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.

News 9/2/11

Top News

CMS issues its final rule on changes to the e-prescribing incentive program and includes multiple hardship exemption categories for EPs. EPs have until November 1, 2011 to request a hardship exemption for the 2012 eRX payment adjustment.

Reader Comments

From CDH: “Re: Epic trainers. More disgruntled ones, this time at Central DuPage Hospital. Of 27 hired, eight have left. They were told they would be certified, but in reality were only credentialed. The principal trainers have purely HR backgrounds without any go-lives under their belt. Training plans are being revised daily as they have not yet stopped the back-end build for the November 6 go-live.” Unverified.

From Arch Moore: “Re: WVHIN and Thomson Reuters. You reported that deal back on January 24, more than seven months before they announced the contract. I heard contract negotiations hit a big snag in June when Thomson Reuters announced to the world (and Wall Street) that they were thinking of getting rid of their healthcare business. Rumor is it was a surprise to everyone. WVHIN must have been impressed with CareEvolution since the deal went through.” Thanks for reminding me. I was thinking I’d said something about this from a reader’s rumor report back in the winter.

HIStalk Announcements and Requests

Wondering what you may have missed this week because you still haven’t signed up to get HIStalk Practice? Wonder no more: EHRA tells CMS that requiring providers to submit patient-level data for CQMs is too big a burden. I annotate toenails using Healthfusion’s MediDraw. athenahealth launches a PCMH accelerator program.  Retail medical clinics are flourishing.  If it’s fall, then it must be time for user group meetings.

On HIStalk Mobile, Dr. Travis covers all the news about apps, home health technology, and mobile health, but also summarizes what it takes to succeed in developing successful apps for consumer health.

On the Jobs Board: McKesson Consultants, Epic Implementation Project Manager, SCC/SMM Consultants. On Healthcare IT Jobs: Epic Physician Trainer, Clinical Nurse Analyst, NextGen Trainers / Consultants.

Allow me to compress my usual Thursday spiel into one-word imperatives, just for the sake of brevity: (a) subscribe; (b) Friend; (c) report; (d) click; and (e) thanks. Did you get all that?

Listening: Ghost on the Canvas, a moving last studio album from Glen Campbell, diagnosed with Alzheimer’s this year. I was never much of a fan, but maybe I should have been given this album’s outstanding songwriting, vocals, and guitar work. To my ears, the 75-year-old, who has sold 45 million records in his 50 years in music, has never sounded better or benefitted so much from fresh-sounding production and contributions from folks like Jakob Dylan and Billy Corgan. It’s everything you’d expect from someone looking back at a life well lived: reflective and poignant, but optimistic (A Better Place says it all). Glen never got much attention from the music industry because he straddled genres (country? pop?) and was goofy on TV and movies, but somebody must be blackballing him if this album doesn’t reap a truckload of awards even without the sympathy vote.

Happy Labor Day, celebrating the rapidly diminishing ranks of us who aren’t out of work or happily drawing government entitlements while practicing leisure. You fashion purists will no doubt be placing your white clothing and seersucker suits into storage next week as summer unofficially ends. For me, it’s college football, perhaps some well-crafted barbeque, and a beer or two unless Mrs. H unveils plans of her own. I will most likely post Monday Morning Update this weekend since that’s what I do, even though fewer folks will read it (time to slip in something really scandalous!) Enjoy the holiday.

Acquisitions, Funding, Business, and Stock

Despite reporting “disappointing” Q2 results Wednesday, SAIC CEO Walt Havenstein speaks positively about the company’s recent acquisition of Vitalize Consulting Solutions:

The addition of Vitalize will expand SAIC’s health solutions portfolio in both commercial and federal markets to help customers better address electronic health records implementation. The combination of Vitalize’s expertise and integrating commercial off-the-shelf software for electronic health records and systems with SAIC’s information integration data analytics, and cyber security capabilities creates a powerful combination in the marketplace.

SAIC’s Q2 numbers: revenue of $2.6 billion (a 6% y/y drop), EPS of $0.32. Analysts expected $2.77 billion and $0.35. Shares fell 13.5% on Thursday, making it the top loser on the NYSE and hitting an all-time low, after the company said reduced government spending is hurting its top line.

Ingram Micro announces a Healthcare Partner Network of healthcare VARs and managed service providers.

Shares in NextGen parent Quality Systems hit a 52-week high Wednesday before slipping a little on Thursday. Market cap is $2.66 billion. Big holders Sheldon Razin and Ahmed Hussein own $459 million and $423 million worth, respectively.

IV equipment maker B. Braun Medical sues CareFusion for patent infringement, claiming CareFusion’s Alaris smart IV pumps violate its patents that include wireless communication with hospital clinical information systems.

Sales

Twelve Community Health Centers in Puerto Rico choose SuccessEHS EHR/PM for their 190 providers and 26 sites.

People

AHIMA names Lisa Spellman as its representative to lead the health informatics committee for the international standards organization ISO/TC215. She was previously with HIMSS and Allscripts.

Steven Liu MD, founder and chairman of Ingenious Med, is named Physician Entrepreneur of the Year by Modern Physician.

Announcements and Implementations

The Buchanan County Health Center (IA) goes live on its first phase of Meditech.

The Greater Dayton Area Hospital Association and HealthBridge announce the go-live of the Greater Dayton Area Health Information Network, which connects four hospitals and over 200 physicians.

The fishing city of Navotas in the Philippines rolls out EMR at nine health centers and one “lying-in” clinic. Midwives will be equipped with 22 BlackBerry smartphones, allowing them to collect patient data as they make house visits.

Physicians connected to Brooklyn HIE can access patient records via from their ClinicalWorks EHR.

Optum enters a strategic relationship with Monarch HealthCare (CA) to manage the clinical operations of its 2,300 independent physicians.

athenahealth launches athenaCoordinator to facilitate care delivery among hospitals, practices, and other caregivers.

Government and Politics

A scathing and well-written reader editorial about “inane” Maryland Medicaid isn’t too keen on accountable care organizations:

Mr. Ransom seems to think that doctors, including the rural ones, will flock to the idea of reward for cost savings and better care management. The people who are enamored with these payment models are mostly lawyers, journalists, politicians, medicolegal pundits, bureaucrats and software companies, especially the last that endlessly inundate the medical profession with ideas that neither materialize in enhanced care for patients nor in increased income for doctors. Instead these ideas have resulted in jobs and increased income for government auditors, care deniers and people who connect doctors to the care deniers, paper pushers and bean counters; folks who will never set eyes on a patient in their lifetime.

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Innovation and Research

A doctor from Wichita State University (KS) develops an iPhone concussion symptom detection app for high school football teams. Concussion Manager, which costs $25 per player, tests before-and-after balance, memory, and reaction time on the sidelines, allowing coaches to take the player out if warranted.

Other

Insiders are responsible for the majority of PHI breaches, with 35% involving employees snooping on their co-workers and 27% the records of friends or relatives. Loss or theft of physical records or equipment account for an additional 45% of breaches.

Fred Trotter reviews the VA’s recently announced VistA Custodial Agent, concluding that, “it doesn’t suck (much).”

Weird News Andy finds the Yale School of Medicine announcement of a paper-free curriculum a little weird (there’s that word again), balancing the $100K annual savings against the $600K upfront iPad cost, inevitable repair bills, and the likelihood of buying Apple’s hot new model every couple of years as being similar to “federal government thinking.” He likes the idea, but finds predicted print savings to be an unconvincing way to justify the cost.

Weird News Guy sent over this link: if you insist on removing animals from their natural habitat and locking them up thousands of miles from home so humans can stare at them, at least give them iPads like the Milwaukee County Zoo has done for orangutans. They play with apps on the donated iPads and will soon have Skype, which will allow them to videoconference with their inmate counterparts elsewhere. That’s obviously a testament to the iPad’s ease of use. Wonder how they’d fare with an EMR? 

Former Carthage Area Hospital (NY) CIO Skip Edie says he was interviewing an out-of-work CIO for an IT position when the hospital’s CEO called the candidate in Edie’s office to tell him he should interview for Edie’s job. Edie says he saw the writing on the wall and turned in his four-week notice, only to be marched off the property. Two days later, Edie’s wife, a patient accounting manager for the hospital, gave her four-week notice and was also escorted out within 10 minutes, she claims. The CEO says both left on their own and would not comment further.

Strange: the Christmas Eve death of a radiologist from Jackson Memorial Hospital (FL) is ruled an accident by the sheriff’s office, which determined that the woman’s necklace became entangled in the shiatsu massager she was using in her bedroom, strangling her. Her husband, also a doctor, says he found her unconscious. The FDA is advising owners to not only throw the specific massager (above) away, but to break it into pieces and put the parts in different batches of trash.

Great news if you are good looking: more attractive people earn an average of $250,000 more during their careers than those who are less good-looking. Not only do the best-looking third of the population earn 5% more money than the average or ugly, they also get better deals on loans. And if you are a pretty woman, you are more likely to marry a higher-earning man. I’m now wondering if Mr. H would give me a raise if I invest in some “cosmetic upgrades.”

Sponsor Updates

• Merge Healthcare’s OrthoEMR v4.0 receives ONC-ATCB certification.
• Hayes Management Consulting reports that Ohio State University Physicians’ use of MDaudit has helped the practice reduce regulatory risk.
• Lancaster General Hospital (PA) selects Wolters Kluwer Health’s ProVation MD software.
• Healthwise will participate in next week’s The Forum 11  Annual Meeting of Care Continuum Alliance in San Francisco.
• NextGen is offering a webinar September 12 to demonstrate its Inpatient Clinicals.
• API Healthcare is exhibiting at the this month’s ASHHRA Annual Conference in Phoenix and the Healthcare Staffing Summit in Philadelphia.
• Vocera smart phones and badge communicators can now receive alerts and notifications from Extension, Inc.
• Greenway Medical announces that PrimeMOBILE now available on iPad as a native app.
• Healthcare Innovative Solutions will participate in this month’s Kansas Hospital Association’s Meaningful Use Summit in Topeka and the South Carolina Hospital Association / South Carolina Medical Association TAP Conference in Hilton Head.
• The Orthopaedic Institute of Central Jersey and Orthopaedic Spine Institute select SRS EHR for their combined 19 providers.
• 3M Health Information Systems partners with Krames StayWell to encode Krames StayWell’s patient education library using the 3M Healthcare Data Dictionary.
• Imprivata and Teradici announce updates to Teradici PCoIP firmware and Imprivata OneSign software that will provide integration and interoperability of PC-over-IP (PCoIP) zero client devices with authentication management and single sign-on software.
• Medicare awards Faith Community Hospital (TX) incentive funds following its successful Meaningful Use attestation using to Prognosis EHR.
• Aspen Advisors publishes two new case studies: Fairview Leverages Seasoned Project Managers to Ensure Successful EMR Rollouts and University Hospitals Prepares for Meaningful Use Attestation. 
• The Fullerton Radiology Medical Group (CA) picks McKesson’s Revenue Management Solutions for its 10-physician practice.
• The Advisory Board and Mercy Clinics announce their inaugural Health Coach Training course in Des Moines, IA in October and November.
• ZirMed partners with training solutions provider Contexo Media to launch ZirMed University, an online portal that provides training on the ZirMed solution as well as courses for continuing education credits.

EPtalk by Dr. Jayne

Earlier this year, the American Medical Association launched a contest to identify an innovative new application for handheld use. The top ten finalists have been announced and voting is open through an AMA website. You do, however, have to be a member to vote. Finalists are in two categories (Physician and Resident/Medical Student) and include applications for tracking hospitalized patients, surgical equipment preferences, and resident duty hours. Personally, my favorite is “What’s Not Covered,” which helps determine what organisms might escape a patient’s current antibiotic regimen.

Speaking of apps, HHS, through the Office of the Assistant Secretary for Preparedness and Response (ASPR) has issued a challenge for a Facebook application to connect friends who agree to check on each other during emergencies and communicate to the community via social media. “Additional accolades” are promised to entries with a “fun or game-like atmosphere for the user.” Maybe some smart developer can cross Angry Birds with a zombie apocalypse theme. Even smarter Facebookers will be sure to friend Inga, Mr. H, and yours truly.

I mentioned last week that Hofstra North Shore-Long Island Jewish School of Medicine is training their incoming medical students as emergency medical technicians. According to a reader, it’s not as new or revolutionary as it sounds – this was done in 1980 at The Medical College of Pennsylvania:

Bradley K, Anwar RA, Davidson SJ, Mariano J. A time efficient EMT-A course for first year medical students. Ann Emerg Med. 1982 Sep;11(9):478-81. PubMed PMID: 7114594.

Another reader alerted me to news about the Kentucky All Schedule Prescription Electronic Reporting system, or KASPER, which I mentioned as recently announcing it would interface with a similar system in Ohio. Kentucky House Speaker Greg Stumbo is seeking information regarding the system’s use (or lack thereof) by the Kentucky Board of Medical Licensure. Stumbo wants to know why the Board isn’t using data on prescribing habits across various geographic areas to investigate suspect physicians.

The article notes that only 30% of Kentucky physicians are using the system. Let’s see: I’d wager that 0% of suspect (or even slightly shady) physicians would use the system, so I’m not sure how more scrutiny of the data would really be a benefit. It goes on to mention that Public Citizen ranks the state as having the twelfth strictest board for disciplinary actions per 1,000 physicians, having been third and second in previous measurement periods.

September is Women in Medicine Month. I’m thankful for the women who came before and paved the way for the rest of us. I’ve been privileged to have some outstanding women as mentors. We’ve come a long way since Elizabeth Blackwell became the first woman to graduate from a US medical school in 1849. There’s still a bit of inequality out there, however: even with record numbers of women in medicine, my medical class was the first one in our institution’s history where women outnumbered men. We felt this acutely when 60+ women were crammed into a gross anatomy locker room designed to hold 20 women. The men’s locker room had 40 empty lockers. Go figure.

Duplicate Drug Checking
A Reader’s Response

I’m one of those readers who works for a vendor of a clinical drug database, though not the one referenced in the article. For the sake of transparency, I’m in product management at First Databank (FDB).

I agree that duplicate therapy is one of the more challenging domains of medication decision support. In the article under discussion, there was a scenario in which two different physicians wrote aspirin orders five minutes apart for a patient who had undergone a cardiac stent procedure. The authors agreed with the duplicate therapy alert that was fired (though they brought to light that the doctor missed it because it was buried amongst nuisance alerts, which I’ll touch on below).

However, in another context, two orders for the same drug will not warrant a duplicate alert (for instance, when a patient gets a one-time dose in the ED and then the order is continued on the floor). Venue matters. And that’s just one context among a number of different contexts that need to be considered, such as change in level of care, timing of the order, same or multiple clinicians placing the order, etc. Most of these factors are outside the purview of the drug knowledge base.

But I am not passing the buck. It is critical for the drug knowledge base to keep evolving to providing decision support that considers additional context.

One approach is to have the duplicate therapy knowledge driven off of pre-configured orders rather than the drug products. This requires that structured orders be employed by the vendor system, but can more easily identify orders that are intentionally given together, such as a bolus with a continuous infusion, or an order for which the nurse decides on the route (also referenced in the article). One of your sponsors, an MD, uses our structured orders, along with their own logic, and asserts that duplicate therapy does not have to overwhelm. 

Of course, as many have pointed out, dialing back the sensitivity in the content is another obvious component. We have done a lot of work on this over the last year. When I entered some of the key examples in the article into our test system, I found that we matched the authors’ recommendations.

We hit on the previously mentioned example of two aspirin orders, but not on the other alerts which the authors felt were spurious and caused the doc not to notice the true duplicate. Similarly, we satisfied the recommendation to generate a hit for an order for metoprolol IV on top of metoprolol PO.

Mr. H.’s insight that attributing severity for duplicates so that a site can turn off the less severe ones “en masse,” as is done with drug-drug interactions, also needs to be tackled. We do support our users with a solution that enables them to easily customize—turn off, or selectively turn on—alerts even without that attribute. 

We recognize that the volume of alerts is still too high for duplicate therapy as well as other domains and are investing heavily in addressing alert fatigue.

Contacts

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

News 8/31/11

Top News

Prognosis Health Information Systems, Inc. signs a definitive agreement to acquire Creative Healthcare Systems, developers of the financial management and patient accounting system MedGenix. Prognosis will integrate MedGenix with its ChartAccess EHR. Creative Health CEO Steve Everest will stay on board to lead revenue management operations.

Reader Comments

From A Vendor: “Re: Billians Health Data and HIMSS Analytics. Do vendor readers have an opinion of the superiority of one over the other as a source of hospital data? We’re interested both in the database and the networking potential of the organization.” Comments are welcome.

From Antoine: “Re: duplicate med alerts. I’m not sure I agree with your comments. A duplicate check is just a med-med check where the two meds are the same. Whatever deficiencies exist in duplicate checks should exist in med-med checks. The abstract of the article said the number of exact duplicates was high, which I assume is an error, unlike conditions where other factors are different.” The biggest different between duplicates and drug-drug interactions is that the latter are graded by severity at the database level, so they can be turned off en masse and unselectively to suppress noise. Those allowed to display are then almost always clinically significant. The former are triggered by partially or wholly identical drug codes in two or more active orders, but further refinement requires looking at order-specific information such as route of administration, overlapping times, and frequency, and if that isn’t done well, those warnings are rarely clinically useful. In the article, some of the duplicate warnings were appropriate, caused by issues in CPOE such as multiple providers not looking at each other’s orders and entering an exact duplicate. Even exact duplicates may or may not be significant: if one order ends tomorrow and the other starts the next day, the system needs to decide whether that deserves a warning. I have readers who work for vendors of the clinical databases that make these “alert or not” decisions, so I welcome their review of the article. But I’ll stand by my conclusion: duplicate warnings are fairly close to useless, at least as measured by the ultimate yardstick – how many times does the clinician ignore the warning and enter the order anyway?

From ADALMA: “Re: Allscripts. I’m an employee and had two flights cancelled because of the weather. My manager called to say family comes first and not to do anything to jeopardize my family or my safety.” Another reader sent over a company e-mail that, while mentioning safety a couple of times, didn’t explicitly say to take care of family first. I attribute that to the fact that it came from a marketing person, so naturally her focus is on the conference rather than general managerial advice. I’m sure interpretations of what’s between the lines of any e-mail vary based on the reader’s disposition, but it seemed fine to me and I wouldn’t be insulted if I worked there – the company seemed appropriately concerned for the well-being of its employees. I was more interested that the reader told me that company attendees share hotel rooms at the conference, so naturally I had to ask how that works – do you get to choose a bunkmate, and what if one of you snores, is hygienically challenged, or is unusually modest? Answer: you either choose a roomie or have one assigned, or you buy out their half of the room with your own money. Forced room-sharing to save the company money always seems a little bit creepy to me, but I can see why it’s financially attractive when you’re sending hundreds of people to one event (but I still wouldn’t like it). Feel free to send me your first-person stories about that arrangement since I’m sure lots of companies do the same.

From Big Fight Brewing: “Re: 3M. ICD-10 is pushing hospitals to computer-assisted coding. 3M is telling clients that their encoder (used by 4,000 hospitals) will not interface with any NLP or CAC solution other than their own. Big clients are not happy.” Unverified.

From Gilbert O’Sullivan: “Re: UNC Health. Announced to its IT employees Friday that Rose Ann Laureto will be the new CIO. Seems to be a good hire.” She is (or was, if the rumor is true) CIO at University of Illinois Medical Center at Chicago. JP Kichak was UNC CIO until recently and still is on his LinkedIn profile, so that’s all I know.

From TRL: “Re: Cedars-Sinai. Live on Stork and a new fetal monitoring system. I’m a consultant and leadership at Cedars-Sinai might be the best in the country. They demand near perfection, but those of us with high demand skills respect being asked to perform at our best. Far too many places are just happy to follow with some strange comfort that just buying Epic is enough. Make no mistake, Epic is good software, but implementation leadership is EVERYTHING when it comes to success.” Unverified.

Acquisitions, Funding, Business, and Stock

Scotland-based charge master vendor Craneware announces financial results for its 2011 fiscal year: pre-tax profit grew from 2010’s $7.26 million to $8.65 million; revenues increased 34% from $28.4 million to $38.1 million.

Blackstone Group seeks a $1.2 billion loan to fund its $3 billion buyout of Emdeon.

India-based business process outsourcer Ajuba Solutions says US healthcare reform has boosted its business, encouraging the company to spend $5 million on technology and $5 million on a new building. It will hire 700 new employees.

Sales

West Virginia Health Information Network selects Thomson Reuters HIE Advantage for its technology backbone.

Ardent Health Services (TN) expands its use of Surgical Information Systems solutions to include anesthesia documentation.

Reston Radiology Consultants (VA), Washington Radiology Associates (VA), Shady Grove Radiological Consultants (MD), and Advanced Diagnostic Radiology (MD) select Merge Healthcare’s RIS.

PriMed (CT) expands its relationship with MED3OOO by selecting InteGreat EHR for its 28 locations and 75 providers.

People

Brad Levin is named North American GM for Visage Imaging. He was previously with GE Healthcare.

Impact Advisors hires Michael Nutter as its director of firm culture and associate satisfaction, a position it also calls “happyologist.” He was previously with Florida Hospital.

Huron Consulting Group names Michael Cadwell and Andrew Schramm as managing directors in its healthcare practice. They’re from Ingenix Consulting and Tefen Management Consulting, respectively.

Lisa Crymes joins Bottomline Technology as director of healthcare products and strategy. She was previously with Emdeon.

Announcements and Implementations

eHealth Global Technologies deploys Axolotl Image Exchange to provide diagnostic image exchange services for hospitals participating in HealtheConnections RHIO of Central New York.

The American National Standards Institute (ANSI) launches the  Permanent Certification Program for HIT that will accredit organizations that certify EHRs. The permanent program will replace the current temporary certification program in 2012. ANSI is accepting applications through October 7.

Allscripts reports that over 4,700 attendees are taking part in this week’s ACE meeting in Nashville.

Florida providers can now use secure email though the Florida HIE Direct Secure Messaging (DSM) service. The secure messaging service is the first milestone in the HIE’s $19 million initiative, which uses technology from Harris Corporation.

Addington Hospital says it will be the first in South Africa to implement Meditech 6.0.

Travis recently mention on HIStalk Mobile something that I hadn’t heard – Facebook allows drug companies (and only drug companies) to disable or edit comments left on their wall. Facebook announced on August 15 that it will no longer give drug companies that option except on pages created for specific drugs. Several drug companies have deleted their pages, while others allow comments if they adhere to stated policy. The reason for Facebook’s original special handling of drug company pages makes sense – if someone’s public comment suggests they’ve experienced an adverse drug event, the company might have to file a report with the FDA, at least in the absence of FDA policy that says otherwise.

Government and Politics

US CTO Aneesh Chopra will deliver a keynote speech at the Consumer Electronics Association’s Industry Forum in San Diego next month. The press releases mentions the announcement of “a major, new digital health and fitness program.”

Innovation and Research

Researchers at Tel Aviv University create a Facebook game that will help them understand how infections spread. PiggyDemic allows Facebook users to infect their friends, which the researchers say is how viruses really spread rather than being distributed equally across populations.

Technology

Yale’s medical school will no longer provide printed course materials, instead giving students iPads and putting all the study materials on them. They expect to save up to $100K in annual printing cost plus the labor involved. “It really makes the curriculum imminently updateable,” the assistant dean was quoted as saying, although hopefully in his mind — unlike that of the reporter — he spelled it “eminently.” Students get an iPad, apps to manage the reading material and recorded lectures, and a gift card to buy a keyboard. Harvard Medical School isn’t quite there yet, letting students buy whatever mobile device they want and giving them the choice of paper or electronic course content.

Physical therapists at Banner Good Samaritan Hospital (AZ) are using video games to put rehab patients through painful exercises. Patients like Wii Bowling, but the hospital is experimenting with Microsoft’s Xbox Kinect since it covers the whole body.

SeeMyRadiology.com releases a free iPhone/iPad remote viewing tool for its medical image exchange.

Other

Vince keeps digging deeper with his company HIStories, aided by readers who send him memory-jogging historical tidbits, so Gerber Alley turned into a two-parter, with Part I above. If you have Gerber Alley info to share (especially any photos of Urban Gerber, who died in 1984) it’s not too late to contribute to next week’s Part II. I love reading these, especially when I recognize someone’s name or picture. I’m thinking about starting an Healthcare IT Hall of Fame with a panel of voters to choose from the nominees. Wouldn’t it be cool to see them inducted at HIMSS or something? Everybody’s suddenly nostalgic about the history of Apple and Steve Jobs (justifiably), so why not our own industry, which goes back even further? Not to mention the “doomed to repeat history” thing.

In Taiwan, HIV-infected organs are mistakenly transplanted into five patients after a hospital staffer misunderstands “non-reactive” instead of “reactive” when the donor’s HIV test results are called in and not double checked.

Indianapolis Colts quarterback Peyton Manning delivers this great line to reporters after being peppered with a few too many questions about his May neck surgery and ongoing recovery:

“I don’t know what HIPAA stands for, but I believe in it and I practice it.”

Apple gives new CEO Tim Cook over $380 million worth of shares, awarded if he remains an employee for ten years.

El Camino Hospital (CA) hires celebrity nurse practitioner Nurse Barb, who seems to already be a hospital employee although it’s not exactly clear, to develop a televised health series and to increase its social media presence.

Weird News Andy was so moved by this story that he titles it, “Sheer brilliance of doctors” with only a tiny trace of his usual dry humor. An 86-year-old Arizona man drops his pruning shears while gardening. The sharp end sticks in the ground and the man slips and falls while picking them up, jamming the protruding handle through his eye socket and into his neck, pressing directly against his carotid artery. Surgeons at University Medical Center remove the shears and repair the damage with wire mesh, saving his eye and leaving him fully recovered other than some minor double vision. There’s plenty to dislike about the US healthcare system, but if you’ve got a lawn tool jammed into your skull, be glad you’re here.

Hurricane Irene Updates

Forty-three patients from Johnson Memorial Medical Center in Stafford Springs, CT were transferred to other facilities when the hospital lost power from two separate power feeds Sunday morning. The hospital had switched to a backup generator, but it failed.

Staten Island University Hospital was one of several hospitals evacuated in advance of Irene. CIO Kathy Kania reports that the hospital sustained only minor damage, including water in “peripheral” portions of the IT department. All IT systems were restored to full operations between 1:30 p.m. and 9:30 p.m. Sunday.

In the mid-Hudson Valley region of New York, flooding and damaged roads are creating the biggest problems for hospitals. Bridges approaching St. Anthony Community Hospital are washed out, leaving the hospital on an island. Several parking lots at Bon Secours Community Hospital are under water and flooding on local roads is making it difficult for employees to get to work. Meanwhile, St. Luke’s Cornwall Hospital is fully functional, though relying on a backup generator.

Dorchester General Hospital (MD) was evacuated Sunday morning and 30 patients were transferred after wind and rain damaged the roof. By 2:00 a.m. Sunday, the floor was covered in four inches of water and water was pouring from the ceiling. The laboratory sustained the most damage, though the ED, operating rooms, central supply, some patient rooms, and the chemo unit were affected.

SCI Solutions offered its customers free appointment voice reminder calls before the storm hit, working with partner TeleVox. Patients with scheduled appointments got a telephone message of the hospital’s choosing, with one hospital’s chosen message being “Hurricane Irene may disrupt power at the facility your appointment is scheduled. Please contact the facility before you leave home to ensure your appointment is still possible and/or call Central Scheduling for information. Please continue listening for your appointment details.”

Sponsor Updates

• maxIT Healthcare presents the Beads of Courage Beads in Space tour, which is traveling to 10 US cities in honor of September’s Childhood Cancer Awareness Month.
• Consulting Magazine includes Impact Advisors and North Highland on its list of 2011 Best Firms to Work For.
• Billian’s HealthDATA introduces HITR.com, a social networking tool for benchmarking hospital IT satisfaction, at an August 31 webinar.
• ESD rolls out its new branding and Web site at Allscripts ACE. Also at ACE: Awarepoint showcases its Patient Tracking Board solution and Allscripts unveils its Mobile EHR apps for iPad .
• GE Healthcare hosts a September 7 webinar entitled EMR & Quality Management.
• Central Maine Medical Center (CMMC) ranks among the nation’s 25 Most Wired and Most Improved following its partnership with The Huntzinger Management Group.
• Faith Community Hospital (TX) gets its Meaningful Use check using Prognosis ChartAccess. The 41-bed hospital signed a contract in October, started implementation in January, went live in March, and attested on June 5.
• PatientKeeper announces that its user group conference will be held in Denver September 18-20.
• Frost and Sullivan awards Merge Healthcare its 2011 Customer Value Enhancement of the Year Award for Medical Analytics.
• Imprivata announces that several organizations are have adopted its No Click Access solution for VMware.
• TeleTracking Technologies releases a white paper that lists the top 10 reasons that RTLS location accuracy in healthcare matters.

Contacts

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

HITlaw 8/29/11

William O’Toole is the founder of O’Toole Law Group of Duxbury, MA.

Monday Morning Update 8/29/11

With much of the Northeast exposed to potential disruptions from Hurricane Irene, I’ve created a page for reports from the field. Leave a comment on that post or send your updates and I’ll keep the page current. Many folks will read this Saturday evening or Sunday, so I’m interested to hear what’s going on. Above is video of Coney Island Hospital being evacuated.

From NoHelp: “Re: Dell Services. Has laid off over 20 folks in their Meditech Solutions Group, with more to come across the legacy Perot Systems Healthcare. With Berk Smith departing, Meditech is not letting up on the C/S 6.0, which is killing MSG. Without competition, they are not able to break away from Meditech and say no to them on deals. Dell is getting less and less interested in that business because it costs a great deal to run, with a very high exec in Round Rock telling me the ROI isn’t there. They will be evaluating whether to keep it running in January.” Unverified.

From Ima Peon: “Re: Allscripts. Just sent a message telling employees to come early to ACE or drive in case your flight is cancelled. Nowhere does it say to think about your own family to ensure their safety during the most serious hurricane to hit the East Coast in years.” The conference starts Monday in Nashville. Hopefully the message sender didn’t feel the need to state the obvious – secure your family first and then take whatever transportation is available (at whatever extra company expense is required) to get to ACE on time if at all possible. In the mean time, I’m watching The Weather Channel with fascination – I’m pretty sure those hyper-excited reporters talking live from one eroding beach or another are being overly dramatic. Mrs. H just noticed that one looked fine until he saw that the camera was on him, then suddenly did a hugely exaggerated “the wind nearly blew me away” stumbling move as he recited the cliché phrase, “conditions are deteriorating.” On the beachhead was TWC veteran Mike Seidel, who provided the funniest TV moments ever during Hurricane Andrew in 1992 when he tried painfully to address the non-English speaking Miami audience in the most deadpan, white bread, C-student Spanish imaginable. I’m pretty sure he would die of starvation in a tacqueria (which is where I had some stupendous carne asada tacos for lunch, in fact). I think most of his South Florida viewers were laughing too hard to evacuate.

From The PACS Designer: “Re: Steve Jobs. His outlook is grim in this photo, taken Friday. TPD is praying for him and will miss his elegant product introductions once he is no longer with us. Here’s a slide show on his best moments.” I’m not running the photo (which I suspect is fake for various reasons that I’ll explain if that turns out to be the case) since I’d rather not remember him the way he looks in it. I’ve worked with a few pancreatic cancer patients and their outcomes were all about the same – 6-12 months of a fairly normal pain-free existence with no change in appearance, then a very fast, somewhat merciful slide to the inevitable conclusion. His diagnosis was made in 2004, so he has already exceeded my best guess. Nobody who knows him seems to like him much, but they all respect him. An authorized biography is due out early in 2012, which may be too late for him to see, but I’ll buy it.

From Mavrikg41: “Re: Epic. [hospital name omitted] was rejected by Epic in the evaluation process because Epic thought [CIO name omitted] was ‘going to get in the way of the success of the implementation.’ They called that out in the report to the hospital’s executives as to why Epic would not be a good fit at [hospital name omitted].” Unverified. I’ve left out the California hospital’s name, but it’s a vendor low blow to call out an hospital executive by name to his or her peers as an excuse for turning down their dozens of millions of dollars. Unless Epic is trying to get the CIO fired, why not just politely decline the business without naming names? It does seem that Epic’s model is occasionally somewhat anti-IT, with a fair number of CIOs leaving somewhere between selection and go-live. Once the Epic train gets rolling in a given hospital, you don’t want to get in front of it since frontline executives seem happy let Epic 20-somethings tell them how to run their business (especially the IT part) instead of listening to their own vastly more experienced people. One might therefore postulate that Epic is often chosen in an environment where both the existing IT systems and the people who maintain them are held in some degree of contempt, rightly or not.

From King Biscuit: “Re: HIStalk. It’s very slow to load at times.” It’s nearly always the problematic Internet Explorer that’s at fault, usually long-obsolete versions like IE6 or IE7, but that doesn’t stop some readers from sending me nastygrams like the server is slow or that all readers are having the problem (neither is true). I’m even more frustrated since the buggy, bloated IE was causing some users to not be able to pull up HIStalk at all a few months back, with the only solution being to program around it in a way that slowed the site down for everyone. I tested from work Friday with IE7, Chrome, Firefox, and Opera (all except IE were fresh installs with caches cleared). IE took at least five times as long as all the others to display the main HIStalk page, often getting ridiculously hung up and throwing out errors when displaying components such as Vince’s HIStory slides, YouTube videos, and sponsor ads. It did better once the page had been cached: IE7 took 18 seconds to display the page, while the others were all basically instantaneous (that was again the front page that holds five posts – the e-mail link is to a single post, which comes up faster). I just tried it with a cache-cleared Chrome on a plain old broadband connection and I was reading the post exactly five seconds after pasting in the URL. Solutions:

1. Upgrade IE if you can. IE9 is current and IE10 is in beta.
2. Download any other browser and use it instead, even if only to read HIStalk.
3. Read the barebones version of HIStalk by appending /print/ to the URL that comes in the e-mail blast. To compare for yourself, try this page and then this one. You’ll miss some stuff, but the page will display quickly.
4. Read by RSS reader or on a mobile device, which again won’t display everything, but it will come up quickly.

I used to only dislike IE, but the frustration it causes HIStalk readers has made me hate it passionately as easily the worst browser available, with extra points for puzzling ubiquity. It’s good for one thing: after a fresh Windows install, use it to immediately navigate to Firefox.com to download a reliable, standards-based browser.

Listening: reader-recommended Pylon, an Athens, GA jangle-punk band started in the late 1970s and basically defunct after the death of their guitarist in 2009. Both REM and the B52s said  Pylon was the best rock band to come out of Athens, including themselves, although Pylon didn’t come close to their commercial success. Fun factoid: the female singer, known for her snarling vocals and dervish-like dance moves, is actually a shy, soft-spoken Southern belle who’s now a staff nurse at Athens Regional Hospital, which as the reader observes, would probably shock and maybe frighten her patients if they were to see Pylon’s old concert videos.

My last poll elicited a lot of votes but not a clear conclusion – 55% of respondents say Epic CEO Judy Faulkner doesn’t have excessive federal influence, meaning not many fewer than that think she does. New poll to your right: should Congress cut back on HITECH money as it tries to reduce the national debt? The poll accepts comments, so leave yours to argue your position.

My Time Capsule editorial from Independence Day weekend, 2006: Public Trading Leads to Trouble for Merge and Misys. The obligatory teaser: “Merge’s nemesis was that least-exciting of corporate swashbucklers, the unseen accountant, whose pressured blessing of questionable bookkeeping practices ticked like a time bomb — buying desperate executives time to avoid the torch-waving mob of unhappy shareholders, but eventually blowing up in the faces of anyone unfortunate enough to be in the vicinity at the time.”

Intelligent Medical Objects announces the availability of a free standalone version of its IMO Problem and Procedure terminology products for the iPhone and iPad, giving users a portable medical code reference library.

HIMSS is whining that as the debt-happy Congress tries to make even a token effort to cut out-of-control expenses, they might touch its precious HITECH money, thereby forcing providers to actually buy their own business tools instead of charging them to every taxpayer without their consent. Thus the new poll I’m running.

More on the rumor that Epic implementers at Carle Foundation Hospital (IL) walked off the job just days before its go-live. What actually happened is that five of its eight outsourced trainers left. It had nothing to do with Epic, but rather the company to which Carle had outsourced training (I won’t name the company since I’m hearing only the hospital’s side of the story). The original reader’s rumor said their gripe related to not being paid, presumably by their own company, but I haven’t verified that.

Healthcare learning technology vendor HealthStream announces management changes: Kevin O’Hara, SVP and general counsel, has resigned effective September 16 to take a CEO position with an unnamed early state perioperative analytics vendor. He has been replaced by Michael M. Collier. SVP Eddie Pearson (above) has been promoted to SVP/COO.

Mike Sweeney, president of maxIT Healthcare, tells me that the company has made both the INC 500/5000 lists and Best Places to Work. He says they’re up to 850 employees and are adding 25-30 more each month. I’d say they’re either at or near the top of the independent healthcare consulting food chain now that many of their competitors have been acquired. I’m sure Mike’s getting lots of tire-kicking calls.

Scottish hospital revenue system vendor Craneware expects ARRA to give it a big US boost, with big numbers expected for Tuesday’s report. The CEO expects headcount to double to 440 in the next three years.

Baxter International will acquire Baxa Corp. for $380 million. It offers IV-related pharmacy systems often supported by hospital IT departments: the DoseEdge workflow manager, Abacus compounding software, and IntelliFill automated compounder.

Former HP CEO Mark Hurd, recruited to Oracle a year ago, made $78 million from his new employer in that 12-month period. That plus HP’s recent public floundering probably makes dealing with Larry Ellison tolerable.

UPMC announces fiscal year numbers: $9 billion in operating revenue, $406 million in profit, and $3.6 billion in investments.

E-mail Mr. H.

Hurricane Irene Reports from the Field

If your hospital or other work location is being affected by Hurricane Irene, send me updates and photos. You can leave a comment on this article, e-mail me whatever you have, or use the Rumor Report form (which can also accept attached photos).

News 8/26/11

Top News

Cerner reveals plans for two stainless-steel and glass office towers for its new Kansas City, KS office complex. The exterior design of the buildings is based on a digitized image of human DNA. Construction of the 660,000-square-foot development, which will house 4,000 employees, is expected to be completed by mid-2015.

Reader Comments

From Beau Tocks: “Re: healthcare’s most influential. Not sure that is the real list of movers and shakers in healthcare, so maybe it says something that Mr. H is not on the list!! Did Judy have some airbrushing .. or go under the knife?” The 100 Most Influential list was developed based on votes from the publication’s readers. I’m sure HIStalk readers would have compiled a totally different list. BTW, Mr. H’s insights extend well beyond HIT — he, too commented that Judy’s new headshot looks a little Photoshopped.

From Dr. Nick Riviera: “Re: ExR. In a sales call yesterday, a physician said, ‘I do not want to buy an EMR. The federal government is only paying people that have an EHR. I am going to buy one of those.’” Scary, on many levels.

From EpicBlackEye: “Re: Carle Foundation Hospital. Heard their Epic consultants walked off the job before next week’s go-live.” Unverified. I e-mailed for confirmation, but didn’t get a response. I’m skeptical pending further information.

From MT Hammer: “Re: All Type medical transcription service, North Brunswick, NJ. Acquired by Medquist. Employees notified by e-mail.” Unverified, but also reported by several All Type employees on an MT discussion board.

From St. Eligius MD: “Re: half of physicians practicing with NPs and PAs. Hallelujah! The AMA must be gnashing their teeth. What wonderful news for a new dawn in medical care for the future – MDs actually working with extenders, rather than trying to keep them out of practice. The sun will have actually risen when NPs, PAs, and CNMs can actually open their own practice.”

From Alabaster: “Re: Medify. I know someone in their focus group, which was mostly clinicians with heavy healthcare advocacy experience. None of them found it intuitive, it covers few conditions, and its goals were unclear. I heard they mostly just scratched their heads.” It looked like they found some cool information and built a nice GUI around it without having a clear vision of who would use it and why. It’s like reading one of those slick HIT articles cleverly written by a reporter with no subject matter expertise, where you’re first impressed because it reads so smoothly and authoritatively, but then you realize only in hindsight that it didn’t really say anything useful.

From Porphyria: “Re: Medify. I searched for ‘autism,’ but the treatments suggested had nothing to do with the condition, suggesting several cancer drugs. Very confusing and inaccurate.”

From OhNoPerot: “Re: Dell Services. Another 200+ person layoff today, all in the legacy Perot teams. Healthcare team continues to take most of the hits as the legacy Dell leadership takes over all key roles.” Unverified.

HIStalk Announcements and Requests,

Are you current on all things ambulatory HIT? New this week on HIStalk Practice: Dr. Gregg applauds collaboration between EHR vendors and specialty societies. An EMR vendor promotes transparency with its Meaningful Use Tracking Board. Healthcare costs may rise as hospitals employ physicians. The AMA gives a thumbs-up to Bundled Payments. If you follow ambulatory HIT, make sure you remain in the know by signing up for e-mail updates on the site.

Also, have a look at HIStalk Mobile and sign up for those e-mail updates if you want, which is full of good mobile health news and analysis by Dr. Travis (example: he was the first I’ve heard mention a special deal given to drug companies by Facebook, where they’re allowed to selectively block objectionable postings to their walls).

Listening: reader-recommended Richard Ashcroft, his latest solo CD (he used to be in Verve). He’s apparently wildly full of himself and some of the reviews have been savage (mostly because it doesn’t sound like Verve), but I like it quite a bit. It’s got a nice orchestra-backed, pop-oriented hip-hop vibe, although it’s a bit repetitive and inconsistent. I probably like it better than Verve, which was known for big-sounding, trippy psychedelic lushness  — you would instantly recognize their Bittersweet Symphony, although you probably thought it was U2 when it came out in 1997. 

If you’re in need of JFK-like “ask what you can do for your HIStalk” ideas, here’s a few off the top of my head: (a) sign up for e-mail updates to your right so that you don’t miss anything and so Inga can brag on the number of folks like you who have done so (7,468, since I know you were about to ask); (b) connect with Inga, Dr. Jayne, and me on Facebook and LinkedIn, giving us a Like if you’re so inclined, and joining the HIStalk Fan Club on LinkedIn like our BFFs have done (1,792, since I know you were about to ask once again); (c) send me rumors, news, or other stuff by clicking the big green Rumor Report monstrosity to your right; (d) check out the sponsor ads to your left, which are becoming less animated day by day, and click on any that tickle your fancy; and (e) do some carefree navigating and searching of sponsor-land in the Resource Center. I get the whole passive reader concept, but a little interaction on your part goes a long way when I’m sitting here alone for very long evenings after work trying to be scintillating using the written word alone. Thanks for reading. 

On the sponsor-only Job Board: Epic Implementation Project Manager, Epic and Cerner Consultants, Regional Sales Executive. On Healthcare IT Jobs, which is back online but a little behind on new job postings: NextGen Workflow Process Consultants, Senior Pharmacy Analyst, Manager IS Clinical Applications.

Acquisitions, Funding, Business, and Stock

Trend alert: the growing number of  hospital-based physicians, along with stock market uncertainty, are fueling investments in practice management companies for hospital-based physicians.

RTLS vendor Awarepoint secures $27 million in a Series F financing round led by Kleiner Perkins Caulfield & Byers. The company will use the capital for growth and to drive adoption of its aware360Platform.

Canada-based aviation simulator company CAE acquires Sarasota, FL-based medical simulator technology vendor Medical Education Technologies Inc. (METI) for $130 million.

Sales

Ipswitch Hospital NHS Trust (UK) will deploy Microsoft’s Vergence single sign-on and context management solution to improve clinician access to systems.

People

Microsoft announces the appointment of Michael Robinson as GM of US Health & Life Sciences and Dennis Schmuland to the newly-created position of chief health strategy officer. Robinson previously served as GM, public sector for the Middle East and Africa.  Schmuland is Microsoft’s former national director of Health Plan Industry Solutions.

Voalté hires Teresa Anderson as its chief nursing officer. She was previously an independent consultant for the American Nurses Credentialing Center.

Announcements and Implementations

HIMSS names two Davies Award winners in the public health category: the Florida Department of Health, Bureau of Epidemiology for its electronic surveillance system for early notification of community-based epidemics; and the NYC Department of Health and Mental  Hygiene for its Primary Care Information project.

The Healthcare Business Solutions subsidiary of New Jersey Hospital Association partners with Artificial Medical Intelligence to offer its member hospitals the EMscribe’s Coding Assisting Coding product to facilitate the ICD-10 transition.

Medicomp announces the initial distribution of ICD-10 mappings and functionality in the new version of its MEDCIN Engine. It includes a new user interface to make it easier to use ICD-10 within EMRs, providing clinically contextual, problem-oriented views of incoming data using standard reference terminology.

QuadraMed announces a new version of its Quantim Facility Coding that will support both ICD-9 and ICD-10, allowing users to test ICD-10 transactions while coding live encounters in ICD-9.

WoundVision announces the launch of iNSIGHT, Web-based risk assessment software that supports prediction and prevention of pressure ulcers.

Crestwood Behavioral Health (CA) deploys the OpenDNS Enterprise intrusion-blocking system in its 23 locations.

Innovation and Research

Healthcare costs are lower when clinicians use an HIE to care for ED patients, thereby avoid ordering duplicate services due to lack of information, according to Humana.

Emory School of Medicine establishes a biomedical informatics department, led by Emory Healthcare CMIO Joel Saltz MD, PhD. He’s also a professor in Emory’s departments of pathology, biostatistics and informatics, and mathematic and computer science (his PhD is in computer science).

Other

GE Healthcare informs Milwaukee-area employees of its intention to cut 81 manufacturing jobs, primarily in assembly operations for GE’s diagnostic imaging business. Those affected likely include some who participated in the company’s annual Community Service Day this week by sprucing up 400 classrooms in area schools.

Kirby Partners is conducting a survey on hospital IT employee retention, with results to be presented at the CHIME CIO Fall Forum (and here first, they’ve promised, in return for my mentioning it). I looked it over and the questions are good. To take the survey, click the appropriate variant: CIO, manager/director with people management responsibilities, or staff member with no people management responsibilities. UPDATE: I changed the survey links because their setup is a bit goofy – the original links forwarded to a specific link that gave the “you already took this survey” message. Try again if you’re interested.

Despite an overall trend towards enterprise solutions, Dimensional Insight’s Diver Solution earned top markets in a KLAS report on business intelligence. Information Builders’ WebFOCUS, IBM Cognos 8 Business Intelligence, McKesson’s Horizon Business Insight, and SAP XI Data Analytics were also ranked.

The Texas prison system has saved almost $1 billion over the last 10 years by implementing a statewide EMR and leveraging telemedicine, according to a press release issued by its EMR vendor (BCA) that cites a Gartner study.

Minnesota Health Information Exchange (MN HIE) quietly shuts down, merging its operations into a Duluth-based Community Health Information Collaborative (CHIC). CHIC’s president and CEO says their work overlapped and there wasn’t enough grant money to go around. MN HIE focused on EDs, with some big-name players that included Allina, BCBS, HealthPartners, and the state’s Department of Human Services. The splashy 2007 announcement of the formation of MN HIE, in which the governor said it would be one of the largest in the country, is here.

An Indiana prosecutor will ask the Office for Civil Rights to investigate the apparently intentionally circulated medical records of a city judge (and election candidate) following his stay at IU Health Ball Memorial Hospital.

Fellow shoe enthusiasts: a friend of mine wore these beauties to a party we attended last weekend. Sadly, I was unsuccessful at stealing them. They come from Turkey, so if you happen to be traveling that way, let me know.

Sponsor Updates

• Companies earning a spot on Inc.’s Top 500/5000 include Advanced MD, Concerro, Culbert Healthcare Solutions, Cumberland Consulting Group, e-MDs, EnovateIT, Enterprise Software Development (ESD), GetWellNetwork, Greenway Medical, H/P Technologies, Hayes Management Consulting, Healthcare Innovative Solutions (now part of Beacon Partners, which also was just named to the Top 100 Best Places to Work in Healthcare list), Iatric Systems, MED3OOO, MEDSEEK, TeleTracking Technologies, Vitalize Consulting Solutions, and ZirMed.
• iSirona releases a white paper illustrating how device integration improves EMR data.
• MD-IT announces a series of webinars for channel partners and transcription associates.
• ICA Informatics releases two new white papers entitled HIE Strategies Discussed at HLNY ACHE and HIEM Expands Use of CareAlign HIE Platform.
• Practice Fusion’s Research Division releases data indicating that one out of three children are now overweight or obese.
• ZirMed partners with Waiting Room Solutions to offer an insurance eligibility and claims solutions for physician offices.
• SCI Solutions will participate in healthcare access management meetings in Maryland, North Carolina, and Arizona in September.
• MEDecision achieves NCQA HEDIS recertification.
• A Billian’s HealthDATA  blog entry discusses the benefits of data in healthcare.
• Nuance offers a webinar entitled Spotlight on Innovation: eScription V10 on September 14.
• Grays Harbor Community Hospital expands its use of Access Intelligent Forms Suite after a successful pilot.
• Aspen Advisors announces successful implementation of CPOE at Virtua (NJ).
• Samaritan Medical Center (NY) selects ProVation Order Sets.
• Frank L. Urbano, MD joins the care coordination and compliance practice of BESLER Consulting.
• Lahey Clinic (MA) selects computer-assisted coding technology from 3M Health Information System.

EPtalk by Dr. Jayne

I’m surprised it hasn’t happened before now — the marketing people have apparently found my e-mail address. Today was apparently Send Jayne a Press Release Day. Leading the pack in the “why bother” division was the American Medical Association with an absolutely banal statement about its stance on bundled payment initiatives at CMS. Blah, blah, blah. The AMA is increasingly seen as irrelevant, and if they hope to counter that sentiment, they really should step it up.

As usually I’m a bit behind in my e-mail, so I was going through it during an extremely boring Grand Rounds presentation. Direct-to-physician marketing group Physicians Interactive wanted my opinion about something. Usually I ignore those messages, but this one invited me to participate in an 8-10 minute market research study about my “use of ePrescribing and Electronic Medical Records.”

With the promise that my opinions would “assist in understanding the potential for reaching Health Care Professions through ePrescribing/EMRs” as well as “help to evaluate the value of integration of clinical reference materials at the point of ePrescribing” I decided to give it a whirl. Unfortunately, the survey was closed by the time I responded. Maybe that’s an incentive to keep up with my e-mail. I’d love to see how companies are thinking about marketing through EHRs. Just what we need – more distractions that are incorporated into our workflows for secondary gain.

In follow up on an item I mentioned earlier this month, the South Carolina man who was denied Medicaid coverage for his breast cancer treatments has been granted coverage by the state Department of Health and Human Services. Director Tony Keck states, “If the federal lawyers choose to deny those claims based on a discriminatory policy, that is their choice and our department will appeal the decision.” I’m no Constitutional lawyer, but score one for states’ rights and general human dignity.

This week is National 5010 Testing Week. Are you ready? From talking to my colleagues, it seems there are quite a few practices out there that aren’t even on compliant software yet.

Hofstra North Shore-Long Island Jewish School of Medicine began classes this month. As a brand new medical school, faculty are putting some interesting spins on how physicians are trained. One of these initiatives includes training incoming students as Emergency Medical Technicians. The goal is not only to teach students valuable skills, but to reinforce the team care concept of medicine.

The school is holding off on its traditional “white coat ceremony” (where students are presented with the white trainee’s coat and often take the Hippocratic Oath) until after the students take the New York state EMT exam. I’ll be looking forward to seeing how these students progress and how a new medical school incorporates healthcare IT in training. If you’re on faculty or involved in this program, I’d love to hear from you.

Contacts

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

News 8/24/11

Top News

HHS announces its Bundled Payments for Care Improvement initiative, a new CMS program that allows hospitals, physicians, and other clinicians to bill their services as a single package instead of as separate items, giving them incentive to manage care better. Applicants can share in the savings over traditional fee-for-service costs, defining their episode of care as one of four models: hospital stay only, hospital stay plus post-acute care, post-acute care only, or a single all-encompassing bundled payment.

Reader Comments

From BubbasChili: “Re: healthcare reform. I have the answer – legislatively re-categorize insurance companies to non-profit status and require that profits over a given amount be distributed back to consumers. I would also push tort reform, but my first idea is the fix. Just my two cents.” Maybe that requirement should be applied to non-profit hospitals first.

From GladItsNotMe: “Re: Lehigh Valley, PA. Has started the evaluation process to replace the old Carecast system. Rumor has it being replaced by that little ol’ vendor out of Madison, WI.” I was too busy at work today to ask Harry Lukens, so I’ll leave this as unverified for now.

From PHEye: “Re: CDC’s Public Health Informatics conference in Atlanta. A speaker complained that HIStalk doesn’t cover public health.” I sometimes touch on public health topics that don’t get much attention otherwise, but those news items aren’t always that interesting to me and probably wouldn’t be to my predominantly hospital-based readers either. And while I appreciate the confidence the unidentified speaker places in a part-time blogger, full-time hospital employee to branch out into an entirely new discipline, I do need to sleep occasionally. I’d be happy to start up a fun, informative public health version of HIStalk as a public service if CDC wants to spend some of its legendary grant money to allow me to quit my day job, but otherwise I don’t have the time to take on new challenges.

From Reporting In: “Re: RelayHealth. Here’s Jim Bodenbender’s e-mail announcing that sales SVP Mike Lang has resigned to work for an EHR vendor. Jeff Gartland replaces him.” I’ll mark this as verified since RelayHealth already updated its management page with Jeff as sales SVP.

From 11YearHITVet: “Re: consulting with less travel. I’m burned out and would like a 50% or less travel schedule. Some of said go into interface work or designing Cerner PowerNotes. Ideas?” I think it depends on how you define “consulting.” Certainly you could do build work remotely, working either for someone else or yourself. Vendors do most of their work of this type offsite given ubiquitous and fast broadband (some of it remotely from Asia, in fact.) But that’s probably not the sexy, high-paying work you’re doing now as the PowerPoint-wielding, suit-wearing expert from afar. If you’re doing general management or operational consulting, it’s really a completely different line of work to do remote technical or functional application support (or to just hire on permanently with a client, for that matter). If  you are willing to make that change and have experience, there’s work out there, especially if you know the hot packages like Epic or Cerner. I’ll let readers chime in since I’ve never been a full-time consultant.

Acquisitions, Funding, Business, and Stock

MedAssets gets approval from its board to repurchase up to $25 million of its stock.

Sales

Presbyterian Healthcare Services (NM) signs a multi-year agreement with Health Care DataWorks (HCD) for its Enterprise Data Warehouse Appliance.

Geisinger Health System chooses Altosoft Insight for Pathology for real-time clinical and AP lab reporting.

Montfort Jones Memorial Hospital (MS) selects NextGen’s inpatient clinical and financial systems.

People

CHRISTUS Santa Rosa Health System (TX) hires George Gellert MD for the newly created position of regional medical informatics officer.

Joyce Hunter, CEO of government healthcare IT consulting firm Vulcan Enterprises, joins HavServe, a volunteerism service for developing countries, as CEO. She has volunteered with a number of healthcare IT organizations, including the local HIMSS chapter, HITSP, Maryland’s CRISP HIE, and Cal eConnect.

Announcements and Implementations

Jersey Shore Hospital (PA) and Fulton County Medical Center (PA) team up to implement Meditech EMR. The critical access hospitals expect to save about $300,000 each by sharing hardware at a hosted facility and scheduling training and implementation at the same time.

Anoto Group announces implementations of its digital pen and paper technology, including Shareable Ink’s implementations with Allscripts, Cerner, Epic, McKesson and Meditech. Other new partnerships directly with Anoto or its resellers include NextGen Healthcare, Intelligent Medical Objects, Waiting Room Solutions, Nightingale Informatix, and Bayscribe.

The Community Health Information Collaborative (CHIC) announces plans to consolidate its operations with Minnesota HIE, resulting in a single state-certified entity named HIE-Bridge.

Ministry Health Care (WI) will implement EHR Doctors’ Medibridge.net HIE technology to enable the exchange of patient information and provide patients with access to their health information.

The Electronic Healthcare Network Accreditation Commission (EHNAC) develops an Outsourced Services Accreditation Program for HIE technology service providers. The program will evaluate HIE vendors to verify they meet industry standards of quality for PHI; follow appropriate privacy and security regulations; and meet acceptable standards for technical performance, business processes, and resource management.

The governor of Guam announces the launch of its first HIE, mentioning that Guam Memorial Hospital will get $5 million in federal incentive money and another $21 million is available for doctors who sign up.

Government and Politics

UK health secretary Andrew Lansley calls on developers to create applications that relate to one of five healthcare themes: personalization, improved outcomes, autonomy and accountability, improving public health, and improving long-term care. NHS is running a developer’s contest, but offering no prizes or funding. Consumers are also encouraged to submit their favorite health apps (“maps and apps”) or those they’d like to see developed.

Other

Once again Mr. H was robbed of a spot on this list of the 100 Most Influential People in Healthcare. Representative Paul Ryan tops the list, followed by Vermont Governor Peter Shumlin and President Obama. Donald Berwick, Kathleen Sebelius, and Farzad Mostashardi were included in the top 10, while Judy Faulkner (with an updated head shot) earned the #44 spot.

A watchdog organization finds that only 15 of the largest 100 HIT firms participated in HIT lobbying efforts between October 1, 2010 and March 31, 2011.

The Department of Homeland Security is soliciting vendors to provide an EHR to store medical data on undocumented residents across 22 immigration detention facilities.

Memorial Hermann Healthcare System (TX) launches Houston’s first HIE. Patients must opt in, with 96% of those that have been asked so far saying yes.

Weird News Andy says he can’t top the quote in this article: “a felony case of stupidity.” A workers’ compensation billing company puts detailed medical information on 300,000 California residents on a server that it thinks is visible only to its employees. Someone Googling discovers that the entire database is wide open on the Internet. The “felony stupidity” comment was in reference to the fact that the company didn’t password-protect the information and didn’t include the “noindex” HTML meta tag that tells search engines to skip indexing that page.

A reader sent over a new JAMIA article called Factors Contributing to an Increase in Duplicate Medication Orders After CPOE Implementation. It looked at the impact of implementing Epic’s CPOE in a 400-bed hospital’s adult and cardiac ICUs (Geisinger, I believe). The number of duplicate med warnings quadrupled, which the study found was caused by (a) multiple providers entering orders at the same time; (b) lack of hand-offs; (c) design problems that caused false alarms; (d) poor data display, where providers entered a new order because they didn’t notice an existing one; and (e) poor local design of order sets that contained pre-built duplicates. Providers both pre- and post-study were neutral about the value of duplicate therapy alerts. The study also found that some potentially duplicate orders weren’t flagged, such as duplicates with differing routes of administration and serial orders where the same therapy was ordered at slightly different times. I didn’t see anything surprising here: duplicate warnings are the ‘stupidest’ of the usual medication screening types (drug, dose, allergy, interaction, drug-lab, drug-disease, etc.) and usually make up at least half of the useless warnings that providers see. There’s no really smart way to tell whether two PRN meds that both contain acetaminophen will be a problem – if the patient gets one or the other but not both, then there’s really no duplication (but that can’t be determined until administration time, not when the order is entered).  Smarter systems ignore route differences (IV vs. topical gentamicin) and maybe skip PRN duplicates and those from the same order set completely, but otherwise it’s almost impossible to separate intentional duplication vs. unintentional. Give the high percentage of provider overrides, one might postulate that duplicate warnings do more harm than good, masking significant problems of other types with their sheer volume and rarely resulting in DC’ing one of the alleged duplicates. I’m not optimistic that it’s a solvable problem – you won’t get a useful answer if you ask providers to sketch out a universal decision tree of when to trigger a duplicate alert, so you can’t expect the computer to improve a process that can’t really be designed. Turning duplicate alerts off completely might be the best strategy.

Seattle startup Medify, staffed with former employees of airfare prediction company Farecast, is creating a searchable consumer database of vetted research study information covering side effects, treatments, and symptoms with social networking connections to similar patients. I struck out on my first search when it didn’t recognize “congestive heart failure” as a medical term, but got a lot of information on “cellulitis” (which talked a lot about maggot therapy for debridement). It’s aimed at consumers, but it looks to me like clinicians would find it useful to get current thought on treatments (not to mention that consumers aren’t going to pay out of their own pockets, but the usual pharma/insurance companies might if it could improve outcomes or cost). Besides, a lot of what it returns is barely understandable even to providers, like when I clicked “clindamycin” for cellulitis and got, “A semisynthetic broad spectrum antibiotic produced by chemical modification of the parent compound lincomycin. Clindamycin dissociates peptidyl-tRNA
from the bacterial ribosome, thereby disrupting bacterial protein synthesis. (NCI04)” Not exactly a compelling Facebook post like the maggots would have been.

The Washington Post highlights an interesting conflict: Medicaid is trying to reduce overuse of EDs as free doctors’ offices to save taxpayer dollars, but much of the potential savings isn’t being realized because hospitals are aggressively marketing their EDs for routine care, hoping to pump up profitable admissions. A quote from South Carolina’s Medicaid director: “When you are advertising on billboards that your ER wait time is three minutes, you are not advertising to stroke and heart attack victims.” For-profits HCA (which runs wait time billboards) and Tenet (which runs billboards and also accepts online ED appointments) claim they haven’t seen a significant increase in Medicaid visits.

Hospitals in Wales are testing university-developed software that can reduce wait times and analyze the cost-effectiveness of medical treatments. It uses simulation and queuing theory, which the project’s director likens to a 1990s computer game called Theme Hospital that allows what-if analysis.

Here’s the kind of lawsuit lunacy that forces hospitals to hire expensive lawyers. A (barely literate) former patient claims a hospital surgeon, while removing his tonsils, implanted a GPS tracker into his armpit.

Sponsor Updates

• Shareable Ink will participate in the Innovation Booth at next week’s Allscripts user group meeting, ACE. The company also gets a mention in a Wall Street Journal article discussing Nashville’s growing  healthcare industry. 
• Holon introduces Pharmacy Workflow Manager, which allow hospitals and IDNs with multiple locations to manage and report workload and productivity.
• GE Healthcare launches Centricity Business 5.0.
• TeleTracking announces the release of RTLS TempTracking.
• CynergisTek announces the release of its Meaningful Use Security Program to assesses compliance with security regs and reduces risk in preparation for MU attestation.
• Modern Healthcare’s 2011 Top 100 Best Places to Work in Healthcare includes Aspen Advisors, Encore Health Resources, Enterprise Software Deployment (ESD), Hayes Management Consulting, Iatric Systems, Impact Advisors, maxIT Healthcare, and The Advisory Board Company. Rankings will be revealed in October.
• Sentry Data Systems will attend Health Connect Partners Hospital Pharmacy Conference next month in Phoenix.
• Orion Health is hosting a free webinar on August 31 entitled Integrating HIE into Clinical Workflow.
• e-MDs launches e-MDs Rounds for the iPhone, giving doctors access to their EHR data via their mobile device.
• Jason Colquitt, Greenway Medical’s director of research services, is elected to a two-year term on the HIMSS EHR Association’s executive committee.
• Perceptive Software hosts a job fair this week at its Shawnee, KS headquarters. The company is seeking to hire more than 60 people in R&D, sales, and professional and technical services. Also announced: the company’s ImageNow product has earned Modular HER certification for both inpatient and ambulatory.
• Informatics Corporation of America and the Health Information Exchange of Montana announce that as of June 6, 2011, three hospitals and one community health center are connected using ICA’s CareAlign HIE solution.
• ZirMed earns its sixth consecutive spot on Inc magazine’s annual ranking of the nation’s fastest-growing private companies.

Contacts

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

Monday Morning Update 8/22/11

From Hot Off the Press: “Re: Cal eConnect. President and CEO Carladenise Edwards PhD steps down.” HOTP forwarded her e-mail from late Friday afternoon announcing her transition to senior advisor of the HIE organization due to “personal reasons.” Cal eConnect was created when California’s HHS department, overseer of $39 million in federal HIE grant money, decided to form a new statewide oversight organization instead of supporting CalRHIO, effectively shutting that organization down in January 2010. TechLeader obtained information suggesting that earlier last week, Cal eConnect suspended its RFP for a provider directory service, with no bidder selected.

From THB: “Re: tax-exempt hospitals. A potential trend?” Three non-profit Chicago area hospitals express shock that the Illinois Department of Revenue has denied their tax-exempt status requests, ruling that they aren’t owned by charitable organizations and aren’t being used for primarily charitable purposes and therefore must pay property taxes like any other business. The state said the hospitals didn’t list uncompensated care on their requests, but did in their own records: Prentice Women’s at Northwestern (1.85% – pictured above), Edward (1.04%), and Decatur Memorial (0.96%). The state says it won’t set a minimum charity percentage, although one legislator is sponsoring a bill that would require at least 3.5% of total revenue. Just for fun, I checked the IRS forms of Edward Hospital: it made a profit of $25 million in the most recent year, paid the CEO $1.6 million, and claimed it provided $45 million in charity care.

From The PACS Designer: “Re: IBM’s 100th anniversary. Most all of us have encountered business relationships with IBM in our work careers. TPD first learned about IBM solutions in the early 1960s while getting educated to be an electronics engineer by being trained on the use of an IBM vacuum tube computer. Later in my electronics career, I worked with IBM to interface the IBM Shark information storage system to a PACS to create one of the first central archives for all hospital information including imaging files.  InformationWeek recently published a video history of IBM’s 100 years.”

Thanks to a few of my overachieving sponsors who have already swapped out their animated ads with a static replacement, well in advance of the January 1 deadline I set to allow them plenty of time. I appreciate it, as do those many readers who requested that change.

Over 60% of respondents agree with the recommendation of Congresswoman Renee Ellmers that HHS study EMR effectiveness and impact on patient safety. New poll to your right: does Epic CEO Judy Faulkner have too much influence on federal government healthcare IT decisions?

Listening (and watching): reader-recommended Live from Daryl’s House, a fascinating Internet program created by (and paid for by) the first half of Hall and Oates. I hated the 80s poofy-haired, “blue-eyed soul” dreck they did and was kind of hoping he’d been reduced to unpaid gigging at the Paducah Holiday Inn, but I now want to be Daryl Hall: inviting all kinds of big music names to jam with him in a barn-like room of his $16 million spread, drinking wine, bringing in guest chefs to cook for them, having scintillating dinner conversations, and recording the whole thing as a homebrew reality show. The audio and video quality are amazing, the guests compelling. My favorites so far have been Grace Potter and the Nocturnals and Krieger / Manzarek of The Doors, with whom Hall does just fine vocal work on my favorite Doors tune, The Crystal Ship. He’s 64, rich, and living large, just playing his music to an Internet audience. I’ll grumblingly admit that even the versions of Hall and Oates tunes he and his guests covered (like the insipid Sara Smile) sound amazing and fresh. I wish I could be that cool.

I swear that Vince Ciotti is digging deeper into company histories with every new HIStory chapter, finding veterans willing to share their previously untold stories. This time he  covers a company I don’t remember: Sentry Data. Upcoming are these vendors: AR/Mediquest, JSData, and Gerber-Alley, so if you have war stories to tell about them, Vince is your guy.

Urology EHR vendor meridianEMR files a lawsuit and gets a restraining order against competitor Intuitive Medical Software (UroChart), claiming UroChart cloned one of its servers and thereby gained illegal access to meridianEMR’s product and the protected health information stored by its clients.

The weekly employee e-mail from Kaiser honcho George Halvorson talks up their first iPhone app, KP Locator, which he says is “the next connectivity path on a journey that is turning into a superhighway of connectivity over time.” He says it’s the first of many that will be built and invites employees to send him ideas for the next round.

An article in Silicon Valley / San Jose Business Journal details how much local hospitals are spending on EMRs. Factoids: (a) 403-bed Mills-Peninsula Hospital spent $50-75 million; (b) six Daughters of Charity hospitals spent a total of $80-90 million; (c) Stanford says it’s spending 30% of its total available capital each year to implement EMRs; (d) Stanford also spent $13 million to hire a 100-member temporary go-live team for three weeks, which must be a misprint or an incomplete description since that’s over $800 per hour;  (e) O’Connor Hospital spent $2-3 million on EMR training; (f) Mills-Peninsula expects to spend 2.5% of the hospital’s entire budget each year in perpetuity for EMR maintenance.

Beth Israel Deaconess reportedly offers its CEO job to Kevin Tabb, chief medical officer at Stanford Hospitals and Clinics, who would replace the ousted Paul Levy. He’s an internist, but went into healthcare IT straight out of residency as a clinical informatics analyst for iKnowMed, a data director for MedicaLogic, president of clinical data services for GE Healthcare, and then chief quality officer / CMIO for Stanford. Sounds like he would be a geeky kindred spirit for CIO John Halamka there.

Asante Health System (OR) chooses Epic, saying “only one vendor had an integrated solution for hospitals and physician offices, and that was Epic.” They also added that Epic puts 47% of earnings back into R&D and has less than 2% of its workforce involved in sales and marketing.

Thirteen Danish hospitals announce plans to migrate their 25,000 employees from unnamed proprietary office software (care to take a guess?) to the open source LibreOffice, a fork of OpenOffice.org.

A computer professor in England enlists the help of his colleagues to create a computer game to help his four-year-old daughter, who has cystic fibrosis. She can control on-screen graphics by breathing into a PEP mask, which forces her airways open, an otherwise monotonous exercise that kids don’t enjoy. Her doctor can review her game results to determine how her lungs are doing. The group hopes to have the game tested and available to the public within a year.

Former Allscripts COO Ben Bulkley is running Fluidnet, a Massachusetts-based IV infusion control system vendor that just raised $25 million in investment capital.

HP wants out of the consumer computer business, but its systems work isn’t such a hit in Ohio either, where the Medicaid Information Technology System that went live on August 2 is inappropriately denying payments to providers, improperly kicking patients off assistance programs, and causing prescriptions to go unfilled by rejecting the Medicaid bills from pharmacies. Rep. Dennis Kucinich will meet with CMS administrator Don Berwick on Tuesday.

Regulation of EMRs by FDA
By Tim Gee

In the HIMSS top nine trends to watch in health IT, they missed a big one: the regulation of EMRs and other applications by the FDA, and potentially transforming providers into medical device manufacturers.

Between the final MDDS rule (which called out hospitals as potential regulated medical device manufacturers) and public testimony by Jeff Shuren, director of CDRH at FDA that the FDA intends to regulate at least some EMR software, healthcare IT is going to be coming to grips with FDA regulations for some time to come.

How many hospitals have written software to acquire data from medical devices? I’d guess over 100. I’ve heard estimates from sources that FDA expects to be regulating thousands of new manufacturers in the near term.

Since the final MDDS rule was published, four providers have registered with FDA as medical device manufacturers and listed their MDDS products with FDA. The providers are Partners, Gundersen Lutheran, Intermountain Health, and the Alaska Native Tribal Health Consortium.

And when FDA regulates portions of EMRs (they’ve set their sights on decision support systems first), providers who modify their EMR applications may be transformed into medical device manufacturers and become regulated, too. How many early adopter hospitals have have written their own DSS from scratch? They, too are likely to become regulated medical device manufacturers.

The MDDS rule was the shot across the bow. Expect a draft guidance document from FDA on regulating EMRs late this year. Yes, FDA will go slow, but responding will be like turning a battleship – it will take a while and require substantial effort in some cases.
In the next two or three years, I’ll bet most hospitals will be looking to hire regulatory affairs / quality assurance directors, and many hospitals may be rethinking their wholesale modification of HIT apps they purchase, not to mention foregoing rolling their own apps.

E-mail Mr. H.

News 8/19/11

Top News

General Dynamics will acquire federal healthcare software vendor Vangent for $960 million, the company announced this week. Says the General Dynamics chairman and CEO, “Vangent is a well-regarded, fast-growing company that will add significant depth and breadth to General Dynamics’ healthcare IT organization, creating a Tier 1-level healthcare IT business unit with the scope and scale to compete in markets that are receiving high priority in current funding and entitlement-reform initiatives” The Arlington, VA-based Vangent, which has 7,500 employees, does work for HHS and the military. It developed the Army’s MC4 battlefield EMR. Kerry Weems, SVP and GM of Vangent’s Health Solutions business, joined the company in 2009 when he left his government position as head of CMS. He was also vice chairman of the American Health Information Community.

Reader Comments

 

From Watchdog: “Re: HIMSS. Pictures of its new headquarters in the financial district of Chicago. They also hired Steve Rosenfield as executive vice president / managing director of HIMSS Media, a new position and department, and seek an associate manager of social media to improve the society’s ‘positive visibility.’ All that was required is an Associate’s Degree.” Steve doesn’t appear to have a degree, but did write co-write this book documenting the late 70s history of an influential Long Island club that includes photos and an audio CD of the folks who performed there (Springsteen, Aerosmith, Rick Derringer, Stanley Clarke, etc.)

From One Of Their Hospitals: “Re: MDG Medical. The support numbers are no longer in service.” I ran this reader’s rumor last week, in which he said his hospital’s pharmacy got word from the pharmacy dispensing automation vendor that they would close their doors last Friday. I said I wouldn’t name them until I checked to see if the phones were disconnected. Sure enough, the support number and PBX option now give a fast busy. The Israel-based company opened an office in Beachwood, OH in 2001 and moved its corporate headquarters to Aurora, OH in 2010. It claims to have 150 hospital customers and was announcing expansion plans as recently as October. I can’t verify anything other than that their support numbers aren’t working and they didn’t respond to my earlier e-mail asking about the rumor.

From Wildcat Well: “Re: RECs. There have been claims that healthcare IT will be the primary sector for job creation. Does it count when a REC receives funds from ONC, the REC coordinator contracts for systems integration work with ‘local’ vendors, and the jobs are filled through the overseas facilities of those vendors? We may just be stupid enough to deserve the mess we are in.”

From Hate Manual Entry: “Re: Sage Healthcare. Rumor is they bought a SaaS-based HER from a recently bankrupted company. Any others hearing the same?” We asked Sage, which said that for competitive reasons, they don’t comment on acquisitions or technologies that may or may not be under consideration.

From Laura: “Re: Joplin. I’m sure you’ve seen that Mercy has announced plans to rebuild in Joplin. They have kept employees on the payroll since the May tornado and raised $500 million in a co-worker fund to help with expenses.” The 28-hospital Mercy (formerly called Sisters of Mercy) will spend $950 million to build a new 327-bed hospital in Joplin. They’re an Epic shop, I believe.

HIStalk Announcements and Requests

Check out the good stuff on HIStalk Practice: Don Michaels of Hayes Management Consulting and the Harvard School of Public Health weighs in on ACOs and the results of CMS’s demonstration project. Julie McGovern of Practice Wise offers recommendations for providers upgrading their software. Rob Culbert of Culbert Healthcare Solutions suggests key performance indicators to assess a practice’s financial health. CMS provides a breakdown of EMR Meaningful Use payments by specialty and provider type. The GAO advises CMS on how to improve physician quality reporting. I’m a simple gal with simple needs and I’ll be simply thrilled if you sign up for e-mail updates while visiting HIStalk Practice.

On the Job Board: Project Manager I, Epic and Cerner Consultants, Senior Enterprise Sales Executive.

Acquisitions, Funding, Business, and Stock

drchrono closes an additional $650K in seed funding and announces the release of OnPatient, a free patient check-in app for the iPad.

Deloitte acquires the assets of Intrasphere Technologies, a New Jersey drug safety and regulatory consulting company that also offers R&D informatics software for registering clinical trials.

HP announces a restructuring that includes ceasing production of tablet computers and smart phones, trying to sell its PC business, and spending $10 billion to acquire British search technology vendor Autonomy at a 64% premium to its share price. The HP Touchpad has barely been on the market for a month. The announcement probably signals the inglorious end of Palm, which HP bought last year for $1.8 billion before phasing out the brand.

Sales

The University of Chicago Medical Center will implement Omnicell’s Inventory Management Carousels with WorkflowRx software for inventory management and Omincell’s automated dispending system.

Imprivata announces that 12 Siemens customers have chosen its OneSign single sign-on.

Stamford Hospital (CT) will implement SmartRoom technology in all of its patient rooms, which provides real-time patient and RTLS information on an in-room monitor and provides touch-screen documentation capability. SmartRoom was developed by UPMC, which owns the company.  

Evergreen Healthcare (WA) chooses Cerner clinical systems.

People

 

Healthcare software vendor Net.Orange names Rob Beardall MD, MPH as EVP/Chief Medical Officer and Troy Roth as SVP of solutions strategy. They come from Health Synectics LTD and MedAssets, respectively.

Paula Guy, CEO of Georgia Partnership for TeleHealth, joins the board of the Georgia Health Information Exchange.

Announcements and Implementations

Arkansas critical care hospitals Piggot Community Hospital, DeWitt Hospital, Delta Memorial Hospital, and Chicot Memorial Medical Center select Healthland.

Nine hospital systems in Western Pennsylvania partner to create the ClincalConnect HIE. dbMotion will supply the infrastructure for the $4 million project.

The radiology department of University of Utah Health Care reports that its use of artificial intelligence resource management software from Allocade reduced overtime cost by 90% and overall FTE expenses by 10-15%.

Miami-based EMR vendor CareCloud says it has tripled headcount in the past year to 80 and will bring on another 30 employees by the end of the year.

Government and Politics

The VA issues an RFI for cloud-based collaboration tools for its entire workforce. They plan to pilot document sharing and calendar applications with 5,000 physicians, potentially replacing Outlook and Exchange, SharePoint, and Jive Software for all of their employees if the pilot is successful.

Other

I got an earful from my doctor and his office manager today about their “horrible” EMR. Since purchasing it a year and a half ago, they’ve suffered through performance issues, upgrades problems, inadequate templates, and many unexpected expenses. The Meaningful Use money, which they’ll receive this month, covers the EMR’s cost but not the $10K per year for maintenance. The doctor blames the vendor, which has been around for less than five years, for releasing an immature product. I checked their Web site and it looks like the latest and greatest. I wonder how often providers opt for bleeding edge, only to later regret not buying the tried and true option?

Here’s a video showing the Texas Health Resources group that climbed Mount Kilimanjaro (including Ed Marx) opening a medical clinic in a Tanzanian village a few weeks ago.

A drug company’s laid-off IT tech pleads guilty to extracting his revenge by wiping out most of the company’s electronic systems while he still had access as a contractor. The drug company lost e-mail, inventory systems, and payroll capabilities, crippling it for several days at an estimated cost of $800K. The tech faces 10 years in prison.

The FBI subpoenas Parkland Memorial Hospital (TX) and its IT department, seeking records related to a former Dallas County commissioner and a telecommunications system business owned by a close friend. According to the Department of Justice, the investigation involves “allegations of public corruption, tax evasion, and money laundering.” The telecommunications company got $3 million worth of consulting work from Parkland and UT Southwestern Medical Center. Another of its customers, the local toll authority, paid $47,500 for a no-bid consulting report that basically said “your equipment needs to be replaced” and included graphics lifted directly from another company’s 12-year-old product manual.

In Ireland, an interim examiner is appointed to review three hospital software vendors that have claimed insolvency, putting the electronic records of 10 million patients at risk. The companies operate under the name IMS Maxims.

French software vendor Atos Healthcare, whose software is used in England to evaluate disability claimants, investigates two employees (one of them a nurse) for their Facebook comments about those claimants, which they characterized as “down and outs” and “parasitic wankers.”

Sponsor Updates

• Intelligent Medical Objects and dbMotion will participate in the Allscripts Client Experience next week.
• MEDSEEK’s eConnect HIE technology successfully connects the WNC Data Link (NC) HIE to the VA’s VistA.
• UCare selects RelayHealth’s Payer Connectivity Services (PCS) for its 230,000+ members.
• API Healthcare will exhibit at the ASHHRA annual conference in Phoenix next month.
• Healthcare Innovative Solutions VP Daniela Mahoney, RN, will present Best Practices in CPOE Deployment Strategies, and Physician Resistance, Adoption and Value Proposition at the Kansas Hospital Association: Meaningful Use Summit, and Executing Key Plays: How Team Members Must Adapt to Succeed at SC Hospital Association the TAP Conference.
• TeleTracking Technologies is offering a free Patient Flow symposium in Raleigh, NC next month.
• Nuance Communications unveils Dragon Medical Practice Edition, which targets the needs of physicians in practices smaller than 25 providers.
• OptumInsight’s Axolotl EMR Lite, version 9.2 receives ONC-ATCB certification as a complete ambulatory EHR.
• A healthcare claims review company implements Symantec’s PGP Whole Disk Encryption to meet HIPAA requirements, claiming a one-month payback period after switching from free encryption software that was killing employee productivity.

EPtalk by Dr. Jayne

I returned home from my most recent sojourn to find the only thing I hate worse than filing my taxes or a root canal — a re-credentialing packet for my hospital privileges. Despite our health system’s large IT department and our belief that we are high tech, the credentialing process is decidedly low tech.

When I was a practicing physician, my practice manager took care of the application and applied sticky flags to areas that needed review or my signature. But now that I’ve crossed to the dark side of information technology, there’s no one in my organizational tree who has any idea how to do these, so I have the pleasure. I think next year I might just ask my former staffer if she’d be willing to do it for cash (as an independent contractor, of course — I’m not about to run afoul of the IRS.)

Under the 26-page “standard” credentialing form was an additional 22 pages of forms to be completed. They had been photocopied so many times they were practically illegible. Lurking at the bottom of the stack were several nearly identical sets of privilege forms for the different hospitals at which I am on staff, one for each facility (heaven forbid they share information from a central repository or from the master application itself.)

I find it slightly humorous that I still hold privileges for OB labor and delivery as well as operative circumcision despite having not performed either procedure in quite some time. Oh yes, and I can also pierce the earlobes of inpatients if I so choose.

In addition, they want a copy of my Curriculum Vitae and documentation of my Continuing Medical Education hours, which along with everything else has to be returned on paper and by mail. Seriously. Everything else we do in the hospital is electronic – CPOE, patient recordkeeping, even patient meal selections done on a touch-screen at the bedside. Except this.

When it comes to the concept of ensuring that physicians have accurate and up-to-date data before approving them to start or continue seeing patients at a facility, we’ve gone back to 1956. (Actually, 1956 was probably easier – you could most likely have just hung your diploma on the wall and started seeing people.)

If this would have been an online process, I’d have knocked it out right away while lounging on the sofa with some quality Netflix and recuperating from my travels. But instead, it goes on the dreaded ‘pile’ somewhere between the bill from the local lawn care guy and the student loan payment coupon, both paper-based businesses.

Turning to health IT news, legislators on the House Energy and Commerce Committee have asked the Government Accountability Office to review Federal Communications Commission efforts to ensure the safety of wireless medical devices. Their request featured discussion of the recent demo where an insulin pump was hacked and hijacked. As I was reading this piece, I envisioned a flashing “As Seen On HIStalk” seal of approval.

Finally, a reader question. It’s been a long time since we have had one and I do enjoy them (hint, hint).

Dear Dr. Jayne,

Is the new Chest-Compression-Only method of CPR taking hold, or is there some resistance to it? I still see classes offered in the older method and have to wonder… why? What do you think?

Breathless but Hearty

Dear Hearty Reader,

I think overall, more data is needed. When I completed my certifications for CPR and advanced life support (both cardiac and trauma) as well as pediatric life support a few months ago, traditional CPR was required. The American Red Cross issued a statement last year about compression-only CPR, stating:

“…Compression-Only CPR until an AED [Automated Extermal Defibrillator] is available is an acceptable alternative for those who are unwilling, unable, or not trained to perform CPR.”

I tend to agree with them. The idea of CPR is that you want to prevent brain death, and unless you’re oxygenating the blood by getting air into the lungs then circulating it with compressions, you’re not going to be as successful if oxygen levels remain low.

On the other hand, if it’s the difference between CPR not being done because a bystander isn’t sure how to do it correctly or is worried about communicable diseases or some of the more unpleasant side effects of bystander CPR, then I think compressions alone are better than nothing.

The American Heart Association offers a trademarked “Hands-Only CPR” method that’s demonstrated on their website. I like their bullet point: “Don’t be afraid. Your actions can only help.” Regardless, knowing the legal world, I offer this advice — if you’re trained in traditional CPR and have no other reason not to do it, traditional CPR should be your first choice. I’d hate to get into a “standard of care” discussion on this one.

Jayne

Have a question about LOINC codes, the Russell Viper Venom time assay, or whether snakebite extraction kits really work? E-mail me.

Contacts

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

News 8/17/11

Top News

The VA has been on-again, off-again on whether it will build or buy a replacement for its VistA system, but former deputy CIO Ed Meagher says the VA and DoD may pay companies billions to write a new open source system. He now works for CSC, one of the contractors hoping to get the VA’s business. I knew the VA recently issued a $5 million contract to create an open source community for the VistA replacement and had previously announced plans to go that route, but I haven’t heard a definitive final word, especially when a group of Epic-friendly politicians is pushing the VA to look at commercial systems. The article’s choice of experts to quote about vendor products is questionable: Allscripts has done a great job creating an open architecture platform (according to an investment firm analyst who just put a Buy rating on MDRX shares) and GE Healthcare could work well in the VA’s environment (according to a government sales guy from GE Healthcare).

Reader Comments

From Too Big for my Breaches: “Re: yet another data breach. I’m getting tired of hearing about these.” St. Francis Hospital (DE) apologizes for a doctor’s loss of a thumb drive containing information on 474 maternity patients. He lost it in the spring, but someone mailed it back to him on June and he didn’t report it until then, pushing the hospital’s 60-day deadline to report the loss. The doctor was authorized to copy the information but violated hospital policy by not encrypting the drive. He must have been researching old cases — the hospital says the in utero babies whose records he copied are now nine or 10 years old.

From Victory at Sea: “Re: UAB. I believe that most people in healthcare are honest and want to help people, but there’s a lot of money rolling around inside these organizations (vendors too) and temptation is always to be found for those who are open to it.” The FBI launches an investigation into Alabama’s only organ donation center, UAB-run Alabama Organ Center, after discovering that its director and associated director had an “improper financial relationship with a vendor.” UAB has fired the employees and parted ways with the unnamed vendor.

From TxPathDr: “Re: Jason Dufner. Anyboy else notice that he had a Greenway Medical logo on his chest for the PGA tournament in Atlanta this week? I can’t remember ever seeing an EMR company logo on a golfer before.” Greenway struck a deal a few weeks back to have him wear their logo and be available for marketing and company-sponsored events. The green logo really pops on his pink shirt.

From A CEO: “Re: our interview. Questions I get from healthcare trade rags and the financial press are vanilla – my sense is the editors / journalists are just trying to get their stories written vs. trying to arrive at insights relevant to their readership. I found your questions intellectually stimulating. Keep doing what you are doing – we appreciate it.” Thanks, both for doing the interview and for the nice words. I don’t like asking stupid questions, at least when I can help it, so I treat my interviews as a conversation. As in most conversations, not everybody is fascinated by every interview of the hundreds I’ve done – it depends on their area of interest. As for me, everybody I’ve interviewed has taught me something.

From Bruce Werner: “Re: interview with our CEO, Mark Debnam. The HIStalk interview was a big success. Our Facebook ‘likes’ jumped significantly. We are proud to be part of the HIStalk family.” Mark of Quality IT Partners and I are both progressive music nerds, so we were nearly breathless in discussing the latest tours and albums from Yes and Asia, which I omitted from the interview transcript since, puzzlingly, not everybody is a fanboy for semi-obscure bands whose heyday was a couple of generations ago.

From Chillicothe: “Re: Epic. Wondering if you saw this?” Several readers sent over a link to that story in The Examiner, a free, conservative DC-area newspaper. It’s all rehash: Judy Faulkner of Epic was appointed to the HIT Policy Committee and Epic employees have given $300K to Democrats since 2006 (doesn’t sound like much for a company of that size). Surely nobody’s shocked that donors get some reciprocal back-scratching, like being appointed, but her spot was set aside as a vendor rep, so why not her? The article takes a somewhat slanted position that Epic isn’t open to interoperability (the article’s one quoted source to back that statement – CEO Glen Tullman of Epic competitor Allscripts, who is himself a lot better connected politically than Judy will ever be). The rag finds a hidden Obama agenda — the examples he’s given of well-run hospitals (Geisinger, Kaiser, Cleveland Clinic, and Mayo) are all Epic customers. One thing I might agree with: it would indeed be a bit suspicious if Epic got the VA’s bid (which doesn’t seem to be happening, at least at this moment) but otherwise, they’re getting plenty of business without government help. And yes, the Obama administration was mighty generous with our money in bribing providers to use EMRs they weren’t spending their own money on. 

From The PACS Designer: “Re: Toodledo. Will Weider of Candid CIO blog fame recently posted about a to-do listing app called Toodledo. You can get Toodledo versions for your mobile phone, as well as an app to add it to your e-mail, on your calendar, and integrate it directly into your web browser.” I’d be interested if it does recurring events and reminders. I don’t use Outlook at home and I’m finding Google Calendar to be pretty sucky when it comes to reminders. In fact, I’m becoming slowly annoyed at most things about Gmail and Google Docs – the spare design was cute at first, but everything feels clunky and I still don’t like the “conversation” design of Gmail since I’m always deleting entire message threads by mistake.

Acquisitions, Funding, Business, and Stock

Intermedix, a provider of RCM services for emergency healthcare services, buys the assets of RCM-provider Comprehensive Medical Billing Solutions of Oklahoma City.

Axiom Systems acquires Ivertexo Internet Solutions, a provider of administrative software solutions for healthcare providers.

MedQuist Holdings announced Q2 numbers Tuesday morning: revenue flat, EPS $0.11 vs. -$0.06. Its acquisition of M*Modal gets clearance to be completed in August. MedQuist shares made the list of biggest Nasdaq losers Tuesday, down 18%. The company says it’s pushing more work offshore, but is being negatively impacted by customers sending work offshore themselves, by customers using speech recognition instead of transcription (which I’m sure is why they are buying speech recognition provider M*Modal for $130 million) , and by providers focusing on EHRs.

Vocera files SEC paperwork for its $80 million IPO.

Sales

Cooper County Memorial Hospital (MO) will spend $2.5 million for Meditech, which it selected over Cerner and Healthland. Hospital CEO Allen Waldo says, “Meditech won the contract because the hospital’s clinicians thought it was more user-friendly and had a better data recovery system.”

The VA awards ICS Nett and Beacon Enterprise Solutions Group a $3.4 million contract to provide the management and installation of an RTLS solution for tracking equipment, supplies, implants, and surgical instruments.

St. Joseph’s Medical Center (CA) selects PerfectServe’s voice, mobile, and Web-based clinical communications system.

The Australian government chooses a consortium of eight firms to participate in the infrastructure build of its $466.7 million personally controlled electronic health record (PCEHR). Winners include Accenture ($47.8 million), Oracle ($17.8 million), and Orion Health ($11 million) along with sub-contractors Telstra, Cerner, ThinkPlace, Extensia, and Ocean Informatics.

People

Lehigh Valley Health Network promotes Donald L. Levick, MD, MBA to CMIO.

Former McKesson Health Solutions CFO and VP Peter P. Csapo will join VHA as CFO.

Beebe Medical Center (DE) names Jeffrey Hawtof, MD VP of medical operations and informatics.

Kevin Groskreutz is promoted to CIO of Hospital Sisters Health System Western Wisconsin.

Bassett Healthcare (NY) names Scott Groom VP/CIO. He was previously with Cabell Huntington Hospital (WV).

Announcements and Implementations

Resurrection Health Care (IL) goes live on its system-wide Epic implementation with the activation of billing and scheduling at 20 ambulatory care clinics. The practices will add EMR over the next six to eight months;  the first of six hospitals will begin go-lives in the fall.

Zynx Health announces two enhancements to its clinical decision support technology: Workflow Management to streamline content development and Export Validation to allow Cerner CPOE users to validate order sets before exporting them.

Vital Images / Toshiba gets 510(k) clearance for its VitreaView browser-based universal patient imaging viewer, which allows EMR and HIE users to view all patient images. It was announced in June.

Government and Politics

President Obama announces new economic initiatives to spur growth and create jobs in rural areas, including loan programs to enable hospitals to purchase HIT. The administration also announces a loan repayment program for more than 1,300 small, rural hospitals to recruit new physicians. The White House estimates that the addition of one new primary care physician in a rural community generates $1.5 million in annual revenue and creates 23 jobs annually.

FDA will hold a public workshop seeking input on what types of mobile medical applications it should regulate on September 12-13 in Silver Spring, MD. This follows FDA’s July draft guidance on that topic.

Other

A proposed compost facility in Freetown, MA is stinking up Meditech’s plan to develop a new office building that could bring 800 jobs to the area. The city is looking into the issue.

CEO compensation at Boston’s nonprofit teaching hospitals is leveling off, with 2009 pay equal to or less than the previous year’s. Elaine S. Ullian, the former CEO of Boston Medical Center experienced one of the biggest declines: $1.8 million in 2009 compared to $4.8 million in 2009.

About 40% of EDs in urban areas e-prescribe compared to just 6% in rural areas.

I’m loving the site (sites, actually: this one and this one) of Atlanta anesthesiologist Michelle Au MD, author of This Won’t Hurt a Bit (And Other White Lies): My Education in Medicine and Motherhood. She’s darned funny, describing her book as: “It contains ‘pages’ and ‘words.’ I done wrote it.’” But if you’re on the fence as to whether she’s wickedly humorous, click the graphic above to enlarge. Brilliant. I think I’ll buy the book.

Vince Ciotti (and I) would approve: McKesson joins The IT History Society as a corporate member.  

Another highly paid non-profit hospital CEO: the head of a 326-bed Brooklyn hospital made $4 million in 2009 while laying off employees and closing clinics that served its predominantly Medicaid patient population. The board gave the usual “market rate” excuse.

Sponsor Updates

• Memorial Sloan-Kettering Cancer Center (TX) signs an enterprise license agreement for iSirona’s device connectivity solution.
• Canterbury District Health Board (NZ) partners with Orion Health to provide secure access to patient information.
• Capsule is exhibiting at this month’s Allscripts Client Experience 2011.
• Capario launches a new Web site, blog, and social media presence on Twitter, Facebook, and LinkedIn.
• Scott Besler of Besler Consulting will discuss New Cost Report Changes at next month’s HFMA NJ’s quarterly meeting.
• NextGen announces a webinar and live demo for its digital pen solution, NextPen.
• MedPlus will exhibit at Epic’s 2011 Users’ Group Meeting in September.
• Practice Fusion’s Research Division releases a list of most-prescribed drugs, derived from its EMR database.
• The 25-bed critical access hospital Lakewood Health System (MN) selects McKesson’s Paragon HIS.
• Billian’s HealthDATA publishes a white paper called Providers’ Perceptions: Mobility in Healthcare.
• Eisenhower Medical Center (CA) contracts with Wolters Kluwer Health for its ProVation gastroenterology procedure documentation and coding software.
• The healthcare business of Thomson Reuters introduces Payment Reform Solutions to help hospitals adopt new payment methodologies.
• Kyle Swarts joins Culbert Healthcare Solutions as a regional sales executive.
• The District of Columbia Primary Care Association subscribes to CapSite’s online service, giving its network of providers the ability to identify technology pricing and packaging options.
• Kareo hires James Mathews its first VP of business development. He has worked for Sage Healthcare, Carefx, and WebMD.
• GE Healthcare will launch Centricity Business 5.0 at next week’s Centricity Business National Users’ Conference in Boston.

Contacts

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

Quality Systems Acquires CQI Solutions

Quality Systems, Inc. announced this afternoon that it will acquire CQI Solutions, Inc. of New Braunfels, TX, which offers hospital systems for surgery management and patient scheduling. CQI will become part of the NextGen Inpatient Solutions business of Quality Systems, with its applications offered as both standalone and integrated products. 

Steve Puckett, executive vice president of Quality Systems, was quoted in the announcement as saying, “We are pleased to extend our portfolio to meet these cross-departmental needs, demonstrating our commitment to the community and rural hospital marketplace. With the additional integration of our award-winning ambulatory solutions, our inpatient and ambulatory clients are now collecting critical data across the care continuum, helping them meet requirements of quality of care initiatives and current business drivers such as Meaningful Use, where clients have already earned in excess of $5 million in incentives.”

Monday Morning Update 8/15/11

From Big Ragu: “Re: HHS CTO Todd Park. Gave a great speech at the Health 2.0 NYC meetup Friday. He was a really dynamic and engaging speaker and showed off some amazing projects from Health Data Palooza, sponsored by IOM and HHS.” He’s at the 51-minute mark of the video here.

From Wanderlust: “Re: [vendor name omitted]. Lackluster replacement for [former VP 1], internal political fights over who owns product strategy, no progress on new revenue cycle product, offices being consolidated, open platform not what was promised to partners, and a shaky start to integration as employees freak out about their long term job prospects. This employee is putting down my copy of Visual Studio and checking out Monster.com. But wait, another rumor is making the halls of the office that does create some hope. That rumor is that [former VP 1] and [former VP 2] may be returning.” All unverified. I’m doing some liberal expunging since obviously there’s no way the company can confirm or deny so I’m not comfortable just throwing it out there, but I’ll say that Wanderlust was mostly right on some items sent my way earlier this year. I just talked to [former VP 1] this week and didn’t get any feeling that a return was imminent, so I’ll attribute that last sentence to wishful thinking.

From HappyNotToBeAMcKessonite: “Re: McKesson. Loses another large system, this time in Albuquerque, to guess who? Good luck finding Epic specialists through job boards. This health system has been cheap in the past, so it’s interesting they have allocated $90 million for the project.” Unverified. The health system wasn’t named, but I assume it’s Presbyterian, which signed a much-touted $22 million Horizon and homecare deal way back in 2001, the same year McKesson bought the rights to Vanderbilt’s WizOrder and called it Horizon Expert Orders. Presbyterian has a lot of Epic jobs posted that look like inpatient, so you can draw your own conclusions.

From Melina: “Re: Siemens. Signed some new deals.” Listed in the announcement: Regional Medical Center (TN) signs up for Soarian Clinicals and Financials; Jefferson Regional Medical Center (PA) goes with Soarian Clinicals; St. Joseph’s Healthcare System (NJ) will migrate off INVISION to Soarian Clinicals and Financials; and University of South Alabama will move from INVISION Clinicals to Soarian Clinicals.

From PumpDoc: “Re: IV pump design errors. I think you have given readers the impression that my company’s Plum A+ pump was the cause of the errors and that’s not true. Can you please clarify? Ours doesn’t have the start button next to the zero and decimal point. I’m guessing someone just picked a stock pump picture to go with the story. Thanks – I am an avid reader!” Correct – I just put up a general picture of an IV pump that didn’t really have anything to do with the article, other than for someone who didn’t know what an IV pump looks like. The article didn’t implicate any particular brand of pump, so it wasn’t the Hospira pump, which as the full-sized picture above shows, has the Start button on the upper left.

From Lodi: “Re: new HIMSS certification. Seems to duplicate the HIT program.” The National Science Foundation is apparently paying HIMSS to develop an entry level certification program, Certified Specialist in Health Information & Management Systems, kind of a junior CPHIMS, which is itself kind of a junior everything (advanced degree, relevant experience, useful specific certifications like PMP or CISSP …) Would you really hire someone on the basis of a credential proving that they are “entry level?” I’ve yet to see any general certification that’s worth anything other than to ease the sometimes justifiable anguish of the resume’-insecure, but it’s their money.

From HIStalker: “Re: salaries. A $6 million hospital CEO!” A hospital CEO salary survey covering only the Midwest finds the pack led by 314-bed Children’s Mercy Hospital and Clinics (MO), which paid its CEO $6 million in the most recent year. Must be a terrible place to work if that’s what it takes to get someone to run it. Mercy Janesville paid $4.5 million, Advocate $4 million, and Northwestern $3.4 million. It’s bad enough when private industry CEOs make massive multiples of what the worker bees are paid, but absurd when talking about non-profit hospitals, all of which ironically anguish publicly over escalating healthcare costs. If public school systems or soup kitchens could bill Medicare, I suppose they’d be unnecessarily run by $2 million administrators.

Honky Cat was moved to wax poetic about HIStalk:

An Ode to HIStalk
It’s 9pm and my bourbon glass in reach;
Mouse, keyboard, email, and alas,
An alert from HIStalk breaches the still.
Curse your anonymity!
Show your face and be criticized.
Yet the rhythm of my heart accelerates.
For I know the contents will amaze and amuse;
I may learn one morsel of data,
One shard of vendor information,
That cuts deeply to the quick
And such as a participle, hangs with an airy loft.
Or, perhaps a CIO interview that portends the strategy versus the reality;
Inga and her shoes.
Could she be the muse?
What have I to lose?
There is meaningful use.

This week’s Time Capsule editorial from 2006 lauds the hard-nosed vendor negotiation style of former NPfIT head Richard Granger. A snip: “Granger holds firm and goes public when he has to, unafraid to rip recalcitrant vendors by name. I like to picture him as a Gordon Ramsay-type scrapper, happy to take someone down a notch when they need it.” Knowing now that NPfIT is pretty much ash-heaped, you might smirk that I was way off base, but I argue no: the real problem was that, despite all that aggressive negotiation and multi-billion dollar contracts, there just were not any contractors or vendors who could pull off their part of the project. They overcommitted and under-delivered, but in this case, poor performance hit them hard financially and they walked away. Granger’s threats were a bit hollow since there were only so many potential contractors out there and the pioneers were coming back with arrows in their backs.

Listening: Big Big Train, recent British progressive rock that sounds like 1970s Genesis before Phil Collins ruined it by selling out to make teen dance tracks. Think And Then There Were Three, from which “Undertow” is one of my favorite songs of all time with amazing music and lyrics. Big Big Train is right up there with them.

A slight majority of poll respondents think hospital CIOs wield undue influence over clinical system selection and implementation. New poll to your right: should HHS study the effectiveness of EMRs and their impact on medical errors as Congresswoman Ellmers has urged? Click the Comments link on the poll widget to explain your rationale if you are so inclined.

Am I the only one getting weary of announcements proclaiming that XX hospital or practice is the first in some state to get Meaningful Use money? I figure there are 50 states, you have both EPs and hospitals, and MU comes in both Medicare and Medicaid flavors, so that’s a potential crap-load of self-congratulatory vendor press releases to wade through, none of which really mean a whole lot. Far more interesting would be a list of certified EMR vendors who don’t yet have even one customer that has received a check. It wouldn’t be any more meaningful, just more fun.

Iowa Children’s Hospital develops a Facebook medication reminder system for teens, especially transplant patients. The patient clicks on which meds they’ve taken and the information is sent back to their PCP.

Some excellent posts you might want to check out: Don Michaels concludes on HIStalk Practice that providers shouldn’t move too quickly to sign ACO contracts given demonstration group’s lack of success in earning payment, while Dr. Travis dissects WellDoc’s consumer health apps on HIStalk Mobile.

The Army tests its MC4 battlefield EMR  on iPad, iPod Touch, iPhone, and Android devices, expecting approval to replace their outdated Motorola handhelds with tablets later this year. What they like: larger screen, gestures, the ability to run common apps, the ability to access the Internet, and patient lookup by their ID card.  Above is a 2008 video of MC4 running on the Symbol (acquired by Motorola in 2006).

It’s been a crazy stock market week, so I thought I’d check the current vs. month-ago prices of some HIT stocks:

Allscripts: $15.27 vs. $19.74 (down 22%)
athenahealth: $53.00 vs. $45.16 (up 17%)
Cerner:  $58.18 vs. $62.29 (down 7%)
McKesson: $79.02 vs. $83.04 (down 5%)
Nuance: $18.04 vs. $21.07 (down 14%)
Quality Systems: $79.77 vs. $89.10 (down 10%)

A conservative political group in Kansas called SOCK (Stop Obama Care in Kansas) wants the state’s Republican party chair to quit, saying that Amanda Adkins has a conflict of interest because she’s an employee of Cerner, and as such has a vested interest in both Obama Care and the government’s push of healthcare IT.

As you must know, Cerner Corporation is not taking a passive stance in hopes of remaining a key player and profit taker in the HIT industry but is very aggressively working, including to influence the government, to ensure its leading position in the HIT industry is maintained if not enhanced. The position of your employer, Cerner Corporation, is diametrically opposed to that of the State of Kansas, the current KGOP platform and the vast majority of the GOP rank and file as well as other Kansans.

SAS hires Graham Hughes MD as the first chief medical officer for its Center for Health Analytics and Insight think tank. He was previously CMIO of GE Healthcare IT.

In the UK, workforce management solutions vendor Allocate Software acquires Zircadian Holdings, a vendor of software used by hospitals to manage physicians (scheduling, locum, and evaluation).

Ridgeview Medical Center (MN) partners with Healthbox to launch a three-month mentorship for up to 10 HIT seed-stage company entrepreneurs.

One of the inventors of the IBM PC says PCs in general are extinct, just like the typewriter and vinyl records. He replaced his own PC with a tablet, but says the devices themselves are not innovative – it’s the social spaces they access where people and ideas meet.

The fascinating story of SAI and its family tree in both directions, in this week’s HIStory from Vince Ciotti (he’s the hirsute lad on Slide 9, wearing a sofa-patterned, suspender-supported plaid suit and flanked by an avocado green touch-tone telephone). He loves your feedback and input, such as suggesting which long-gone companies he should write about (my list: Atwork, Continental Medical Systems, HealthQuest, Health Data Sciences, Phamis, and TSI).

Children’s Hospital Colorado is hit with a federal equal opportunity lawsuit for rejecting a job applicant for a staff assistant position who they found to have fibromyalgia, meaning she can’t sit at a desk or work on a computer for long periods. She wants the job, back pay, compensation for emotional distress, and punitive damages.

Dan Moriarty, founder of HIStalk Gold Sponsor Stimulus Search, has joined Health Data Specialists as recruiting manager. They focus on resources for Epic, Siemens, Cerner, and Meditech.

Stanford bioinformatics researchers mine the electronic patient databases of Stanford University Hospital, Vanderbilt, and Partners HealthCare to discover a drug-drug interaction between the heavily prescribed drugs pravastatin and paroxetine. Said the study’s lead author, “We’re bioinformatics people, not clinicians. We can develop ways to mine these huge data sets for interactions that have escaped attention, but you have to start with a clinical expert to curate a set of drugs and effects so you’re looking for something that actually matters in the real world. I’d love to hear from pharmacists about the kinds of questions they would like answered with data-mining. Their drug knowledge is invaluable to this kind of program.”

West Penn Allegheny Health System (PA) will partner with Highmark, Allscripts, and Accenture to offer EMRs to private practices. A local physician says WPAHS is obviously trying to keep its beds occupied: “If a hospital comes into your office and offers to front you $250,000 for an electronic medical records system, they’re not doing it out of the goodness of their hearts.”

Florida’s multi-millionaire Governor Rick Scott is criticized for paying low rates on state-provided health insurance, which he says is appropriate since he has the same plan and cost as everybody else. State big shots (all 32,000 of them) apparently get family medical insurance for premiums of less than $400 per year. Wildly generous state and federal government employee benefits and retirement plans somehow never seem to come up in all the zeal to control the cost of entitlements.

In India, a former hospital COO is arrested for stealing the hospital’s patient data and selling it to other hospitals through a consulting company he started. The hospital got wind of what was happening and installed keylogging software that showed him e-mailing information from his personal account.

E-mail Mr. H.

News 8/12/11

Top News

Rep. Renee Ellmers (R-NC) asks HHS Secretary Kathleen Sebelius to study the adoption, benefits, and cost effectiveness of healthcare IT, including its impact on medical errors. She’s a nurse and her husband is a physician; she ran for Congress as a critic of government-run healthcare. She chairs the Subcommittee on Health Care and Technology. She was quoted in a March press released as saying this about PPACA waivers:

As a nurse of twenty years, wife of a surgeon and owner of a wound clinic, I am not only aware of the problems that currently exist in the American health care system, I have seen them up close as a caregiver, a patient and a small business owner in the health care industry. Unlike the remedy we were promised, ObamaCare has done nothing to improve the quality of health care in our country, and has already done significant damage to the economy. I join Chairman Graves in asking for a full explanation of the waiver process, to ensure that individuals and small businesses are treated fairly.

Reader Comments

From Data Dump: “Re: [vendor name omitted]. Loses years of patient data at an Epic facility, is technically unable to recover data from the backup.” Unverified, so I’ve omitted the name of the enterprise content management vendor. I’d be interested in hearing from the client, though.

From CagneyInMillerton: “Re: Yale. You are missing a big story on their not rolling out Epic. Big negative money angle and someone going after Harvard CIO position.” I asked CIO Daniel Barchi, who reports that (a) they are two months away from their first practice go-live; (b) they are under budget; and (c) the three hospital go-lives have been moved up, with the first going up in April 2012 and the last in June 2013. They are implementing Epic in three hospitals, the School of Medicine, the 800-physician Yale Medical Group, and several independent community physician practices. Daniel says if the Harvard rumor was about him, it’s not true.

From One of Their Hospitals: “Re: [vendor name omitted]. Based on a phone call our pharmacy received, they are closing their doors Friday.” Unverified. I asked for confirmation from the company, but got no response. This Ohio-based vendor offers medication and supply management systems, mobile carts, and software. I think the source is solid, but I’ll give the vendor a little extra time to respond (or call this weekend to see if the telephone has been disconnected).

From Ronnie James Dio: “Re: Computerworld article on HIT job growth. The author says SimplyHired has 7,200 HIT jobs posted out of 4.9 million. That sounded way too low, so I contacted SimplyHired to find out how they arrived at this number. Their answer: they just searched for the specific term ‘healthcare IT,’ which does not even remotely identify all healthcare IT positions. Downright goofy.”

HIStalk Announcements and Requests

This week on HIStalk Practice: legislation is proposed to allow PAs and NPs to qualify for Meaningful Use funds. Aprima Medical acquires an RCM company. AAFP posts its EHR survey results online. Meaningful Use incentives drive physicians to adopt EHRs. Sage Health employees volunteer at CHCs in honor of National Health Center Week. Integritas President Mary Stroupe explains why even “ineligible” providers should adopt certified EHRs. When you are catching up on your ambulatory HIT news, show some love to our loyal HIStalk Practice sponsors by clicking on their banners and learning what they are all about, Heck, they could be offering some good stuff you didn’t even realize you needed. Thanks for reading.

On the Jobs Page: Director of Public Relations, Project Manager – Healthcare Implementation, Developer I. Healthcare IT Jobs is temporarily offline while some administrative and technical work is completed to move it to a new hosting service, but it will be back soon. 

You know who’s cool? You, for reading – thanks. To take cool to the next level, consider: (a) signing up for e-mail updates; (b) socially attaching yourself to Inga, Dr. Jayne, and me on Facebook and LinkedIn (Dann’s HIStalk Fan Club has 1,751 members, so you might as well join that while you’re at it); and (c) checking out the sponsor offerings by clicking the lovely (and soon to be non-animated) ads to your left or delving deeper in the searchable, categorized Resource Center. We can’t promise to always be the most informative and entertaining site in HIT, but it’s not for lack of trying. 

Acquisitions, Funding, Business, and Stock

An Emdeon shareholder sues Emdeon and Blackstone Group, charging that Blackstone’s $3 billion buyout offer for Emdeon undervalues the company.

Nuance announces Q3 numbers: revenue up 20%, EPS $0.13 vs. –$0.01, or $0.35 vs. $0.30 excluding one-time expenses, beating analyst expectations of $0.34. Healthcare revenue was up 22%.

CSC’s Q1 numbers: revenue up 3.1%, EPS $1.17 vs. $0.91, but the earnings jump was partially due to a one-time tax benefit. The company restated guidance, but both analysts and shareholders reacted negatively. Revenue is projected to be flat even with the contribution of newly acquired iSOFT. In the earnings call, the CEO declined to speculate on the potential future of NHS’s NPfIT, a big customer of CSC and its former subcontractor, iSOFT.

Sales

The VHA awards Apelon a multi-year blanket purchase agreement for its terminology and data interoperability solutions.

The Wisconsin HIN selects ABILITY network to provide electronic messaging services for its connected stakeholders.

Flagler Hospital (FL) chooses Allscripts Sunrise Enterprise, also endorsing the Allscripts PM/EHR for its 130 affiliated physicians.

People

Genomind hires former MEDecision CEO Scott Storrer as COO.

Decision Resources Group names John Ho, MD president of its Decision Resources Consulting.

Health Language Inc (HLI) promotes April Yoder to VP of professional services.

Navigant adds eight senior consulting professionals to its healthcare practice.

Announcements and Implementations

UPMC and Nuance sign a 10-year agreement to develop EMR information capture technologies related to speech and clinical language understanding, as well as natural language-powered data repository searches. UPMC will also standardize on Nuance to provide speech and natural language processing tools for its 20 hospitals, 30 imaging centers, and 400 outpatient sites. Nuance says the co-developed solutions will be generally available by the end of the year.  

Government and Politics

Two years after to agreeing to merge their EMRs, officials from the DoD and VA admit it could take up to six more years to complete the project. VA insiders acknowledge that the process has been complicated by bureaucratic infighting, as each agency is unwilling to give up its legacy health system. The departments have now agreed to slowly upgrade both networks into a new shared system over the coming years.

Kansas Governor Sam Brownback returns a $31.5 million HHS grant, saying he had doubts the federal government would be able to maintain its promised future payments. Kansas was one of six states awarded grants to establish HIEs that other local governments could use as a model; Oklahoma also rejected funds for the project. Critics say the move was politically motivated.

Other

Hospitals tell KLAS they need more comprehensive and integrated systems for pharmacy inventory management. Providers report that the biggest functionality gaps for these systems involve formulary database integration, expiration date tracking, and reporting.

A British physician risks being “struck off the medical register” for bad behavior that includes self-prescribing medications, asking an employee to shred hospital correspondence related to an ongoing investigation, and biting a police officer.

In Australia, a software error causes the deletion of prescription records for more than 140 patients, with the conditions of 14 of them found to have worsened during that time.

Canadian researchers blame poor IV pump design for the 4.5% of medication errors that involve children receiving 10 times the intended drug dosage, often in PICU/NICU. They point out that IV pump keypads have the decimal point, zero, and confirm buttons side by side.

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Mayo Clinic opens a high-tech consumer wellness information storefront in the Mall of America, intending it to be a gateway to its services. Features include wellness evaluations, symptom checkers, “trained health experience navigators,” and unnamed products for sale. Mayo says they have no plans to replicate the project in other malls, but wants to “learn about adapting its services to other settings.”

Another part of Mayo’s mall experiment: an iPhone-powered scavenger hunt.

The team of GAUCHOS, an Open Software electronic charting application developed for volunteer clinicians (homeless shelters, the Operation Smile cleft palate repair organization, etc.) launches a Kickstarter project. They hope to raise $83,800 in crowdsourcing funds to complete the Operation Smile rollout and to develop a tablet version that does not require Internet connectivity. Like all Kickstarter projects (including a couple that I’ve donated money to), swell prizes are offered — $1,000 gets you a launch party invite and Web recognition, but just $15 earns a logo coffee mug.

A Sage Healthcare survey finds that non-EHR using physicians have different expectations than those actually using EHRs. Physicians already using an EHR say they’re happy if it tracks outcomes and reduces errors, while the holdouts say they expect the EHR to increase their revenue.

A computer-on-wheels catches fire at Uniontown Hospital (PA), requiring firefighters to air out the third floor.

Sponsor Updates

• Team GetWellNetwork and CEO Michael O’Neil will compete in the September 11 Nation’s Triathlon in Washington, DC to support the Leukemia and Lymphoma Society. The team’s fundraising page is here. They are participating in memory of Justin Thornton, who died of leukemia this year at 19. He was the son of Lt. Cmdr. Tony Thornton, CIO of National Naval Medical Center.
• Hamilton General Hospital (TX) achieves Stage 1 Meaningful Use using the EHR of Healthcare Management Systems (HMS).
• Elsevier releases a new white paper, “Two Years and Counting,” and updates its eBook, A Guide to Education and Training for ICD-10 Implementation.
• Healthcare Innovative Solutions will exhibit at Siemens Innovations 2011 on August 14-17.
• Orlando Health selects MEDSEEK ‘s 360-Degree Patient Experience to create a single patient interface to multiple EHRs.
• Louisiana Health Information Exchange (LaHIE) chooses Orion Health as its primary technology provider.
• e-MDs announces that physicians of its client, Silver Sage Center for Family Medicine, are the first priority primary care physicians in Nevada to receive Meaningful Use funds.
• Anita Archer, director of regulatory and compliance services at Hayes Management Consulting, provides some thought leadership on how ICD-10 can improve patient care and the importance of EMR documentation. Hayes also published a white paper on vendor selection.
• Staffing and consulting provider H/P Technologies will exhibit at the Epic UGM in September.

EPtalk by Dr. Jayne

As of last month, the American Academy of Family Physicians is no longer offering a paper mail-back card for its Continuing Medical Education quizzes. Participants will need to complete the quiz online. Definitely a step in the right direction as far as encouraging computer literacy at a basic level. Despite what those of us in the IT space might think, there are still quite a few docs out there who haven’t used a computer. Usually when those folks are integrated into our health system, I have the privilege of training them one-on-one. You’d think it would be exasperating, but it’s often very rewarding as you see one of these physicians start to realize the power of computers.

A 26-year old South Carolina man was denied participation in a federal assistance program for breast cancer patients because he’s a man. Approximately 1% of all new breast cancer cases each year involve men. This gentleman doesn’t have health insurance and didn’t qualify for Medicaid. The Breast and Cervical Cancer Prevention and Treatment Act is a federal law designed to help patients in this category;  unfortunately, you have to be female to qualify. South Carolina has tried to cover male patients under this provision in the past but has been denied. The Centers for Medicare and Medicaid Services state they’re working to find a solution.

Speaking of CMS, it recently launched the Hospital Compare website to go along with the Physician Compare website that we’re all so fond of. There is much more information available to look at for hospitals: process of care measures, outcomes measures, etc. Of course, hospitals have been more transparent about this information than individual physicians, so it’s not surprising.

In other South Carolina news, Greenville Hospital System is offering “speed-dating” events to try to match young adults with physicians. Realizing that health reform legislation will increase the number of young adults with insurance coverage (by allowing them to stay on parents’ policies, purchase through exchanges, or enroll in Medicaid) they’re using Facebook and more social events to draw these patients in.

Sometimes I receive e-mails I just can’t believe. Here’s what came from the American Medical Association the other day:

Find out how you can achieve meaningful use without an EHR. Learn about a unique approach to meeting federal meaningful use guidelines at less cost than an electronic health records (EHR)-based approach by viewing a webinar at noon Eastern time Wednesday from Amagine, Inc., a subsidiary of the AMA, and WellCentive. The program will feature a demonstration of WellCentive EHR-M.

Really? The marketing folks behind this blurb should be fired. The product demonstrated has EHR in its name. How does that make it not an EHR? Is it really any cheaper than the cheapest certified system out there?

A quick visit to the WellCentive website looks like it’s just another modular product. And I bet once you get done buying WellCentive EHR, WellCentive PQRS, WellCentive e-Rx, WellCentive Patient Outreach, WellCentive Registry, and WellCentive Connect (you get my point) you might as well have bought a top-shelf complete EHR.

The Department of Veterans Affairs is sponsoring a contest (complete with a $50,000 prize) to use its Blue Button download tool to develop a personal health record and place the technology on 25,000 physician websites. Over 300,000 veterans have used the Blue Button on MyHealth.va.gov to download data in the last year. The goal is to expand this functionality to the 17 million vets receiving care from non-VA providers. The contest runs through October 18 unless someone wins it sooner.

A shout-out to all of you at Community Health Centers since this is National Health Center Week. You are vital to the healthcare of so many people. I’m continually amazed by the ability of some CHCs to deliver high-quality care to a challenging population on a shoestring budget. Keep up the good work, and thank you!

Contacts

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

News 8/10/11

Top News

IBM and nine other vendors file protests with the VA for not being chosen to participate in its $12 billion technology program. All the protests except IBM’s have already been denied.

Reader Comments

From Observer: “Re: Flagler Hospital, St. Augustine, FL. Replacing Meditech with Allscripts Sunrise, which beat Epic and Cerner as well. It’s a 300-bed  HealthGrades Best 50 hospital.” Unverified, although I had heard that an unidentified hospital had signed on.

From Otoscope: “Re: hospitals that have successfully attested. Is there a list somewhere that includes which vendors they use?” I haven’t seen a list like that. If you have, let me know.

From Unlisted: “Re: shakeup at ONC. Arien Malec, coordinator of NHIN Direct, is returning to RelayHealth. Dr. Doug Fridsma will leave his current post and take over Dr. Chuck Friedman’s former position as Chief Scientist. All of this will leave ONC-sponsored interoperability efforts lost at sea.” Arien tells me that he announced his departure from ONC on Monday – his nine-month RelayHealth leave had turned into 18 (he was not an ONC employee). He reports that it was already announced that Doug Fridsma is covering the Office of the Chief Scientist role in addition to Office of Standards and Interoperability. I wouldn’t say that any of this necessarily qualifies as a shakeup, though. 

HIStalk Announcements and Requests

You may have read last week that I was traveling a bit, leaving Mr. H to carry an even heavier load than usual. In addition to some shoe shopping (a mere two pair), I paid a visit to eClinicalWorks and athenahealth. If you care to learn details about eCW’s nifty new headquarters, or see some pictures of Jonathan Bush’s office, you’ll find the write-ups on HIStalk Practice.

Acquisitions, Funding, Business, and Stock

Private equity firm Halyard Capital invests in RCM provider Practice Insight.

At least five law firms file class-action lawsuits against WebMD, alleging that the company misrepresented its financial position to shareholders and failed to make timely disclosures about projected drops in  advertising revenues. CEO Wayne Gattinella lowered revenue guidance for 2011 in July and the stock price fell 30%; however, company insiders sold $44.7 million in stock in the months following the issuance of WebMD’s February financial statements.

SAIC completes its acquisition of Vitalize Consulting Solutions.

Emdeon reports Q2 net income of $5.8 million, up from $4.2 million a year ago. Non-GAAP adjusted net income was $31.8 million ($0.26/share) which beat analysts’ expectations of $0.25/share. Revenues were up 16% to $282.1 million. The company announced last week that it will be taken private by a Blackstone Group fund.

Symphony Corporation, a Madison, WI-based technology provider, acquires JGI, a New Jersey human capital management consulting firm. Both companies claim a significant healthcare presence.

Sales

Stormont-Vail Healthcare (KS) selects TeleHealth to provide interactive patient education services.

Mille Lacs Health System (MN) contracts with Indigo for its Identityware SSO and access management solution.

Iowa Health System will use Medicity’s HIE technology to connect its hospitals and clinics.

People

LSU Health Shreveport promotes Marcus Hobgood to CIO.

SCI Solutions names Joel French managing partner and CEO and Jeff Anderson managing partner and chief sales officer. Founder John Holton will serve as managing partner and COO. French was most recently VP/GM Healthcare of Motion Computing; Anderson was managing director at Huron Consulting Group. SCI also announced that The Wicks Group of Companies and New Enterprise Associates have invested in the company to support its expansion efforts. 

RedBrick Health, a Minnesota vendor of technology-driven online wellness services, names Daniel Ryan as CEO.

Announcements and Implementations

Taiwan goes live on its nationwide EMR initiative in November, allowing physicians across the country access to patients’ clinical information.

Cerner says that all 18 Major League Soccer teams have implemented its HealtheAthlete health management platform. During the 2010 season, 621 players were tracked in the system and 1,500 injuries were logged.

The Christ Hospital (OH) implements a real-time interface that captures data from hemodialysis treatments and imports it into its Epic EMR.

Stillwater Medical Center (OK) integrates its the vital signs monitors in its same-day surgery unit with its Meditech HIS using Accent on Integration’s Acceleor Connect technology.

Dell and NextGen announce plans for Dell to sell and support NextGen’s ambulatory and inpatient solutions and to provide hosting services for NextGen clients. Dell also becomes the platform of choice for NextGen solutions and for NextGen’s internal use.

LA Care Health Plan (CA) will spend $1.5 million to develop and implement an eConsult system at 47 LA County safety net sites. It will handle provider communication and referral requests. A previous pilot program was claimed to reduce face-to-face specialist visits by up to 48%, depending on the specialty.

Government and Politics

New Hampshire Governor John Lynch signs legislation that establishes the state’s Health Information Organization (NH-HIO.)

HHS issues a Notice of Proposed Rulemaking regarding the use of metadata standards to support health information exchange.

In Australia, standards work for the government’s eHealth program is stopped when the non-profit Standards Australia fails to secure a new government contract.

Other

The Colorado Department of Public Health and Environment fines Heart Check America $3.2 million for a variety of violations, including performing diagnostic scans without the order of a state-licensed physician. The company was also cited for failing to monitor employee radiation exposure and not having policies and procedures to ensure safe CT scanner use. The company closed its Denver facility in May following a state inspection.

HIT jobs will grow 20% annually through 2018, according to the US Bureau of Labor Statistics. Because of particularly strong demand for CIOs and CTOs, individuals from banking, manufacturing, and other industries are now being hired into healthcare.

KLAS reports that Cerner’s Millennium PowerChart has the most hospitals live on CPOE, followed by Epic.  An average of 81% of orders are being entered via CPOE in Cerner hospitals and 83% at Epic sites. The third-ranked McKesson had 90 installations of Horizon CPOE at the end of 2010, with an average of 45% adoption, plus 11 Paragon sites with 25% average adoption. Overall industry adoption of CPOE was still less than 22%.

Doom and gloom from Down Under: The Australian Medical Association warns that the federal government’s online medical records system is “doomed to failure” because not enough people will sign up for it. Patients are required to opt in to participate; the medical association wants the government to make participation mandatory unless the patient opts out.

Strange: an health board IT technician in New Zealand is fired by the CIO for departmental theft. His loot: one blank DVD.

Weird News Andy is nuts about this premature discharge story: a man tucks his girlfriend’s pink pistol into his waistband as the couple enters a grocery store, accidentally pulling the trigger and shooting himself in his private parts. The girlfriend calls 911 and the emergency operator tells her to apply pressure, but not to look at the wound. “I did look at it and it’s pretty bad,” she admitted. The local police department turned the unfortunate incident into a teaching moment, helpfully advising locals to use holsters rather than jamming weaponry down their pants Hollywood-style.

WNA also turns up this story: a 26-year-old with breast cancer and no health insurance is denied coverage by a Medicaid program specifically created for that condition. The reason: he’s male. Above is CMS’s special coverage conditions, which exclude the several thousand men who are newly diagnosed each year.

An Ann Arbor, MI couple who owned hospital inventory software company Ariel Software are indicted for failing to pay taxes to the IRS over a 12-year period. They are accused of withholding $880,000 in employment taxes, but spending most of the money on the business instead of sending it to the IRS. The husband was also charged with failing to file personal tax return for several years.

A former VA data warehouse manager is sentenced to 11 years in prison for extracting patient information from the VA’s system and using it to file 800 fraudulent tax returns through his home tax preparation business.

Doctors in Estonia complain about the HP-developed EMR used there, saying that entering data for a single patient requires 50 mouse clicks and opening dozens to hundreds of documents one at a time.

General Cannabis announces that its WeedMaps marijuana dispensary finder took in $1.1 million in July. Its patient management system will complete beta testing shortly and offers patient self-scheduling, electronic medical records, and an appointment reminder system. According to the CEO, “Our technology is applicable beyond cannabis and we are already in development on our next medical niche.”

Members of a Florida ministry’s medical bill-sharing program join together to pay each other’s “responsible” medical bills, eliminating the administrative expense of for-profit insurance companies. The program, which the ministry insists is not insurance, pools expenses for members to share as they wish. It also offers healthy living rewards and helps its parishioners adopt healthy lifestyles. Its interactive tools include a 24×7 Twitter-like Prayer Stream for prayer requests and offers of encouragement.

The parent company of a West Virginia nursing home will appeal a jury’s $91.5 million medical negligence verdict that claimed its understaffing caused the death of an 87-year-old resident.

Sponsor Updates

• The College of American Pathologists, the CDC, the AHA, and Surescripts will present The Lab Interoperability Cooperative: Engaging and Empowering Hospital Laboratories and Public Health Agencies in Electronic Laboratory Reporting for Meaningful Use at CDC’s Public Health Informatics 2011 Conference, August 21-24.
• Besler Consulting publishes a paper on Healthcare Reform – Do You Have The Clinical Outcomes to Achieve the Financial Rewards?
• API Healthcare is exhibiting at Healthcare WFM 2011 August 19.
• Bulletin Healthcare announces an opening for Senior Medical Writer.
• EDIMS is attending the iHT2 Health IT Summit next week.
• Voalte will hire 50 employees over the next three years as it expands its Sarasota, FL offices.
• Employees of Sage Healthcare are doing volunteer work at community health centers this week as part of the company’s support of National Health Center Week.
• DIVURGENT publishes a paper entitled Meaningful Use Requirement for HIPAA Security Risk Assessment.
• MediServe is offering a Webinar, CMS 2012 Final Rule – How Will the New Rule Impact Your Facility?”
• St. Joseph’s Hospital Health Center selects CareWorks CMS from CareTech Solutions for its Web sites.
• dbMotion receives ONC-ATCB 2011/2012 certification for three use cases.
• GE Healthcare releases Centricity Advance – Mobile as an iPad application, while also announcing U.S. launch of Optima CT660.
• MEDecision Inc. announces that its 2011 URAC accredited Alineo Clinical Programs are available.
• Access announces that 10 of its customers have been named to HHN’s Most Wired Hospitals list for 2011.
• AdvancedMD receives recognition as the top EMR for OB/GYN.
• GetWellNetwork releases a new white paper, Meaningful Use of Health Information Technology: Requirements and Solutions in Patient and Family Engagement.
• A National eHealth Collaborative HIE report recognizes two Orion customers, HealthInfoNet and SMRTNET for their mature HIEs.
• The Advisory Board Company expands it Austin,TX software center following a 10-year, $372,590 incentive deal with the city. The company will create 239 jobs and invest $8.1 million in improvements to its leased space by 2017.
• Greenway Medical reports that its customers have secured more than $1 million in combined Medicaid and Medicare Meaningful Use incentive funds.

Contacts

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