coordinator Farzad Mostashari.

The VA gives Harris Corp. a two-year, $200 million blanket purchase agreement to develop VistA-connected outreach tools, including creating a point-of-service kiosk, redesigning the VA’s quality Web site, supporting the National Utilization Management Integration project, and developing a replacement bed management system.

The government’s Substance Abuse and Mental Health Services Administration (SAMHSA) awards 29 grants totalling $25 million over three years to increase access to behavioral health services with information technology.

Federal prosecutors file an $8.1 million fraud suit against Kernan Hospital (MD), part of the University of Maryland Medical System. The government says the hospital intentionally changed its billing system to create a diagnosis of severe malnutrition, looking for the words “protein malnutrition” and pressuring physicians to add that condition as a secondary disease.

Other

Nearly 300 GE Healthcare employees in Salt Lake city form a human pink ribbon in recognition of Breast Cancer Awareness Month. The company has scheduled similar displays across a couple of dozen cities.

The hospital EHR market is expected to peak in 2012, with revenues of $6.5 billion.

Twenty-six percent of CHIME CIOs say their organizations have qualified to receive Meaningful Use funding, with 13% actually having been paid. About 93% expect to achieve the Stage 1 MU during the first three years of the program.

An Internet outage in a small North Carolina town leaves a medical practice that uses a Web-based EMR out of luck. “We’re electronic medical records, and neither one of our softwares will come up because we’re Internet-based. If the Internet goes down, we have to just call patients back to get appointments re-scheduled.”

An Illinois physician claims his health system employer placed him on administrative leave because he has “no computer skills.” Steven Kottermann MD, who was a family physician with Memorial Health System, admits that he fell behind on his electronic charting after the health system’s implementation of Epic. The doctor believes that Memorial is at fault because “they bought a lousy system.”  The hospital’s chief medical officer says the issues go beyond the doctor’s EMR proficiency.

Sponsor Updates

• GE Healthcare recognizes Frederik Memorial Hospital (MD) and Northeast Georgia Medical Center (GA) as winners of its 2011 Leaders of Change Awards at the Centricity Perinatal Users’ Group National Conference.
• Sentry Data Systems earns a spot on the South Florida Business Journal’s Top 25 Fast Tech Awards for significant revenue growth.
• Khalid Moidu, MD, PhD (Orlando Health) and Stephen Claypool, MD (Wolters Kluwer Health) will present Innovation Lab: Evidence Based Order Sets Tools from a Dynamic Hospital-Vendor Partnership at AMIA 2011.
• NVISION Laser Eye Centers (CA) selects NextGen for its 10 eye centers.
• NexJ Systems will host a free Webinar entitled The Next Generation of Health Information Exchange October 28th. NexJ Systems, by the way, was recently named the sixth fastest-growing company in North America on Deloitte’s  2011 Technology Fast 500.
• AdvancedMD receives the Healthcare Hero Award for Innovation from Utah Business Magazine.
• OptumInsight releases a guide for physicians to minimize security risks entitled Keep Patient Data Secure: Simple Actions for a Digital World.
• dbMotion and Allscripts will co-host a webinar on physician EHR connectivity on November 16th featuring dbMotion CMIO Joel Diamond MD and Ryan Winn, VP and CIO of MidMichigan Health.
• Perceptive Software will showcase its enterprise content management solutions at the Gartner Symposium/ITexpo in Spain.
• Newton-Wellesley Radiology Associates (MA) boosts its financial performance and prepares for ICD-10 using McKesson’s Revenue Management Solutions.

EPtalk by Dr. Jayne

Now that we’re in the last quarter of 2011, Physician Quality Reporting System (the artist formerly known as PQRI) data is available through the CMS quality portal. Groups can access data by taxpayer ID and individual providers can also request reports based on their NPI. Next year should be a little different, with CMS agreeing to provide interim feedback reports to those who use claims-based reporting. Too bad for those of us who are Meaningful Users of our EHR technology and are reporting through registries rather than claims.

Speaking of CMS, regulatory reforms are on the table, with two proposals being introduced and a third being finalized this week. Modifications to the Medicare Conditions of Participation would allow multi-hospital systems to have a single governing body for multiple hospitals rather than requiring each have its own governance structure. Hopefully combining governance structures will help those of us on staff at multiple hospitals within a health system to reduce the number of committees on which we are forced to serve.

Proposed modifications for non-hospital providers address durable medical equipment suppliers and dialysis providers. Also addressed are outdated e-prescribing technical requirements. Hiding towards the end of the document is language to end the use of the term “Medicaid recipient” and replace it with “Medicaid beneficiary.” Although this makes it parallel Medicare, I can’t help but think there are political games afoot, with this being one more move to make people think that Medicaid is insurance rather than an entitlement program.

We all know we live in a society that’s increasingly saturated by technology, specifically audiovisual media. The American Academy of Pediatrics Council on Communications and Media releases guidelines stating that children under age two should avoid television viewing. This also includes passive viewing while playing in a room where an adult or sibling may be watching.

There’s an app for that: Mobile MIM is one of a growing number of apps to receive FDA approval. It allows viewing of diagnostic images, including MRI and CT scans. Although the app (one version for physicians, one for patients) is free, physicians must pay $1 to upload each image to its cloud-based repository. Viewing the study costs $1 to $2 depending on the receiving device. Earning FDA approval took more than two years and included modification to the app to detect poor lighting conditions that are inappropriate for the interpretation of radiologic studies. Maybe the FDA should also include logic to detect whether it is being used in a bar, as my colleague was attempting.

Recent data from social media analytics firm Amplicate shows that over the last year, 69% of Facebook and Twitter users reported hating a particular insurance carrier. Data from over 2,500 posts is aggregated by payer. In contrast, the other industries the firm tracks were more positive, with 56% of users loving their grocery store chain and a 70% expressing a love connection for fast food chains. More negative than health insurers: banks.

The FDA approves Hologic’s Trident specimen radiography system. The system is designed for intraoperative specimen imaging during minimally-invasive, stereotactic, or ultrasound-guided breast biopsies and includes the ability to export to PACS.

October is Breast Cancer Awareness month. I first saw the Pink Glove Dance on HIStalk. It’s always good to see healthcare workers having fun and raising awareness about a disease that impacts so many people. More than 100 organizations are competing for thousands of dollars to donate to their favorite charities, so get out there and vote. Here’s a shout out to my co-workers who are fighting this disease and a special nod to all the women in my family who have beat it, including one 20+ year survivor. Love you, Mom!

Contacts

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

News 10/19/11

Top News

A newly signed California bill will require electronic medical records systems to maintain a record of changed or deleted information. The Confidentiality of Medical Information Act, which will become law on January 1, requires systems to log the user’s identity, the date and time of the change, and a record of the information that was changed or deleted.

Reader Comments

From Sole Food: “Re: shoes. This conversation is from the Late Late Show last week. Craig Ferguson to Monica Potter: ‘Oh, nice shoes.’ Monica Potter: ‘Yeah, I heard you like shoes.’ Craig Ferguson: ‘No, I like women, and I know that women like shoes.’ So don’t let anyone give you a hard time about posting pics of women’s footwear.” I couldn’t agree more. Inga likes cute women’s shoes, I like how women look in cute shoes. HIStalkapalooza is a lot classier now that many of the ladies come dressed to the nines. Women like dressing up, men like seeing dressed-up women, everybody wins.

From The PACS Designer: “Re: Ethernet – Fibre Channel convergence. TPD is celebrating the 10th anniversary of the design of the first Windows/UNIX based PACS that relied on Ethernet, and a Fibre Channel RAID to permit downloading of 500MB image files in under 30 seconds. Now, 10 years later, you are going to be hearing more about the convergence of 10-Gbps Fast Ethernet, and Fibre Channel storage arrays using a new term ‘Data Center Bridging Exchange’ as it tries to become the new standard for data storage.”

Acquisitions, Funding, Business, and Stock

Lexmark, the parent company of Perceptive Software, acquires Netherlands-based Pallas Athena for $50 million in cash. Pallas Athena, which is a provider of business process and document output management solutions, will become part of Perceptive.

TransUnion Healthcare, which offers revenue cycle tools, acquires Financial Healthcare Systems, the Denver-based vendor of the ClearQuote software that estimates out-of-pocket patient responsibility at the point of service.

Sales

BloodCenter of Wisconsin, Community Blood Center of Kansas City, and the US Department of Defense contract with Mediware for its InSight Performance Management platform for blood management.

DeVry University signs a five-year agreement with QuadraMed to incorporate its Quantim suite of HIM coding, compliance, and record management solutions into the school’s health sciences curriculum.

Eastern Connecticut Health Network selects MobileMD’s 4D HIE solution.

Riverside Health System (VA) selects the EMR-Link solution of Ignis Systems for lab and radiology order integration for over 200 physicians. The company differentiates its product as making all labs equal to physicians and their EMRs, which it says differs from the lab-funded, lab-centric integration model.

Sheridan Healthcare, the country’s largest anesthesia group with 1,200 providers and 100 hospitals and ambulatory surgery centers, chooses Shareable Ink as its standard documentation and charge capture tool.

CapitalCare Medical Group (NY) chooses ImplementHIT’s OptimizeHIT training platform to prepare its 110 providers for an Allscripts EHR upgrade.

People

Healthcare Information Xchange of New York (HIXNY) names Mark McKinney as CEO, replacing Dominick Bizzarro, who joined InterSystems earlier this year. McKinney is the former director of integrated services for SXC Health Solutions. HIXNY merged with the Adirondack Regional Community HIE earlier this month.

MED3OOO hires former Tenet Healthcare executive Jeffery E. Flocken as EVP of accountable care and hospital services.

Ingenious Med appoints Jim Keener as CTO. He was previously VP of development of Verisign.

Clinical decision support provider DiagnosisOne names Francis X. Campion, MD as VP of clinical affairs. He’s a member of the Department of Population Medicine at Harvard Medical School.

Announcements and Implementations

Meditech client Aspen Valley Hospital (CO) implements Summit Healthcare’s Downtime Reporting System to address business continuity.

Blue Shield of California will distribute $20 million in grants to 18 California hospitals, health systems, and physician groups to help them develop ACOs.

The University of North Carolina Hospitals implement the RF Assure Detection System for preventing and detecting retained surgical items in patients.

New York City’s Department of Health and Mental Hygiene (DOHMH) implements NextGate MatchMatrix Terminology Registry to standardize data shared by EHR systems.

Imprivata announces that six additional hospitals using McKesson solutions have implemented OneSign, Imprivata’s single sign-on solution.

Enterprise RTLS vendor Intelligent InSites integrates active RFID readers and tags from RF Code into its solutions.

Government and Politics

New York’s state development agency grants eHealth Global Technologies $750,000 in tax credits to support the company’s expansion. eHealth Global, a medical record retrieval and diagnostic image exchange service provider, will invest $3 million in the expansion and will increase its staff from 75 to 155 over the next five years.

CMS adds WellCentive as a qualified Registry provider for the 2011 PQRS program.

The VA will solicit bids for a WiFi-based real-time location system for tracking assets, employees, and patients its 152 hospitals, with an RFP to be issued by the end of the year.

Bill O’Toole of O’Toole Law Group has expanded his HITlaw article about EHR vendor certification into a white paper called EHR Certification Alert for Providers, summarized as: “The absolute heart of the issue is recognizing that in some cases multiple products that are marketed individually by a vendor are grouped together for testing and ultimately certified together and not separately.”

An Associated Press review finds that Medicare often suspends bogus providers, but then quickly reinstates their payments even after their prosecution. The review found that appeal hearings often have nobody in attendance from CMS or their contractors, leading to a rubber stamp reinstatement of billing privileges. The article says pay-first policies (“pay and chase”) have made fraud so easy and lightly penalized that drug dealers and mobsters have given up their previous scams in favor of Medicare fraud. Disjointed government processes are blamed: contractors don’t share information, provider ID revocation doesn’t automatically initiate criminal proceedings, Medicare’s lawyers don’t show up at hearings, and nobody’s collecting surety bonds required of medical equipment providers when they skip town.

Innovation and Research

A good Business Insider article lists eight healthcare startups that are “shaking up” the industry. Among them: ZocDoc (online doctor appointments), Cake Health (medical expense tracking), Avado (doctor-patient relationship management software), and Sharecare (consumer Q&A with medical experts).

Technology

Dell ends its 10-year storage reseller agreement with EMC. The move was not a surprise, given Dell’s multiple acquisitions of data-storage technology over the last three years.

HP and Lucile Packard Children’s Hospital (CA) announce a real-time patient status system that uses EMR data to represent patient status, rather than traditional handwritten notes on whiteboards. During a trial period, researchers found that the Patient-Centered Dashboard prompted a change in care in one out of three patients.

Other

HealthGrades reports that Washington DC, New York City, and Kansas City are the top communities on a per capita basis in which consumers look for healthcare providers online.

Orion Health says it could hire up to 200 employees New Zealand following its acquisition of the former Microsoft Amalga HIS hospital information system.

At least 255 communities are attempting to support health information exchanges, but only 12% of them are self-sustaining. That’s still 33% better than 2010 estimates.

The 2010 Annual HIMSS Conference is recognized as “The Show with the Most Innovative Practices” at the Trade Show Executive Gold 100 Awards & Summit. HIMSS10 also ranked 33 on the Gold 100 list.

The Commonwealth Fund releases its annual National Scorecard on US Health System Performance. Some highlights (or perhaps lowlights):

• Despite big gains in EMR usage among primary care providers, the US lags far behind leading countries in EMR adoption.
• Although the US is showing promising improvements on several key indicators, quality of care remains uneven, with evidence of many inefficiencies and inequities in care.
• Other advanced countries are outpacing the US in providing timely access to primary care, in reducing premature mortality, and in extending health life expectancy. At the same time, these other countries are spending considerably less on healthcare and administration.

Readers have occasionally speculated about the EMR status of Lehigh Valley Health Network (PA), with a couple of them saying LVHN has chosen Epic. Not true, according to SVP/CIO Harry Lukens, who was kind to provide an update. LVHN, a GE Healthcare customer, is looking at GEHC, Allscripts, Cerner, and Epic. Scripted demos for all interested staff have begun, with those of GEHC and Epic completed (with similar combined scores of functionality and comments.) Harry says LVHN is planning to eliminate one vendor in November and another in January after site visits, then come to a final decision by March, although he’s philosophical in expecting the unexpected: “Keep in mind I also planned on attending the World Series to watch the Phillies play, which is my way of saying ‘stuff happens,’ a simple observation that planning is filled with things that happen for no reason.”

Central Vermont Medical Center and Fletcher Allen Health Care create a corporate affiliation that will allow them to share centralized services, among them Fletcher Allen’s Epic system.

Weird News Andy says, “I can see right through their plan,” as three Delaware Valley hospitals report the theft of scrap X-ray film, apparently by silver-seeking thieves posing as employees of a company hired by the hospitals to recycle their old film. And in a story WNA finds simultaneously weird and sad, a 47-year-old man appears on Howard Stern’s satellite radio show hoping to generate donations toward the $1 million he needs to pay for corrective surgery for his elephantiasis-swollen scrotum, which weighs 100 pounds.

Sponsor Updates

• Texas Regional Medical Center enhances its medication barcoding initiative with the implementation of the Access Intelligent Forms pharmacy labeling solution.
• Southeast Alabama Medical Center reports that its deployment of ProVation Order Sets has yielded cumulative benefits of $1.7 million.
• McKesson launches Episode Management, which automates bundled payments for episodes of care.
• Mac McMillian, CEO of CyngerisTek, will participate in a telebriefing on HIPAA privacy and security audits, hosted by Law Seminars International.
• T-System CMIO Robert Hitchcock, MD,  addresses critical issues in EDs in a podcast entitled Hospital Emergency Departments in Crises.
• Carefx Corporation releases a white paper entitled Patient Portals – The Pathway to Patient Engagement and an Enhanced Patient Experience.
• Hayes Management Consulting issues a white paper and Webinar on achieving Meaningful Use.
• Crittenden Regional Hospital (AR) meets Stage 1 MU utilizing the EHR and consulting services of Healthcare Management Systems,
• Merge Healthcare’s RIS v7.0 receives Complete EHR certification for MU.

Contacts

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

Orion Health Acquires Microsoft’s Former HIS Product; Companies Will Co-Market Offerings

Orion Health, an independently owned software company that offers HIE, integration, and clinical portal products, will announce later today that its subsidiary, Orion Health Asia Pacific, has signed an agreement to acquire the Microsoft software suite formerly known as Amalga HIS and Amalga RIS/PACS. The companies will also announce that they will co-market Orion Health HIE and Microsoft Amalga Unified Intelligence System (Amalga UIS) to health information exchanges and integrated delivery networks.

Amalga HIS was developed at Thailand’s Bumrungrad International hospital by Global Care Solutions and was acquired by Microsoft in October 2007. It  offered 50 clinical and administrative applications (including lab, medication management, RIS/PACS, electronic medical records, CPOE, clinical documentation, financial management, and HR management) that were used by seven Asia-Pacific hospitals. Microsoft announced that it was ceasing ongoing development of the product in July 2010, but would support existing customers for five years.

Orion will market the former Amalga HIS solutions as Orion Health HPM (Health Process Management.) According to Orion Health CEO Ian McCrae, “The addition of the Microsoft’s HIS assets is a natural extension of Orion Health’s portfolio of products that enable us to offer a complete solution to a wide range of hospitals and health organizations in Asia Pacific. The health sector in a number of Asia Pacific countries is overdue to make the transformative leap to the next generation of systems which integrate the complete healthcare ecosystem rather than siloing information in individual organizations or facilities.” The Thailand development center will become Orion Health’s fourth software engineering location.

We spoke to Paul Viskovich, president of Orion Health North America, who said, “The initial focus of the product will be the Asia and Australasia market. We’re focusing on moving customers forward and expanding that and integrating that application suite with Orion’s current offering.”

The agreement also calls for the two companies to co-market Orion’s HIE and worfklow solutions along with Amalga UIS.

Paul Viskovitch told us, “We can provide the HIE solution requirements, with Amalga UIS providing the analytics and the business intelligence that they require. When you sell to the IDN space, they’re starting to look at an HIE as the foundation for an ACO in many cases. We’re starting to see the Amalga UIS component, with its business intelligence and analytics, as a key part of providing a solution.”

Nate McLemore, general manager of business development, policy, and international sales of Microsoft’s Health Solutions group, told us. "We were hearing a lot from both customers and prospects that as we were in the HIE market, both in the community HIE as well as the enterprise-based HIE, that they loved the portal and workflow solutions that Orion provided, but also understood  the value that Amalga provided with a deep data platform and data analytics. Our customers and prospects were torn because we came at the problem from different directions. We spent the last several months working on how to address that and really go to market with a combined offering that gives customers the robust portal and workflow of health exchange through Orion, but also the data analytics and data platform capabilities of Amalga.”

We asked Nate McLemore how Microsoft might work with other potential partners like Orion. He said, “As Amalga moves more and more toward a data platform, we see working with partners to provide the data aggregation components of Amalga into the solutions they have.”

Orion Health, headquartered in New Zealand with a head USA office in Santa Monica, CA, offers an HIE platform, the Orion Health Hospital clinician portal, the Symphonia messaging and mapping tools, and the Rhapsody Integration Engine.

Monday Morning Update 10/17/11

From Epic4All: “Re: Epic. It’s the de facto EHR for hospitals in Seattle with two more area community hospitals implementing it – Overlake and Valley General Medical. This is on top of the largest system Swedish Medical Center (and associated hospitals), UW, and Group Health already live.” Unverified. Your statement will probably elicit scathing comments from the same handful of high-strung readers who howl that any mention of Epic is pandering favorably to the company, conveniently missing the point that they are outselling everyone (not to mention that I run quite a few negative comments about Epic as well.) I’d bet money that anyone who gets that worked up at the mention of Epic either (a) works for a struggling competitor, or (b) applied to work for Epic and got turned down (or both). I suppose I could write endlessly about Invision or STAR, but who would find that relevant or interesting?

From Soliloquy: “Re: Epic. Heard that one of the Adventist facilities on the West Coast is stopping its ambulatory implementation and will put out an official announcement next week. Someone also told me that Ventura County is walking away from Epic at their two public hospitals.” Unverified.

From Another Take: “Re: Fasttrack’s comments on Cerner Health Conference. This consultant writeup is favorable, but seems to be without bias. I found it an interesting juxtaposition.” Most interesting to me was that Neal Patterson compared Cerner to Apple, which seems a stretch given the implementation challenges and user-visible complexity of Millennium, Cerner’s unwavering focus on investors instead of innovation, and emphasis on enterprises instead of individual users. I’d say Cerner is a lot more like Microsoft, Oracle, or IBM in that regard, but Neal’s obviously looking to ride some Apple coattails (or perhaps is badly hiding some Steve envy). That doesn’t detract from what Cerner has accomplished, but drawing a self-comparison of a conservative enterprise software vendor to the consumer-focused and innovative Apple is always going to cause some eyes to roll.

Thanks to HIStalk reader Jared, who sent me an iTunes gift certificate with a note of thanks for HIStalk. He wasn’t looking for a plug, but I’ll give him one anyway since it was a nice surprise – he’s the founder of Splint, which is building EMR client iPhone apps for nurses (of which he is one.)

Armed with a bulging iTunes balance courtesy of Jared, I decided to see if I could find an interesting iPad app or two for HIStalk readers. The result: Splashtop Remote Desktop, one of the coolest things I’ve seen lately (especially for $1.99). Load the app on your iPad or iPhone, install the free streamer app on the PC you want to control, and you’re done – the app finds your PC and you can instantly start controlling it just like you were sitting in front of it. Not only is the video fast and smooth, the PC’s sound even plays over the iPad’s speakers (!!) I sat outside on the deck with a snack and fired up Word, ran my Iolo System Mechanic registry backup, closed down my invoicing program that I’d forgotten was open, and streamed some Flash video that normally doesn’t work on iPad. It looked exactly like the video above. You can run your desktop apps from anywhere, send files to yourself that you forgot to take along, run Office apps or Outlook without having anything installed on your iPad or iPhone, and maybe even do work-related IT geeky stuff like remote into servers, launch non-Web enabled apps, and do inside-the-firewall stuff from anywhere (by using remote desktop). That’s pretty amazing if you ask me.

I must be getting cranky since I keeping coming up with new grammatical pet peeves, but here’s an HIT-specific one: calling an enterprise-wide implementation of Cerner, Epic, VistA, Meditech an EHR (“The hospital is installing Epic’s EHR.”) I really dislike the non-specific term EHR in general since it describes the end result (stored patient information) and not the applications that create or view that information (CPOE, medical device interfaces, imaging systems, etc.), but it’s really a stretch to use the term EHR to include patient-irrelevant applications such as revenue cycle, supply chain, and workforce management that are often part of the same enterprise-wide implementation. The Feds got everybody throwing around the term EHR to make the same old EMRs of yesteryear sound more appealing, but the tried and true terms made more sense because they were specific: PM/EMR, clinical systems, order entry, etc.

Listening: new from reader-recommended Mayer Hawthorne, a young white nerd from Michigan who shockingly sounds exactly like a 1970s Motown / Philadelphia soul act with high vocals, horns, strings, and funky bass (Stylistics, Cornelius Brothers & Sister Rose, Billy Paul). Here he is on my new fave music show, Live from Daryl’s House. Super catchy, fresh, and retro. He does a great job on Private Eyes with Daryl Hall on the video. This is another chance for those folks stuck in a post-college musical rut (AC/DC in drive time, anyone?) to listen to something recorded in this millennium — think of it as a gateway drug to music that your parents didn’t listen to.

Readers aren’t quite sure how ACOs will affect quality and cost, with the number of those who predict both will improve being exactly offset by those who say both will get worse. New poll to your right: should HITECH compensate providers for using EHRs they bought before the program started? (I didn’t forget that I don’t like the term EHRs, but I used it since we’re talking HITECH here.)

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

My Time Capsule editorial this week, stretching its legs after being filed away since 2006: Don’t Look Now, Your Loop is Open. An excerpt: “We bought the technology least likely to be used, that addresses errors least likely to be harmful, that doesn’t help the user who needs it most, and deployed it in patient care areas where serious errors are least likely to occur.”

RIS/PACS vendor Candelis gets FDA 510(k) clearance for its cloud-based diagnostic image routing and sharing tools.

A SIS-sponsored survey finds that 43% of anesthesia providers either use or will implement an anesthesia information management system, with 28% planning to evaluate systems in the next year.

Ohio State University Medical Center was scheduled to go live on its $102 million Epic system early this past Saturday morning.

Physician’s Computer Company earns ONC-ATCB certification for its pediatrics-specific PCC-EHR v6.0.

Virginia Tech researchers develop software that limits smart phone access to data to specifically defined locations, then wipes it clean when the phone leaves that area. It can also limit smart phone functionality by location, such as shutting down cameras and e-mail when phones are in a hospital operating room.

Awarepoint and Meditech collaborate to develop an ED offering that allows locating patients and tracking critical milestones in real time from the Meditech system. Monongahela Valley Hospital (PA) is its first user.

Florida’s doctor-shopping database finally Monday morning. It’s not perfect, however: pharmacies can wait up to seven days to update it with prescription records, its use is optional for doctors and pharmacies, and most of its potential users don’t know it’s coming online. I was talking to a rural GP who uses an interesting approach to weed out his many drug-seeking patients: he gives them a quick urine screen every time they visit. If they show use of marijuana, cocaine, or other illegal drugs, he shows them the door immediately. He also sends them packing if they have excessive levels of their prescribed drug (indicating abuse) or zero levels (indicating that they’re selling the drug instead of using it). Not surprisingly, the vast majority of his abusing patients are on Medicaid.

Kansas City-based hospital chain HMC/CAH files for Chapter 11 bankruptcy protection, with its biggest creditor being software vendor CPSI at $1.2 million owed.

Bill Wallace, a retired SVP of IT of BCBS Kansas, is named CEO of Kansas Health Information Exchange Inc., the organization’s first employee.

A personal injury law firm’s press release says it settled a wrongful death lawsuit against Northwestern Memorial Hospital (IL) for $5 million, where a 55-year-old physician patient died after a nurse gave him insulin despite a doctor’s order saying it should not be administered. The law firm deposed a nurse who said she had contacted hospital administrators several times to complain about high workload and inadequate staffing. The law firm manages to squeeze in a jab against the medical profession, saying “it is both tragic and ironic that this type of obvious error would happen to a physician in this age of physicians protesting malpractice claims.”

E-mail Mr. H.

News 10/14/11

Top News

Forbes lists the 25 highest paid corporate CEOs in the Unites States. Leading them all: McKesson’s John Hammergren, with single-year compensation of $131.2 million. Forbes helpfully points out that “ObamaCare could end up helping three of the top-10 improve their lot in years to come … Hammergren won’t have to worry about waiting in line to see a doctor.”

Reader Comments

From MoreOutTheDoor: “Re: Dell Services. Two more Perot vets gone from the healthcare group, Jack Evans in the summer and now Dave Marchand. Both had significant leadership roles and were well respected.” Unverified.

From Lead Pipe: “Re: article comment. I commented on an article with a link to my company. It did not appear.” I delete comments that (a) pitch a product or company (that’s not fair to paying sponsors or to readers), or (b) pitch an site or publication that accepts advertising (that means they compete with HIStalk, which is fine, but it’s not my job to promote them.) Sometimes if the comment has value, I’ll just remove the pitch part.

From CMIO/CIO: “Re: Cerner Health Conference. As a 13-year veteran, neither I or my associates attend for the breakfast, unlike FastChange. This has been one of the best CHCs with leading edge differentiators coming to general availability like NLP (nCode) and semantic search. Great networking with not only US clients, but ever-increasing global client base.”

From Shippy: “Re: Cerner conference. Although the comments by FastChange are not incorrect, they could be counterbalanced with the fact that Cerner at least has a vision and passion in the right direction Also, half the problems that Cerner clients are having are not a result of Cerner and its products, but with IT management teams  that understaff projects and still don’t really understand what doctors do.”

From North Dallas Forty: "Re: Nemours. Sent a letter to employees this week stating that computer backup tapes from 2004 were taken from a locked storage cabinet. The tapes include personal information that includes bank account information. I wonder if anyone has been reprimanded?” Verified. Like most organizations that have been breached, Nemours is belatedly passionate about security practices, publicly vowing to start encrypting backups and to store tapes securely offsite.

From Lindy: “Re: University of Virginia Medical Center. CIO left a few weeks back after a semi-successful Epic install. Docs were starting to complain.” Unverified.

From Confused Friend: “Re: Epic. A friend works for an Epic customer and wants to get into consulting, but was told by the company she talked to that they have a 90-day non-compete for customers who are currently installing. She insinuated this was being pushed by Epic. Odd given that the customer went live more than a year ago on her particular product. I’m a former Epic employee and that’s the first I’ve heard of this. Is Epic instituting new policies for consulting firms?” I’ve long since stopped trying to make sense  of Epic’s non-compete policy, so I’ll open it up to anyone who knows its latest flavor.

From Hospital Geek: “Re: [health system name omitted.] We started an ambulatory rollout of Epic about six months ago that would have covered 600 physicians. The project was cancelled a couple of weeks ago.” I omitted the health system’s name because, frankly, I don’t think this is true. If it is, send over some non-anonymous proof and I’ll be happy to name names.

From Too Big to Fire: “Re: Microsoft. Elite developers from an EHR vendor have received 80%+ discounts at the fabled Company Store when visiting Microsoft’s campus. Customers are now required to purchase more Microsoft products. A vendor that allows this practice should disclose those discounts to customers.” I don’t understand what it is that customers are being required to purchase or what the vendor would disclose, so I don’t really have a reaction.

HIStalk Announcements and Requests

This week on HIStalk Practice: athenahealth and Cook Children’s Health Care introduce technology to integrate 2D vaccine barcode data with athenaclinicals. Seventy percent of hospitals and health systems plan will hire more physicians over the next 12-18 months. Phytel wins a contract with Lehigh Valley Health Network’s physician group. eClinicalWorks takes the top stop on the Worcester Business Journal’s list of top-growing private regional companies. Jonathan Bush goes to DC and shares his thoughts on the flaws of EMR attestation. And coming up next week: HIStalk’s Must-See Vendors for MGMA 2011 since I’m heading to Vegas in about 10 days and will be sharing updates on speakers, educational sessions, exhibits, parties, and of course, fashion. Sign up for e-mail updates so you don’t miss a thing.

I’m back from a short, Internet-free vacation in which I interacted with Mrs. HIStalk rather than e-mail. I was apparently one of few: it seemed that many folks around us were too focused on their smart phones to actually look up at either the person they were with or the rather picturesque surroundings. We sat adjacent to a young couple in a restaurant as the male half of the couple endlessly flicked his phone (while eating — he obviously required multi-modal sustenance) to see if any of his fake friends had posted something on Facebook to which he needed to be made immediately aware, while his real-life female partner sat completely ignored (I tried not to draw inferences about how he might correspondingly conduct his romantic overtures.) Maybe I should have followed his model — I’m hopelessly behind on e-mail and general HIStalk tasks to the point I should have just stayed home, not to mention trying to catch up on my hospital job.

I’ve observed, too, that with everybody running around with smart phones and poking at them constantly as though they suffer from an involuntary nervous tic, everybody expects e-mail conversations to be conducted like instant messaging. If you don’t reply quickly (because you’ve turned the darned device off, it’s late at night or into the weekend, or you just don’t have the time, like my trying to prioritize 300 or so e-mails), they send the message again. Not only are people going to die having spent most of their waking hours staring at their phones as though they were crystal balls emitting the secrets of the universe, they won’t even realize they are dearly departed until someone posts a Facebook update.

Inga ran things just fine in my absence, I notice with satisfaction. I get swamped pretty easily since I’m the single point for almost everything (I obviously don’t scale well,) but Inga jumps in where she can on the rare occasions I reluctantly cede temporary control. As for me, I’m already overwhelmed and exhausted anew.

Speaking of BlackBerry, I’m struggling to decide: which company is going to die first of executive incompetence, RIM or Netflix?

Listening: Kingdom Come, a 90s hair band that sounded a whole lot like early Led Zeppelin, which as good as they occasionally were, led (no pun intended) them to be considered a Zep ripoff (“Kingdom Clone,” the wags called them.) I remembered them only because I read a fascinating biography of long-dead Led Zeppelin manager Peter Grant while on vacation (I found it by the pool towel hut) and he said Kingdom Come was terrible. I never was a Zeppelin fan, so Kingdom Come sounds fine to me.

On the sponsor-only Jobs Board:  HL7 Interface Developer, RVP Sales – Western Territory, Front End Engineer, Physician Consultant – Sales Support. On Healthcare IT Jobs:  Manager of Clinical Information Systems, Solutions Sales Executive, Pharmacy Informatics Analyst, Epic Ambulatory Lead Trainer and Trainer.

Thanks to World Wide Technology, Inc., supporting HIStalk as a Platinum Sponsor. The St. Louis-based systems integrator, which has been around since 1990 and has $3.3 billion in annual revenue, offers healthcare-specific services that include patient identification, temperature and humidity monitoring, privacy and security, point-of-care communication and collaboration, IT infrastructure, staff and asset visibility, and services specifically for Cisco TelePresence (they sell a billion dollars’ worth of Cisco products each year.) I notice that the company was named on Thursday to the InformationWeek 500 for the first time, so that’s a pretty big deal. WWT has sales offices around the world and engineers in most US cities, making them easy to find. Thanks to World Wide Technology for supporting HIStalk. I’m a bit in awe when a company that size (or any size, for that matter) steps forward to help me with what I do, as offbeat as that sometimes is.

Acquisitions, Funding, Business, and Stock

Infosys says it is not in discussions for the acquisition of the healthcare business of Thomson Reuters despite earlier media reports (including a mention in HIStalk.) That could mean that those reports were incorrect, but also potentially only premature.

Mobile developer Remedy Systems and physician marketer Physicians Interactive form Tomorrow Networks, a healthcare-only mobile advertising network for app developers that can “tie advertisements to healthcare data points that include ICD-9 codes, CPT codes, and healthcare professional (HCP) specific information.”

Sales

Orlando Health chooses Brainware for document processing.

People

Debbie Ruggles, RN, is named clinical informatics manager of Providence Medical Center and Saint John Hospital (KS), tasked with overseeing the hospitals’ implementation of Epic.

LodgeNet Healthcare hires Sachin H. Jain, MD, MBA, as senior medical advisor. He was previously Don Berwick’s senior advisor at CMS and a special assistant to former ONC head David Blumenthal.

VistA guru Tom Munnecke decides to un-retire and get back into health informatics consulting. An interesting new post from his blog: he wrote a book called The Friendly Computer in 1980 that gave Commodore’s president the idea to call their computer the Amiga, and more impressively, pitched the idea of the “Intelligent Telephone” in 1977 – to none other than Steve Jobs.

Announcements and Implementations

Cardiology Associates of North Mississippi implements White Plume Technology’s AccelaSMART charge capture and medical coding review technology to pass charges between its GE Centricity EHR and athenahealth practice management system.

Ohio State University Medical Center announces plans to double its telestroke technology capabilities using technology from REACH Health.

Thomson Reuters releases Infection Xpert, a clinical intelligence dashboard to improve infection prevention workflow.

Shareable Ink earns 2011/2012 EHR Modular ONC/ATCB Certification. Said Founder, President, and CEO Steve Hau, “It’s the first time you can get Meaningful Use with pen and paper.”

Barnes-Jewish Hospital (MO) launches a mobile app to reduce appointment no-shows.

Premier partners with Encore Health Resources to create an HIT implementation roadmap for organizations moving toward an ACO-type model of integrated, coordinated care. It will be based on Encore’s CoreQUEST and CoreGPS tools.

Government and Politics

The Center for Public Integrity, through its iWatch News publication, tries to stir up some HITECH controversy in its report on EHR stimulus payments. The authors question why long-term EHR users are getting incentive checks if the the goal was new adoption. A representative for Senator (and obstetrician) Tom Coburn is quoted:

If providers have been paid for systems they already had in place, that seems to be an inexcusable waste of taxpayer dollars. It makes no sense for HHS to pay physicians for systems they already have.

I have to side with HIStalk contributor Dr. Lyle Berkowitz who, in the same article, points out that achieving Meaningful Use is not a slam dunk, and paying providers for “doing the right thing before there were even rewards to do so is actually not a bad message to send.”

Senator Chuck Grassley wants to know who authorized the shutdown of HHS’s National Practitioner Data Bank, established in 1986 to confidentially track physician malpractice and disciplinary cases. The reason: a Kansas City reporter was able to identify a Kansas neurosurgeon even though the publicly accessible data was supposed to be de-identified. HHS says the information wasn’t intended for the public to see in the first place, but says they’ll still put it back online “as soon as possible.” Two facts stand out: (a) there’s no such thing as truly “de-identified” information, assuming someone has the resources and motivation to match up multiple public data sources; and (b) Chuck Grassley writes a lot of indignant and demanding letters that never seem to amount to anything except get him mentioned in the press (no offense, Chuck, I’m a big fan, but follow-through is everything.)

The VA is testing an iPad-based portal to its electronic medical records called the iHealth adaptor.

Technology

Cerner announces its Skybox on-demand storage service offering, an enterprise-wide cloud storage system powered by Nirvanix Private Cloud Storage that allows customers to consolidate their storage of clinically related data objects under a usage-based pricing model.

Other

From KLAS: since Virtual Radiologic’s purchase of telaradiology provider NightHawk last year, NightHawk customers are reporting challenges with turnaround times and the transition to vRad’s technology and up to half of those customers are seeking alternatives. vRad’s performance scores have also slipped.

Meanwhile, KLAS provides a less-than-glowing report on Meditech’s v6 in unusually blunt terms, saying Meditech’s products are generally less functional but cheaper than those of competitors, and even though 6.0 is “half-baked and more expensive,” it’s still cheaper than those competing products and therefore “worth the pain to make it work for them.” KLAS concludes that customer satisfaction depends on their expectations.

Here’s Vince’s latest HIStory, this time covering JS/Data in the first of a two-parter. He’s finding that veterans of these long-gone companies still speak fondly and happily about their experiences and the people they knew there. Sometimes I wonder if it will be the same positive feelings down the line for today’s rookies, for whom HIT was already a big business by the time they came on board.

HIT service provider Anthelio will hire 200 people in Michigan, mostly medical insurance billers and coders. The company is building a 50,000 square foot Center of Excellence in between Detroit and Flint.

Dennis Ritchie, who created the C programming language and co-developed UNIX, died Wednesday at 70 of prostate cancer.

Shareable Ink CEO Steve Hau tells a group of Nashville executives that he is not yet convinced the region offers a critical mass of superior engineering talent. He moved from Boston to Nashville last year to capitalize on Nashville’s healthcare industry concentration.

Healthcare Growth Partners releases its Q3 merger and acquisition review. Trends they’ve spotted: non-traditional vendors are entering the market, ACO activity is motivating investment in systems such as analytics, hospital best-of-breed solutions are struggling against enterprise vendors, and vendors are seeking growth financing rather than selling out.

Somebody just posted this video tour of the famous Epic treehouse.

Epic is awarded a patent for GUI method called a “dynamic order composer” of entering patient orders using a pre-populated order entry form. It sounds like it suggests orders based on patient information and popularity.

Doctors in China are striking over being physically attacked by the family members of patients. One orthopedist says doctors are a disadvantaged group since “we have spent so much of our youth on a medical degree that yields so little economic reward.” Ninety-six percent of doctors there say they are unhappy with their salaries, which average just 19% higher than those of factory workers.

An employee of a Baltimore law firm loses a portable hard drive containing the medical records of 161 cardiac stent patients who are suing a local cardiologist. The company explained that its employee was taking the information home on an unencrypted drive as a precaution against loss, but forgot it on the light rail. The law firm offered patients a one-year membership in an identity theft service in a letter mailed to patients two months after the breach, saying it was on “behalf of St. Joseph Medical Center,” the hospital at which the cardiologist formerly practiced. The law firm’s own site doesn’t mention the event at all as far as I can tell.

Weird News Andy finds this story fascinating, especially the last line. Two pregnant women get into a fight with two other women in a Philadelphia hospital room, with one of the moms-to-be slashing the two non-pregnant ones with a knife. All were visiting “a male patient who is recovering from a gunshot wound.”

Sponsor Updates

• Billian’s HealthDATA launches Better Business by 2012, a blog series for healthcare vendor sales and marketing teams. The company is also offering an October 19 Webinar on clinical informatics featuring Michele Burke RN, clinical transformation manager with North Shore Long Island Jewish Health System, who will talk about EMR implementation.
• CynergisTek CEO Mac McMillan will discuss security challenges and best practices for long-term care at this weekend’s 2011 Leading Age and IAHSA Global Aging Conference in DC.
• Peer Consulting enters into a Provider Consulting Organization agreement with CapSite for its Hospital Purchasing Database solution.
• Palestine Regional Medical Center (TX) selects ProVation Medical Software for its gastroenterology procedure documentation and coding.
• Our Lady of the Lake Regional Medical Center and Our Lady of the Lake Children’s Hospital (LA) implement GetWellNetwork’s interactive patient care solution.
• Allscripts deploys the IXIASOFT DITA CMS DITA to manage its documentation process.
• Ysbyty Ystrad Fawr, a new hospital opening in December in Wales, will feature the use of Vocera’s communication system.
• The MedAssets Bundled Payment Solution earns PROMETHEUS Payment-ready certification from the Health Care Incentives Improvement Institute.

EPtalk by Dr. Jayne

A few weeks ago, I complained about having to fill out paper credentialing forms. Today I received my hospital’s proposed updates to the Medical Staff Bylaws. Under the section addressing allied health professionals (nurse practitioners and physician assistants), there are several revisions that pertain to electronic submission of data for paperless credentialing. Let’s hope it doesn’t only apply to them but to the physicians as well.

HIMSS has announced the lineup of keynote speakers for the 2012 Annual HIMSS Conference & Exhibition. Biz Stone, co-founder of Twitter, leads off on Tuesday, followed by National Coordinator for Health Information Technology Farzad Mostashari on Thursday. Friday closes out with political strategist Donna Brazile, former White House press secretary Dana Perino, and Blue Zones founder Dan Buettner. I’m not that excited about HIMSS in general, but I do rather fancy Mr. Mostashari in his dapper bow tie.

Friday is the last day for the HIMSS 2011 Annual Award nominations. As an anonymous pseudo-celebrity, I’ll never qualify for one of these and I’m not sure how relevant they really are. Frankly, the HISsies are the only awards I really follow.

The Washington Post reports on data indicating that our bacterial friends actually help keep us healthy. Researchers cite both antibiotics and an obsession with cleanliness as causing potential imbalance in the microbial universe, contributing to asthma, allergies, obesity, diabetes, and other conditions. I guess the “Three Second Rule” for edibles that hit the floor may not be as bad for the average college student as we once thought.

Inga beat me to the punch reporting on a recent study that concluded that high chocolate consumption is associated with a lower risk of stroke. Dark chocolate (my personal fave) is also thought to raise HDL (good cholesterol) as well as lower LDL (bad cholesterol) and blood pressure. Although an apple a day gets all the publicity, I’m going to start a “Truffle a Day” campaign.

Field correspondent Martini McBride reported in from the AHIMA opening reception in Salt Lake City. The QuadraMed booth featured both ICD-10 and ICD-9 cocktails. The word is that the ICD-10 version was much better and the light-up glasses were also fun. Let’s hope the real ICD-10 is also smooth and refreshing. I have readers promising to send updates from McKesson and other exciting get-togethers, so stay tuned.

Contacts

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

News 10/12/11

Top News

At this week’s Cerner Health Conference, Cerner CEO Neal Patterson tells 10,000 attendees that Meaningful Use is creating a “duopoly” in healthcare IT and that healthcare will fundamentally change over the next  decade. Patterson also unveiled plans for cloud technology that will coordinate clinical data from multiple systems and use Cerner search and analytics tools to evaluate and manage health.

Reader Comments

From HomeBody “Re: Homecare technology. Homecare technology is definitely an up and coming topic of interest among healthcare today, especially on the hospital side. I see it only becoming a more and more important piece of this proposed continuum of care model.” Thanks for all the comments in favor of increased coverage on homecare, assisted living, and long term care IT. Mr. H and I will strategize a bit more. Meanwhile, if you happen to be an expert willing to share your expertise, let us know.

From FastChange “Cerner Health Conference. Ughhh. Painful!  No breakfast, too crowded because facility is too small, making us  get scanned for every session- causing huge lines of course. No consistency in their Solutions Gallery- lots of vaporware from various groups competing with each other and they are still 1-2 years behind other vendors in things like mobile and ACO type software. Ten thousand people here but that includes Cerner staff, which appear to be every other person I meet. Haven’t met a happy Cerner client yet. But the keynote speaker, blogger and doctor Wendy Sue Swenson (Seattle Mama Doc) was great.” Other than that Mrs. Lincoln, how was the play? I should add that despite FastChange’s less than glowing report, I noted many very positive comments posted on Twitter (#CHC11).

HIStalk Announcements and Requests

Mr. H is on one of his well-deserved Internet-less get-aways, so it’s all me today.  Whenever Mr. H leaves me in charge, I feel Alexander Haigish, in that I’m-in-control-even-though-I’m-really-not kind of way. Mr. H will return to power soon.

Thank you to all my Facebook friends who sent over birthday greetings. If you would like the opportunity to make me feel special next year, it’s not too soon to Friend me (and Mr. H and Dr. Jayne) or like HIStalk on Facebook. We are also happy to connect with you on Linked In, should you would prefer to keep our relationship on a more professional level.

Acquisitions, Funding, Business, and Stock

VC funding in HIT more than tripled in the third quarter, compared to a year ago. Fifty different organizations invested $207 million for 17 deals, which included ZocDoc ($75 million) and Awarepoint ($27 million.) M&A transactions totaled $4.7 billion for acquisitions that included Emdeon ($3 billion), Sage Healthcare ($320 million), and M*Modal ($130 million.)

Sales

Surgical Care Affiliates chooses workforce management solutions from Kronos.

SIU HealthCare (IL), a network five hospitals and 43 clinics,  selects GE Healthcare’s Centricity Business to compliment its existing Centricity EHR.

People

Medsphere Systems hires John Bright as VP of sales and marketing. Bright previously led sales for Henry Schein Medical Systems.

Virtual Radiologic names Jim Tierney SVP of Operations for vRad Radiology Alliance. Tierney was formerly CEO for the 62-physician Suburban Radiologic Consultants.

Allscripts and IDX veteran Todd Young joins PureWellness as COO.

Announcements and Implementations

The Community Health Information Collaborative’s HIE Bridge connects to the VA to exchange veteran health data via the ApeniMED NHIN platform.

Kettering Health Network (OH) completes its four month, enterprise-wide transition to the InterSystems Ensemble platform.

Local boy scouts and other community members helped create a festive atmosphere during Chelsea Community Hospital’s (MI) $12 million transition to Genesis System EHR.

The local paper profiles Lakeland Regional Medical Center (FL) and its go-live on Cerner’s EHR. I was slightly amused that the hospital’s chaplain was the first person quoted about the transition, saying, “We’ve been circulating on our patient units and they’re feeling confident. It’s exciting.” I never realized that hospital chaplains were active participants in EHR implementations, but then again I have never worked in a hospital.

CPSI customer Morton County Health System (KS) becomes the first hospital in Kansas to receive payment from Medicare for its meaningful use of EMR.

Government and Politics

Illinois Governor Patrick Quinn announces that the state’s Office of Health Information Technology selected InterSystems to develop the infrastructure for the Illinois HIE.

Innovation and Research

In addition to the meta data cloud project, Cerner hints at future products that optimize iPhone and iPad technology, as well as software that incorporates voice commands.

Other

Florida Hospital places a newspaper advertisement in the Orlando paper notifying patients of improperly accessed patient information. The “Public Notice” informs patients that between January 1, 2010 and August 15, 2011, three employees, who have since been fired, were believed to have accessed patients’ demographic data. The employees targeted ER patients involved in car accidents and passed the information on to an attorney-referral service. The hospital is offering credit monitoring to patients that might have been affected.

Best news of the day: Swedish scientists find that eating chocolate – preferably dark – can reduce a woman’s risk of stroke by 20%. Other benefits include reduced blood pressure, lower insulin resistance, and less crabbiness (ok, that last one conclusion was based strictly on my own personal research.)

Sponsor Updates

• Edge Solutions partners with BridgeHead Software to resell and deliver Bridgehead’s backup, recovery, and archiving solutions.
• At this month’s MGMA meeting in Las Vegas, MED3OOO will showcase its newly released InteGreat EHR, which now includes end-to-end integration with the MEDCIN Engine.
• T-System Inc. will highlight its products in a “virtual ED” at this week’s ACEP Scientific Assembly. T-System will also host the next Board Certification for Emergency Nursing meeting October 17-18 in its Dallas headquarters.
• Greenville Hospital System University Medical Center goes live with Holon’s Pharmacy Workflow Manager at all 11 of its pharmacies.
• Besler Consulting’s Vicente Farina shares insight into Direct Graduate Medical Education (GME) and Indirect Medical Education (IME) payments, two types of Medicare payments specifically for teaching hospitals.
• EDIMS is exhibiting at this week’s ACEP 2011 Scientific Assembly in San Francisco.
• Wellsoft announces its fall conference schedule, which includes the 2011 ACEP Scientific Assembly, the Emergency Department Administration Conference (EDAC), and HealthAchieve.
• Surgical Information Systems (SIS) announces that SIS Anesthesia V5 has received ONC-ATCB certification by the Drummond Group.
• Practice Fusion will simulcast its November 11th Connect 2011 meeting.
• Imprivata earns a Strong Positive rating  in Gartner’s report, MarketScope for Enterprise Single Sign-on.
• The local paper highlights Hasbro Children’s Hospital’s (RI)use of the GetWellNetwork.
• Intelligent Medical Objects is participating in the Cerner 2011 Health Conference, AMIA, and NextGen’s User Group meeting.
• Healthwise will participate in this month’s Patient Centered Primary Care Collaborative in Washington, DC.
• Ignis Systems releases its EMR-Link Maintenance Training Webinar schedule.
• Greenway’s PrimeSuite EHR achieves CCHIT certification in Women’s Health.

Contacts

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

Monday Morning Update 10/10/11

From Spell Chequer: “Re: HIPAA. I thought you’d appreciate this full-page ad, from an e-guide on HIPAA compliance.” We’re reaping what we sow as a society. It’s considered uncool to correct anyone’s spelling or grammar these days, and thus sloppy mistakes are the rule. Text message writers and tweeters have dumbed down the language the point that it’s barely understandable. What could be more cluelessly arrogant than the implied message, “I’m too important to take the time to spell and write well, so I expect you to translate for me?” As foreign students work endless hours to master English to ensure their future success, ours spend their time butchering it. But even near-illiterates shouldn’t misspell an acronym, especially one in which they claim renowned expertise.

From Major Payne Diaz: “Re: 5010 upgrades. You still need to feed the clearinghouse 5010 data, so the practice management software needs to be updated with vendor code to enact the changes. Then the facility needs to make their modifications – install the new 5010 sub-forms, modify table values, modify the loop/segment data sent for a particular payor. None of these can be performed by the scrubber or clearinghouse. Consider just one – Pay to Provider (rather important, don’t you think?) How would the clearinghouse know this information unless the source system / scrubber values it appropriately? Since when did the clearinghouses get crystal balls?”

From McMessy: “Re: McKesson. Both employees you mentioned left after they got word that Horizon Clinicals is going maintenance-only.” I’ve seen no announcement about Horizon, so if you have, please send something my way to confirm. That rumor keeps floating around (like the one suggesting that MPT is going to be sold,) but it’s all smoke and no fire so far.

I was asked by a book publicist to consider writing about a new book called Your Medical Mind. I did, and it was a somewhat mixed review. It contains good if not occasionally obvious ideas about making medical decisions, but isn’t all that much fun to read, is a bit padded, doesn’t fully answer the question the subtitle asks, and either isn’t clear on its intended audience or fails to engage them on their level. I still like the concepts, though, even if I wouldn’t necessarily invest the time or money to buy the book. I’d like to see the authors (or someone else) turn it into a movement that would probably be more effective on a larger scale. It’s a good conversation-starter, at least.

My Time Capsule editorial this week from September 2006: Drug Rep Gifts Banned – What About IT Reps? A snip: “Having decision-making authority means vendor reps will try to soften you up like gangsters wooing supermodels — with flattery, rapt listening, and a shower of baubles.”

Most respondents to my poll said they follow their employer’s security policies all the time, but of course I didn’t really ask how stringent those policies are (especially those related to encryption of data on portable drives, accessing Web sites and online e-mail accounts from company devices, etc.) New poll to your right: what effect will ACO-type reimbursement models have on quality and cost?

St. Louis-based NextGen reseller KIG Healthcare Solutions is sold to another reseller, GBS Corporation of North Canton, OH.

A jury finds that Teva, Baxter, and McKesson must pay $20 million for selling the anesthetic Propofol in large vials that the plaintiffs say implied the vials could be used for multiple patients. Punitive damages of up to $600 million are being sought. The first two companies (not McKesson) were hit with a $500 million verdict previously in another case. Plaintiffs claimed the companies stopped making smaller vials of Propofol because the larger ones were more profitable; patients sued after contracting hepatitis from a Nevada colonoscopy clinic. The CDC said the infections came from the clinic’s use of Propofol vials for multiple patients, but the defense argued that the infection could have come from improperly sanitized instruments. The clinic’s former owner and some of his employees were indicted on criminal counts that included racketeering, insurance fraud, and patient neglect, but he was found incompetent to stand trial. Since McKesson is a distributor and not a manufacturer, you would expect their involvement to have been limited to filling the orders of its customers. Nearly 300 lawsuits have been filed against Teva, which says it will pay any damages levied against its distributors such as Baxter and McKesson.

Howard Hays, MD, MSPH, acting CIO of the Indian Health Service, testifies in a Senate hearing on that organization’s use of real-time videoconferencing, consultations, patient monitoring, and mobile health. They are providing services such as behavioral telehealth, home blood pressure monitoring for chronic disease management, tele-nutrition, and remote neurosurgical consultations from the University of New Mexico Regional Trauma center. Video of the hearing is here.

A Texas Tribune article covers practice groups in that state that are following new IT-enabled models. Examples: one practice performs all wellness exams in a single visit, answers patient e-mails 24×7, and logs diagnostic results immediately to their EMR. Another offers specialty storefronts, same-day appointments, and valet parking. Kelsey-Seybold Clinic in Houston has 373 physicians in 20 facilities, all with in-house lab and x-ray facilities, uses a single EMR (Epic), has offered an accountable care plan through Cigna for four years. They use the EMR to prevent duplicate tests or treatments and to provide best-practice alerts and preventive reminders. It’s a good reminder that a well-run practice can scale up without needing a hospital to buy it, although most practices are run as small businesses without a lot of business savvy (hint: if your business manager is the spouse of one of the doctors and the IT expert is one of their unemployed nephews, the chances are good that even notoriously inefficient hospitals could run it better).

Great Plains Health Alliance will use $5.2 million in federally guaranteed USDA loans to buy clinical software for 22 rural hospitals.

A Massachusetts state senator introduces legislation that would take away the power of the Massachusetts Historic Commission to restrict the use of land that isn’t listed in the state’s Register of Historic Places. That’s in response to Meditech’s announced plan to take its jobs elsewhere when the Commission insisted that a lengthy archaeological survey be performed before new offices could be built.

The widely decried “Coke and fries” program in Australia in which retail pharmacists would have received computerized reminders to push a particular company’s herbal remedies along with prescriptions has been shut down. The president of the pharmacy guild that came up with the idea is appalled that media coverage was negative. “The idea that community pharmacists would take part in commercial up-selling without regard to their professional standards is offensive to our profession and rejected by the guild.”

Hospital software vendor CPSI pays $102,000 to its employees after a Department of Labor compliance audit finds minor errors in some of its pay rules. CPSI was paying 1.5 times the hourly rate for overtime and a flat fee for being on call over the weekend. The issue involved employees who were already on overtime before the weekend started. The company thought (as did I) that on-call pay is discretionary and not subject to overtime regulations. Of its 1,000 employees, audits found 247 who were affected, with an average payout of $60. As CPSI CEO Boyd Douglas said, there would have been no discussion if CPSI simply shafted its employees like most companies and forced them to take call with no extra compensation.

Cleveland Clinic announces its Top 10 Medical Innovations for 2012, of which two involved healthcare IT: data analytics and mobile apps for physicians. Its just-ended Medical Innovation Summit was like a dream for right-winger capitalists rather than compassionate healthcare advocates, with keynotes by Dick Cheney, Jeff Immelt of GE, and the CEOs of drug and device companies looking for the next bottom line booster.

Oracle settles charges that it overcharged the federal government for software over a nine-year period by not offering Uncle Sam the same discounts that the company’s commercial customers receive. Oracle will pay $199.5 million under the False Claims Act, with the company’s former employee who filed the whistleblower lawsuit pocketing a cool $40 million. Oracle says it followed the rules, but the incidents are so old (1998 to 2006) that it can’t find reliable witnesses and would rather just move on.

Merge Healthcare chooses Dell as its preferred provider of cloud-based computing services, storage, and enterprise hardware. Meanwhile, Chicago Mayor Rahm Emanuel announces that Merge intends to grow its local workforce from 900 to 1,100 over the next two years and install 100 of its Vital Kisoks around the city.

Last month’s arrest of the 17 year-old Matthew Scheidt posing as a physician assistant in a Florida hospital marks the third time he attempted to practice medicine at local hospitals. The earliest documented attempt was in 2007, when the then 13 year-old Scheidt masqueraded as a nurse; he also twice claimed to be a sheriff’s deputy. The Orange-Osceola State Attorney’s Office announced that Scheidt will be procescuted as an adult on two felony counts of impersonating a physician assistant and four felony counts of practicing without a license.

Nuance Communications discloses it has acquired Swype Inc. for $102.5 million. Swype is a provider of alternative keyboard input functions for mobile devices.

We were sent a fun resignation letter that made its way around. The author gave the OK to run it as long as his name and that of the company were removed (although he knows it won’t be hard to figure out which company he resigned from.) He was surprised that his vendor employer didn’t delete it off the e-mail server. Inga and I found him amusing in a Ricky Roma kind of way, so we’re trying to get him to write for us.

Let’s be honest. Resignation letters are usually brief, nice and boring. My goal is to make this none of those things. The only good ones are those accidentally sent out to the whole company where everyone tries to figure out why they got an e-mail about “Frank” who worked here for eight months as an IT consultant in Boise. Good ol’ Frank – he was solid from a technical standpoint, but not so solid at the TO: line of an e-mail.

I thought I might write this as a Top 10 list because that has never been done before … ever. I’m sorry, I have just been informed that I am only able to write this as a Top 7 list. If you want the full Top 10, you will need to wait for the next version – top10.1.1 or Service Pack 2.

And now, the thoughts of a man in a powder blue tuxedo.

10. Keep in touch. Keep in touch is the worst phrase ever. Let’s update that one: “Keep in touch on LinkedIn because I may need a recommendation soon.”

9. The Mothership. I am taking credit for giving the office this moniker, and it has now passed the test because I heard an “executive” use this phrase. I also like to put the word “executive” in quotes.

8. Casual attire. For those of you reading this outside of the Sanctuary walls (no, not that kind of sanctuary, that’s the name of our building), did you know that we can wear jeans every day? There are still some guidelines and I feel some of our IT friends need a little assistance. I have seen so many Canadian tuxedos in the last six months that I feel like I am backstage at a Rush concert.

7. Last season, our softball team was named the Crooked Numbers. It’s a softball term, I guess, but I also think it also describes the reason why we lost so many “executives” a few years ago.

6. Handing in your two-week notice. Other than my current haircut, this was my biggest mistake. I should have said that I am going to consult for all of our top competitors and am building an EHR in my garage so they would have kicked me out right away. Now I had to stay for two weeks to help “transition” someone into my “role” and “drag down morale” with my “shifty eyes” and “rugged good looks.”

5. (This item was not approved by legal, technical accounting, corporate, finance, and/or a gang of angry ninjas.)

4. I will miss many of you. Not all of you of course. But if I had to pick what I will miss most, it is you, free Diet Coke machine. Thank you for early morning wake-ups, late night keep-ups, and mid-day pick me ups. You are the epitome of ICARE.

I have worked here for nearly four years and there are some great people here. I thank them for everything.

Always up for a fried appetizer.

E-mail Mr. H.

Pediatric Office of the Future by Dr. Gregg

Lots of folks are gearing up for (or just gearing down from) their pick of the onslaught of fall HIT and/or healthcare conferences. I know most of you HIStalk fans aren’t pediatric-oriented per se, but I’m guessing that most of you were, at one point or another, children. I’m further guessing that many, if not all, of you appreciate a little humor amidst your techno-serious daily chores.

With these guesses in mind, I asked Mr. H to share the following two video clips with you. They were 100% donated to the 100% non-profit, educationally-focused “Pediatric Office of the Future” (POF) exhibit which I am honored to direct at the upcoming American Academy of Pediatrics-National Conference & Exhibition, Oct. 15-18th, in Boston. These very fun clips were created specifically for our brand new “Tech Talk Theater” by the very good and amazingly-talented folks at Nuesoft. These were all done in house with family and friends, but you’ll swear they hired out!

I can 99.9% guarantee these short “sizzle reels” will bring a smile to your day! (The 0.1% accounts for those incorrigible curmudgeons out there or those who watch just after walking out of a hospital finance meeting.)

Please disregard the blatant “self”-promotion for the greatly expanded POF with our new focus upon all 3 offices where docs work: outpatient, inpatient, and mobile. Disregard, too: our 500% growth; our 31 fantastic sponsors; our brand new “Hospital of the Future” booth; that we’re helping a local free clinic; that we’re giving away low cal ice cream; that we’ve got robots, telemedicine, patient engagement & education tools, cool hospital tech, diagnostic wizardry, etc.; or that we’ve got our new Tech Talk Theater running 28 little 15-minute talks throughout the show with a diversity of speakers on “news, views, & current events from the world of pediatric healthcare technology.”

Did I hear someone say “Emmy”? We’re Tweeting about it at @PedsOfficeFutur.

E-mail Dr. Gregg.

Book Review–Your Medical Mind

TLC Book Tours asked me to review Your Medical Mind: How to Decide What is Right For You by Jerome Groopman MD and Pamela Hartzband MD. No compensation was provided other than they sent a free copy. I agreed to review the book because I’m a fan of one of the author’s previous books, How Doctors Think.

This book asks a sobering question: can you trust clinicians to always recommend the best course of medical action given your particular personal beliefs and circumstances? Reading it can be uncomfortable. You are reminded that medicine is not quite the pure science that it sometimes seems and that most of us would like to believe. There are few silver bullets.

Physicians and patients each have their own value systems and motivations. They don’t always overlap. The authors urge patients to take control of their treatments, do their own research, and work with their doctors to individualize their treatment to their own satisfaction.

This paragraph from the introduction neatly encapsulates the entire book’s theme (to the point that I wouldn’t necessarily suggest buying the book if you already understand this concept):

Despite many scientific advances, the unsettling reality is that much of medicine still exists within a gray zone where there is no black and white answer about when to treat and how to treat. Often, there are several differing approaches to treatment, each with its own risks and benefits. The best choice for an individual may be anything but simple or obvious.

In other words, with apologies to the 1960s counterculture movement: Question (Medical) Authority, but in a constructive way.

Those of use who work in hospitals get this point since we see examples of it all the time. Doctors sometimes offer patients a single treatment option that they themselves admit they wouldn’t accept for their own family members. Professionals whose opinions differ don’t speak up, figuring it’s none of their business. The book will provide a service if it only gets that point across – nobody knows your body and mind better than you, so you need call your own shots when it comes to medical care.

The opening chapter, called “Where Am I in the Numbers?” urges patients to both understand any numbers presented to them (such as, “This drug causes side effects in x% of patients”). Also, to realize that “stories” from other patients may over-influence the perceptions of both physicians and patients since both tend to believe stories that echo what they already believe (or want to believe.)

The chapter called “But Is It Best for Me?” is slightly critical of evidence-based medicine, the idea that if you read enough scientific literature, every patient can be treated from a cookbook. Its key point is that even those guidelines are subject to bias, only this time that of the people who reviewed the literature to create the guidelines for treating “average” patients.

The book also examines the effect of coping mechanisms. An interesting example is the driven patient who, when faced with a new diagnosis, gets consumed with the idea of researching “the best of the best,” convinced that making the right provider choice can overcome the disease process. Conversely, providers and insurance companies have engaged their advertising agencies to use that belief to bring in new business with feel-good personal stories in ads that suggest everything will be fine if you just call up the particular organization with your insurance card handy.

Other patient decisions are addressed. How do you make end-of-life decisions, and are a patient’s “pull out all the stops” wishes good for the society that bears the economic cost? Do economic formulas such as quality of life indicators really mean anything? Should you choose a doctor who thinks like you, or one who doesn’t?

The authors bring forth critical medical issues, especially since it does so in an economically motivated environment where treatment decisions are often driven by the government, computers, and corporations. Most patients would be surprised to find that they have a voice in even routine treatments, and more importantly, that their voice is essential in achieving the outcomes most important to them as a human being. If everything could be distilled into a formula, restaurants wouldn’t need menus – you would just sit down and let the computer order for you the same meal that everybody else like you gets or that you’ve enjoyed in the past.

Your Medical Mind should start (or augment) a patient-centered movement. Medicine may be a science, but treatment is an art. As much as we’d like to see the body as a set of numbers that can be made to go up and down by drugs and surgery, it’s not that simple. Its message is that everybody (and every body) is different, and you can’t treat the body without the involvement of the mind. As wise doctors have said long before technology, you treat the patient, not the symptoms.

I would probably recommend this book, but with reservation. It’s not especially fun to read, especially if you’re like me and want to cut to the chase like the subtitle suggests (how to decide what is right for you.) The patient stories wear a bit thin, especially when they are broken out into sections separated by chunks of often unexciting citations of other works. It seems to me that the core idea was padded out considerably to justify the price of a full-sized hardcover book (it contains 308 pages, of which 90 are acknowledgments, notes, and the index; the stories sag under the weight of pointless detail). It could have done a better job in distilling all the stories into an action plan for various medical circumstances, such as what to ask before agreeing to surgery or starting on a new prescription. Its readability level is probably too high for the average patient to comprehend.

What I would really recommend, then, is that somebody take these and other patient-centered ideas and turn them into something the average patient can start using now. Most patients will never read the book, and many who read it won’t connect it to an immediate medical decision when the time comes to make one. If the idea is to education patients beyond just selling books (which  few people read these days,) then the message needs to be mobilized in the form of videos, checklists, or how-to pamphlets that can be handed out in medical practices. On the provider side, how about a set of guidelines on how to communicate (both ways) with patients about what’s best for them?

My final thought was this: we’re getting further away from what Your Medical Mind advocates, at least for the average patient seeing the average doctor. Insurance companies and hospital-owned practices don’t want to pay for exploring patient wishes. Doctors get paid for cranking out the encounters and following a corporately-developed, cost-effective treatment formulas. The country is already going broke over healthcare costs, so who’s going to pay for anything more than symptom Whac-a-Mole, where limiting an encounter to ten minutes, getting lab results into the “normal” range, and prescribing from standard treatment algorithms constitutes a medical job well done no matter what the patient thinks?

In that respect, Your Medical Mind is revolutionary. The idea “you’re not the (medical) boss of me” is threatening to the status quo. Doctors and patients have to stay on the good side of insurance companies and the government, where “having insurance” is equated to “having access to healthcare.” If there’s going to be a patient-centered revolution, it will need to be fought behind the closed doors of the examination room, where medicine still what it always was – respectful and honest conversations between doctors and their patients about what’s best for them.

Cerner To Acquire Clairvia

Cerner announced this morning that it will acquire Clairvia, a Durham, NC-based vendor of care coordination and workforce management solutions that are used by more than 400 organizations. Cerner will integrate Clairvia’s Care Value Management suite into its Healthe Intent and CareAware solutions as a comprehensive resource management offering.

”Health care worldwide is experiencing a resourcing deficit that is forecasted to grow dramatically in the next several years," said Jeff Townsend, Cerner executive vice president and chief of staff. "The fundamental supply of staff and other assets simply cannot meet rising patient demand. Clairvia’s predictive models driven by EHR data not only cut costs by aligning the right resource at the right time but, more importantly, optimize patient outcomes. With this acquisition, we are solidifying our commitment to the workforce management marketplace and interoperable cloud-based solutions that focus on providing positive clinical, operational and financial returns for our clients."

The acquisition is expected to close this month and is not expected to have a material impact on Cerner’s fiscal year results. Clairvia President and CEO Beth Pickard will join Cerner with the acquisition.

HIStalk interviewed Beth Pickard last December.

News 10/7/11

Top News

The Cerner Health Conference starts Saturday in Kansas City, with more than 10,000 attendees expected.

Reader Comments

From Tired CIO: “Re: McKesson Paragon. A recent invite was sent to the Paragon user community for a Webinar that will discuss ‘product line updates’ from company executives. This is a first, as far as I know. Also sent was an e-mail blast informing the clients that the support line for Paragon will be re-routed to the HPF division on Friday so that all Paragon employees can attend an off-site meeting (also a first.) It’s looking like there may be something in the works for Paragon.” Unverifed, but that makes a couple of recent rumblings along those lines.

From Joseph Prang: “Re: 5010 upgrades. Most of the 5010 work is being done by clearinghouses, but practice management system vendors are sending daily faxes and e-mails to their customers demanding that they upgrade to be 5010 compliant. Why would practices need to upgrade unless they are submitting directly to a payor or their clearinghouses are requiring 5010 claim input (which none are, as far as I know?) It should not matter. Practices are coughing up big bucks to get their upgrades in, but should be able to submit in Sanskrit if the clearinghouses do their job.” We talked to a couple of other in-the-know folks, who agreed.

From Emmett Hunter: “Re: Cerner. Making an acquisition Friday. Cloud-related.” Unverified.

From Blue Devil: “Re: Todayskick.com. Were you consulted prior to launch?” Brilliant. A site dedicated to showing off your shoes and shopping for new ones. Nope, I wasn’t consulted, which is likely why there appears to be a dearth of sexy pumps. I might have to go through my closet this weekend and upload my Alexander McQueen / Stuart Weitzman / Christian Louboutin collections.

From AtlantaHITGal: “Re: Jay Deady of Awarepoint has hired two employees away from McKesson in what looks like some sort of package deal since both resigned the same day this week. I know McKesson isn’t pleased, but I’m not sure they can do anything to stop the talent exodus that began two years ago.” I omitted the employee names since I didn’t verify their departure.

From Gitane: “Re: Swedish Medical Center alliance with Providence Health Services. In a FAQ document for employees, Epic is mentioned briefly. Document attached.”

HIStalk Announcements and Requests

One more thing to ensure HIT well-roundedness: read HIStalk Practice. This week’s highlights include wine and acrobatics in the MGMA exhibit hall (look for the Medic and IDX booths in the video.) Private companies outshine public ones in the KLAS mid-year rankings of ambulatory EHRs. Navicure readies for ICD-10. Physicians believe that decision support tools and AI will prevent diagnostic errors. Rob Culbert advises on the the right way to subsidize employed physicians. Stay in the know by signing up for e-mail updates. Thanks for reading.

Listening: The Killers, grandiose pop that sometimes sounds like U2, sometimes 80s Britpop, sometimes Muse. The Las Vegas band is hardly obscure: they’ve sold millions of albums, won a slew of awards, and on Independence Day last year, played in a salute to the military on the White House lawn at the President’s invitation.

Inga thinks we should run more stuff about homecare, assisted living, and long term care IT. Neither of us knows too much about it. What do you think? Is there an audience for that and any experts who might help us out?

Jobs on the Job Board: Regional Director of Enterprise Sales, Product Director – Acute Revenue Cycle Solutions, Implementation Project Manager. On Healthcare IT Jobs: Pharmacy Informatics Analyst, Solution Sales Executive – Microsoft HSG, HL7 Interface Analyst, Epic Consultant Manager.

Acquisitions, Funding, Business, and Stock

Navigant acquires Paragon Health, a practice management and consulting firm specializing in cardiovascular practices.

Practice management and billing software provider Kareo, Inc. closes a $10 million equity investment led by Greenspring Associates. Kareo, which has grown more than 100% per year for the past three years, will use the capital to expand its sales and marketing initiatives and to add at least 30 employees by the end of the year.

Wireless asset tracking vendor AeroScout acquires Sentient Health, which offers medical supply inventory management tools.

Sales

PeaceHealth signs agreement through GE Healthcare to upgrade to Streamline Health’s AccessAnyWare v5.1.

Advocate BroMenn Medical Center and Advocate Eureka Hospital (IL) select MediRevv to provide A/R management services.

Ventura County  (CA) enters into a $32 million contract with Cerner to provide EHR to the county’s hospitals.

Children’s of Alabama selects iSirona’s device connectivity solution to deliver data from medical devices to its Allscripts EMR.

People

Aegis Health Group hires William Walker (Medkinetics) as VP of IT services.

Dell names Andrew W. Litt, MD (Litt Healthcare Ventures, NYU Langone Medical Center) chief medical officer for the company’s Healthcare and Life Sciences Services division.

Announcements and Implementations

Merge Healthcare introduces Merge Honeycomb, a cloud-base medical imaging sharing network that is open for use by anyone at no charge.

Iatric Systems earns Surescripts e-prescribing certification for its discharge instructions function that allows prescription routing to retail pharmacies in all states.

Medical Specialists, an Indiana medical practice, uses Shareable Ink and its Allscripts EHR to, in its words, “merge technology and personalized healthcare.”

Verizon Connected Healthcare Solutions and Duke University will collaborate on projects for mobile health and consumer healthcare education, with Verizon providing the infrastructure and Duke contributing people and intellectual property.

Government and Politics

Meaningful Use by the numbers:

• 88,399 physicians and hospitals had signed up for the Medicare program by the end of September; an additional 24,030 registered for the Medicaid program.
• As of September 30, CMS had paid more than $850 million in EHR incentives ($357 million for Medicare and $493 million for Medicaid.)
• Medicare incentive payments have been paid to 3,772 physicians and 158 hospitals.

The Medicare Payment Advisory Commission (MedPAC) votes to endorse a plan to repeal the sustainable growth rate (SGR) formula for Medicare physician pay and replace it with one that keeps rates steady for primary care physicians over the next decade and cuts other physician services 5.9% for three years, then freezes those rates for seven years.

Innovation and Research

A UTMB report looks at the use of telemedicine and the use of mobile and wireless technologies in healthcare. It’s brief, but interesting. The site of its Center for Telehealth Research and Policy has good resources.

Other

Computer Science Corporation (CSC) shareholders file a class action lawsuit against the company over its participation in the UK’s NPfIT project, alleging that CSC deliberately misled them with overly optimistic projections of its ability to deliver, its financial performance, and the viability of the Lorenzo software from subcontractor iSoft, claiming the company knew for years that it was “dysfunctional and undeliverable.”

Plastic surgery for men is on the rise, with facelifts up 14%. Rhinoplasty is the procedure of choice for men, though otoplasty and liposuction are popular as well. Anyone want to venture a guess what surgical procedure remains the top pick for women?

I’ve read a bunch of Steve Jobs quotes in the last 24 hours. Here’s my favorite:

Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart. Stay hungry. Stay foolish.

I’ve enjoyed watching this excellent video of Steve Jobs delivering Stanford’s 2005 commencement address. It’s like Apple’s products: carefully designed, casually presented, and deceptively simple. The message of finding a job that matches what you love to do is powerful. On death: “I’ve looked in the mirror every morning and asked myself, ‘If today were the last day of my life, would I want to do what I am about to do today?’ Whenever the answer has been ‘no’ for too many days in a row, I know I need to change something. Remembering that I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life.”

Athenahealth Chairman and CEO Jonathan Bush writes a guest post for Forbes titled Hospitals Might Be Heading Into Trouble, where he likens the “buying binge” and excessive borrowing of hospitals acquiring physician practices to that of Fannie Mae in pushing people into houses they couldn’t afford. He predicts that (a) hospital systems will fail in numbers too big to be bailed out by investors or the government, or (b) hospitals will complete their vertically integrated monopolies and strong-arm higher patient volumes and prices. A snip:

In my ‘hospitals gobbling docs’ scenario, software is the bottleneck to profitability. The supposed enabler of the referrals that the above business model is predicated on, is not working to that end. Why would it be? Software is not a web-native connected system. It doesn’t update when the rules change. Software doesn’t even let you send patients from one hospitals to the next (unless one is owned by the other and using the same server – can you imagine? In this day and age?). In fact, outside of vertically integrated systems like Kaiser Permanente and Cleveland Clinic (and they are highly-specialized solutions) and a few others, you’d be hard-pressed to see any cases where software is greasing the referral wheels. In other words software is mucking up the model.

Weird News Andy channels Buster Keaton in his wordless wry commentary. It’s pretty common to see cemeteries adjoining hospitals in the South, leading to the inevitable knee-slapping quip by one’s father driving the family car, “People are dying to get out of one and into the other.”

A six-year-old boy is treated by a hospital ED for a broken wrist. Three months later, the boy suffers permanent brain damage after being beaten by his mother’s boyfriend, who walks away with two misdemeanor charges and probation. The boy’s father sues the boyfriend and the hospital, claiming the ED doctors should have suspected child abuse from the broken wrist, requiring them to contact authorities. The boyfriend ignores the suit and the hospital prevails in two courts, but another court reverses the decision. This time, the jury finds the hospital negligent and orders it to pay the family $25 million.

Sponsor Updates

• Rockcastle Regional Hospital and Respiratory Care Center (KY) shares clinical data with the Kentucky HIE using the Healthcare Management Systems Connex interoperability platform.
• Nuesoft Technology names Cornerstone University and Colorado College the Fall 2011 winners of its College Health Scholarship program. 
• Merge Healthcare releases an eBook entitled Meaningful Use Guide for Radiology.
• Metropolitan Medical Services partners with iMDsoft to offer the MetaVision Anesthesia Information Management System.
• ZirMed and HEALTHCAREfirst announce a partnership to offer an RCM  solution to home health and hospice care agencies.
• nVOQ and Health Language Inc. will collaborate to deliver the voice recognition solution Say It for Health Care.
• HITEC-LA selects NextGen Healthcare as a preferred vendor.
• Wellsoft receives the highest marks for EDIS solutions in the recent KLAS EDIS report.
• JHIM highlights three hospitals using T-SystemEV to attain Meaningful Use  in the ED.
• EDIMS will participate in the ACEP 2011 Scientific Assembly October 15-18 in San Francisco.
• New Zealand-headquartered Orion Health celebrates the opening of its Paris office with an event at the New Zealand Ambassador’s residence in Paris.

EPtalk by Dr. Jayne

I’m waiting anxiously to hear what the Institute of Medicine has to say tomorrow regarding essential health benefits. As part of the Affordable Care Act, insurers will be required to cover these essential benefits across 10 categories that include professional services, drugs, hospital care, and laboratory services.

The Washington Post feature Wonkblog covered this in an easy-to-read article. I need to be more careful, though, because I was reading this piece while multitasking (aka “not paying attention”) during a Big Meeting and apparently had some facial leakage that might have been perceived as smirking.

My favorite quote is from Tekisha Dwan Everette, director of federal affairs for the American Diabetes Association: “You have to be cognizant that you can’t narrowly include every miniscule coverage option or the whole thing will implode on itself.” I love her use of “implode” and think it’s a perfect descriptor for what we’ll be seeing over the next few years. A close second from National Health Council Vice President Marc Boutin: “As we moved through some of the actuarial analysis, we found that covering everything really isn’t affordable.” Duh. Did they really need to ask an actuary about that, or just a middle school algebra student?

I wonder how many patients will lobby for coverage of the new gray hair prevention pill under development by cosmetic giant L’Oreal? Patients will have to start taking it daily at least 10 years before their hair starts turning gray and then continue taking it for life. I wish I had known about this before I crossed the line into IT administration. I hope they include a Magic 8-Ball to help predict when patients might go gray.

Although many states have already started issuing Meaningful Use checks, providers in the Beehive State can start applying for their piece of the pie starting Monday. For those of you who have forgotten those state nicknames you learned in fifth grade, let me Google that for you: Utah.

Quirky FDA approval: A gel called LeGoo has been approved to temporarily plug small blood vessels during bypass surgeries. It typically dissolves after about 15 minutes, but can be eliminated earlier with application of a cold pack. The FDA wisely warns physicians not to use it on vessels that deliver blood to the brain. Duh #2 of the day.

A new book The Web-Savvy Patient instructs patients facing a medical crisis how to best use the Internet to be an informed patient. Tips include how to tell the difference between good information and poor or vendor-sponsored information. It encourages readers to populate a Personal Health Record to centralize their health information.

Inga scooped me earlier this week with photos from the eClinicalWorks National Users Conference. Although my contacts weren’t as fast with their smart phones, they did deliver the goods. According to my roving reporter, the highlight of the exhibit hall was the Harlem Globetrotters guy and the basketball setup at the Emdeon booth. I know some other meetings are coming up this fall – and I hope to see more submissions from readers. Extra consideration will be given to photos that feature excellent cocktails, costumes, celebrities, or general mayhem. Cerner, AMIA, and NextGen attendees, I’m counting on you!

Contacts

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

Steve Jobs Dies

Apple co-founder and visionary Steve Jobs has died, Apple announced this evening. He was 56.

News 10/5/11

Top News

A former patient files a $20 million class-action lawsuit against Stanford Hospital & Clinics on behalf of 20,000 fellow patients, seeking $1,000 each following a data breach in which patient records were posted on a commercial Web site for almost a year. Stanford has issued a statement blaming co-defendant Multi-Specialty Collection Services, which at the time of the breach was providing collection and billing services.

Reader Comments

From Boot Scootin’: “Re: eClinicalWorks National Users Conference. You should have been at the party. I think you would have enjoyed the dancing and noticed some good-looking cowboy boots.” Indeed, these folks look to be having some fun and the “skirts with boots” look is one of my all-time faves. eCW is entertaining a crowd of 2,700 this week in Scottsdale.

From Rye Catcher: “Re: subcontractor payments. I’m a long-time reader and huge fan. I did EHR implementation work this summer as a subcontractor for one of your sponsors. I’ve done work for them previously and was always paid on time, but haven’t been paid for June and July hours and haven’t worked for them since July. The CEO gives me ever-changing reasons for the delay, telling me four times that the check was in the mail and giving me fake tracking numbers twice. I wonder if your readers have experienced this problem and can offer any tips? I’d rather not take the legal route, but my options are dwindling.” Please leave a comment on this post if you have ideas that can help RC (short of engaging a leg-breaker to get someone’s attention.)

From The PACS Designer: “Re: Apple iPhone 4S instead of iPhone 5. CEO Tim Cook surprised his audience with the announcement that the new features for the iPhone family will be called iPhone 4S. Prices will be $199 with 16 GB of memory to $399 with 64 GB. It will come in a black or white case. A new feature called Assistant adds voice activation capabilities for apps. Transcribing with the iPhone 4S could be a future enhancement for healthcare users when the app becomes available.” A little more horsepower for graphics, GSM and Sprint capability, the Siri personal assistant, eight-hour talk time, and a better camera are the features, but the most significant change may be the lower price (not to mention that the previous models will be discounted as well). Sounds like a comparative disappointment, putting some wind in the Android sails (or sales). Apple shares closed down a tiny percentage. Somehow it all seemed kind of dull without Steve Jobs around, like watching a band play with a replacement lead singer.

Here’s a demo of Apple’s Siri technology. They bought the company for a couple of hundred million last year. There’s a Nuance connection other than Siri uses Nuance speech recognition: the company that formed Siri out of a government research project (SRI International) incubated and IPO’d Nuance at the end of the 1990s.

From Shanana: “Re: HCA. Do you know if they’ve made their decision on Epic or Cerner? Or when they will?” I haven’t heard, but I have readers from there who may provide an update.

From Inga’s BFF: “Re: AHIMA. Here are some shoe pictures!” I get two reactions when I run shoe pictures: the ladies gush and the men accuse me of pervdom. Like most men, though, I don’t know a flat from a pump, but I’ll take my chances in pandering to the women.

From Pathos: “Re: Sunquest’s acquisition of PowerPath. Wonder what will happen to its CoPathPlus AP product?” According to the FAQ (which is marked confidential, but it’s out there on the Web), both products will be supported and enhanced going forward, giving Sunquest a 24% market share. All Elekta employees working on PowerPath will transition to Sunquest and there is an “absolute and clear ‘No Sunset’ policy.”

From Denali: “Re: McKesson Paragon. Heard they’re going to start selling it as just a revenue cycle product. They will still support clinicals. Are they finally admitting that HERM will never be more than a slick PowerPoint?” Unverified. McKesson said they would provide a response from their PR folks, but I haven’t heard back for a couple of days.

From Loop Froots: “Re: HIPAA. Our small healthcare information technology needs to speak with someone about making sure our storage of PHI is compliant with HIPAA and other regulations. We haven’t stored PHI so far, but may need to in the future.” I think Loop is looking for some consulting or advisory help if anyone is qualified and interested. E-mail me and I’ll pass your info along.

From Bomp deBomp: “Re: [provider name omitted]. They’re using an outdated system to rip off the government stimulus money. The system does not allow scanning or viewing images, so they use pieced together applications that are dangerous to patient care. EKGs and x-rays are viewed by different systems and outside reports aren’t available until the patient is discharged. The system is tedious to use, so notes are scant and can’t be followed by other personnel, not to mention that ordering meds and labs is so time-consuming that most physicians do verbal and faxed-in orders. Critical results are hard to find. The lawyers are going to have a heyday, but their physicians will take the brunt of the settlements. Meaningful Use has never been so bastardized.” Unverified.

From Been There: “Re: NPfIT. Having worked for several miserable months on the UK disaster at the very beginning, it was obvious that it would fail. The guy running it had zip, zero, nada experience in health care and didn’t see why that would matter. He was all about writing gotcha contracts with the vendors and ‘holding their feet to the fire.’ Don’t blame it on the docs, blame it on the idiots in charge.” I’ve made that observation previously and it’s a fascinating one: just about every vendor involved got pressured to sign unfavorable contracts, then bailed when it was clear they could be neither successful nor profitable. I don’t know of any precedent where vendors with multi-billion dollar contracts still wanted out and there weren’t really any others qualified to replace them.

HIStalk Announcements and Requests

Posted on Twitter: “#FF @histalk and @IngaHIStalk are great sources of HIT industry scuttlebutt, rumors, and inside knowledge. Also music & shoe ideas too.” What a great 140-character summary.

My doctor’s office now has an electronic check-in kiosk. Very cool. You verify your appointment online, print out a one-page confirmation with a bar code, then when you get to the office, just skip around all the people waiting in line, wave your bar code under the scanner, and take a seat. It’s way easier to use than an airport kiosk and a great way to avoid all the coughing, bleeding, and wheezing folks (and their secretions and excretions) who would otherwise be ahead of you in line.

Acquisitions, Funding, Business, and Stock

Business integration and data management service provider Liaison Technologies closes $30 million in financing to accelerate its growth in the life sciences, healthcare, and HIE markets.

Sales

University Medical Center in Nevada contracts with Interpoint Partners for revenue cycle and clinical products, as well as Interpoint’s 835 denial management software.

The National Cancer Institute’s Center for Cancer Research awards Harris Corporation a $37 million re-compete contract to continue managing data for the center’s clinical research.

Capital Health System, Inc. selects Hayes Management Consulting’s MDaudit Hospital software for proactive risk mitigation.

Carson-Tahoe Regional Healthcare (NV) selects ProVation Order Sets, powered by UpToDate Decision Support, as its electronic order set solution.

Central Illinois Health Information Exchange finalizes a contract with ICA to implement the CareAlign HIE platform.

People

Keith Hagen, former COO of Aperio and CEO of QuadraMed, is named president and CEO of Quantros, which offers quality performance and risk management applications.

Connexall USA appoints Bob Kennedy (Kryptiq) as VP of sales.

Radiologist and former White House Fellow Pat Basu, MD joins Virtual Radiologic as chief medical officer.

The National Quality Forum hires Rosemary Kennedy, the former chief nursing informatics officer of Siemens Medical, as its VP of HIT.

AHIMA elects Kathleen Frawley, associate professor and chair of HIT at DeVry University, as the association’s president-elect for 2012. Other new members to AHIMA’s board include Ann Frischkorn Chenoweth (3M Health Information Systems), Dwayne M. Lewis (DML Consulting), and Melissa M. Martin (West Virginia University Hospitals.)

Ingenious Med names former A.D.A.M president and CEO Mark Adams as its CFO.

Jonathan Goldberg, VP/CIO of St. Peter’s Health Care Services (NY), will hold the same role with the newly formed St. Peter’s Health Partners, which brings together St. Peter’s, Albany Memorial, St. Mary’s, and Samaritan, all in the Albany area.

Announcements and Implementations

Anthelio enters a strategic partnership with MedQuist to implement MedQuist’s clinical documentation services at several of its facilities, also offering the company’s Front-End Speech Recognition and Natural Language Understanding solutions to its clients.

Connecticut Children’s Medical Center preps for its $20 million Epic implementation that will cover both the hospital and its 165 specialty physicians.

HHS, AHIMA, and North Shore Medical Labs (NY) announce a demonstration project to support broader use and adoption of EHRs by providers in underserved communities. AHIMA will provide free HIT training and North Shore will donate EHR software and services through Nortec Software. The project is part of AHIMA’s “HIM Jobs for America initiative,” which supports employment and training opportunities for HIT professionals.

Streamline Health, which has posted losses in recent quarters, announces a new brand identity (logo, Web site, and product names) intended to “represent the Company’s progress as it continues its transformation into an externally focused, high-growth healthcare technology company.” I wonder if my life would be any spicier if I refreshed by brand identity (hair color and new wardrobe) or if, in the end, it would just be a better-looking me with the same old life. Hmm.

The local paper reports that the cost for Kettering Health Network’s (OH) Epic implementation is $100 million. That’s double what network officials said when the project was announced two years ago.

Vocera announces the release of its B3000 Communication Badge, which offers enhanced durability, audio quality, and speech recognition.

Nuance Communications announces a new version of its eScription platform, which includes a streamlined documentation creation process and enhancements to the quality assurance workflow.

RelayHealth adds Blue Button capability to its network, allowing patients to download, print, and share their health information with a single click.

Government and Politics

ONC awards APP Design, Inc. a $1.2 million contract to design ways to help patients understand their choices about how their information is shared, including in an HIE environment. It will result in an e-consent pilot with Western New York’s HEALTHeLINK.

Technology

eClinicalWorks unveils four new products at its National Users Conference this week, including a patient app for Web-enabled devices; Project Scribe, which converts free text to structured data; Project Nimbus, which enables practices to view and update patient data during outages; and eClinicalWorks for the iPad. All will be out by next summer.

Security companies will host a free Medical Device Hacking Summit in Minneapolis next month.

Rock Health opens up the application window to find its next round of startups to accelerate in San Francisco. Applications are due by November 14 and the next group of entrepreneurs moves into its office in January for five months. The above video has entrepreneurs explaining what Rock Health is. Below that are the folks who run it: Halle, Leslie, Clare, and Jess.

Other

From KLAS:  over 80% of providers will use emergency department information systems to help them attest for Stage 1 Meaningful Use, though many products lack required functionality such as medication reconciliation and CPOE. Half of Epic, Cerner and Medhost customers report being ready for MU, but 2/3 of those using McKesson, Meditech, and Picis mention one or more functionality gaps that need to be addressed.

Cherie Lester, an old friend of HIStalk, has an interesting post on her EngageMeHIT blog on how to prepare for a Skype-based job interview. My favorite tip: no pets. If you’ve every been on a conference call with a working-from-home person who doesn’t know how to use the mute button and whose giant-sounding dog barks at every passing vehicle outside, you’ll understand.

A telehealth project in Canada diagnoses and treats dermatology conditions in Africa’s developing countries, expanding the Canada-only Consult Derm to an international philanthropic program called Telederm Outreach.

Weird News Andy cleverly notices that in this case, the mouse really is connected to the computer. Scientists in Israel implant a computerized cerebellum into a brain-damaged mouse, allowing its brain to communicate with its body. If you’re wondering where the scientists happened to find a brain-damaged mouse, you probably don’t want to know more about how animal experiments are conducted.

A hospital staff psychiatrist makes The New York Post for pulling down $516K in taxpayer-paid overtime in addition to his $174K salary, reporting an average of 110 hours per week that also include one four-day stretch of working around the clock.

Sponsor Updates

• Mac McMillian, CEO of CynergisTek, participates as a panelist during the October 5 webcast Health Information Exchange Privacy and Security – Are you Ready?
• SRSsoft partners with Omedix to provide SRS clients with a fully integrated patient portal.
• Mike Smyly, chief business development officer for Inland Northwest Health Services, will co-present with Tim Cromwell from the VA in a National eHealth Collaborative Webinar on HIE leadership and sustainability Wednesday afternoon (October 5) at 1:00 p.m. Eastern.
• Merge Healthcare announces the creation of a clinical advisory board, led by CMO Cheryl Whitaker.
• AsquaredM offers an October 11 Webinar called Applying Value Stream Mapping to the Revenue Cycle.
• Hayes Management Consulting releases a synopsis of the final CMS rule for RACs.
• InHealth Clinical Documentation Solutions joins MD-IT as an MTSO Associate.
• QMACs Inc partners with MED3OOO to offer its physician clients the company’s InteGreat EMR and PM products.
• Brian Levy, MD, CMO and SVP of Health Language Inc., presented an education session on medical terminology and interoperability at this week’s AHIMA convention.
• Medicity’s Kipp Lassetter and McKesson’s Emad Rizk, MD  earn nominations to Modern Healthcare’s and Modern Physician’s list of the 50 Most Influential Physician Executives in Healthcare.
• NextGen Healthcare hosts an October 6 webinar entitled Providing Practices a View into What Matters Financially.
• Concerro will preview its new ShiftPredict schedule modeling tool at the ANCC National Magnet Conference this week in Baltimore.
• SourceHOV signs an agreement with 3M Health Information Systems to make  its outsourced coding resources available with 3M’s suite of ICD-10 products and services.
• San Juan Regional Medical Center (NM) selects Access Universal Document Portal to move perinatal documents from GE Centricity into Meditech.  ‎

Contacts

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