Sunquest Acquires PowerPath Pathology System

Sunquest Information Systems has acquired the PowerPath anatomic pathology information system from Sweden-based Elekta AB for $33 million USD, it was announced this morning in Europe.

Sunquest President and CEO Richard Atkin said of the acquisition, “Sunquest’s commitment to Anatomic Pathology and serving the pathologist has created a natural fit for PowerPath within the Sunquest solution suite. Together, we will have an increased critical mass and expertise to meet the needs of the pathologist in this important and growing market. I am excited to welcome the PowerPath customers into the Sunquest family.”

Elekta, which markets oncology solutions, acquired PowerPath along with IMPAC Medical Systems in 2005. The product was previously sold by IMPATH and Tamtron.

Elekta President and CEO Tomas Puusepp said, “PowerPath is clearly a leading brand in its sector with an impressive customer list of prestigious institutions. However, the synergies between PowerPath and Elekta have been limited and we expect that PowerPath will have good prospects with Sunquest, given their more complementary business"”

PowerPath is supported by 44 US-based employees. Elekta reports that it generates annual revenue of $12 million and is used by more than 450 facilities worldwide that offer surgical pathology, dermatopathology, cytology, and autopsy services.

Monday Morning Update 10/3/11

From Urban Legend: “Re: MediServe. Has acquired rehab scheduling and practice management vendor SpectraSoft.” Verified. MediServe, which offers rehab and respiratory therapy applications, has acquired SpectraSoft, an Arizona-based vendor of systems that include hospital and practice patient scheduling, physical therapy, appointment reminders, and billing.

From The PACS Designer: “Re: iPhone 5 launch. It’s official — Apple will hold its launch for the iPhone 5 on October 4. With this introduction, we’ll be seeing CEO Tim Cook give the presentation instead of Steve Jobs. It will be interesting to see how someone other than Steve does with the new feature presentation for the expected crowd.” Purportedly leaked photos are coming about, above which is one. Most interesting to me will be (a) how Tim Cook does, and (b) how long the fanboy lines are. I expect high demand, reinforcing the obvious – the country’s economic suffering is not universally shared as many folks stand in unemployment and food bank lines, while others clamor in similarly long lines to plunk down cash to replace their perfectly workable cell phones with cooler ones.

From Fed Up: “Re: anonymous comments. I’m disappointed that you gave a company my IP address. I now fear for my job.” I don’t divulge anything I receive to anyone, so it wasn’t me, but the comment you left may have contained enough specifics for the company to take an educated guess on its own. If any organization was pressuring me hard to give them information that wouldn’t be appropriate, the first thing I’d do is post the full details of their request on HIStalk and let the readers decide who’s being unreasonable (that’s a lot of bad PR if the company is out of line.) I will, however, always offer companies the space to rebut comments that are incorrect, and unlike newspapers who bury such comments, I’ll put them right in HIStalk if they keep it concise. Seems fair to me.

From IV Drip: “Re: Health 2.0. The on-stage production is well run by the company employed to do that and incorporates live demos and unscripted comments. The non-stage component is what most people complain about – there is a significant lack of organization in vendor relations and logistics. There’s also the point of reference for vendors – it’s not a bland, measured, vendor-subsidized event with a huge exhibit space where content is determined a year in advance. Attendees love drinking from a fire hose of innovation over a packed two days instead of being exhausted after four days of cattle drive-like trudging around mega-halls and a Las Vegas-like show floor. It’s about networking and meeting new people. They could do a better job with logistics, but if it turns into a vendor brown-nosing type show like HIMSS, I and many other won’t be there.” It’s always a tough trade-off – everybody wants a conference that’s information-driven, off the wall, and fun (and largely paid for by vendors), but with good logistics, decent food, and a comfortable setting. Like most parties, the host’s job is to invite the right people, make sure they are relaxed and happy, and stay out of the way. That’s why I like low-key HIMSS chapter events and user group meetings, but never liked TEPR and was indifferent to last year’s mHealth Summit (bad logistics and not all that fun overall.) I will say that with my ultra-limited event organizing experience (a handful of HIStalkapaloozas, with vendor-provided event planners doing most of the work) you don’t have to sell your soul to vendors to get them to participate. Those involved in my events have been almost insistent that their participation be downplayed even though it was costing them a bundle. I always suggest a little vendor fair area for the sponsor or maybe some giveaways or a short company pitch from the stage, but they’ve always declined. However, I guess when you’re charging as much as HIMSS for exhibiting and putting competitors elbow to elbow in Gladiator Hall, expectations are raised.

New HIS-tory from Vince Ciotti, covering AR/Mediquest. If you’ve been in HIT long enough to remember that company and if you’re going to HIMSS in Las Vegas, put your contact information here to get on Vince’s e-mail list for the get-together he’s arranging there for the pre-1980 HIT’ers.

Listening: new from all-girl Dum Dum Girls, kind of a jangly, upbeat, lo-fi version of The Pretenders with some GoGo’s and spaced out Mazzy Star thrown in.

My Time Capsule editorial from 2006 for this week: For Employees in Uncarpeted Areas, Hide Technology Complexity Like McDonald’s Does, in which I said, “Medical errors, including technology-induced ones, have gotten so bad that some hospitals are actually advising patients to bring along a friend to protect them from staff mistakes. I can’t imagine any other business throwing in the towel and admitting defeat to customers. I’d have just two words for a restaurant waiter who suggests that I watch the cook to make sure he doesn’t poison me: ‘Check, please.’”

Time for me to vent (sorry) about trite words and phrases that spread like the plague from the Internet to the parroting mouths and keyboards of the easily impressionable: “not so much,” “meh,” “totally,” “epic fail,” “it’s all good,“ “just sayin’” and anything in the form of “Best. ____. Ever.” I postulate that these are the same vocabulary-challenged people who pleased themselves to no end in the 90s by cleverly inserting random outbursts of “Not” and “Party on, Garth” at every conversational opportunity and are hopefully embarrassed about it to this day. The Internet, like TV before it, can make you smarter or stupider, depending on how you use it (and a survey of the offerings suggests that the smart money is betting on the latter.)

The majority of respondents think Vista Equity Partners got a good deal in acquiring Sage Healthcare, or at least that’s how I interpret it. New poll to your right, suggested by a reader: do you know and/or follow your employer’s policies regarding device encryption and handling of confidential information like PHI?

University of Texas System chooses CodeRyte for enterprise-wide computer-assisted inpatient and outpatient coding. They will also use the company’s DataScout data mining technology.

Welcome to new HIStalk Platinum Sponsor HealthStream. The Nashville-based company offers innovative learning solutions that enable the training and business objectives of healthcare organizations: patient safety, workforce development, regulatory training, and technology education. HealthStream’s customers include 50% of US hospitals. Its Authoring Center is an open platform that allows content creators to develop and distribute learning modules using the tool of their choice – PowerPoint and PDFs, for example. Competency Center is a competency and performance management solution that hospitals use to create customized performance appraisals and competency assessments. The SaaS-based Learning Center is a learning platform and courseware library that supports 2.4 million active healthcare workers, with 70,000 course completions and 100,000 student log-ins every day from healthcare users. Also offered is a turnkey nurse CE library. Hospitals call HealthStream when they need to improve patient safety, implement quality programs, develop nurse effectiveness, improve compliance, and ensure that clinicians are trained to use new technology and medical devices. Thanks to HealthStream for supporting HIStalk.

Amcom Software’s Messenger middleware earns FDA 510(k) clearance as a Class II medical device. It connects patient monitoring systems to smart phones and pagers, allowing rules-based alert messages to be sent to clinicians.

A Reuters article says that HIT stocks are priced high because of HITECH-spurred revenue growth, but are susceptible for a big fall if Congress gets serious about reining in the red ink and cuts some of the HITECH billions. Specifically named as trading at at a high multiple: Cerner. It’s a pretty shallow article that recites the obvious and, puzzlingly, claims at the end that open source is a big threat to vendors.

Practice Fusion CEO Ryan Howard is profiled in the San Francisco newspaper. He says the company was out of cash and had only 2,000 users at the end of 2008, but has since raised $36 million in financing and signed up 120,000 users tracking 20 million patients in its free EMR. He mentions some company goals: use its customer data for healthcare predictive modeling and create a birth-to-death patient record for patients. The above video, Cracking the Entrepreneur Code, is new and covers some of the same ground about the scrappy startup – he says the company was basically out of business until he got an insurance company check for injuries he received in an auto accident, which he used to make payroll instead of for getting himself fixed up. “When we got funded, I was four years behind on my taxes and needed two root canals. The lesson here: before you go too far down this road, ask yourself what you’re willing to give to pursue your dream.” The first 17 minutes of the video where he’s talking should be mandatory viewing for anyone involved in a startup. It’s fascinating to hear about how in the early days (himself plus three engineers) he did a zero-budget homebrew press campaign to get on the radar of investors.

Greenway Medical Technologies expects to add 400 new jobs and will undertake a $12 million expansion at its corporate headquarters in Carrollton, GA, according to state officials. The company filed for a $100 million IPO a few weeks ago.

MED3OOO (I can never figure out how to spell the name – sometimes they use zeroes like MED3000 and sometimes Os like MED3OOO) puts out a cool video showing their InteGreat EHR running on an iPad with Medicomp’s Quippe. They unfortunately didn’t post the video anywhere that allows me to embed it here, so you’ll have to click the link, but I promise it’s worth it if you want to see an entirely new way for doctors to document. Quippe is undeniably cool and the InteGreat demo is well done. It even contains a bonus in the last five seconds: an Inga quote. I asked if it’s really her on the video since it kind of looks like her in a shadowy way, but she swears it isn’t.

Chester River Hospital Center (MD) was scheduled to go live on Meditech Saturday, replacing QuadraMed Affinity.

Mark Rosenbloom MD, the founder and CEO of electronic clinical reference vendor PEPID, starts an age management practice in Illinois, offering a $995 per month program of lab tests, vitamins, and training sessions.

Two small Long Island weekly newspapers are baffled when all available copies are quickly bought up from vending machines and newsstands, with at least two teams of people grabbing all available copies at or above the cover price. Based on the overlapping stories in both papers, the newspaper strongly suspects friends of a local doctor who was charged with Medicare fraud were trying to keep the story quiet. Jesse Stoff MD was arrested for giving kickbacks to patients after billing Medicare for unnecessary services. He billed Medicare more than $800,000 in one month, tipping the feds off to run a sting operation in which an undercover agent was paid $300 for five visits. The money was delivered in a “kickback room” with a Soviet-style poster warning patients not to talk about the scheme.

The Washington state chapter of the American College of Emergency Physicians sues the state over a new rule that limits Medicaid recipients to three ED visits per year for non-emergency conditions. They have a vested interest since ED docs often bill patients directly for their services. The state’s Medicaid medical director says he had to trim $35 million from his ED budget somehow and only about 3% of Medicaid ED patients are frequent flyers who will be affected, not to mention that up to half of the frequent ED visitors go there seeking drugs. The top Medicaid user in previous audits was a 27-year-old woman who visited EDs 172 times in one year (every other day) complaining of headaches.

E-mail Mr. H.

News 9/30/11

Top News

VA CIO Roger Baker says his organization will allow smart phones and tablets on its network starting Monday, with the first batch of 1,000 users swapping out their laptops or BlackBerries for devices running an unnamed OS (Apple). He also says he’d like the VA to develop an enterprise-wide apps store, with some of those apps coming from its recently announced open source EHR project.

Reader Comments

From Matt Holt: “Re: unsubstantiated. C’mon Inga, be nice, or at least reasonable. Keanu’s comment that Health 2.0 was super disorganized? I hear everything from my team — including the three people who didn’t like my write-up of their bios — and I never heard about an argument breaking out about an ad. No one wrote mentioned the fact that we’re the only health conference with more than 120 LIVE demos, that we had two big time health plan CEOs talking directly about technology, that we put the ONC head on stage with seven patients, or that we had 1500 people come – more than 50% up on 2011? Guess next time I’ll have to ask the 20-30 people telling me that Health 2.0 is the best conference they go to that they should e-mail you instead.” Thanks, Matt, for filling in the missing details, although we just ran what an attendee (and sponsor, apparently) sent us. Maybe I am just bummed I couldn’t have been there myself to experience it. Next year.

From High-Heeled: “Re: Error messages. In my role of helping physicians survive and thrive with EHR adoption, some are generally frustrated by the error messages their applications throw up. This is a new error message one of our doctors sent to me and told me it didn’t bother her at all!” Please tell your physician that wine makes me more tolerant as well.

From Lou Reed: “Re: just good enough. Farzad Mostashari is urging the HIT Standards Committee to put out standards that are ‘good enough’ to get started on HIE. In my HIT experience, any link that is ‘just good enough’ handles the core data, but any data outside the norm (such as exceptions, outliers, etc.) gets trashed. Just look at what craziness the open text segments in HL7 cause. Providers will be spending thousands of man-hours trying to sort out this out as they trip over the myriad of exceptions that come up in health care cases. Although I am a firm believer in not letting the perfect be the enemy of the good, there are times when that approach does not fit. This is one. Would he take his child on a plane that is ‘just good enough’?”

From Sorbino: “Re: EHR. Check this KLAS report. Ever heard of PCC – Physician’s Computer Company?” I’ve heard of them, but I was never quite sure what they did (some kind of reseller, I figured). The PCC EHR, which is pediatrics specific, puts up monster KLAS scores. They’re pretty new on the report, though, and there’s often a honeymoon period before the scores start to slip as the company grows, expectations are raised, and an increasing number of users are surveyed. Still, it’s an impressive accomplishment. There’s something to be said for focusing on a particular market segment and excelling in it.

From Just Tennille: “Re: SRS user group meeting. I always feel that I’m among friends there and came home energized. “ I can see where the “energized” part came from – check out the Red Bull and coffee bean chocolates bar. All that’s missing is caffeine IV bags. The SRS developers, lined up for intros and appearing uncomfortable in their seldom-worn and/or borrowed suits, look like they would love to change into nerdwear, ravage the caffeine stash, and sling some code. That’s what you want in a developer, which is why the glad-handing and photogenic sales guys become physically uncomfortable in their presence. I’ve never had an energy drink, but I’ve noticed recently how expensive they are in bars and stores, probably making them even more profitable to their manufacturers than wine or liquor since they don’t have to pay high federal alcohol taxes (Red Bull’s founder is worth $3 billion). I bet they were a hit at the user group meeting.

From Meaningful User: “Re: NY Times on the UK’s HIT fiasco. Blumie toots a different horn now that he’s back using these poorly usable systems.” It’s a fun read, calling NPfIT “a slow-motion train wreck” and asking three experts on whether a similar disaster could befall HITECH, which costs even more than the hugely expensive NPfIT boondoggle. Former National Coordinator #1 David Brailer says the UK ran NPfIT as a giant procurement program, running all over clinicians in the process. Richard Alvarez of Canada Health Infoway says both the US and Canada are taking a different path than Britain in setting standards and outcomes, but not doing the actual implementation. Former National Coordinator #3 David Blumenthal echoed Brailer in saying it has to be a collaborative effort with clinician involvement. You docs who aren’t sold on even subsidized EMRs may have more power than you imagine, or at least Brailer thinks so: “The experience in Britain is a warning to us. The thing that brought them to their knees was the confrontation with doctors.”

From CDMer: “Re: stolen tapes. Another day, another breach.” SAIC says computer backup tapes were stolen from the car of one of its employees on September 14, potentially exposing the detailed health information of 4.9 million military beneficiaries who received care, lab tests, or prescriptions in San Antonio area facilities such as Brooke Army Medical Center.

From Dolphins Fan: “Re: loss of Minnesota PHI. When something like this happens, everyone always points out that it was against company policy. Every healthcare company on the face of the earth has a PHI policy and most have an encryption policy. Unfortunately, for many companies the goal is to put a policy in place to make people happy, but then they fail to enforce it. Execution of a policy, versus simply having a policy, is where you really see how important PHI protection is to a company.”

HIStalk Announcements and Requests

In case you have been too busy following season-ending baseball drama, tracking the latest presidential polls, or watching Dancing with the Stars, here are a few highlights from HIStalk Practice over the last week: Dr. Gregg mulls over Abe Lincoln and HIT innovation. Electronic medical reminders improve care in elderly patients. Younger docs are not necessarily better at EHR than their older peers. MED3OOO serves up education, networking, and fun at its annual user conference. eClinicalWorks sells swag for charity at their national user conference this weekend in Phoenix.  If you have not been a HIStalk Practice regular in the past, I have good news: we are still accepting new subscribers. Thanks for reading.

Welcome to Executive Search Recruiting, supporting HIStalk as a Platinum Sponsor. The Cornelius, NC-based ESR is a boutique search firm (no, they don’t find boutiques, they recruit executives and sales talent) that works with providers, payers, vendors, and consulting forms to bring on partners, principals, directors, sales executives, and consultants, to name a few of the positions they can help with. They’ve worked with companies ranging from startups to Fortune 500 companies, so there’s a 100% chance that they’ve helped an organization similarly sized to yours, offering customized fee structures that include flat fee per hire, retained searches, contract work, and an interesting (low) hourly fee share for billable consultants. The company’s employees average 15 years’ of healthcare experience in executive search, so they know where to find the really good people (hire a bad one on your own and the value proposition becomes clearer.) On the other side of the jobs table, if you’re a high performer looking for an opportunity, check out their current openings and get in touch with Don Calhoun. Thanks to Executive Search Recruiting for supporting HIStalk.

Everybody likes big and/or round numbers, so here are some for HIStalk. E-mail subscribers: 7,546. Likes on Facebook: 1,595. Mr. H connections on LinkedIn: 920. Dann’s Fan Club members on LinkedIn: 1,857. Number of unique readers: 21,350. Number of visits since 2003: 4.56 million. You will make the small round number (zero) of HIStalk full-time employees happy by increasing those numbers where you can. Thanks.

On the Jobs Board: Implementation Project Manager, Epic and Cerner Resources, Director – Product Demonstration Specialists. On Healthcare IT Jobs: HL7 Interface Analyst, Director, Clinical Applications, IT Technical / Product Support Specialist, Epic Consultant Manager.

If you were toiling away in HIT prior to 1980 and want to reconnect with old pals at HIMSS, sign up so Vince can e-mail you details about a little get-together at the HIMSS conference. One reader is hoping for Neil Pappalardo or Octo Barnett from Meditech to attend, but even if they don’t, quite a few interesting folks have already said they’re planning to be there.

Acquisitions, Funding, Business, and Stock

Greenway Medical announces that it is acquiring certain technology assets of CySolutions, a provider of clinical management and EHR solutions for FQHCs and community health centers. Greenway did not disclose the purchase price or the exact technologies it’s buying, but does indicate that CySolutions CEO Bill Young and other development staff members will join the company.

Prognosis Health Information Systems completes its acquisition of Creative Healthcare Systems, a provider of financial management and patient accounting systems.

Sales

Jeff Davis Hospital (GA), a 25-bed Critical Access Hospital, selects Healthland’s Centriq EHR.

Meadowlands Hospital and Medical Center (NJ) chooses PatientPoint’s patient engagement platform for care coordination and revenue cycle management.

Allegiance Health (MI) signs a three-year contract with TrustHCS for its ICD-10 education services and DNFB Assurance program.

Atlantic General Hospital (MD) contracts for Sunrise Clinical Manager from Allscripts. The hospital already uses Allscripts on the ambulatory side.

Blue Cross Blue Shield of North Carolina will spend $15 million to subsidize the implementation of the Allscripts MyWay EHR for 750 North Carolina physicians, with 85% of the cost covered for eligible independent practices and 100% for free clinics, including training and support. BCBSNC will work with the NC Area Health Education Centers to help practices achieve Patient Centered Medical Home status and will also help providers connect to the North Carolina HIE. Allscripts will contribute an additional $8 million to the project.

St. Francis Hospital (CT) executes a three-year agreement with MED3OOO to provide RCM services for its 200 employed physicians.

People

Ryan A. Secan, MD, the former medical director of hospitalist programs at Lowell General Hospital Medical Group and Anna Jaques Hospital, joins MedAptus as chief medical officer.

T-System promotes Erin Estes from director of implementation services to VP and GM of performance solutions.

Announcements and Implementations

Cerner announces the Cerner Reference Lab Network, which requires one standard connection to communicate with all reference labs on the network.

Community Medical Centers (CA) goes live this week on Epic.

CareTech Solutions earns HDI Support Center Certification for its Service Desk IT help desk offering, which it says is the only hospital-specific help desk in the country. The company also just invested $1.5 million to reconfigure and remodel the operation. The press release casually mentions that it’s an “on-shore medical help desk,” meaning that when you call, you’re talking to someone in Troy, Michigan, United States of America.

Scottish charge master vendor Craneware announces financial tools designed for Critical Access Hospitals.

Government and Politics

HHS launches the Comprehensive Primary Care initiative, which will pay primary care practices $20 per beneficiary per month for providing better-coordinated care for Medicare patients. The program calls for participation from private and state insurance providers, requires providers to meet certain quality measures, and will eventually include a shared savings component for participants.

iSoft will provide its Enterprise Management hospital information system to create the Brunei Healthcare Information System, a government project with a goal of creating a single electronic record for every patient in Brunei.

Fujitsu prepares to sue the UK Department of Health for $1.1 billion, saying it’s owed that amount after pulling out of NPfIT in 2008.

Innovation and Research

A hospital in England explains its green IT efforts, which include moving to virtualized servers, replacing desktops with thin client devices, and implementing the NightWatchman power management solution that powers down idle PCs in non-critical areas.

Other

An Atlanta medical practice’s IT specialist pleads guilty in federal court to intentionally accessing the protected computer of a competing perinatal medical practice. Using his home computer, Eric McNeal accessed the system of a former employer, downloaded patient data, then deleted all the patient information from the practice’s computer. He used the patient data to run a direct mail marketing campaign to benefit his new employer. He faces up to five years in prison and a fine of up to $250,000.

Weird News Andy elects not to steal second base in declaring, “I’m not touching this one.” A woman undergoing a swap-out of her breast implants wakes up after surgery to find herself with symmastia, also known as  “uniboob.” She said, “It looked like I had one big breast instead of two,” but the uniboob has since been successfully re-cleaved by another surgeon and the inevitable lawsuit has been settled.

National eHealth Collaborative seeks nominations for its board.

Consumers in Australia complain about the pharmacy association’s plan to push a particular manufacturer’s nutritional supplements when patients pick up their prescriptions. The association’s computer system will remind the pharmacist to tell the patient that the supplements can help mitigate side effects of the prescribed drug. The association’s president is particularly proud of the computer reminders, calling them a “world first for IT-enabled, software-promoted pharmacy sector messages to facilitate targeted recommendations to patients.” The manufacturer’s CEO raised the most ire when she characterized the sales program as a “Coke and fries” upselling opportunity that will boost pharmacy profits. The president of the Australian Medical Association was unimpressed: “I think the evidence for Coke and fries is about the same as the evidence for these products.”

A Denver-area agency ICU nurse is charged with identity theft and theft of medical records after Centura Health discovers he had accessed patient records inappropriately. The complaint against him says he used patient information to sign up for credit cards. His nursing license from another state had already been suspended in connection with a prescription fraud investigation.

A St. Louis-based physician and geriatrician urges the US to emulate the healthcare system of France (#1 in the world vs. the US at #37) and its smart card system. which is really just a microchip ID card that contains no medical information and is required for every citizen over 16 years of age:

The most magnificent component of the French medical system is the "Carte Vitale." This looks like a credit card and is given to the physician by the patient. It is inserted into a computer allowing the physician to review the patient’s basic medical history and is also used for billing the patients visit to the government. The patient thus controls his or her own health records, maintaining privacy.

A family practice physician in Canada, talking to a reporter about the loss of a PHI-containing memory stick from a local hospital, says patients of his own practice are not at risk. “My system is hard copy — paper, and it’s worked for me and many doctors in the city who still use it. It’s awfully hard to lose an entire filing cabinet.”

Thomas Manning, the retiring head of Commonwealth Medicine (a consulting division of the University of Massachusetts Medical School,) will become the state’s highest paid retiree with an annual pension of $347,000 when he retires next year. The organization is under investigation for receiving no-bid Medicaid contracts from the state that cost $138 million per year, but says that’s not related to Manning’s retirement.

Sponsor Updates

• Imprivata reports that the healthcare sector is the leading adopter of desktop virtualization technology, according to a recent cross-industry survey of 477 IT decision makers.
• Wolters Kluwer Health announces that Children’s Healthcare of Atlanta (GA) has selected its ProVation MD software for its GI departments.
• Surgical Information Systems (SIS) becomes an Industry Supporter of the American Society of Anesthesiologists (ASA).
• TeleTracking Technologies announces a free webinar series addressing patient throughput, overcrowding, RTLS asset management, performance improvement, and inter-hospital transfers.
• The executive director of medical operations for Pocono Raceway (PA) discusses how emergency responders are using technology from T-System and Shareable Ink.
• MobileMD introduces its 4DX Connected Health Record, an EHR application for small and family physicians that should be ONC-ATCB 2012 certified in Q4.
• Capsule announces record growth, including the addition of over 90 facilities over the last six months.
• iMDSoft adds Metropolitan Medical Services as a reseller of its MetaVision Suite.
• Billian Publishing launches HITR.com, a HIT benchmarking and social networking community for providers and vendors. The free tool includes customer satisfaction scores for nearly 40 IT systems and 300 vendors.
• CapSite releases a study of the RIS market and finds that 22% of hospitals have plans to buy a new RIS. Sixty-one percent of installed RIS systems are at least five years old.
• HIT consulting firm Care Communications collaborates with Elsevier/MC Strategies to incorporate Elsevier’s ICD-10 transition tools into its ICD-10 readiness and implementation offerings.
• Frost & Sullivan awards Awarepoint its RFID and RTLS Healthcare Competitive Strategy Leadership award.
• For the twelfth consecutive year, CMS extends its use of McKesson’s InterQual Criteria for decision management.

EPtalk by Dr. Jayne

Web sites like Groupon offer discounts on a variety of products and services. A recent article notes that such discounts may be illegal where health care services are concerned. Because part of a patient’s payment is kept by the site, it could be interpreted as violating anti-kickback laws. The American Medical Association hasn’t taken a stand, but two medical boards in Oregon (dental and chiropractic) have banned the practice.

The National Labor Relations Board affirms the right of a physician to terminate an employee for bad-mouthing the practice via social media. However, if multiple employees are collectively complaining regarding legitimate issues, employees may be protected. Timing, audience, and composition are key determinants of whether the speech is protected or not. Better dust off those policies and procedures and make sure social media use is addressed at your practice or hospital.

US District Judge Marcia Cooke has blocked enforcement of a Florida law that restricts physician questions about patient ownership of firearms. For those of you customizing EHR content and intake forms to remove these questions, you’re off the hook.

Accenture is chosen to head efforts to build a national Personal Health Record system in Australia. Orion Health and Oracle are also on the team. The system will include both patient and provider portals.

I maintain admitting privileges at a community hospital that is just now preparing to implement CPOE. I received a hilarious memo from them this week which contained so much worthless consultant-speak that I could have won a round of “Buzzword Bingo” without missing a beat. My favorite part was the discussion of a “cross-functional team dedicated to surveying spaces throughout the facility for process utilization.” I think this is fancy-talk for, “We have to figure out where we’re going to stick all these blasted workstations.” Broom closets, beware!

Sixteen organizations (including vendors, consultants, and advocacy groups) come together to form the Accountable Care Community of Practice. In their own words: “The overriding goal of the CoP is to help enable rapid, effective and efficient adoption and use of Health Information Technology (HIT) by providers implementing new care models in support of accountable care.” In addition to Webinars, they will hold regional forums in Minneapolis, Boston, New York, San Francisco, Seattle, and Austin.

PEPID announces the delivery of the National Drug Code (NDC) database to health IT systems. I’m not a fan of using NDC information for drugs, as it introduces a certain “clutter factor” depending on how vendors utilize it. Although highly specific, NDC codes for a given dose of a particular drug differ based on what kind of packaging holds the drug. As a front-line clinician, I personally don’t care if the pharmacy has 500-tablet stock bottles or 100-capsule stock bottles or which manufacturer it comes from. And don’t forget that generic drugs can have dozens of different NDC codes for the same medication.

I thought of Inga when I came across this business mentioned on a friend’s Facebook page. If it was in my home town, they would definitely get my business. It would also be an excellent name for a woman-owned software consulting firm. Now why didn’t I think of that? I could have probably expensed a number of sassy shoes as a business / advertising expense.

Contacts

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

News 9/28/11

Top News

Two Minnesota hospitals start notifying 16,000 patients that their medical information was contained on a laptop that was stolen. The hospitals blame subcontractor Accretive Health, whose employee left the laptop in a locked car outside a restaurant. The company did not give a reason that its employee had PHI on a personal laptop that was, contrary to company policy, not encrypted.

Reader Comments

From Keanu “Re: Health 2.0 conference. It might be bigger this year, but so far it’s super disorganized (and has been during the lead-up.) I’ve spoken to multiple vendors and sponsors they’ve managed to upset (including us.) I just witnessed a big argument about an ad gone wrong. Signage is lacking and has misspellings. We’ll see how the actual show goes.” Keanu sent a follow-up email, saying the first full day of the show was “semi-organized anarchy,” though better than the initial setup day.

From Jackie Dan “Re: Health 2.0. It’s sort of an interesting meeting and a cross between a mini-HIMSS and a VC startup competition. Everyone is trying to prove they’ve got the next ‘disruptive business model.’ A couple of interesting trends here though, like the whole Dr Chrono/Practice Fusion freemium thing. An insider at Practice Fusion told me that their paying customers are pretty much negligible compared to their purported 100k+ users, although, he still seemed ‘confident’ that they would survive/make money on ad revenue.” I have my own theories on the freebie EMRs and suspect Practice Fusion’s Research Center makes a nice impact to the bottom line.

From Doctor Who “Re: HIStalk resilience. FYI, you guys have significant sway these days. My profile in the Health 2.0 program makes direct reference to a post I made after HIMSS. HIStalk seems to have staying power. BTW, in addition to tons of people vying for money, the Health 2.0 conference is inspiring with some really cool and smart ideas out there. And the reception even included an open bar with Inga-like drinks (coco-tinis, nikita margaritas.)” Glad for the vote of confidence on HIStalk, as I kind of like this gig. HIStalk is over eight years old, so it’s been around for awhile. Bummed I missed the drinks. Next year, Matt.

From Fred Norris: “Re: HIMSS webinar. Got this in e-mail today. Doesn’t HIMSS charge hospitals a bunch to be members so they can benefit from their neutral, unbiased education services? Are they offering equal time to GE, Cerner, Epic, etc.? How can HIMSS claim to run a vendor-neutral annual conference (you have to swear that to be a presenter) and then run this marketing seminar? I’m sure they’re charging Siemens a fortune, so will they lower our annual dues proportionately, or are they just in it for the money like all vendors?” I raised a fuss when HIMSS started shilling its infomercials, but nobody seemed to share my indignation (or maybe they were just not surprised enough to care given the ever-blurring line between HIMSS and other vendors). Like a TV station during election season, HIMSS will indeed offer equal time to all other vendors – at an equal price. I do resent HIMSS passing sales pitches off as education, but that horse left the barn long ago and all you can do is try not to step in the part that’s left.

From NeverEnuf: “Re: Jackson. I thought you’d like this article on executive pay not being sufficient!” The new CEO of financially desperate Jackson Health System (FL), himself a former banker and city manager, gets some heat from the local paper by hiring two $500K executives who also have no hospital administration experience, one an accountant and the other a former IBMer. The CEO says the whole management team is paid well below market rates, which is definitely the case since he himself makes “only” $590K for trying to turn around the ultra screwed up Miami public hospital. That sounds plenty fair for a county official, but you know how hospitals are.

From Viggo: “Re: Thanks for looking over our Web page. I appreciate the favor.” I get quite a few requests for one thing or another: making an introduction, giving an opinion about a potential employer, offering thoughts on a vendor or product. I politely turn quite a few (maybe most) of those down since I don’t have much free time and it gets overwhelming at times (not to mention that much of the time, I’m just as clueless as the requestor and don’t want to just throw something out there implying otherwise.) My decision tree looks like this: (a) is the requestor a friend of HIStalk in some way – a sponsor, a guest article submitter, an interview subject? (b) if not, have I exchanged e-mails with them previously? (I save all my outbound e-mails, so I can tell); (c) is the requestor at least superficially supportive of HIStalk, like by being in the HIStalk Fan Club on LinkedIn or a friend in Facebook? I’ll do whatever I can to support people who support me, but I get more requests than I can handle as an after-work hobbyist (for example, I’m still writing after a crappy and long day at work that was followed by four hours of HIStalk work; my pager is going off; I won’t get to bed for another hour; and six hours later, I’ll the cycle start over again. If you’re waiting on e-mail from me, that’s why.)

From DDLT-AAGL: “Re: Epic. Having Epic installed at all necessarily gives you full access to the server-side code (which is not much use without Epic’s internal-only set of tools for navigating it.) Client (Hyperspace) code is effectively a black box to customers except where APIs are specifically created for custom forms, etc. Numerous server-side programming points allow predefined access at various code entry points — usually this is limited to simple code such as customized text output for a field, etc. But you can do a lot in theory. They draw an absolute line at customers editing any Epic-released code. Pure custom code is (reluctantly) tolerated (as it cannot be prevented by virtue of how Cache works) but discouraged and unsupported.”

Acquisitions, Funding, Business, and Stock

PatientKeeper lands $1.5 million of a planned $3 million debt financing round from a group of nine backers.

CareCloud, a provider of cloud-based PM, EHR, and RCM solutions for physicians, raises $20 million in Series A funding, led by Intel Capital and Norwest Venture Partners.

Greenway Medical Technologies amends its $100 million IPO, noting that it intends to list its shares on the New York Stock Exchange using the symbol “GWAY.”

Telehealth provider Tunstall Healthcare Group will acquire American Medical Alert Corp, a provider of  remote health monitoring and communication services, for $82.3 million.

Sales

HHS awards SAIC a contract to provide full life-cycle operations, maintenance, and enhancement services for its HRSA Data Warehouse. The maximum contract value is $15 million over five years.

The Health Information Network of Arizona (HINAz) partners with  Axoloti Corp (OptumInsight) to create a statewide HIE.

The state of Alaska hires Cognosante to conduct evaluation, technical assistance, and consulting services for the state’s HIE system.

Health Partners of Philadelphia selects MyHealthDIRECT’s Web-based scheduling solution.

Select Data chooses Emdeon’s RCM solutions for its home health customers.

Allegiance Health (MI) chooses TrustHCS to provide ICD-10 training and coding services.

The VA awards HP Enterprise Services a $10.4 million contract to provide a WiFi based RTLS to the VA hospital in Ann Arbor, MI.

People

Kony Solutions appoints Sriram Ramanathan (IBM) as chief technology officer.

Announcements and Implementations

Three Illinois-based health systems and two physician clinics join forces to establish the Lincoln Land HIE, which will utilize Medicity’s exchange technology.

Onslow Memorial Hospital (NC) will activate the second phase of its Meditech implementation next month with the go-live of clinical documentation by  non-physician users. Physician online documentation will start in April 2012.

The hospital authority for Memorial Hospital (GA) approves the $747,125 purchase of an integrated PM/EHR system for physician practices.

Floyd Valley Hospital (IA) begins its $500,000 EMR conversion to Meditech’s Client/Server release.

The American Hospital Association extends its third consecutive, three-year exclusive endorsement of Hyland Software’s OnBase solution as the ECM solution of choice.

Transcend Services releases a front-end speech technology and transcription platform that incorporates template-based documentation tools from its newly acquired Salar division.

MidSouth eHealth Alliance goes live on ICA’s CareAlign 1.0 HIE platform at 16 facilities.

3M Health Information Systems announces the release of its 3M 360 Encompass System, which unites coding, documentation improvement, and performance monitoring by providing auto-suggested codes and real-time clinical documentation improvement prompts.

NoMoreClipboard.com announces cc:me, a new addition to its personal health record service that allows patients to send and receive medical information electronically via the Continuity of Care Document format. They’re most famous for concocting (along with Medical Informatics Engineering) the Extormity fake EMR vendor. A quote from that brilliant spoof:

Generating a return on an investment first requires an investment. The heftier the investment, the more substantial the return could potentially be if there is, in fact, a measurable return. The Extormity EMR Software Suite is built on a proprietary software model renowned for its complexity. This proprietary platform and all of its components must be procured and implemented as a complete package we call the Extormity Bundle (which describes both our comprehensive package and its associated cost) … Planning for this additional infrastructure can be provided by the Extormity Strategic Consulting unit, with implementation provided by the Extormity Solutions and Services Business Unit. These Extormity business units operate in silos, ensuring that you receive and pay for duplicated services.

In Australia, Garner defends a report it prepared for Queensland Health in which health officials requested (and obtained) changes that critics say favored the selection of Cerner for a $180 million statewide EMR project. Gartner highlighted the fact that it considered Cerner the only vendor of a “Generation Three” product (on a five-generation scale, which QH’s ehealth program director wrote is equivalent to “a HIMMS scale of 5”) that is up and running in Australia. Both parties said the change was intended only to call out information already contained in the report, which provided Cerner with no advantage. It doesn’t seem the slightest bit fishy to me, but I’m not looking at it through political goggles like some of the torch-wavers down there.

Government and Politics

In the UK, ministers are considering offering US-based NPfIT contractor CSC another chance (and more money) to get iSoft’s Lorenzo up and running even though individual hospital trusts aren’t all that interesting in trying to implement Lorenzo and NPfIT is being shut down. The newspaper article called CSC “one of the worst-performing IT contractors” for being paid billions of pounds for trying, generally unsuccessfully, to implement Lorenzo, which helped seal NPfIT’s fate. 

Technology

Health 2.0 and Walgreens name Team mHealthCoach the winner of the Walgreens Health GuideChallenge and award mHealthCoach a $25,000 cash prize. mHealthCoach developed a tablet-based application that that displays data retrieved from multiple health and social media sources.

An open source advocate whose medical condition required an implantable defibrillator wants vendors of similar devices to make the source code of their proprietary software available for third party inspection, citing occasional medical device recalls. She admits that even as a programmer she wouldn’t have a clue what she was looking at or wouldn’t have any option other than getting the device or not, but adds, “I don’t want to rely on Medtronics for something as essential as my heart.”

Other

More frequent physician-patient encounters may lead to quicker control of Type 2 diabetes measurements and improve outcomes, according to a study that reviewed the EMR of almost 30,000 patients.

I knew my Starbucks made me happy: an Archives in Internal Medicine report finds that depression risk in women decreases as caffeinated coffee consumption increases.

Most health organizations are underprepared to protect patient privacy and secure data, with over half of health organizations reporting at least one privacy and security issue over the past two years. The most frequently reported violations came from internal sources improperly using PHI.

An interesting Slate article says the highest-paid doctors are the most likely to lose their cushy gigs to automation. Examples cited: technology allows faster reads of Pap smears and mammograms; technology can eliminate the need to get a second radiologist to check a mammogram; and surgical robots help surgeons work faster and allow them to work remotely. A fun quote:

By definition, specialists focus on narrow slices of medicine. They spend their days worrying over a single region of the body, and the most specialized doctors will dedicate themselves to just one or two types of procedures. Robots, too, are great specialists. They excel at doing one thing repeatedly, and when they focus, they can achieve near perfection. At some point—and probably faster than we expect—they won’t need any human supervision at all. There’s a message here for people far beyond medicine: If you do a single thing—and especially if there’s a lot of money in that single thing—you should put a Welcome, Robots! doormat outside your office. They’re coming for you.

Here’s Vince’s latest, Part II on IHC. Have I said I love reading these? You can add to the historical archive by e-mailing Vince.

Marty Gettman, a director at McKesson Provider Technologies in Atlanta working on the CareBridge Services Team, died September 15. He was 49. Condolences can be left here.

A 23-year-old traveling nurse covering for striking and locked-out RNs at Alta Bates Summit Medical Center (CA) kills a cancer patient by accidentally running nutritional supplement through an IV line instead of a stomach tube. Another contract nurse says the 500 replacement RNs were “thrown in” amidst “complete chaos” with only a brief orientation, not that orientation is needed to avoid making a colossal mistake like this by overriding all the safety precautions (like tubing that doesn’t fit the wrong kind of port).  

Sponsor Updates

• Merge Healthcare will incorporate Fovia Medical’s High Definition Volume Rendering (HDVR) across its entire PACS platform. Also announced by the company: speakers at its October 4-7 user group meeting in Chicago include Mayor Rahm Emanuel and HHS CTO Todd Park.
• T-System Inc. honors Ashtabula County Medical Center (OH), Mason General Hospital (WA), Montrose Memorial Hospital (CO), Osceola Regional Medical Center (FL), and PeaceHealth St. Joseph Medical Center (WA) with National Awards for Emergency Department Excellence.
• Iatric Systems’ Patient Discharge Instructions earns Surescripts certification.
• Business Day with Terry Bradshaw will feature The Huntzinger Management Group on the Fox Business Network on October 1.
• Ron Jones, an OptumInsight SVP, encourages CFOs to make the ICD-10 transition a priority in a guest blog post. The company also announces that 30 hospitals will implement its coding solution.
• dbMotion’s Elizabeth S. Willett discusses whether providers should develop an internal connectivity platform or join an externally driven HIE.
• Brad Hawkins, MEDSEEK’s VP of clinical experience, will participate  in this week’s North Carolina Healthcare Information & Communications Alliance Conference and Exhibition.
• Physicians with Kiddie West Pediatric Center (OH) secure stimulus funds using MED3OOO’s InteGreat EHR.
• PatientKeeper presents its Customer Innovation Award for 2011 to Clinical Practice Management Plan (NY) for its extensive and innovative use of PatientKeeper Charge Capture.
• Vocera names William Zerella (Force10 Networks) as CFO and Linda Esperance (MarketTools) as the company’s first VP of human resources.
• Orthopaedic Associates of Wausau (WI) will replace its existing EMR with SRS.
• Memorial Hospital & Health System (IN) subscribes to the CapSite Hospital Purchasing Database.
• McKesson Specialty Health introduces its Innovative Practice Services to help oncology practices improve their financial health through the use of business, technology, and clinical tools.

Contacts

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

Monday Morning Update 9/26/11

From My Little Pony: “Re: Epic. They’re recruiting programmers from Hong Kong.” The job posting says Epic is looking for Hong Kong software developers, with paid relocation to Verona. Epic will have a recruiting team in Hong Kong in November. I found the list of solutions the noobs might be working on interesting: genomics and proteomics, telemedicine, creating software that adapts to the individual user, developing next-generation user interfaces, and adding gesture recognition. Epic always resists the idea of outsiders setting usability standards that vendors would be required to follow, but it sounds as though the company has something potentially big in the works. Another version of the same ad is aimed at developers from Singapore.

From Gluteus Max: “Re: Epic being perceived as ACO ready. Epic is good at storing and presenting data, but it’s not good at doing useful things with it. If the ‘Epic Octopus’ business model theory is correct, that’s very much by design. Analytics and data sharing are two of the most important features ACOs will need, so it’s difficult to believe Epic is ‘close to ACO-ready.’” Unverified.

From Verona Notes: “Re: Epic. Now has 266 customers, up from 224 last year and 190 two years ago. Future vision shows Epic is listening to usability criticism, such as software that understands the physician-patient conversation and readies documentation and orders. Unsurprising stock tip: IBM servers dominate competition in internal Epic tests. Amazing logistics for so many people, but starting late=disrespect.” Unverified. There’s that usability thing cropping up again.

From Bea Fragilis: “Re: Epic. To what extent are Epic-certified people allowed to make changes to local hospital code? My sense is that those changes must be minor, documented, and controlled from Verona.” I’ve heard that Epic will let responsible customers change source code and will even provide them with programming standards and documentation to help, although they don’t encourage everybody to start hacking around. I’m interested in that answer as well, not to mention how the customer gets access to the source code (or the extent to which application behavior can be controlled through external hooks).

From MT Hammer: “Re: front-end speech recognition. A new study finds that it results in 800% more errors in patient reports compared to transcribed dictation.” The study, published in the American Journal of Roentgenology, finds that 23% of reports created with front-end speech recognition (i.e., you dictate into a microphone and your words immediately appear on the computer screen) contained at least one major error vs. only 4% of those created from standard dictation and human transcription. Overall, the error rate with speech recognition was eight times higher than with human transcription. Interestingly, speaker accents didn’t make much difference, but imaging modality was a predictor of error rates. I don’t have access to the full text of the article, so I would be interested in radiologist’s analysis (such as the significance of issues defined as errors, why the radiologist didn’t catch the mistakes on the screen when using speech recognition, etc.) Also keep in mind that this compared only two transcription options, with the third being back-end speech recognition like that of the former eScription (now Nuance), which I believe has much higher accuracy since it can consider context and history rather than just pronunciation (similar to what transcriptionists do).

From The PACS Designer: “Re: Windows 8 tour. Microsoft has revealed aspects of its new Windows 8 platform for developers to peruse. Windows 8 will be tightly integrated with a new Internet Explorer 10 using a next generation internet platform called HTML5.”  The problem with pre-iPhone cell phones is that they worked like tiny, underpowered PCs with crappy keyboards. I’m not sure we need the opposite problem – PCs that work like huge iPhones – especially since touch screens are extremely rare in PC-land and the point is lost anyway since you’re either sitting in front of a desktop keyboard or a laptop. My understanding is that Win 8 will have two user interfaces, one for mobile use and one for desktop. MSFT had better make sure not to screw up the latter in trying to pander to those who yearn for an iPhone clone as their primary device.

From King Coal: “Re: HIStalkapalooza. Which night? Looking forward to it with bated breath.” Don’t count on it just yet. The potential sponsor had some venue contracting issues and won’t have enough space  to handle the historically large turnout (and waitlist.) I may end up cancelling it for Las Vegas, leaving you to read your HISsies winners online instead of seeing Jonathan Bush’s one-man show crafted around them (and that I really will miss).

My Time Capsule this week from 2006: The VA Outperforms Private Hospitals in IT Vision and Resolve. An aliquot: “Like a tailor-made suit, VistA was developed to meet the VA’s needs, not those of a vendor’s ‘average’ hospital customer. Just as hospitals talked themselves into buying instead of building (helped along by vendors and risk-averse CIOs,) the industry’s darling turns out to be a homebrew job.”

Reporters and TV stations have gone crazy with their lazy, press release-sourced coverage of the prospect of turning healthcare encounters over to the Jeopardy-winning IBM Watson (most common lame headline: “The computer will see you now”) but readers here weren’t equally impressed with its announced use by WellPoint, with most saying IBM and WellPoint will get the benefit instead of patients and providers. New poll to your right: now that Sage Software has announced plans to sell its healthcare division to Vista Equity Partners, who will benefit most from that transaction?

I’ve enjoyed Vince’s HIStory series immensely, to the point that I suggested that the pre-1980 industry pioneers get together at the HIMSS conference to reminisce (and knowing some of those folks, perhaps tipple a tad). Shelly Dorenfest, Bob Pagnotta, John DiPierro, and David Pomerance are a few of those who have said they’ll be there. If you know them, you should be there, too. Drop your e-mail info on this form and Vince will be in touch. Think of it as a 30+ year class reunion of the College of HIT Hard Knocks.

This week’s e-mail from Kaiser boss George Halvorson talks up the company’s newly won Davies Award win, also mentioning that Kaiser hospitals make up 35 of the 60 HIMSS EMRAM Stage 7 hospitals and that the remaining KP hospitals are all Stage 6. And despite early reports of HealthConnect availability problems, he says KP has won six awards from the Uptime Institute, the only healthcare organization to ever win (although as a counterpoint, that’s data center uptime, and plenty of ways exist to knock users off systems even though the server is chugging along). He also mentions some employee-recommended technology projects that have been funded by KP’s internal innovation fund: an automatic glycemic calculator, a hospital capacity prediction tool, and an SMS appointment reminder system.

Weird News Andy finds this story about hospital drug shortages and the resultant third-party profiteering scary. I’ll elaborate from experience to scare him more. Even if you ignore the possibility of obtaining counterfeit or impure drugs when forced to buy from secondary channels, the patient safety risks with drug shortages are considerable. Product packaging and sometimes concentrations differ from what nurses and doctors are used to, greatly increasing the chance of wrong drug / wrong dose errors. Sometimes the backup drug is therapeutically similar but chemically inequivalent, meaning doctors are forced to use a drug that wasn’t their first choice and one they may not be all that familiar with, making it more likely that something will go wrong. Shortages come and go all the time, so information systems can’t be kept current to steer prescribers to the one currently being used, sometimes requiring IT workarounds that neuter electronic protections such as dose and allergy checking. Those drugs may have similar active ingredients that are still different enough to trigger unexpected drug allergies and drug-drug interactions. My analogy is always this: suppose you’re about to have open heart surgery, but the drugs your surgeon always uses are on shortage, meaning the surgeon will have to compromise with a less-desirable drug that they’ve rarely or never used. You’d be mad at someone for letting that situation occur. The problem here is that everyone involved claims to be innocent and powerless.

On WNA’s slightly lighter side (it involves death, so it’s still not all that light), he captions this story as “Spinal Tap’s drummer?” Coroners in Ireland review the death of a man whose body was found burned in his sitting room, with no damage to the floor on which it rested, no evidence of foul play, and no signs of the source of the flame.  They conclude that he died of spontaneous combustion. A retired pathology professor ruled out divine intervention, saying, “I think if the heavens were striking in cases of spontaneous combustion, then there would be a lot more cases.”

A good article covers the high cost of children’s hospitals, with the Nemours Children’s Hospital (opening next year) in Orlando leading it off. The 95-bed hospital, being built in a city that already has two large and notable children’s hospitals, will cost $400 million ($4.2 million per bed) and was approved by the state only after the well-funded Nemours called in some political favors. Mentioned about high-profile children’s hospitals in general: lack of financial transparency, fast-rising costs accompanied by big executive paychecks and impressive construction projects, big financial war chests, and only tiny amounts of charity care provided. I can say from experience that those multi-million dollar children’s hospital CEOs have the ultimate weapon to keep the donor and political largesse flowing – feel-good happy ending stories of miraculous medical work accompanied by fuzzy-focus, intentionally heart-tugging pictures of adorable babies and toddlers. Your hospital will lose every time if your particular medical miracles involve less Hollywood-like episodic interventions on behalf of elderly patients, the chronically and incurably ill, psychiatric patients, and that particularly colorful stratum of society that shows up in the ED full of street drugs, hostile microbes, and intentionally inflicted wounds.

Don Berwick says CMS administrator is the best job he’s ever had, but he’ll lose it on December 31 unless the Senate confirms him by then. No confirmation hearings have been scheduled.

The New York Times covers telepsychiatry, where patients receive counseling sessions via Skype or specialized Web apps like Breakthrough.com. Says a psychologist, “In three years, this will take off like a rocket. Everyone will have real-time audiovisual availability. There will be a group of true believers who will think that being in a room with a client is special and you can’t replicate that by remote involvement. But a lot of people, especially younger clinicians, will feel there is no basis for thinking this.”

An OB-GYN subpoenas Bellevue Medical Center (NY), demanding a list of every person who accessed the Internet from the hospital on a particular day in 1999. The doctor is trying to find the person who posted defamatory comments about her on a physician review site, claiming she has reason to believe it came from a particular NYU doctor. The hospital says it keeps access logs for only 30 days, but the doctor’s legal team found a computer forensics expert who claims he knows a sophisticated (and undoubtedly expensive) way to bring back 12-year-old records.

E-mail Mr. H.

News 9/23/11

Top News

The British government says it will “urgently dismantle” the failed $18 billion NPfIT project in favor of locally controlled initiatives after a series of gloomy reports from government auditors, with the final report released Thursday concluding, “There can be no confidence that the programme has delivered or can be delivered as originally conceived.” NHS will keep only the parts that work (e-mail, the appointment system, PACS, and the communications infrastructure). They also admit that the cost of getting out of various big-dollar contracts will probably exceed the cost of just paying out the rest of the money specified in the vendor contracts. The co-director of a patient advocacy group summarizes, “Thank goodness politicians have decided to stop money being poured into a huge bottomless pit. Now we must pray that they don’t sanction pouring it into endless incompatible regional pits.”

Reader Comments

From Steve Stifler: “Re: Epic UGM. Judy’s dreams of world domination are beginning to seem credible. Carl Dvorak was very clear that he doesn’t want videos of the meeting showing up in HIStalk and nobody wants Judy mad at them.” That’s Judy in costume above. Several readers sent over photos and links to unlisted YouTube videos from the meeting. I’ll be nice to Carl and Judy and not run them here, especially since they wouldn’t be all that interesting to anyone without an Epic connection anyway.

From Graying CIO: “Re: Epic UGM. This image says more to me than any other about the power and scope of Epic. Buses for the user group meeting attendees snake into the distance next to a two-acre hole in the ground that will be a future 10,000+ seat auditorium, replacing the 6,000-seat one that is too small. Others were struck by the image as well – I saw at least five people whip out their phones and take the same picture. The interesting thing about the executive overview (two hours of insight opened by Judy Faulkner and closed by Carl Dvorak about Epic, the healthcare IT environment, and Epic product development) is that it was positive and Epic is clearly on a growth tear, but that ICD-10 and Meaningful Use have drawn all of the focus and attention for the past few years and will continue to do so. Epic is responding well, but Carl was very clear that these topics have interfered with innovation both within Epic and by its customers.”

From CommunityHIZ: “Re: HP firing its CEO. I think this whole HP thing is a ruse orchestrated by Hammergren. This is kind of like Alabama thanking God for Mississippi every night before bed. With HP in shambles, nobody will focus their attention on Hammergren’s self-created mess at McKesson. (For those who don’t know, Hammergren serves on HP’s board).” More below, including my slightly critical evaluation of HP’s board (“the most inept board in America”) when they hired the guy not even a year ago.

From NoNeedHere: “Re: Accretive Health lawsuit. Juicy details in the legal documents.” A summary from the proceedings: revenue cycle management vendor Accretive Health hired an SVP over revenue cycle operations at four hospitals even though he had basically zero revenue cycle experience. He was fired and sued the company claiming sexually and racially discriminatory conduct by a mid-level supervisor, while the company said his work was substandard and hospitals were complaining about him. The district court found for the company and the US Court of Appeals affirmed the judgment in favor of Accretive on Wednesday. I’m blurring the names, although they’re in the public record if you really care.

From Larry Leisure: “Re: Sage. Unloads healthcare division. What a mess over there. I’m running for athena as fast as I can.” Thanks to Larry for e-mailing me about the announcement this morning just a couple of minutes after it came out. He probably knows that I like scooping everybody, which I believe I did in getting out a quick news blast since I happened to be at my desk at the hospital at the time. I actually think the news is good for the healthcare group. Let’s be honest, Misys and Sage shared more than their British heritage, financial software focus, and US EMR company ownership – they were never really all that interested in the US healthcare market other than for its potential to boost their predictable but unsexy profits. You’ve got to be kidding me that Sage’s CEO is blaming HITECH and healthcare reform for messing up its PM/EMR cash cow, especially when the unit booked a not-too-shabby 13.5% profit margin in the latest financial report (maybe the healthcare management team could do OK if it weren’t for the transoceanic shackles.) I can only interpret his statement to mean that once customers got a taxpayer-funded incentive to increase their EMR investment, they took the opportunity to look elsewhere. If I were a Sage Healthcare employee or customer, I’d be clinking the champagne flutes that the Brits are turning tail and letting the historically successful Vista Equity Partners take over the franchise, even though it’s likely they’ll be doing some painful but necessary cost-cutting (you can do the math: they’re paying about 1.4 times revenue or 10x annual profit, so a margin boost is needed to justify the price.) Your thoughts (anonymous if you like) are welcome since I’m just a cheap-seater here. What’s good about this deal, what’s bad, and what should Vista do?

From THB: “Re: McKesson vs. Epic. Are we back in court again for this? The issues the parties were asked to brief are: If separate entities each perform separate steps of a method claim, under what circumstances, if any, would either entity or any third party be liable for inducing infringement or for contributory infringement? See Fromson v. Advance Offset Plate, Inc., 720 F.2d 1565 (Fed. Cir. 1983).” This is the case in which McKesson sued Epic for infringing on its patent involving Web-based doctor-patient communication, such as for appointment and refill requests. The district court tossed that case out in April 2011, saying that McKesson couldn’t prove that Epic or any other single party performed all the steps in the claimed infringement by Epic’s MyChart.

HIStalk Announcements and Requests

The latest good stuff from HIStalk Practice: athenahealth and meridianEMR update their Meaningful Use dashboards. Mitochon Systems blasts fellow free EHR vendor Practice Fusion for its “over-reaching claims.” A whopping 90% of physicians say they use at least one social media site for personal use. Julie McGovern shares insights on software upgrades, compassion, and expectations.  Speaking of expectations, I expect you to sign up for HIStalk Practice e-mail updates when you take a peek at these stories. And thanks for reading.

Inga’s away schmoozing around at some conference, so the little red squares will be in scarce supply today. She will be back by the time you read this.

Listening: Opeth, genre-bending progressive metal from Sweden. Not for everybody, but I like it.

We like readers signing up for our e-mail blasts, connecting with us on Facebook and LinkedIn, sending us rumors, and supporting our sponsors. Since you are smart, we will trust you to take that subtle hint.

On Healthcare IT Jobs: Epic Applications Systems Analyst – Ambulatory, Data Warehouse Architect, Business Intelligence Developer, Epic Beacon Consultant.

Welcome to new HIStalk Platinum Sponsor MedAssets of Alpharetta, GA. The company provides solutions for revenue cycle (patient access, charging coding, UM, billing, A/R management, etc.); supply chain management (contracting, sourcing, inventory management, distribution, A/P); resource management (decision support, performance analytics, process improvement, workforce solutions), and consulting services. Their elevator pitch is easy to understand – they will sustainably improve provider operating margins by 1.5% to 5%. Case studies on their site include Fletcher Allen Healthcare ($12 million in benefit from contract management improvements and  data-supported contract renegotiations), Cooper University Hospital (reduced A/R days from 60 to 37 and added $43 million to the bottom line), and Westchester Medical Center (identified $8.9 million in supply chain savings by using analytics to examine costs right down to the individual screws used in orthopedics). Note and appreciate their non-animated ad. Thanks to MedAssets for supporting the constantly clacking keyboards of HIStalk.

Acquisitions, Funding, Business, and Stock

The bumbling HP board fires its equally bumbling CEO Leo Apotheker after 11 ugly months on the job, hiring former eBay CEO Meg Whitman to replace him. Apotheker, the third fired HP CEO in six years, gets a $25 million parting gift to go away. SAP canned him after only seven months before HP inexplicably brought him in on a golden throne, so he raked in dozens or maybe hundreds of millions in his total two-company CEO tenure total of 18 months. I said this when HP hired him in October 2010:

Speaking of SAP, HP and “The Most Inept Board in America” choose the former CEO of SAP to be HP’s next CEO. SAP fired the Germany-born Leo Apotheker after a disastrous seven months as CEO, although some say he was the scapegoat for a terrible company strategy that predated him. HP is paying him like he’s a star: $1.2 million in salary, incentives of 200-500% of that with $2.4 million guaranteed, $72 million in options, a $4 million signing bonus, and $4.6 million in moving expenses (that’s a lot of U-Hauls). I’ll go with the summary of Oracle CEO Larry Ellison: “I’m speechless. HP had several good internal candidates … but instead they pick a guy who was recently fired because he did such a bad job of running SAP.” Their pre-Hurd CEO pick was an ultra-expensive termination, too: HP’s value dropped in half after Carly Fiorina orchestrated the company’s merger with Compaq. She was let go in an ugly fight about the time the company admitted that it spied on the personal phone records of journalists and its own board members trying to find out who was leaking information about its strategy.

Sales

Ellenville Regional Hospital (NY) selects Craneware’s Chargemaster Toolkit-CAH solution to atuomate its charge master management process.

The University of Texas MD Anderson Cancer Center chooses MedQuist’s Speech Understanding and Natural Language Understanding platform from M*Modal for its ClinicStation EMR and RadStation radiology systems.

Swedish Medical Center (WA) signs for Microsoft Amalga for coordinating care and managing populations.

Announcements and Implementations

Biggs-Gridley Memorial Hospital (CA) will go live on the Prognosis ChartAccess EHR in January.

The Gorge Health Connect (OR) HIE creates a video that shows how it’s using the government’s Direct Project (via Medicity) to connect providers in a pilot project.

Vodafone signs a deal with NantWorks to develop mobile healthcare services. That’s the new name for the technology companies owned by Patrick Soon-Shiong, the physician and drug company founder whose $7 billion net worth earns him the #39 spot on the Forbes list of richest Americans.

Innovation and Research

A study published in Health Affairs finds that the Meaningful Use Stage 1 hospital CPOE threshold of 30% of orders probably won’t have much impact on heart-related Medicare deaths, but the proposed 60% Stage 2 threshold should be enough to move the outcomes needle.

David Bates will lead a team of researchers from Brigham and Women’s Hospital in using supercomputer-powered analysis of the hospital’s EMR data to look for complex correlations among patient characteristics, genetics, drug interactions, and outcomes of heart failure patients. They hope to create computer models that can help choose effective heart failure interventions.

Other

Beacon Partners’ ACO Readiness Study finds that only 15% of healthcare organization respondents are “very familiar” with ACOs and 61% say they are “somewhat familiar.”

Speaking of ACOs, providers view Cerner and Epic as the vendors that are most ACO ready. 

St. Rose Hospital (CA) is cutting 10% of its workforce due to problems that include “complications involving a new McKesson computer system that went live in late June, the recession’s impact on the hospital’s fragile bottom line, and managed care contracting snafus, including a two-week period in July when ‘we were not able to get bills out,’ [CEO] Mahoney said.”

Former National Coordinator David Blumenthal, now back at Harvard, talks up EMRs at a Boston event. He talked about his own long-ago personal experience with EMRs, although I’m never clear what kind of practice he had or whose EMR he used. Some of the docs in audience apparently made negative comments about time required to use the EMR. One said, “The computer is really like that third person in the room, and a 2-year-old at that. It’s hard to manage” Blumenthal urged patience, saying, “The current crop of products is not the crop we will have in five years. However, we will be just as unhappy with the crop we have in five years because our imaginations will soar ahead of reality.”

University Medical Center (NV) lost $70 million last year, but the CEO says he thinks next year’s move to electronic medical records will save money in the form of reduced labor costs and errors.

Sponsor Updates

• Indiana University Health Bloomington and Paoli Hospital go live on McKesson’s Horizon Patient Folder electronic document management system.
• Greenway Medical Technologies announces that its PrimeSuite EHR client, Alpine Urology, is the first practice to connect to CORHIO’s HIE. 
• The Pittsburgh Technology Council awards TeleTracking Technologies its Tech Titan MVP award.
• TeleTracking’s user conference will be held next month in San Diego.
• MEDSEEK announces GA release of Quick Response Codes to facilitate the patient marketing programs of hospitals. 
• Anesthesia Business Consultants and iMDSoft announce their partnership to offer a complete AIMS and anesthesia billing solution.
• Joan Coner of maxIT Healthcare is recognized in Strathmore’s Who’s Who Worldwide Edition for her 20+ years of contributions and achievements in healthcare consulting.
• Orion Health announces receipt of ONC-ATCB 2011/2012 certification of its Clinical Portal V7.0.
• Covisint releases a new whitepaper entitled Performance-Based Care for Accountable Care Organizations.
• MediServe clarifies newly announced changes to Medicare Part C Advantage plans.
• GE Healthcare will introduce an HIE in Australia. 
• The Rothman Institute  (PA/NJ) selects the SRS EHR for its 100-provider, 14-location practice.
• Michigan Health Information Network Shared Services engages OptumInsight for its HIE platform.
• Central Penn Business Journal names MEDecision to its list of 100 Best Places to Work for the third straight year.
• MD-IT announces the addition of Quality Transcription Services to its Medical Transcription Service Organization Associate program.

EPtalk by Dr. Jayne

Lots of folks are talking about the recent Department of Health and Human Services plan that would allow patients direct access to their laboratory test results. The proposed rule involves three HHS agencies: CMS, CDC, and the Office for Civil Rights.

Changes to the Clinical Laboratory Improvement Amendments (CLIA) are required to allow this. Patients would be able to receive copies of their lab reports on request. When faced with patients receiving lab results directly (as opposed to receiving them from their physician or another health professional), many physicians react negatively.

The consumerization of healthcare has had profound impacts on how care is delivered. Patients are better able to participate as a member of the healthcare team, which is good. However, the potential impacts of releasing lab (or any other diagnostic testing) data directly to patients should not be overlooked.

These are not uncharted waters. Many health systems already release data directly to patients, often after a delay of a day or two to allow the ordering physician to review the results and contact the patient. Others release results only after the ordering provider has signed off, again presumably to allow a conversation with the patient where needed.

Physicians worry that direct release of lab data to patients (particularly without annotation) will generate a flurry of phone calls. Before I used an EHR, I would mail each patient a copy of their lab results with my notes / comments / care plan written directly on the results. It was efficient and made for clear documentation in the chart. The occasional “abnormal” result of no significant consequence was simply marked “OK,” and 99% of patients did well with this approach. Of course, there was always the occasional patient who would call wondering if their low chloride level (one point below cutoff) was a health concern, despite the “OK.”

Radiology reports are a little trickier. Narrative reports are sometimes less clear and informative, particularly if you deal with (as I have lately) a radiology group that refuses to definitively address what they see and instead dictates a jumble of “might be” and “can’t rule out,” punctuated by the always-present “clinical correlation needed.”

My health system releases both lab and radiology reports to the patient through a secure portal, but only after a time delay. Depending on the nature of the test, the delay is shorter or longer. For example, blood tests such as cholesterol levels are released after a day or two, but CT and MRI scans are held for seven days. This gives us time to contact patients about their situation before they see the results.

Since we’ve been doing this, I’ve had several patients who had significant concerns about what they’ve seen on their reports. Many patients, even after they’ve heard from the team about their results or changes to the care plan, head straight to Google to find out what all those big words mean. What they see sometimes leads to panic and fear.

When patients in this situation call, my recommendation is to add them on to the schedule same-day or as soon as possible. Unfortunately, talking about it on the phone lacks the face-to-face reassurance that patients often need. If they come in, I can pull up the films and we can review them together along with any Internet articles they’ve been reading. The visit is reimbursable and provides an additional opportunity for health counseling or disease management education.

It will be interesting to see how lab vendors decide to handle this. Most will probably go with online patient portals, I’d guess. Depending on how often your insurance carrier or provider changes lab vendors, this could lead to multiple places where patients have to access their data over time, assuming they decide to provide the information in an ongoing fashion vs. a one-time release.

Do you work for a laboratory provider? How is your organization planning to address this? E-mail me.

Contacts

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

Sage Healthcare Sold to Vista Equity Partners

Sage Group PLC will sell its Sage Software Healthcare unit to private equity firm Vista Equity Partners for $320 million in cash, the British company announced this morning. The sale is expected to be completed in November.

Sage CEO Guy Berruyer said in a statement, “The sale of Sage Healthcare allows management in the North American region to focus on the considerable opportunities that exist within our core U.S. customer base.”

He was also quoted as saying, “When we bought this business, we could not have predicted that the Obama administration would change the market in the way it did. This business was contracting and it had moved away from our core strategy. Our North American business has been performing less well overall. Selling the healthcare business will allow our US team to concentrate on our business priorities again.”

Sage said it will take a loss of up to $108 million on the sale of the former Emdeon Practice Services, which it acquired for $565 million in August 2006. In the most recent six-month reporting period, the healthcare division earned profits of $15 million on revenue of $111 million.

News 9/21/11

Top News

Aetna, Humana, Kaiser Permanente, and UnitedHealthcare will pool five billion medical claims records in a data mining initiative to identify trends in cost, utilization, and intensity of care. Beginning in 2012, the not-for-profit Health Care Cost Institute will combine 11 years’ worth of records from the carriers, publish scorecards, and support analysis of aggregate trends to qualified researchers.

Reader Comments

From Wilbur: “Re: Aventura. Did you already get this? You interviewed Howard Diamond for the HIStalk Innovator Showcase. Really neat company, people, and technology.” Denver-based Aventura HQ, which offers a clinician front end for EMRs and other systems, raises $13 million in its first round of institutional vendor funding. I profiled the company in late July. Wilbur isn’t a shill, by the way – he sent this non-anonymously and he has no vested interest in the company (nor do I.)

From Elane Twofer: “Re: UPMC electronic medical records alteration. I’m puzzled why that is central to peer review. Mr. HIStalk, please provide some advice and your wonderful wisdom.” The trial begins in Pittsburgh of a lawsuit brought by a deceased patient’s family against UPMC Presbyterian (PA). The family claims that doctors caring for a 62-year-old inpatient failed to note in his electronic medical record that he would be difficult to intubate. He experienced respiratory distress, exacerbated by a nurse who inappropriately gave him a tranquilizer to calm him down, and doctors could not establish an airway. He died. The family’s attorney says UPMC’s EMR transaction records show that its head of quality assurance tried to add a red-letter “Dif Intub” warning to his EMR three days after he died. The hospital says the entry was for peer review purposes rather than to favorably falsify the records. I know this reader and I believe the hope is that I’ll expound against EMRs from this example, but I’ll take the opposite approach. I’ve been on various hospital committees (death, tissue and transfusion, etc.) and I’ve seen first hand paper charts that were falsified after the fact by doctors and nurses to cover their butts after making mistakes that harmed patients. It wasn’t hard to suspect they did it (the handwriting was clearly different, the change was present only on the original order and not the copy, etc.) but hard to prove. If the family is correct, UPMC’s own electronic records will provide the inarguable evidence. Score: EMR 1, paper 0. I’d like it even better if standards were in place that would physically protect all electronic documentation transactions from database-level changes, journaling every entry, change, and deletion as a permanent record that even IT uber geeks could not destroy.

From Ludmila: “Re: NJ chapter of the American Academy of Pediatrics. Apparently there’s about to be a blowup over its PCORE (Pediatric Council on Research and Education) section accepting money related to referring practices for HITECH, which it isn’t allowed to do as a 501(c)(3) corporation.” Unverified. I e-mailed the organization and received no response.

From Sepulchre: “Re: Meaningful Use. Frequent reader, first time I’m posting a question. No one has been able to answer this. In getting your ‘certified’ system and achieving MU, what happens if the user decides to change vendors? During that kind of transition, you would expect your reporting on objectives could be impacted and you might not meet them for the year. Do you incur penalties from Medicare during that time? Seems like a great setup for vendors. Once you use them and achieve MU, you must keep using them to avoid penalties.” Hopefully my really expert readers will weigh in.

From Reluctant Epic User: “Re: McKesson ad. Do you think they’re struggling in the large hospital market because their marketing department thinks people are still running Pocket PCs?” I like the irony of the “Better Technology” headline right beside some old and not-so-good technology, but their problems are more related to Horizon than what it runs on.

From Space Ghost: “Re: newsletter. Writing headlines must be a tough job.” The mistake is especially notable since it came from Government Health IT, whose parent company has HIMSS (or HIMMS, if you prefer) as a majority owner. The correct spelling is obviously the first word of the article, so someone went out of their way to screw it up.

Acquisitions, Funding, Business, and Stock

Practice Fusion announces that it has received over $6 million in additional funding from several new investors, including Western Technology Investment (an early Facebook investor) and Scott Banister (Idealab, IronPort.)

EMR vendor SuccessEHS acquires the MediaDent practice management, electronic dental record, and dental imaging solution from MMD Systems. SuccessEHS will offer the integrated solution to Community Health Centers, including the 190 that are already its customers. 

Transcription vendor MedQuist raises guidance and announces a $25 million stock repurchase program following its recent acquisitions of M*Modal, All Type Medical Transcription Services, and JLG Medical Transcription Services.

India-based technology vendor Wipro says it’s looking to acquire US-based health and life sciences companies, especially those with analytics and mobility products and companies involved in revenue cycle management. Wipro also says it will benefit from ICD-10 conversions as US work is offshored to India and the Philippines.

The Advisory Board Company launches its new logo and Web site, which emphasize its research work plus newer offerings that focus on technology applications and healthcare support. An interesting history of its logo over the years says it started as a drawing of the townhouse owned by the founder’s mother (the company’s first headquarters, in 1979), followed by the Jefferson Memorial-related logo that was used for 20+years, then finally the new version that’s based on a revolving bookstand designed by Thomas Jefferson to allow him to check multiple references at once, a prototype of the database (which also happens to look like the letter A.)

I keep forgetting that The Advisory Board Company is publicly traded, so here’s how shares have done over the past couple of years compared to the S&P 500 (green) and Nasdaq (red). An ABCO share bought for around $25 two years ago would be worth over $60 today.

People

Meditech announces that family physician Steven Jones, MD will join the company to act as lead its EHR development efforts. He has served on the company’s Physician Advisory Committee.

MedAssets reports in an SEC filing that Neil Hunn, president of revenue cycle technology, is leaving the company to pursue “other career opportunities.” He joined the company in 2001, was promoted to RCT president in January 2011, and leaves with $570,000 in separation pay. Meanwhile, Greg Strobel (above) moves from president of the revenue cycle services business to president of the MedAssets RCM segment.

Bayhealth Medical Center (DE) names Lynn Gold as senior director of information services and telecommunications. She was previously with GE Healthcare.

Announcements and Implementations

Mobility is here to stay. It’s tactical in a sense because it is a device that allows people to do their work differently. Physicians and other clinicians are falling back into workflows that are natural to the work they are doing. They were forced out of that workflow with the advent of technology 25 years ago when they would have to go somewhere to log on to a PC. They had almost forgotten that they used to do rounds at the bedside. Now it’s conceivable and practical for them to be able to do that. The patients feel a higher level of engagement because of the tools.

Ophthalmologists at a UK hospital work on OpenEyes, an open source ophthalmology EMR.

Government and Politics

HHS’s Text4Health Task Force issues recommendations to HHS regarding text messaging and mHealth apps: a) develop and host evidence-based health text message libraries and make them available to the general public; 2) develop further evidence on the effectiveness of health text messaging programs; and, 3) explore partnerships to create, implement, and disseminate health text messaging and mHealth programs. 

In Australia, Queensland Health is negotiating with Cerner for a $249 million (US) hospital clinical systems contract, with the opposing political party claiming that health officials changed an independent report to give Cerner an edge and that the technical information Cerner provided was inaccurate.

Senior executives and physicians from Ireland are visiting the VA this week to learn more about its VistA system.

A newspaper article says patients are somewhere between surprised and offended at being asked for their ethnicity and race during physician visits, newly required by the Affordable Care Act. An ophthalmologist says many patients cross out the “race” question and one patient answered “the Boston Marathon.”

Innovation and Research

Researchers in Spain are working on a “garment-based patient biomonitoring platform,” or smart shirt, that will monitor vital signs and patient location.

AHRQ offers guidelines for future and current EHR users on avoiding unintended consequences. Credit to Joe Conn of Modern Healthcare, whose article about this came up in an unrelated Google search I was doing.

Texas Heart Institute releases a free iPhone and Android app to train medical students in auscultation (listening to the heart). It was developed by James Wilson MD, director of cardiology education.

Technology

I ran across this interesting (and free) tool. Chatter is like a private, secure, and hosted Facebook, a social network for businesses that allows co-workers to push out updates, share files, and solve problems. Signup for the hosted app requires only a company e-mail address, and the network is private to users within that domain. Clients are available for iPhone, iPad, BlackBerry, Android, and the desktop. It’s owned by Salesforce.com.

An article on MIT’s Technology Review profiles speech recognition software in healthcare, specifically Nuance’s Clinical Language Understanding.

Other

Posted on Twitter:  a picture of the opening session at Epic’s user group meeting. The poster notes, “This is a big auditorium!” Epic is expecting 11,500 attendees, including 6,500 customers, for the four-day event in Verona. Another tweet from a Stanford University physician: “35-45% US pop covered by Epic EMR, 2% of world pop covered, $92 billion in claims in 2010!”

Here are more Epic UGM photos from a reader. Thanks for sending them over. Above is the lunch tent built for the conference. They’re offering horse carriage rides and bikes for exploring the back trails. The theme is “Once Upon a Time” and attendees were invited to attend Tuesday’s opening session in musical costume as Judy was to do (I’m thinking Ziggy Stardust drag or Insane Clown Posse makeup). Your updates and photos are encouraged.

The American Nurses Association signs on as partner in Care About Your Care, a healthcare wellness awareness initiative supported by the Robert Wood Johnson Foundation, AHRQ, and ONC.

In what are believed to be the harshest prison sentences ever for Medicare fraud, a federal judge orders 50-year and 35-year sentences to American Therapeutic co-owners Lawrence Duran and Marianella Valera. The company billed Medicare for over $205 million in claims over eight years for mental health services that were either not required or never provided to patients. They were ordered to pay $87.5 million in restitution.

The Honolulu Police Department tries to figure out how to bring criminal charges against one of its officers for posting a hospital bed photo of a suspect on Facebook. The patient had been badly burned while trying to steal copper wire, giving the officer creative inspiration for the Facebook caption, “See when you like steal copper.”

Sponsor Updates

• A 12-member GetWellNetwork triathlon team led by CEO and Founder Michael O’Neil raised $36,000 for The Leukemia & Lymphoma Society in The Nation’s Triathlon in Washington, DC on September 11, 2011. The team’s donations led all national participants as it honored the memory of Justin Thorton, who died of leukemia at 19 earlier this year.
• 3M partners with Clinical Architecture to offer 3M Healthcare Data Architecture, a terminology-mapping interoperability and data standardization solution.
• Iatric Systems adds a clinical quality measure component to its Meaningful Use Manager product and earns expanded ONC-ATCB certification.
• CynergisTek and Diebold will partner to showcase their “Smart Hospital” security model at The Healthcare Facilities Symposium and Expo September 20-22.
• Alan W. Portela, CEO of AirStrip Technologies Inc. will participate as a panelist at the AdvaMed 2011 MedTech Conference September 26-28.
• API Healthcare partners with Role-Based Practice Solutions to track, manage, and develop professional role competencies.
• Colette Weston of ADP AdvancedMD provides a 5010 transactions update based on progress by AdvancedMD and partner RelayHealth.
• CaroMont Health (NC) selects RelayHealth to facilitate HIE among the hospital, employed physicians, and affiliated physicians.
• Healthwise SVP Molly Mettler will moderate a panel discussing shared decision-making at the World Congress Leadership Summit September 22-23.
• Highline Medical Center (WA) selects Wolters Kluwer Health’s ProVation Order Sets for its healthcare campuses and 20 clinics.
• Prognosis HIS clients Parkview Hospital (TX), Stonewall Memorial Hospital (TX), and Throckmorton County Memorial Hospital (TX) qualify for MU incentive funds using the ChartAcess EHR.
• Monongahela Valley Hospital signs a multi-year agreement to use Thomson Reuters Micromedex solutions for evidence-based clinical reference information.
• EHR Scope reports that its free online service EMRConsultant.com has made over 5,000 referrals so far in 2011.
• NYU Langone Medical Center establishes the Joan H. Tisch Center for Women’s Health, which will incorporate Epic’s EMR technology and palm scanning identification from PatientSecure.
• Allscripts is named a finalist for the Chicago Innovation awards.

Contacts

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

Monday Morning Update 9/19/11

From LongTimePharmacist: “Re: CPOE. A clever video done to YMCA. We all need some CPOE laughs now and then.” I like it. I always look for tiny glimpses of hospital reality: the nurse with charge stickers all over her top, the well-used Tabasco bottle on the table in the doctors’ lounge, and the drug shortage list taped to the pharmacy wall. The “everybody in the pool” finale is subtle and appropriate. They did a nice job.

From Cassie: “Re: hospital performance. The hospitals that have spent millions on EMRs and CPOE and have meaningfully mediocre outcomes to show for it.” A New York Times article contrasts hospitals on Joint Commission’s annual quality report (those who were 95% compliant with specific treatment standards) to reputation-based lists. Not even one of the hospitals listed on the US News & World Report Best Hospitals Honor Roll made the Joint Commission’s list, meaning tiny, no-name community hospitals and podunk VA hospitals beat Johns Hopkins, Cleveland Clinic, Mass General, and every hospital in New York City. That latter omission raised the ire of the president of the Greater New York Hospital Association, who said healthcare is complicated and any one list can’t be definitive. Which is correct, but it still illustrates the obvious: big academic medical centers excel in some areas (eye-popping architecture, richly compensated superior diagnostic and surgical talent, and excellent teaching and research capabilities) and lag in others (patient satisfaction, getting meds administered on time and rooms cleaned on schedule, and delivering solid outcomes cost effectively). I’ve worked in both small community hospitals and large academic medical centers and have concluded that for the latter, it’s tough to scare employees into rule-following when mediocre professors get jobs for life under the tenure system, service employees are paid market-excessive salaries to assuage organizational social guilt, and almost nobody gets fired or laid off even when they deserve it.

From Burnt Umber: “Re: new Epic hospitals. [Hospital A] and [Hospital B] are going with Epic.” I contacted the CIOs at the unrelated hospitals, who responded quickly and cordially that they are close to making a decision. They asked that I not run anything just yet since their final negotiations might be messed up as a result (as one of the CIOs said, “I am a dedicated reader and I know the impact that this could have.”) Both offered to talk to me afterward about who they chose and why, which will be a far more compelling read than me just quickly blurting out their rumored choice. I’ll have more in a few weeks.

From The PACS Designer: “Re: innovative IT solutions. TPD salutes Texas Health Resources for being recognized by InformationWeek for developing an innovative IT solution by integrating an automated risk-assessment tool with its electronic records system to cut down on blood clots, which are a leading cause of hospital deaths. Other healthcare IT solutions from Christiana Care Health System, Lehigh Valley Health Networks, and Kaiser Permanente were also recognized for using IT to innovate healthcare processes.“

My Time Capsule editorial from 2006 for this week: Few Threats to Healthcare IT’s Big Three. I named the Big Three inpatient vendors that were leaving competitors in the dust, which just wasn’t said in polite company back then.  A sample: “I don’t see anyone catching up to these Big Three, with the possible exception of dark horse McKesson. GE Healthcare, Siemens, Eclipsys, Misys, and others may get an occasional full-system sale, but they’re mostly fighting over crumbs.”

Vince’s HIStory this week covers Intermountain Healthcare (IHC), Part I of a two-parter. E-mail Vince if you can help him out with fun facts about upcoming historical HIT footnotes AR Mediquest and JS Data.

Most respondents don’t expect HHS to verify Meaningful Use attestation claims all that closely. New poll to your right: who will benefit most from WellPoint’s use of IBM Watson technology?

Dr. Travis covers the use of mHealth by pharmacies and health systems on HIStalk Mobile. 

An article in The Verona Press says that Epic’s user group meeting this week will draw 6,500 guests, with a total attendance of 11,500 counting the company’s 5,000+ employees. It must be like having Woodstock in your tiny farm town. Pictures and reports are welcome. The rain and mid-60s high should give way to sunnier and slightly warmer weather for the conference.

Ten transcriptionists at a Washington hospital, unhappy that their jobs have been outsourced to Webmedx on short notice, want the option to take severance with benefits instead of accepting what they say is a pay cut to to work for Webmedx. The hospital says its contract with Webmedx (the transcription company that was bought in July by Nuance and announced here in June) will save it up to $2 million over five years. The other gripes of the transcriptionists: the jobs they were offered involve sitting in front of a monitor at home waiting for assignments to pop up on the screen when the cheaper offshore transcriptionists aren’t available; they don’t all have broadband connections; some of the work involves editing the output of speech recognition systems instead of transcription (which pays less); and they will be required to transcribe for other hospitals whose doctors and accents are unfamiliar to them. Being squeezed by cheap offshore labor on one side and sophisticated speech recognition systems on the other is not exactly a position of power. That’s a national problem, of course – compared to the old labor-intensive and technology-unaffected factory jobs of yesteryear, we just don’t need as many employees as we have people who need a job.

Last week was the HIMSS Policy Summit, where HIMSS coaches its members to pester Congress to keep spending taxpayer dollars on healthcare technology (aka “advocacy”). Part of their pitch, predictably, was to not derail the HITECH gravy train. Members were also the Charlie McCarthy to the HIMSS Edgar Bergen in asking Congress to support a national patient identifier. You might think that Congress would have more important matters to deal with (a country rapidly circling the drain), as should providers (high costs and lackluster results that are helping cause the aforementioned drain-circling).

UAB Health System (AL) names Jorge Alsip MD as its first CMIO. He was a consultant with Cerner.

Hardly shocking: big organizations that profit from the sale of cancer drugs urge the Joint Committee on Deficit Reduction to reject a Medicare change recommended by the Congressional Budget Office that would save $3 billion (or from their dollar-sign viewpoint, would be a “$3 billion cut to cancer care” that would result in “weakening the nation’s cancer system.”) Like they always say about healthcare – one person’s excessive costs is another person’s livelihood, with every suggestion for eliminating excessive costs triggering cries of wounded anguish from the livelihood side of the same equation.

A British hospital moves a patient’s medical history to another hospital using Patients Know Best, a patient controlled health records system in which the patient uses a Facebook Friend-like function to add new doctors to the clinical team.

Piedmont Healthcare (GA) will spend $180 million on new IT systems that I assume includes Epic, reported here as an unconfirmed rumor in July but bolstered by the presence of a bunch of Piedmont job listings for inpatient Epic people. They’ve been an Eclipsys/Allscripts client for quite some time.

Nine Rite Aid drugstores in Michigan roll out OptumHealth’s NowClinic, which allows people to conduct a 10-minute IM or webcam-based chat with a doctor 24 hours a day for $45, the outcome of which can be a prescription filled by Rite Aid. 

A North Dakota clinic opts out of a Blue Cross Blue Shield medical home program called MedQHome, saying it violates the HIPAA rights of patients by sharing their information with MDdatacor, a third-party consultant, without their permission. BCBS North Dakota insists that patient permission is not required.

University of Michigan Medical School will start a Computational Medicine and Bioinformatics Department.

E-mail Mr. H.

News 9/16/11

Top News

HIMSS announces its acquisition of for-profit so2say communications, a German healthcare IT news distribution company whose European publications include HealthTech Wire and the recently acquired British Journal of Healthcare Computing.

Reader Comments

From No Surprise: “Re: Presbyterian, NM. Epic is in, McKesson loses another account. E-mail went out to employees Wednesday. Also, Lee Marley started as CIO in August, coming from Stanford.” Posted here as a rumor on August 15, but a solid one since I noticed that Presbyterian had Epic inpatient jobs posted on its site. Lee Marley’s LinkedIn profile verifies that she became SVP/CIO at Presbyterian in August after a couple of years as associate CIO at Stanford.  

From Redial: “Re: [company name omitted]. Another shakeup: just days ago, [name omitted] has suddenly left as VP of business development following the sudden departure of [name omitted] in August. Senior VP [name omitted] has been moved to the side following the discovery of his romantic relationship with a subordinate. There have been other significant departments of key management personnel over the past 12 months. Something is definitely wrong at the top.” Interesting, although I’m sure the company won’t confirm most of that except by catapulting litigious lawyers in my direction if I name names. At least I can feel smug knowing who it is.

From Ask Sam: “Re: HIPAA. Obviously they don’t know how to spell it.” They clearly need a new headline writer considering that healthcare is also spelled incorrectly (the article itself spells both words right, so there’s little excuse).

From WhoBuyz: “Re: acquisition. Who could this be? The $300-500 million range sounds very large to go unnoticed.” Sources say huge India-based software and consulting firm Infosys is in discussions about buying a US “public services and healthcare space” firm for $450-500 million, with the unnamed company booking annual revenue of $300-500 million. Infosys has extensive healthcare offerings that include payor analytics, disease management, supply chain, wellness management, Meaningful Use optimization, data warehousing, and infrastructure services. UPDATE: according to several sources, the acquisition will be the healthcare business of Thomson Reuters,  at a price of up to $750 million.

HIStalk Announcements and Requests

Recent tidbits from HIStalk Practice: the 2008 HISsie cartoon revisited. Telehealth saves money  in the treatment of chronically ill patients. US doctors earn more than physicians abroad. Dr. Gregg claims he is a Luddite and embraces his “onesy” status. Jonathan Bush rants about Meaningful Use attestation and his wish for his competitors’ “ethically-based suicide.” Doctors are down on AMA. World peace, a balanced budget, or better knowledge of the ambulatory HIT world are possible if you take 10 seconds to subscribe to HIStalk Practice’s e-mail updates.

Listening: brand new from Wild Flag, all-female low-fi rockers from Portland, OR.

Latest pet peeves: simplistic does not mean the same thing as simple (the former means recklessly oversimplifying complex concepts), nor does opportunistic mean taking advantage of opportunities (it means taking quick action that may be ethically questionable). Vendor CEOs misused both words recently in the national press, which would have cast a negative light on their companies except for the fact that their gaffe sailed right over the heads of the majority of people who didn’t know the difference.

Jobs on Healthcare IT Jobs: Expert MUMPS Developer, Epic MyChart Builder/Analyst, Senior Systems Analyst – Interfacing, Implementation and Account Manager.

Acquisitions, Funding, Business, and Stock

Medical billing and RIS software provider Zotec Partners merges with Medical Business Service, a provider of billing services for hospital-based practices.

Allscripts CEO Glen Tullman, commenting on a share price that is virtually unchanged from a year ago, says integration concerns with the former Eclipsys put MDRX in “the penalty box,” but growth is coming since the acquisition positioned the company well for the changes spurred by healthcare reform.

Shares in Merge Healthcare hit a 52-week high on Wednesday. Above is the one-year share price of MRGE (blue), the S&P 500 (green), and the Nasdaq (red). A year-ago investment would have earned a 151% profit ($2.77 vs. $6.95) if you sold Thursday.

People

HIT services firm Gestalt Health appoints Charles Fazio, MD as CMIO. He was previously CMIO of Medica Health Plans.

Availity names Kelly Heape Parsons CFO, SVP, and corporate secretary to replace retiring Margaret Gomez.

Billing service provider AdvantEdge Healthcare Solutions hires John A. Roberts (InfoLogix) as chief financial and administrative officer and Michael Youmans (Concerro, McKesson) as SVP of sales and marketing.

Announcements and Implementations

Medsphere announces general availability of its latest version of OpenVista EHR, which includes an option for users to customize their views, dashboards, and workflows.

In Maine, Time Warner Cable launches Healthcare Solutions to connect providers and support home health monitoring by offering VPN service, managed security, and web conferencing.

The AMIA 2011 Annual Symposium will be held October 22-26 at the Washington Hilton in Washington, DC. Keynotes include the director of NIH and Farzad Mostashari from ONC. AMIA is a lot more science-oriented than the HIMSS boat show – I looked through the list of sessions and didn’t see any duds, provided you’re of the informatics persuasion, anyway. Full registration is $835 for non-members if you sign up by October 6. Reports from there are welcome.

McKesson integrates its iKnowMed oncology EHR with its Lynx Mobile drug inventory management system, allowing meds to be prepared in advance of the patient’s visit.

Patient check-in company Phreesia announces an electronic Medicare Annual Wellness Visit Form that it claims saves providers 15 minutes per patient in complying with the new Medicare Part B entitlement.

West Texas RHIO wins an Outstanding Program Award from the Texas Rural Health Association. The four founding hospitals, all of them competitors, use the remotely hosted ChartAccess Comprehensive EHR from Prognosis Health Information Systems.

Dell Services Healthcare and Life Sciences wins a Project Management Office of the Year award for its 96% project success rate.

Smiths Medical announces its PharmGuard Anesthesia Software Service, which providers hospitals with a customized anesthesia drug library for their Medfusion 3500 syringe pumps.

Anthelio launches a 24×7 physician-staffed help desk to support hospital clinical systems rollouts. Other types of clinicians are also available to callers.

A CliniComp press release says that on September 11, 2001, its Essentris EMR used by Bellevue Hospital was the only inpatient one that kept running through the events of that day. I’m not sure: (a) if they’re talking about Bellevue only or all hospitals in Manhattan or New York; (b) how they know that; and (c) if using September 11 as a product pitch is in good taste. If you can get past those issues, the press release is a good read.

Athenahealth’s co-founders are mentioned as backers of startup Healthpoint Services, which offers “e-doctor clinics” in rural India. Athena COO Ed Park is a director. Villagers can get a telehealth consult in the office for 80 cents and diagnostic tests for $1, which the company says is affordable to the patients and break-even for it. Vital signs are taken in the office and sent to the physician and to the EMR. The company also offers a water service that gives families the ability to fill their jugs with clean water for $1.50 per month.

Other

Hospital employees and their family members incur healthcare costs that are 13% higher than that of the general population; are 22% more likely to visit the ER; and are more often  diagnosed with chronic medical conditions. Any theories why?

Cook Children’s Medical Center (TX) opens a 106-bed, $51 million NICU with all private rooms, the largest in the country. They cite research showing that babies do better when light and temperature can be individually controlled and when family members don’t have to leave.

SAP will release a tablet-based EMR front end app by the end of October, according to this article.

Sponsor Updates

• Software Testing Solutions shared its booth with an animal rescue organization at the Sunquest Users Group meeting this summer, giving attendees a chance to pet three rescued puppies. All were adopted during the conference and STS matched attendee donations made to the rescue organization. This is the second year STS has promoted the organization in its booth, raising over $4,000 and placing 10 dogs in homes.
• The Axolotl-powered Idaho Health Data Exchange adds St. Joseph Regional Medical Center and Pathologists’ Regional Laboratory to its network.
• Practice Management Associates (VA) selects the ADP AdvancedMD PM for RCM services.
• Citrus Valley Health Partners (CA) and MidMichigan Health (MI) select Allscripts Community Record, powered by dbMotion, and will underwrite and host Allscripts EHR for their affiliated physicians.
• OptumInsight names Ray Ambay, MD (Tampa Institute for Plastic Surgery), James A. Haley, MD (Veterans Hospital, Tampa), David Rossman, MD (Mass General Imaging), and Susan Strate, MD (clinical and anatomic pathologist) to its physician advisory board.
• DIVURGENT is participating in next week’s Epic UGM 2011 and is sponsoring a presentation by Bert Reese, CIO of Sentara Healthcare.
• e-MDs and Delmarva Foundation of the District of Columbia offer free assistance to DC-area e-MDs users wanting to take advantage of PQRS incentives.
• Allscripts, HP, Keane, and NCR are recognized by the InformationWeek 500 2011 list of top technology innovators.
• Kony Solutions shares findings from its Mobile Marketing and Commerce Study, including the observation that 40% of organizations believe the biggest challenge to their mobile strategy is developing applications across multiple operating systems and devices.
• Jersey Health Connect selects RelayHealth to provide HIE technology.
• Imprivata and PhoneFactor announce a partnership to provide phone-based authentication services to caregivers.
• GetWellNetwork’s Team in Training completed in the Nation’s Triathlon to Benefit the Leukemia & Lymphoma Society and raised $36,000.
• CareTech Solutions is promoting its CareWorks CMS Plug-In modules at this week’s SHSMD in Phoenix.
• MyHealthDIRECT CEO Jay Mason will speak at the Health IT Summit in New York September 20-21.
• CynergisTek CEO Mac McMillan expresses criticism of the Federal Health IT Strategic Plan for 2011-2015 in an information security article.
• MobileMD will participate in next week’s joint New Jersey and Delaware HIMSS Conference and Interoperability Demonstration in Atlantic City.

EPtalk by Dr. Jayne

I always enjoy hearing what readers have to say. I was double delighted to find that Daniela Mahoney’s piece on CPOE also included a recipe for profiteroles with coffee ice cream. Sounds like a good project for a quiet fall night (if fall ever arrives). She mentioned upcoming thoughts on adoption and organizational culture – I hope there are recipes included.

The Healthcare Billing and Management Association began its Fall Annual Conference yesterday. Due to horribly slashed budgets in clinical IT areas, which pretty much canceled my ability to attend any meetings this year, I have to live vicariously through colleagues and friends. In the first of these reports from the field, Bianca Biller reports:

HBMA Fall Conference in Vegas, baby. Held at the Bellagio, but actually the overflow accommodations are quite fine. Staying at your fave haunt Vdara Hotel & Spa, right in the midst of CItyCenter. Over 50 new members/attendees to the Fall Conference. Played Vendor Bingo for a chance at $1,425 jackpot tomorrow evening. Best giveaway was from Gateway EDI — decks of cards and gaming instructions. Quite creative for the Vegas venue.

Started the meeting with “Hot Topics in Compliance,” but only billing geeks/nerds would be excited about this session. Good reality check reviewing HIPAA + HITECH, 5010, ICD-10, 2012 Proposed Physician Fee Schedule cuts – all specialties. And let’s not forget the proposed SGR of 29.5% cuts for 2012 along with Medicare revalidation! Is anyone thinking about our patients in all of this? It’s a great day to be in the billing business!

P. S. Only 72 days until 5010!

Despite her feelings on compliance, I’m glad Bianca is my billing geek because she definitely gets the job done. And somehow, she succeeded in NOT getting her conference budget slashed. Maybe I need her to teach me the wicked ways.

MGMA reports that 70% of practices are looking into becoming Patient Centered Medical Homes and more than 20% are already accredited by a national organization. The top five challenges:

• Care coordination agreements with referral physicians
• Financing the transition
• Care coordination for high-risk patients
• Modifying or adopting an EHR to support PCMH
• Projecting financial impact of transition to PCMH

Clinical note of the week: several studies, one of which was published in May’s Journal of Strength Conditioning Research, show that low-fat chocolate milk helps athletes recover from training, especially if you add an Oreo cookie (a favorite of billing software developers, from what I understand.) That’s data I can work with.

MSN has recommendations that should be required reading for many an e-mail user. I’ve seen some e-mail signatures lately that are doozies. For most tech industry players (Voalte excepted), hot pink isn’t a strong corporate branding strategy. Political quotes are definitely a no-no, as are annoying or flashing fonts. The next-to-last paragraph had me laughing:

At public relations group Outside media, Sammi Johnson says she and her colleagues put quotes from fictitious “Saturday Night Live” inspirational writer Jack Handy in their quotes. One employee’s signature is, “Contrary to what most people say the most dangerous animal in the world is not the lion or the tiger or even elephant. It’s a shark riding on an elephant’s back, just trampling and eating everything they see.”

At this point, I’m going to take my Oreo cookies and my glass of milk (alas, not chocolate) and run.

Jayne

“To me, clowns aren’t funny. In fact, they’re kind of scary. I’ve wondered where this started and I think it goes back to the time I went to the circus, and a clown killed my dad.”

Contacts

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

News 9/13/11

Top News

President Obama declares this week to be National Health Information Technology Week.

Reader Comments

From MT Hammer: “Re: All Type acquisition. As you reported earlier, MedQuist makes it official.” Sort of, anyway – the financial advisor  to All Type Medical Transcription Services issues a press release about its role in the transaction. Reported here on August 25 by Hammer, who didn’t hurt ‘em.

From Proud athenista: “Re: athenahealth’s MU dashboards. The other day I was surprised to learn my very own company was going public with our MU transparency and just read the great interview with Jonathan Bush. Whodda thunk it would ever happen? I suggest that all vendors share their numbers.” PA is referring to last week’s HIStalk Practice  interview with athenahealth CEO Jonathan Bush, who discussed the company’s decision to publish the performance of its athenaclinical clients against Meaningful Use metrics. We are happy to share similar information from other vendors, though I can only think of a couple of others that are offering those details.

From Funky Bunch: “Re: Medicare attestation numbers. Here is some information from CMS that you may have seen.” CMS says $149 million has been paid as of July 31, but it doesn’t give a provider count or breakout of hospitals vs. eligible professionals. Medicaid incentive payments total $248 million and registrants for both programs total 77,549. Hospitals would get pretty big checks for their Medicare attestation, so that number might represent a fairly low number of EPs. On a related page, CMS answers the question of whether audits will be performed: maybe, so keep your documentation for at least six years, it says, else the payment “will be recouped.”

From Just Askin’: “Re: Innovator Showcase. Is that paid promotion?” I’m kind of insulted that you would ask that, but no. Interested companies applied and my volunteer review team (investment guys and a hospital person) choose a handful from the several dozen that they felt were truly innovative based on some rather probing application questions. One of those companies happened to be a current HIStalk sponsor by coincidence and all of them earned their spot strictly on merit.

From Farmer Joe: “Re: Meaningful Use incentives. You seem to make a lot of implied negative statements about spending taxpayer dollars on these. Farm belt clinics are faced with closing due to low patient volume and MDs looking to retire, but with no residents who want to join them due to low pay and practices still on paper. These rural communities provide 80% of the food in this country. Every American who eats anything they don’t grow or hunt themselves should be glad to pay money to keep these practices in business to keep young farmers from quitting and moving to cities.” Sounds like a bit of a stretch that farmers will stop farming if the rest of us don’t buy EMRs for their doctors. If we have to subsidize money-losing medical practices, then I’d rather do it directly instead of paying them to adopt a particular technology that isn’t guaranteed to improve either their medical capabilities or their profitability. And I’m nearly always going to be against new government spending like HITECH, stimulus, TARP, artificial jobs creation, or whatever other cause du jour has aroused our debt-happy and votes-desperate Congress. As someone once said, “The American Republic will endure until the day Congress discovers that it can bribe the public with the public’s money.”

Acquisitions, Funding, Business, and Stock

Streamline Health reports Q2 results: a net loss of $7,000 vs. a loss of $76,000 last year; revenue $4.1 million vs. $4.7 million.

Telehealth provider Teladoc secures $18.6 million in funding
.

EDI provider MD On-Line acquires healthcare communications company Strategic EDGE Communications.

Sales

Via Christi Health (KS) purchases QuadraMed’s Identity Management solutions.

Newberry County Memorial Hospital (SC) selects Summit Healthcare to provide interface engine technology for its Meditech system.

Wilmington Health (NC) chooses Humedica MinedShare as its clinical data warehouse.

People

HHS Secretary Kathleen Sebelius announces the appointment of Leon Rodriguez as director of the Office for Civil Rights, replacing Georgina Verdugo. He was chief of staff and deputy assistant attorney general in the Justice Department’s Civil Rights Division. He was nominated by the President last December to be Administrator of the Department of Labor’s Wage and Hour Division, but that nomination was withdrawn last week.

vRad names Sandy Schmitt SVP of Strategy and Development. She was previously with Allina and VHA.

 
AT&T names its first CMIO, rheumatologist Geeta Nayyar MD, MBA. She was previously with Vangent.

MediClick promotes President Mike Merwarth (above) to CEO, taking over for Ron Kupferman, who remains chairman of the board.

Hon S. Pak, MD joins AirStrip Technologies as a senior advisor. He was previously CMIO for the Army Surgeon General and is an innovator in telemedicine, particularly teledermatology, and is a graduate of the United States Military Academy and a former combat medic.

Announcements and Implementations

HIMSS names four additional winners of its 2011 Davies Awards of Excellence: Kaiser Permanente (Organizational / Epic); Fallon Clinic (Ambulatory / Epic); James F. Holsinger, MD (Ambulatory / e-MDs); and Hudson River Healthcare (Community Health Organization / eClinicalWorks).

McKesson introduces McKesson Practice Choice, a Meaningful Use certified, Web-based integrated EHR/PM solution for small, independent primary care practices.  The company also announces McKesson Practice Care, a service line that offers patient-centered medical home consulting in conjunction with AAFP’s TransforMed and available exclusively for practices running Practice Partner, Medisoft Clinical, Lytec MD, and Practice Choice.

Zynx Health will hire 40 new employees, including those with technical and sales experience.

Anvita Health is awarded a patent for a decision support system that can apply a variable medication patient co-pay, which it calls “dynamic, context-specific pricing.” Its intended use is to encourage optimal prescribing by charging the patient extra if he or she insists on getting prescriptions for drugs known to lack efficacy or safety. Co-pays can be reduced if a patient accepts a less-expensive cancer drug that matches responsiveness markers, or if patients are compliant with their prescribed meds.

A group of University of Alabama in Huntsville professors launches Decision Innovations, whose first product is a nurse staffing dashboard started as a 2008 pilot project with Catholic Health Initiatives. The company won the $100,000 Alabama Launchpad 2011 Business Plan competition and is setting up shop now.

Health benefits provider WellPoint signs a deal to develop commercial healthcare applications using IBM Watson technology. Few specifics were given, but the press release suggests that the applications could help physicians choose treatment options and direct patients to providers who have the best track record in treating their condition. WellPoint says it will start pilot projects early in 2012.

Government and Politics

HHS awards $8.5 million to 85 community health centers in Beacon Communities for the adoption of HIT.

HHS Secretary Kathleen Sebelius reports that 80,000 providers have applied to received Meaningful Use incentive payments and 70% of primary care physicians in rural communities have signed agreements with RECs.

A proposed HHS rule would give patients direct access to their own lab test results.

Technology

Microsoft previews Windows 8 (that’s the working name, anyway). This SlashGear hands-on review shows it running on a tablet (assuming someone other than Apple is making them by the time Win 8 hits the streets). The big question for me: how well does a design that looks like it was borrowed from the iPad work on a desktop using a keyboard and mouse? Microsoft is betting the cash cow that consumers and businesses want their desktop and laptop PCs to have a radically different user interface.  

Software that creates natural-sounding news articles from a set of facts could write medical journal articles, the company that developed it says. They claim it can compose a unique, smooth-reading article in about one minute that even experts can’t tell wasn’t written by a human.

Other

The Canadian hospital that refused to name the nurse who breached the electronic records of 5,800 patients, citing her right to privacy, changes its mind after the province’s privacy officer declares there is no such law in a newspaper’s letter to the editor. The hospital now says it will give the nurse’s name, but only to patients who state by letter that she accessed their files.

An interesting article in the Charleston, WV newspaper covers Charleston Area Medical Center’s patient transfer center, an air traffic control-like room with a huge electronic status board showing bed status in its three hospitals.

I awoke this morning realizing I had been dreaming that a network technician was working to maximize the speed of my home network. I gloated when he told me how impressed he was with the labeling of all the devices, and I was school girl giddy when he complimented me on the strength of my passwords. We then discussed the merits of various printers. I am clearly overdue for a vacation.

A former pediatric nurse at NYU Langone Medical Center says hospital employees snooped in her medical records and, from her history and diagnosis of endometriosis, assumed she was a virgin. Her co-workers then kept trying to convince the 41-year-old woman to have sex, she says, with a neurosurgeon making references to “The 40-Year-Old Virgin” movie. She’s suing the hospital for $45 million, claiming it didn’t protect her medical records.

Wake Forest Baptist Medical Center (NC) fires and sues a former administrative director for “unjustified, vindictive, malicious, and gratuitous actions.” His transgression: he alerted the state that it was overpaying his employer under the terms of its health plan. The state auditor agrees, saying sloppy state contracting and oversight allowed the hospital to overbill by $1.34 million. The hospital says it was none of the former employee’s business and its contract allows it to raise prices without notifying the state.

The Wall Street Journal highlights the industry’s transition from ICD-9 to ICD-10 and mentions several of the wackier codes. One of my personal favorites: V91.07XA (burn due to water skis on fire.) athenahealth’s CTO Jeremy Delinsky correctly notes that, “You have millions of transactions flowing in the healthcare system and this is an opportunity to mess them all up.”

  Even Weird News Andy finds this cringe-worthy news item from China “too weird for words.” A man bathing with live eels as part of a spa’s exfoliation treatment is startled when he looks down at his private area and sees a six-inch-long eel disappearing by the obvious method of ingress. The eel found its way to his bladder on its own, but removing it required a three-hour surgical procedure.

Sponsor Updates

• Sandhills Pediatrics (SC) receives $184,000 in ARRA incentives from its use of SRS.
• MEDSEEK announces the availability of ecoSmart Patient Precision predictive analytics technology.
• Practice Fusion forecasts that 5,000 of its eligible provider clients will receive $18,000 in Meaningful Use incentives in 2011.
• Two T-System employees, CMIO Robert Hitchcock, MD and Center for Performance Excellence Manager Janie Schumaker, RN, are elected to the board of the Emergency Department Practice Management Association.
• Aspen Advisors releases a case study on the Epic implementation of St. Anthony’s Medical Center’s (MO). 
• BridgeHead Software announces the successful integration of its MediStore archive technology with  three leading PACS products.
• Ben Michelson of Hayes Management Consulting discusses lessons learned from ICD-9 implementations in a guest article.
• Wolters Kluwer Health releases a ProVation MD module to support participation in the ACC National Cardiovascular Data Registry CathPCI Registry.
• Thomson Reuters introduces MarketScan Treatment Pathways to analyze medical care, outcomes, and costs.
• TeleTracking Technologies announces the availability of its RTLS to the UK healthcare market.
• Cumberland Consulting Group provides a checklist of 10 things hospitals should consider as they undergo EHR implementation.
• MidMichigan Health uses Concerro’s ShiftSelect in its retiree return-to-work program.
• The AHA Center for Healthcare Governance selects CareTech Solutions and its customer San Luis Valley Regional Medical Center as presenters for its Fall Symposium.
• The Massachusetts Department of Public Health replaces its e-Forms system with Access’s electronic forms on demand solution.
• AT&T contributes $100,000 to support a mobile health initiative to use smartphones in diabetes education.
• Elsevier / CPM Resource Center will integrate its evidence-based clinical practice guidelines and documentation solution into the McKesson EMR of Medcenter One(ND).
• Iatric Systems adds the federal government’s Blue Button capability to its PtAccess patient portal, which allows patients to download their health information as a text or PDF file.

Contacts

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

HIStalk Innovator Showcase – Health Care DataWorks 9/12/11

Company name: Health Care DataWorks, Inc.
Address: 1801 Watermark Drive, Suite 250, Columbus, OH 43215
Web address: www.hcdataworks.com
Telephone: 614.255.5400
Year founded: 2008
FTEs: 20

Elevator pitch

HCD provides business intelligence solutions that enable healthcare organizations to improve quality and reduce costs.

Business and product summary

Our products are innovative in that they are an accelerator for organizations that recognize the need to leverage their siloed data to improve their performance, but don’t want to spend years building an enterprise data warehouse (EDW) from scratch. Health Care DataWorks (HCD) brings a pre-built, packaged EDW that is immediately ready to feed data. Our clients are able to see value within months rather than years.

HCD’s EDW Appliance bundles robust hardware, AIX operating system, Oracle 11g database, HCD’s own comprehensive enterprise data model, plus hundreds of pre-built standard reports and a dozen pre-built dashboards with hundreds of key performance indicators with drill-down capability covering quality, Meaningful Use readiness, revenue cycle, operating room, nursing scorecard, to name just a few. 

Our company is innovative in that it was founded and is managed by people that grew up in hospitals and health systems, as opposed to within a vendor organization. Our CEO has been a healthcare CIO for most of the past 20 years at various-sized organizations. Our COO led business intelligence development efforts at a major academic medical center for over eight years. As such, HCD has “walked a mile” in the shoes of its clients and has a unique, first-person understanding of the problems that healthcare executives are trying to solve with integrated data.

Finally, HCD is innovative because — unlike the Goliaths in the industry that it typically competes with, such as Oracle, IBM, and SAP, which have many product lines and foci — HCD has a laser focus on delivering innovative, value-added business intelligence solutions to hospitals and health systems, and as such, can be much more nimble and responsive to its customers.

Strategic Roadmap — for organizations very early in thinking about how they will use BI / analytics / EDW. This process will ensure you have buy-in for whatever decisions you make in this area and takes approximately five months.

Dashboard Appliance — for organizations that want to do a proof of concept for an EDW or to meet a specific need that requires a dashboard solution. Low price allows starting on the path towards an EDW without losing any of work done in populating the dashboards.

EDW Appliance — for organizations that are ready to build an Enterprise Data Warehouse and want tools and technology to accelerate that process.  

Target customer

Large and mid-market hospitals and hospital systems.

HCD’s products allow the users to pull data from multiple source systems making the data accessible in one location. The ability to run reports and drill down using friendly dashboard interfaces gives decision makers the information required to make knowledge-based action plans.

Competitors

Microsoft, Oracle, and IBM are a few of the better-known competitors in the industry.

Advantages over competitors

As a spin-off from the Ohio State University Medical Center, the founders of Health Care DataWorks have developed and worked the product from the ground up.

List five fast facts about the company or product.

1. Ohio State University Medical Center spin-off.
2. All five founders have worked or still work with the EDW at OSU.
3. Won TechGenesis Grant of $50,000 after to a market analysis that determined a large unmet need for the product.
4. Named Gartner “Cool Vendor” 2011.
5. The EDW Appliance was one of the first data warehouse solutions to achieve Stage 1 Meaningful Use certification.

Pitch video created specifically for this Showcase

What problems have you solved using HCD’s product and what has been the overall impact on your organization?

We are in the very early stages of implementation, having just signed a contract. Our vision project vision statement is:

To support our mission and vision, we will implement a set of business intelligence tools and a data warehouse, starting in 2011, that will transform integrated clinical, financial, and operational data from the disparate systems throughout the organization to information that is aligned and driven from the strategy and will support real-time decision-making to enhance clinical care, support research, and facilitate economic and financial forecasting

The impact to the organization has not been profound as of yet, but we are looking for some innovative solutions which will empower our decision-makers with data to make good business and clinical decisions. Having the data at their fingertips vs. having to contact IS for the data or to run a report; providing dashboard capabilities related to their KPIs and quality indicators; looking at predictive analytics to utilize the value of the data as we look at risk-based contracts, etc.

If you were talking to a peer from another organization, how would you describe your experience with HCD?

The experience has been very positive. HCD has been very responsive and knowledgeable about healthcare data warehouse and business intelligence. They have also been very flexible in terms of contracting and even providing a proof of concept phase of the project / contract. It has been a much different experience working with a smaller, more nimble company than some of the bigger players who may dictate how the process will work.

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

HCD is a startup company, and as such, you will be taking on more risk than a mature vendor, but the risk may well be worth the reward given their current products, future offerings, and expansive healthcare knowledge.

An interview with Herb Smaltz, CEO of Health Care DataWorks

A lot of big companies sell dashboards and data warehouses. Why would customers choose to buy from a small, healthcare-only vendor?

We are laser focused on healthcare. Competitors obviously have lots of different product lines, lots of different vertical markets.

The other thing that resonates with our customers is that we all came from the health system. I’ve been CIO pretty much my whole career, dating back to even before you could call it a CIO job. I’ve been doing this for a long time, sitting in that chair trying to solve these kind of problems. Our COO, Jason Buskirk has been working in the BI department building BI apps and solving those problems from a development standpoint inside the health system for eight years. All of us on the senior team that spun this technology out of Ohio State have been doing this for a long time.

We’re a young company. We’re three years old now, but we’ve been harboring this technology over 13-14 years now in a major academic medical center with built-in health system. Again, trying to solve these kinds of problems of data integration and really making sense of really heterogeneous, really potentially dirty data to solve business problems. 

I think those things resonate with our customers. That we walked a mile in their shoes and were one of them, if you will. Even though we are clearly a vendor company, well grew up in health systems and the technology has really been hardened in that kind of an environment.

We went through those years of at OSU where we were stubbing our toes on the best way to build a data model; the best way to build performance; the best way to build query capabilities. For most startups, they’re stubbing their toes with their customers as they build their product.

I think all those things make it a little more comfortable for folks to go with Health Care DataWorks.

You offer your product as an appliance in one configuration. Realistically, what kind of time, effort, and skill set would a client need to connect everything and go live?

That’s one of the things that we offer as a value proposition. We’re really an accelerator for organizations that are right at that precipice of trying to figure out how to get all their data to work together.

If you talk to people like Gartner and others, for the folks who try to build it themselves, it’s a good three-year prospect to build it from scratch. We’ve packaged everything: the hardware, operating system, Oracle 11g database licenses, our own very comprehensive data model, and tons of content. Lots of pre-built dashboards with scorecards and hundreds of reports. 

Essentially, we can just drop that in to an organization’s data center or just use our hosted data center, whichever they prefer. Instead of sitting around a table having discussions about how these tables should be built and what these data elements ought to be called and how the table joins ought to work, they’re immediately just working on populating this packaged data warehouse appliance that we bring to them. Within four to six months, they’re typically using one of the dashboards. They’re using a bunch of standard reports in whatever area they’re focused on.

But one caveat. Source data that comes from those various EMR systems, ERP systems, scheduling systems — you name it, there’s tons of systems in a hospital and health system — they’re notoriously dirty. When you bring that heterogeneous data into an appliance, what it exposes is some of that dirty data. 

One of the things that can cause delays is data governance. Seeing that the data is not good, having to go back to the source systems and the owners of those source systems — whether that be the chief medical officer or nursing or wherever the data was pulled from — and work with them on how to best move forward. Do you want to expose the data as it is, with some asterisks and caveats? Such as, “There are number of blank fields, but from this day forward, we’ve asked our registration folks to fill those fields in.”

That whole data quality, data governance within each hospital is a new core capability that they really need to develop. The ability to take their data from their various systems and help to make that cleaner and cleaner and cleaner over time.

But typically, it’s four to six months from the time that we sign a contract to the time that they can get use of a set of reports or a dashboard or a scorecard.

It’s been a year since you signed Orlando Health. What results have they seen?

Orlando Health is one of those organizations that this issue of data quality and data governance has come up. Very quickly, we were able to get their quality dashboard in place. One of the things they wanted to do to before they exposed it to their users was to clean up all their data.

I’m a fan of, you know, “data gets better with use.” Now to be sure, at a physician level or a patient level, you want to make sure that data is right. There’s that tradeoff. Orlando Health has really focused a lot on their data quality. They’ve been busy for a number of months working on data quality, getting the data quality up to speed. But their dashboard was ready and loaded with data within months of getting the appliance in place. 

With another customer, Essentia Health, we did a proof of concept with them. Just three months later, they got a Top of the Hospital dashboard up. They put in place a data governance group, which has been meeting and working on those sorts of things. 

It’s one of those things where the technology really isn’t the thing that holds people back. It’s the ability to make decisions about the data that it exposes and how they want to deal with that and handle it. In some cases their source system data is very clean and they can very quickly move on and deploy that to users. In Essentia’s case, that’s what happened.

In Orlando Health’s case, they had a number of fields that were blank in their source systems. For example, a referring physician is one of those that was blank. They had 160,000 instances of a blank referring physician. If you want to do analysis on where your patients are coming from, it’s important to fill that in. They had to go back to their registration department and essentially say, “We really need this field filled in.”

Anybody you talk to in the marketplace will tell you there’s no silver bullet technology that can overcome poor source system data quality issues. With all of our customers, we absolutely offer that acceleratory capability, to immediately let them start using the data. The question really becomes is whether the data coming from their source systems is of a high enough quality that they want to expose that to end users to make business decisions on. We very much work with them on that data governance process in making decisions around that and helping them to the point they’re exposing that data to make business decisions.

What do you hope to gain from the exposure?

As you mentioned, we are a small company. We don’t want to take anything for granted. We want folks to get an understanding of the company, the fact we’re laser focused on healthcare providers in particular. We very much appreciate it. Any small company can benefit from people knowing about you. We hope to be included in more RFPs, and we’re getting more and more. We just closed Presbyterian Health System  in Albuquerque, New Mexico and Children’s Medical Center Dallas. Because we’re competing against folks like Oracle, IBM, and Microsoft and the exposure really does help.

Monday Morning Update 9/12/11

From Jimmy Doogan: “Re: McKesson InSight conference September 20-23. Will HIStalk be covering? The tone will be interesting, as I would say the MPT part of the company hunkers down to milk their existing customers.” I wish I had the time to attend conferences, but it’s hard getting time off from the hospital. I’d be keenly interested in reports from everybody’s favorite convention city (Pittsburgh) if someone wants to volunteer be the official HIStalk mole. A key MCK metric will be the number of attendees, since those Horizon sites already announced as moving to Epic or other systems probably won’t bother sending folks to InSight. They will get some offset, though, from the increasing number of users of Paragon and other systems. Key questions I’d like to see answered: (a) how viable is Horizon Clinicals as go-forward strategy for both MCK and its customers; (b) how is the company positioning itself to compete against competitors (notably Epic and Allscripts) that have tied the inpatient and ambulatory sides of the house together; (c) what is the status of Horizon Enterprise Revenue Management as reported by real-life users; and (d) given that most of the MCK products are still mid-performing silos of legacy acquisitions, are they willing to invest in actually building products appropriate for the reality of healthcare reform, or will they just run a prevent defense in trying to keep the maintenance and services revenue stream going as long as possible (or sell the whole MPT package off, if you believe the occasional rumors.)

From Ingram Connor: “Re: The Advisory Board Company. Dave Garets is quietly putting together a dream team of industry heavyweights. Mike Davis, Jim Adams, Jim Klein, Ernie Hood, Peter Kilbridge, Ken Kleinberg, Doug Thompson, and Daphne Lawrence.” I also heard (and I think it’s OK for me to say) that Dale Sanders, CIO of Cayman Islands Health Services Authority, will be joining ABCO this week, although continuing as a senior advisor to the Caymans.  

From Sir Lord Baltimore: “Re: low check number on EHR incentive payment. Incentives are paid the same way an eligible professional receives his or her Medicare or Medicaid reimbursement. Many receive payments electronically, so they also receive the incentive payment electronically.” Makes perfect sense – thanks. I’d still think that as much as ONC and HHS congratulate themselves publicly on how well they’re spending taxpayer dollars that they’d provide specific HITECH payment numbers if those numbers are in fact impressive.

From The PACS Designer: “Re: eMix for image sharing. TPD is all for promoting the sharing of patient image files, and now eMix is available to enhance patient image file sharing. The service is road map to  a Meaningful Use application, provided courtesy of DR Systems.”

From Snidely: “Re: Lucile Packard Children’s Hospital. I’ve heard they’re being forced to adopt Epic since Stanford uses it and Epic is ‘interoperable’ only if everybody else is on Epic. This is the Epic Octopus, where once they get into a system, everybody has to switch to it if they want to talk to each other. That makes Epic much more expensive than the initial quote if you want your systems to communicate.” Unverified. If true, I assume that means Cerner, installed just four years ago and the subject of several Packard articles touting its patient safety features, gets the boot.

Most hospital respondents say their boards make at least a token effort to seem analytical before approving IT projects put before them. New poll to your right, with the idea triggered by Inga’s interview of Jonathan Bush: how comprehensively will HHS audit providers who get HITECH checks by the honor system of attestation?

I don’t know what you were doing back in the innocent summer days of July 2006, but I was writing this week’s Time Capsule editorial, CCHIT’s First Certification List is Unsatisfying, where I said, “I think the federal government will encourage the use of certified EMR products by sweetening reimbursement or making it a requirement for government-related purchases.”

HHS Secretary Kathleen Sebelius will kick off the Consumer Health IT Summit Monday afternoon (September 12) at 1:00 Eastern (the announcement says EST – doesn’t it bug you when people incorrectly say EST instead of EDT instead of just sticking with the always-appropriate ET?) Anyway, Farzad Mostashari of ONC will also be on hand. You can watch via live webcast. Bring your own lunch.

The Kickstarter project for the GAUCHOS open source EMR for volunteer clinicians won’t likely make its $84,000 fundraising goal with only $4,700 raised and five days to go, meaning they’ll get nothing since Kickstarter is all or none. The project continues, however.

Weird News Andy breaches the surface of this subject: a billing contractor for Stanford University is blamed for posting the medical information of 20,000 of its ED patients on a website. Someone posted the Excel worksheet on a tutor-hiring site for students, asking for help with creating a bar graph from the patient information. The worksheet sat there for a year, visible to anyone. The billing company, Multi-Specialty Collection Services LLC, seems to have gone into seclusion since its Web page has apparently been taken down and the owner isn’t returning media calls.

Gerber Alley: The Final Chapter, courtesy of Vince. I’m picturing some Nancy Sinatra-style go-go boots out of frame in the attractive young lady’s picture on Slide 5 (now someone’s grandmother, I’d guess.)

US Rep. Barney Frank (D-MA) tells the Massachusetts Historical Commission to get off Meditech’s back and let it build offices in Freetown, MA, saying he was “unpleasantly surprised” by the group’s demand that Meditech conduct a year-long archaeological study before starting construction. Meditech said they’d take their 800 jobs elsewhere. A local newspaper editorializes: “From their lofty perch in points north, members of the commission — who, on the topic of dirt, sure do know how to muck up a good situation — are strikingly out of touch with the workaday world of the SouthCoast, which holds the dubious distinction of consistently ranking among the state’s highest areas for unemployment.“

It’s a mess at Parkland Memorial Hospital (TX), as the Justice Department launches an investigation and CMS announces termination of the hospital’s Medicare agreement on September 30, although Parkland can keep those privileges by accepting help from outside consultants (gee, wonder which option they’ll choose?) The hospital already announced plans last week to replace President and CEO Ron Anderson, whose held that job for almost 30 years, saying it will create a new job for him next year. To outsiders, Parkland is mostly known — at least by mature audiences — as the place where JFK and Lee Harvey Oswald died nearly 50 years ago (followed by Jack Ruby a few years later).

An employee of Methodist Hospital (TX) is charged with using patient information to take out short-term loans in their names, buying herself a $125K Maserati, a BMW convertible, and some nice Gucci clothes.

Bizarre: a UK factory electrician is nearly killed when a compressed air line goes up his shorts and into his rectum, inflating him like a balloon. “There was air fizzing around inside my back passage and stomach. It was so weird,” he observes. It was reportedly a co-worker’s prank.

E-mail Mr. H.

News 9/9/11

Top News

I reported weeks ago that Beth Israel Deaconess Medical Center was prepared to offer its CEO job to Stanford Chief Medical Officer Kevin Tabb MD, who has spent nearly all of his medical career in informatics roles on both the vendor and provider sides of the house as an IT geek. BIDMC announced Tuesday that he has accepted the position. My assessment then was that “he would be a geeky kindred spirit for CIO John Halamka,” which both FierceHealthIT and DotMedNews quoted and nicely credited to HIStalk.

Reader Comments

From Inquiring Mines: “Re: Medicare stimulus check. A local group got their federal check and its check number was less than 200, an ungodly low number to have been issued. A provider in the group was told only 6,000 providers had filed to date. Am I missing something? The Medicare spigot doesn’t seem to be flowing as expected.” IM sent a scan of the provider’s check and it does appear that, unless CMS has multiple accounts (this one is called “EHR Incentive Payment Account”) they haven’t issued many checks to date.

From Pacman: “Re: Mayo – Elkin lawsuit. A $1.9 million attorney’s fee award for Mayo against Dr. Elkin.” Unverified. This is the suit in which a Mayo doctor (Elkin) sued Mayo over software he developed while employed by them, but then took the source code with him when he left. The jury found in favor of Mayo in April, but also ruled that the doctor is due royalties under Mayo’s royalty sharing policy. As is nearly always the case with lawsuits, the big winners are the lawyers.

From Harvey: “Re: Mediware. Reported a very solid quarter, but indicated that their labor costs have gone up. It would seem that, despite overall job market woes, there’s a bit of a bidding war on for HIT staff.” Mediware’s Q4 numbers, announced Wednesday: revenue up 20%, EPS $0.25 vs. $0.12, with a big DoD blood bank software contract pushing the numbers up. The one-year share price is above, with MEDW (blue) compared to the Nasdaq (red) and the S&P 500 (green). Market cap is $91 million.

HIStalk Announcements and Requests

Listening: Black and White America, the new album from Lenny Kravitz. Retro 60s funky with big horns in places, modern soul elsewhere, and melodic rocking on some tracks. A great sound throughout and lyrics that aren’t the usual dance track drivel. I get quite a few e-mails from readers wondering how to get back in the habit of listening to new music and I would recommend this as easy to enjoy – it’s got a nice beat, it’s not explicit (he’s religious), and it’s original. And Watching: Mercy (a pretty good hospital yarn) and The Good Guys (a funny cop buddy series). Netflix is predictably in full meltdown mode since any fool could see that its content providers like Starz would be holding it hostage once their old contracts ran out, so I’m watching now before the lack of programming (or increase in price) pushes me to cancel.

Jobs on Healthcare IT Jobs: eGate Integration Analyst, Senior Systems Analyst – Physician Systems, Implementation and Account Manager, Pegasus Health IT Director. There’s quite few interesting jobs there.

HIT is a contact sport, so get off the couch and interact with us: (a) subscribe to the e-mail updates so you can be a like Paul Revere galloping down the cubicle rows shouting out the latest shocking news that I’ll deposit in your inbox if only you’ll allow me; (b) do all that friend / like / connect stuff on your choice of social media sites, seeking out HIStalk, Dr. Jayne, Inga, and me so that we might consummate our union electronically; (c) send me news, rumors, or whatever interests you about the industry; (d) behold with wonderment (and perhaps some strategic mouse-clicking) the graphical proof to your left signifying the unlikely fact that impressively powerful healthcare technology firms are willing to support an anonymous muckraker who struggles to keep a hospital job given the extensive time required to keep up with all the HIT windmill-jousting that needs done; and (e) appreciate that our world revolves around patients, no matter how much electronic insulation separates them from us. Thanks for reading.

Acquisitions, Funding, Business, and Stock

Mediware’s Q4 numbers: $16 million in revenue, up 20% from last year; net income $6.3 million vs. $3.2 million.

Private equity firm The Riverside Company acquires Avatar International, which administers patient satisfaction surveys.

Teleradiology firm Virtual Radiologic acquires the 60-radiologist practice Diagnostic Imaging, Inc. (PA/NJ).

Hospital revenue cycle predictive analytics vendor Apollo Data Technologies Health, Inc. changes its name to MethodCare, Inc.

Sales

CHRISTUS Health (TX) selects HiSoftware’s Compliance Sheriff for SharePoint solution for HIPAA compliance with Sharepoint data.

Royal Caribbean Cruises selects eSeaCare EHR for its Azamara Club, Celebrity, and Royal Caribbean International cruise lines. Dang, I sure need to do a site visit.

CMS contracts for ICD-10 code translation technology from 3M Health Systems to assist with the conversion of the agency’s systems, applications, and reports from ICD-9.

People

Zynx Health appoints Bill O’Connor, MD (Allscripts) as SVP of global product management and marketing and David Cerino (Microsoft Health Solutions) as EVP and COO.

CSC promotes David Levitt from account director to VP of HIT solutions for its North American Public Sector Health Services division. 

Healthcare investment bank Leerink Swann names Bill Suddath managing director of the firm’s Healthcare IT and Technology Enabled Services franchise. He was previously with Robert W. Baird & Co.

AHIMA appoints Lynne Thomas Gordon, MBA, RHIA, FACHE as CEO. She was previously with the Children’s Hospital at Rush University Medical Center.

CentraCare Health System (MN) names Amy Porwoll CIO, replacing the retired Charles Dooley.

Announcements and Implementations

Humility of Mary Health Partners (OH), which includes three hospitals owned by Catholic Health Partners, goes live on its $56 million Epic system.

Accenture completes an assessment and plan to support implementation and interoperability standards for a statewide HIE for the Texas Health Services Authority.

The VA will expand its Virtual Lifetime Electronic Record pilot in which the health records of veterans are electronically shared with the Department of Defense aid private healthcare facilities. It says the HIE capabilities will be live this fall.

The ONC launches HealthIT.gov, a new website which includes HIT information for both healthcare professionals and consumers. It’s definitely prettier and easier to navigate that older ONC site, but contains much of the same information.

MetroWest Medical Center (MA) debuts its use of the EarlySense system, which uses motion sensors placed underneath beds to track patients’ vital signs. Massachusetts Governor Deval Patrick was on hand.

TeraMedica introduces a medical archiving solution capable of managing from 25,000 to 10 million medical image procedures.

Free EHR vendor Mitochon Systems announces built-in connectivity from its EHR to Hoag Hospital’s Medicity-powered HIE.

Qualcomm and Life Care Networks launch a Wireless Heart Health 3G mobile health project in China. Components include smartphones with ECG sensors, Web-based EMR software, and clinic-based 3G wireless workstations that give 30 physicians access to the electronic records and ECG data.

Government and Politics

Federal agents arrest 42 people in South Florida for suspected Medicare fraud. Assisted living facilities and related businesses convinced out-of-state elderly and disabled people to come to Florida for a fresh start (and to bring their Medicare cards along). They’re accused of submitting $160 million in phony claims, of which Medicare dutifully paid $90 million without question. The lead FBI agent chastised HHS for not preventing fraud upfront, saying that it takes extensive resources to catch the crooks, who by the time they’re arrested, have usually spent all the money.

Innovation and Research

Albert Einstein College of Medicine of Yeshiva University will use an NIH-funded grant to study advanced retroviral drug therapy in HIV/AIDS patients in Central Africa. Clinics will implement the OpenMRS open source medical record to collect data, also giving governments the option to make its use a national initiative.

Technology

Inova Health System (VA) partners with a genomics company to sequence the genomes of 500 pre-term NICU babies and their parents to identify OB-related diagnoses and treatments. Information from Inova’s EMR will be used to study outcomes.

Other

A physician’s guest editorial in The New York Times makes the common observation that electronic medical records are good as long as the caregiver doesn’t let the computer interfere with their relationship with their patients.

In the old days, when a patient arrived in my office, I laid the paper chart on the desk between us. I looked directly at the patient. As we spoke, I would briefly drop my eyes to jot a note on the page, and then look right up to continue our conversation. My gaze and my body language remained oriented toward the patient nearly all the time. In the current computerized medical world this is impossible. I have to be tuned toward the computer screen to check labs, review X-rays, read prior notes, document the patient’s current concerns. Like most internists, I know that the interview is the most important part of a patient visit. It always yields far more information than the physical exam, which, in many ways, is an afterthought. But now that the computer is impeding the intimacy normally achieved during the talking part of the visit, I find that I rely on the physical exam more. Once the patient and I have broken free from confines of the desk, with its dictatorial PC, we have a more comfortable realm, that of touch. As soon as there is skin-to-skin connection, conversation flows more easily. In the absence of a machine lodged between us, the traditional doctor-patient relationship is restored.

An Ontario hospital notifies patients that an employed nurse inappropriately accessed the records of 5,800 patients. The mother of one of them was upset by the hospital’s  response to her request for details:  they won’t release the nurse’s name because doing so would violate the breacher’s privacy.

Weird News Andy likes this ink: an 81-year-old grandmother gets a chest tattoo that says, “Do Not Resuscitate,” fearing that doctors won’t see the DNR entry in her medical record. “I do not want to be half dead, I want to be fully dead … I don’t want to lie for hours, months or even years before dying. I don’t want my family to remember me as a lump. My mother-in-law lived to be 106 and in the last six years of her life she’d have been much better dead. She was miserable.”

Also from WNA is this story in which England’s Primary Care Trusts are demanding that family physicians reduce their use of ultrasound, MRI, and CT scans. WNA has a cost-saving solution: send them through TSA’s body scanners.

Police in China are investigating the death of a patient during a fire in a hospital OR. Employees evacuated themselves and all patients except one, a man whose leg was being amputated under general anesthesia. When they returned, they found him on the OR table, dead of smoke inhalation.

Sponsor Updates

• The Disposable Film Festival and Practice Fusion launch Disposable Film Festival Health to encourage original short films about health, medicine, patients, or doctors. Participants will compete for a $5,000 prize.
• Orion Health is adding more than 100 new positions, with about two-thirds in New Zealand and the rest in North American and the Asia-Pacific region. Most of the openings are in R&D.
• Ten unaffiliated physician practices connect to the Coastal Connect HIE (NC) and begin the electronic transmission of patient referral data using Medicity’s iNexx technology.
• Radiology Associates LLC (LA) selects McKesson Revenue Management Solutions for practice management and medical billing services.
• Robert Freedman of Hayes Management Consulting will moderate an ICD-10 panel discussion at HCCA’s New England Regional Annual Conference on September 9 in Boston.
• Stockell Healthcare Systems and ZirMed announce a partnership in which ZirMed’s claims management will be integrated with Stockell’s Insight Revenue Cycle Information System.
• Decatur Medical Center (IL) will deploy Wolters Kluwer Health’s ProVation Order Sets. Wolters Kluwer also signs a multi-year contract with Health Shared Services British Columbia for its Lexicomp solution.
• TeleTracking Technologies announces the formation of its RTLS Workflow Consulting Group. The company is also hosting a free webinar, RTLS Asset Management and How to Make the Most of Your Owned Equipment Resources.
• MediServe clarifies the PAI Discharge Window. 
• Cumberland Consulting Group promotes Tom Howard to principal.

EPtalk by Dr. Jayne

JAMA is e-mailing physicians to take part in a survey regarding mobile electronic devices. Questions included: what devices are owned; plans for new device purchases; how much time is spent each day using a mobile device for medical information; when during the day devices are used; how important the device is for various pursuits; and desirability of a medical journal app for full text articles.

Mailbox alert: The Centers for Medicare & Medicaid Services will be mailing revalidation requests to over a million health care providers, more than half of which are physicians. Providers who enrolled prior to the institution of new screening criteria on March 25, 2011 will have 60 days to recertify their enrollment or be blocked from billing Medicare. Providers worry that the already cumbersome Medicare enrollment process will negatively impact honest providers rather than catch the crooks for which it was intended.

This week’s New England Journal of Medicine includes Electronic Health Records and Quality of Diabetes Care. The authors looked at diabetes care data from 569 providers at 46 practices from 2007 to 2010, concluding that the “findings support the premise that federal policies encouraging the meaningful use of EHRs may improve the quality of care across insurance types.” The practices included safety-net providers and publicly reported performance data. On composite standards for diabetes care, EHR locations scored higher than paper-based locations for outcomes and also showed a higher annual improvement (after adjusting for insurance, age, sex, race, ethnicity, language, income, and education.)

The authors note that this is in contrast to other recent studies showing no improvement in quality for practices using EHR. They attribute their favorable results to looking at systems with clinical decision support that is specifically designed to improve care and which include mechanisms for care coordination and provider communication. Additionally, patients had to visit the practice two or more times during the study period for inclusion. The authors propose that this demonstrates a “mutual commitment to longitudinal care” which may have been lacking in other studies.

Medical Economics recommends some LinkedIn groups for social media savvy physicians to join. I was disappointed to not see the reader-created HIStalk Fan Club on the list. With over 1,800 members, it beats all but two of the groups listed.

Several of my friends who are consultants in the health IT realm spend most of their weeks traveling from practice to practice. Since food is no longer served in most parts of the not-so-friendly skies, road warriors are often subjected to the carry-on fare of their neighbors. One former colleague was so offended by his neighbor’s snack he e-mailed me from 30,000 feet looking for sympathy. Normally I’d tell him to “suck it up,” but he snapped a photo of the fare: Ahi tuna jerky. The aroma was bad enough that someone asked a flight attendant to speak with the passenger about putting it away. I’m not sure about the rationale behind dehydrating a perfectly good piece of fish, but to all the road warriors out there, may your flights be fish-free.

Have a health IT road warrior horror story? E-mail me.

Contacts

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

News 9/7/11

Top News

AmerisourceBergen Corporation completes its $35 million acquisition of IntrinsiQ. The company, which offers the IntelliDose oncology dosing application, will become part of AmerisourceBergen’s ION Solutions unit.

Reader Comments

From Auntie Social: “Re: Twitter. I’ve never found much value in Twitter. I’d rather have the Readers’ Digest version of a speaker’s talk versus endless Tweets of every point. Other Tweets are just self-indulgent promotions. However, with the recent earthquakes, hurricanes, floods, and fires, I am finally seeing its value and am hooked.” The fifth hottest Twitter topic in August: Hurricane Irene. Justin Bieber was ranked #2.

From Celerite: “Re: transparency. Vendors should not tolerate employees who use inside testing results to trade stocks of partner companies. Avoid costly mistakes by asking your vendor how they prevent this.” I’m afraid I didn’t really follow this, especially the customer angle, but maybe I’m slow.

From A. Tool: “Re: GE. They’re laying off Americans and moving their X-ray division from Wisconsin to China, but earlier this year, Obama picked Chairman Jeff Immelt as ‘jobs czar’ tasked with figuring out how to create US jobs. Is he really the most qualified guy to be providing employment advice?”

Acquisitions, Funding, Business, and Stock

One Medical Group closes $20 million series E funding, led by Maverick Capital. Epocrates co-founder Tom Lee is the CEO and founder of One Medical, which operates nine physician offices in San Francisco and New York. They use a self-developed EMR and other technology to minimize administrative overhead.

Billionaire Patrick Soon-Shiong forms a new company, NantWorks LLC, that will combine his technology businesses, some of which involve healthcare, under a single umbrella.

Sales

Sandlot adds five Texas Health Resources hospitals to its HIE platform.

People

SRS hires Michael P. Lang as EVP of sales. He was previously with RelayHealth and GE Healthcare.

MedQuist announces new executives from M*Modal, which it recently acquired: Michael Finke (president – above), Juergen Fritsch (chief scientist), and Detlef Koll (CTO.)

John Reiffenberger is promoted to CIO of the VA’s Black Hills Health Care System (SD).

Announcements and Implementations

Rhode Island’s HIE currentcare (highly annoying all lower case and then italics) is capturing clinical data using InterSystems HealthShare.

Covenant Health System and Memorial Hermann develop clinical integration programs, in which independent physicians and a health system collectively negotiate commercial payor contracts that include quality and cost incentives. Both programs use CRIMSON physician performance and population management tools from The Advisory Board Company. Covenant reports reducing their average length of stay by 1.1 days and having no reported cases of ventilator-associated pneumonia for 18 months, while Memorial Hermann’s physician group had a 29% shorter length of stay and 15% fewer complications than non-participating doctors.

Government and Politics

HHS grants $11.9 million to 40 rural health networks to support EHR adoption.

In Australia, New South Wales will spend $115 million this year on healthcare IT projects that include a statewide electronic medication management system, a specialist EMR, a system for ICUs, infrastructure upgrades, and new corporate systems.

President Obama, addressing the American Legion conference in Minneapolis last week, touches on electronic medical records:

At the same time, our outstanding VA Secretary, Ric Shinseki, is working every day to build a 21st century VA. Many of our Vietnam vets are already submitting their Agent Orange claims electronically. Hundreds of you, from all wars, are requesting your benefits online. Thanks to the new “blue button” on the VA website, you can now share your personal health information with your doctors outside of the VA. And we’re making progress in sharing medical records between DOD and VA. We’re not there yet. I’ve been pounding on this thing since I came into office. We are going to stay on it, we’re going to keep at it until our troops and our veterans have a lifetime electronic medical record that you can keep for your life.

Other

Healthcare leads employment growth, adding 30,000 jobs in August. Ambulatory health provided 18,000 positions and hospitals another 7,700.

Varian’s ARIA oncology system moves from last place in KLAS’s 2010 oncology system report  to first, beating out Elekta/MOSAIQ and IntrinsiQ/IntelliDose. Epic Beacon earned the highest overall performance score, but was not ranked because of a limited sample size.

Weird News Andy asks, “Who has the brains, who has the heart, and who has the skin in the game?” as he ponders this story: Britain’s NHS is considering turning over its transplant program to a private German company that pled guilty last year to illegally transplanting human organs. The Netcare subsidiary of General Healthcare Group paid over 100 poor children from Brazil and Romania to donate kidneys for its rich customers, performing the surgeries at a hospital in South Africa.

Sponsor Updates

• Allscripts is hosting a meet and greet career event for its services organization this week in Tampa.
• Aspen Advisors ranks #1 out of 350 firms for consultants’ attitudes on their firms’ business outlook.
• Comanche County Memorial Hospital (OK) selects the eClinicalWorks EHR for its employed physicians and non-affiliated practices.
• AdvancedMD offers free Webinars this month entitled, “Four Easy Steps to Qualify for Meaningful Use.”
• Surgical Information Systems goes live at Battlefords Union Hospital and Lloydminster Hospital in Canada.
• PatientKeeper CEO Paul Brient  will speak at the Stifel Nicolaus Healthcare Conference in Boston this week.
• MD-IT releases MD-IT iConnect for the Android operating system, enabling smart phone dictation, direct access to the MD-IT Platform, and the ability to view patients’ longitudinal history from a mobile device.

Contacts

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

HIStalk Innovator Showcase — Trans World Health Services 9/5/11

Company name: Trans World Health Services, Inc.
Address: 10509 Professional Circle, Suite 102, Reno, NV 89521
Web address: www.transworldhealth.com
Telephone: 775.852.9440
Year founded: 2003
FTEs: 7

Elevator pitch

We provide software and consultancy to help FQHCs, Community Health Centers, and other healthcare providers deliver better, more cost-effective care.

Business and product summary

We offer three product lines – Health Center Accelerator (real-time performance improvement software), Better Care Better Value Suite (comparative benchmarking and analytics software and services), and process improvement consultancy, which all work together to give Community Health Centers and other healthcare providers the tools they need to best manage their activities. We evaluate the client’s operation; apply analytics and experience to correct process flow issues; determine which meaningful measures need to be inspected and monitored; implement the appropriate libraries of performance improvement dashboards, alerts, and interfaces to the source data systems; and train and support the users.  

Users include all levels of management right through to front-line staff within the administration, finance, and clinical areas. Our cost model is based on packaged or risk-based fees for initial consulting and implementation, and a monthly license fee for use of the monitoring software and/or access to the benchmarking service. The system can either be locally hosted or delivered in a SaaS environment. By delivering real and measurable improvements in organizational performance, the return on investment for our
pilot site is greater than 500% on an annualized basis and paid for itself within the first three months of deployment.

Who is your target customer?

While our targets could legitimately be any healthcare organization from a small primary care clinic or physician practice to the largest integrated delivery network or payer organization, our current focus is on Federally Qualified Health Centers (FQHC) and Community Health Centers.

What customer problem do you solve?

We highlight and solve process and efficiency impediments that are preventing Health Centers from delivering optimal service levels so they can use their resources more effectively. This leads to cost reductions per patient encounter and increases the ability of the organization to deliver more care and treat more patients with current or slightly expanded resource levels in line with their core mission.

Who are your competitors?

Excluding competitors that are split between pure practice management consulting and pure complex dashboard, workflow, and analytics software providers (which are many and very expensive), there are few companies that offer pre-packaged, healthcare customer-specific dashboard software including pre-packaged efficiency best-practice consulting. Those that do exist, for example: onFocus Healthcare; DashboardMD; The Advisory Board; and MedeAnalytics; are mainly hospital and integrated delivery network focused. Within the Health Center marketplace, we have only found one that would appear to be even slightly similar in positioning: InterPoint Partners.

Why are you better than your competitors?

Our senior management each has over 25 years of senior expertise in healthcare performance improvement, process redesign, quality improvement, clinical utilization, and software development. That translates into knowing right where to go to uncover meaningful areas to focus and improve. Our dashboard software mashes multiple clinical, financial, and operational data sources and runs in real time, providing users with immediate access and drill-down capabilities to see why and where the problems are occurring either at the moment they can be addressed, or by identifying them through proprietary forecasting techniques to prevent problems from even arising through early warning alerts. Traditional single silo reports that are typically run days or weeks after the fact become irrelevant since they are produced too late to save the critical time-limited resources.

Pitch video created specifically for this Showcase

Customer Interview (CEO of a non-profit, community-owned health center)

Your organization was seeking financial and quality improvements. What results have you seen and how much of that was attributable to Trans World Health Services?

The actual results have been about $500,000 to $700,000 in increased revenue over the last 18 months, and about 70% is directly attributable to processes identified through the use of the accelerator and the consultative services.

Organizations always say they have plenty of data, but little information. Was that your situation before, and how has that changed?

We had an enormous number of spreadsheets and data. We also had data integrity issues. It wasn’t until TWHS did a forensic analysis and helped us to clearly define and analyze the data did we reach a point where we could actually begin making rock-solid data supported decision making. It has removed significant amount of doubt and discussion from our ability to operate.

If you were speaking to a peer from another group, how would you complete this sentence: "You should talk to Trans World Health Services under these circumstances:" 

If you plan on surviving the challenges of healthcare reform. This product and the services offered by TWHS will revolutionize the way Health Centers function and operation in the future. Don’t be caught later wishing you had made the investment.

An interview with Bryan Lang, founder and CTO of Trans World Health Services

Tell me about the company.

The market that we’ve targeted and really gone after in America is the Community Health Center market, Federally Qualified Health Centers, FQHC lookalikes, and rural clinics. This market has been tremendously underserved. They’re under tremendous increase in growth and demands. They’ve never had this technology available before.

We developed this technology that was used in every single hospital in England to be able to visualize and to predict where you’re going. We wanted to make it available to this very cost-effective market segment in America. That’s our focus right now.

What do we do differently from the others? Well, it’s a very underserved market. You have occasional dashboard add-on products to the HER. For example, NextGen has an add-on dashboard product, but you get to build your own using that product. 

Our approach is very different. There are five points in our framework. We want to pull information together so they can see and understand what’s going on. We have the analytics to identify variances and opportunities for improvement. We have the predictive modeling to show where they’re heading. We embed best practices into our software so that rather than building your own, you can see exactly where you are relative to others, relative to your own benchmarks, and what you need to do to make a difference. Finally, the data quality in the health center market is substandard in many cases; we really want to be able to show data quality improvement on auditing capability so they can trust their data. 

A simple example of combining the information from various systems involves patient scheduling. If a Health Center is not fully booking its appointment slots, we’re able to say, “Why is that?” and take a look at where the patterns are. Take a look from their population health management systems or their disease registries to say clinically who should be treated, and to be able to combine that, put a value associated with it. 

For example, “This is the value of your diabetic population that needs to be seen.” Combine that data to put it in front of them, in front of the booking people — the people who need to be seen so they can call them up, fill those empty appointment slots, and run a full schedule. That’s a combination using the practice management system, possibly a population health management system or an electronic medical record, and financial information to say, “This is how you affect a positive change by filling your appointment schedules more.” Ultimately that leads to increased revenue with existing staff, so that that’s better for their financial performance.

I ran across a presentation from Livingston Medical Group that was pretty impressive. Can you describe some of the results that they have realized using your product?

Livingston was a very interesting client. They brought us in originally because of the concern about losing productivity due to the implementation in electronic health record. What they wanted to do was have us make them more efficient.

We originally got into a common measure of productivity, which is their providers were not achieving three patients per hour. Three patients per hour essentially is the baseline that many Health Centers run on. We then were able to take a look in that by pulling the data together showing visually that this wasn’t a function of providers slacking off — this was a function of the fact that they had not filled those appointment slots. They hadn’t even provided the providers with enough patients to be able to see to make their targets.

Right off the bat, we were able to pull this information and change some of their fundamental processes so that they could start filling those slots and achieve better provider productivity and revenue. Unfortunately, about this time, they had a tremendous financial crisis. California stopped paying, and then they had outsourced their billing services. Unfortunately, their billing backlog started climbing. They were not able to generate bills. They were not able to bring in revenue. Their financial system went into a crisis.

At that point, neither the billing company nor they were able to see where the problems were. They just didn’t have access to the information. We were re-tasked to be able to open up the information, show the visibility, provide insight into where the problems were in the process. 

We found a huge number of bills that had never been transmitted. We found reasons for blockages and why they hadn’t been paid. We were able to very quickly open all this up so they could see where the problems were, see what they needed to do to solve the problem, solve the problems, and then see the revenue flowing through. It was a very, very narrowly averted crisis. As John will say, they came within a couple of weeks of not being able to stay operational. That was one of the things that we were able to provide for them.

We also showed them how we could provide a huge additional amount of retained earnings for them. Some were north of 700% was what our estimates showed if we changed a few of their fundamental processes and brought them in line with what best practices would be. You hear all this and you say, “Well, that’s something that systems aren’t going to be able replace consultants,” and, no they aren’t. We really believe that the consultancy component is a big part of what we deliver. However, by building in what a lot of consultants normally would do into the software, embedding those best practices, making it a problem-focused solution, so you can see if you have a problem in a given area. 

You can say, for example, “How financially effective are our letter campaigns – our recall letter campaigns to get patients to come back in?” It’s very, very difficult to get answers to that information. That’s a question that is asked in our system, so you go right to that question and click on that and you can go right down into where you can see letter campaign by letter campaign. How effective are you every time you send out a batch of letters to get patients back in, how many are there coming in, and what value is that offering to the organization as a result of sending these recall letter campaigns out.

That’s some of the things that we did at Livingston. We’ve had a very, very good working relationship with them. We originally came in there at saying, “We’ll work with you as long as you believe us to be effective in helping you out” and added to the library item after library item to our system so that we just keep on building module after module. It’s a very interesting market and we look forward to staying in it for awhile.

Healthcare customers tend to like solutions that have quick implementation and payback. What you’re offering sounds like technology and consulting services that require a commitment to change on the customer’s operational side. How do you sell that?

We sell that in two ways. We sell it in a traditional manner where that’s bundled together, where there’s a package of consultancy based on the problems that they’ve identified and very, very similar problems exist across the spectrum. Based on the problems identified, this is what we’d do for the system to be able to plug our system into the various other systems, to be able to present the information to their executive team, and then to be able to work through the top five problems or issues that they want to focus on. We generally package that in terms of an initial three months’ worth of consultancy as well as the software. From that, they make their own determination on how much consultancy they want to have going forward.

There must be a fair amount of overhead in getting those sales by helping them identify their problems and then convincing them that your combination of services and product can help resolve them. Do you see that as a limiter of your growth potential?

Getting in the door is very interesting. We try to minimize the cost of sales, because these price points are not at all what business intelligence systems would be for hospitals. We try to go to conferences or out where groups of them come together or meet in groups. We also do a lot of WebEx demos.

But the problems are very similar across the spectrum of Community Health Centers in America. Once we have a set of solutions, we can say, “You’re probably looking at this, this, and this. Let’s show you what this would be” and you get head nods around the table very quickly.

What do you hope to gain from this exposure?

We hope to gain a lot understanding of how we can make a difference in helping Community Health Centers. Ultimately, we’d certainly like to go back to our original market, which is hospitals, and take that and step forward from the traditional models, but really build that consultancy behind it to say, “Where are my problems and what do I need to do about the problems now, today, so that they don’t become a statistic tomorrow?”

Monday Morning Update 9/5/11

From It’s All Good: “Re: Sage Healthcare. Tom Chmielewski, VP of product management, leaves to ‘pursue other interests,’ following the recent departures of project management execs Mike Burger (PM/EHR), Rob Price (practice analytics), and Mark Martin (EDI). It’s an interesting time to be cleaning the product management house. Who’s minding the store for Stage 2 and beyond?” A source verifies that Tom Chmielewksi has left the company.

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

Listening: reader-recommended Metric, female-led Canadian indie rock with only a little bit of guitar (reminds me a little of Muse, but more subdued). I was surprised that I missed a band this good, but it turns out I didn’t: I recommended them back in April 2009. Really good stuff, fresh and tight. I’m happy for the reminder to listen to them all over again.

My Time Capsule editorial this week, archeologically excavated from the ash heap of history circa 2006: “Hospitals Want Software to Do The Dirty Work of Changing Physician Behavior.” A free sample of the equally free product: “No software contains a switch that turns resistant physicians into docile, rule-following sheep who make better decisions under the watchful eye of Big Brother’s can’t-miss medical guidelines.”

InterSystems acquires Siemens Health Services France from Siemens, whose Clinicom system is used by 60 French hospitals. InterSystems will pair Clinicom with its TrakCare HIS, which offers electronic patient records, documentation, order entry, flowsheets, patient management, ED, OR, rad, lab, pharm, and billing. InterSystems acquired TrakCare and its Australian developer, InterSystems application partner TrakHealth, in 2007.

The joint VA-DoD EHR will yield an open source results, at least according to VA CIO Roger Baker. That statement didn’t come from DoD, which has a rich history as an intractable, contractor-enriching bureaucracy not interested in giving up control or collaborating outside its walls.

Indiana Secretary of Commerce Mitch Roob will resign to become president and CEO of WoundVision, an Indianapolis company that sells software that performs risk assessment and predicts pressure ulcers. He replaces founder James Spahn MD, who will remain board chair.

Microsoft will work with Social Interest Solutions, a non-profit that connects low-income individuals and families to health resources. Microsoft wants to use the organization’s knowledge to get involved with government health insurance exchanges.

This article says US News & World Report used HIMSS Analytics data to choose their top hospitals, which I thought was bizarre since HIMSS Analytics looks only at IT metrics and US News evaluates death rates, reputation, and several non-IT factors. Turns out the story is not really correct: USN&WR used the HIMSS Analytics information only to create a Most Connected Hospitals list by cross-referencing its own top hospitals with those that are EMRAM Stages 6 or 7.

We are collectively torn on the issue of whether Congress should rescind HITECH money. New poll to your right, for hospital employees: to what degree does your board review and analyze big IT requests before approving or rejecting them? I got the idea from Joel French’s interview, in which he marveled that boards of struggling hospitals approve $70 million system purchases (I assume he meant Epic) without any guarantee the investment will help the bottom line. My experience with hospital boards is that members (community movers and shakers, hefty donors, and a token smattering of social advocates) are mostly interested in the community relations aspect rather than deep diving into operational decision-making. Rightly so, hospital executives would argue. It’s like Congress: the outcome of  big decisions is a foregone conclusion since the execs have persuasively lined up the support they need long before the issue is brought up for a board vote.

This article says hospitals are using doctors with questionable objectivity or even “doctor bots” (example 1, example 2, both using the same doctor name but pictures of different people) to spit out medical advice via Twitter, which gain a following and reap AdSense revenue for the commercial sites they link to. The bots take existing articles of questionable value that have no references or detailed information, swap words using an electronic dictionary to make it look like something new, and then tweet links to it. My first thought was that laws would surely prohibit either falsely claiming to be an MD or dispensing questionable advice as one, but then I realized that (a) someone would have to file a complaint, and (b) those laws are mostly at a state level, so it may not be clear whose domain something like this falls under.

Cayman Islands Health Services Authority CIO Dale Sanders tells me the national healthcare conference will be held November 17-19 at the Ritz Carlton in Grand Cayman. I think I need to be there.

Meditech cancels plans to build an office building in Freetown, MA after the state historical commission overrides an archaeological firm’s recommendations and insists that the company dig, sieve, and log the contents of a two-foot layer of dirt covering 21 acres, which Meditech says would have taken at least a year. Town officials fear the company will look out of state for a substitute location. The mayor of Fall River, where the company already has offices, says his town will beat any Freetown offer.

Healthcare RTLS vendor Versus Technology announces Q3 results: revenue down 15.4%, net income –$15,000 vs. $38,000.

Oroville Hospital (CA) is profiled in a local publication for its impending implementation of the WorldVistA’s EHR, the first US hospital to go live on that particular variant of the VA’s VistA. From the Bob Wentz, the 153-bed hospital’s CEO: “Why do most healthcare organizations and doctors’ offices have software owned by a company? … What if they wanted to change to a different provider? What would it cost them to get out? And they would get no help transferring their data.” On the other hand, he’s not exactly objective – according to the article, he’s associated with Tenzig Corp., which it says offers hospital implementation services for VistA. I don’t know what happened to the hospital’s original plan to implement Medsphere’s OpenVista, announced in 2007, that caused them to switch to WorldVistA. It was announced a few days ago that WorldVistA EHR 2.0 earned ATCB certification as a complete inpatient and ambulatory EHR, with Oroville proving money, enhancements, and coordination.

More from Vince Ciotti on Gerber Alley. Care to share some vendor reminiscing from back in the day? (that being defined as pre-1990, let’s say, involving visionaries or now-defunct companies). E-mail Vince.

Continua Health Alliance releases its 2011 Design Guidelines for personal health devices, with new coverage of Bluetooth Low Energy temperature sensors, ZigBee networks in which a single sensor communications with multiple hosting devices, and user identification over a Wide Area Network interface.

A survey in Ireland finds that almost 50% of people diagnose themselves using the Internet instead of seeing a physician. Nearly half of those surveyed said they would use SMS or IM to communicate with their physician if available.

A hospital in England ditches the “do not disturb” vests that nurses were wearing to prevent distractions during medication administration. Patients hadn’t complained, but newspapers had run quotes from other areas in which visitors claimed to be miffed at being told to leave the nurses alone until they had given all their meds, even though studies have shown significant error reduction when nurses are allowed to focus on the task at hand. One might logically conclude that if it weren’t for the social aspect of being hospitalized, hospital units should be closed off to outsiders just like the psych ward or an auto garage. You’ve got dangerous equipment and drugs being hauled around, bodily fluids flowing, people trying to focus on life-and-death tasks, and patients having life-threatening events, all while visitors are getting in the way, asking questions, and spreading germs. It’s like trying to run a busy restaurant kitchen where patrons are allowed to wander in and out and maybe reach around the chef for a sample.

A futurist’s view of sleep technology and the “hotel room of the future” predicts that within 20 years, sleepers will be able to choose their dreams and share them with others; wear active contact lenses that will deliver 3D TV images directly to their retinas; and participate in virtual lovemaking where feelings and emotions are shared via skin sensors.

Government contractor CSC acquires Baltimore-based Maricom Systems, which provides informatics and data management systems used by HHS. 

Allscripts files suit against Virginia-based consulting company Visus, alleging trademark infringement. Allscripts claims the company used its company and product names without approval to promote EHRs. Visus has removed references to both Allscripts and NuWave from its site (before and after image above) after both companies insist they have no relationship with Visus.

A nursing professor in Canada conducts a telenursing pilot project in which nurses monitor home-based diabetic patients using smart phones and the Internet. Part of the project involved creating an interactive telehealth platform that is being commercialized by McGill University with Magellan Global Health, of which the professor appears to be president and COO after the company was merged with her medical tourism company. Being a professor has to be the best job in the world. You get a substantial paycheck for teaching a few classes a week at a pretty campus that offers lots of entertainment opportunities, you get grant money and eager beaver student research assistants, and there’s plenty of time to run consulting or product businesses on the side.

Jeffrey Kriseman, an Arizona State University PhD student, is profiled for developing an open source messaging system used to exchange public health information for disease surveillance. It’s being used by Nevada providers to submit reportable lab results to public health agencies, qualifying them for HITECH money. Kriseman is finishing his PhD in biomedical informatics.

Strange: the FBI investigates a prosthetic manager at University of Minnesota Medical Center, accusing him of convincing patients to replace their perfectly useful artificial limbs with new ones, after which he would sell their old ones on eBay.

Stranger: a 17-year-old part-time doctor’s billing clerk is arrested in Florida after posing as a physician’s assistant, convincing the hospital’s HR department to give him a PA badge so he could work in the ED where he examined patients, dressed wounds, and performed CPR on a patient in cardiac arrest. He was caught after he pestered HR to upgrade his badge so he could hang out in the doctors’ lounge, but gave the excuse that he was working undercover for the police. He had previously been dismissed from a Sheriff’s Explorer teen police program for wearing a deputy’s badge and bulletproof vest in public.

E-mail Mr. H.