News 8/3/11

Top News

Atlanta-based transcription vendor Transcend Services announces that it has acquired electronic clinical documentation and charge capture vendor Salar Inc. in an $11 million cash for stock transaction that closed last week. According to the announcement, Salar had $1.2 million in operating income on $4 million in revenue last year. Transcend says it will migrate its speech recognition technology to Salar-based templates for users who prefer that form of documentation, allowing it to offer customers a hybrid solution that will help them meet Meaningful use requirements. Salar, founded in 1999, will remain in Baltimore as a business unit of Transcend. They are the latest in an amazing string of HIStalk sponsors to be successfully acquired, for which we congratulate Todd Johnson and his fun band of pirates — we call them that since they attended our HIMSS reception in swashbuckling regalia a couple of years ago.

Reader Comments

From E-Reader: “Re: NextGen. Will announce later this week that it will partner with Medseek for a new enterprise patient portal for hospitals.” Unverified, but reported by several readers.

From CIO: “Re: HIS vendor quote. This is my new favorite, just received from GE: ‘While we do our best to eliminate as many crashes as possible with each release, we did not expect crashing to go away with DP7 entirely, only to be reduced.’” Unverified. I actually admire that they came clean technically. While everybody’s #1 preference would be for a vendor to fix all technical problems (and cause none), the #2 preference is for the vendor to at least disclose when a problem exists so it can be mitigated in ways that don’t make the client’s IT department look stupid.

From Amish IT Guy: “Re: EMR. Take a look at this one and see how long it takes you to realize something funny is going on. It’s an EMR for marijuana dispensaries. Do you get a medical necessity button that always says, ‘ Duuude, go for it?’” An LA TV station went undercover last to film some of this vendor’s EMR clients using the system to illegally issue marijuana cards without any physician involvement, causing the company to threaten those users with termination of their accounts so they wouldn’t “blemish the good practices of everyone else.”

From Epic Guy: “Re: overseas expansion. There’s a small office in Abu Dhabi now.”

 From CERNest Goes to Camp: “Re: Cerner’s executive cabinet. The most recent annual report showed 10 executives, with Gorup and Illig as mostly inactive honoraries. That leaves eight execs, of which three have left in the last few weeks (Wing, Herzog, and Valentine) even as the stock was doing very well. If they really do need to go after acquisitions or new business to offset the business that Epic has taken from them, the second order churn at the VP and director level may hurt the traditionally well oiled machine.”

HIStalk Announcements and Requests

Inga has been doing a bit of traveling, so her contributions this time around are mostly straight news, thus the absence of her cute little red icon to indicate opinion, snark, or insight. I expect the ratio to improve next time.

Acquisitions, Funding, Business, and Stock

Mobile healthcare communications vendor Vocera files plans for an $80 million IPO, with shares to be traded on the New York Stock Exchange. Some big securities firms are involved: JP Morgan, Piper Jaffray, Robert W. Baird, and William Blair. The company had $69 million in sales for the year just ended.

NLP provider Coderyte raises $2.5 million from nine investors, including Polaris Ventures and Solstice Capital.

MedAssets reports Q2 net revenue of $147.4 million, up 55% from last year, primarily due to its acquisition of Broadlane in November 2010. Acquisition costs attributed to a quarterly loss of $2.5 million ($0.04 per diluted share) versus $3.3 million in 2010 ($0.06 per diluted share.)

Allscripts reports Q2 numbers: revenue up 11%, EPS $0.08 vs. $0.09, meeting consensus earnings expectations excluding one-time expenses.

The Allscripts conference call transcript is already up. Nuggets:

• CEO Glen Tullman cited a June CapSite survey that found Allscripts leads all EHR vendors in mind share.
• Allscripts beat Cerner at two-hospital, 550-bed Heritage Valley Health System (PA) in a newly announced Sunrise deal.
• A South Australia deal was announced, with SA Health signing a “limited pre-production software license agreement” as the first stage in implementing an EHR across 80 hospitals and clinics. Value of around $50 million was implied.
• The company is expecting 5,000 attendees at the Allscripts Client Experience later this month, where Allscripts will demonstrate full integration of their ambulatory and inpatient EHRs.
• Allscripts may move slowly into more hosted offerings like they offer for Sunrise.
• Glen mentioned a figure of 300-400 big hospital EHR deals being done in the next 18-24 months and he expects to get" “more than our fair share” of those.

Automated Tracking Solutions files a patent infringement lawsuit against a number of healthcare RFID/RTLS vendors, including Awarepoint, TeleTracking, and RadarFind. ATS sells no competing products that I can tell – its only assets are patents (the oldest being from 2005, with one of the technical illustrations above) and its lawyer owner.

CSC completes its acquisition of Australia’s iSOFT Group.

The COO of Humana mentions EMRs in the company’s earnings call:

And then finally, in the Stars and quality area, EMR investment. You may have seen some press releases that we’ve done here recently with companies like Allscript and Athenahealth and others where we’re trying to get a lot more information in electronic medical records going forward, in line with what the government’s doing. We think there’s a real opportunity there. And finally, in the clinical area, the Care Hub, something that we talked about with all of you in the past. Our clinical messaging system and workflow system, more rules, engine and accelerating IT spend there. Mike talked about hiring more Humana Cares nurses throughout the United States, field nurses throughout the United States in areas where we anticipate growing. And then finally, we did some work here recently to in-source all of our DM programs, and we’re going to accelerate that because we’re seeing some nice results there.

Sales

UW Health Partners Watertown Regional Medical Center (WI) selects GetWellNetwork’s interactive patient care solution.

USC University Hospital and USC Norris Cancer Hospital (CA) choose MedAssets as their exclusive provider of technology-enabled business office outsource services.

People

Tele-ICU provider Advanced ICU Care names Bradley Green VP of sales.

Sandlot LLC, a Texas-based subsidiary of North Texas Specialty Physicians, names Kimberly Alise as CEO. She was previously CEO and co-founder of EHR vendor Empower Systems. 

Former Sandlot CEO Telly Shackelford is promoted to CIO of North Texas Specialty Physicians.

Alex Veletsos, formerly of Orlando Health, joins Ascension Health Services as CIO of St. Mary’s of Michigan and St. Joseph Health System.

Announcements and Implementations

In an SEC filing, Cerner discloses it paid $36.3 million for its May acquisition of Resource Systems, a provider of long-term care software.

Integrated Document Solutions partners with SourceMedical to provide document scanning and outsourced paper imaging services to SourceMedical clients transitioning to EHR.

Healthland launches Healthland Centriq, an EHR solution for rural clinicians.

Delaware Valley Hospital (NY) uses professional services from Accent on Integration and the Siemens OPENLink interface engine to integrate and share data with the Southern Tier Health Link RHIO.

Kareo announces the availability of free support to all its customers. The company also notes that internal surveys show that customer satisfaction is up 325% as a result of several recent improvements.

Clinical communications technology vendor Voalté signs its first reseller agreement. Houston-based Halco Life Safety Systems will offer its Voalté One smart phone solution to hospitals there.

Florida Hospital and Cerner will work together on a system that facilitates communication between patient care physicians and their researcher counterparts, connecting Cerner’s clinical systems with its PowerTrials and Discovere applications to automate and integrate diabetes research activities.

Phytel introduces its Hospital Readmission Management solution to automate post-discharge care processes and reduce readmission rates.

An AIDS prevention group in India is finishing its software to track HIV-positive pregnant women and their babies, necessitated by hospitals that don’t bother filing their reports.

Spain-based technology vendor Andago, which offers government and eHealth software (including Continua-compliant mobile health applications for wellness, disease management, and independent living) leases space in a University of Miami research building adjacent to Jackson Memorial Hospital for its first US office.

The Government of Jordan launches a regional health clinic that will use Cisco’s Care-at-a-Distance HealthPresence technology to link specialists from two hospitals for consultations.

Government and Politics

AMIA weighs in on the proposed HIPAA Accounting of Disclosures rule. Their concerns:

• HHS assumes that EHRs maintain user-friendly audit trails that covered entities (not to mention their business associates) can easily extract and hand directly over to the patient.
• The NPRM uses the term “designated record set” inconsistently, and hospitals have a large number of IT systems that may contributed to that set.
• Patients won’t get much benefit since the disclosure list doesn’t address their primary concern – large-scale electronic theft – and will confuse them since they are generally unaware that many people they don’t see directly are involved in their care, such as students and back-office employees.
• The rule proposes to include the full name of those accessing records without asking those caregivers for consent, which AMIA cleverly points out isn’t that much different than looking at patient records without their consent.
• Just a quick look at a patient’s record could generate dozens of entries, but still not capture all accesses, such as seeing a patient’s name on a list or running a query (like from a data warehouse) that touches a patient’s record. They also question whether medical case presentations and guest expert rounding require someone to log the “accesses” manually.
• AMIA worries that provider may simply eliminate access rather than account for it, such as denying research access to students.
• Data transmission, such as batch file extracts, don’t generally populate audit logs.
• If HHS really believes that few patients will request disclosure logs (which is how it justifies the workload involved), then maybe it’s not really worth the provider and vendor cost of making them available.
• Even complete audit logs won’t answer the specific questions that patients probably had in requesting a report, such as “Did my ex-girlfriend who works at your institution look at my record, and if so, why?”
• AMIA is “astounded” that research use must be included in access reports, even those involving an IRB, patient authorization, or a limited data set.
• HHS’s $20 million estimate of cost to providers is absurd since that’s only $30 per covered entity. Even just a wording change to a single provider’s Notice of Privacy Practices would cost thousands of dollars in legal review fees.

Other

We mentioned a couple of weeks ago that Cayman Islands Health Services Authority CIO Dale Sanders told us they would be re-competing their Cerner contract. Here’s more. The bid document says the Cerner system costs $2.7 million per year, but users find it cumbersome and are “largely unhappy with the workflow and user interface.” The hospital is seeking a less-expensive alternative that is free from the “dysfunctional influence of the US financial and economic model” for healthcare.

HHS Secretary Kathleen Sebelius gives EMRs a plug during a tour of the tornado-damaged St. John’s Regional Medicine Center in Joplin, MO. Says Sebelius:

"There’s no question that … the availability of an electronic record may have actually saved lives. They were able to immediately go into the treatment phase and not spend a lot of energy trying to reconstruct (records)."

Georgia’s second annual Health IT Leadership Summit will be held on November 8 at Atlanta’s Fox Theater. Entries for its first innovation awards are due August 24.

Pocatello Family Medicine (ID) sends potential breach letters to its patients after finding that a technician forgot to reactivate the firewall after maintenance work, leaving its EMR wide open on the Internet for several months. The practice says it doesn’t think anybody accessed the patient records, although someone did park some movies on their server.

Weird News Andy reproduces this article from India, which describes the surprise of surgeons in finding that a male patient admitted for a suspected hernia had a complete set of female reproductive organs in his abdomen. He’s recovering well from his hysterectomy.

I love this Epic ad from a 1984 MUMPS journal, as sent over by Limber Lob. Here is his explanation:

Attached is an advertisement from Epic that appeared back in 1984. I had set this ad aside so I could someday ask Judy about the comment at the bottom, which reads, "All Epic software is written in the MIIS dialect of MUMPS."

But a colleague just reminded me that it was all about speed, as Meditech’s MIIS dialect of MUMPS was very fast and ran circles around all other early MUMPS implementations, such as those from Digital Equipment Corporation (DEC) and InterSystems.
As you know, Neil Pappalardo, who founded and still owns Meditech (which still uses MIIS), was the original developer of the MUMPS programming language when he worked for cardiology researcher Octo Barnett at the Massachusetts General Hospital in the mid-1960s. As MUMPS moved slowly towards (ANSI) standardization, Neil wanted to pursue his own ideas at a faster pace, and left MGH to develop MIIS and found Meditech. Back in 1984, when minicomputers were slower than today’s slowest desktop machines, Judy used the MIIS dialect of MUMPS for Epic’s software because it was the fastest game in town But as the other (standard) MUMPS implementations got faster, the benefits of using ANSI Standard MUMPS dominated the language selection decision, and Epic switched to the ANSI/ISO Standard MUMPS that virtually everyone but Meditech uses today. This ad surprised me, as I hadn’t remembered the details, but it’s good to be reminded that system speed has been an Epic priority since the beginning.

Sponsor Updates

• Presbyterian Intercommunity Hospital (CA) selects ProVation MD software from Wolters Kluwer Health for documentation and coding of gastroenterology procedures.
• St. Luke’s Hospital & Health Network (PA) chooses Allscripts EHR and PM for their 1,600 physicians, underwriting a portion of the cost to enable the physicians to qualify for ARRA incentives.
• Heritage Valley Health System (PA) signs up for Allscripts Sunrise, which it will connect to its Allscripts Enterprise ambulatory EHR.
• NP Scharmaine Lawson-Baker (LA) uses Practice Fusion’s free, Web-based EHR and her iPad to care for senior and disabled patients via house calls.
• T-System Inc announces that it will incorporate content from PEPID into its ED information system, T-SystemEV, improving accuracy and patient care.
• Merge Healthcare announces Covenant Healthcare’s selection of iConnect Access to provide images to its physicians. Northeast Georgia Health System (NGHS) also selects iConnect for its HIE strategy, while and Mon General Hospital (WV) chooses Merge Cardio as its enterprise-wide cardiovascular information system.
• Stockell Healthcare Systems announces that ProMedica St. Luke’s Hospital (OH) is ProMedica’s tenth facility to go live with its InsightCS Revenue Cycle Information System.
• Keane, an NTT Data Company, announces that SVP Robb Rasmussen will speak at the CIO 100 Symposium on cloud computing in August.
• Thanks to NPC Creative Services, which counts quite a few HIT vendors among its strategic PR clients and keeps us in the loop with new announcements (and who is an HIStalk sponsor itself).
• Intelligent Medical Objects (IMO) is attending the Aprima and ACE user group meetings in August.
• Gateway EDI is exhibiting at MGMA Alabama, MGMA Georgia, and PriMed Mid-Atlantic in August.
• TeleTracking Technologies attributes its strong second quarter to the 14 new hospital contracts for its TransferCenter referral automation software.

Contacts

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

Monday Morning Update 8/1/11

From ACC_Champs: “Re: NCHICA’s response to Accounting of Disclosures. By getting input from all sides of the issue, they have drafted a great response.” Some of their concerns:

1. Just because few people ask for Accountings of Disclosures now doesn’t mean they won’t in the future, requiring hospitals to do a lot of unpaid work.
2. The scope needs to be better defined since not everything is stored permanently in the EMR (such EKG strips, as I read from their example).
3. The definition of “access” should be clarified, such as if someone searches for “John Smith” in an EMR and is shown a long list of John Smiths, is that considered “access” of every one of them?
4. It’s not as easy to generate an Access Report as you might think, with hospitals churning out tons of data from many systems (one hospital found that an average six-day inpatient stay generated 1,800 accesses).
5. Access logs aren’t something the typical patient would be able to understand, meaning they may expect someone to spend time explaining them.
6. Patients who don’t understand that hospitals have a lot of unseen people involved in their care are going to file unwarranted complaints to OCR.
7. Employees aren’t protected from ambulance chasers or crazy patients who could easily obtain their full names by requesting an access report.

From Quaid: “Re: Siemens. Hawaii Health Systems Corporation just signed a $28.7 million deal for Soarian.” Verified.

From Anony: “Re: Piedmont Healthcare, Atlanta. Can’t believe I haven’t seen it here yet, but they’re moving from Allscripts to Epic.” As usual, the best way to verify is to check the hospital’s job postings since the Epic implementation method requires hiring a ton of people fast, including posting all jobs instead of just reassigning current staff. Piedmont listed several inpatient Epic positions on July 12, so I’d say that’s confirmation. I should also mention that Johns Hopkins signed its Epic contract this week. Both will apparently be Allscripts Sunrise losses.

From Anonymous: “Re: Allscripts. Continuing to reduce workforce in Raleigh as jobs are offshored, with 15-20 folks gone in the last week or two.” Unverified.

From Nasty Parts: “Re: Compugroup. Heard on the street that they’re buying the Sage Healthcare business. Folks at Compugroup USA HQ openly talking about it.” Unverified.

From KnowurCMIO: “Re: Cerner and Epic. Epic has indeed started expanding overseas — they have a satellite HQ in the Netherlands and have already installed there. I suspect they will begin seeing rapid growth once the implementations stateside slow down. Spaarne Hospital was the first EpicCare client in Europe in 2007.”

From Bob: “Re: shoe hoarder. I read this and thought of Inga.” A Philadelphia mom who happens to be a big-money poker champ owns 1,200 pairs of shoes (one pair worth $4,000) stored in four closets, one of them a converted sitting room. She’s profiled in a film about shoe nuts, which concludes that such compulsion is related to seduction and sex. I’ll let Inga to clarify her own motives.

Here’s the latest HIStory from Vince, this time covering Dynamic Control.

Listening: the new CD from teen rockers Jessica Prouty Band, sent over by her mom, who has a lot of history in HIT. Their sound has matured a lot over the years I’ve followed them, putting them right up there with Evanescence, Within Temptation, and some of the other female-led metal rockers. Big sound for a four-piece, with singer Jessica handling the bass very well. This is a really polished production – you would never suspect that the members are barely old enough to drive to their gigs. Video here.

My Time Capsule editorial from 2006 this week: When CIOs Are Under Pressure, “Man of Action Syndrome” Kicks In, snipped herein: “From my limited experience, I would say that CIOs overrule the concerns of nurse informatics people nearly 100 percent of the time and IT-based physicians at least 50 percent of the time.”

Most respondents believe that HITECH’s legacy will be increased EMR adoption, although the “waste of taxpayer money” camp was right on their heels. New poll to your right, spurred because I got a HIMSS member survey recently: how would you grade your satisfaction level with HIMSS? As always, you are able and encouraged to add your comments by clicking the Comments link on the poll, visible after you’ve either voted or clicked the View Results link.

HIMSS moved its Chicago headquarters this weekend.

Sage announces Intergy v7, which includes user enhancements, certification of all 44 ONC-ATCB clinical quality measures, and 5010 support for the PM/EMR system.  

NHS Scotland contracts with Imprivata for its OneSign single sign-on and password reset solution.

A reader sent over the full text EHR articles that were just published in the July issue Journal of Oncology Practice. Here’s a brief rundown of those I found interesting.

• A US Oncology team, working with iKnowMed to standardize over 500 chemo regimen order sets, found that 10% of them needed to be eliminated, with changes required for all the rest (other than changes in title, the most common changes involved updating the cited references and changing doses and cycles). They mention that EMRs can help address drug safety issues.
• NorthShore (IL) looked at the cultural impact of moving all inpatient and outpatient oncology ordering to Epic in 2005. The main benefit was data sharing among members of the multidisciplinary team (labs, rads, referrals, appointment information) and patient communication (secure communications, online test results). Chemo ordering in Beacon was found to be more complete and safer, with the percentage of complete documentation going from 67% to 93% and pharmacy interventions also increasing. They’re at 100% e-prescribing (other than for narcotics and oral chemo), outpatient med rec is over 90%, and AR days have dropped to 30. They’re using Epic’s data for research and quality monitoring.
• A Vanderbilt group looked at improving compliance with nursing guidelines on chemo administration and documentation using their systems (WizOrder, Horizon Meds Manager, Horizon Expert Documentation, StarPanel). Pros: two-signature compliance improved, standardized MARs were easier for nurses to follow, alerts improved safety. Cons: systems could not track doses by relative day or dose number, could not document infusion stop time, stat and verbal orders required an override, and pharmacy had to adjust schedules frequently to avoid “wrong time” alerts.
• Johns Hopkins pediatric oncologists wrote up their CPOE design process and creation of Eclipsys Sunrise MLMs to check height and weight, to force inclusion of hydration orders, and to provide the capability to adjust chemo doses by percentages. They also developed a fast-track process for creating and approving new order sets.
• Memorial Sloan-Kettering described their Eclipsys CPOE chemo ordering implementation. They created 1,250 adult and 466 pediatric order sets and mandated CPOE-based ordering. They reported nearly universal use of the order sets. I didn’t see anything that documented clinical outcomes, but they did mention problems related to cumulative dose calculations and alerts.

From McKesson’s earnings call:

1. They talked a lot about acquiring Portico Systems (surprising given that McKesson is a massive company acquiring a relatively tiny company for $38 million, which would be just a few weeks’ pay for CEO John Hammergren since he took home $151 million last year) and said little about their drug business.
2. Technology Solutions  revenue was up 6%, but only because of revenue recognition timing – they expect growth to be a little better than last year’s 2%.
3. Hammergren mentioned “significant progress” in the technology business, but basically said focus is on implementation rather than sales even though the company is “continuing to strategically position the business for continued growth.”
4. He said that clinical systems are today’s opportunity, but a lot of McKesson’s customers are running 20-year-old financial systems that might be candidates for Horizon Enterprise Revenue Management.
5. He thinks that big companies (“the anchor tenant”) will be the healthcare IT winners in the payer, hospital, and physician practice markets since smaller companies won’t be able to get to those prospects cost effectively.
6. He mentioned some “consolidation in our overhead and our selling infrastructure last year.”
7. An analyst asked directly about IT customer retention in calling 2010 “a tough year” for McKesson, with Hammergren’s response being that the company had spent a lot over the last two years to make its products better and he hopes the market share changes are a trailing rather than a leading indicator, with the potential of a slight rebound in market share this year with Paragon as the leader.

My sideline analysis of the MCK call (your comments are welcome):

1. Most of the analysts’ questions involved the company’s challenges in the IT business, again surprising given its core business of drug distribution.
2. McKesson seems to be acknowledging that it’s falling behind Epic and other vendors on the clinical systems side and is placing its only hope on a pendulum swing back to financial systems and its struggling HERM.
3. The company hopes that product improvement will stop the market share slide.
4. I inferred no commitment to innovation, acquisitions, or thought leadership, just that McKesson is banking on its huge size and customer touch points to keep selling all of its products.

The local paper covers the $36 million Epic system that will be in place when Orange Regional Medical Center (NY) moves to its new hospital next week. It says that stimulus money will cover half the cost.

In Canada, Nova Scotia will implement a $27 million system for sharing patient medication information, with all pharmacies expected to be linked by 2013.

Hawaii Governor Neil Abercrombie announces that Thomas Tsang, MD will join his healthcare transformation leadership team. He is ONC’s medical director over Meaningful Use, but it’s not clear from the announcement whether he’s resigning that post.

GE Healthcare Performance Solutions acquires Medical Event Reporting System, a Web-based system that helps hospitals collect and analyze patient safety events. It was developed by Columbia university with AHRQ support. The company, also called MERS, had been a GE Healthcare JV partner since 2008. A white paper on its use by Mount Sinai Hospital (NY) is here. GE says it’s working on rollouts to 16 hospitals.

From Cerner’s earnings call:

1. The company talked up its physician practice sales, saying its improvements in the user interface and workflow positioned its products well as clients look for systems that integrate inpatient and outpatient.
2. CERN says it is different from competitors in its willingness to connect to other systems.
3. They are expecting Meaningful Use to keep driving sales for years.
4. They suggest that 50% of US hospitals will reselect their core systems in the next 5-7 years as even those customers who are happy today will find their vendors falling short with regard to interoperability and reporting.
5. The ProFit financial system is doing better.
6. CERN says they expect to take on more outsourcing contracts since they are more able to hire scarce HIT employees than hospitals.
7. Neal didn’t pop in for even his usual one-paragraph drive-by.

Shares in Omnicell touched off a 52-week-high Friday after turning in good numbers after the market close Thursday: revenue up 6.6%, EPS $0.08 vs $0.02. The one-year share price (blue) against the S&P 500 (green) is above. Market cap is $567 million.

Meditech filed its quarterly report Friday, with revenue up 25% and EPS up 33% ($0.86 vs. $0.64). The cost of acquiring the 78% of shares in ambulatory vendor LSS that it didn’t already own was given as $13.7 million in cash, with LSS’s first quarter performance being $0.8 million in net income on $5.4 million in revenue.

Strange: the former head of Alberta Health Services (Canada), who left his job in November after repeatedly telling reporters at an emergency meeting that he was too busy eating a cookie to answer their questions, gets $735K in severance. He seemed overly peeved, but made sense in pointing out that maybe the eager beaver talking heads should attend the scheduled press briefing that was being held in 30 minutes instead of chasing him down the street for their own personal on-camera moment.

E-mail Mr. H.

News 7/29/11

Top News

Cerner’s Q2 numbers: revenue up 15%, EPS $0.42 vs. $0.33, beating earnings expectations by a penny after excluding one-time items.

Reader Comments

From AzEMRGuy: “Re: Tucson Medical Center. Hiring for multiple Epic positions.” Above is the hospital’s recruitment video, which talks up Epic opportunities. I assume that means Allscripts Sunrise is egressing unless TMC switched systems since the last time I was there. CORRECTION: reader Zaphod Beeblebrox correctly notes that I confused University Medical Center in Tucson (a Sunrise client) with Tucson Medical Center. TMC is already an Epic customer.

From Instamatic: “Re: displaced CIS vendors. This chart from the KLAS newsletter says 2010 sales volume remained about the same as 2009. Would you assume that most of the displacements are Epic’s?” I would assume so, especially given the win/loss numbers that KLAS put out along with the graphic (almost two-thirds of sales to 200+ bed hospitals went to Epic, with Horizon customers being especially ripe for the plucking). I’ve been saying for a year or two that Epic is dominating the market of mid-size hospitals and up (say, 300+ bed community hospitals, but also academic medical centers and IDNs), putting a big-time hurt on Cerner, non-Paragon McKesson, and the former Eclipsys. Not to mention as the healthcare system inevitably consolidates under healthcare reform, more organizations will hit Epic’s sweet spot of size and scope as they look to standardize. Vendors such as GE, QuadraMed, and Siemens weren’t much of a sales factor anyway, so that would seem to leave Epic on the high end and Meditech and Paragon for everyone else as the only vendors booking significant net-new customers. That’s not considering rural and critical access hospitals, which would look at Meditech, Paragon, HMS, Prognosis, and a few others. I think you’ll see the others trying to make their numbers with hosting, upselling, and services – in other words, they’re in a mature market, which can throw off some nice profits while waiting for the inevitable downward slide to accelerate. They all have other business lines, so they’ll be fine. I’m not saying that’s good or bad, just how it looks to me.

From Mathemagician: “Re: Cerner. They can’t compete with Epic any more for hospitals of more than a couple of hundred beds, so they have three ways to drive growth: (a) sell to very small hospitals that don’t already have systems; (b) provide outsourcing services to existing customers, such as IT outsourcing and revenue cycle management; and (c) sell outside of the US where Epic doesn’t tread.” I would agree, adding also Cerner’s apparent interest (possibly Epic-motivated) in providing actual healthcare and healthcare management services rather than just IT products and services. Cerner’s biggest competitive weapon is its market cap, which provides options that the company appears to be tentatively exploring.

From rsm2800: “Re: Journal of Oncology Practice. The July issue contains 12 articles about EHRs in oncology.” Only subscribers can read the full text articles, but the titles relate to CCHIT certification; Memorial Sloan-Kettering’s chemo ordering system (which must be the amazingly cool Allscripts Sunrise work I saw at HIMSS last year); CPOE in peds oncology; standardized CPOE order sets; EMR-based checklists; use of natural language processing to extract clinical information from free text documentation; chemo medication administration systems; patient-physician e-mail; EMR effects on culture; CPOE outcomes; and the interest in sharing information by those with cancer. The topics sound excellent.

HIStalk Announcements and Requests

Have you kept up with HIStalk Practice this week? A few highlights: MGMA joins CHIME and other professional organizations in calling for HHS to withdraw its proposed HIPAA accounting of disclosure rules. DrFirst intros an e-prescribing option for controlled substances. The American Academy of Ophthalmology publishes a list of EHR requirements for ophthalmologists seeking to achieve Meaningful Use incentives. Salaries for physician practice managers remained flat in 2010.  Sign up for the e-mail updates while you are passing through and thanks for reading.

I featured Aventura in the latest Innovator Showcase this week. Just to recap the process: several dozen companies nominated themselves to be included; my expert team of investment bankers and providers chose eight of them after reviewing their application materials; and those companies will complete a video, a customer testimonial, and a telephone interview to be presented with their showcase article. Two of the eight have been featured so far. It’s quite a bit of work for the companies and for me, but readers have asked me repeatedly to give creative vendors a chance to be seen.

Keep an eye on the swinging pocket watch … you are getting sleepy … when you awaken, you will feel happy and rested. You will immediately sign up for e-mail updates to your upper right … your legs and arms are getting heavy … you will make the inevitable electronic connections offered by Facebook and LinkedIn to Inga, Dr. Jayne, and Mr. H … you can barely keep your eyes open …. you love HIStalk’s sponsors and will feel fulfilled by clicking their ads … going into a deeper sleep as you pledge to send me news, rumors, articles, or anything interesting … you’re become a little more alert … when I count three you will awaken rested and refreshed, feeling better than you’ve ever felt … one, two … and almost forgot, you’ll bark like a dog every time you hear the word “interoperability,” you’ll never embarrass yourself again by writing trite Internet phrases such as “wow, just wow” or “Best. Wine. Ever” and you’ll send love notes to Mr. H and Inga … three. Thanks to readers for reading, sponsors for … sponsing, and caregivers for caring.

Acquisitions, Funding, Business, and Stock

McKesson reports Q1 results: revenue up 9%, EPS $1.13 vs. $1.10, meeting Wall Street revenue expectations but falling short on earnings. Technology Solutions revenue was up 6% with adjusted profit of $119 million. The earnings call transcript should be out tomorrow and it usually has some interesting nuggets about the company’s software business.

Private equity firm Blackstone Group is rumored to be in discussions to acquire Emdeon for more than $3 billion. Shares jumped from less than $13 to over $16 on Thursday, closing at $15.49.

Healthcare learning and employee competency platform vendor HealthStream announces Q2 results: revenue up 26%, EPS $0.08 vs. $0.06.

NextGen parent company Quality Systems, Inc. reports Q1 results: revenue up 21%, EPS $0.65 vs. $0.42, beating estimates on both. Shares will split two for one on October 27.

CPSI’s Q2 numbers: revenue up 30%, EPS $0.72 vs. $0.39, blowing through estimates.

Revenue cycle management company Precision Revenue Strategies renames itself MediRevv.

Medicity’s performance is featured in Aetna’s earnings call Wednesday, which said its contract backlog is $200 million. Aetna made $537 million in profit on $8.3 billion in revenue for the quarter. Also stated about Medicity, which it acquired on January 3 for $500 million:

Our strategy is to grow our footprint in this space and to deliver clinical and administrative content through Medicity’s installed base of health information exchanges. For example, Medicity has developed and is beginning to distribute a suite of applications that are certified as being compliant with the federal meaningful use standards. Medicity’s application development expertise and patented distribution technologies are great examples of how the company combines content and connectivity.

At Aetna, we are excited about our role in promoting health information technology because we believe it has tremendous potential to improve the quality of health care and to make health care more affordable. We continue to build a portfolio of businesses that simultaneously generate high growth fee revenues and improve the performance of our health plan businesses.

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Sales

Texas Health Resources contracts with Streamline Health for its Epic Integration Suite.

The Tehachapi Valley Healthcare District Board of Directors (CA) approves the purchase of Healthland’s EHR. The local paper reports that the $400K five-year cost of HMS was one-fourth that of competitor McKesson.

HealthSouth selects Cerner to provide EHR for its 97 inpatient rehab facilities.

Memorial Hermann chooses CodeRyte for computer-assisted coding.

Hoag Memorial Hospital Presbyterian (CA) signs for Unibased ForSite 2020 Resource Management System for enterprise scheduling and a patient portal.

People

Former Wipro Technologies CIO Laxman K. Badiga joins Anthelio as COO.

Pat Cline, president and board member of Quality Systems, announces that he will retire this year.

Accretive Health names Joseph Bellini chief revenue officer.

Shared Health hires former WebMD founding COO Michael Heekin as CEO.

Announcements and Implementations

Misys Open Source Solutions wins the international “Best Use of Open Source Technology” award for its Misys Connect HIE solution.

The Rhode Island REC accepts ABILITY Network as an health information service provider to provide its member secure health information exchange.

Epocrates announces first phase availability of its Epocrates EHR mobile and Web-based EHR, designed for primary care practices with 10 or fewer physicians. The company will also offer a license to a native Apple iPhone app that supports remote patient look-up, schedule access, and e-prescribing capabilities.

Other

CMS’ Office of the Actuary predicts that national healthcare spending will hit $4.6 trillion by 2020, up from this year’s $2.7 trillion. The biggest increase in spending (8.3%) will occur in 2014, when many federal health reforms take effect.

The Salt Lake City paper observes the challenges of connecting physician practices and hospitals via Utah’s Clinical Health Information Exchange, with incompatible EMRs leading the list. An interesting tidbit that may have been inadvertently disclosed by a University of Utah Health Care spokesperson: they’re using Cerner on the inpatient side and Epic for outpatient, but will soon migrate to a single system. You’ll want big odds if you’re betting on Cerner to win that deal.

The Town of Freetown (MA) lays out the requirements Meditech will need to meet to develop a five-story, 186,000 square foot office building there that could bring up to 800 jobs to the area. Meditech’s costs are estimated at $80-100 million.

Tampa General Hospital (FL) files a $9.2 million claim against the estate of a deceased 29-year-old patient who had spent five years as an inpatient. Maybe they should use any proceeds to hire case managers or buy equity in a skilled nursing facility that will accept transfers.

Sponsor Updates

• Cottage Hospital (NH) achieves Medicare Stage 1 Meaningful Use through its use of the Healthcare Management Systems (HMS) EHR.
• Michigan Eye Institute chooses the SRS EHR for its eight-provider, five-location practice.
• Five providers from Aquidneck Medical Associates (RI) receive an $18,000 check for their Meaningful Use of the eClinicalWorks EHR, making them among the first in the state.
• Microsoft recognizes MEDSEEK as its 2011 US Public Sector Partner of the Year.
• Milwaukee Health Care Partnership and Wisconsin Health Information Exchange (WHIE announce a two-year extension of their contract with My Health Direct.
• St. Mary’s Regional Medical Center (OK) selects Merge Healthcare’s cardiology solution, while Sisters of Mercy (MO) adds the company’s iConnect solution.
• Mount Carmel Health Partners (OH) chooses MedVentive Population Manager to support improved patient care and clinical outcomes.
• Lexmark reports record earnings for Q2 and acknowledges the contribution of its Perceptive Software business unit.
• Health Language Inc (HLI) launches an upgrade to its Provider Friendly Terminology solution, now containing over 120,000 terms.
• T-System announces a call for entries for its Client Excellence Awards.
• Sentry Data Systems expands to a new office in Austin, TX while partnering with UT’s health IT program.
• GetWellNetwork adds two options for its interactive patient care system, a multi-function touchscreen and a lower-price, eco-friendly nettop.
• ZirMed announces successful transmission of claims and receipt of electronic remittance advices using HIPAA 5010 format.

EPtalk by Dr. Jayne

Quite a few organizations are using scribes as part of their EHR. A local hospital (which happens to be an Epic client) recently started using scribes in the emergency department, with the goal of having scribe coverage for all emergency physicians by early next year. According to a PR piece, several companies provide scribes and offer scribe training, with an estimated 200-plus hospital emergency departments starting to use scribes over the last two years.

Our group experimented with scribes several years ago when there weren’t as many formal opportunities for scribe training. We mainly wanted to use scribes in physician offices to aid EHR adoption and provide a safety net for older docs who were close to retirement and resistant to EHR implementation, but who still needed to get data into the system for patient safety and care continuity purposes.

A medical assistant or medical secretary would typically receive additional training, but it was rare for the practice to go the distance and hire someone to do the staffer’s usual work while he/she was scribing. As you can imagine, it doesn’t go well when you take a full-time employee and add another full time job to his/her plate. The program was dead before it ever left the gate.

Scribe staffing firms target pre-medical and pre-nursing students who are looking for experience in the healthcare field who are willing to work cheap. Starting salary for a scribe is $8 to $10 an hour. After preclinical training, the firm that’s staffing our local hospital includes a 100-hour “apprenticeship” with a senior scribe before new scribes are allowed to work independently.

The non-profit American College of Clinical Information Managers (ACCIM) recently emerged to hopefully help the rapidly proliferating scribe programs develop standards and monitor themselves. A visit to their website revealed an online training program and an exam leading to certification as a Clinical Information Manager, which can be taken after as little as 100 hours of work with a minimum of 100 patients documented. The exam costs $40 and an annual certification costs $20.

I like the idea that they require certified scribes to complete 20 hours of continuing education a year. Our state medical board only requires 25 hours for physicians and I think that’s pretty sad. Although the website said it would have a list of individual certified scribes, I wasn’t able to find it. Corporate members of the ACCIM include Scribe America and Emergency Medicine Scribe Systems.

As a physician, I’d love to know that all my data is being captured the way I like it while I can focus on the patient in front of me. From experience, though, I know it’s hard to have that level of teamwork and trust when you’re in a shift-work environment. I’ve done my share of emergency department work, and unless the scribes are remarkably consistent, I think it would be hard to have a different one for every shift.

The local paper profiled this change, noting that the scribes “win” by seeing jobs first-hand as they are “attached to the hip of a physician.” Do they really? I wonder what the average shelf life of a scribe is?

Depending on what they see, it might send them running in the opposite direction of actually entering the healthcare field. Most pre-med students are pretty smart cookies who will quickly figure out if they truly have a calling for days where you stand for 12 hours without a meal or a trip to the bathroom in exchange for taking on upwards of $250,000 in student loan debt.

On the other hand, it’s a great way to get experience and actually get paid. Back in the dark ages when I was an undergrad, unless your parent was a doctor and would hire you to work in the office, the only experience you could get was as a volunteer. I’d certainly rather have had the opportunity to do scribe work than to do what I did, which was to edit a medical textbook written by an extremely cranky researcher who had chosen someone without a firm grasp of the English language to do a first pass on her book before firing him. Although frustrating, I must say it prepared me for some of the technical manuals and white papers that grace the ever-growing stacks on this CMIO’s desk.

Do you have scribes at your hospital or health system? Do they make for happier EHR users? E-mail me.

Contacts

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

HIStalk Innovator Showcase – Aventura 7/27/11

Company name: Aventura
Address: 1001 17th St. Suite SL-100, Denver, CO 80004
Web address: www.aventurahq.com
Telephone: 888.484.4643
Year founded: 2008
FTEs: 25

Elevator pitch

Aventura overcomes technical hurdles that exist at the intersection of where your caregivers use your computer systems to deliver the computing experience that doctors and nurses demand.

Business and product summary

Aventura is in the business of making caregivers happy and IT look like heroes. Aventura’s revolutionary new platform fundamentally improves the usability of computing systems for doctors and nurses, leading to increased productivity. Aventura also centralizes and standardizes many aspects of the enterprise environment, saving IT significant time and headaches. Our software is licensed to hospitals through enterprise agreements, and our raving fans are the caregivers that use our solution every day.

The best way to understand Aventura is through a quick example of a user’s experience. A doctor or nurse logs on at a new terminal in a patient room using dual-factor authentication (smart cards, proximity cards or biometric). Based on who this person is, their new location, and any other pre-defined set of rules established by the hospital, Aventura begins updating this person’s existing desktop session (which has been securely locked from their last location) before displaying it.

For example, printing defaults are updated, some applications may be hidden, necessary ones pop up automatically, and some URLs (including already open ones) may be restricted or hidden. This updated desktop and all appropriate applications are then presented to this caregiver.

What is most important about this process is that it all happens in less than five seconds. Log-out is as instant as removing his card. Access is simple and secure. Usability for doctors and nurses is significantly increased because they are no longer wasting time logging in and accessing the right applications and data, and instead can focus on the job they signed up to do: provide incredible patient care.

Who is your target customer?

Today Aventura sells its services to small, medium, and large size hospitals. In the future, Aventura will be delivering its services also to physician practices.

What customer problem do you solve?

Aventura is a small company focused on solving one enormous healthcare IT problem. All the billions of dollars being spent on new IT systems and improving clinician productivity will never realize their full potential because of a “weak link” at the intersection of where doctors and nurses have to access these systems. Adoption of these new systems, including CPOE, suffers not because of the applications themselves, but because of the painful process and useless time wasted by doctors and nurses trying to access these new applications 50 to 70 times a day.

That is simply unacceptable for us, so we’re doing some pretty amazing things to fix it. Aventura has designed something totally new, an architectural framework that delivers what caregivers need in order to do their job from any location, securely, in less than five seconds every single time.

Aventura architecture (click to enlarge)

Who are your competitors?

Today, there are no other companies in the market providing the breadth and depth that Aventura delivers when it comes to delivering a dynamic computing environment. While there are a number of folks piecing together clinical desktop solutions using various virtualization and SSO solutions, these projects don’t overcome the technological barrier and the associated issues of roaming a static desktop session.

Why are you better than your competitors?

The idea for Aventura was born in a hospital. We understand that doctors and nurses want instant access to the right data and computing services from any computer at any time. However, in order to make this happen, we recognized that there are significant architectural limitations in today’s computing environments, and that the only way we were going to be able to address this problem is with an architectural solution.

Other companies have partial fixes; single sign-ons, roaming desktops, expensive one-offs, but they are all still based on a static operating system that was never designed to serve people who work on dozens of different computers in a single day.

Aventura’s new platform called Enterprise Operating Framework allows us to dynamically update clinicians’ computing sessions, and respond to their needs based on who and where they are. Access is intuitive and consistent and completely respects the way clinicians want to work. Further, Aventura is designed to provide this improved caregiver experience using whatever computing infrastructure a hospital currently has in place.

In other words, we can deliver our dynamic computing experience using any virtual desktop technology, or what is even more cool, leveraging only the existing PCs that most hospitals have in place.

Pitch video

Customer interview (infrastructure and customer support manager for a two-hospital, 300-bed system)

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

Aventura has allowed us to extend the refresh cycle of the hardware inventory and still take advantage of new software technology that requires greater processing power and memory.  The smart card solution improved the security and authentication process, which helped meet HIPAA requirements.  The ease of use and ability to move the user’s desktop from workstation to workstation has greatly improved the clinician’s workflow.

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

We have had a very positive experience with Aventura.  Their staff has been responsive to requests for enhancements and is readily available to provide technical support when needed.

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

If you would like to reduce the cost of your hardware refresh and provide a secure, standardized desktop solution for your end user.

An interview with Howard Diamond, CEO of Aventura

Hospitals seem pretty happy with single sign-on and technologies like Citrix that allow wireless users to stay connected even though their connection may drop temporarily as they move around. Why do they need your product?

I probably don’t accept your basic premise. Most of the customers that we have and most of the pilots we’ve got going are people that are probably already using an SSO and are already using virtualization like Citrix or VMware or Terminal Services. They still have significant problems in terms of caregivers getting access to the different systems and applications they use.

The average nurse logs in 50 to 70 times a day. Even with an SSO, the amount of administrative burden on them is pretty dramatic.

This would be a fairly key piece of infrastructure if your technology sits between the clinicians and their systems. How do you convince hospitals to trust that aspect to a relatively small company?

That’s a challenge, without question. The approach we take from a sales perspective is we have three phases of implementation.

Our first phase is what we call a lab pilot. If somebody is seriously interested in our technology, for $15,000, we come and show them how it would work in their specific environment to connect it to their specific infrastructure. They get to play with it for three to four weeks in a lab environment.

Once they’ve done that, they opt to go into what we call a production pilot. They try the technology in a real unit of the hospital with real caregivers interacting with real patients.

Based on those two experiences, they then make the decision to buy the software. We set up a pretty sophisticated try-and-buy in their environment.

Sounds like that’s good for the customer, but difficult for the company since hospitals have a long buying cycle anyway. Is it difficult to plan your business around a long-term pilot?

There are two different pieces to it. First of all, we charge $15,000 for the lab pilot. We charge $40,000 for the production pilot. We’re not doing it for free.

We have a hospital doing their production pilot right now. One week into the production pilot, they called us up and said, “All right, we’re convinced. We want to buy the software now.” Even though the theory is that it can lengthen the sales cycle, what is actually does is truncate it, because once they get the technology in front of the caregivers, the caregivers who are not using the technology see the caregivers who are and say, “Wait a minute, you’ve got to be kidding me. We’re not going to wait three months to get access to that. We want access to it now.”

Who is it that makes that decision and what objectives do they have when they come to you or you come to them?

Our point of entry is usually a CMIO if they exist. A lot of time we work directly with IT, but our focus is to get caregivers directly involved pretty quickly because the core of the technology really dramatically addresses things from the caregiver’s perspective. So where there isn’t a CMIO, we work with both CMOs and their like and influential doctors. We definitely get the caregivers involved very early in the process.

Has anybody done studies of the benefits?

Yes, pretty dramatic. Caldwell, which is actually just finishing up their lab pilot and moving to a production pilot, has actually already done a research study where they claim that their analysis showed that doctors would save over 40 minutes per shift and nurses would save over 80 minutes per shift using our technology.

What’s your method of pricing the solution and how do customers justify its cost?

The approach is it like a SaaS charge. Our base price is $15  per user per month.

The ROI actually is pretty easy to do. We show dramatic productivity gains on the caregiver’s side. Because of the fact that we do things like manage printing and provide them with a significant amount of self-help from a printing perspective, we actually show some pretty quick specific gains for IT, particularly in terms of reduction of calls to help desks.

I saw your Web site mentions the roving printer concept. I guess that’s a weakness in a lot of clinical systems. Is that a big draw for customers?

Yes. I’ll be honest with you — when my staff first built it into the product, I thought it was pretty boring. It was not an area that I had particular interest in. It’s turned out to be a dramatically important thing.

It turns out that pretty much every back-end system out there, particularly the EMRs, are horrible when it comes to managing the printing. The fact that we fixed that has actually become an enormous positive for us, even though as CEO, I was too stupid to understand that for a while.

You mentioned a couple of customers on your site, Denver Health and Alegent. Where are they in their implementation and how many clinicians do they have using the devices?

Thousands. Denver Health has been using the technology for a few years and they use it everywhere. The same thing is true of Alegent at their 10 hospitals. If you talk to Mike Westcott, who’s the CMIO at Alegent, he’s actually an embarrassingly great evangelist for us. Greg Veltri, who’s the CIO at Denver Health, is as well. In both cases, they’ve got literally thousands of caregivers using our technology every day.

I was curious why you sell only to healthcare. It seems like that the solution that you have would be of interest to other industries. Is healthcare just the entry point, or is there something unique about healthcare that makes this more attractive than it would be elsewhere?

You’re pretty on top of it. I’m impressed. The reality is that we work with a lot of virtualization partners. The very first thing they ask us whenever they get to know the technology is why we’re not bringing it into other industries.

This technology was born in a hospital, it was developed in a hospital, and the founder started it there. I came and took over the company a little over a year ago. We will go more horizontal in the next year and a half, but I believe that small companies fail a lot because of lack of focus.

Since the heart of the company is in healthcare, we’ll establish our beachhead in healthcare pretty strongly before we move horizontally. But there are a number of other industries that are appropriate for it, and a lot of the virtualization partners we work with want to bring it into places like manufacturing and legal right away.

What do you hope to gain from this exposure?

When we get in front of caregivers, they are blown away by the technology. It literally is something that every time we do a bake-off comparing our technology with anything else out there. Caregivers give it a dramatic grade.

The exposure is just a really important thing. It’s a very small company. We’re just starting out. The technology has just been released in its new form as we talked about some of the stuff we submitted to you. Getting exposure is just great for us.

News 7/27/11

Top News

McKesson completes its $38 million acquisition of provider management tools vendor Portico Systems, announced last month.

Reader Comments

From The PACS Designer: “Re: LogMeIn Central.  LogMeIn has announced a new cloud based service called LogMeIn Central for IT administrators to monitor network uses by iPad and iPhone users.  As the expansion of iPad usage increases in institutions, it appears to be a solution that could ease the management and demand for information access by users.”

From Epic Guy: “Re: Johns Hopkins. Announced today at Epic that they are our latest enterprise customer. Probably not a big surprise to most readers of this blog.”

HIStalk Announcements and Requests

Listening: reader-recommended Joe Bonamassa, an amazing blues/rock guitar virtuoso. Here’s live video of his cover of Yes’s Heart of the Sunrise and Starship Trooper. Pretty old school for a guy who’s only 34.

The folks at CapSite hooked me up with access to their database of actual RFPs, proposals, and hospital contracts after I wrote a little about it a few weeks back. I pulled up a few vendor products and was instantly looking at individual facility price breakout worksheets and actual PDF contract scans (I love terms and conditions, so I was engrossed, although I felt kind of dirty reading some other hospital’s contract even though the facility name was redacted). They’re offering a free 30-day trial of CapSite Lite to providers. I’m not pitching it, just saying that if you would benefit from seeing the kind of deals other hospitals are getting or interested in market reports, you could give it a look for free.

Prognosis Health Information Systems is supporting HIStalk as a Platinum Sponsor, which I appreciate. The Houston-based company offers the Web-native, standards-based, HIE-ready ChartAccess EHR for rural and community hospitals, one of the first to be certified by CCHIT way back in 2007 and again among the first with ONC-ATCB Stage 1. Its affordable, modular solutions include CPOE, clinical decision support, eMAR, pharmacy, clinical documentation, ED, lab, radiology, ADT, document management, patient scheduling, patient accounting, and even an ambulatory EHR, all running on client-free SQL Server with a choice of local or remote hosting. Its value prop involves minimal hardware cost, centralized maintenance and upgrades, automated backups, and shortened time to go-live (Ness County Hospital in Kansas was live four months after choosing ChartAccess.) They’ll even finance its purchase. Thanks to Prognosis for supporting the work we do.

Acquisitions, Funding, Business, and Stock

GE Healthcare has begun the previously announced relocation of the global headquarters of its diagnostic imaging business from Waukesha, WI to Beijing, China.

Sales

Memorial Sloan-Kettering Cancer Center chooses iSirona for medical device integration with Epic outpatient and Allscripts Sunrise inpatient.

People

Martin Tursky, one-time CIO at Aultman Hospital (OH), is named president and CEO of Memorial Hospital of Rhode Island.

Announcements and Implementations

Wentworth-Douglass Hospital (NH) goes live on Soarian’s CPOE this month and on Soarian Financials in October.

Southern Coos Hospital (OR) goes live this week on McKesson’s Paragon EHR.

CodeRyte announces an NLP-based Health System Coding that extracts information from supporting documentation to support accurate HIM coding.

Concerro releases a new video pitching its Internet-based ShiftSelect employee scheduling and shift management system. The male actor is a Bill Shatner-type scenery-chewing bad actor (maybe intentionally so — check out his hammy foot-stomping emphasis at 1:00), but his female counterpart is good.

Italy-based pharmacy technology vendor Health Robotics takes on a Spanish partner to help with US marketing after a legal squabble with former distribution partner McKesson. In a no-holds-barred announcement in March (written by too-perfectly named marketing coordinator Claudia Flaim), Health Robotics accused McKesson of having a “David/Goliath syndrome” in taking a “bullying strategy” after being “unwilling to cope with competition” and then making up “a non-existent excuse for its own failures.” I don’t know who’s right or wrong, but give the scrappy upstart points for coming out swinging, although heavy legal expenses so early in a product’s rollout can’t be good for business, especially when you’re a new Italian company trying to get a US foothold.

Government and Politics

The VA will allow iPhones and iPads on its hospital networks starting in October, with initial access provided to e-mail and VistA. It’s even considering allowing employees to choose one of those devices instead of a laptop. CIO Roger Baker says his IT department will soon roll out approved access to cloud computing applications, which got some VA users in trouble last year who were found to be keeping patient information in Google Docs.

Other

Four hundred Kaiser Permanente IT employees collectively lose 1,500 pounds in its CIO Challenge, including computer specialist Frederick Curiel.

Thumbs up to Apple. Over the weekend, my iPhone slipped out of pocket and hit the pavement, cracking the screen. I scheduled an appointment at my local Apple store with one of the Geniuses, even though I didn’t have much hope they could do anything beyond selling me a new iPhone 4.  After I flashed the designated Genius my best Inga smile and showed him the sad state of my phone, he explained that cracked screens were not covered by warranty. However, he said he would go ahead and switch out my old phone for a new one at no charge. Perfect customer service and the right thing to do, especially given Apple’s  release of the Phone 5 in just a few weeks.

Uh oh. Apparently Google is deleting the Google+ accounts of users not using their real names. Lame. If Inga HIStalk stops following you, go ahead and blame Google.

Nurses at a New Zealand hospital complain that “dumb” staff scheduling software from HealthRoster is to blame for nurse fatigue, saying it creates schedules with long runs of consecutive work days and rotating shifts that allow as little as seven hours between them.

The Chicago Tribune profiles some health-related Web startups that include HealthTap (personalized health information from a panel of experts), Simplee (healthcare expense tracking), ZocDoc (book provider appointments online), and Practice Fusion (free EMR). That’s a lot of Rounded Arial fonts and blue color schemes.

Weird News Andy can’t decide whether it’s the instrument or the “doctor” that’s not the sharpest knife in the drawer. Police find a 63-year-old man lying naked outside his house with a knife handle sticking out of his stomach, which he then removes and replaces with a lit cigarette. He had noticed a protruding hernia and decided to remove it with a butter knife. A surgeon contributed advice that is most likely unneeded by anyone other than this individual: “It is absolutely impossible for someone to fix their own hernia.”

Sponsor Updates

• Ampla Health chooses MED3OOO’s InteGreat EHR for its eleven FQHC and community health centers.
• CAP/SNOMED Terminology Solutions is selecting beta sites to participate in full Lab Interoperability Cooperative pilot.
• Gateway EDI is offering resources for HIPAA 5010 conversion preparation.
• NextGen offers an August 3 webinar on clinical data sharing, with the CMIO of Colorado Associated CHIE and the CMO of Avista Adventist Hospital presenting.
• Wellsoft welcomes new clients AnMed Health (SC), Capital Health (NJ), Southwest Mississippi Regional Medical Center (MS), Pikeville Medical Center (KY), and Thomas Jefferson University Hospitals Methodist Hospital (PA).
• RJ Infusion Services (KS) selects Perceptive Software’s ImageNow to give instant access to patient records from anywhere.
• Baptist Memorial Health Care (TN) selects RelayHealth for a 14-hospital HIE.
• Children’s Memorial Hospital (IL) selects Merge Healthcare’s iConnect to give radiologists and treating providers immediate on-site and remote access to images.
• New York eHealth Collaborative selects e-MDs as a Meaningful Use Partner.
• East Orange General Hospital (NJ) goes live with GE Centricity Enterprise.
• Practice Fusion names the Top Five Worst Electronic Medical Record Myths.
• Tampa General Hospital (FL) selects CareTech Solutions’ Service Desk to augment its existing help desk, focusing on physician support.
• University of North Carolina Hospitals, University of Washington Medical Center, University of Kansas Hospital, and University of Kentucky Hospital go live with Physician Insight Plus from Carefx, which provides dashboards that tracking, analyzing, and comparing performance on clinical and operational outcomes, safety, and utilization.

Contacts

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

Monday Morning Update 7/25/11

From Give Me a Break: “Re: press releases. Do readers find it as annoying as I do when a vendor issues a press release congratulating its customers for making a list of some kind? The average health system has over 240 apps from 70 vendors.” I do indeed find that particular practice somewhere between pointless and annoying, right up there with those announcements that “applaud” some government decision that benefits the vendor directly. That’s especially true when the award the customer has won comes from a for-profit company looking for publicity (see: Most Wired, any company’s customer awards). I’m generally hostile toward press releases that contain no discernible news, even of the self-serving variety. They’re lucky that lazy magazines and sites are so desperate for free content that they’ll foist crap like that on their readers anyway, hoping that hyperventilating headlines and cutesy writing will keep readers from noticing the waste of their time.

From DeeDee: “Re: University of Missouri Health Care. The video with their being named HIMSS EMRAM Stage 6 has some marketing polish, but interesting. Buy-in of the Tiger public/private venture seems impressive.”

From Tooter: “Re: Webmedx. You didn’t mention that HIStalk ran the Nuance acquisition rumor before the announcement was made.” True enough: I ran MT Hammer’s rumor report on June 24, while Nuance announced the acquisition on July 14.

From Lucy Gucci: “Re: Epic new hire blog posting on WSJ. I remember feeling this way about starting at Epic, too – excited to be a business traveler and still glossy-eyed over the architecture. Also, I’ve heard that Judy is talking about the June new hire class making up a certain percentage of the national job growth for that month.” A 21-year-old new grad (business administration, Asian studies) gushes with enthusiasm about being hired as an Epic project manager, ready to “improve patient care, create better processes, and in general aid hospital systems” as she “moves rapidly toward adulthood.”

Most respondents say the government shouldn’t get involved with EMR usability, although not by a large margin. New poll to your right, from a reader’s comment: what will HITECH’s legacy be?

Listening: reader-recommended Big Head Todd and the Monsters, straight-head soulful rock with thoughtful lyrics and an unchanged member lineup (and relatively unchanged musical style) for 25 years.

Unrelated, but music again: singer Amy Winehouse is found dead at 27, joining other notoriously drug-abusing rock stars to expire at that age (off the top of my head, that list includes Jim Morrison, Janis Joplin, Jimi Hendrix, Kurt Cobain, and Brian Jones).

This week’s Time Capsule editorial from 2006: Your Co-Workers Are Your Biggest IT Security Problem. A snip: “A hospital’s internal documents and policies probably aren’t all that interesting to competitors, but you might reconsider storing Social Security and credit card numbers.”

I hung on every word of Vince Ciotti’s HIStory this week since it covers Compucare, IBAX, and other faded names from yesteryear that still seem recent to HIT long-timers (the notepad cover I use every day is a Compucare one, so I’m just realizing how long I’ve had it). He got help this time around from pioneers Ed Gavin, Sheldon Dorenfest, and David Pomerance. Given the great response Vince is getting, I’m thinking he should reprise his SMS reunion of a couple of years ago, except open it up to anybody who worked in HIT in the old days (before 1980, let’s say) and do it at the HIMSS conference. Then he could really tap into some first-person memories for future installments. Vince is willing to take his show on the road for interested classes or groups (like regional chapters of HIMSS or HFMA) – just e-mail him.

Dell confirms the rumor I ran Thursday from Jamie that healthcare VP Berk Smith, brought over in its Perot acquisition, is leaving to start a healthcare-related company.

Thanks to the folks at Preceptor Consulting of Fort Myers, FL, supporting both HIStalk and HIStalk Practice at the Platinum level. Preceptor offers design, build, testing, and training support for all the top clinical systems (Epic, Cerner, McKesson, etc.). Their name comes from what they do: provide licensed clinicians (physicians and nurses) to get those systems live, which they’ve done in more than 500 healthcare facilities over the past five years. Their motto will be familiar physicians: See IT. Do IT. Teach IT. You’ve spent a lot on that shiny new clinical system, so spend a little more to engage authoritative, experienced clinician experts who will make sure it’s built right, tested as safe, and accepted by well-trained users (think of it as cost-effective CIO/CMIO job security insurance). Find out why the largest health systems get clinical implementation support and healthcare IT expertise from Preceptor Consulting. Thanks to Preceptor for supporting HIStalk and HIStalk Practice.

Here’s a really well done video about Preceptor Consulting I found on YouTube, with some of the “preceptors” talking about working on site at hospitals and some of their clients talking about their experience. “Any time you had a question or an issue, they were right there to help. I don’t think you could make the transition without the preceptors. I don’t think it could be done.”

Athenahealth sues AdvancedMD, claiming the company violated an athenahealth patent. The patent number cited suggests that the suit is related to athenahealth’s centrally maintained insurance billing rules engine.

John Halamka will resign his part-time position as CIO of Harvard Medical School, saying it needs someone full time, but is staying on at BIDMC.

A former EVP and general counsel of Children’s Hospital of Philadelphia pleads guilty to charges related to his embezzlement of $1.7 million from the hospital, accomplished by submitting and approving fake invoices. He bought himself a yacht with its own captain.

CodeRyte will make some announcements this week about a new Natural Language Processing system for computer-assisted coding in hospitals, which a few customers have already signed up for. Fun executive team facts: CEO Andy Kapit taught autistic kindergarten children. Chairman and President Richard Toren invented the EpiPen, which has saved the lives of countless allergic patients. COO Glenn Tobin and Chief Revenue Officer Don Trigg are fairly recent hires from Cerner (COO and UK GM, respectively).

GE announces Q2 numbers: revenue down 4%, EPS $0.35 vs. $0.28. GE Healthcare revenue was up 10%, with profit up 8% to $711 million.

Hospital of St. Raphael (CT) fires three employees after one of them takes cellphone pictures of the fatal gunshot wounds of a 17-year-old ED patient and sends them to other employees.

A hospital in England, which pays the travel expenses of some family members visiting patients in its mental health units, suggests that the family members use Skype instead to save money.

Eighteen former employees of insurance company Molina Healthcare file a lawsuit against their former employer, its former CIO, and outsourcer Cognizant, claiming they were discriminated against as the IT department brought in increasing numbers of Indian workers to the point it was called “little India.” They say the department celebrated Indian holidays while making employees work Thanksgiving and Christmas, promoted only employees from India, and conducted meetings in Indian languages. They charge Molina with firing 40 technical workers the day after Cognizant was approved to bring in 40 H-1B employees. The former employees also claim that Molina regularly violated HIPAA requirements when the H1-B workers would send full, unencrypted patient files to their counterparts in India.

E-mail Mr. H.

News 7/22/11

Top News

Athenahealth will acquire Proxsys, a Birmingham, AL-based vendor of front-end revenue cycle tools that include medical necessity checking, insurance verification, pre-certification, referrals, and facility scheduling. The all-cash deal is worth up to $36 million. Athenahealth says it will use Proxsys technology in its newly announced athenaCoordinator service, which will move patient and insurance information between hospitals and their affiliated physician practices in return for a per-transaction fee. ATHN shares are up almost 10% Thursday in after-hours trading following the release of positive Q2 numbers and news of the acquisition. Share price has nearly doubled in the past year, giving the company a $1.69 billion market cap.

Reader Comments

From Scrambled CIO: “Re: software conversions. We are in the middle of a lot of system replacements and consolidation. I am amazed at the estimates and fees associated with a flat file conversion from SCC Soft Computer. Three hundred hours for a pathology conversion.” I assume you’re converting “from” rather than “to” SCC, in which case they have little incentive to give you a deal knowing you don’t have an option and your wounded former-customer indignation won’t matter anyway. It’s funny that I was describing exactly that scenario to someone at work today, where you’ve told your vendor that you’re dumping them down the road and they stop returning your calls and price everything at list-plus-larceny. It’s like an ugly divorce – if you had known how cold and vindictive your spouse could be, you’d have insisted on a pre-nup or maybe married someone else. But I don’t know the particulars in this case, so in fairness to SCC, I’ll just say “unverified” and assume there was a rationale for the price quoted.

From Crabby: “Re: ARRA’s legacy. it will not be widespread adoption of EHRs. but rather the technical standards that ONC has laid out. They will do more for our industry, patient safety, and adoption than any sexy interface or legislation could ever do. Access to complete patient data across the continuum of care will be enough of a reward for a provider to login. Once logged in, we must make it easier for him/her to click the buttons than to bark at the nurse.” No one expected ARRA to be a panacea and fix all of HIT’s flaws, but incorporating standards should reap some benefits. Yep, there is still more work to do.

From Jamie: “Re: Berk Smith. The Dell Healthcare VP/GM resigned Wednesday after 22 years at Perot Systems and Dell. He’s leaving for a startup.” Unverified. I e-mailed a Dell press contact, but haven’t heard back.

From Emily: “Re: 3M Health Information Systems. Another round of layoffs last week following another poor quarter of sales.” Unverified.

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week: the ever-witty and irreverent Dr. Joel Diamond reflects on technology over the past decade. Highlights from AAFP’s 2011 EHR User Satisfaction Survey. digiChart’s new CEO suggests the company is prepping itself to be acquired some day. Patients feel disrespected by their doctors.  Canadian docs express familiar-sounding complaints about EMRs. Almost 70% of practices are looking to become a PCMH. In honor of Oscar de la Renta’s 79th birthday (or just because), feel free to sign up for the e-mail updates while you are checking out the hottest ambulatory HIT news.

I am now on Google+, though I haven’t figured out what it’s going to give me that I don’t already have with Twitter, Facebook, and LinkedIn. However, if you feel the need to be in my circle, send me an invite.

Unrelated except to music fans: an influential but seldom-acknowledged musician of the 60s and 70s died this week. Grass Roots lead singer Rob Grill was 67. I actually saw them live well past their heyday in a bar holding maybe 25 fans and chatted with them while getting a beer. They still sounded good playing I’d Wait a Million Years, Temptation Eyes, Sooner or Later, and Midnight Confessions.

On the sponsor-only job board: Senior Enterprise Hospital Sales Executive, Senior C#/.NET Developer, Configuration Architect. On Healthcare IT Jobs: Informatics Analyst, Senior Systems Engineer – Windows Server Technology, Senior Director of Applied Clinical Informatics, Vice President of Client Services.

Acquisitions, Funding, Business, and Stock

athenahealth reports Q2 revenues of $77.9 million, up 33% from 2010. Non-GAAP adjusted net income was $7.9 million ($.22/share), compared to 2011’s $4.1 million. The company beat analysts’ estimates of $.18/share and revenues of $75.08 million.

The provider of MyMedicalRecord PHR announces an agreement that gives a Chinese venture partner warrants to purchase up to four million shares of its stock. Sounds impressive until you notice the share price is $0.04, valuing the big international deal at $160,000.

Private investment firm Veronis Suhler Stevenson acquires hospital financial analytics software vendor Strata Decision Technology, which claims 800 hospital customers that include Allina, Catholic Healthcare West, and Cleveland Clinic.

Express Scripts will acquire its prescription drug benefits competitor Medco in a $29.1 billion deal. The companies, whose combined revenue is $110 billion, say they’ll be able to lower costs and improve health with their combined drug purchasing power.

Microsoft’s Q4 numbers: revenue up 8%, EPS $0.69 vs. $0.51. beating consensus earnings estimates of $0.59. Windows revenue slipped for the third straight quarter, while Office revenue was up 8%.

Sales

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Parkview Health (IN) signs an agreement with Streamline Health Solutions to upgrade six of its hospitals to accessANYware v1.9.

Northrop Grumman will partner with Verizon and Wellpoint subsidiary National Government Services to develop predictive modeling technology for CMS’s National Fraud Protection Program. CMS announced last month that it had awarded Northrop Grumman the $77 million fraud detection contract.

People

Clinical integration and search technology provider Apixio names Steve Roberts its VP of sales and Jenny Field its director of product marketing. Roberts is a former VP of sales for NextGen; Field was director of ambulatory medical informatics for Salinas Valley Healthcare System.

Former Healthland president and CEO James Burgess takes over as CEO for Advanced Health Media.

HFMA president and CEO Richard L. Clarke will retire on July 31, 2012.

Jason Bray is named CIO of Oklahoma State University Medical Center. He was previously CMIO of the OSU Center for Health Sciences.

Announcements and Implementation

Summa Health System (OH) deploys BIO-key’s fingerprint biometrics for authentication with Allscripts Sunrise Clinical Manager platform.

PHR vendor Dossia announces its Health Manager health management system, which it says will improve the health behaviors of its users through personalization involving games, social dynamics, incentives, and messaging. Dossia chair Craig Barrett says it represents the next generation of PHRs.

Government and Politics

CHIME chimes in on proposed changes to HIPAA, saying the standards would be difficult for providers to meet and should be scaled back. CHIME claims the rules rely too much on technical capabilities that are not widely available and fail to acknowledge the amount of human intervention necessary to achieve compliance. Of particular concern is the proposed requirement for providers to create a consolidated report that documents all incidents of PHI access within a designated record set.

The VA and Department of Defense were charged with developing overall integration between their organizations at a Chicago demonstration project for the first Federal Health Care Center, with some EHR integration due October 1, 2010 (single sign-on for clinical staff, single patient registration, and orders portability). A GAO report says they missed the date for the first two items but those are live now, but they’re struggling with lab orders. Pharmacy order integration has been “indefinitely delayed” and five pharmacists were hired to manually verify orders between the two systems and to check for drug-drug interactions. The GAO says they’re struggling because of the same old problems that always come up: “lack of an integrated and comprehensive project plan from VA and DoD.”

Other

The Women’s Health ABU at Cerner breaks out into a dancing flash mob during lunch at Cerner headquarters. Diners included Cerner associates, about 100 new hires, and over 40 clients. All I have to say is I want to be part of a dancing flash mob one day.

Core Health is running its annual HL7 Interface Technology Survey for CIOs/CTOs, IT managers, and HL7 professionals. They did a nice job last year. Respondents are entered in a drawing for a ThinkPad tablet.

Weird News Andy is on the tail of this story, which he summarizes as, “His butt, her end as a CNA.” A nursing assistant is fired from her job at a transitional care facility and faces voyeurism charges after taking pictures of a male patient’s buttocks, which she described to a co-worker as “too funny,” and posting them on her Facebook.

WNA also fell for this story from England: a disabled man who falls out of his wheelchair in a hospital’s parking garage just 100 yards from its ED has to wait 25 minutes for paramedics to be sent from the other side of London. A bystander claims hospital nurses refused to help and said they aren’t allowed to treat patients outside their areas, although a hospital spokesperson says no such rules exist and nurses have responded to garage emergencies previously. 

Data integration software vendor Informatica and the IT division of Hospital Corporation of America are embroiled in a legal squabble over software license fees, with Informatica claiming HCA owes it $6.3 million following a license audit. HCA interprets the scope of its license differently and disputes the claim.

Cayman Islands Health Services Authority CIO Dale Sanders tells me that they’re re-competing their Cerner contract, with the core vendor tender here. If it were me, I’d plan the install for January and watch the resumes flood in from cold-haters more than willing to spend the winter there at discounted rates.

A 34-year-old Australian woman who died immediately after visiting a physician for an ear infection is found by coroners to have experienced an allergic reaction to the antibiotic Ceclor, prescribed for her by an 85-year-old “computer illiterate” doctor who did not notice her documented allergy on the screen. The doctor has since given up his license and sought psychological counseling. 

An indicted New Jersey couple who sold medical students and licensed physicians a $5,000 medical licensing exam test prep course that included stolen questions remains on the run, while their student-customers, most of them foreign medical school graduates, are being asked to defend their scores by re-test. Several have already failed and may lose their medical licenses. The National Board of Medical Examiners got suspicious when the wife took the USMLE exams several times and scored low, with a surveillance camera review showing her taking pictures of the computer monitor.

Researchers in Brazil find that tweets containing the word “dengue” correlate to local outbreaks of dengue fever, the disease that kills hundreds of people each year there, allowing authorities to identify geographic areas of outbreak and respond more quickly.

A 27-year-old hospital nurse in England is arrested after insulin was injected into IV bags in a storeroom, killing five patients.

Sponsor Updates

• Sunquest Information Systems hosted a “Build a Bike” team-building event at its user group meeting last week. Fifteen bikes were donated to local Tucson charities.
• United Regional Health Care System (TX) signs an enterprise license agreement for iSirona’s device connectivity solution.
• TELUS expands its Canadian EHR ecosystem with the connection of Optimed Software Corporation’s AccuroEMR to TELUS Health Space.
• CareTech Solutions announces that 14 of its clients were named Most Wired 2011 Hospitals. Five more were named Most Improved.
• Billian’s HealthDATA interviews Gail Donovan, EVP/COO of Continuum Health Partners about the economic challenge of providing high quality care and outcomes.
• Besler Consulting’s George Porette offers analysis on Medicare DSH and uncompensated care reimbursement in The Besler Beacon, the company’s quarterly newsletter.
• Awarepoint’s Q2 bookings beat 2010’s numbers, increasing its hospital client count to 153.
• Medicity’s Novo Grid is ranked the #1 private HIE solution by KLAS, the position it has held since the category was first reported last year.
• Porter Hospital (IN) will install the iConnect image operability solution from Merge Healthcare.
• Tulsa Spine and Specialty Hospital (OK) selects ProVation MD for physician point-of-care documentation.
• Jennifer  Lyle, CEO of Software Testing Solutions, will serve as a Meaningful Use panel presenter at the iHT2 Health IT Summit in Denver next week.
• Southwest Mississippi Regional Medical Center chooses Wellsoft’s EDIS for its two hospitals.
• Thomson Reuters and CareEvolution expand their partnership to deliver the Thomson Reuter’s HIE Advantage solution, which leverages CareEvolution’s secure interoperability solutions and Thomson Reuters’ analytics expertise.
• The 40-provider Philadelphia Hand Center contracts for the SRS EHR.

EPtalk by Dr. Jayne

I was intrigued by the item in Monday’s Sponsor Updates regarding the Surescripts White Coat of Quality program. I have to admit not being familiar with it, but was able to find its Web site. Frankly, I’m surprised to see that only four vendors were given this recognition for 2010. To quote directly (including grammatical and spelling errors) from the Surescripts website:

The criteria for earning a White Coat in 2010 was, by design, very straight forward:

1. Provide a signed commitment from company leadership affirming their organization’s commitment to quality.
2. Measure quality metrics as specified in the published industry guidelines and report those metrics each month to Surescripts.
3. Implement changes to software that address issues identified in quality reporting. Take steps to eliminate any issues measured in #2 above.
4. Raise prescriber awareness through training.

As a provider, this seems like a slam-dunk. I’m not sure why more vendors aren’t on the list, especially some of the larger ones.

I was flipping through Health Data Management while watching HIPAA training and a McKesson ad aimed at independent physicians caught my eye. It grabs the reader with “I didn’t survive my residency to be an I.T. Manager” and says solutions are “arriving fall 2011.” The ad features an older gent with some pronounced hair loss.

To me, this ad seems aimed at either (a) physicians who are the last-ditch holdouts for putting off EHR implementation, or (b) those that hoped they could retire before someone forced them to bite the bullet and go electronic. Nothing new on the Web site, so I suspect this is just marketing rather than something truly transformational. Maybe it’s a discount for AARP members.

Speaking of independent spirits, a colleague cornered me in the doctor’s lounge waving an article on usability from American Medical News, reminding me how much he reveres his paper charts.

(I still don’t quite understand what the AMA is doing with this publication. They offer it in both print and digital versions, but the same article has different publication dates. I understand the Web version is going to come out before the snail mail version, but can’t we at least use the same dates, hmmm? This was dated June 20 online and July 11 in print for those of you who are playing along with the home game.)

Anyway, the article doesn’t tell us anything we don’t already know regarding usability. Guess what? Vendors are trying to reduce click counts, de-clutter screens, and save us from alert fatigue among other not-so-small feats like being certified for Meaningful Use, transitioning to 5010 and ICD-10, and so on.

The piece mentions CCHIT’s five-star usability rating as a tool some vendors use to differentiate themselves. Wondering if this is anything like the above-mentioned White Coat of Quality, I wanted more information. (I’ve been deployed on stable systems for some time and have a low tolerance for boastful sales practices, so it’s been a while since I’ve played the system / vendor selection game looking at it through the eyes of the average user.)

The CCHIT Web site seems clunky and vendors are not in alphabetical (or any other seemingly rational) order. I never did find a list of those products that had received the five-star usability rating, although a Google search brought up lots of individual vendor listings, many of products I wasn’t familiar with. Maybe my search skills are deteriorating or maybe it was the effects of too much fruit of the vine while watching what might be the saddest web-based HIPAA training I’ve ever seen in my life as I apply for staff privileges at a new hospital. Still looking for the list – can anyone help a girl out? E-mail me.

Contacts

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

SAIC To Acquire Vitalize Consulting Solutions

Vitalize Consulting Solutions has signed a definitive merger agreement that will make the company an independent, wholly owned business unit of Science Applications International Corporation (SAIC), the McLean, Virginia-based government contracting firm. Terms will not be disclosed in the announcement, to be issued later this week.

Vitalize CEO Bruce Cerullo told HIStalk that SAIC pursued the acquisition to support its strong position in government healthcare IT. The Department of Veterans Affairs is considering commercial healthcare IT products, while the Coast Guard has already contracted for software from Epic Systems. Vitalize, with 600 consultants and annual revenue of over $100 million, runs one of the country’s largest independent Epic practices, Cerullo said.

”Meaningful Use will normalize, but will follow with ICD-10, HIPAA 5010, and Accountable Care Organizations. We want to play hard in that arena,” Cerullo said. “SAIC has great tools and methodologies they want to bring into the commercial world and we want to move into government.”

Cerullo said Vitalize’s leadership team and organizational structure will not change. Its headquarters will stay in Reading, MA with offices in Kennett Square, PA and Santa Ana, CA.

“We’re committed to bringing together the best of Vitalize with the best of SAIC,” Cerullo said. “We’re going to go slow. SAIC is growing at 8-10%, while we’re growing 100% year over year. They know what we’re doing is working.”

He added, “Vitalize has been part organic growth, part acquisition, and I suspect we will do more of both. We’re swapping private equity owners for a strategic owner. Our organizational structure, benefits, compensation, sales, and practice-oriented structure will remain.”

Completion of the transaction is expected in August.

News 7/20/11

Top News

The FDA releases draft guidance on the oversight of mobile medical applications. The two categories of apps that would qualify for oversight include those that serve as an accessory to an FDA-regulated device (for example, one that connects with a PACS) and those that turn a mobile platform into a mobile device (the smart phone is used as an EKG device.) In some cases, software developers would have to demonstrate that their mobile apps work comparably to their non-mobile versions.

Reader Comments

From Vince Ciotti: “Re: Epic’s 75 wins in 200+ bed hospitals. All of Epic’s clients are multi-hospital IDNs since ‘normal’ community hospitals simply can’t afford their epic fees. Judy won’t even condescend to bid to single facilities under 200 beds. If the typical multi has 5-10 hospitals, that represents about 10 wins for Epic. Still, at their incredibly high prices, this was enough to drive Epic to over $800M in revenue last year. Add in the hundreds of millions in hardware fees even bigger implementation ‘consulting’ fees they generate and Epic alone may represent our long-lost economic recovery!”

HIStalk Announcements and Requests

Thanks to Inga for capably holding down the fort while I was away. It was good to be gone and almost as good to be back. I’m behind, but that’s not unusual – the only change is that I’m determined to stop feeling guilty about it since it’s too many jobs, not sloth or lack of time management skills, that’s responsible. I’d go part time at the hospital if that was feasible.

Listening: the first new Yes album in 10 years. I’ve been a fan for much of my life and I saw them live not long ago, so I like it even as I acknowledge that prog rock isn’t everyone’s cup of tea. Reading: Life by Rolling Stone Keith Richards (excellent, either he and/or his hired gun co-author is a genius), so I may need to crank some B-side Stones.

Acquisitions, Funding, Business, and Stock

Healthcare Growth Partners releases its quarterly HIT market report, with merger and acquisition activity recovering well from low activity a couple of years ago. Here’s a quote:

Generally, sub $100 million companies have three valuation inflection points: proof-of-concept, initial scalability, and expansion scalability.  Proof-of-concept is value created when a company shows that its product can be successfully sold and deployed in a commercial setting.  This inflection point is generally of more value to venture investors than it is to acquirors, as companies at this stage tend to be too early to realize significant value through a sale.  Initial scalability occurs when an earlier stage company begins to show strong profitability at high levels of growth,  although the organization is still small and lean. Expansion scalability takes place after a company has matured to a level where it takes on real infrastructure, and the company begins to show strong profitability after building out a mature corporate organization. 

Although the size of a company at each inflection point can vary significantly based on a company’s product or services and sector, the general rule of thumb in HIT is that proof of concept occurs at revenue of less than $1 million, expansion scalability in the $5 to $10 million revenue range, and mature scalability in the $20 million revenue range.

Philips reports Q2 numbers: revenue down 2.6% and a loss of $1.9 billion, with the CEO announcing cost reductions and share buybacks. Its healthcare business fared better than the company overall, with an 8% sales increase.

Apple announces Q3 numbers: revenue up 82%, EPS $7.79 vs. $3.51, wildly beating analyst expectations of $5.82. The company sold more than 20 million iPhones and 9.25 million iPads in the quarter.

Shares in WebMD Health recovered a bit on Tuesday following Monday’s drop of more than 30%, which was triggered by the company’s announcement of lowered revenue expectations. The one-year share price graph looks merely unimpressive until you notice that the straight vertical line to the right is not the margin of the graph.

Lawson Software, whose $2 billion acquisition by Golden Gate Capital and Infor was completed last week, has begun restructuring and employee layoffs.

Australia’s federal court approves CSC’s acquisition of iSoft for $202 million after 97% of shareholder votes were cast in favor of the proposal.

A major player in HIT consulting will announce its acquisition later this week. I’m holding back specifics until the announcement comes out. It’s going to be a pretty big deal (no pun intended).

Sales

ADVANTAGE Health Solutions signs an agreement with IGIHealth for its ORBIT Clinical Exchange and portal to support ADVANTAGE’s ACO infrastructure.

Children’s Medical Center Dallas selects the Enterprise Data Warehouse business intelligence tool from Health Care DataWorks .

Final Support chooses EMR-Link from Ignis Systems to provide lab-EMR integration for its GE Centricity customers.

People

The board of Franciscan Hospital for Children (MA) fires CEO Paul J. DellaRocco, citing financial irregularities that include the inappropriate submission of expenses.

Former Allscripts COO Eileen Martinson is named CEO of Sparta Systems, a provider of quality and compliance management software.

RTLS vendor Versus promotes Susan Pouzar to VP of sales.

Practice Fusion hires Zachariah Gursky as its first VP of ad sales. He was previously with Coupons Inc.

Todd Cozzens is promoted to CEO of Accountable Care Solutions, a new business unit of Optum. He was previously with the company’s OptumInsight business, the former Ingenix that bought Picis, of which Cozzens was CEO. He mentions his new job and some thoughts on “virtual Kaisers” and their data needs in his latest blog posting.

Announcements and Implementations

The Georgia Health Information Technology REC selects Halfpenny Technologies to develop a lab hub demonstration project for the exchange of clinical data.

Banner Health (AZ) completes its pilot of MyHealthDirect and will be implementing the service across all its facilities. This news clip explains how Banner is using MyHealthDirect to book appointments at low-cost clinics and thus reduce unnecessary ER visits and wait times.

Middle Park Medical Center in Kremmling (CO) begins implementation of Healthland’s EHR and anticipates a go-live by the end of the year. The 19-bed hospital expects to qualify for up to $250,000 in EHR incentives.

Johns Hopkins Medicine begins recruiting for over 60 people to implement Epic. Positions for the initial ambulatory rollout will focus on clinical documentation, analytics and research, and scheduling and registration.

LodgeNet Interactive restructures LodgeNetHealthcare into an independent but wholly-owned subsidiary. Gary Kolbeck, who was previously GM of LodgeNet Healthcare, will serve as president.

Microsoft establishes a Web page for Google Health users interested in transferring their data to Microsoft’s HealthVault record. The site includes step-by-step instructions on how to move the data.

Government and Politics

HHS’s Office of Inspector General finds that 12 of 13 states do not plan to verify all the eligibility requirements for paying Medicaid EHR incentives to doctors and hospitals . The reason: most states lack the data necessary for complete verification because data collection requires too much effort and too many resources.

The federal government files a complaint against a Kentucky nursing home for fraud, but also alleges that five residents died from “worthless care.” Nurses were accused of failing to administer diabetes meds, diapering patients who had normal bladder function, ignoring physician orders, and not showing up at all for one 2.5 day period in which the nursing home had no RN coverage at all.

Innovation and Research

The Industrial Designers Society of America awards Silver recognition to Seattle-based Artefact for its design work on the prototype of the Seattle Children’s Patient Information System.

Use of a real-time alerting system for patient deterioration reduced LOS 9.7 to 6.9 days and increased clinician response from 29% to 78% in a UK study. The $1.5 million Patientrack system was developed by an intensivist in Tasmania, but no Australian hospitals were interested in trying it. The weak link seems to be that it requires the nurse to manually enter the vital sign values.

The VA offers a $50,000 prize to a developer who implements Internet-based technology similar to the government’s Blue Button program, which allows patients to download a summary of their health records. The competition started Monday and ends when a winner is chosen or on October 18, whichever comes first.

Other

According to the local paper, independent physicians wanting to tie into Lee Memorial Health System’s Epic EHR would have to pay $15,000-$16,000 for the software license plus $25,000 to $80,000 per practice to cover implementation fees. Annual maintenance is an additional $4,500 per provider. Depending on the size of the practice, that could be a hard sale. Independent physicians in the area control about 84% of outpatient care.

UPMC removes 29 of its 51 directors following a consultant’s recommendation for improving the board’s effectiveness. Its membership had swelled over the years as representatives were added from acquired hospitals.

Memorial Health System (CO), the hospital whose electronic patient records were breached by a city-employed nurse and part-time psychic, says it has fired 22 employees in the past three years for privacy issues. One of them was caught looking up the records of friends so she could create a birthday database.

Odd: a woman sues a Pennsylvania hospital and the county child protection agency when her newborn baby is turned over to foster care after testing positive for opium, which the mother blames on her own ingestion of poppy seed-containing salad dressing. Both organizations had been sued by another mother a few months ago for exactly the same thing, except that particular mom blamed a poppy seed bagel.

Sponsor Updates

• MEDSEEK announces its fifth consecutive year on the HCI 100 list, based on its 2010 revenue performance.
• Sentry Data Systems CMO William Kirsh DO, MPH participated as a writer and editor for a HIMSS Revenue Cycle Task Force white paper.
• Surescripts recognizes  Allscripts as one of seven vendors to achieve Gold Solution Provider Status for e-Prescribing. Surescripts also awards e-MDs its White Coat of Quality.
• AdvancedMD announces the release of its ONC ATCB-certified EHR 2011 solution that includes an enhanced patient portal, new Meaningful Use reporting tools, and utilities for submitting immunization and health surveillance data.
• API Healthcare is offering a variety of sessions on creating more effective workforce management at its annual user group meeting this week in Milwaukee.
• Orion Health’s Rhapsody Integration Engine and Rhapsody Connect earn ONC-ATCB EHR module certification .
• Providence Health & Services selects Elsevier / CPM Resource Center as its vendor of choice for evidence-based clinical content.
• Concerro releases a series of white papers collectively called the Workforce Management Wellness Series.
• Kony hires Peter Buscemi to lead the company’s global marketing efforts.

Contacts

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

HITlaw 7/18/11

Who’s On First?

Recent O’Toole Law Group engagements have raised a critical issue that’s worth passing on to HIStalk readership.

When providers contract with vendors, they expect certain products and services. This much is obvious. The issue presented here arises as a result of all the distributing, bundling, packaging and rebadging of products.

Vendor A may offer Vendor B’s product alongside its own products. In this case, Vendor A is a distributor (and usually a reseller) of Vendor B’s product. Typically this type of collaboration exists when the two products perform related tasks for the provider. Like ice and your favorite drink, each is good, but together they are great!

Vendor X may offer a product called “TurboEMR” that also has some type of label like, “powered by HISware” or something to that effect. This probably means Vendor X has HISware’s software embedded in its product, and the “powered by” refers to this fact. In this case, Vendor X is sublicensing technology developed by HISware.

In each situation, the provider gets the package deal and the functionality it is seeking, which would not be possible with only Vendor A or Vendor B in the first instance or with only Vendor X in the second.

So everyone wins, right? Hopefully, but maybe not.

When things go well and you have a great prime vendor that really steps up and fills that role, life is good. The provider gets precisely what they signed up for. They have a single point of contact for resolution of problems with any of the products involved.

But what happens when things go wrong? Are the responsibilities and procedures clearly set out? Key contract components that must be addressed fully by all vendors involved include support obligations, copyright / patent protection, indemnification, and liability provisions, to name a few.

How does the provider determine exactly what they are getting and precisely whom they are dealing with?

One simple way to determine the “who” part is to look for the warranty of ownership. Something like, “Vendor warrants that it owns the software.” Once you find that section, really analyze it. It is probably not more than a sentence or two, three tops.

If the vendor warrants that it is the developer and sole owner of the technology being licensed, then you are dealing with a single vendor and its products. This is the cleanest, most simple scenario.

(Quick sidebar here: it must be a warranty, not a representation. Warranties have certain protections and remedies that representations do not.)

If the vendor warrants that it is the owner of the technology OR that it has the right to license it, that is your red flag duct taped to a flashing light. This is not bad, but it means the product contains or is packaged with third-party software. You need to be aware of this and you must obtain certain crucial contract terms for your protection.

The best-case scenario (keeping in mind that there is another vendor involved that is not a party to your agreement, which is the reason behind this article) is a warranty from the vendor that you are contracting with that it has warranties of ownership, operation, and error correction (for example) from the other vendor. This is critical because it can then be used to back up the same warranties from your selected vendor to you.

The biggest warning flag you could ever encounter is where there is a disconnect in the protection(s) offered. If the vendor warrants that “all software is great and works fine and they will fix everything, but this warranty does not apply to a certain line item or product,” then you have a problem. What happens if there is a failure with the excluded software?

If you have no answer while reviewing contract language, just imagine the discomfort you will feel if your system is down and all indications point to the excluded product.

OK, stay with me here. All the legal stuff aside, what those in IT really want to know is what happens if there is a problem with the products.

As stated before, with a solid prime vendor you are in good shape. But what about those unfortunate situations where fingers get worn out from all the pointing?

To try and avoid heartburn later, fix the contract up front. Try this simple exercise. Remember connect the dots, those partially finished pictures in coloring books with numbered dots? Connect them in numerical order and complete the picture! Give it a try with your software agreement.

If you have more than one vendor involved, just imagine a system crash, and then try to connect the dots to all the vendors, especially the vendor behind the scenes. Do you have adequate warranty protection? Do procedures exist for escalating a software problem to the correct level at the vendor? Can you get to the vendor at all??

Make clear for each product included, or component thereof, which vendor is responsible for support, updates, fixes, etc.

Make certain that you have contract pathways to obtain that service. Assume vendor A is first point of contact. When the problem ultimately is identified as residing in Vendor B’s product, then what? It may be that the responsibility remains with Vendor A, but it also may be that Vendor A is only responsible for “Level 1 Support” and then you go to Vendor B for the difficult stuff. Ideally Vendor A stays involved and shepherds the issue through to resolution, sort of like a new car warranty. Inga’s Cadillac dealership did not build the car, but when the car breaks down, you take it back to Inga’s to get it fixed. Inga’s then takes care of the work required and is backed up by the manufacturer.

Taking the car analogy a little further, in terms of your contracted vendors, while you may know who is in the driver’s seat, you may not know who else is along for the ride. It could be an awesome two-seat Tesla roadster with two great vendors, or it could be the mud-covered SUV with a bunch of buddies all saying they work together just fine (and the driver is wearing really dark shades.) Due diligence in contracting pays off, and lack of diligence can really sting you later.

Vendors, please make it clear. You know best what is going on. Put it right out there.

After 20+ years doing this, I still remember a situation where an executive at a monster hospital chain felt something had been “snuck in.” In reality it was not, but the impression stuck hard and fast in this executive’s mind and we had to face extra scrutiny for several years to follow. Kind of like a dog that gets whacked by something at one of those birthday parties where twenty kids are running around screaming and things get zany and someone hands a whiffleball bat to the kids for the piñata. Anyway, the dog gets whacked (accidentally, of course) and never forgets the kid that did it. Don’t be the kid with the bat!

Tangential issue: get a warranty that states no other software is required, from your prime vendor or any other vendor, for operation of the software products being licensed. If other software is required but not included, require a listing in the agreement of all such products. Failure of your prime vendor to include something on this list should mean the vendor has to pony up and pay for it. That will bring all the fine details right to the top.

Finally, once you get everything above all set, make sure that all your hard work does not blow away in the wind because a vendor subcontracts work or assigns the agreement to another vendor. Include provisions prohibiting assignment or subcontracting without the customer’s agreement. That way you know what you are getting, from whom you are getting it, and that things will stay that way unless you agree otherwise.

Please take care in your interpretation of this article. I have been involved in countless good situations involving multiple vendors and very happy customers. When the provider does get a good prime vendor that truly takes on its role, you win. No question it works well in the right situations. My point is to be diligent and try to avoid bad situations by at least having good contract language on your side. The combination of a poorly performing vendor and weak or lousy contractual support will really ruin your day.

Big takeaways:

• Contract language, warranties, and obligations should be consistent as applied to all products and vendors involved, even if designated to a prime vendor. Watch for disconnects in supporting language.
• The contract should map out clearly the support chain and obligations of the vendors involved, again, even if designated to a prime vendor.
• Require listing all software required for operation of the products being licensed and obligation for the vendor to provide whatever they failed to list.
• Prohibit assignment and subcontracting by the vendors without your consent.

This article is intended to provide general advice and is not by any means exhaustive on the issues or language required and must not be taken as specific legal advice. Hopefully HIStalk readers enjoy the presentation and take away a valuable lesson or two.

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

Monday Morning Update 7/18/11

From Brass Tacks: “Re: Danbury Hospital. They fired the CFO over this.” Former Danbury CFO William Roe is sentenced to 33 months in federal prison for embezzling $200,000 from Danbury Hospital (CT) and former employee St. Rita’s Medical Center (OH) by approving invoice payments to a fake software consulting company he had set up. Roe, who made $594K in 2009, blamed poor judgment and begged for a light sentence. The judge, unimpressed by his two court order violations, said, “Your primary concern is for yourself and your family, who have already benefited from the funds you’ve stolen.”

A New York Times article on usability of clinical systems highlights the usual arguments: usability experts say there’s no question that today’s systems are measurably poorly designed to the detriment of clinician users and patients, while vendors strongly resist the imposition of usability standards or mandatory usability testing.

Most poll respondents say the person running the company that employs them is honest and honorable. New poll to your right: should the federal government measure and report the usability of clinical systems?

Essentia Health (ND) goes live on Epic’s EHR July 31th.

Gartner positions mobile application development platform provider Kony in the “Visionaries” quadrant of the Magic Quadrant for mobile consumer application platforms.

David Roberts, HIMSS’s VP of government relations, says it is unlikely that Congress would vote to eliminate future funding for EHR Meaningful Use incentives, despite the current current stalemate in federal budget negotiations. To eliminate the incentives, Congress would need to specifically vote to narrow the scope of the program or eliminate the program entirely. Roberts believes that legislation lacks adequate support to be passed in either houses of Congress.

The weekly e-mails of Kaiser Chairman and CEO George Halvorson are often HIT-related, with this week’s no different. Kaiser researchers have published autism-related studies made possible by its extensive patient data warehouse. They found that pregnant woman who used certain drugs greatly increased the odds of having an autistic baby, but vaccines were not among those drugs. They also found that children are dying of whooping cough because they aren’t being given pertussis vaccine.

Here’s the latest installment of HIStory from Vince Ciotti, this time covering vendors of minicomputer systems.

Greenway Medical Technologies files registration to raise up to $100 million in an IPO. Underwriters include Morgan Securities, Morgan Stanley, William Blair, Piper Jaffray, and Raymond James.

Caristix is offering a free beta program for software that helps hospital integration analysts identify and document custom HL7 interface segments and values.

Indian River Medical Center (FL) hires as its first CIO Bill Neil, formerly IT director at Presbyterian Healthcare Services (NM).

Scripps Health (CA) chooses Meddius to provide Integration as a Service, replacing its Sybase integration engine.

Yale New Haven licenses the Rothman Index, which uses real-time clinical systems information to generate a patient score that helps clinicians identify patients whose condition is deteriorating.

UPMC’s living donor kidney transplant program was shut down in May because up to six transplant team members failed to notice a Cerner EMR lab result alert indicating that a donor had undiagnosed hepatitis C. Her kidney was transplanted into a patient who did not have the disease, resulting in the temporary shutdown of the program. The surgeon who did most of the procedures was removed from his position, joining his equally high profile colleague who was fired in an earlier UPMC transplant scandal. A highly regarded transplant nurse was suspended for two weeks. Outside experts blamed generally poor EMR design, saying that UPMC administrators had a “knee-jerk reaction” in removing the surgeon, who had been under pressure to increase procedure volume, instead of examining the system that allowed the error to occur.

Seven former nurses from Valley Regional Medical Center (TX) sue the hospital, alleging they were fired in retaliation for making good faith reports of unsafe patient conditions. The nurses were terminated for "insubordination" after opposing assignments they claimed endangered critically ill patients. One nurse explained the situation as follows:

"It’s about standing up for your patient. We got into this profession to advocate for our patients… Patients who can’t speak up for themselves… And that’s what we’re trying to do here."

EHRs provide more comprehensive information on health services received than do Medicaid, according to a study published in the Annals of Family Medicine.

Mayo Clinic announces it is close to completing the development of tools that can identify and sort digital health information from any EMR, regardless of file format and data organization. Mayo’s project is funded by the HHS through its $60 million Strategic Health IT Advanced Research Projects (SHARP) program.

Next month CMS will roll out a pilot program for the electronic transmission of documents to support claims. Designated “health care handles” will serve as intermediaries between CMS and providers.

Strange: a city-employed nurse is fired for inappropriately accessing the electronic medical records of hospital patients. She says the real issue is her part-time job as a psychic, where she told patients they were about to experience heart attacks and claimed to be speaking to deceased co-workers from beyond the grave.

Contacts

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

News 7/15/11

Top News

Nuance Communications acquires transcription services provider Webmedx. Both companies offer outsourced transcription services with speech recognition capabilities and offer NLP technology to extract information and convert it into discrete data. It’s been a busy week for the transcription services and speech technology segment: earlier this week, MedQuist announced plans to acquire M*Modal for $130 million.

Allscripts adds four senior execs to its leadership team including Cliff Meltzer as EVP of solutions development, Steve Shute as EVP of sales, Jackie Studer as SVP and general counsel, and John Guevara as CIO. Meltzer is an Apple, Cisco, IBM, and CA Technologies veteran and replaces the now retired John Gomez. Long-time IBM-er Shute replaces Jeff Surges, the current CEO of Merge Healthcare. Studer (GE Healthcare) takes over for Kent Alexander, and Guevara (Microsoft, Intermec, Siemens) is Allscripts’ first CIO.  Allscripts also announced the department of COO Eileen McPartland, who is leaving to become CEO of a private company outside of the healthcare industry.

Reader Comments

From Charlie Brown “Re: Worried. Hey Inga. No push e-mail this AM for HIStalk and no new postings since yesterday. Did HIStalk break?” Thanks for your concern, Chuck, but nothing is broken (well, nothing that I know about, anyway.) Alas, Mr. H didn’t set up anything in advance for posting Wednesday, so we went a rare mid-week day with no Readers’ Write or interview. Mr. H promised me he’d eventually return from vacation, so look for an in-box full of HIStalk blasts next week.

From Boozers “Re: 2010 market share. Wow. Look at how Epic is hurting McKesson.” This table from KLAS shows Epic won 75 deals last year in the 200+ bed hospital market and had no legacy losses. The next best performer was Cerner, with 14 wins and six legacy losses. At the bottom: McKesson Horizon with four wins and 24 legacy losses. Ouch.

From Court Jester “Re: From the floor at AMDIS. Lots of interesting discussions and speakers and talk around the evolution of technology adoption by physicians. The hottest topics center around  CPOE and clinical documentation and the need for good workflow and ease of use.” AMDIS’s 20th Annual Physician-Computer Connection Symposium is wrapping up Friday in Ojai, CA. I must admit that if I were Court Jester I would be hanging by the Ojai Resort’s gorgeous pool rather than in the back of one of a meeting room.

HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Gregg dialogs with Stupid Simple and S&M. Sermo intros Sermo Mobile and iConsult. A whopping 76% of physicians with smart devices utilize iPhones. Physicians increased their ability to generate registries after implementing EHRs. Telepsychiatry is not catching on as fast as other telemedicine services. If you sign up for the HIStalk Practice e-mail updates, the budget crisis might be resolved and the US women might crush Japan. With stakes like that, how can you not sign up? And thanks for reading.

Acquisitions, Funding, Business, and Stock

drchrono closes $675,000 in its first round of institutional financing. Investors include several VC firms, plus Gmail creator and FriendFeed cofounder Paul Buchheit and Google’s principal engineer Matt Cutts. drchono offers a free EHR for the iPad.

Sales

Nevada Rural Hospital Partners, a 14-hospital alliance, partners with Anthelio (formerly PHNS) to provide business office solutions and coding services to member hospitals.

People

Progress Software appoints Philip M. Pead to its board of directors. Pead is the current chairman of the board for Allscripts and the former president and CEO of Eclipsys.

Dominick Bizzarro, the CEO of the Healthcare Information Xchange of New York, resigns to join InterSystems as business manager for the HealthShare HIE platform.

Announcements and Implementations

Nevada-based HealthInsight launches its HIE using Axolotl’s platform. Providers will begin sharing patient information in September.

Cheboygan Memorial Hospital (MI) outsources its IT operations to Phoenix Health Systems, who will implement Meditech’s EHR and provide IT leadership and service desk support.

Government and Politics

A bipartisan group of Congressmen introduces a bill that would amend the EHR incentive program to benefit multi-campus hospitals. The legislation would give each hospital campus the opportunity to earn Meaningful Use incentives.

Innovation and Research

The US Patent and Trademark Office awards Epic Systems a patent for “a system and method for providing decision support to appointment schedulers in the healthcare setting.”

Other

Directors of the Kingsport, TN-based RHIO CareSpark vote to cease operations this fall, citing an unsuccessful effort “to transition from a grant and contract based nonprofit organization to a user subscription and revenue sustained entity.” CareSpark was formed in 2005 after receiving $600,000 in funding from the Foundation for eHealth Initiatives and local partners.

Sponsor Updates

• Greenway Medical and PGA Tour Golf Pro Jason Dufner debut their new partnership at the British Open. Note the Greenway logo on Dufner’s jacket.
• The Drummond Group awards SRS EHR ONC-ATCB certification as a complete EHR.
• GE Healthcare releases a new white paper discussing the annual cost of healthcare-associated infections in terms of dollars and lives. GE Healthcare also announces the formation of MIND, a coalition to help physicians detect, diagnose, and manage neurodegenerative diseases.
• The Entrepreneurs EDGE awards Lexicomp, a Wolters Kluwer Health subsidiary, its fourth Crain’s Leading EDGE award for creating economic value in Northeast Ohio.
• Blanton Godfrey, Ph.D. and board chairman of the Institute for Healthcare Improvement will be the featured speaker at TeleTracking Technologies annual client conference in San Diego in October.
• Sage awards Peter Christensen Health Center (WI) its Healthcare Best Practices award at the Sage Summit conference in Washington DC.
• Practice Fusion announces Practice Fusion Connect 2011, a free EMR event for its 100,000+ clients, November 11th in San Francisco.
• AirStrip Technologies expands its leadership team, promoting Bruce Brandes from chief sales officer to EVP and chief strategy officer. Also, AirStrip was named InformationWeek magazine’s Most Transformative Healthcare Application at this week’s Healthcare Leadership Forum in NYC.
• Emmi Solutions selects Health Language, Inc. to enhance the usability of its patient engagement programs.
• North Highland announces an expansion into Japan through a partnership with GENEX.
• Iatric Systems earns ONC-ATCB certification for three more products. Iatric is also hosting a slew of free Webinars over the next three months, covering a variety of clinical and technical topics.
• Precyse hires Kristen Saponaro as VP of marketing. Saponaro was the principal of Saponaro Communications, LLC, the consulting firm that supported Precyse in its recent rebranding efforts. Precyse was also recently awarded a medical transcription services contract with Community Medical Center (PA).
• Anson General Hospital (TX) leverages its ChartAccess EHR from Prognosis to successfully attest for Meaningful Use.
• NextGen execs Charles Jarvis and Tony Landauer are scheduled panelists at next month’s CompTIA Breakaway 2011 in Washington, DC.
• Allscripts provides its preliminary Q2 financial numbers, which include expected bookings of about $240 million and profits and revenue above analysts’ expectations.

EPtalk by Dr. Jayne

It’s been difficult to get back to the routine with me returning from the beach and Mr. H vacationing, but the lovely Inga has been doing a fantastic job holding down the HIStalk fort. Although I’m still somewhat achy from the gut-busting laughter that accompanied Dr. Gregg’s recent comments on the EHR selection process, I didn’t want to miss the opportunity to share some newsy tidbits and random thoughts.

HHS releases a proposal to revise HIPAA and harmonize it with HITECH provisions. The AMA states: “The proposed rule seemingly goes beyond what is required by laws and would pose significant burdens on physicians if finalized.” The comment period ends on August 1, so let your voice be heard.

The Sage Summit is being held this week at the Gaylord National Hotel and Convention Center in Washington DC. Partner Days are July 10-15 and Customer Days are July 12-15. I understand the Wednesday evening event was “Night at the Museum” at Smithsonian Air and Space. Anyone attending? Let us know what you are seeing and hearing.

A recent survey shows consumers have a higher opinion of facilities using the word “Hospital” as opposed to those who have gone to the ritzier-sounding “Medical Center.” Respondents felt Hospitals provided better care and were more cutting edge. What’s in a name? It reminds me of when a previous employer named their brand new facility the “Cancer Center of Excellence.” Not only was it just tacky, but as far as Centers of Excellence go, it was a new service line that hadn’t gone anywhere near proving itself through outcomes or peer recognition. Personally, I’d like to see a survey on “Information Technology” vs. “Information Services” vs. “Information Systems” departments. A rose by any other name…

For those of you who have been eagerly awaiting implementation of new DEA rules for e-prescribing controlled substances, you’ll probably have to wait on your medical marijuana scripts. The DEA has stated that cannabis “has no accepted medical use and should remain classified as a highly dangerous drug.” Advocates can now appeal to federal courts after a nine year delay. DEA Administrator Michele Leonhart states that “the known risks of marijuana use have not been shown to be outweighed by specific benefits in well-controlled trials that scientifically evaluate safety and efficacy.” How hard do you think it would be to enroll patients in THAT study?

Thanks to Mustang Sally, who sent an article on physicians who use Twitter anonymously. It has some interesting examples, but closes with a mention of the American Medical Association’s ethics policy on social media, which warns that “actions online and content posted… can undermine public trust in the medical profession.” I don’t agree with physicians griping about patients on Facebook or Twitter, but you can imagine that I do see a benefit in anonymity. The full text of the Policy, approved in 2010, can be found here.

Interesting piece from the Kaiser Family Foundation: “Why It’s Okay that EHR Adoption Will Fall Behind 2011 Goals.” The authors cite “cleaning house” as a cause, meaning “older, costly, and difficult-to-implement legacy EHRs will be replaced by less expensive, more agile systems that have been developed specifically for meaningful use and are deliverable in the cloud as Software-as-a-Service.”

I’m off to sample my employer’s mandatory online training offerings, which apparently I must complete or I won’t get paid. After a week of fuzzy umbrella drinks, I’ve decided that Workplace Harassment, Personal Protective Equipment, and Privacy 101 go best with a nice Cab from Joseph Phelps. Have any other suggestions for excellent educational wine pairings? E-mail me.

Contacts

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

News 7/13/11

Top News

The Government Accountability Office reports that the federal government’s systems for analyzing Medicare and Medicaid data for possible fraud are inadequate and underuse, making it difficult to detect the $60 to $90 billion in fraudulent claims paid out each year. The GAO also notes that:

• CMS spent $150 million on new systems that went live in 2009, yet crucial pieces are missing.
• The current systems don’t include Medicaid data and CMS’s plans to share Medicare and Medicaid data with states and implement new software have been delayed.
• Of the 639 analysts who are suppose to use the system, only 41 have been trained so far.

CMS’s top anti-fraud administrator was scheduled to testify for a Senate subcommittee Tuesday to discuss the findings.

Reader Comments

From Bamma Bubba “Re: UCLA HIPAA violation settlement. Hospital snoops will never stop – it’s a people problem, not an IT problem. Could be a way to increase federal revenue, but then hospitals just pass the costs on to patient and insurers.” Yep, even though our mothers told us to mind our own beeswax, humans are generally just plain nosy. And at HIStalk we also like to make fun of people that can’t spell HIPAA.

HIStalk Announcements and Requests

Mr. H is still vacationing for a few more days. Either Mrs. H has banned him from the computer or he is in the Land of Bad Internet (I’m betting the latter) because I’ve hardly heard a peep from him in two days. Until his return, feel free to send any hot news my way. Or, if you don’t have hot news, just drop me an e-mail for the heck of it.

Sales

When Sidra Medical and Research Center (Qatar) opens in 2012, it  plans to run the Cerner Millennium platform and be the first fully digitized medical facility in the country.

People

Mediware hires Michael Anania as VP and GM of the company’s Blood Center Technologies product group. Anania’s previous employers include Roche Diagnostics and Baxter Healthcare.

MGMA names Susan Turney, MD its president and CEO, succeeding the retiring William F. Jessee, MD. Turney, who is an internist, has served as CEO of the Wisconsin Medical Society since 2004 and founded and chaired the Wisconsin Statewide HIE.

Apollo Health Street beefs up its sales force with the addition of four regional VPs: Ken Bartlett (SSI, McKesson), Dan Contilli (Healthation, SunGard), Troy McCormick (Invikktus, Emdeon) and David Richards (Dell Services, EPBS-Internedix.)

PointClear Solutions, a provider of HIT product development services, names Rodney Hamilton, MD, CMIO and managing director of its product strategy practice. Hamilton most recently was chief strategy officer for Vanguard Health Systems; he also spent time as a physician liaison with McKesson.

Announcements and Implementations

Predixion Software collaborates with the development team of Clinical Looking Glass to create a predictive model for reducing patient re-admissions. Clinical Looking Glass is a decision support tool that was developed at Montefiore Medical Center (NY).

Chelsea Community Hospital (MI) goes live next weekend on its $12 million EMR system. Chelsea is part of Trinity Health so I am assuming it’s a Cerner implementation.

The Indiana HIE reports that 70 distinct hospitals, long-term health facilities, and health systems were connected to the exchange as of the end of 2010. For the full year, IHIE delivered 3.3 billion pieces of clinical information, which is about 1.1 billion more than 2009’s totals.

Government and Politics

Arizona, Connecticut, Rhode Island, and West Virginia have now launched their Medicaid EHR incentive programs, bringing the total number of live state programs to 21. Only 14 of those states states have issued incentive checks.

Other

Cerner is sponsoring a 10-week weight-loss competition aimed at helping Kansas City residents drop a combined 100,000 pounds. The KC Slimdown Challenge is expected to involve about 20,000 people. For the calculator-challenged, that’s about five pounds a person.

Corepoint Health is the top-rated vendor in KLAS’s just-released interface engine report. Corepoint has the largest presence of any vendor in smaller healthcare facilities but very few clients in facilities over 500 beds. InterSystems was ranked a close second, though almost all InterSystems Ensemble customers are in 500+ bed facilities.

Sponsor Updates

• Cumberland Consulting Groups promotes Erik Howell to principal. Howell has managed multiple HIT projects for Cumberland since joining the company in 2004.
• Surgical Information Systems is hosting a July 13th webinar on how social media affects healthcare.
• PatientKeeper’s 2011 User Group Conference is scheduled for September 18-21 in Denver.
• Lori Prestesater, RelayHealth’s VP of strategy and business development, will be discussing ACOs and Meaningful Use as a panelist at the Institute for HIT’s summit July 26-27 in Denver.  Also at the summit: Software Testing Service CEO Jennifer Lyle, who will join a panel discussion on strategies to achieve Meaningful Use.
• URAC awards accreditation to MEDecision’s Alineo health utilization management platform.
• Cancer Treatment of America  selects CareTech Solutions’ Service Desk to provide 24x7x365 IT support for its national network of  centers.
• Concerro is offering a July 23rd webcast on nursing documentation and reimbursements. Coding expert Glenn Krauss will lead the discussion.
• Karen Knect of Encore Health Resources will overview e-Measures during a online session July 13th.
• The Los Angeles County Department of Health will implement Wellsoft Emergency Department Information Systems at its Los Angeles County and USC Medical Center hospitals.
• Vocera Communications names John McMullen to its board of directors. McMullen is a SVP and treasurer at HP and will serve as chairman of the audit committee.
• GE Healthcare launches its fully integrated EMR/PM system, Centricity Practice Solution 10.
• CynergisTek CEO Mac McMillan will be a panelist for the launch of Clearwater Compliance’s HIPAA-HITECH Blue Ribbon panel July 14th.

Contacts

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

MedQuist Holdings to Acquire M*Modal for $130 Million

MedQuist Holdings announced the signing of a definitive agreement to acquire M*Modal and its Speech Understanding technology for total consideration of $130 million, which includes $77.2 million in cash and 4.1 million shares of common stock.

Former Misys CEO Vern Davenport was appointed chairman and CEO of the new entity. He will replace Peter Masanotti as CEO and Bob Aquilina as chairman. Aquilina will continue to serve on MedQuist’s board. and Masanotti will remain a consultant to MedQuist through the end of September.

MedQuist has already been using M*Modal’s technology for its medical transcription business. The company intends to enhance further the integration of M*Modal’s front-end speech recognition technology with MedQuist’s clinical documentation platform.

M*Modal has a current annualized revenue run rate of $24 million, about $7 million of which came from MedQuist.

Monday Morning Update 7/11/11

From 4merMCK: “Re: McKesson. USA Today reported that MCK’s Hammergren made $150m in 2010, a sizable increase. The gap in salary alone for MCK-IT employees is approximately 375x, and merit increases in the former HBO were 2.5%, or around $2,000. Under Hammergren’s leadership, MCK shares have risen around 20%. At the end of the day, it is shareholder value that drives CEO compensation. Whether that’s worth his increase, only shareholders can answer. Rumor in Alpharetta is that the HIT business was shopped around, but based on the asking price and a declining base, there were no offers. Now they are trying to determine what a ‘growth’ strategy would look like.” Unverified.  

From The PACS Designer: “Re: Internet2 and healthcare. Rural healthcare facilitated through the use of telemedicine solutions is a trend that is gaining more attention. One new area that can accelerate the adoption of telemedicine applications is Internet2, which offers higher speed communications tools. The FCC’s Rural Health Care Pilot Programs (RHCPPs) have been in the past a funding source for employment a rural EHR and telemedicine experiments. State-by-state license requirements for physicians has been one of the roadblocks to further expansion of the concept.”

From Mr. HIStalk: “Re: holiday woes. Funny that I’m reading this on a plane to vacation.” The referenced article includes suggestions for prepping the office in advance of taking R & R to avoid “vacation interruptus.”  Coincidentally, Mr. H just skipped town for some well-deserved time off, leaving me (Inga) as the designated second-in-command. The same article notes that 30% of workers are like Mr. H and intend to contact work while on vacation. Mr. H barely opened his first beer before checking in (and contributing to this post), but Mrs. H and I are hoping he’ll get into the chillin’ mode soon.

Technology vendors and the healthcare system are most responsible for disconnected patient information, readers say. New poll to your right, just to change it up a little: is your company’s CEO honest and honorable?

The Tennessee Comptroller of the Treasury releases an audit reporting finding that Community Health Network (CHN) lost or misused $1.26 million between 2007 and 2009. CHN is a non-profit organization that provides medical technology to rural communities, often through grants. Auditors claim the company’s former CEO, Keith Williams, improperly received more than $80,000 by paying himself unapproved bonuses, making personal purchases with CHN’s credit card, and claiming reimbursement for meal purchases that were paid for with CHN’s credit card. Former CFO Paul Monroe was found to paid over $10,000 in unauthorized pay. Auditors also say that Williams and Monroe falsified grant invoices and grant reports and misused proceeds from a state grant to purchase almost $600,000 in unauthorized software. The software vendor later hired Williams as a consultant while he was still employed at CHN.

Georgia Governor Nathan Deal will speak Monday morning from the Alpharetta headquarters of McKesson Provider Technologies, pitching the state’s campaign to lure technology jobs. It will be streamed live at 8:30 a.m Eastern.

More from Vince on minicomputers, this time focusing on the companies that wrote software for them, one of the biggest of which was started in the proverbial garage.

The VA reveals plans to allow clinicians to use  Android devices, iPhones, and iPads, in addition to the currently supported BlackBerries.

This week’s Time Capsule editorial from 2006: USB Drives Would Help Consumers Quickly Access McClinics. Its conclusion: “This system of having patients walking around with their own information ready to plug into a provider’s system seems like the best solution for now.”

Morris Hospital & Healthcare Centers (IL) names Cassie Brown manager of health information management. I like that Brown worked at Morris Hospital as a medical records file clerk while in high school school and college and before learning the ropes at a couple of other medical facilities.

Healthcare jobs grew by 13,500 in June, though the hospital sector declined 0.1%. Ambulatory healthcare added 16,500 jobs, including 5,000 in physician offices.

HIStalk Practice’s own Dr. Gregg gets a shout out in the Columbus (OH) business journal for being the state’s first doctor to get an EHR stimulus check from Ohio Medicaid.

Broadlawns Medical Center (IA) becomes the first medical center in the state to use PatientSecure’s biometric patient ID system.

British Columbia’s former deputy minister of health Ron Danderfer pleads guilty of fraud in relation to benefits he received between 2004 and 2007. Danderfer, who oversaw the creation of the province’s $222 million EHR system, admits he accepted the use of a vacation condominium and a job for his wife.

Surescripts and the authors of JAMIA-published article, “Errors associated with outpatient computerized prescribing systems,” issue a joint statement to clarify the study’s use of the term “e-prescribing.” The authors point out that their use of the term “e-prescribing” does not reflect the way the term is used today, nor does it match the federal government’s definition. The study examined what was considered e-prescribing back in in the old days (2008); that is, prescriptions generated by a computer, faxed to a pharmacy, and then printed. You’ve got to admit that “E-Prescribing Doesn’t Make The Grade” is a far more compelling headline than one that says, “The Way Things Were Done Three Years Ago Wasn’t All That Great.”

Contacts

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

News 7/8/11

Top News

The start of Stage 2 Meaningful Use will likely be pushed back a year, now that ONC head Farzad Mostashari, MD agrees the current timeline is too aggressive. Stage 2 requirements won’t be finalized for another year, so the growing consensus is that a January 1, 2013 start date would not give EPs, hospitals, and vendors adequate time to prepare.

Reader Comments

From WildCat Well: “Re: Comcast. Considering offering an EMR system at no cost to physicians who subscribe to Comcast Metro Ethernet services. Physicians have their choice of six-plus EMR preferred providers.” Unverified, although readers have been suggesting that a deal of this type has been in the works for some time.

From Man in the White Suit: “Re: Shoe Beacon. You should really be more discrete about where you live.” There’s nothing better than good yard art to express one’s obsessions.

HIStalk Announcements and Requests

Check out the new HIStalk Resource Center. Our new reader-requested tool gives you an easy way to search for products and services in over 100 HIT-related categories. Fifty-two HIStalk sponsors have provided details of their offerings and quick links to request more information. To get there: (a) click on the link at the top of this page; (b) click the small banner below the Founder sponsor banners to your left; or (c) click the link on the Related Sites listing to your right. We will continually update the Resource Center, so check it out regularly and let us know what you think.

Ever find yourself wondering what the heck is going on in the ambulatory HIT world? If so, make sure you are a HIStalk Practice e-mail subscriber. Here are some highlights from this week’s posts: Rob Culbert offers tips for documenting operational and functional workflows to boost customer satisfaction and cash flows. MGMA reveals the top challenges for practice managers. NextGen parent company Quality Systems brings homes three Stevies. AHRQ offers a toolkit to analyze workflow before, during, and after and HIT implementation. Thanks for stopping by.

Listening: angry 1970s punk from Cleveland’s Dead Boys. Arguably better than the Ramones.

Sales

Aria Health (PA), Norton Healthcare (KY), and St. Luke’s Health System (ID) contract with Hyland Software for its OnBase enterprise content management software.

Aria also selects Allscripts Community Record, powered by dbMotion, to enable data sharing between the hospital’s Allscripts Sunrise, the employed physicians’ Allscripts Ambulatory EHR, and third-party EHRs used by other regional providers.

The State of New Jersey posts an RFI for the New Jersey Health Information Network, requesting “a single, complete solution” and suggestions of how it can sustain itself financially.

People

SmartBusiness profiles EnovateIT’s Fred Calero, who leads his company “by treating others as they would like to be treated.” He notes that many of EnovateIT’s employees started on the company’s assembly lines building medical carts.

NCO Group promotes Michael Albrecht to lead its Healthcare Services sales team.

UnitedHealth Group names Larry Renfro as CEO of its Optum business unit. He replaces Mike Mikan, who is leaving to run a private equity fund. Renfro was CEO of the company’s Ovations group.

Richard Noffsinger joins Aetna subsidiary ActiveHealth as president and CEO. He was previously with Anvita Health, Amicore, and Microsoft. He replaces Gregory Steinberg, who will head up clinical innovation for Aetna.

Bob Zollars, chairman and CEO of Vocera since 2007, is profiled in Smart Business of Northern California. He was previously with Wound Care Solutions, Neoforma, and Cardinal Health.

Announcements and Implementations

University Physicians Hospital (AZ) goes live with EmergisoftED.

CareCore National announces that its TouchMED prior authorization application for physicians is available on the Cisco Cius tablet. You might expect that this announcement and product information would be available on the company’s Web site since they went to the trouble of issuing a press release, but you would be wrong.

Cerner’s uCern customer collaboration platform wins an award from Jive, the company whose technology powers it.

University Medical Center (NV) says it has $25 million to spend for system upgrades needed to qualify for HITECH money, but needs $60 million. Its county owners say they don’t plan to make up the shortfall. The hospital is negotiating with McKesson.

Government and Politics

UCLA Health System settles with HHS for $865,500 for alleged HIPAA privacy and security violations. Two celebrities accused hospital employees of peeking in their charts.

CMS says it won’t be ready to electronically receive quality outcome data for Meaningful Use in 2012 as originally planned. That means that in 2012, EPs and hospitals can report outcome data via attestation and data calculations, just like they’ve done for the 2011 payment year.

The president of the Ontario Medical Association says political party leaders should forget about the scandal-ridden and expensive eHealth Ontario and include electronic medical record programs in their platforms anyway.

Innovation and Research

A JAMA-published study finds that critical access hospitals lag other hospitals in survival rates for heart attack, heart failure, and pneumonia. The author suggests telemedicine as a possible solution.

Technology

A Florida doctor who came up with the idea for his iMobile Health Record in 2001 is finally getting it to market. Users key in their medical history and med and get a health score in return. It will sell for 99 cents. If it’s the guy I’m thinking, though, he is loaded with credentials: orthopedic surgeon, president of the hospital medical staff, CMIO for a clinical guidelines vendor, researcher, and entrepreneur. I was prepared to make fun of the idea, but he’s got enough credibility to keep me quiet.

Other

A fired medical data technician sues University Medical Center (NV) for failing to accommodate her claustrophobia by forcing her to work in a cubicle. She has medical documentation backing her claustrophobia claims, so the hospital settled for $150,000.

Physician-run hospitals score 25% higher in quality measures than those where the CEO is a business school type, although the study can’t explain why other than perhaps physicians are truer to the core business of health.

KLAS reports that the number of live HIEs has more than doubled since last year, with private HIEs increasing more rapidly than public HIEs. The lack of traction of public HIEs is attributed to more complicated governance and concerns over long-term funding. Among HIE vendors, Medicity, RelayHealth, and Cerner ranked highest for private HIEs.

Weird News Andy is atwitter at this news, which he tags as “researching in 140 characters or fewer”: Hopkins researchers run two billion public tweets through software to extract those related to health, then analyze patterns related to allergies, flu, obesity, cancer, and other conditions. They believe tweets can help uncover public health information, but they recognize that users don’t get into much detail, they are usually younger and US-centric, and they probably won’t tweet about some health issues.

A federal appeals court upholds the 2009 conviction and 10-year prison sentence of former McKesson chairman Charlie McCall. His lawyers claimed he signed public filings and auditor letters without knowing that his acquired HBO & Company (McKesson paid $14 billion for it) was inflating revenue figures by improperly recognizing software revenue, but the appeals court ruled 3-0 that he knew exactly what was going on. MCK shares dropped almost by half the day the company announced its findings and still have not regained their pre-Charlie price more than 12 years later.

Somehow I missed this: Dennis Quaid keynoted at the 2009 HIMSS conference, talking about the heparin overdoses that nearly killed his newborn twins, but merged his Quaid Foundation with the non-profit Texas Medical Institute of Technology a year later.

Sponsor Updates

• Kansas City Business Magazine recognizes Perceptive Software as one of the city’s top 10 companies for global growth. Selection was based on company culture, community involvement, plans for growth, and commitment to employees. The company has grown its employee count by 40% in the last year.
• Aventura Hospital and Medical Center (FL) selects ProVation, a division of Wolters Kluwer Health, for gastroenterology and procedure documentation and coding.
• Sunquest is hosting its 2011 User Group conference July 11-15 in Tucson. New to this year’s meeting: an executive two-day conference, a session by the College of American Pathologists,  and a discussion of the lab’s role in ACOs.
• MD-IT is searching for a VP of sales and marketing.
• West Virginia Regional Health Information Technology Extension Center selects Greenway Medical’s PrimeSUITE as a prequalified EHR. 
• GetWellNetwork adds Jeff Fallon as VP of business development and national accounts.
• Capsule  is exhibiting at the 2011 HMS Regional Training and Exposition July 12-13 in Austin, TX.
• Holon Solutions appoints Worth Roberts to VP of sales for its eastern region.
• OptumInsight partners with RemitDATA to offer Remit Advice Professional, a Web-based analytics service for physician offices that analyzes health plan remittance notices and provides coding and reference tools.
• Symantec and Allscripts partner to offer an online privacy and risk assessment tool for identifying potential gaps in HIPAA and HITECH compliance.
• Wayne Memorial Hospital (NC) selects the Access Enterprise Forms Management suite to integrate electronic patient forms with its Meditech system.
• Webinar alert: a clinical analyst from Jefferson Regional Medical Center will share how his hospital used iSirona’s device integration solution to connect more than 40 devices to Sunrise Clinical Manager. It’s on July 20 at 1:00 PM EDT.
• The use of the AirStrip OB smartphone monitoring system by Rowan Regional Medical Center (NC) is profiled on a Charlotte TV station, with one OB-GYN predicting that its use could become a nationwide standard of care. AirStrip Cardiology goes live at Cedars Sinai and Texas Health Resources.

EPtalk by Dr. Jayne

I received a lot of feedback about Monday’s Revolutionary-themed Curbside Consult, including some historical corrections and the hilarious photo of Colonial Kermit. HIStalk readers are the best!

Dr. Jayne,

Terry

Duly noted. My reference used the word “adopted” to describe what the Continental Congress did on July 4. A handwritten draft was signed by John Hancock and Charles Thomson that day and was sent to be printed for distribution. As for the final product, the National Archives says that most signed on August 2, 1776. The Archives also notes that t “one of the most widely held misconceptions about the Declaration” is that everyone signed it on July 4, so I guess I’m not alone.

I’m glad to encounter another Molly Pitcher fan. I shamelessly admit that I dressed as her once for a patriotic event. Everyone thought I was Martha Washington, though. Maybe I should have put a cannonball wound in my skirt.

Dr. Jayne,

Weird News Andy

Andy always delivers and provided multiple links for my reading pleasure, which I will of course share. I remember this fact from World History and probably a Monty Python movie, but being in Colonial Mode must have suppressed it.

Emergency Medicine covers plague
EyeWitness to History and The Black Death
Attacking a Castle – also includes excellent coverage of fire, battering rams, and other mayhem

Several readers responded to my recipe solicitation. Here are a few submissions mixed with my personal favorites. And thanks to Janice – I took your advice,but instead of vodka/cranberry on ice with a blue umbrella (apparently my cocktail accessories are lacking),I threw in some blueberries.

Fourth of July Cocktails
Patriotic Cocktails
Twenty Red, White & Blue Cocktails
Five Red, White and Blue Cocktails (including the one pictured above)

No one seemed eager to share a potato salad recipe (what does the proportion of cocktail recipes to side dish recipes say about the average health IT reader, I wonder?) but one reader did share this link — and who doesn’t love a Web site called Killer Salad anyway?

Now, back to our regularly scheduled HIStalk feature …

It is the month of July, and the usual articles about avoiding medical mistakes and the perils of new interns starting rotations at academic medical centers (the “July Effect”) have started to show up. Prevention leads with  14 Worst Hospital Mistakes to Avoid, noting that most mistakes are medication-related.

MSN jumps right in with Don’t Get Surgery in July…, citing a 10% spike in fatalities in teaching hospitals during the month “confirmed by a new Journal of General Internal Medicine study,” but then saying the spike isn’t due to surgery anyway. It’s basically a hack of the Prevention article, so don’t bother going there. The article is actually from 2010 and the original source is available in PDF here.

Internship was bad enough when all you had to do was write your orders on paper, I can’t imagine walking in with CPOE on top of it. I’d love to interview a PGY-1 to get his/her impressions on healthcare IT but obviously can’t do it with one of my own housestaff. Anyone with friends just starting internship or are you a faculty member willing to serve up an intern? E-mail me.

Contacts

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

News 7/6/11

Top News

Management consulting firm Beacon Partners will announce Wednesday that it has acquired Healthcare Innovative Solutions (HIS), which offers consulting services related to clinical system implementation and workflow redesign. The ten-year-old HIS gives Beacon additional Siemens capabilities, adds to its CPOE expertise, and boosts its revenue and headcount by 15%. I did an HIT Moment With interview with HIS CEO Daniela Mahoney RN a few weeks ago. Congratulations to HIS as the latest in a long list of HIStalk sponsors to be successfully acquired.

Reader Comments

From NAFTA Doesn’t Work: “Re: Ontario. Healthcare informatics is at an all-time low here, with contracts based on who you know. I applied for a NAFTA-defined TN-Visa for professionals after being hired for a US contracting gig. No problem if you are a US citizen coming into Canada for EMR work, but if you try to go into the US, you are in for a chop-busting. Bring your degrees, transcripts, licensure, immunization records, and first-born child. An immigration officer berated me for being an RN and computer science graduate, saying ‘Seems like an odd combination, doesn’t it? Who would hire you anyway? Why are you trying to take jobs from Americans?’ Like it’s my fault your country can’t find enough people qualified to implement clinical systems based on the $19 billion ARRA commitment. Nothing like being stuck between a rock and a hard place.” We’re not very visitor-friendly here, that’s for sure, but that’s a 9/11 thing. We have a massive Homeland Security bureaucracy, along with a close-the-borders mentality that has caused quite a drain in technology expertise. I know from limited travels out of the country how unwelcome even US citizens are made to feel at immigration after short-term travel, so I can only imagine being a non-citizen trying to relocate here. I felt more welcome and respected in Russia than Newark.

From Mr F: “Re: The PACS Designer’s WebGL blurb. Key point left out: Microsoft won’t be implementing it in IE because they think it is inherently insecure.”

From Dakota Dan: “Re: Henry Ford Health System SVP/CIO Arthur Gross. No longer on their Web page.” His bio page has been removed, but that’s all I could turn up since I don’t have contacts there that I recall.

From Collard Greens: “Re: KLAS. To consolidate their ambulatory EMR categories, also looking to consolidate/drop research for other ‘non-profitable’ research segments.” I contacted Adam Gale, president of KLAS, who says you are partly right. KLAS is planning to reconfigure their ambulatory EMR categories to better map how those solutions are actually sold to the market. Something like, let’s say, small practices (1-10 docs), medium (11-50), and large (51+). Adam says the other half of your statement isn’t true, though: market need rather than profitability drives the research segments KLAS covers and they’re planning to continue rating mostly the same categories ongoing. It almost seems the opposite to me: they keep adding interesting categories.

HIStalk Announcements and Requests

Someone asked me at work today about the Stage 1 Meaningful Use rule for hospital clinical decision support. Since I had to look it up anyway to make sure I hadn’t forgotten something, here’s the summary. You have to implement at least one real-time alert and it can’t involve drug-drug interactions or drug-allergy contraindications. It must use information from the meds list, allergy list, demographics, or lab results. The rule must address something that’s of high clinical priority to the hospital and you have to be able to track compliance with the rule. If the rule is of the “don’t enter this order under any circumstances” variety, then the numerator could be calculated as: (number of times the rule fired minus the number of orders entered anyway) divided by the number of times the rule fired. Otherwise, you would need to electronically ask the provider if they changed their intentions based on the rule’s recommendation since you can’t assess compliance or rule effectiveness otherwise, unless you’re comfortable looking at overall ordering patterns for changes (and I wouldn’t be).

Thanks to new HIStalk Platinum Sponsor McKesson Paragon HIS. If you follow the industry, you know that Paragon is pretty hot stuff, named for five straight years as Best in KLAS in the Community HIS category. It’s certified, runs on a single database, is fully integrated (including clinical and financials), has low hardware costs, is intuitive and easy to use, and runs on pure Microsoft technologies (including SQL). Clinical modules include clinical assessment, CPOE, care plans, order management, meds, and results reporting. On the financial side, there’s patient management, AP/GL/MM/FA, payroll, resource scheduling, HIM, transcription, utilization review, and release of information.  Ancillary apps include pharmacy, OR, ED, rehab, radiology, lab, mobile phlebotomy, and micro. If you are a Meditech customer or prospect, McKesson would be happy to send you a white paper describing the benefits of Paragon for your consideration. I’ll throw in an observation that even though KLAS ranks it under the Community Hospitals category, I’ve heard from users first hand that it scales well to facilities up to at least 400 or 500 beds even though you don’t need a lot of IT people to run it, so don’t let that label scare you off. Thanks to the McKesson folks involved with Paragon HIS for their support of HIStalk.

Acquisitions, Funding, Business, and Stock

Cerner shares hit an all-time high Tuesday (at least it looks like it as I’m eyeballing the share price graph), closing at $63.00 and pushing the company’s market cap to $10.6 billion.

Chicago area- based Resurrection Health Care and Provena Health will merge their twelve hospitals.

Sales

University Hospitals Case Medical Center (OH) will deploy athenaCollector for its 1,000 providers. Its MSO is already an athenaCollector client.

Presbyterian Intercommunity Hospital (CA) signs a services contract with Zotec Partners to manage its radiology department’s revenue cycle.

People

Blount Memorial Hospital (TN) names Clay Puckett CIO and assistant administrator. He was previously senior director of IS for Carolinas HealthCare System.

Mathematician Robert Morris dies at 78, leaving a biography that should be made into a movie. He helped develop Unix, was a master cryptographer for the National Security Agency, led a 1991 cyberattack against Iraq before the first Gulf War, developed Unix security protocols in the 1970s that are used on Apple devices today, developed software that tracked enemy submarines and astronomical bodies, and warned Congress in 1983 that computer viruses were a risk but not likely to be created by children. He was proven wrong in that last assessment five years later when his own son’s worm program spread out of control and took down 6,000 Department of Defense computers (the lad is now an MIT computer science professor).

Announcements and Implementations

Legacy Salmon Creek Medical Center (WA) will go live on its $110 million Epic EMR by the end of September.

Government and Politics

CMS issues its proposed fiscal 2012 Medicare payment rules and suggests minor increases for most facilities and a whopping 29.5% decrease for physicians. Outpatient payments would increase 1.5%, ACS’s 0.9%, and dialysis facilities 1.8%.

Technology

Radiology site AuntMinnie runs an article on biometric ID,  mentioning palm vein scanning (PatientSecure), physician mobility (Imprivata), fingerprint ID (Digital Persona), and proximity biometrics (Proxense).

Other

Here’s Vince’s latest, this time on minicomputers and complete with names you haven’t heard in quite some time, like Burroughs, DEC, and Four Phase.

Epic ranks #1 in new HIT contracts for hospitals of greater than 200 beds. KLAS calls Epic’s track record of successful implementations “unmatched” despite lagging technology and a large price tag. Cerner was #2, with many of its new contracts involving new facilities for existing customers. The report finds hospital consolidation is increasing the interest in system integration.

Johns Hopkins Hospital (MD) will eliminate 160 clerical positions by the end of the year as the hospitals switches to electronic medical records. The hospital will try to reassign the workers, who had been responsible for order transcription and creation and maintenance of paper charts. A reader sent a note last week saying Johns Hopkins was moving to Epic for its ambulatory clinics; Mr. H predicts the move to Epic will be system-wide.

USA Today profiles Banner Health’s (AZ) five year-old eICU network, which relies on remote critical care specialists to provide guidance to onsite providers. Banner has invested $11.3 million in equipment for the telehealth system and estimates that over the last four years, the program has helped prevent 600 deaths, reduced days in critical care by 26,000, and cut hospital stays by 100,000.

AMA will draft model legislation for HIEs that will spell out who owns clinical information and who can view it. They seem concerned about insurance company ownership of HIE technology vendors (Aetna and UnitedHealth Group, which own directly or indirectly Medicity and Axolotl, respectively).

Would you trust your HIPAA compliance education to this company?

I thought of Dr. Jayne’s observations about the unhealthy lifestyle choices her patients often make when I read this article. A motorcyclist flips his Harley and dies of a head injury during an organized ride protesting mandatory helmet laws. Experts said the helmet he was illegally not wearing would have saved him. The event organizers, the state chapter of American Bikers Aimed Towards Education, announced that the rider “risked his all for freedom.”

Sponsor Updates

• Aaron Kaufman, GM and VP of Kony Healthcare, will speak at World Health Congress (MA) July 28-29.
• Clairvia leads the market segment in Staff/Nurse Scheduling according to KLAS 2011 Mid-Term Performance Review.
• CareTech Solutions launches its Zero Worries campaign to promote the company’s hospital IT help desk services.

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