John Gomez 7/30/12

HIT Integration Analysis Guide

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

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

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

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

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

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

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

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

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

Single Platform Analysis

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

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

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

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

Integrated Platform Analysis

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

Level 0 Integration – The Basics

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

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

Level I Integration – Content Integration

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

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

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

Level II Integration – Infrastructure

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

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

Level III – TCO Analysis

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

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

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

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

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

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

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

John Gomez is CEO of JGo Labs.

Roper To Acquire Sunquest for $1.4 Billion

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

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

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

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

Monday Morning Update 7/30/12

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

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

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

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

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

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

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

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

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

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

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

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

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

TPD has updated his list of iPhone apps.

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

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

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

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

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

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

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

Some quotes I highlighted from the McKesson earnings call:

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

Some quotes I highlighted from the Cerner earnings call:

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

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

E-mail Mr. H.

News 7/27/12

Top News

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

Reader Comments

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

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

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

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

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

— Richard Turner (@Therapist38) July 25, 2012

HIStalk Announcements and Requests

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

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

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

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

Sales

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

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

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

People

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

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

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

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

Announcements and Implementations

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

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

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

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

Government and Politics

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

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

Other

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

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

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

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

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

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

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

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 7/25/12

Top News

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

— Cerner Corporation (@Cerner) July 23, 2012

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

Reader Comments

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

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

— Avinesh Raman (@UhVeeNesh) July 23, 2012

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

— scott newcomb (@wsnewcomb) July 23, 2012

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

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

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

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

— Jacob Tamme (@JacobTamme) July 22, 2012

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

HIStalk Announcements and Requests

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

Sales

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

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

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

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

People

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

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

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

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

Announcements and Implementations

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

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

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

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

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

Technology

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

Other

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 7/23/12

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Mr. H.

News 7/20/12

Top News

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

Reader Comments

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

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

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

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

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

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

HIStalk Announcements and Requests

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

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

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

Sales

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

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

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

People

MedVentive appoints Bernard Chien (Radisphere) chief technology officer.

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

Announcements and Implementations

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

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

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

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

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

Government and Politics

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

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

Other

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

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

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

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

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

SAIC To Acquire maxIT Healthcare for $473 Million

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

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

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

News 7/18/12

Top News

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

Reader Comments

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

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

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

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

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

HIStalk Announcements and Requests

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

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

Sales

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

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

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

People

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

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

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

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

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

Announcements and Implementations

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

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

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

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

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

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

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

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

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

Other

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

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

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

Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

Monday Morning Update 7/16/12

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

E-mail Mr. H.

Dr. Sam 7/13/12

MEMS and the Patient – Computer Real-Time Interface

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

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

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

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

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

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

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

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

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

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

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

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

Gentlemen, start your nano-engines.

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

News 7/13/12

Top News

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

Reader Comments

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

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

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

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

HIStalk Announcements and Requests

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

Sales

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

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

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

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

Announcements and Implementations

INTEGRIS Health (OK) deploys Amalga from Caradigm.

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

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

Other

Here’s the latest cartoon from Imprivata.

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

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

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

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne

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

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

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

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

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

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

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

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 7/11/12

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

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

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

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

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

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

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

Sponsor Updates

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

E-mail Mr. H.

Monday Morning Update 7/9/12

From Gob Bluth II: “Re: Health Information Partnership for Tennessee (HIP TN). HIP RIP. Another HIE bites the dust.” Verified. Gob forwarded the e-mail that went out to stakeholders on Friday, along with a copy of the official announcement that will be released Monday. The three-year-old state network says officials decided to pursue a simpler strategy of using the DIRECT system as a HIP replacement. HIP TN chose Optum’s Elysium Exchange (the former Axolotl) in October 2010 and now it’s going to the Greek mythology version of Elysium, the afterlife of the chosen.

From Data Birth: “Re: Consumer Reports hospital safety rankings. I’ll wager the reason the data were inconsistent or missing is because hospitals don’t want this particular information to reach the eye of regulators or the public. You would think this would be available through Joint Commission inspections.” In my experience, the Joint is good for two things: (a) reacting to headlines by setting big-picture goals and ever-moving standards that never result in hospitals getting punished, and (b) clearing the hallways of carts and getting storage boxes away from the fire sprinklers, which happens only when their inspectors are on site. Hospitals in the past have been given a clean bill of health by Joint Commission, only to be threatened with shutdown immediately afterwards by inspectors from the state or CMS over egregious patient safety problems. I’m not casting implications on the Joint’s motivations since I’d much rather have them than not, but they’re making nice coin by not only selling inspections but also the tools and services that help hospitals pass them, and sometimes I think they struggle with the balance of being both a regulator and a vendor (like other similar organizations.) I think they see their role as more consultative than punitive, while sometimes the latter seems more appropriate.

From Max Payne UK: “Re: NHS and Epic. Epic doesn’t have a UK localised product and Cerner is installed in several Trusts. Reportedly, Cerner was cheaper than Epic. So how did Epic wind up being the winner? What consulting company or consultant advised the Trust on this decision?” Hospitals often choose Epic for non-financial reasons: perceived honesty, a near-perfect track record of going live on time, general polish on issues like training and documentation, and lack of Wall Street pressure that could shift their focus quarter by quarter. Not to mention that the big price tags mentioned for Epic projects are all-inclusive of even internal labor, which other vendors don’t include to the later discomfort of their customer. If you’ve seen the actual contracts (and I have), Epic isn’t always more expensive than arguably inferior alternatives. With regard to localization, they have over 5,000 employees and have learned from the mistakes made by others, so the have a leg up on the pioneers before them who crawled back with arrows in their backs. You bring up a good point – do organizations buy Epic because consultants recommend it, or do consultants even get involved with Epic decisions? And as one last thought, Epic (and Meditech) are big enough to command UK attention, but emerged unsullied by the NPfIT meltdown since they weren’t players, so that’s a plus for them. I would hope that those who made the Epic decision talked to the Cerner-using trusts first.

From Konrad: “Re: job stress. I often wonder if part of the fear of EMR and Obamacare is tracking of stressful of employers, like cancer centers. One place I worked actually did that for employees.” The former CEO of France Telecom is released on bail after being questioned by government officials about the suicide of more than 30 company employees in the two years just before he quit. He says the suicide rate was similar to that of non-employees and blames pressure brought on by the economy and the company’s minority shareholder (the French government), but did say he wishes he had paid attention to the warnings of doctors that the company’s massive layoffs and unreasonable performance targets were causing employee health issues.

From BitesTheDust: “Re: John Muir. Epic must have gotten another major McKesson account – this time John Muir in California. Looks like the CIO (Eric Saff) is already gone too as an executive firm looks for his replacement and prefers Epic experience.” They chose Epic awhile back, I think. I had run a rumor here (without naming the hospital) that Epic had originally declined to work with John Muir over some perceived conflict with its IT department and told the hospital’s board as such. I think this may happen more often that we know – the Epic train rolls right over the CIO during selection or implementation when Epic’s way isn’t warmly embraced by IT.

From HR Guy: “Re: stack ranking of employees. Epic does stack ranking as well, with about the same results, combined with the slow hire/quick fire mentality it’s been pretty deadly.” An article about Microsoft’s lack of agility and its fall from swaggering innovator to bean-counting market follower blames stack ranking, the practice that requires a fixed percentage of employees to be identified as great, adequate, or poor, with the great getting promotions and the poor getting shown the door. It concludes, based on Microsoft employee interviews, that everybody spent more time stabbing each others’ backs and sucking up to those who might review them instead of worrying about how Apple was beating them like a drum. Steve Ballmer gets a lot of the blame (honestly, what does Microsoft see in that guy that nobody else does?) but the damage was well underway when Bill Gates was still running the show. A former marketing manager concludes, “I see Microsoft as technology’s answer to Sears. In the 40s, 50s, and 60s, Sears had it nailed. It was top-notch, but now it’s just a barren wasteland. And that’s Microsoft. The company just isn’t cool any more.” Epic does apparently follow the same practice of quickly categorizing employees based on feedback from managers and co-workers who may barely even know them. I like the practice in theory, but as in most aspects of life and business, execution is everything.  

Welcome to new HIStalk Platinum sponsor Visage Imaging. The San Diego company is a global provider of enterprise and advanced visualization solutions that make slow, trickily deployed client-server and Web-based PACS approaches obsolete. No more reconstructions at the modality console while the radiologist twiddles his or her thumbs waiting on digital mammography or PET/CT — Visage 7 makes even the largest multi-slice datasets completely navigable in seconds via an intelligent thin-client viewer displaying server-rendered 2D, 3D, 4D, and advanced visualization imagery on a single desktop (in plain language, huge images don’t need to be pushed painfully and slowly from the hospital data center to the radiologist’s workstation – the server does the work and interpretation gets underway faster no matter where the radiologist is sitting.) Its platform enables enterprise viewing and interpretation and image enablement of EMRs, VNAs, HIEs, and RIS/PACS. You can use it on smart phones and even on Macs. Thanks to Visage Imaging for supporting HIStalk.

I headed over to YouTube to see if Visage Imaging had anything there, and lo and behold, here’s a brand new video on Visage 7 that includes some cool product video (though being a non-radiologist, anything with lots of movement and color seems cool to me).

Clearing out my “Listening” box for now: Phideaux, interesting “psychedelic progressive gothic rock” led by TV soap opera director Phideaux Xavier. Think Jethro Tull, Kansas, and Renaissance rolled into a more modern package with bigger production. It’s really good, especially coming from a guy who directs General Hospital as his day job. I’m playing it loud enough for Mrs. HIStalk to ask me what I’m listening to, though her tone suggests an interest that doesn’t necessarily involve my loading it to her Nano.

Inga and I are coincidentally both traveling this week (not together, just to be clear) so we may be occasionally tardy in our responses and terse in our writing as we take rare simultaneous vacations. Let me know if anything really important comes up this week that I might otherwise miss since I’m hoping to spend a few more hours than usual not working.

Thanks to the following sponsors, new and renewing, that supported HIStalk, HIStalk Mobile, and HIStalk Practice in June. Click a logo for more information as you ponder with me the illogicality of respected, successful companies backing a shoot-from-the-lip journalistic ne’er-do-well who nonetheless appreciates their support in forms that often extend beyond financial to personal. There hasn’t been a day in the nine years I’ve been writing HIStalk that I didn’t marvel at how cool it is to live my Mr. H alter ego even though it’s purely imaginary.

PPACA pretty much splits us as taxpayers, but we apparently like it fine as healthcare IT people. New poll to your right: which group would you target first to reduce healthcare costs? Obviously it’s a simplistic question with limited answer choices, so the poll accepts comments for your further elucidation.

A Physician’s First Watch poll on the Affordable Care Act drew similar results, with 65% of respondents (presumably mostly doctors) saying they like the Supreme Court’s decision (which presumably means they like PPACA).

CapSite releases its 2012 Laboratory Information Systems study. By the numbers, the dominant vendors are Meditech, Cerner, and Sunquest, and 81% of respondents say they won’t be replacing their system within two years. I like reading CapSite’s reports because they’re formatted as PowerPoints saved as PDFs and they get right to the point with charts. I had forgotten until I read the graphic above that Allscripts offers a LIS, which I assume is the former Sysware that it acquired in 2006. I also noticed that Epic’s Beaker is moving up the LIS ladder even though it’s not quite there yet, but probably will be by the time its newly implementing customers are ready to take another look at lab systems.

For the stats-obsessed among us (not me, but maybe Inga, and surely that one person who always e-mails me to ask), June’s readership numbers were really good given the annual summer slowdown: 102,849 visits and 191,515 page views, up a bunch from last year.

Weird News Andy finds the comments left on the Physicians’ Declaration of Independence interesting.

Here’s why e-MDs CEO Michael Stearns is  no longer with the company, as explained to its customers via e-mail. Grizzled Veteran provided that rumor last week. Founder and board chair David Winn has replaced Stearns as CEO.

This might be the first time that a hospital is acquired primarily for the value of its expected Meaningful Use payout. Cookeville Regional Medical Center (TN) will hold back $700K of its $6.7 million acquisition price for Cumberland River Hospital until that hospital gets its $4 million in Meaningful Use money. CRMC’s CEO said, “Part of the viability of this acquisition is the fact the Meaningful Use dollars are tied to it. That’s why it’s vital to have those dollars. That’s why we were adamant to have a hold-back of $700,000 so that we wouldn’t close the deal and they would stop working if they have a chunk of money held out there to comply with the purchase."

Vince continues his HIS-tory this week with HMS, having connected with co-founder Tom Givens to get a first-hand account of those heady days. I suspect many of you who are enjoying Vince’s series lived the experience first-hand in some of the 1970s-80s companies he has mentioned (and those he’ll be mentioning down the road). If so, Vince could use your old pictures and papers for future installments, but most of all, your anecdotes of what it was like back in the day.

E-mail Mr. H.

HITlaw 7/6/12

Practice Fracture and EMR Rights

Physician groups are signing up for EMR technology in a rush in order to meet eligibility deadlines for reimbursement under the HITECH Act. Unfortunately one of the key considerations in the process, the license agreement, is too often seen as a “last step” on the checklist. As I have urged in previous papers and postings, this should not be the case, as many items are overlooked in the push to acquire an EMR, implement, go live, and finally attest to Meaningful Use.

One important issue that is left unaddressed in the supermajority of licenses is transfer rights in the event of a practice split.

By split I do not mean the situation where a physician leaves a practice and the practice remains intact, because in those cases the license stays with the practice. No issue there. The departing doc takes nothing away in terms of license rights.

But when a practice splits and dissolves, what happens with the EMR license? How is data divided and protected? Who is responsible to the vendor for the security and confidentiality of the EMR system?

When licensing EMR technology (or any other type), the practice should negotiate terms for the perhaps unlikely but still possible situation of the practice breakup. The first request to the vendor should be an accommodation permitting the transfer of the license to multiple successor entities in the event of a breakup. Note that this will rarely, if ever, be without additional cost to the subsets of physicians, and many vendors have minimum provider thresholds, all of which is fair. If a vendor does not market customarily below a certain provider level, there is a reason, which is in most cases ongoing cost. They have determined the minimum sustainable level at which a product can be licensed, enhanced, and supported.

That said, the key issue here is the right to split the license should the need arise. No vendor wants to lose a client, and if the vendor can accommodate a license split, they actually increase their client base and revenue stream.

Next on the priority list would be some recognition by the vendor that in the event of a non-subscription-based license split, some accommodation will be made in terms of original license fee investment. (Quick sidebar – I exclude subscription-based systems because there is no upfront, perpetual license fee – it is simply pay as you go.)

With regard to non-subscription license fees, providers should not expect a known, predetermined allowance, as there are too many factors involved. For example, a five-provider license could be split into subsets of providers in 120 different ways, if my math skills are still up to par (5 factorial, or 5 x 4 x 3 x 2 x 1). Now do the math for a 10-provider license and you will be amazed at the number of combinations. Further, if the license is more than five or seven years old, the practice has in all likelihood taken a full depreciation on the initial investment and should keep this in mind.

I suggest that the most you could reasonably request is a statement that the vendor will make an accommodation of some type with regard to license fees, perhaps on a prorated basis allowing for depreciation and subject to the vendor’s minimum provider level. Prior implementation costs and support fees are clearly not eligible, as those services were provided and paid for. However, there may be a savings to be realized if minimal implementation and training are required by the new practices due to the familiarity with the incumbent vendor’s system. There is real incentive to the vendor to move from a single customer to multiple customers, with no sales effort, minimal implementation effort, and increased revenues, both one-time and recurring. The flip side is the customer should not expect to split a single license into multiple licenses and systems with no corresponding increase in fees, especially support fees.

Although not a pleasant topic, the practice breakup is a possibility, and having a pathway for continued use of the subject technology is important. If done up front, it means one less (or smaller) headache should the breakup occur.

Another very important issue is the data in the EMR. If a practice breaks up, what happens with the data? The first issue here is to determine what happens between the physicians with regard to their respective patients’ data. Consider record retention periods and ongoing access to records by patients or former patients. These are not issues for the vendor, and the best time for the practice to address these issues is when the EMR (or other) technology is acquired.

The associated request to the vendor should be a “transition services” accommodation. This should include the willingness to export or convert data to another vendor’s system should the practice at some point move to a different technology, obviously at a cost. Next you should discuss and investigate (before signing), the ramifications of splitting data into subsets, even if to populate new systems from the same incumbent vendor, and address those as well. Find out before implementation if there are any issues to consider regarding how the EMR or associated database should be structured.

Finally, when the practice breakup occurs, what happens with the original EMR system? The customer practice has obligations to the vendor. These must be carefully considered and fully performed. From the vendor’s point of view, it does not really matter which entity (original or successor) is responsible, but that there is an accountable entity involved. This may not be necessary if the original system is split and licensed anew to subsets of the practice, with the eventual result that there is no “old system.” However, too many times I have assisted vendor clients in situations where the provider customer expects new systems to be created with credit(s) or allowance(s) given for the original system, but then also expects to keep the original system alive and well and running in order to access historical data.

It doesn’t work that way, especially if the original practice is dissolved. The vendor needs protection. Providers should recognize that if you “want it both ways” you should expect to pay full price for the new systems, which is entirely fair. I have used the example many times that you cannot purchase a new car at a price based on trading in your old car, and then decide to keep the old car with no corresponding increase in price for the new car. Note there is also the reasonable middle ground where the old system may be accessed and “wound down,” with corresponding support fees, for a limited period of time after which the system goes away and the customer certifies this to the vendor.

When practices do not work out details ahead of time as to license and data ownership rights, the vendor gets drawn into the fray. As far as the vendor is concerned, the original licensee — the practice itself — is the holder of the license and the owner (as between vendor and customer that is) of the associated data. If you find yourself in this situation as a provider customer, develop a few options that might work between practice members and then approach the vendor.

Just keep in mind that no vendor wants to be asked to decide issues that are properly between practice members. If your EMR license agreement does not contain language permitting a partial license transfer for the benefit of practice members in the event of a practice split, you can imagine what might result. Some members might want to continue using the system and consider the license “theirs”. Others might seek to block that effort. Both might go to the vendor and ask for a ruling. For the benefit of all, I will repeat once again, address these issues up front at acquisition time.

In summary, practice groups should plan ahead when signing for new technology. Negotiate license transfer rights. Expect to pay something, but know you have established a transfer pathway. Determine between practice members what happens with the practice data if the practice breaks up. Discuss this with the vendor, address conversion of data in the license, and investigate database configuration options for implementation time. Do all this at the time the technology is acquired.

Time spent addressing important license issues at the acquisition stage helps avoid future problems, whether between practice members or the practice and the vendor.

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA. You may contact him at wfo@otoolelawgroup.com and follow him on Twitter @OTooleLawHIT.

News 7/6/12

Top News

Consumer Reports rates hospitals on safety in the August issue just published, with a surprising number of the big names omitted from the top. The safest hospital in the country, says CR, is Billings Clinic (MT) with a score of 72 on a 100-point scale. The worst is Sacred Heart Hospital of Chicago, which racked up a 16. At the bottom of their respective states: Central Florida Regional Hospital (FL), South Fulton Medical Center (GA), Wake Forest Baptist Medical Center (NC), Medical Center of Lewisville (TX), and Clinch Valley Medical Center (VA). However,they could only review 18% of US hospitals because of missing or inconsistent information (there’s another IT challenge if you’re up for one). Criteria were infections, readmissions, communication, CT scanning, complications, and mortality. You can bet that hospital marketing people are spinning the numbers even as we speak given that even the top-rated hospitals still scored low.

Reader Comments

From Grizzled Veteran: “Re: e-MDs. Word on the street is that President and CEO Michael Stearns is no longer with the company. He’s no longer listed on their management page.” Unverified, but his bio has indeed been expunged.

From Jog: “Re: Baptist Memorial Memphis. A buddy told me they’re leaving McKesson for Epic.” Unverified.

HIStalk Announcements and Requests

The latest goodies from HIStalk Practice: attorney Jessica Shenfeld discusses four questions every physician in private practice should ask themselves. Hayes Management Consulting’s Rob Drewniak provides advice for practices to improve internal security and protect against security and privacy threats. Lawmakers introduce legislation that would allow behavioral health providers to participate in the MU program. AMA recommendations for practices weighing HIE options. If you are are not a regular HIStalk Practice reader, what are you waiting for? And if you are, thanks for reading.

I replaced HIStalk Mobile’s comment function with a version that improves readability, allows logging in with Facebook credentials, supports easy subscribing to comment updates, and allows easy sharing of comments with social networking sites. It has other functions that I’ve turned off for now, but look it over on this post and let me know if you think I should install it on HIStalk as well. Try posting a comment, but just remember it’s like HIStalk in that incessant spamming from overseas has forced me to approve each comment, so you may not see yours immediately.

Listening: Black Bonzo, Swedish rockers that sometimes sound like 1970s hard-rocking but musically precise prog bands like Uriah Heep, Deep Purple, and Kansas with a bit of Anglagard mixed in. They’re sporting big Mellotron and Hammond organ sounds, always a plus in my book. And if you’re looking for something laid back and different but still proggy, try fellow Swedes Moon Safari.

Sales

Oak and Main Surgical Center (NJ) selects SourceMedical’s Vision OnDemand for EHR and billing.

Gilbert Hospital and Florence Hospital at Anthem (AZ) choose the Healthcare Management Systems EHR.

People

Mobile health development tools vendor Diversinet names Bret W. Jorgensen (MDVIP) chairman of the board to succeed Albert Wahbe, who is retiring as chairman but keeping his board seat.

Other

Doctors at Australia’s Gold Coast Health say their new clinical system is “totally inadequate and dangerous” because of log-in problems, delays in finding records, and lost information. A hospital spokesperson admits that the system is “very bare-bones” and “does some things particularly poorly,” but they don’t have the money to fix the problems. The hospital’s rollout was part of a $200 million Cerner project by Queensland Health, which was accused of fast-tracking its Cerner selection by intentionally wording its proposal to exclude other vendors. 

Also in Australia, a Canberra Hospital executive admits that the hospital changed dozens of ED records each day to make their publicly reported ED wait time stats look better. Auditors also found that the user accounts under which the records were altered were generic and had weak passwords that had never been changed. The auditors also noted that the iSoft system has a “feature” of not recording previous values when information is changed, making audit logs nearly worthless had the hospital checked them (which they hadn’t.)

And in yet another Australia story, the government admits that its recently launched $480 million personally controlled health record system can’t accept patient names with hyphens, requiring online registration to be taken down right after go-live. Accenture gets the black eye, not only for that, but also because the system was hacked during development because of what the government says was sloppy Accenture security practices. Other reports suggest that Accenture completed only 40% of the agreed-on work by go-live. The president of the Australian Medical Association summarized the system’s launch as “throwing a paper plane out the window at Cape Canaveral.”

A newspaper in M*Modal’s home state of Tennessee questions why the company wants to sell itself for what some analysts are calling a too-low price of $1.1 billion, saying it’s worth at least $300 million more than that and that it would be better off pursuing its growth with a financial partner rather than a new owner. Several law firms are threatening to file the usual shareholder class action lawsuits that claim the company didn’t hold out for maximal shareholder return.

In Canada, Hotel-Dieu Grace Hospital rolls out a bed control smartphone app that displays available beds, expected discharges, and the length of time ED patients have waited for a bed.

Greenville County, SC pilots software in a program to triage low-acuity 911 calls to a nurse to determine if emergency response is warranted. The chief medical officer of Greenville Hospital System says that 5% of patients use 50% of the system’s ED resources, with 61 patients accounting for 1,000 visits in one year (with one patient racking up 100) and most of them weren’t really emergencies. They cite figures saying that connecting patients to a medical home, managing their care, and helping them with transportation and prescription costs reduced the ED visits by 26% and patient days by 55%. The county says 20% of the 911 calls it gets are for non-emergency situations, but it is still required to send an ambulance at a trip cost of $280. The software they’re using isn’t named, but is used nationally in the UK.

Methodist Dallas Medical Center (TX) suspends its kidney and pancreas donor program after transplanting a donated kidney into a patient who wasn’t next in line on the recipient list. The hospital blames human error – the donor ID number wasn’t matched to the recipient.

UnitedHealthcare launches its Blue Button program, which like the original VA program will allow its 26 million insurance enrollees to view, print, and download their health information by mid-2013.

Access to medical care isn’t a problem for some: the governor of Iowa is hospitalized “out of an overabundance of caution” after choking on a carrot and vomiting it up during a ceremony.

Only in America: a New Jersey woman hit in the face by a baseball at a Little League game two years ago says the 11-year-old catcher did it intentionally when he overthrew the pitcher he was warming up in the bullpen. She’s suing him for medical costs plus pain and suffering, plus her husband has added his own damages of loss of her apparently valuable consort to raise their demand to $500K. The boy’s parents, both Little League volunteers, say they’d like to beat the charges in court, but it would cost thousands of dollars and require the young players to take the stand. The Little League national organization has refused to get involved.

Sponsor Updates

• Sunquest Information Systems hosts its annual users group conference August 6-10 in Phoenix.
• ZirMed earns full EHNAC HNAP certification.
• CSI Healthcare IT spotlights its 2011 sales leader, Bryan Richardson.
• NextGen’s parent company Quality Systems Inc. wins two Gold Stevie Awards in the 10th Annual American Business Awards.
• CPU Medical Management Systems, a division of MED3OOO, releases Version 7.01 of its MED/FM practice management and billing software.
• Consultant Cynthia Castro discusses the ease of the 5010 conversion process using Kareo’s software.
• NextGate posts a fun story highlighting the travel adventures and challenges of two of its engineers implementing NextGate EMPI in Spain. 
• Lancet joins the Informatica INFORM Channel Partner Program.
• nVoq director Derek Plansky discusses the advantages of using speech recognition with CPOE.

EPtalk by Dr. Jayne

The AMA reports that through efforts to process health insurance claims more effectively, more than $8 billion has been put back into the US healthcare system. I’m not sure where the savings has gone. The report mentions that physicians had to spend more time on prior authorizations, adding $728 million in “unnecessary administrative costs and countless hassles.” I’m betting that much of the savings went into for-profit coffers.

No surprise: a study published last month found no association between patient satisfaction and a practice’s adoption of patient-centered medical home processes. A researcher states, “It may lead to better care for the patient, but some of these things maybe turn these places into factories.” Based on anecdotal evidence from the Medicare beneficiaries in my family, I don’t disagree. Team care results in less face time with their physicians. Even though patients get better diabetic care, they don’t perceive it as having as much value as chatting directly with their physicians (even about subjects unrelated to their care).

A bill recently passed in the Pennsylvania Senate moves the Keystone State closer to its first statewide health information exchange. Governor Tom Corbett plans to sign it, setting up the Pennsylvania eHealth Partnership Authority to oversee its development. The goal is a decentralized system to connect regional private HIEs currently under construction.

Citrix offers a video promoting the ability for physicians to always be accessible “whether it’s in the middle of the night or on their day off.” Grammar issues aside, I’m not in favor of the idea that physicians need to be accessible 24×7. I see too many burned out docs on a daily basis. New technologies allow them to access charts from everywhere, making them reluctant to sign out to covering partners. Allowing people time to unplug and participate in self-care activities is essential to promoting healthy caregivers. I know the kind of decisions I make when I receive a phone call at 2 a.m. while I’m on vacation, and they’re generally not at the level I want to deliver where patients are concerned.

For ambulatory EHR developers: a recent study finds that more than 25% of American teens have sent nude photos of themselves electronically. The authors suggest that physicians who care for teens ask them about sexting practices. It’s time to think about adding some new questions to those well-child visit templates, I suppose.

Quote of the day: “Harassment is supposed to be sexy. You’re not even doing it right.” Thanks to one of my favorite consultants, I was recently introduced to Better Off Ted. For those of you who haven’t seen it, the plot revolves around the R&D department of a soulless conglomerate. In some ways it reminds me of our industry. Episodes are 21 minutes long, which is just the right length to take a break but not feel like you’re idly wasting time.

Thanks again to all the readers who sent birthday wishes on Facebook, Twitter, and e-mail. It was nice to receive them throughout the day and they helped mitigate any dread of being a year older. I’m pretty sure being a CMIO ages one more rapidly than other careers. However, I’m content knowing that with age comes wisdom (or at least the sense of having been there and done that, and knowing how much heartburn a new project will bring when you see it coming 50 yards away).

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

News 7/4/12

Top News

Speech recognition vendor M*Modal will be acquired by the private equity arm of JP Morgan Chase for $1.1 billion in cash, representing an 8.3% premium over Monday’s closing share price. Philips owned a 70% share of MedQuist until 2008, when it sold its shares to CBay for $200 million. The resulting MedQuist Holdings then acquired bankrupt transcription vendor Spheris in 2010, acquired M*Modal in July 2011 for $130 million, and then took that company’s name in January 2012.

Reader Comments

From HISEsq: “Re: Cerner. Sued for patent infringement by a patent troll named CeeColor, whose only claim to fame seems to be suing HIT and security companies.” CeeColor’s intellectual property, like that of other patent trolls, is vaguely described. In their case, it’s a proximity-based computer security system. I mentioned in March that the same company sued Imprivata claiming similar infringement. Googling their name turns up nothing but lawsuit filings, so one might logically assume all they have is a patent bought elsewhere and a lawyer with lots of free time available to hound companies into paying them “licensing fees.”

From Reppin’: “Re: GSK. You should run the GSK Las Vegas sales kickoff video if you can find it. That’s what’s wrong with healthcare. The big boys scream to government, ‘Get off our backs, we can regulate ourselves.’ They can’t, and a $3 billion fine is nothing to them. Executives should have been fired. They aren’t alone: Abbott, Pfizer, etc.” Drug maker GlaxoSmithKline will pay $3 billion for promoting two of its popular drugs for unapproved uses and for hiding safety information about a third drug. Its marketing tactics included sending doctors on pheasant hunting trips to Europe and paying them for speaking. GSK pushed doctors to prescribe Paxil for depression in children even though the drug was not approved by the FDA for patients under 18. GSK says it has learned its lesson, which would be remarkable given the very long list of similar problems the company has bought its way out of over years (overbilling Medicaid, charging third-world countries high prices for AIDS drugs, adulterating drugs, dodging US taxes, and hiding drug side effects.) Company profits dropped in the most recent quarter to a “disappointing” $2.1 billion, so the “huge” fine amounts to around 18 weeks’ of profit. Maybe that’s the lesson they’ve learned – settlement payouts for arguably criminal wrongdoing are just a marketing cost. If it were me, I’d go after the docs who were willing to place their patients in danger for perks – publishing their names publicly should have been a condition of the settlement. We know drug companies often lean toward scumbaggery given ample opportunity, but they didn’t take the Hippocratic Oath and represent themselves as the patient’s advocate while pimping out their prescription pads.

From Luis: “Re: GSK. Cleveland Clinic is mentioned. Did they find the drug problems with data mining out of Epic?” The original journal article was published by Steven Nissen MD, chairman of cardiovascular medicine at Cleveland Clinic and drug company critic. He did the legwork proving that Vioxx and Avandia cause problems, leading to an FDA crackdown on their use. Above is an interview in which he talks about healthcare reform and how Cleveland Clinic is different. They went live on Epic on the ambulatory side in 2000, so they may well have dug into their own data to link drugs to patient harm. Even if they didn’t, many health systems will be able to do that going forward – all they need is enough patients to make a valid sample size.

From GreenGiant: “Re: Valley Medical Center, Renton, WA. Live on Epic ambulatory on July 2.” I apparently missed the link on their main page. Its board voted in December 2010 to move from McKesson to Epic.

From HIT Guy: “Re: fat-producing foods. The Supreme Court talks about broccoli, healthcare firms punish obese workers, and Vince Ciotti talks about making certain foods expensive. Science is now saying that diets that were previously thought good for you aren’t, and the early studies were good examples of how not to do a study.” A New York Times article talks up a theory that I believe in firmly: weight isn’t as simple as calories in minus calories out, with a new study finding that it’s more about the carbs consumed than the calories. My theory is that weight problems are due to fat storage and insulin regulation (i.e., the hypoglycemic index), not just taking in more calories than are burned off. I also believe that not all exercise is created equal, and pure cardio is good but building muscle is better. You can run your butt off on the treadmill for an hour and only burn the equivalent of a candy bar, so that’s not going to work for most folks unless their body composition changes.

From James: “Re: healthcare system repair. Taiwan was a free market system like ours and became one of the best by going with a single payer, which gets the full pool of money for both healthy and sick patients, can’t cherry pick the young and healthy, negotiates prices with providers and manufacturers, and makes judgments for what to reimburse. Private payers still have a crucial role for all the stuff that the main payer doesn’t cover, like physical therapy, allied health, home care, etc.” I’m frustrated enough with the current non-system here that this alternative is sounding attractive.

From Tom: “Re: healthcare system repair. If I could change one thing, it would be to eliminate employer-based health insurance, a remnant of the World War II era. Individuals buying insurance directly from payers improves continuity of care, removes a major employer cost, incents individuals to manage their health, and reinforces the need for interoperability. It would open the floodgates on HIT innovation and use of tools such as mHealth and PHRs.” I’m becoming cynical that any solution that involves insurance is doomed. Not only because insurance companies will always find ways to make a profit from healthcare, but because healthcare insurance covers more than just catastrophic situations. Homeowner’s insurance is relatively inexpensive because you collect significant amounts only if you suffer major damage, which nobody in their right mind wants, so if we all pay a little everybody is spared from losing their home due to a tornado or fire. Imagine the cost of homeowner’s insurance if it covered every possible problem with appliances, appearance, and the lawn and business were created around collecting inflated payments for providing those services. Not only would policies be priced out of reach, services would become so expensive that you’d have to have insurance to afford them, causing prices to just keep going up to everybody’s benefit except the person needing the service. I’d like to see the concept of healthcare separated completely from the requirement of buying a third-party company’s actuarial bet that you’ll consume less of it than they charge you.

From SW: “Re: ACA. Stan Hupfeld, former president and CEO of Integris Health, wrote an excellent book summarizing the Affordable Care Act, why solutions for other countries won’t or can’t apply here, and how neither party serves us well.”

From CIO: “Re: ROI due diligence on clinical systems. My organization is spending many dozens of millions to install inpatient clinicals. We paid attention to ROI, but it was not the driving factor, and actually I am grateful for that. Proving out a hard ROI is not only a challenge, but I think it diverts attention from the real reasons an organization may want to pursue a new system. Our organization changed our IT strategy after years of integration issues from a ‘best of breed’ to ‘integrated clinical system.’ We did this prior to the guarantee of Meaningful Use funding because we felt it was the right direction for our organization and patient safety. As a part of our new system installations, we resolved a number clinical and IT data exchange issues that have improved patient safety measurably. One small example relates to interface issues with messages erroring out, requiring manual work to resolve the specific problem. On occasion this included patient allergies and other vital data. And for those of you in the industry, you know all the other examples of data exchange challenges that also impacted best of breed approaches. We could have put a price on risk / actual claims / patient harm for this and related issues, but we kept on focus on the improvements we wanted and not the dollars. And frankly with all the other challenges pressing down on hospitals, I take some pride in knowing that we have a safer environment with our new system than our prior ones. This approach may not stand up to real accounting scrutiny, but I think the real question is, ‘Are patients materially safer?’ For us, the answer is yes.” 

From Bruce Brandes: “Re: Pliny’s question about FDA regulatory oversight of mobile apps. What Pliny is describing is a clinical decision support system. FDA considers these to be at least Class 1 medical devices per their mobile medical app guidance. Where the data is processed is not important. If the input and display take place on a device, whether it’s a mobile app, web page, terminal application, hardware/software product, then the device is a medical device and subject to regulatory oversight. The determination of whether the device is considered Class 1 or 2 depends on the risk to the patient attributed to a misdiagnosis or delay in treatment. From a regulatory standpoint, class 1 and class 2 devices require the company establish and maintain the same quality management system and design and servicing controls. The only difference is Class 2 devices require premarket approval by FDA, Class 1 devices do not.” Bruce is EVP and chief strategy officer of AirStrip Technologies, which has a lot of experience working within FDA guidelines. I’ve always assumed that most of the healthcare apps out there weren’t created with the FDA in mind, but maybe I’m wrong. Feel free to chime in.

Acquisitions, Funding, Business, and Stock

HealthStream acquires Decision Critical, an Austin, TX-based provider of learning and competency management products for acute care hospitals, for $4.3 million.

Dell will purchase IT management software provider Quest Software for $2.4 billion.

Microsoft announces a $6.2 billion write-down of the $6.3 billion in cash it paid to buy online advertising company aQuantive in May 2007.

Announcements and Implementations

Catskill Regional Medical Center (NY) goes live on Epic in its two hospitals of 235 and 25 beds.

Grand Itasca Clinic and Hospital (MN) announces a partnership with Allina Health System to install Excellian, Allina’s version of Epic. Allina will provide implementation assistance and support.

The local paper highlights the T-System and NextGen implementation of White Mountain Regional Medical Center (AZ).

David Runt, CIO of Contra Costa Health Services (CA), tells me that they went live on Epic (called ccLink at their place) on July 1 enterprise-wide (hospital, clinics, and health plan.) I notice from David’s LinkedIn profile that he spent 22 years as a medical service corps officer in the US Air Force Medical Service, so I’ll throw out an Independence Day nod to David and his fellow veterans for their service.

In the UK, Cerner complains to Cambridge University Hospitals Foundation Trust that its EHR bidding process was a sham and it had already chosen Epic without regard to submitted prices. The trust says it followed the rules when it picked Epic in April.

Oracle announces its Health Sciences Network for developing and conducting clinical trials, working with Aurora Health Care and UPMC to create a cloud-based system to manage de-identified patient information from member providers. Aurora was a key player, providing its patient information in hopes of improving its work in several hundred research studies. Expected challenges include the possible unwillingness of academic medical centers to participate, the difficulty in combining information from a variety of proprietary EHR data formats, and the storage required to eventually add genomic information.

Caradigm, the Microsoft-GE Healthcare joint venture, announces that the number of active users of its identity and access management solutions (Vergence, expreSSO, and Way2Care) has increased by 50% in the past 18 months.

Government and Politics

A proposed California bill would change the Confidentiality of Medical Information Act, which allows patients to sue healthcare providers for up to $1,000 per breached medical record. AB 439 would eliminate damage awards for first offenses and in some cases for repeat offenses if the provider notifies patients whose records were exposed and takes preventive action. The bill’s sponsor is McKesson.

Innovation and Research

The for-profit technology subsidiary of Palomar Health Foundation, which operates Palomar Pomerado Health (CA), announces that AirStrip Technologies has acquired exclusive rights to its MIAA mobile EMR viewer application. I first wrote about it in February 2011 when Cisco was helping pay for its development.

DataMotion files a provisional patent for a Direct Project-based secure e-mail messaging system for patients and providers.

Other

A London Daily Mail article covers Epic Systems. It’s loaded with snark and off-topic rants, but says that not only will Epic sign a $16 million, two-trust contract, but will soon take on another two hospitals in England and most likely bag more as each trust makes their own decisions and sees the value of using Epic as a data-sharing replacement for the failed NPfIT. It describes Judy Faulkner as “a 68-year-old Harley-Davidson-riding friend of President Barack Obama” who lives in a “nice, but not palatial” house. The paper tried to pry information from someone who answered the phone at Epic and was told, “Your messages have been passed on, and if we want to get back to you, we will.” It speculates that the massive Verona campus expansion was spurred by the likelihood of Epic’s expansion in England.

Another Epic article, this one from Wisconsin, describes the company’s construction boom, with its reporters counting 12 construction cranes hovering overhead. The company expected to hire 300 more employees in June and 1,000 more for the year, bringing its total to over 6,000 (and another 750 expected next year). The Farm Campus will add another 1,000 offices, underground parking for 1,000 cars, and the 11,000-seat auditorium that looks like a UFO crashed and buried itself into cow field. The article says the new construction on the 811-acre campus is valued at around $400 million, with 1,300 construction workers on site making it the biggest construction job in the Midwest.

Orthopedic surgeon Larry Bone MD (I’m not making that up) finishes up basic training and is shipping off to Afghanistan for a three-month tour of duty as a battlefield trauma surgeon. He’s 64. The head of orthopedic surgery at the University of Buffalo wants to give back for the treatment his son received after an IED explosion in Iraq six years ago.

A JAMIA article evaluates CPOE orders that are cancelled and then immediately re-entered on a different patient, concluding that over 5,000 orders per year are being entered on the wrong patient. The proposed solution: make physicians enter the patient ID twice before allowing order entry.

In England, a 22-year-old teaching hospital cancer patient becomes delirious from dehydration and missed meds, finally dialing the equivalent of 911 to say he’s thirsty and nobody will give him water. Nurses send police away when they arrive, but the patient dies shortly afterward. His mother, who says her son was restrained, sedated, and ignored in his room the night before he died, said a nurse asked afterward, “Can I bag him up?”

Sponsor Updates

• Bottomline Technologies offers webinars on payments and cash management.
• RelayHealth shares details of its role in preparing for ICD-10.
• Liaison Healthcare Informatics will provide awareness activities in support of National Health IT Week September 10-15. Liason is also sponsoring NCHICA’s quarterly roundtable meetings for CIOs and CMOs/CMIOs.

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.